Kaifukuki Rehabilitation Ward Research Articles

Association Between Sarcopenic Complications and Readmission in a Kaifukuki Rehabilitation Ward: A Retrospective Cohort Study.

Objectives This study investigated the association between sarcopenia and readmission to the Kaifukuki Rehabilitation Ward. Methods We conducted a retrospective observational study in a Kaifukuki Rehabilitation Ward in Japan. Muscle mass was evaluated using a body composition analyzer (InBody, Tokyo, Japan). Grip strength was measured using a grip dynamometer, and walking speed was measured using a 10-meter walk test. Sarcopenia was characterized based on the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. The presence or absence of readmission was calculated from the medical charts. This study used Rstudio for statistical analysis (Posit, Boston, USA). To examine the effect of sarcopenia on readmissions, we used the Kaplan-Meier method to estimate readmissions. Differences between curves were assessed using the log-rank test. Results A total of 131 patients were selected during the target period (March 1, 2020, to August 31, 2021). Of these, 12 (9%) were readmitted during the study period. The median patient age was 83 years. The study population consisted of 53 males (40%) and 78 females (60%). Sixty (50%) patients in the no-readmission group and seven (58%) patients in the readmission group had sarcopenia. For readmission, the presence of sarcopenia yielded an unadjusted hazard ratio of 1.37 (95% confidence interval: 0.41 to 4.56) and an adjusted hazard ratio of 1.74 (95% confidence interval: 0.52 to 5.83). Conclusions Sarcopenia may be a prognostic factor for readmission in Kaifukuki Rehabilitation Wards. Therefore, further evaluation is necessary.

Satisfaction Survey for Regional Clinical Pathway for Stroke Patients in Acute and Rehabilitation Hospitals in Japan.

We collected opinions about the use of a stroke-specific regional clinical pathway for facilitating collaboration between acute and rehabilitation hospitals in Japan. The study surveys were administered in acute hospitals designated as primary stroke centers and certified by the Japan Stroke Association (n=961) and in rehabilitation hospitals affiliated with the Kaifukuki Rehabilitation Ward Association (n=1237). The survey collected information on interfacility collaboration when caring for patients admitted during the acute phase following non-traumatic stroke from April 2020 to March 2021. We examined the pathway's usefulness and challenges relative to facility type using the χ2 test. Of 422 acute hospitals and 223 rehabilitation hospitals that responded to our survey, 259 (62.1%) acute hospitals and 164 (85.4%) rehabilitation hospitals used the pathway. Fewer rehabilitation hospitals than acute hospitals considered that the pathway was useful (52.0% vs. 63.8%, P=0.02). Fewer rehabilitation hospitals did not experience pathway-related problems when compared with acute hospitals (38.0% vs. 55.8%, P<0.01). Personnel at rehabilitation hospitals were less satisfied with the regional clinical care pathway than those in acute hospitals. These results suggest that the current stroke-specific regional clinical pathway could be improved.

Development of an empowerment scale for inpatients in the Kaifukuki Rehabilitation Ward: validation of the validity and reliability of the scale and difference between the empowerment scale and the FIM.

The Kaifukuki Rehabilitation Ward (KRW) provides patients with support for improving the ability to perform activities of daily living and acquiring autonomy. The ability to solve problems independently, defined as empowerment, is crucial for life after hospital discharge. The purpose of this study was to develop a new empowerment scale for KRWs and verify its validity and reliability. This new scale was created by selecting items suitable for KRWs from previous work on developing empowerment scales. The assessment of the validity and reliability of the scale and a comparison of this scale with the Functional Independence Measure (FIM) were performed based on 159 responses. Although three of the 18 items showed response biases, the factor structure of the scale showed moderate validity (RMSEA = 0.083, correlation coefficient between subscale and total score = 0.61 - 0.83). The concurrent validity and internal consistency were generally good, and the test-retest reliability of the total score was 0.93 in the intraclass correlation coefficients. There was no correlation between the FIM and the new scale. The developed empowerment scale has certain validity and reliability and may provide a different outcome than the FIM.

Deep Learning-Based Functional Independence Measure Score Prediction After Stroke in Kaifukuki (Convalescent) Rehabilitation Ward Annexed to Acute Care Hospital.

IntroductionPrediction models of functional independent measure (FIM) score after kaifukuki (convalescent) rehabilitation ward (KRW) are needed to decide the treatment strategies and save medical resources. Statistical models were reported, but their accuracies were not satisfactory. We made such prediction models using the deep learning (DL) framework, Prediction One (Sony Network Communications Inc., Tokyo, Japan).MethodsOf the 559 consecutive stroke patients, 122 patients were transferred to our KRW. We divided our 122 patients’ data randomly into halves of training and validation datasets. Prediction One made three prediction models from the training dataset using (1) variables at the acute care ward admission, (2) those at the KRW admission, and (3) those combined (1) and (2). The models’ determination coefficients (R2), correlation coefficients (rs), and residuals were calculated using the validation dataset.ResultsOf the 122 patients, the median age was 71, length of stay (LOS) in acute care ward 23 (17-30) days, LOS in KRW 53 days, total FIM scores at the admission of KRW 85, those at discharge 108. The mean FIM gain and FIM efficiency were 19 and 0.417. All patients were discharged home. Model (1), (2), and (3)’s R2 were 0.794, 0.970, and 0.972. Their mean residuals between the predicted and actual total FIM scores were -1.56±24.6, -4.49±17.1, and -2.69±15.7.ConclusionOur FIM gain and efficiency were better than national averages of FIM gain 17.1 and FIM efficiency 0.187. We made DL-based total FIM score prediction models, and their accuracies were superior to those of previous statistically calculated ones. The DL-based FIM score prediction models would save medical costs and perform efficient stroke and rehabilitation medicine.

Shifts to the Community-based Rehabilitation from a “Kaifukuki Rehabilitation Ward” for Convalescent Period Patients

Shifts to the Community-based Rehabilitation from a “Kaifukuki Rehabilitation Ward” for Convalescent Period Patients

The impact of different surgical treatments for intracerebral hemorrhage on functional outcomes during the convalescent stage.

We examined whether different surgical methods for intracerebral hemorrhage have an impact on functional outcomes at discharge from the Kaifukuki Rehabilitation Ward (KRW). The participants included 100 patients with first-onset hypertensive ICH. Craniotomy was performed in 52 patients, endoscopic hematoma evacuation in 31 patients, and functional independence measure (FIM), length of hospitalization, and rate of discharge to the home of the two groups were examined retrospectively. The time between surgery and admission to the KRW was significantly shorter in the endoscopic hematoma evacuation group than in the craniotomy group. Although there was no significant difference in the functional prognosis at discharge, endoscopic hematoma evacuation may contribute to higher FIM gain, shorter length of hospitalization, and a higher rate of discharge to home because of the ability to transfer to KRW earlier than in the case of craniotomy, owing to less surgical invasion. Endoscopic hematoma evacuation had a shorter time to admission to KRW than craniotomy; however, differences in surgical methods did not result in a difference in functional outcomes.

Prototype of an empowerment scale in the Kaifukuki Rehabilitation Ward

Prototype of an empowerment scale in the Kaifukuki Rehabilitation Ward

The Physical Therapy for Reconstruction of Gait Function in Severe Hemiplegic Stroke Patients in Kaifukuki (Convalescent) Rehabilitation Ward

The Physical Therapy for Reconstruction of Gait Function in Severe Hemiplegic Stroke Patients in Kaifukuki (Convalescent) Rehabilitation Ward

The Management of Brain Tumor Patients in Kaifukuki (Convalescent) Rehabilitation Ward

脳腫瘍はさまざまな機能障害を引き起こし日常の活動や参加を制限する．脳血管疾患などと同様にリハビリテーション医療の役割の重要性は認識されているが，回復期リハビリテーションにおける入院管理の検討は不十分である．過去の報告や当院に入院した脳腫瘍患者に関するデータをもとに回復期リハビリテーション病棟における留意点や対応の検討を行った．良性の髄膜腫が多く，全体として入院リハビリテーション治療での有意な機能的改善を認めたが，合併症の治療や検査で急性期病院への転院を要することがあった．機能や生命の予後を考慮した入院リハビリテーション治療だけでなく，検査や合併症，後療法日数の管理などで急性期病院との連携や退院後支援を含めた包括的リハビリテーション医療体制の構築が望まれる．

Weight gain is associated with improvement in activities of daily living in underweight rehabilitation inpatients: a nationwide survey

We retrospectively analysed large-scale, nationwide data from the Kaifukuki (convalescent) Rehabilitation Ward (KRW) survey of 2015. Patients were classified into two groups based on changes in body mass index (BMI) during their KRW stay: increased BMI and non-increased BMI. The primary outcome was motor functional independence measure (FIM) score at discharge, and the secondary outcomes were motor FIM gain and full oral intake at discharge. We analysed 4605 patients (64% women; mean age, 79.3 years). Of these patients, 1128 and 3477 were classified into the increased and non-increased groups, respectively. Multivariate analysis showed that BMI increases were independently associated with motor FIM scores at discharge (partial regression coefficient = 1.165; 95% confidence interval, 0.671-1.659) and motor FIM gains, although BMI increase was not associated with full oral intake. Thus, increasing body weight might lead to activities of daily life improvement in underweight patients undergoing post-acute rehabilitation.

Comparison of prediction accuracy of the total score of FIM motor items at discharge in post-stroke patients in a Kaifukuki rehabilitation ward

Wada Y, Sonoda S, Okamoto S, Watanabe M, Okazaki H, Okuyama Y. Comparison of prediction accuracy of the total score of FIM motor items at discharge in post-stroke patients in a Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2019; 10: 71-76.

Development and evaluation of a formula for predicting introduction of medication self-management in stroke patients in the Kaifukuki rehabilitation ward

BackgroundMedication self-management in stroke patients is important to prevent further progression of disease and incidence of side effects. The purpose of this study was to create a formula for predicting medication self-management introduction in stroke patients using functional independence measure items and patient data, including medication-related information.MethodsThis was a retrospective analysis of 104 patients (cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage) discharged from the Kaifukuki rehabilitation ward at Showa University Fujigaoka Rehabilitation Hospital from January to December 2012. Multivariate analysis was performed to develop a formula for predicting achievement of medication self-management.ResultsOf the 104 patients, 39 (37.5%) achieved medication self-management. In the logistic regression analysis, number of drugs, age, walk/wheelchair mobility FIM, and memory FIM were extracted as significant factors independently contributing to achievement of medication self-management (p < 0.05). The prediction formula was [4.404 − 0.229 × number of drugs at admission + 0.470 × walk/wheelchair mobility FIM at admission + 0.416 × memory FIM at admission − 0.112 × age].ConclusionsIn the future, this formula may be used as an index to predict success of medication self-management in stroke patients.

Differences in FIM improvement rate stratified by nutritional status and age in stroke patients in kaifukuki (convalescent) rehabilitation ward

Fujitaka Y, Tanaka N, Nakadai H, Sato R, Watanabe M, Kageyama N, Okamoto T. Differences in FIM improvement rate stratified by nutritional status and age in stroke patients in kaifukuki (convalescent) rehabilitation ward. Jpn J Compr Rehabil Sci 2017; 8: 98-103.

Investigation of factors involved in patient falls during the early stage of hospitalization in a &lt;i&gt;Kaifukuki&lt;/i&gt; rehabilitation ward

Teranishi T, Kondo I, Okuyama Y, Tanino G, Miyasaka H, Sonoda S. Investigation of factors involved in patient falls during the early stage of hospitalization in a Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2017; 8: 10-15.

An Integrated Approach to Falls Prevention in a Kaifukuki Rehabilitation Ward: Efforts of the Patient Safety Committee

An Integrated Approach to Falls Prevention in a Kaifukuki Rehabilitation Ward: Efforts of the Patient Safety Committee

Relationship between improvement in GNRI, a nutritional index, and improvement in motor FIM in elderly stroke patients hospitalized in a &lt;i&gt;Kaifukuki&lt;/i&gt; Rehabilitation Ward

Tokunaga M, Beppu A, Tamura Y, Oowaki K, Tokunaga Y, Ishihara C, Shibata K, Tanaka K, Takayama M. Relationship between improvement in GNRI, a nutritional index, and improvement in motor FIM in elderly stroke patients hospitalized in a Kaifukuki Rehabilitation Ward. Jpn J Compr Rehabil Sci 2016; 7: 7-12.Objective: To clarify the relationship between improvement in the Geriatric Nutritional Risk Index (GNRI) and improvement in the Functional Independence Measure (FIM).Methods: The subjects were 155 patients aged 65 years or older selected among stroke patients admitted to a Kaifukuki Rehabilitation Ward. Seven items, including GNRI at hospital admission and degree of GNRI improvement, served as independent variables. For multiple regression analysis, motor FIM score at hospital discharge was the dependent variable. For multiple logistic regression analysis, motor FIM gain (1:13 points or more, 0:12 points or less) was the dependent variable.Results: GNRI at admission was a significant positive independent variable in the multiple regression analysis. GNRI at admission and degree of GNRI improvement were both significant independent variables in the multiple logistic regression analysis, with odds ratios of 1.084 and 1.090, respectively.Conclusion: Improvements in motor FIM are greater when GNRI at admission and the degree of GNRI improvement are larger.

Expected Duties of Pharmacists and Potential Needs of Physicians and Nurses on a Kaifukuki Rehabilitation Ward

This study investigated the required duties of pharmacists in a kaifukuki rehabilitation ward from the viewpoint of the ward physicians and nurses. A questionnaire survey was distributed to 27 facilities with kaifukuki rehabilitation wards. The questionnaire examined which duties the physicians and nurses expected from pharmacists while on the ward (4 areas, 10 items), as well as the time required for pharmacists to carry out those duties. Multivariate analysis was used to investigate which types of work took the most time for pharmacists on kaifukuki rehabilitation wards. Responses were received from 43 physicians and 184 nurses who worked on the kaifukuki rehabilitation wards of 19 facilities. The results revealed that the essential duties performed by pharmacists were the management of medical supplies, instruction on the use of self-medicating drugs at the time of introduction, and monitoring drug side effects. Furthermore, some duties, such as the distribution of medicines and changing or suggesting new drugs, required pharmacists to spend extended time on the ward. The responses indicated that physicians and nurses recognized the necessity for pharmacists to perform ward duties along with their routine work. This study shows that physicians and nurses working in kaifukuki rehabilitation wards demand proactive participation from pharmacists in appropriate medical therapy, such as instruction in the administration of medications and assessment at the time of prescription changes.

Formula for Predicting FIM Gain and Discharge FIM

Tokunaga M, Sannomiya K, Nakashima Y, Nojiri S, Tokisato K, Katsura K, Watanabe S, Nakanishi R, Yamanaga H. Formula for Predicting FIM Gain and Discharge FIM —Methods using Median Values of FIM Gain Stratified by Admission FIM, Age, Cognitive Function, and Transfer Interval—. Jpn J Compr Rehabil Sci 2015; 6: 6-13.Objective: To predict FIM gain and discharge FIM score by multiplying the standard value by influence coefficients for age, cognitive function, and transfer interval.Methods: The subjects were 1,118 stroke patients admitted to a Kaifukuki rehabilitation ward of hospital A. The median value of motor FIM (mFIM) gain and discharge mFIM based on mFIM at the time of admission was used as the standard value. We then created a formula for predicting mFIM gain and discharge mFIM by multiplying the standard value by the influence coefficients for age, cognitive function, and transfer interval.Results: The correlation coefficient between the actual and predicted values was 0.681 in the prediction of mFIM gain and 0.874 in the prediction of discharge mFIM. The residual of the subtraction of the predicted value from the actual value was 1.4±12.5 (median value: 0) in the prediction of mFIM gain, and 1.3±12.6 (median value: 0) in the prediction of discharge mFIM. Conclusion: The correlation coefficient is comparable with those of reports that use multiple regression analysis. This new method clearly showed the relationship between factors and mFIM gain/discharge mFIM.

回復期病棟におけるリハビリテーションシステムの変更によるアウトカムの変化&amp;mdash;入院時の治療期間・ゴール設定に基づいた起立訓練・ADL訓練を中心とした短期集中リハビリテーション&amp;mdash;

目的：回復期病棟のリハビリテーション（以下，リハ）システムの変更による治療成績を検証した．方法：治療期間・ゴールを設定し起立訓練とADL訓練中心の病棟訓練に変更した．変更前の6 カ月間の入院患者54 名と変更後4 年間の同時期の入院患者679 名の在院日数，FIM利得，FIM効率，自宅退院率を比較し，脳卒中，大腿骨近位部骨折，廃用症候群に層別化し同様に検討した．結果：全体で在院日数は96.5 日から4 年目には29.2 日に短縮した（p＜0.001）．FIM利得は有意差はなかったが，FIM効率は0.22から0.91に上昇した（p＜0.001）．自宅退院率は85.2％から99.1％に上昇した（p＜0.001）．脳卒中患者と大腿骨近位部骨折患者でも同様に在院日数は有意に短縮し，FIM効率は有意に上昇した．廃用症候群は症例数が少なかったが在院日数は有意に短縮した．結論：リハシステム変更により在院日数，FIM効率，自宅退院率が改善した．

Relationship between sleep disorder and subjective feelings of recovery in convalescent stroke patients

Koeda S, Sumigawa K, Koike Y, Sato C, Imai H, Osanai E, Shimizu T, Muto Y, Harigae A, Mizunashi A, Osanai T. Relationship between sleep disorder and subjective feelings of recovery in convalescent stroke patients. Jpn J Compr Rehabil Sci 2014; 5: 125-130. Objective: Sleep disorder occurs at a high frequency in stroke patients and can disrupt the progress of rehabilitation. Here, we investigated stroke patients’ recognition of their improvement (i.e. their subjective feelings of recovery). We also explored ways of preventing and treating sleep disorder in these stroke patients by determining the relationship between subjective feelings of recovery and sleep disorder. Methods: The study subjects were 42 patients who had been hospitalized in a kaifukuki (convalescent) rehabilitation ward for stroke. Subjects were scored on a Visual Analog Scale (VAS) for subjective feelings of recovery and on the Pittsburgh Sleep Quality Index (PSQI) as an indicator of sleep disorder. Results: A significant negative correlation was found in the relationship between subjective feelings of recovery and PSQI score. PSQI scores in the group with Low subjective feelings of recovery (VAS < 35%) were significantly higher than those in the group with High subjective feelings of recovery (VAS ≥ 35%). Sleep disorder in the former group was severe. Subjective feelings of recovery were significantly positively correlated with the stage of recovery from motor paralysis and with Activities of Daily Living (ADL) ability. However, the PSQI score was not correlated with either of these latter two measures. Conclusions: We speculated that a decrease in subjective feelings of recovery caused by motor paralysis and a decline in ADL abilities in patients with VAS scores lower than 35% led to impairment of the sleep state. These results suggest that evaluation of subjective feelings of recovery is an effective predictor of sleep disorder in stroke patients.