Convalescent Rehabilitation Ward Research Articles

The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients.

The main outcome measures were Functional Independence Measure (FIM) gain and home discharge. Results In total, 417 participants (165 males and 252 females; mean age, 78.8years) were assessed and classified into home discharge (n=226) and non-home discharge (n=191) groups. The median FIM score was 77 (interquartile range 57-96). Multiple linear regression analysis revealed that increased use of drugs during hospitalization negatively correlated with FIM gain. Multiple logistic regression analysis showed that increased use of drugs was independently associated with a low possibility of home discharge. Conclusion The increased use of drugs during hospitalization was negatively associated with both functional recovery and possibility of home discharge among geriatric stroke patients in a convalescent rehabilitation ward.

Comparison of characteristics among stroke patients with different mobilities at discharge in a convalescence rehabilitation ward

Comparison of characteristics among stroke patients with different mobilities at discharge in a convalescence rehabilitation ward

Approach and effect of rehabilitation nutrition team in convalescent rehabilitation wards

Approach and effect of rehabilitation nutrition team in convalescent rehabilitation wards

Social Problems Faced by Elderly Persons Who Experienced Bereavement of a Live-in Family Member during Hospitalization and the Support Provided: Two Case Reports in a Convalescent Rehabilitation Ward

Social Problems Faced by Elderly Persons Who Experienced Bereavement of a Live-in Family Member during Hospitalization and the Support Provided: Two Case Reports in a Convalescent Rehabilitation Ward

Prognosis of Patients with Indwelling Urethral Catheters Admitted to the Convalescent（Kaifukuki）Rehabilitation Ward

Prognosis of Patients with Indwelling Urethral Catheters Admitted to the Convalescent（Kaifukuki）Rehabilitation Ward

Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes.

The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=-0.131, P=0.031). Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

Reliability and Validity of the Japanese Version of the Mini-balance Evaluation Systems Test in Patients with Subacute Stroke.

The objective of the current study was to evaluate the reliability and validity of the Japanese version of the Mini-Balance Evaluation Systems Test (J-Mini-BESTest) in patients with subacute stroke. Eighteen patients who had suffered a first hemiplegic stroke (mean age, 59.1 ± 27.0 years) and had been admitted to convalescent rehabilitation wards were enrolled. The J-Mini-BESTest, the Berg Balance Scale (BBS), and the functional reach test (FRT) were used to assess balance. Four physical therapists (PTs) observed and scored the J-Mini-BESTest while another PT conducted the test. The interrater reliability of the J-Mini-BESTest was assessed using intraclass correlation coefficients (ICC[2,1]) for the total and section scores, and kappa statistics for each item. Internal consistency of the five raters was assessed using Cronbach's alpha. Concurrent validity of the J-Mini-BESTest was assessed against the BBS and FRT using Spearman's correlation coefficients. The ICC[2,1] of the total and section scores were 0.90 (95% confidence interval: 0.81-0.95) and 0.63-0.85, respectively. Cronbach's alphas were 0.80-0.87. The kappa statistics were 0.47-1.00. The scores of the J-Mini-BESTest were significantly correlated with those of the BBS (rho=0.66, p=0.006) but not with those of the FRT (rho=-0.36, p=0.189). The J-Mini-BESTest showed excellent inter-rater reliability and internal consistency. Although the J-Mini-BESTest was not correlated with the FRT, it was significantly correlated with the BBS. The J-Mini-BESTest is a reliable and valid tool for evaluating dynamic balance in patients with subacute stroke.

Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes.

The effect of the use of potentially inappropriate medications (PIM) on mortality and functional outcome after strokes is unclear in Japan. The aim of the present study was to establish whether treatment with PIM affects functional improvements among geriatric patients convalescing after strokes. This retrospective longitudinal study included consecutive geriatric patients admitted and discharged from convalescent rehabilitation wards for stroke between 2010 and 2016. Demographic data, laboratory data and the Functional Independence Measure (FIM) were analyzed. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIM, and the primary outcome was motor FIM gain. Multivariate regression analysis was carried out to analyze the relationship between PIM use and functional recovery. In total, 272 participants (102 men, 170 women; median age 79 years, interquartile range 72-85 years) were included in the present study. Multivariate regression analysis of motor FIM gain, adjusting for confounding factors, showed that PIM use was independently and negatively correlated with motor FIM gain. In particular, anticholinergic drugs (such as antipsychotics, antidepressants and first-generation antihistamines) were significantly increased from admission to discharge. Increased PIM use during hospitalization might be a predictor of reduced functional improvement in geriatric patients after strokes. Geriatr Gerontol Int 2018; 18: 321-328.

The effect of malnutrition on discharge outcome of stroke - Examination in convalescent rehabilitation ward of single hospital –

Background: Malnutrition have a major influence on home discharge of stroke patients.

Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients

The purpose of this study was to investigate the prevalence of sarcopenia following stroke, musculoskeletal disease, or hospital-associated deconditioning in convalescent rehabilitation ward inpatients. The association between the activities of daily living (ADLs), dysphagia, and sarcopenia was also assessed. A cross-sectional study was performed in consecutive patients admitted to convalescent rehabilitation wards. Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength. The primary outcome was the Functional Independence Measure (FIM) score. Body mass index, Mini Nutritional Assessment-Short Form score, Food Intake Level Scale (FILS) score, Charlson Comorbidity Index, premorbid modified Rankin scale, time from onset, reason for admission, bioelectrical impedance analysis for skeletal muscle mass and fat mass, and handgrip strength were also assessed. Univariate and multivariate analyses were used to determine whether ADLs and dysphagia were associated with sarcopenia. The study included 637 patients (mean age: 74 years; 271 men and 366 women). Sarcopenia was diagnosed in 343 (53.0%) patients (141 men and 202 women). Sarcopenia was identified in 53.6% (125/233) of stroke patients (59.8%, 50.0%, and 34.6% of patients with brain infarctions, brain hemorrhages, and subarachnoid hemorrhages, respectively). Sarcopenia was found in 51.3% (154/300) of patients with musculoskeletal diseases (59.5%, 53.6%, and 36.5% of patients with hip fractures, vertebral compression fractures, and total knee arthroplasty, respectively). Of patients with hospital-associated deconditioning, 61.5% (64/104) had sarcopenia (95.1% and 39.7% of patients with pneumonia and other acute diseases, respectively). Multivariate analysis showed that FIM motor domain and FILS scores were independently associated with skeletal muscle mass loss and decreased muscle strength. The prevalence of sarcopenia in convalescent rehabilitation ward inpatients was 53.0%. ADLs and dysphagia were independently associated with sarcopenia in this study population. Sarcopenia with disabilities should be assessed for all patients in rehabilitation settings.

Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients.

To study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman's correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79-0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

Sarcopenia and cachexia evaluation in different healthcare settings: a questionnaire survey of health professionals.

The rates of sarcopenia and cachexia evaluations by different occupational groups at different settings are unclear. The objectives are to evaluate and compare the relative use of sarcopenia and cachexia evaluations among dietitians and associated healthcare professionals in a diverse range of settings. Participants were 4,621 members from the Japanese Association of Rehabilitation Nutrition. Settings included acute general wards, convalescent rehabilitation wards, long-term care wards, homecare service, and other settings. A questionnaire-based cross-sectional study was performed to evaluate assessments for sarcopenia and cachexia among dietitians and other professionals. Multiple comparisons based on Bonferroni method and logistic regression analysis were used. 718 (15.5%) answered the questionnaire. Data from 683 valid questionnaires were analyzed. Muscle strength, muscle mass, physical function, and cachexia were assessed by 53.4%, 51.1%, 53.4%, and 17.4% of dietitians. At convalescent rehabilitation wards, these rates were 81.8%, 62.0%, 82.5%, and 14.0%. The use of muscle strength and physical function evaluations was significantly lower among dietitians than among physical therapists and occupational therapists. The use of muscle mass and cachexia evaluations was not significantly different among the occupations. The use of muscle mass and strength evaluations was significantly higher in convalescent rehabilitation wards than in acute general wards, long-term care wards and facilities, and other settings, but not in homecare services. Cachexia evaluations were not significantly different between all settings. Raising the awareness of cachexia and sarcopenia among dietitians is a key issue, which should be addressed.

回復期リハビリテーション病棟に入院した脳卒中患者のADL 回復に関連する要因:─後ろ向きコホート研究─

回復期リハビリテーション病棟に入院した脳卒中患者のADL 回復に関連する要因:─後ろ向きコホート研究─

Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward

Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake.

Rehabilitation in a convalescent rehabilitation ward following an acute ward improves functional recovery and mortality for hip fracture patients: a sequence in a single hospital

[Purpose] The convalescent rehabilitation ward (CRW) plays an important role for hip fracture patients in Japanese super-aged society. The purpose of this study is to clarify the usefulness of the CRW concomitant with acute wards in a single hospital. [Subjects and Methods] 110 hip fracture patients were evaluated; 63 patients were moved from acute wards to the CRW in the same hospital (Group C) and 47 patients were treated in acute wards only (Group A). Patient selection was determined by each attending doctor. The outcomes were examined from medical records. [Results] 90.5% of patients in the group C were discharged to home and 57.4% in the group A. 92.9% of patients in the group C had regained their ambulatory ability at discharge and 88.9% in the group A. The average total functional independence measure scores at discharge were 96.4 in the group C and 85.0 in the group A. The one-year mortality was 2.4% in the group C and 8.3% in the group A. [Conclusion] Using a CRW concomitant with acute wards in a single hospital could achieve a high home-discharge rate, good functional recovery, and low mortality in hip fracture patients.

Exercise using a robotic knee orthosis in stroke patients with hemiplegia.

[Purpose] The Robotics Knee Orthosis (RKO) is a knee–ankle–foot orthosis with active robot assisting technology. The purpose of this study is to examine the effects of exercise with the RKO (RKO-exercise) in stroke patients with hemiplegia. [Subjects and Methods] Participants were nine stroke patients with hemiplegia, residing in a convalescent rehabilitation ward. The duration of the RKO-exercise program was 10 days. Participants were evaluated three times prior to intervention, once after intervention, and one month post intervention. Each session consisted of standard-of-care physical therapy for 60 minutes and RKO-exercise for 20 minutes. Dependent variables were 10-meter gait speed, cadence, Berg Balance Scale (BBS) score, stride length, the absolute value of left-right symmetry of the step length, and one-leg support period while walking. Data were analyzed using a one-way repeated measures ANOVA. [Results] Stride length, left-right symmetry of the step length, and one-leg support period while walking changed following the RKO exercise program. 10-meter walking speed, cadence, percentage of one-leg support period (affected side), and BBS changed significantly at one month post treatment time points. [Conclusion] It is expected that RKO-exercise helps recovery process after the stroke. RKO-exercise effectively treats impaired mobility in patient status-post stroke.

Benefit of Kampo medicine as the complementary therapy at convalescent rehabilitation wards

Benefit of Kampo medicine as the complementary therapy at convalescent rehabilitation wards

回復期リハビリテーション病棟において，補中益気湯は脳血管障害後遺症患者の炎症性合併症発症率を抑制する

回復期リハビリテーション病棟において，補中益気湯は脳血管障害後遺症患者の炎症性合併症発症率を抑制する

N-terminal Pro-brain Natriuretic Peptide Level as a Prognostic Predictor in Elderly Patients in a Convalescent Rehabilitation Ward.

ABSTRACTObjective:N-terminal pro-brain natriuretic peptide (NTproBNP) levels were investigated to predict outcomes for elderly patients in a convalescent rehabilitation ward.Methods:The study included 75 patients aged at least 75 years who were admitted to the convalescent rehabilitation ward of Naruto-Yamakami Hospital. Based on NTproBNP levels on admission, the patients were divided into those with NTproBNP levels ≥400 pg/ml (Group A) and those with NTproBNP levels <400 pg/ml (Group B). Patients were also divided into three groups according to their outcomes: Group I, death-related discharge or emergency transfer; Group II, home discharge; and Group III, medical/nursing care continuation. Group A patients were further divided, according to the time course of NTproBNP levels, into Group A-I (levels increased) and A-II (levels unchanged/decreased). The correlation coefficients between outcomes and each measurement index were determined, and discriminant analysis was performed among the groups.Results:The NTproBNP level on hospitalization was significantly higher in Group I than in Groups II and III. There were significantly more death-related discharges and emergency transfers in Group A than in Group B and in Group A-I than in Group A-II. In discriminant analysis, assuming the outcome to be a dependent variable in Group A-I and Group A-II, the canonical correlation was 0.81 (P<0.05).Conclusion:The study findings suggest that NTproBNP levels are useful for predicting patient outcomes.

Comparison of Functional Independence Measure (FIM) Gain between Groups with Extreme Differences in FIM Score at Admission

Objective: There are several methods for inter-hospital comparison of the improvement in Functional Independence Measure (FIM). However, it is not known which method is most suitable. The purpose of this study was to elucidate which of 4 methods can most successfully compare the average improvement in motor FIM (mFIM) at each hospital with the least influenced by the difference of mFIM score at admission. For this purpose, we considered 3 groups divided based on motor FIM score at admission as 3 hospitals. Methods: The subjects were 575 stroke patients hospitalized in a convalescent rehabilitation ward. We divided the subjects into 3 groups based on mFIM score at admission (13 to 38 points, 39 to 64 points, and 65 to 90 points) and investigated whether there were significant differences in the values derived from mFIM effectiveness, corrected mFIM effectiveness, deviation value of mFIM gain, and multiple regression analysis. Result: Significant difference in the improvement in mFIM between 3 groups divided by mFIM at admission was not observed only for the use of the deviation value of mFIM gain. Conclusion: Deviation value of mFIM gain, which is the least liable to the influence of differences in mFIM score at admission, is useful as a method to compare average improvement in mFIM among hospitals.