Convalescent Rehabilitation Ward Research Articles

MON-P038: Relationship Between Nutritional Improvements and Activities of Daily Living (ADL) of Elderly Japanese Patients in Convalescent Rehabilitation Ward

MON-P038: Relationship Between Nutritional Improvements and Activities of Daily Living (ADL) of Elderly Japanese Patients in Convalescent Rehabilitation Ward

Increased C-Reactive Protein and Weight Loss are Associated with The Inability to Switch from Tube Feeding to Oral Intake in Patients with Cerebrovascular Disease

Background: Appropriate nutrition management is required for elderly patients with cerebrovascular disease. These patients can present with no oral intake at admission, although several patients subsequently switch to oral intake during hospitalization. Therefore, we aimed to investigate the factors associated with patients who require the continuation of tube feeding. Methods: We retrospectively examined clinical factors at admission and discharge of two groups of patients with cerebrovascular disease who attended a convalescent rehabilitation ward: the switching group (n=17), who switched from no oral intake at admission to oral intake at discharge, and the continuation group (n=47), who continued tube feeding until discharge. This study design is retrospective cohort study. Results: A comparison of the two groups revealed that continuation of tube feeding was associated with a greater loss of body weight between admission and discharge (−3.8±4.0 kg in the continuation group vs. −1.5±2.0 kg in the switching group), and an increase in the C-reactive protein level, compared with a decrease in the switching group (2.2±6.9 mg/dL in the continuation group vs. −2.2±4.3 mg/dL in the switching group). These results suggest that to maintain and improve physical function, cognitive function, and daily life activities in patients with cerebrovascular disease with no oral intake, weight loss and inflammatory disease onset should be assessed. Conclusion: We believe that a comprehensive approach to oral intake should be used for patients with cerebrovascular disease.

Poor oral status is associated with rehabilitation outcome in older people.

Poor oral status is associated with increased physical dependency and cognitive decline. Malnutrition, a potential result of poor oral status, is associated with poorer rehabilitation outcome and physical function. However, the association between oral status and rehabilitation outcome is not fully understood. The present study investigated the association of poor oral status with rehabilitation outcome in older patients. A retrospective cohort study was carried out of 108 consecutive patients (mean age 80.5 ± 6.8 years; 50.9% men) who were admitted to convalescent rehabilitation wards. The Revised Oral Assessment Guide was used to evaluate oral status. Rehabilitation outcome was evaluated by the Functional Independence Measure (FIM) on discharge. Multivariate analyses were applied to examine the associations between poor oral status and motor-FIM on discharge. According to the Revised Oral Assessment Guide score, 14.8% of participants had normal oral status, 52.8% had slight to moderate oral problems and 32.4% had severe oral problems. The median scores of motor-FIM on admission and on discharge were 52 (interquartile range 25-70) and 75 (interquartile range 51-89), respectively. Multivariate analysis showed that the Revised Oral Assessment Guide score and the motor-/cognitive-FIM scores on admission were significant independent factors for motor-FIM on discharge, after adjusted for sex, age, length of stay, nutritional status, handgrip and causative diseases (P < 0.001). Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int 2017; 17: 598-604.

Nutritional Improvement Correlates with Recovery of Activities of Daily Living among Malnourished Elderly Stroke Patients in the Convalescent Stage: A Cross-Sectional Study

BackgroundWhether nutritional improvement correlates with functional recovery in convalescent stroke patients is unclear. ObjectiveThis study was conducted to examine the relationship between nutritional improvement and recovery of activities of daily living among malnourished elderly stroke patients in the convalescent stage. DesignThis study used a cross-sectional study design. Participants/settingOne hundred seventy-eight malnourished stroke patients aged 65 years and older from convalescent rehabilitation wards in Japan between April 2012 and December 2014 were included in the analyses. Main outcome measuresThe participants were classified into three groups according to the Mini Nutritional Assessment Short-Form (MNA-SF) score at discharge (0 to 7 as no improvement, 8 to 11 as lesser improvement, and 12 to 14 as greater improvement). The primary outcome was functional independence measure (FIM) efficiency (FIM gain/length of hospital stay). The secondary outcomes were FIM gain and discharge outcome. Statistical analysisOne-way analysis of variance, χ2 test, and Kruskal-Wallis test were performed for univariate analysis. Linear regression analysis was used to adjust for covariates such as age, sex, length of hospital stay, FIM (motor and cognitive) on admission, and lower-order items of MNA-SF. Binomial logistic analysis for discharge outcome (home/others) was performed to adjust for covariates such as age, sex, and FIM. ResultsStudy participants included 85 men and 93 women with a mean age of 77 years. Based on MNA-SF, 16 were classified as no improvement, 113 as lesser improvement, and 49 as greater improvement. The median FIM efficiency and length of hospital stay were 0.27 points/day and 151.5 days, respectively. The greater improvement group had significantly higher FIM efficiency than the other groups (P<0.001). Home discharge rate was also higher in the GI group (P=0.014). Linear regression analysis for FIM efficiency indicated that mobility, neuropsychological problems, and weight loss, which were lower-order items of MNA-SF at discharge, were independent explanatory variables (R2=0.373; P<0.001). ConclusionsThese findings suggest that nutritional improvement such as maintenance of body weight is associated with the efficient recovery of activities of daily living among malnourished elderly convalescent stroke patients.

Potential factors, including activities of daily living, influencing home discharge for patients with putaminal haemorrhage.

BackgroundConvalescent rehabilitation wards assist stroke patients in acquiring skills for activities of daily living to increase the likelihood of home discharge. However, an improvement in activities of daily living does not necessarily imply that patients are discharged home. We investigated the characteristics of patients with putaminal haemorrhage who are discharged home following convalescence in rehabilitation wards.MethodsThe sample comprised 89 patients (58 men and 31 women) with putaminal haemorrhage hospitalised in the convalescent rehabilitation ward of our hospital between August 2012 and July 2013. Their age ranged from 29 to 88 years (61.9 ± 11.9 years). The lesion occurred on the right side in 48 and on the left in 41 patients. The mean period from onset to hospitalisation in the convalescent rehabilitation ward was 30.8 ± 17.2 days, and the mean hospitalisation period was 70.7 ± 31.8 days. We examined age, sex, haematoma volume, duration from onset to hospitalisation, neurological symptoms, cognitive function, functional independence measure, number of cohabitating family members and whether the patient lived alone before stroke, and the relationship among these factors and discharge destination (home or facility/hospital) was assessed.ResultsThe discharge destination was home for 71 and a facility or hospital for 18 patients. Differences were observed in age, haematoma volume, neurological symptoms, cognitive function, functional independence measure score on admission and discharge, number of cohabitating family members and whether the patient lived alone before stroke for patients discharged home. Patients who required long-term care and were discharged home were more likely to be living with family members who were present during daytime. Home discharge was possible if functional independence measure score was ≥70 at the time of discharge for motor items and ≥24 for cognitive items, even if a patient lived alone before stroke.ConclusionsAlthough the presence of cohabitating family members was important, the factor most strongly influencing home discharge was the patient’s activities of daily living status at the time of discharge. For patients who lived alone before stroke, physical and cognitive functions must be maintained for them to be discharged home after rehabilitation.

Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward.

[Purpose] There have been no investigations into the improvement of activities of daily living among patients suffering from post-stroke depression on admission to convalescent rehabilitation wards in Japan. This study aimed to assess the improvement of activities in daily living in patients with or without post-stroke depression at the time of admission to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study included 108 stroke patients divided into two groups according to their Geriatric Depression Scale 15-item short form scores. Activities of daily living were assessed using the Functional Independence Measure. The degree of improvement on the Functional Independence Measure was defined as the difference between scores on admission and at discharge. [Results] The Functional Independence Measure gain score was significantly different from the Functional Independence Measure total score. There was a significant interaction between time period and post-stroke depression factors for the Functional Independence Measure total score. A multiple regression analysis revealed a significant association between Geriatric Depression Scale score and Functional Independence Measure total score. [Conclusion] The present study suggests that post-stroke depression has a negative impact on recovery of activities of daily living and on rehabilitation outcomes in a convalescent rehabilitation ward setting.

&lt;b&gt;A prediction model for activities of daily living for stroke patients in a convalescent rehabilitation ward&lt;/b&gt;&lt;b&gt; &lt;/b&gt;

PURPOSE: To create a model to predict independence in the activities of daily living at discharge in stroke patients in the convalescence stage. The study also examined whether the predictability of functional independence at discharge would be improved by creating a specific prediction model for each rehabilitation facility. METHODS: To create the prediction model, data of 65 first stroke patients were analyzed using stepwise multiple regression analysis. Age, time post-stroke, Functional Independence Measure motor subscale score, Functional Independence Measure cognitive subscale score, Stroke Impairment Assessment Set, Berg Balance Scale, and Vitality Index at admission were selected as predictor variables of Functional Independence Measure motor subscale score at discharge. The accuracy of this model was compared with an existing prognosis model using data from 98 first-stroke patients, comparing the difference between actual and predicted Functional Independence Measure motor subscale score at discharge for each model. RESULTS: The prediction formula created included admission Functional Independence Measure motor subscale score, Vitality Index, age, and Stroke Impairment Assessment Set score. The adjusted R square value was 0.60. The prediction errors of the new and previous models were −2.5 ± 10.8 and −18.3 ± 18.7, respectively, which were significantly different. CONCLUSION: Our results suggest that prediction accuracy may be improved by creating prediction formulas specifically for each institution.

Influence of increased amount of exercise on improvements in walking ability of convalescent patients with post-stroke hemiplegia.

[Purpose] This study aimed to determine the effects of increased amount of physical therapy exercise on improvements in the walking ability of patients with stroke. [Subjects and Methods] The subjects were selected from patients with stroke who were hospitalized in the convalescent rehabilitation ward, and included 91 patients who received physical therapy for 2.5–3 exercise sessions per day during 2005–2006 (PT3unit group), and 86 patients who received physical therapy for 4.5–6 exercise sessions per day during 2010–2015 (PT6unit group). The functional independence measure (FIM) score evaluates the walking ability of patients during hospital admission, 2 and 4 weeks after admission, and at discharge. The FIM score was stratified according to the degree of lower limb motor paralysis and subsequently compared between groups. [Results] Among the patients with complete paralysis and severe paralysis, the FIM-Walking scores at 4 weeks after admission and at discharge were significantly higher in the PT6unit group than in the PT3unit group. No significant differences were found between the PT6unit and PT3unit groups for patients with mild and moderate paralysis. [Conclusion] Higher amounts of physical therapy exercise contributed to improvements in the walking ability of patients with complete and severe lower limb paralysis.

The fact of the team-approach at the convalescent rehabilitation ward: In case of the Hatsudai Rehabilitation Hospital

The fact of the team-approach at the convalescent rehabilitation ward: In case of the Hatsudai Rehabilitation Hospital

Changes in the perception of physical therapy among students educated in a clinical clerkship based on the guidelines for clinical clerkships in a convalescent rehabilitation ward

Changes in the perception of physical therapy among students educated in a clinical clerkship based on the guidelines for clinical clerkships in a convalescent rehabilitation ward

Assessment of Independent Walking by Stroke Patients: Effects of an Assessment Sheet Used in Convalescence Rehabilitation Ward

Assessment of Independent Walking by Stroke Patients: Effects of an Assessment Sheet Used in Convalescence Rehabilitation Ward

回復期リハビリテーション病棟看護師の多職種連携実践能力に関連する要因

回復期リハビリテーション病棟看護師の多職種連携実践能力に関連する要因

Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward.

Background. A risk factor associated with stroke onset is chronic kidney disease (CKD). To prevent stroke reoccurrence, it is necessary to strictly manage blood pressure, lipids, and plasma glucose. Therefore, some cases are forced to polypharmacy, elderly patients in particular. Polypharmacy often leads to adverse drug reactions and has the potential to negatively affect the rehabilitation of stroke patients. The aim of the present study was to investigate the effects of polypharmacy using a functional independence measure (FIM). Methods. A total of 144 stroke patients with CKD were included in the present analysis. We divided stroke patients into those taking six or more drugs (polypharmacy group) and those taking less than six drugs (nonpolypharmacy group) upon admission. Patient background features, laboratory data, and FIM scores were compared. Results. FIM-Motor (FIM-M) efficiency, age, and diabetes mellitus were positively associated with polypharmacy. FIM-M efficiency in the polypharmacy group was significantly lower than in the nonpolypharmacy group. Conclusion. Polypharmacy interferes with the effect of rehabilitation in stroke patients with CKD. Pharmacists and doctors should make efforts to optimize medications to be able to respond to the outcome of each patient.

A Cross-sectional Study on Falls in a Convalescent Rehabilitation Ward

A Cross-sectional Study on Falls in a Convalescent Rehabilitation Ward

Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients.

This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIMⓇ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. The multiple logistic regression analysis showed that the FIMⓇ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.

Differences of alterations by orthosis clinic during convalescent rehabilitation ward phase and during chronic phase

Differences of alterations by orthosis clinic during convalescent rehabilitation ward phase and during chronic phase

Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study

A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight <18.5 kg/m(2), standard 18.5-<23 kg/m(2), overweight 23-<27.5 kg/m(2), obese ≥27.5 kg/m(2)). The primary outcome was the FIM gain, and the secondary outcome was the FIM score at discharge. Multiple regression analysis was performed to analyze the relationship between BMI and functional recovery. In total, 897 participants (males 484, females 413; mean age 71.6 years) were analyzed and classified as underweight (134), standard (432), overweight (277), and obese (54). The median FIM gain and the FIM score at discharge were 30 and 114, respectively. The FIM gain in the obese group was significantly higher than those in the other groups. Multiple regression analysis revealed that obesity was independently correlated with the FIM gain, and those at discharge after adjusting for confounders such as age, gender, and FIM score on admission. Obese Japanese convalescent patients with stroke may have some advantages for functional recovery in rehabilitation wards.

Development of the toilet assistance chart and examination of its validity in a convalescent rehabilitation ward

Development of the toilet assistance chart and examination of its validity in a convalescent rehabilitation ward

Effects of resistance training using LST in convalescent rehabilitation ward inpatients in Japan

Effects of resistance training using LST in convalescent rehabilitation ward inpatients in Japan

回復期脳卒中患者における6分間歩行距離と 運動機能および自覚的運動強度の関連

回復期脳卒中患者における6分間歩行距離と 運動機能および自覚的運動強度の関連