Convalescent Rehabilitation Ward Research Articles

Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture.

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

Effect of heart failure and malnutrition, alone and in combination, on rehabilitation effectiveness in patients with hip fracture.

Heart failure and malnutrition are known to each negatively affect a patient's ability to improve their activities of daily living (ADL) through rehabilitation. Here, we investigated whether the negative effects of malnutrition and heart failure on ADL are additive in patients after hip fracture. This retrospective observational cohort study included 155 patients with hip fracture admitted to convalescent rehabilitation wards. Nutritional status was measured with the Geriatric Nutritional Risk Index (GNRI). Heart failure was assessed using plasma B-type natriuretic peptide (BNP) levels. Based on their GNRIs and BNP levels, patients were classified into four groups: a high GNRI (≥92)-low BNP (<100pg/ml) group (n=54); high GNRI-high BNP (≥100pg/ml) group (n=7); low GNRI (<92)-low BNP group (n=67); and low GNRI-high BNP group (n=27). The main outcome was rehabilitation effectiveness (REs). To confirm above hypothesis, heart failure was also assessed by American College of Cardiology/American Heart Association (ACC/AHA) stage classification, whereas nutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), either. REs in the high GNRI-low BNP group, high GNRI-high BNP group, low GNRI-low BNP group, and low GNRI-high BNP group were 64.8±22.6%, 36.0±22.0%, 40.6±23.6% and 28.5±25.9%, respectively. REs was higher in the high GNRI-low BNP group than in other three groups, and REs in the low GNRI-low BNP group was higher than in the low GNRI-high BNP group. When we evaluated heart failure by ACC/AHA stage classification instead of BNP, or evaluated nutrition by MNA-SF instead of GNRI, the similar results were demonstrated. Multiple linear regression analyses revealed that age (p<0.01), handgrip strength (p<0.01), GNRI (p<0.05), and BNP (p<0.01) were significantly associated with REs. These results suggest that malnutrition and heart failure are independently associated with REs and that they have an additive negative effect on improvement of ADL in elderly patients with hip fractures.

Machine Learning Algorithm Identifies the Importance of Environmental Factors for Hospital Discharge to Home of Stroke Patients using Wheelchair after Discharge

Background and purposePhysical environmental factors are generally likely to become barriers for discharge to home of wheelchair users, compared with non-wheelchair users. However, the importance of environmental factors has not been investigated adequately. Application of machine learning technology might efficiently identify the most influential factors, although it is not easy to interpret and integrate various information including individual and environmental factors in clinical stroke rehabilitation. This study aimed to identify the influential factors affecting home discharge in the stroke patients who use a wheelchair after discharge by using machine learning technology. MethodsThis study used the rehabilitation database of our facility, which includes all stroke patients admitted into the convalescence rehabilitation ward. The chi-squared automatic interaction detection (CHAID) algorithm was used to develop a model to classify wheelchair-using stroke patients discharged to home or not-to-home. ResultsAmong the variables, including basic information, motor functional factor, activities of daily living ability factor, and environmental factors, the CHAID model identified house renovation and the existence of sloping roads around the house as the first and second discriminators for home discharge. ConclusionsOur present results could scientifically clarify that the clinician need to focus on the physical environmental factors for achieving home discharge in the patients who use a wheelchair after discharge.

Safety Management in Convalescent Rehabilitation Ward

Safety Management in Convalescent Rehabilitation Ward

Nutritional Management in the Convalescent Rehabilitation Ward

Nutritional Management in the Convalescent Rehabilitation Ward

Gait Reconstruction at Convalescent Rehabilitation Ward

歩行は人間にとって移動手段の中心であり，回復期リハビリテーション治療における歩行再建は最も重要な課題の1つである．装具は歩行トレーニングを行ううえで重要なツールであり，回復期入院中の装具療法は脳卒中ステージ理論に沿って歩行課題を設定し，歩行トレーニングを進める．そのためには，装具の目的を治療用装具と機能代償用（生活用）装具に大別し，使用目的に応じた装具の調整・処方を行い，装具療法を進める必要がある．また，装具療法のみならず生活期の装具難民を生み出さないためにも患者教育をしっかりと行うことが重要であると考える．

Rehabilitation Approach to Patients with Higher Brain Dysfunction in Convalescent Rehabilitation Wards

Rehabilitation Approach to Patients with Higher Brain Dysfunction in Convalescent Rehabilitation Wards

Predictive validity of the Mini Nutritional Assessment Short-Form for rehabilitation patients: A retrospective analysis of the Japan Rehabilitation Nutrition Database.

Malnutrition is associated with worse outcome in rehabilitation patients; however, appropriate malnutrition screening tools for this population have not been investigated. We examined the predictive validity of specific cut-off values of the Mini Nutritional Assessment Short-Form version 2 (MNA-SFv2) for Japanese rehabilitation patients. This retrospective cohort study analyzed adult patients (≥20years) in the Japan Rehabilitation Nutrition Database who were in convalescent rehabilitation wards after stroke or hip fracture. Patients were classified into three categories based on MNA-SFv2 original (0-7, 8-11 and 12-14 points, respectively) or modified (0-5, 6-7 and 8-14 points, respectively) cut-off values: malnutrition, at risk of malnutrition or well-nourished. Functional independence measure (FIM) and home discharge were compared between the categories. Overall, 489 patients were analyzed. Based on the MNA-SFv2 original and modified cut-off values, 64.4% and 36.0% were malnourished, 32.3% and 28.4% were at risk of malnutrition, and 3.3% and 35.6% were well-nourished, respectively. Malnutrition defined by both cut-off values was significantly associated with the FIM at admission, whereas only those defined by modified cut-off values predicted the FIM at discharge (B, -7.1; 95% confidence interval=-12.3 to -1.9). Neither original, nor modified cut-off values predicted discharge to home and long-term care facilities. An MNA-SFv2 score of 0-5 points may be useful to identify Japanese patients with poor outcomes in a rehabilitation setting.

Effect of Food Odors on Subjective Degree of Appetite Among Patients Undergoing Convalescent Rehabilitation

The goal of this study was to evaluate the effect of food odors on subjective degree of appetite in patients on a convalescent rehabilitation ward. The degree of subjective appetite for sauce and curry odor samples was significantly stronger than that for the odorless sample. But the evoked intensity of subjective appetite did not differ between the 2 groups, and none of the samples affected the degree of perceived favorability. These results suggested that sauce and curry odors can enhance the appetite and food consumption of patients in convalescent rehabilitation wards.

Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study

BackgroundVarious factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation.MethodsWe conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the “continuation group,” and those who were not able to continue were categorized as the “non-continuation group.” We analyzed the groups’ demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge.ResultsAfter enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085–1.831; p = 0.0076).ConclusionSuccessful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation.Trail registrationThe Ethics Committee’s registration number is “TGE01216–066”.

The effect of partially hydrolyzed guar gum on preventing influenza infection.

Seasonal influenza infection in hospitals is a serious problem, and infection prevention is important. We examined retrospectively the effect of prebiotics using partially hydrolyzed guar gum (PHGG) in the prevention of influenza infection. Among the patients who were admitted to Hokusei Hospital between April 2017 and March 2019, 522 patients consuming food orally (492 in the convalescent rehabilitation ward and 30 in the long-term care ward) were included in this single-center retrospective cohort study. Patients were divided into two groups: a group continuously taking PHGG (PHGG group; 172 patients in the convalescent rehabilitation ward and 16 patients in the long-term care ward) and a group not taking PHGG (non-PHGG group; 320 patients in the convalescent rehabilitation ward and 14 patients in the long-term care ward). The incidence of influenza during hospitalization, stool pH, and Bristol Stool Form Scale (BSS) at 2 months after admission (2 months after the start of PHGG intake in the PHGG group) were compared between the two groups. In addition, stool pH and BSS were compared between patients who developed influenza and those who did not. A total of 24 patients developed influenza. These patients were from the non-PHGG group (12 in the convalescent rehabilitation ward and 12 in the long-term care ward), with a significant difference in the incidence of influenza between these two sub-groups (p<0.001). The non-PHGG group had more patients with high stool pH (90th percentile or higher) (p=0.097, not clinically significant, in the convalescent rehabilitation ward and p<0.001 in the long-term care ward). This group also had more patients with very poor BSS (score 1 or 7) (p=0.045 in the convalescent rehabilitation ward and p<0.001 in the long-term care ward). In addition, patients with influenza onset had high stool pH and very poor BSS regardless of their wards. The incidence of influenza was found to be different between patients with and without taking PHGG. Stool pH and BSS were different between patients with and without PHGG intake and those with and without influenza onset, suggesting that PHGG can affect the intestinal environment and thus contribute to reducing the incidence of influenza.

Pharmaceutical Factors for Functional Independence Measure (FIM) in a Convalescent Rehabilitation Ward

Pharmaceutical Factors for Functional Independence Measure (FIM) in a Convalescent Rehabilitation Ward

Decision Tree Algorithm Identifies Stroke Patients Likely Discharge Home After Rehabilitation Using Functional and Environmental Predictors

Background and purposeThe importance of environmental factors for stroke patients to achieve home discharge was not scientifically proven. There are limited studies on the application of the decision tree algorithm with various functional and environmental variables to identify stroke patients with a high possibility of home discharge. The present study aimed to identify the factors, including functional and environmental factors, affecting home discharge after stroke inpatient rehabilitation using the machine learning method. MethodThis was a cohort study on data from the maintained database of all patients with stroke who were admitted to the convalescence rehabilitation ward of our facility. In total, 1125 stroke patients were investigated. We developed three classification and regression tree (CART) models to identify the possibility of home discharge after inpatient rehabilitation. ResultsAmong three models, CART model incorporating basic information, functional factor, and environmental factor variables achieved the highest accuracy for identification of home discharge. This model identified FIM dressing of the upper body (score of ≤2 or >2) as the first single discriminator for home discharge. Performing house renovation was associated with a high possibility of home discharge even in patients with stroke who had a poor FIM score in the ability to dress the upper body (≤2) at admission into the convalescence rehabilitation ward. Interestingly, many patients who performed house renovation have achieved home discharge regardless of the degree of lower limb paralysis. ConclusionWe identified the influential factors for realizing home discharge using the decision tree algorithm, including environmental factors, in patients with convalescent stroke.

Percutaneous Endoscopic Gastrostomy Reduces Aspiration Pneumonia Rate in Stroke Patients with Enteral Feeding in Convalescent Rehabilitation Wards.

ABSTRACTObjectives:The effect of percutaneous endoscopic gastrostomy (PEG) on the prevention of aspiration pneumonia and improvements in activities of daily living (ADL) for enteral feeding-dependent stroke patients is unclear. We sought to clarify differences in the rates of aspiration pneumonia and ADL improvement between stroke patients receiving PEG and those receiving nasogastric tube feeding (NGT) in convalescent rehabilitation wards.Methods:We assessed 10 years of data from the Kaga Regional Cooperation Clinical Pathway for Stroke, which covers patients in the southern district of Ishikawa Prefecture of Japan. Logistic regression analysis with propensity score adjustment was used to examine how the enteral feeding method affected aspiration pneumonia rates. Linear regression analysis, adjusted by propensity scores, was also performed to ascertain the effect of the enteral feeding method on ADL improvement.Results:Overall, 47 patients with PEG and 49 patients with NGT were analyzed. The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than in the PEG group in the propensity score-adjusted logistic regression analysis (odds ratio 4.67, 95% confidence interval 1.30–16.67, P=0.02). The enteral feeding method had no significant effect on ADL improvement in the propensity score-adjusted linear regression analysis.Conclusions:In convalescent rehabilitation wards, aspiration pneumonia was more likely to occur in stroke patients with NGT than in those with PEG; however, the enteral feeding method did not affect ADL improvement. These results provide a basis for determining the appropriate enteral feeding method for stroke patients who cannot take adequate nutrition orally during convalescence/rehabilitation.

Examination of Classification Characteristics of Excretory Movement Process in Elderly Patients in a Convalescent Rehabilitation Ward

Examination of Classification Characteristics of Excretory Movement Process in Elderly Patients in a Convalescent Rehabilitation Ward

ウェアラブルデータと機械学習を用いた回復期リハビリ病棟脳卒中患者の機能指標(FIM)予測

ウェアラブルデータと機械学習を用いた回復期リハビリ病棟脳卒中患者の機能指標(FIM)予測

Quantifying Face-to-Face Communication among Multidisciplinary Medical Professions in a Convalescent Rehabilitation Ward by using a Name Tag-Type Information Communication Device

Context: Although quantitative analyses of human behavior data collected through wearable sensors have uncovered principles of complex human behaviors and organization performances, quantitative assessment has not been conducted on communication among the medical team, despite its importance. Aims: The aim of the study is to quantify face-to-face communication in a multiprofessional medical team using a sociophysical method and wearable sensors. Settings and Design: The study was conducted at a rehabilitation ward in Japan; this was a pilot study. Subjects and Methods: The amount of time spent on face-to-face communication among 36 multidisciplinary medical professional in a rehabilitation ward was recorded using name tag-type sensors for 2 weeks. The average communication time per week for each pair of participants was calculated; the network diagrams were drawn by using Cytoscape software. The unpaired t-test and Welch's F-test used together with the Games–Howell post hoc test were performed to compare the communication times between two groups and among three groups, respectively. Results: The following three groups emerged: ward staff (nurses and care workers), rehabilitation therapists, and physicians/medical social workers. The communication time between physicians and ward staff (mean, 8.0 min/week) did not differ from that between the physicians and rehabilitation therapists (5.5). The communication time was longer among rehabilitation therapists (61.7) than among the ward staff (45.7), both of which were longer than that between the ward staff and rehabilitation therapists (4.8). Conclusions: Quantitative measurement of face-to-face communication time using wearable sensors characterized the staff behavior in a multiprofessional medical practice in a rehabilitation ward, which may affect medical team performance, such as patient outcomes.

Incidence of new-onset sarcopenia and associated factors in stroke patients on a convalescent rehabilitation ward

Incidence of new-onset sarcopenia and associated factors in stroke patients on a convalescent rehabilitation ward

Changes in the Physical Parameters of Patients Enrolled in a Convalescent Rehabilitation Ward, Who Consumed a Branched Chain Amino Acid (BCAA)-Enriched Oral Solution

Changes in the Physical Parameters of Patients Enrolled in a Convalescent Rehabilitation Ward, Who Consumed a Branched Chain Amino Acid (BCAA)-Enriched Oral Solution

Outcome prediction in patients with putaminal hemorrhage at admission to a convalescent rehabilitation ward based on hemorrhage volume assessed with computed tomography during acute care.

[Purpose] The aim of this study was to assess the usefulness of computed tomography for outcome prediction in patients with putaminal hemorrhage at admission to a convalescent rehabilitation ward. [Participants and Methods] Patients admitted to our convalescent rehabilitation ward after transfer from acute care hospitals were included in this study. Multiple regression analyses were performed using the score in the motor component of the Functional Independence Measure at discharge as the target value. Hemorrhage volume assessed with computed tomography during acute care and age were set as the explanatory variables. The motor component of the Functional Independence Measure score at admission and the time (days) from onset were also recorded. Correlation analyses between all the possible pairs of explanatory variables were then performed. [Results] Hemorrhage volume and age were both significant contributors to the motor component of the Functional Independence Measure score at discharge. However, the contribution of hemorrhage volume disappeared when the time from onset and motor component of the Functional Independence Measure score at admission were added. Hemorrhage volume significantly correlated with the time from onset and motor component of the Functional Independence Measure score at admission. [Conclusion] The present findings suggest that computed tomography may be useful for outcome prediction from the acute stage in stroke patients with putaminal hemorrhage. However, because of multicollinearity, its predictive power was reduced when the patients were transferred to a convalescent rehabilitation ward.