Convalescent Rehabilitation Ward Research Articles

Combined Assessment of Cognitive and Balance Abilities to Predict Falls in Patients in the Convalescent Rehabilitation Ward.

This study aimed to investigate the relationship between falls and cognitive and balance problems in patients. This retrospective observational study analyzed the medical records of 1010 older patients admitted to a convalescent rehabilitation ward. The primary endpoint was fall occurrence during ward stays. The main outcomes were the Mini-Mental State Examination (MMSE) and Standing Test for Imbalance and Disequilibrium (SIDE), with patients divided into groups of MMSE ≥28 and <28 and SIDE ≥2b and <2b. During ward stays, 220 patients (22%) fell. Estimating the fall risk of the MMSE ≥28 + SIDE ≥2b group compared to that of other groups revealed that only the MMSE <28 + SIDE <2b group had a significantly higher fall risk, with a hazard ratio [95% confidence interval] of 3.13 [1.51-6.46]. Combined MMSE and SIDE assessment at ward admission facilitated the easy identification of individuals at high fall risk.

How Predictive is the FIM at Discharge from Convalescent Rehabilitation Ward by the FIM at Admission?：A Study Using Multiple Regression Analysis and Cross-validation

How Predictive is the FIM at Discharge from Convalescent Rehabilitation Ward by the FIM at Admission?：A Study Using Multiple Regression Analysis and Cross-validation

Effects of structured positive feedback intervention on standing reach ability among older adults admitted to a convalescent rehabilitation ward: a small-sample pilot randomized controlled trial.

Interventions to improve the standing reach ability of older adults are essential for full functional independence, and structured positive feedback (PF) may be an effective intervention strategy. The purposes of this pilot randomized controlled trial (RCT) are to investigate the preliminary efficacy of structured PF for improving the standing reach ability of older patients admitted to a convalescent rehabilitation ward and evaluate the feasibility of a future full-scale RCT. Thirty-two eligible older adults (83.3 ± 5.9years, 23 women) out of 587 potential participants were randomly assigned 1:1 to structured PF (experimental) and conventional rehabilitation (control) groups. Only the experimental group received PF intervention for standing reach ability once every 3days. Both groups engaged in conventional rehabilitation programs for 2-3h every day. The primary outcome was change in Functional Reach Test (FRT) performance after 5weeks of the indicated intervention compared to baseline. Secondary outcomes were change in Short Falls Efficacy Scale International (Short FES-I), a self-reported measure of fear of falling, and Functional Independence Measure (FIM) scores after the 5-week intervention. The estimated difference in mean FRT change (∆) between experimental and control groups was -4.1cm (P = 0.07) according to a linear mixed model, supporting the potential efficacy of PF for improving standing reach ability. Further, Hedge's g value was 0.71, consistent with a moderate effect size. However, the estimated mean change in Short FES-I between groups also indicated greater fear of falling in the experimental group (∆ = -4.5, P = 0.009, g = 1.0). In contrast, the intervention effect on FIM was negligible (∆ = 2.0, P = 0.66, g = -0.1). These results support the preliminary effectiveness of structured PF for improving the standing reach ability of older adults. A larger-sample RCT is warranted for validation and optimization of the structured PF protocol. The University Hospital Medical Information Network (UMIN) Registered 31 May 2022 (UMIN000047647).

Actual situation of nutritional management and factors related to activities of daily living ability at discharge in convalescent rehabilitation ward.

In this study, we aimed to investigate changes in the Geriatric Nutritional Risk Index (GNRI), a nutrition-related prognostic indicator, in our convalescent rehabilitation ward and determine how this index relates to activities of daily living (ADL) ability at discharge. We retrospectively analyzed data of 107 patients admitted to our convalescent rehabilitation ward between April and September 2023. We used the GNRI as the nutritional risk index and Functional Independence Measure (FIM) as the ADL index. The patients' mean age was 80.0 ± 10.3 years; 38 were males and 69 females. The patients' mean body weight at admission was 51.2 ± 10.2 kg, which significantly decreased to 50.2 ± 9.4 kg at discharge (p = 0.0006). Their mean body mass index (BMI) also significantly decreased from 21.4 ± 3.4 at admission to 20.0 ± 8.2 at discharge (p = 0.002). The mean GNRI significantly decreased from 93.1 ± 8.6 at admission to 91.7 ± 8.4 at discharge (p = 0.023). The mean body weight decreased until the fourth month after admission; however, no decreasing trend after the fifth month was observed. The mean monthly energy intake gradually increased after admission and reached the calculated energy requirement of 1,415 ± 22 kcal at the fifth month. Multivariate analysis demonstrated that at discharge, the GNRI score was positively associated with the FIM score (β = 0.21, p = 0.0008). Body weight and GNRI scores decreased after admission but stopped decreasing after the fifth month due to a gradual increase in energy intake. At discharge, the FIM score was positively associated with the GNRI score. We expected that active nutritional therapy from the beginning of hospitalization would increase the GNRI by the time of discharge and eventually improve ADL ability at discharge.

Association Between BMI Reduction and Activities of Daily Living Improvement in Elderly Patients With Musculoskeletal Disorders in a Convalescent Rehabilitation Ward.

Background As populations age, musculoskeletal disorders significantly affect the quality of life (QOL) and functional independence of elderly individuals. While BMIis commonly used to assess nutritional status and is linked to physical function, the relationship between BMI reduction and improvements in activities of daily living (ADL) remains unclear in elderly patients with musculoskeletal disorders. This study aimed to explore this relationship in a rehabilitation setting. Methods This retrospective cohort study included 75 elderly patients (65 years and older) with musculoskeletal disorders admitted to a convalescent rehabilitation ward. Patients were categorized into two groups based on BMI reduction: those with a decrease of ≥0.7 kg/m² and those with <0.7 kg/m². Functional Independence Measure (FIM) scores were recorded at admission and discharge. Statistical analyses, including logistic regression, were conducted to examine the relationship between BMI reduction and FIM improvement. Results There was no significant difference in FIM gain between the BMI-reduced and non-BMI-reduced groups. Logistic regression analysis also found no significant association between BMI reduction and FIM improvement, even after adjusting for age, gender, length of stay, and initial FIM scores. Discussion The absence of a significant association may be due to factors such as postoperative swelling, comorbidities, and the predominance of female participants, who may experience less muscle mass loss. Study limitations include the lack of data on dietary intake and body composition. Future research should include broader assessments, such as muscle mass and swelling, to better evaluate rehabilitation outcomes in elderly patients with musculoskeletal disorders.

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial.

The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population. To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia. This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21days. The CG underwent a standard daily rehabilitation routine for 21days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21days of rehabilitative training. The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population. The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

Concurrent and predictive validity of the Global Leadership Initiative on Malnutrition criteria for adult patients in convalescent rehabilitation wards

Background & aimsThe Global Leadership Initiative on Malnutrition (GLIM) criteria has been recognised as major diagnostic criteria for malnutrition in adults worldwide; however, its validity in rehabilitation settings remains unclear. This study investigated the concurrent and predictive validity of the GLIM criteria for adult patients in convalescent rehabilitation wards. MethodsThis retrospective cohort study was conducted using pre-established datasets from convalescent rehabilitation wards in a hospital. The inclusion criteria were adults aged ≥18 years admitted to the wards between November 2018 and October 2020 who were available for body composition assessment. Malnutrition diagnoses were determined by registered dietitians (RDs) using the GLIM criteria. The Subjective Global Assessment (SGA) was performed by another RD and used for the malnutrition reference standard. The GLIM criteria sensitivity and specificity were examined for SGA. The odds ratios and hazard ratios of GLIM-defined malnutrition for the total score of the Functional Independence Measure (tFIM) effectiveness and non-home discharge were calculated using univariable and multivariable logistic regression analyses and Cox proportional hazard models. ResultsData from 723 patients were extracted from the dataset. GLIM-defined malnutrition was confirmed in 207 (28.6%) patients, 87 (12.0%) with moderate malnutrition and 120 (16.6%) with severe malnutrition. The SGA graded 146 (20.2%) patients with moderate malnutrition (grade B) and 86 (11.9%) with severe malnutrition (grade C). The GLIM criteria (malnutrition/ no malnutrition) had fair sensitivity (76.7%, 95% confidence interval [CI]: 70.7–82.0%) and good specificity (94.1%, 95% CI: 91.6–96.0%), indicating acceptable concurrent validity. GLIM-defined moderate malnutrition had poorer sensitivity than severe malnutrition (42.5% vs 81.4%). Logistic regression analyses revealed no evidence for the association between GLIM-defined malnutrition and poor tFIM effectiveness (adjusted odds ratio [AOR]: 1.09, 95% CI: 0.71–1.69) and non-home discharge (AOR: 1.19, 95% CI: 0.76–1.84). The Cox proportional hazard analyses also showed no effect of malnutrition on outcomes. ConclusionThe GLIM criteria had fair sensitivity and good specificity, indicating acceptable criteria for diagnosing malnutrition in rehabilitation settings. However, its predictive validity for functional recovery and discharge outcomes was insufficient.

Impact of Hospital Dentistry on Patients' Food Intake Status in Convalescent Rehabilitation Ward.

Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status. This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD). Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non-texture-modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined. A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36-48.01). Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards.

A qualitative study of stressors faced by older stroke patients in a convalescent rehabilitation hospital.

This study aimed to explore the stressors experienced by older patients with stroke in convalescent rehabilitation wards in Japan. Semi-structured interviews were conducted with four stroke patients aged > 65 years who experienced a stroke for the first time in their lives. The interviews were analyzed using the Steps for Coding and Theorization method for qualitative data analysis. The results of the qualitative analysis demonstrated that patients experienced specific stressors, such as, difficulty in movement of the paralyzed hand, fear of stroke recurrence, and dietary problems. Some stressors were manageable through healthcare professionals' active and sensitive communication strategies. These stressors were derived from the theoretical framework of "stressors related to hospitalization" and "stressors related to the illness". Additional stressors emerged from the interaction between these two types within the theoretical framework. The results of this study contribute to a deeper understanding of the specific stressors experienced by older stroke patients during the recovery process.

Improved trunk muscle quality in patients with stroke increases improvements in activities of daily living

BackgroundThis study aimed to determine whether an increased trunk muscle quality index (TMQI) is associated with activities of daily living (ADL) in patients ≥ 65 years of age with cerebral infarction in a convalescent rehabilitation ward. MethodsThis retrospective observational study included patients aged ≥ 65 years who were admitted for post-stroke rehabilitation in Okinawa, Japan, between May 2018 and December 2022. The TMQI was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups based on the change in the TMQI during hospitalization: increase-in-TMQI and no-increase-in-TMQI groups. Multiple regression analysis was employed to explore the impact of increased TMQI on functional independence measure (FIM) -motor gain. ResultsWe included a total of 315 patients (79.1 ± 7.9 years of age, 51.7% men) in our analyses. Over half (165 [52.4%]) of the patients exhibited an increase in TMQI scores, and 150 (47.6%) patients did not exhibit an increase. No significant difference was observed in motor FIM score and motor FIM gain at admission and discharge between the groups with and without increased TMQI. Increased TMQI was independently associated with increased FIM-motor gain (adjusted R2 = 0.340 and R2 = 0.357, coefficient = 1.736, 95% confidence interval: 0.52–2.95, P = 0.005). ConclusionsThe results of this study suggest that increased TMQI has a positive effect on the recovery of physical function in patients with stroke. Further prospective studies are needed to elucidate the relationship between increased TMQI and ADL.

Relationship between Improvement in Physical Activity and Three Nutritional Assessment Indicators in Patients Admitted to a Convalescent Rehabilitation Ward.

We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge.

Prognostic Equations and Accuracy of a Total Score of Functional Independence Measure at Discharge for Different Diseases in a Convalescent Rehabilitation Ward.

Prognosisand goal setting from admission in the convalescent rehabilitation ward, supported by a multidisciplinary team, enhance rehabilitation and discharge support. Predicting functional independence measure (FIM) outcomes can further optimize these processes. This study aimed to develop prognostic equations for the motor FIMat discharge for stroke, hip fracture (HF), vertebral compression fractures (VCFs), and total knee arthroplasty (TKA), which are common diseases in patients admitted to convalescent rehabilitation wards, using multiple regression analysis, and to clarify the difference in the accuracy of the predicted motor FIM according to the disease. This study included 965 patients admitted to our hospital. The objective variable consists of the motor FIM at discharge, and the explanatory variables were age, sex, days from onset to admission, total admission motor FIM, and total admission cognitive FIM. A stepwise multiple regression analysis was performed. The analysis of the difference in the accuracy of predicted motor FIM by disease used the absolute value of the residuals. The total motor FIM and cognitive FIM at admission were extracted for all four diseases included in this study. The absolute value of the residuals appeared to be more accurate for TKA, HF, stroke, and VCF in that order. Although differences in the accuracy of the prediction equation were observed by disease, this prediction equation can be used as an approach to review the details of rehabilitation and discharge and can be tailored to each case.

Predictors of Complete Oral Intake in Patients With Stroke After Tracheostomy.

Tracheostomy procedures inhibit swallowing, although details of subsequent recovery of oral intake remain unknown. This retrospective cohort study aimed to investigate factors influencing dysphagia improvement in patients with subacute stroke after tracheostomy. The study included 117 patients who underwent tracheostomy after subacute stroke, cerebral hemorrhage, or endogenous subarachnoid hemorrhage and received care at 2 convalescent rehabilitation wards in urban and suburban Japan between 2015 and 2022. The primary outcome measure was the achievement of complete oral intake. Patient demographics, Functional Independence Measure scores, body mass index, food intake level scale scores, and the presence of severe white matter hyperintensities on imaging were retrospectively collected from medical records. Statistical analysis involved univariate logistic regression to identify potential predictors and multivariate logistic regression to refine the model while accounting for multicollinearity. In total, 47% of patients achieved complete oral intake on discharge. Sex, days from onset to admission, Functional Independence Measure motor and cognitive scores, body mass index, food intake level scale scores, and severe white matter hyperintensities were identified as potential predictors in the univariate analysis. However, multivariate logistic regression identified only food intake level scale scores (odds ratio [OR], 3.687 [95% CI, 1.519-8.949]; P=0.004) and severe white matter hyperintensities (OR, 0.302 [95% CI, 0.096-0.956]; P=0.042) as significant predictors of complete oral intake. In patients with subacute stroke undergoing tracheostomy, the level of oral intake on admission and severe white matter hyperintensities on imaging may be better predictors of complete oral intake. However, prospective studies with larger sample sizes and more comprehensive data are warranted to confirm these findings.

The cutoff values of functional independence measure scores for predicting discharge destination in the early stroke phase.

This study aimed to determine cutoff values of functional independence measure (FIM) scores to predict the discharge destinations of patients with acute stroke. The sample included 318 patients with acute stroke (mean age, 72.0 years; women, 39%). The discharge destination was categorized into three groups: home, postacute rehabilitation (hospital with convalescent rehabilitation wards), and postacute care (institution without convalescent rehabilitation wards). We assessed FIM after lifting bed restriction. Multinomial logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of the FIM scores for predicting discharge destinations, with postacute rehabilitation as a reference. Cutoff values of motor and cognitive FIM scores for distinguishing home from postacute rehabilitation and postacute care from postacute rehabilitation were determined using receiver operating characteristic curves. The proportion of home, postacute rehabilitation, and postacute care were 34.6%, 41.8%, and 23.6%, respectively. After adjustments for clinical variables, the ORs (95% CIs) for motor and cognitive FIM scores for home versus postacute rehabilitation were 1.08 (1.04-1.11) and 1.05 (0.98-1.12). Furthermore, those for postacute care versus postacute rehabilitation were 1.01 (0.98-1.04) and 0.92 (0.87-0.98). The cutoff values of the motor and cognitive FIM scores for distinguishing home from postacute rehabilitation were 37.5 (sensitivity: 0.92; specificity: 0.64) and 23.5 (sensitivity: 0.78; specificity: 0.67). Furthermore, those for distinguishing postacute care from postacute rehabilitation were 15.5 (sensitivity, 0.81; specificity, 0.51) and 12.5 (sensitivity, 0.74; specificity, 0.64). The identified cutoff values may serve as early indicators for predicting discharge destinations from acute stroke care.

Factors associated with an improvement in extracellular water-to-total body water ratio in older adults with hip fractures: A decision tree analysis

Background & AimsThe extracellular water-to-total body water ratio (ECW/TBW) increases with age and after fractures. A high ECW/TBW may hinder improvements in physical function and skeletal muscle mass. However, the effects of ECW/TBW improvement have not been properly investigated. The aim of this study was to investigate the factors associated with ECW/TBW improvement in older adults with hip fractures. MethodsThis retrospective cohort study included 203 patients with hip fractures who were admitted to a convalescent rehabilitation ward. ECW/TBW and skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. The patients were classified into two groups: those with an improvement in ECW/TBW (n = 123) and those without an improvement (n = 80). Decision tree analysis was performed to examine the factors associated with ECW/TBW improvement. As a secondary objective, a multiple regression analysis was performed to identify the factors associated with SMI gain. ResultsDecision tree analysis identified rehabilitation volume and protein intake as the first and second factors most significantly associated with an improvement in ECW/TBW, respectively. Multiple regression analysis showed that improved ECW/TBW (β: 0.400, p < 0.001) was significantly associated with SMI gain. ConclusionsRehabilitation volume and protein intake are clinically important for improving ECW/TBW in older adults with hip fractures.

Association of Sarcopenia and Its Components with Depression Symptoms in Older Patients with Stroke.

Recent studies have reported an association between sarcopenia and depression symptoms. To date, no reports have investigated the association between sarcopenia and depression symptoms evaluated using the Geriatric Depression Screening Scale (GDS)-15 in patients with stroke. Therefore, this study aimed to investigate the association between sarcopenia and its components and the improvement of depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward. Patients with stroke aged ≥65 years admitted to a convalescent rehabilitation ward were included in the study. Participants were categorized into sarcopenia and non-sarcopenia groups based on the 2019 Asian Working Group for Sarcopenia. Here, depression symptoms were evaluated using the GDS-15, in addition to demographic characteristics. This study's primary outcome was the GDS change from admission to discharge. Multiple regression analysis was performed to investigate the association between GDS change and sarcopenia and its components. Overall, 118 participants were included, with the mean age of 78.7±8.1 years, and 58 (49%) were classified in the sarcopenia group. Multiple regression analysis showed that sarcopenia (β=-0.283, 95% confidence interval [CI] -1.140 to -0.283, p&lt;0.001) and handgrip strength (β=-0.317, 95% CI -0.162 to -0.014, p=0.021) were independently associated with GDS change. Sarcopenia and handgrip strength were significantly associated with improved depression symptoms in patients with stroke admitted to a convalescent rehabilitation ward. However, further prospective studies should investigate the association between sarcopenia and depression symptoms in patients with stroke.

Relationship between progressive improvement in gait ability one year after discharge and skeletal muscle characteristics of stroke survivors

BackgroundThe clinical importance of skeletal muscle characteristics for improving gait ability of stroke survivors is increasing. We aimed to examine the association between muscle quantity and quality at discharge and changes in gait independence at the time of 1 year after discharge in patients with stroke. MethodsThis prospective observational study included 100 patients with stroke who were admitted to a convalescent rehabilitation ward. We defined muscle quantity and quality operationally as muscle thickness and echo intensity observed in ultrasonography images, respectively, and measured quadriceps muscle on the paretic and non-paretic sides at the time of discharge. The outcome measured in our study was changes in gait independence 1 year after discharge, as assessed by the Functional Independence Measure gait assessment tool score. ResultsAmong the study participants, 23 (23.0 %) were assessed to have reduced gait independence, while 77 (77.0 %) were evaluated to have improved or maintained gait independence. Our multivariate logistic regression analysis revealed that only muscle quantity on the paretic side was significantly associated with an improvement or maintenance of gait independence (odds ratios 3.32; 95 % confidence interval 1.01–10.95; p = 0.049). ConclusionsOur findings revealed that an improvement in gait independence 1 year after discharge was influenced by quadriceps muscle quantity on the paretic side at the time of discharge in patients with subacute stroke. This finding highlights the importance of lower limb muscle quantity on the paretic side as a clinically significant factor that influences the improvement in gait ability after hospital discharge.

Relationship Between Mild Cognitive Impairment and Activities of Daily Living in Older Patients in Convalescent Rehabilitation Wards

Aims Rehabilitation is commonly used in older patients with mild cognitive impairment (MCI). This study aimed to determine whether MCI affects the effectiveness of rehabilitation in older patients. Methods This was a retrospective cohort study of patients who received rehabilitation in convalescent rehabilitation wards (CRW) in Japan between January 2021 and December 2022. Results 141 patients who met inclusion criteria were included in this study. The patients were divided into MCI and non-MCI groups based on the Mini Mental State Examination score. At admission, MCI patients were significantly older, and had longer hospital stays, malnutrition, lower grip strength, and lower motor independence measures (FIMS) scores. After propensity score matching to adjust for differences in baseline characteristics, motor FIMS scores at discharge remained lower in the MCI group. Conclusions The presence of MCI is associated with ADL at discharge in older adults admitted to a CRW for rehabilitation.

Effects of rhythmic auditory stimulation on gait speed in older adult inpatients in a convalescent rehabilitation ward: a pilot randomized controlled trial.

To assess the impact of gait training with rhythmic auditory stimulation (RAS) on enhancing gait speed in older people admitted to a convalescent rehabilitation ward (CRW), compared to conventional gait training methods. The study was designed as a single-center, open-label, pilot, randomized, parallel-group study. Thirty older people admitted to CRW were divided into two groups: the experimental group, which received gait training with RAS (n = 15, females = 53.3%, mean age = 83.9, SD = 6.5), and the control group, which underwent usual gait training (n = 15, females = 60.0%, mean age = 81.3, SD = 8.4). Regardless of their assigned group, all participants underwent 30min training sessions, five times a week, for 3 weeks. The primary outcome was the 10m walk test (10mWT), and the secondary outcomes included the Medical Outcome Study 8-Item Short-Form Health Survey and the Japanese version of the modified Gait Efficacy Scale. All measurements were taken at baseline and again at week 3. Results indicated that older people in CRWs in the experimental group showed significant improvements in their 10mWT (effect size - 1.02) compared to the control group. None of the secondary outcomes were significant. This study suggests the preliminary effectiveness and feasibility of a gait practice intervention using RAS in a CRW. The University Hospital Medical Information Network (UMIN) Registered 1 October 2022 (UMIN000049089).

Association between sarcopenia at discharge and functional outcomes 1 month and 6 months after discharge in patients in convalescent rehabilitation wards.

This retrospective cohort study investigated the relationship between sarcopenia and Activities of Daily Living capacity after discharge from convalescent rehabilitation wards. We included consecutive patients discharged from three convalescent rehabilitation wards in a hospital in Japan between December 2018 and October 2020. Sarcopenia was diagnosed based on the criteria of the 2019 Asian Working Group for Sarcopenia, utilizing skeletal muscle mass index and handgrip strength. Statistical analyses were carried out separately for men and women. The primary outcome was a higher motor domain (motor Functional Independence Measure [mFIM]) and a higher cognitive domain (cognitive Functional Independence Measure [cFIM]) of the FIM score 1 month after discharge. The secondary outcomes were higher mFIM and cFIM scores 6 months after discharge, analyzed using binary logistic regression. Among 305 participants (mean age 70.0 years, 148 men), 93 were identified as having sarcopenia. The prevalence of sarcopenia was 16% for outpatient rehabilitation services, 59% for home-visit rehabilitation services and 50% for older adult day care. Logistic regression analyses showed that sarcopenia at discharge was not an independent variable for mFIM at 1 month (odds ratio [OR] 20, 95% confidence interval [CI] 0.31-1300 for men, OR 0.51, 95% CI 0.11-2.4 for women) and cFIM (OR 0.63, 95% CI 0.10-3.8 for men, OR 5.3, 95% CI 0.81-34 for women). At 6 months, sarcopenia at discharge was not an independent variable for mFIM (OR 0.30, 95% CI 0.02-3.6 for men, OR 0.40, 95% CI 0.06-2.5 for women) and cFIM (OR 0.16, 95% CI 0.01-2.4 for men, OR 0.00, 95% CI 0.00-1.1 for women). Sarcopenia at the time of discharge from convalescent rehabilitation wards does not independently predict FIM 1 month or 6 months after discharge. Geriatr Gerontol Int 2024; 24: 715-721.