Non-rehabilitation Group Research Articles

Unmet Needs Post Stroke: Level of Unmet Need According to Discharge Destination

Abstract Background Stroke survivors often face unmet needs after leaving acute and rehabilitation services (McKevitt et al., 2011). UK and Ireland stroke guidelines (2023) advise a 6-month health and social care review for all patients, yet resource access in hospital and community settings hinder this. Targeting those with the most unmet needs could improve service delivery. Consequently, we examined unmet needs of stroke patients post-rehabilitation, comparing those who were discharged to rehabilitation (RG) to the non-rehabilitation group (NRG). Methods Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Groups: RG included patients discharged to Early Supported Discharge or inpatient rehabilitation; NRG included patients not discharged to these services. Data: Collected demographic information and assessed unmet needs using a modified Greater Manchester Stroke Assessment Tool. Analysis: Using Microsoft Excel, group comparisons were made using chi-squared tests and t-tests, with log transformation applied to non-normally distributed data. Results 251 patients attended during the data collection period (69 patients (27%) in RG, 182 patients (73%) in NRG). The average age was 68 in both groups. The RG had a longer mean length of stay (23 days) compared to the NRG (19 days) (p=0.0007). The RG also had a higher mean score on the clinical frailty scale (RG 4, NRG 3, p=0.05). In the RG, 97% reported no follow-up after discharge, compared to 78% in the NRG. A greater proportion of RG patients reported swallow difficulties (12% vs. 3%, p=0.03), mobility difficulties (46% vs. 30%, p=0.02), and falls (41% vs. 30%, p=0.008) compared to NRG patients. Conclusion Data from this exploratory study suggests substantial unmet needs among post-stroke patients with a significantly higher level of unmet needs among patients who were discharged to post-acute rehabilitation. Despite this, the majority of these patients were not seen by community services at the time of 6-month review.

The factors affecting rehabilitation to society of emergency department based post-suicidal care program recipients

The aim of this study is to investigate the factors affecting rehabilitation to society of Emergency Department (ED) based post-suicidal care program recipients. This prospective observational study was conducted at the ED of a general hospital in Seoul between March 2018 and October 2020. Patients who agreed to ED based post-suicidal care were followed up after 2 and 4 months and classified into a rehabilitated group and a non-rehabilitated group respectively. We analyzed the patients’ demographic data and suicide-related data. We used the Chi-square test or the Fisher’s exact test, the student’s t-test and multivariate logistic regression analysis. A total of 86 patients were included in this study. Factors that disturb rehabilitation of suicidal attempters were the presence of a housemate, a history of psychiatric admission, an acute disease or disability on 1st follow-up and the presence of a housemate, educational level and 1st non-rehabilitation on 2nd follow-up on univariate analysis. Multivariate logistic regression analysis showed that the absence of a housemate and 1st rehabilitation were associated with rehabilitation. This study shows that fast rehabilitation is important for rehabilitation of suicidal attempters and the presence of housemate can be a risk factor for non-rehabilitation.

Compliance and rehabilitation effects of Zheng's supine rehabilitation exercise performed at home among patients with chronic obstructive pulmonary disease: a retrospective study.

Zheng's supine rehabilitation exercise (ZSRE) can be performed by elderly patients with the acute exacerbation of severe or extremely severe chronic obstructive pulmonary disease (COPD) with high safety and compliance and was helpful for their recovery. Investigation is warranted of the compliance and rehabilitation effects of ZSRE performed at home in patients with COPD. We performed telephone interviews with 157 patients with COPD who were hospitalized on the 26th floor of the National Clinical Research Center for Respiratory Disease and who received COPD education and ZSRE training from 1 September 2015 to 31 August 2016. We retrospectively analyzed the patients' compliance with performing ZSRE at home after discharge and the frequency of hospitalization for treatment of acute exacerbation in both the previous and subsequent years. Among the 157 patients, 66 failed to complete home ZSRE after discharge (non-rehabilitation group), 41 performed home ZSRE once a day after discharge (one-session rehabilitation group), and 50 performed home ZSRE at least twice a day after discharge (multiple-session rehabilitation group). The home ZSRE compliance rate was 57.96% (91/157). There were no significant differences in the mean number of hospitalizations in the year prior to receiving COPD education and ZSRE training among the non-rehabilitation group (1.06±0.75), one-session rehabilitation group (1.27±0.78), and multiple-session rehabilitation group (1.16±0.91). However, there was a significant difference in the mean number of hospitalizations among the groups in the year following discharge (1.44±1.17, 0.78±0.82, and 0.66±0.75, respectively). The number of hospitalizations significantly increased in the non-rehabilitation group and significantly decreased in the one- and multiple-session rehabilitation groups. Home ZSRE can be performed with high compliance by elderly patients with severe or extremely severe COPD and can reduce the number of readmissions.

Quality of Life of Lower Limb Amputees; A Comparative Study between Rehabilitated vs Non-Rehabilitated Groups

Amputation is a surgical operation for the removal of a limb that is necessary when limb recovery is impossible, where lower limb amputation (LLA) is frequently carried out for several reasons, such as diabetes, infection, RTA, or locally unresectable tumors. Objective: To compare the quality of life of lower limb amputee population between rehabilitated and non-rehabilitated groups. Methods: A cross-sectional study was conducted on 185 patients having lower limb amputation, out of which 115 patients were taking physiotherapy sessions and 70 were not taking any physiotherapy sessions. The data were collected from CHAL Foundation Islamabad and CHAL Foundation Swabi. A self-structured questionnaire (containing demographics, and clinical characteristics of participants) and SF-36 questionnaire was used to gauge the quality of life of both rehabilitated and non-rehabilitated groups of lower limb amputees. Results: The findings indicate that there was a significant difference found in the quality of life of lower limb amputees between the rehabilitated group and the non-rehabilitated group. Conclusions: To conclude, in light of our preliminary findings, we infer that the quality of life of lower limb amputees in rehabilitated group participants was better than those of non-rehabilitated group participants.

Early Post-Cesarean Rehabilitation in A Tertiary Hospital in Burkina Faso

Introduction: early post-caesarean rehabilitation could be an ideal alternative in terms of direct health savings for the parturient and indirect for the community. Objective: Studying the effects of early rehabilitation after caesarean section in women at Yalgado Ouedraogo teaching hospital (YOTH) Methodology: This was a cohort study comparing two groups of patients who underwent a scheduled caesarean section from 7th May to 4th September, 2020 in the obstetrics department of YOTH. Group 1 consisted of women benefiting from the early rehabilitation protocol (n=124) and group 2 consisted of non-rehabilitated women (n=124). Results: The times of first getting up (p=0.01), walking (p<0.05), first drink (p=0.0001), removal of the urinary catheter (p<0.05), and urination (p<0.05) were significantly reduced in group 1. There was no statistically significant difference in postoperative pain. The mean time to first urination after removal of the urinary catheter was 18.8 ± 4.3 hours in the rehabilitated operated group versus 28 ± 10.5 hours in the non-rehabilitated group (p < 0.05). The first rise took place on average 7.2 ± 1.5 hours after the cesarean section in the rehabilitated group versus 8.1 ± 3.7 hours in the non-rehabilitated group (p=0.01). There was a significant reduction in length of stay (p < 0.05) and cost of treatment (p=0.) Conclusion: The early rehabilitation protocol after caesarean allows a significant improvement in terms of functional recovery, length of stay and cost of treatment.

Study on the correlation between hemodynamic status of the transverse sinus-sigmoid sinus and the clinical efficacy of sigmoid sinus wall reconstruction.

For patients with pulsatile tinnitus who have both transverse sinus stenosis and sigmoid sinus wall anomalies, sigmoid sinus wall reconstruction surgery is the first-choice treatment when the trans-stenotic pressure gradient less than 10 mmHg. However, not all patients are cured by surgery. We hypothesized the abnormal hemodynamics caused by transverse sinus stenosis is associated with the clinical efficacy of surgery. Eight pulsatile tinnitus patients treated with surgery were retrospectively reviewed (4 rehabilitated, 4 nonrehabilitated). All patients had radiologically diagnosed transverse sinus stenosis and sigmoid sinus wall anomalies. A numerical simulation of the hemodynamics of the transverse sinus-sigmoid sinus was performed using computational fluid dynamics technology. Changes in the blood flow patterns before and after surgery were observed. The blood flow velocity at the stenosis, vorticity of blood flow in the sigmoid sinus and wall pressure distribution in the sigmoid sinus wall anomalies area were compared. The blood flow velocity in the stenosis (preoperative P = 0.04, postoperative P = 0.004) and vorticity in the sigmoid sinus (preoperative P = 0.02, postoperative P = 0.007) pre- and post-surgery were significantly higher in the non-rehabilitation group than in the rehabilitation group. No significant difference was found in the wall pressure distribution in the sigmoid sinus wall anomalies area (preoperative P = 0.12, postoperative P = 0.24). There is a clear correlation between the abnormal hemodynamic status caused by transverse sinus stenosis and the clinical efficacy of surgery. The blood flow velocity at the stenosis and vorticity of blood flow in the sigmoid sinus are factors influencing the clinical efficacy of surgery.

Rehabilitation and In-Hospital Mortality in COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients. A single-center retrospective study, involving 990 COVID-19 patients (42.4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital, was conducted. Association of rehabilitation during hospitalization with in-hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications. Over the 3-month study period, 475 (48.0%) inpatients were referred for rehabilitation. Patients who received rehabilitation were older (73.7 ± 14.0 vs 62.3 ± 17.2). There were 61 hospital deaths (12.8%) in the rehabilitation group and 165 (32.0%) in the nonrehabilitation group. Receiving rehabilitation was associated with an 89% lower in-hospital mortality (odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.06-0.19) after adjusting for multiple confounders and COVID-19 disease markers. In sensitivity analyses, the results were significant in subpopulations defined by age group, sex, race, length of hospitalization, or pulmonary presentations. Each additional rehabilitation session was associated with a 29% lower risk of in-hospital mortality (OR per session: 0.71, 95% CI: 0.64-0.79) in the fully adjusted model. Among hospitalized COVID-19 patients, receiving early rehabilitation was associated with lower in-hospital mortality. Our findings support implementation of rehabilitation services for COVID-19 patients in acute care settings, but further research from randomized clinical trials is needed.

Treadmill training based on the overload principle promotes locomotor recovery in a mouse model of chronic spinal cord injury

Rehabilitative treatment, including treadmill training, is considered an important strategy for restoring motor function after spinal cord injury (SCI). However, many unexplained problems persist regarding the appropriate rehabilitative method and the mechanism underlying the beneficial effects of rehabilitation. Moreover, only a few preclinical studies have been performed on rehabilitative interventions for chronic SCI, although most patients have chronic injuries. In fact, several preclinical studies reported that rehabilitative training was less effective when applied during the chronic phase than when applied sooner. While numerous studies have examined the effects of treadmill training during the subacute phase, the training conditions vary considerably among preclinical reports. Therefore, establishing a standard training protocol is essential for achieving beneficial rehabilitation effects at the chronic stage. Since the difficulty of applying an appropriate training load hinders training at constant speeds, it is important to adjust the training intensity in accordance with the exercise tolerance of an individual animal to provide further functional recovery benefits. Here, we created a novel quadrupedal treadmill training protocol based on the overload principle for mice with incomplete thoracic SCI. We subjected SCI model mice to rehabilitative training according to the protocol for two consecutive weeks starting at 42 days after injury. We examined the treadmill speeds at which the mice were able to run based on the severity of paresis and investigated the impact of the protocol on functional recovery. Assessment of running speed changes during the treadmill training period revealed faster treadmill speeds for mice with mild paresis than for those with severe paresis. The training parameters, including the speed and distance traveled, were positively correlated with the changes in motor function. These results suggest that the most suitable running speed during treadmill training differs according to the level of motor dysfunction and that running longer distances has a positive impact on motor functional recovery. Based on this established protocol, we compared functional and histological results between the chronic SCI groups with and without rehabilitation. The gait analyses showed significantly better functional improvement in the rehabilitation group than in the nonrehabilitation group. Histological analyses revealed that the BDNF- and VGLUT1-positive areas of lumbar enlargement were significantly increased in the rehabilitation group. These findings implied that rehabilitation promoted not only motor performance but also motor control, including forelimb-hindlimb coordination, even in chronic SCI, resulting in functional improvement by treadmill training alone. Therefore, rehabilitative training based on the overload principle appears to be one of the appropriate treatment options for incomplete thoracic SCI, and evidence of its efficacy exists in actual clinical settings.

Effect of Pulmonary Rehabilitation on Erector Spinae Muscles in Individuals With COPD.

A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. This was a retrospective cohort study. Thirty-nine subjects with COPD who received PR and underwent chest computed tomography before and after PR were evaluated (rehabilitation group). We also evaluated 39 age-matched subjects with COPD who did not receive PR (nonrehabilitation group). Data were collected from August 2010 until March 2020 in both groups. The ESM cross-sectional area (ESMCSA) was measured using axial computed tomography images, and annual changes were calculated. The 6-min walk distance (6MWD) was measured before and after PR; the minimum clinically important difference was defined as 30 m. ESMCSA declined in the nonrehabilitation group over time (-116.0 ± 141.2 mm2/y) but increased in the PR group (51.0 ± 95.3 mm2/y; P < .001). The annual increase in ESMCSA was significantly higher among subjects with an increase in 6MWD that exceeded the minimum clinically important difference compared with nonresponders in the rehabilitation group. The annual change in ESMCSA was negatively correlated with comorbidity index, and triple therapy (long-acting β2-agonist/long-acting muscarinic antagonist/inhaled corticosteroid) had a favorable effect on annual change in ESMCSA. Multiple regression analysis revealed that only PR was an independent factor for annual change in ESMCSA. ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.

Quality of Life among Primary Caregivers of Children with Cerebral Palsy Living in Sarlahi and Rautahat Districts of Nepal.

The objective of this study was to determine the quality of life and factors associated with quality of life among primary caregivers of children with Cerebral palsy. A cross-sectional study was carried between primary caregivers of children with cerebral palsy in rehabilitation group and non-rehabilitation group. Purposive sampling technique was used to collect data Results: Median age of caregivers was 34 years (age 20-70 years), and there was significant difference between age in two groups (p=0.028). 83 (86.5%) caregivers were female with significant difference between gender in rehabilitation and non-rehabilitation group (p=0.03). Majority of primary caregivers were mother 71 (74%) in both groups. Among all 96 caregivers, 78.1% of caregivers had poor quality of life (Score in questionnaire below 75% taken as poor quality of life).There was no significant difference between quality of life in rehabilitation and non-rehabilitation group (p=0.42). Factors associated with quality of life in rehabilitation groups was illiteracy (p=0.005), aggressive nature of child (p=0.050), uncooperative nature of child (p=0.025), poor knowledge about child condition (p<0.001), and low financial support (p=0.051). Similarly, factor associated with quality of life in non-rehabilitation group was gross motor function classification system level of child (p< 0.001) and more perceived stress (p=0.048). Majority of primary caregivers was mother and had poor quality of life and there was no significant difference between overall quality of life of caregivers in rehabilitation and non-rehabilitation group.

A retrospective study of canine cervical disk herniation and the beneficial effects of rehabilitation therapy after ventral slot decompression

The objective of this study was to evaluate the clinical outcome of ventral slot decompression and rehabilitation therapy in dogs with cervical intervertebral disc herniation (IVDH). Surgical decompression was performed in dogs with IVDH using the ventral slot procedure. After surgery, physiotherapeutic rehabilitation consisted of a combination of electrotherapy, infrared therapy and mechanical massage; treadmill exercise was started when the animal could stand up. A total of 58 dogs were selected from the hospital and included in two groups: rehabilitated group (RG, n = 34) and non-rehabilitated group (NRG, n = 24). Dogs of each group were subdivided into five groups based on a pre-operative clinical grading system. Grade 1 designated spinal pain only, grade 2 designated ambulatory paraparesis, grade 3 designated non-ambulatory paraparesis, grade 4 designated paraplegia with deep-pain perception intact and grade 5 designated paraplegia without deep-pain perception. Post-operative changes of both groups were evaluated and compared, including time until unassisted standing and walking after surgery and the success rate. Overall, 79.41% (27/34) of dogs had a successful neurologic outcome in the RG group, which was significantly (P &amp;lt; 0.05) higher than the NRG group 62.50% (15/24). Interestingly, the success rate differed when the preoperative grading system was considered. The success rates of grades 1, 2, 3, 4 and 5 were 100% (9/9), 100% (7/7), 75% (3/4), 53.85% (7/13) and 100% (1/1), respectively, in the rehabilitated groups, whereas in the non-rehabilitated groups success rates were 100% (5/5), 83.33% (5/6), 60.00% (3/5), 28.57% (2/7) and 0% (0/1), respectively. The differences in success rates between the two groups according to grading were 0, 16.67, 15, 25.57 and 100%, respectively. The proposed rehabilitation therapy after surgical decompression of cervical IVDH can improve the success rate when the preoperative pathological condition is severe.

Association between rehabilitation during hospitalization and perinatal outcomes among pregnant women with threatened preterm birth

Objective This study conducted a nationwide retrospective cohort study to evaluate whether rehabilitation for pregnant women during long-term hospitalization is associated with adverse perinatal events. Methods We performed a retrospective cohort study using a diagnosis procedure combination (DPC) database, a national inpatient database for acute-care inpatients in Japan. Hospitalized pregnant women diagnosed with threatened preterm birth, who stayed in the hospital for 7 days or longer from July 2010 to March 2017 in Japan were identified. One-to-four propensity score-matched analyses were performed to compare perinatal outcomes between patients with and without rehabilitation during hospitalization. The primary outcome was preterm birth (<35/0 weeks of gestation) during hospitalization. Results Of the 141,705 eligible patients, 351 (0.25%) received any type of rehabilitation during hospitalization. One-to-four propensity score matching created a rehabilitation group (n = 338) and a nonrehabilitation group (n = 1352). The propensity-matched analysis showed that the proportion of preterm births in the rehabilitation group was lower than that in the nonrehabilitation group (5.9% versus 8.9%; risk difference: −3.0%; 95% confidence interval (CI): −5.9 to −0.03). Conclusions This retrospective nationwide study suggests that rehabilitation for hospitalized patients with threatened preterm birth may reduce the risk of preterm birth. Brief rationale In this nationwide study, we suggest that rehabilitation for long-term hospitalized patients with threatened preterm birth may reduce the risk of preterm birth.

A follow-up study on the long-term effects of rehabilitation in children with autism spectrum disorders

Autism spectrum disorders are complex neurodevelopmental disorders. Early intervention training is a very important treatment strategy. Under the current background of rehabilitation supply in China, the long-term efficacy of intervention is unexplored. This study aimed to investigate the effects of long-term rehabilitation and related factors affecting the recovery of autistic children. A total of 137 autistic children were followed up for 3 years. They received two neuropsychological assessments at the first visit and 3 years after referral. Assessments included Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), and Developmental Diagnostic Scale of Children Aged 0-6 Years. All children were asked to visit rehabilitation centers for rehabilitation training. In the study, 105 children with autism spectrum disorders (ASD) received rehabilitation training according to the physician's orders (the rehabilitation group), and 32 patients did not receive rehabilitation training (the nonrehabilitation group). The ABC, CARS, and developmental quotient scores of the rehabilitation group were statistically significant between initial assessment and reassessment. No significant difference was observed in the nonrehabilitation group. Rehabilitation training significantly improved the core symptoms and cognitive function in children with ASD, exerting a long-term rehabilitation effect. The initial language development quotient, children's training time, and parental participation time of autistic children significantly impacted the change in ABC.

Canine thoracolumbar intervertebral disk herniation and rehabilitation therapy after surgical decompression: A retrospective study.

Objective:The purpose of this study was to evaluate the clinical outcome of surgical decompression and rehabilitation therapy in dogs with thoracolumbar intervertebral disk herniation (IVDH).Materials and Methods:After surgery, physiotherapeutic rehabilitation was performed by a combination of electrotherapy, infrared therapy, training for standing, deep tendon reflex, and aquatic treadmill exercise. A total of 186 dogs were selected from the hospital records and included in two groups: the rehabilitated group (RG, n = 96) and non-rehabilitated group (NRG, n = 90). Dogs in each group were subdivided into three groups based on a pre-operative clinical severity grading system and those in grades 2–4 were included in this study. Post-operative neurologic functions, unassisted standing, walking, and the success rate of both groups were evaluated and comparedResults:Overall, 86.46% (83/96) of dogs had a successful neurologic outcome in the RG group, which was significantly (p < 0.01) higher than the NRG group 52.22% (47/90). Interestingly, the success rate differed when the preoperative grading system was considered. The success rates of grades 2, 3, and 4 were 97.14% (34/35), 97.33% (42/45), and 43.75% (7/16), respectively, in the rehabilitated groups, whereas in the non-rehabilitated groups, success rates were 82.35% (28/34), 51.85% (14/27), and 17.24% (5/29), respectively. The differences in success rates among the groups according to grading were 14.79%, 41.48%, and 26.51%, respectively, indicating that the proposed rehabilitation therapy is remarkably advantageous for increasing the success rate.Conclusion:Rehabilitation therapy after surgical decompression of thoracolumbar IVDH improves neurologic functions and increases the success rate, especially when the preoperative pathological condition is severe.

Safety and efficacy of in-hospital cardiac rehabilitation following antiarrhythmic therapy for patients with electrical storm

BackgroundExercise-based in-hospital rehabilitation for patients with electrical storm (ventricular tachycardia/ventricular fibrillation, VT/VF) following antiarrhythmic therapy may prevent the deleterious outcomes of prolonged immobility, but the safety and efficacy of this strategy are still uncertain. We retrospectively investigated the rate of electrical storm recurrence in patients receiving rehabilitation. MethodsSixty-seven patients receiving therapy for electrical storm were included in this study. After treatment, patients were divided into rehabilitation (n=39) and non-rehabilitation (n=28) groups. ResultsIncidences of electrical storm recurrence and VT/VF requiring anti-tachycardia pacing or electrical defibrillation did not differ significantly between the rehabilitation and non-rehabilitation groups (13% vs. 21% and 28% vs. 25%, respectively). However, early mobilization initiated ≤2 days after primary therapy was disadvantageous for electrical storm and VT/VF recurrence compared to later mobilization (21% vs. 6% and 34% vs. 19%, respectively). Although the activities of daily living (ADL) at admission were significantly lower in the rehabilitation group, the scores were restored to the level of the non-rehabilitation group at the time of discharge. Univariate analysis revealed that high B-type natriuretic peptide (hazard ratio [HR]: 3.2; 95% confidence interval [CI]: 1.1–11), decreased left ventricular ejection fraction, and elevated E/E′ (HR: 3.4; 95% CI: 1.1–11) were associated with VT/VF recurrence. ConclusionsThe incidence of electrical storm relapse is substantial following antiarrhythmic therapy, but it is not increased by in-hospital rehabilitation. Although caution is urged for early mobilization, sustaining mobility to resume activity is recommended because ADL levels tend to deteriorate as a result of prolonged bed rest.

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm.

BackgroundVirtually no reports on the effects of exercise in patients with a small abdominal aortic aneurysm (AAA) exist.Methods and ResultsWe conducted a retrospective cohort study on 1515 patients with a small AAA before surgery at 2 high‐volume hospitals in Tokyo, Japan, from April 2004 to September 2015. A carefully modified cardiac rehabilitation program without excessive blood pressure elevation during exercise was prescribed to 50 patients with an AAA. Using propensity score matching, mortality and clinical outcomes, including AAA expansion rate, were compared between 2 groups: rehabilitation group and nonrehabilitation group. The background characteristics of the rehabilitation group (n=49) and the nonrehabilitation group (n=163) were almost identical. The risk for AAA repair was much lower in the rehabilitation group after matching (before matching: hazard ratio, 0.43; 95% confidence interval, 0.25–0.72; P=0.001; and after matching: hazard ratio, 0.19; 95% confidence interval, 0.07–0.50; P<0.001). AAA expansion rate was slower in the rehabilitation group (before matching: rehabilitation versus nonrehabilitation group, 2.3±3.7 versus 3.8±3.4 mm/y [P=0.008]; after matching: rehabilitation versus nonrehabilitation group, 2.1±3.0 versus 4.5±4.0 mm/y [P<0.001]). Elevation of blood pressure during exercise was positively correlated with AAA expansion rate after the rehabilitation program (r=0.569, P<0.001).ConclusionsCardiac rehabilitation protects against the expansion of small AAAs and mitigates the risk associated with AAA repair, possibly because of the decreased elevation of blood pressure during exercise.Clinical Trial RegistrationURL: upload.umin.ac.jp. Unique identifier: UMIN000028237.

A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan

ObjectiveWe used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan. MethodsThis study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual’s experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ). ResultsWe received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as “I want to know where we can have olfactory rehabilitation” and “I want to have rehabilitation if olfaction recovers.” The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)． ConclusionPatient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy.

Impact of continuous in‐home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year

To verify the effect of in-home rehabilitation on quality of life and activities of daily living in elderly clients. In this non-randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non-rehabilitation group (n = 100 each). The non-rehabilitation group received basic in-home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1-year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non-rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time-points and no significant changes in activities of daily living over the course of the study. The results of the present study suggest that long-term continuous in-home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; 17: 1866-1872.

Swallowing Rehabilitation Affects Period of Hospitalization after Surgery for Tongue Cancer.

Functional rehabilitation has been reported to improve swallowing. The effect of the presence or absence of such rehabilitation has yet to be compared in oral cancer patients, however. The purpose of this study was to investigate its effect on correlations between the period of hospitalization and the period of tube feeding (from the day of surgery to termination of tube feeding) and period of oral nutrition (from termination of tube feeding to discharge). Body weight was also measured on admission and discharge and the difference calculated. A correlation was observed between period of hospitalization and period of tube feeding in the rehabilitation group, and with the periods of tube feeding and oral nutrition in the non-rehabilitation group. In the rehabilitation group, the period of tube feeding appeared to affect period of hospitalization. On the other hand, termination of tube feeding did not tend to affect period of hospitalization. These results suggest that both periods were factors affecting period of hospitalization in the non-rehabilitation group. Not performing swallowing rehabilitation, therefore, resulted in the period of oral nutrition affecting the period of hospitalization. This suggests that it is essential that nutrients be ingested in moderation after termination of tube feeding, when they are only taken orally. Moreover, these results also indicate that rehabilitation is important in improving quality of life after discharge.

Impact of exercise-based cardiac rehabilitation on long-term clinical outcomes in patients with left main coronary artery stenosis.

Cardiac rehabilitation may reduce cardiovascular mortality and morbidity rates in patients with coronary artery disease. The specific relationship between cardiac rehabilitation participation and left main coronary artery stenosis is unknown. Prospective registry analysis. Data from a registry of 3120 patients with left main coronary artery stenosis, collected between 1995 and 2010, were analyzed. A total of 596 patients (19.6%) had participated in a cardiac rehabilitation program. The crude seven-year mortality, cardiovascular mortality, target-vessel revascularization and myocardial infarction rates were significantly lower in the cardiac rehabilitation than in the non-rehabilitation group, and the incidence of stroke tended to be lower in the cardiac rehabilitation group. Multivariate analysis showed that cardiac rehabilitation was associated with significantly lower risks of mortality (hazard ratio (HR), 0.70; 95% confidence interval (CI), 0.49-1.00; p = 0.05) and cardiovascular mortality (HR, 0.69; 95% CI, 0.48-0.97; p = 0.03). However, the adjusted HR of myocardial infarction, target-vessel revascularization and stroke did not differ significantly. Propensity score-matched analysis of 507 pairs showed that cardiac rehabilitation was associated with significant decreases in mortality (HR, 0.62; 95% CI, 0.43-0.89; p = 0.009) and cardiovascular mortality (HR, 0.54; 95% CI, 0.36-0.80; p = 0.002) but had no beneficial effects on myocardial infarction, target-vessel revascularization or stroke. Exercise-based cardiac rehabilitation participation was associated with significant decreases in mortality. Our findings show that cardiac rehabilitation programs should be implemented in standard management for patients with left main coronary artery stenosis.