Rehabilitation Hospital In Japan Research Articles

Response Shifts in the Canadian Occupational Performance Measure: A Convergent Mixed-Methods Study.

A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process. To detect the effects of RS on the COPM. Convergent mixed-methods research. Subacute rehabilitation hospital in Japan. Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital. In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS. Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores. Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores.

Influence of Daily Aerobic Exercise Duration on Phase 2 Cardiac Rehabilitation at a Rehabilitation Hospital and Health-Related Quality of Life After Discharge.

Phase 2 in-patient cardiac rehabilitation (CR) at a rehabilitation hospital is now added the medical service fees in Japan and in light of the recent reimbursement for CR, a study needed to be performed to determine exertional exercise on its effectiveness and benefits to patients. We examined the effects of daily aerobic exercise duration on health-related quality of life (HR-QoL) at 6 months after discharge from phase 2 CR. Of the 54 consecutive cardiovascular disease patients admitted to a rehabilitation hospital after acute care, 43 were considered acceptable candidates for enrollment according to predetermined inclusion and exclusion criteria. Of these, 40 patients completed study requirements, including return of a questionnaire on HR-QoL survey 6 months after discharge. The primary outcome was HR-QoL as evaluated using the EuroQol five-dimension five-level (EQ-5D-5L). Two multiple regression models were constructed to assess the influences of daily aerobic exercise duration (content of rehabilitation) and other clinicodemographic variables assessed during acute care (model 1) or at transfer from acute care to a rehabilitation hospital (model 2). Both model 1, which included age, Barthel index of daily function before hospitalization, and daily aerobic exercise duration in the rehabilitation hospital (R2 = 0.553, P < 0.001), and model 2, which included New York Heart Association functional classification at transfer, Charlson comorbidity index at transfer, and daily aerobic exercise duration (R2 = 0.336, P = 0.002) identified aerobic exercise duration as a significant independent factor influencing HR-QoL at 6 months post-discharge (model 1: P = 0.041; model 2: P = 0.010). Enhanced daily aerobic exercise content during phase 2 in-hospital CR can significantly improve longer-term HR-QoL among cardiovascular disease patients independently of other clinicodemographic factors, including age, activities of daily living before treatment, and baseline condition at rehabilitation onset. These findings, that in the small sample size, support the continued expansion of phase 2 CR at a rehabilitation hospital in Japan.

A U-shaped relationship between body mass index and functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation

ObjectiveA relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. MethodsThis was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery. ResultsThe mean motor gains were highest in the 23.5–25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5–25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09–8.87), the 17.5–19.4 kg/m2 group (1.99; 1.03–3.87), the 19.5–21.4 kg/m2 group (1.93; 1.05–3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33–8.42) were significantly associated with poor functional recovery, but not in the other groups. ConclusionsOlder survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.

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.

Association of Existence of Sarcopenia and Poor Recovery of Swallowing Function in Post-Stroke Patients with Severe Deglutition Disorder: A Multicenter Cohort Study.

Background: The effect of sarcopenia on the recovery of swallowing function, and the interaction among sarcopenia, nutrition care, and rehabilitation therapy are inconclusive. Methods: This multicenter cohort study was conducted between November 2018 and October 2020 in convalescent rehabilitation hospitals in Japan and included post-stroke patients aged ≥65 years with dysphagia. All participants were assigned to sarcopenia and non-sarcopenia groups. The primary outcome was the achievement of ≥2 Food Intake Level Scale [FILS] gain, and the secondary outcomes included Functional Independence Measure (FIM) gain and efficiency. Considering the effect modification of energy intake and rehabilitation duration, logistic regression analyses were performed. Results: Overall, 153 participants with (median age, 82 years; 57.5% women) and 40 without (median age 75 years; 35.0% women) sarcopenia were included. The non-sarcopenia group had more patients who achieved an FILS gain of ≥2 (75.0%) than the sarcopenia group (51.0%). Sarcopenia was independently associated with a poor FILS gain (odds ratio:0.34, 95% confidence intervals: 0.13–0.86) but not associated with FIM gain or efficiency. This association was not affected by the rehabilitation duration or energy intake. Conclusions: In conclusion, sarcopenia was negatively associated with the recovery of swallowing function in stroke patients without interaction by energy intake and rehabilitation duration.

The impact of the coronavirus disease 2019 pandemic on changes in antimicrobial prophylaxis and development of genito-urinary tract infections after urodynamic study: A retrospective comparative study of a single rehabilitation hospital in Japan.

AimsTo investigate the changes in the proportion of antimicrobial prophylaxis (AP) during the urodynamic study (UDS) and the frequency of posttest genito‐urinary tract infections (GUTI) before and after coronavirus disease 2019 (COVID‐19) pandemic, and evaluate this associations.Patients and MethodsPatients who underwent UDS between 2015 and 2021 were targeted, and they were allocated to pre‐2020 as before the appearance of COVID‐19 and post‐2020 as after that, and propensity score matching was performed. The impact on AP was assessed by the administration rate, and that on the development of febrile GUTI after UDS was assessed for an equivalence by the GUTI‐free rate at 7 days after testing.ResultsAfter matching, 384 cases of 192 cases each were included. The frequency of AP was 58.3% in pre‐2020 and 77.1% in post‐2020, an increase of about 19%, and the rate increased significantly in post‐2020 (p < 0.001). However, the incidence of GUTI after UDS was 4.2% and 4.7%, respectively, with no significant difference. The ratio of GUTI‐free rates was within the equivalence margin, confirming an equivalence before and after the appearance of COVID‐19.ConclusionsUnder the influence of COVID‐19 pandemic, even though AP rate during UDS was increased by 19% from that brought by following the guideline‐based administration methods, the frequency of GUTI after UDS was similar, so it is thought to be important to use AP during UDS appropriately for high‐risk cases as recommended in the guidelines.

Reliability and minimal detectable change of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and the trunk control test for individuals with spinal cord injury.

Cross-sectional study. To evaluate the reliability and calculate the measurement error of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and trunk control test (TCT-SCI) in individuals with spinal cord injury (SCI). Rehabilitation Hospital in Japan. The evaluations of TASS and TCT-SCI for individuals with SCI were video-recorded. The inter-rater reliability (two physiotherapists) was confirmed using the videos. ICC (2,1), kappa coefficient (κ) were used to determine the reliability of the total score and each item. Each minimal detectable change (MDC) was calculated. The TASS and TCT-SCI total scores showed excellent inter-rater reliability (ICC = 0.99, and 1.00). The kappa coefficients of TASS were acceptable to excellent for 8 items (κ = 0.76-1.00), below acceptable for 1 item (κ = 0.62). The kappa coefficients of TCT-SCI were excellent for 12 items (κ = 0.83-1.00), below acceptable for 1 item (κ = 0.68). The inter-rater MDC of the TASS total score was 4.07 points, and the MDC of the TCT-SCI total score was 1.13 points. The intra-rater MDC of the TASS total score was 3.86 points. Both TASS and TCT-SCI showed high reliability. Differences of less than four points in TASS and one point in TCT-SCI were interpreted as measurement errors between the two raters.

Functional Independence Measure Subtypes among Inpatients with Subacute Stroke: Classification via Latent Class Analysis.

ABSTRACTObjectives:Using Functional Independence Measure (FIM) records, this study used latent class analysis (LCA) to clarify the structure of activities of daily living (ADL) status in patients following stroke.Methods:In this retrospective, single-center study, we extracted the medical records of patients with stroke who were admitted to a rehabilitation hospital in Japan between April 2018 and March 2020. LCA was used to determine classes of ADL status based on response patterns in FIM items converted from the original seven levels to three levels: Complete Dependence, FIM1–2; Modified Dependence, FIM3–5; Independence, FIM6–7. We compared the length of stay and discharge destinations among subgroups of patients with different ADL status at admission.Results:From 373 patients, 1592 FIM records were analyzed. These were classified into six ADL status classes based on “Complete Dependence,” “Modified Dependence,” and “Independence” in the motor and cognitive domains. Significant differences were observed among the six admission ADL subgroups for the length of stay (median values in patient subgroups based on admission ADL status: 126, 146, 90, 65, 44, and 29 days in the Motor Complete/Cognitive Complete, Motor Complete/Cognitive Modified, Motor Modified/Cognitive Modified, Motor Modified/Cognitive Independent, Motor Independent/Cognitive Modified, and Motor Independent/Cognitive Independent groups, respectively) and discharge destinations (patients discharged home: 27%, 62%, 81%, 92%, 95%, and 98%, respectively, and to acute care hospitals: 18%, 14%, 8%, 8%, 2%, and 2%, respectively).Conclusions:LCA successfully stratified ADL status in patients with stroke undergoing rehabilitation and may aid in determining an appropriate treatment regimen.

The 1-year continuation rate and discontinuation factors of vibegron and mirabegron: A retrospective comparative study in a rehabilitation hospital in Japan.

To compare the 1-year continuation rate and discontinuation factors between vibegron and mirabegron in patients with neurogenic and nonneurogenic overactive bladder. Continuation or discontinuation of the target drugs and reasons for discontinuation as well as patients' grounds and adverse effects were evaluated retrospectively from the medical records between September 2018 and December 2020. After selecting patients according to the inclusion and exclusion criteria, 180 cases taking mirabegron and 132 taking vibegron were adjusted for intergroup variability by propensity score matching. We performed Cox proportional hazards regression for the 1-year continuation rate and Fine-Gray proportional hazards regression for the 1-year cumulative incidence of discontinuation events. Subgroup analysis was also performed for the background factors related to the 1-year continuation rate. The 1-year continuation rate was 83.8% for vibegron and 58.2% for mirabegron, and the hazard ratio was 0.32 (95% CI: 0.18-0.57, P < .001) as for an incidence of discontinuation events of vibegron against mirabegron. The incidence of discontinuation due to an inadequate efficacy was 8.7% for vibegron and 29.1% for mirabegron, and similarly the hazard ratio was 0.26 (95% CI: 0.12-0.55, P < .001). The subgroup analysis indicated a similar tendency in each subgroup except for that of catheterization, and there was no significant interaction between the groups. It is suggested that vibegron is superior to mirabegron in the continuity of administration in neurogenic and nonneurogenic overactive bladder populations without catheterization with fewer discontinuations due to inadequate efficacy.

Nutritional status and activities of daily living in patients with Parkinson's disease.

Patients with Parkinson’s disease are often frail and likely to be malnourished. Several studies have reported the adverse effects of malnutrition on functional outcomes; however, the association between nutritional status and activities of daily living is unclear among patients with Parkinson’s disease. This study aimed to investigate the relationship between nutritional status and activities of daily living in patients with Parkinson’s disease. We conducted a retrospective cohort study with the data of 124 patients who were consecutively admitted to a rehabilitation hospital in Japan, among whom the data of 61 patients were included in the analyses. The Controlling Nutritional Status score was used to measure the nutritional status of the participants, and the motor subdomain of the Functional Independence Measure was used to assess the activities of daily living. Piecewise linear mixed-effects models were fitted to the data after adjusting for confounding factors. A poor nutritional status (i.e., Controlling Nutritional Status score >3) was significantly associated with a poor Functional Independence Measure gain, which was defined as difference in the score values of the Functional Independence Measures between discharge and admission. Our findings could aid in developing nutritional intervention programs for patients with Parkinson’s disease by employing the Controlling Nutritional Status score to improve their activities of daily living.

Effective Combined Assessments of Weight Bearing Ratio and Four Square Step Test in Predicting Falls in Discharged Stroke Patients

BackgroundWe aimed to determine whether combined assessments of single movement tasks could predict falls in community dwelling people with stroke and it was more precision than the berg balance Scale consists of 14 movements. MethodsThis prospective cohort study performed at five rehabilitation hospitals in Japan. Participants comprised 78 patients with ambulatory stroke. The single movement task assessments performed at discharge and included the weight bearing ratio, the 30-second chair standing test, the one-leg standing time, the four square step test and the timed up and go test. The results were used to derive a logistic regression equation to predict falls within 6 months from discharge. Area under the curve was used to compare prediction accuracy between the logistic regression equation and the berg balance Scale. ResultsOverall, fifteen participants experienced a fall. The weight bearing ratio of the unaffected side and four square step test were observed to be significant assessments identified from the logistic regression analysis. The Area under the curve of the combined tests of weight bearing ratio of the unaffected side and four square step test was 0.78, which was higher than the than that of the berg balance Scale (0.70). ConclusionsThis study found that a combined assessment using single movement tasks including the weight bearing ratio of the unaffected side and four square step test predicted falls in people with stroke post-discharge more precisely than the berg balance Scale.

Psychological Effects of Hands-On Training Using Public Transportation among Inpatients with Physical Disabilities: Analysis of the Self-Efficacy and Perception of Occupational Enablement Using a Multimethod Design

Introduction This study is aimed at understanding how practicing the use of public transportation can affect the self-efficacy and perceptions of occupational enablement among patients with physical disabilities in a recovery rehabilitation hospital. Method We recruited 21 inpatients with physical disabilities caused by stroke or orthopedic diseases from a recovery rehabilitation hospital in Japan and used a multimethod design including an intervention study and a follow-up survey. The intervention study utilized a before-after trial and provided hands-on training in the use of public transportation as the intervention. How self-efficacy and perceptions of occupational enablement changed before and after the intervention was measured using the visual analog scale (VAS). The follow-up survey was conducted to investigate whether patients used public transportation postdischarge. Results Only differences in the VAS scores regarding self-efficacy were significant between before and after the hands-on training in the use of public transportation, whereas differences regarding the perceptions of occupation enablement were not. Self-efficacy after the intervention was higher than that before the intervention. In the follow-up survey, both VAS scores of the psychological factors were significantly higher in the group that used public transportation postdischarge than in the group that did not. Conclusion Providing hands-on training in the use of public transportation for inpatients with physical disabilities increased their self-efficacy, indicating that psychological factors should be evaluated to predict their occupational skill improvement and to verify the outcomes of an occupational therapeutic intervention.

Chair-stand exercise improves post-stroke dysphagia.

To elucidate the effects of whole-body exercise on clinical outcomes, including dysphagia status, between stroke patients with dysphagia who are undergoing convalescent rehabilitation. This retrospective cohort study included consecutive patients with post-stroke dysphagia in a rehabilitation hospital in Japan between 2016 and 2018. Dysphagia was defined as a Food Intake Level Scale (FILS) score <7. Participants were asked to perform a repeated chair-stand exercise as a whole-body exercise in addition to the convalescence rehabilitation program. Study outcomes included the FILS score and presence of dysphagia at discharge, the Functional Independence Measure-motor (FIM-motor) score and length of stay. Multivariate analyses were used to determine whether the frequency of daily chair-stand exercise was independently associated with study outcomes, after adjusting for potential confounders; P < 0.05 was considered statistically significant. Of the 637 patients admitted, 148 stroke patients with dysphagia (mean age 72.7 years; 48.6% men) were included in the final analysis dataset. The median daily frequency of repeated chair-stand exercise was 36 (12-65). In multivariate analyses, the frequency of chair-stand exercise was independently associated with the FILS score at discharge (β = 0.231, P = 0.015), the presence of dysphagia at discharge (odds ratio: 0.982, P = 0.035), FIM-motor at discharge (β = 0.205, P = 0.008) and its gain (β = 0.237, P = 0.013), and length of hospital stay (β = -0.042, P < 0.001). Chair-stand exercise is associated with preferable clinical outcomes, including dysphagia status, activities of daily living and length of hospital stay, in stroke patients with dysphagia. Post-stroke dysphagia rehabilitation should include whole-body exercises in addition to conventional rehabilitation programs. Geriatr Gerontol Int 2020; 20: 885-891.

Relationship Between Performance Improvement in Activities of Daily Living and Energy Intake in Older Patients With Hip Fracture Undergoing Rehabilitation.

ObjectiveTo analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown.MethodsThis retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m2. Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score.ResultsThe final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain.ConclusionAmong elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.

Impaired oral health status on admission is associated with poor clinical outcomes in post-acute inpatients: A prospective cohort study

Oral health is an integral part of nutrition and rehabilitation. The purpose of this study was to investigate the impact of impaired oral health status on clinical and functional outcomes in post-acute in-hospital rehabilitation. We conducted a prospective cohort study of hospitalized patients undergoing rehabilitation at a 225-bed post-acute rehabilitation hospital in Japan. All newly admitted patients were eligible to enroll during the two-year research period. Oral health status was evaluated on admission using the Revised Oral Assessment Guide (ROAG). Nutritional status, assessed using the Mini Nutritional Assessment-Short Form; activities of daily living, assessed by Functional Independence Measure motor scores; home discharge; all-cause in-hospital mortality; and length of hospital stay were measured as clinical and rehabilitation outcomes. Multivariate analyses were used to determine whether the ROAG score on admission was associated with these outcomes at discharge. Of the 1066 patients enrolled, 1056 were included in the final analysis. The mean age was 70±17 years. Fifty-two percent of patients were women. Stroke (21.7%) and musculoskeletal disorders (30.5%) were the most common reasons for admission. Slight or moderate to severe oral health problems were detected in 609 (57.7%) and 163 (15.4%) patients, respectively. Eighteen patients died during hospitalization. The ROAG score at admission was independently associated with Functional Independence Measure motor scores at discharge (P=0.022), home discharge (P=0.005), in-hospital mortality (P=0.039), and length of hospital stay (P=0.045), after adjusting for potential confounders. Impaired oral health status may be associated with rehabilitation outcomes in hospitalized patients. Early detection of oral health problems and treatment by dental professionals, or through cooperation between medical and dental professionals, should be implemented in these patients.

Sarcopenia is associated with worse recovery of physical function and dysphagia and a lower rate of home discharge in Japanese hospitalized adults undergoing convalescent rehabilitation

The aim of this study was to evaluate the effect of sarcopenia on functional outcomes, including activities of daily living (ADLs); dysphagia status; and the rate of home discharge, among hospitalized adults receiving convalescent rehabilitation. A retrospective cohort study was conducted with 898 patients newly admitted to in-hospital convalescent rehabilitation wards at a single rehabilitation hospital in Japan. Baseline sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cutoff values of the Asian Working Group for Sarcopenia. The primary outcome was ADLs, assessed by Functional Independence Measure motor (FIM-motor) score at hospital discharge. The secondary outcomes included dysphagia, assessed by the Food Intake Level Scale (FILS), at discharge, and the rate of home discharge. Three multivariate analyses revealed an association between sarcopenia and the clinical outcomes. Each analysis adjusted for the following confounders: age, sex, time from onset, premorbid ADLs, comorbidities, cognitive level, nutritional status, major drugs, and admission diagnoses. After enrollment, 795 patients (mean age 74.9 ± 13.2 y; 59% women) were included in the final analysis. Admission diagnoses included stroke (n = 276; 34.7%), musculoskeletal disorders (n = 382; 48.1%), and hospital-associated deconditioning (n = 137; 17.2%). Of the 795 patients examined, 402 (50.6%) had sarcopenia. The multiple linear regression analysis showed that sarcopenia was independently associated with FIM motor score at discharge in patients with all disease types (β = -0.189 [stroke], -0.240 [musculoskeletal disorders], -0.230 [hospital-associated deconditioning]; all P < 0.05), with FILS score at discharge only in patients with musculoskeletal disorders (β = -0.271, P < 0.001), but not in patients with stroke (β = -0.061, P = 0.375) or those with hospital-associated deconditioning (β = -0.131, P = 0.070). The multiple logistic regression analysis showed that sarcopenia was associated with rate of home discharge in all disease types (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.067-0.597 for stroke; OR, 0.242; 95% CI, 0.076-0.772 for musculoskeletal disorders; OR, 0.121; 95% CI, 0.110-0.347 for hospital-associated deconditioning; all P < 0.05). Sarcopenia is associated with worse recovery of ADLs and dysphagia and a lower rate of home discharge in hospitalized adults undergoing convalescent rehabilitation. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population.

Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score.

[Purpose] This study investigated whether it is possible to predict return to home at discharge from a rehabilitation hospital in Japan using the home care score of patients with cerebrovascular or osteoarticular disease and low activities of daily living at admission. [Subjects and Methods] The home care score and functional independent measurement were determined for 226 patients at admission and at discharge from five hospitals, and receiver operating characteristic analyses were conducted. [Results] The home care score cutoff point for the prediction of return to home at admission and at discharge was 11, and the area under the curve was more than 0.8. The area under the curve of the home care score was 0.77 for patients with low activities of daily living and within this group, the probability of return to home was approximately 50%, as predicted by the functional independent measurement. The home care score increased after receiving intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for the prediction of return to home from a rehabilitation hospital, although prediction using the functional independent measurement is difficult for patients with low activities of daily living. Moreover, comprehensive interventions provided by the rehabilitation hospitals improve the ability to provide home care of the patient’s family, which is assessed by the home care score.

SUN-PP227: Comparison of the Prevalence and Characteristics of Undernutrition in Paediatric Patients Admitted in University, Acute Care and Rehabilitation Hospitals in Japan

SUN-PP227: Comparison of the Prevalence and Characteristics of Undernutrition in Paediatric Patients Admitted in University, Acute Care and Rehabilitation Hospitals in Japan

Impacts of family support on the rehabilitation outcome of stroke inpatients at rehabilitation hospitals in Japan—a multi-center study

having an FoF. In contrast, cognitive functions did not differ between groups. Conclusion(s): Similar to other studies, we showed that having an FoF is associated with getting older, being a woman, and the experience of falling. However, having an FoF did not appear to influence cognitive function in community-dwelling elderly adults. Implications:Our results suggest that having an FoF does not affect one’s cognitive function. Consequently, FoF may be related to psychological factors unaffected by declines in cognitive functions. However, this study was cross-sectional and cognitive function among participants was good overall. Future longitudinal studies are needed to investigate FoF in a population with poor cognitive functions.

Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan

Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients.