1
|
Kondo T, Tsuboi H, Nishiyama K, Takahashi G, Nishimura Y. Effects of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists in patients with severe burn injury. Burns 2024:S0305-4179(24)00120-7. [PMID: 38604823 DOI: 10.1016/j.burns.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
Rehabilitation treatments for patients with severe burn injury (SBI) are difficult owing to the lack of knowledge, skills, and experience among clinicians and physical and occupational therapists, resulting in serious patient disability. This study retrospectively evaluated the effectiveness of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists (Physiatrist and Registered therapist Operating rehabilitation: PROr) for patients with SBI admitted to our hospital's burn intensive care unit (BICU). Eligible patients were classified into the PROr and standard rehabilitation (SR) groups. Contents of the rehabilitation program in the BICU, the functional ambulation categories (FAC), and the Barthel index at the first rehabilitation, BICU discharge, and hospital discharge were collected. Of the 184 patients with severe burns admitted to the BICU, 29 (PROr group, n = 16; SR group, n = 13) met the eligibility criteria. The PROr group received more types of exercise interventions for a longer time than the SR group. No significant differences in the FAC and Barthel index scores at the first time of rehabilitation were found between the two groups; however, the scores of FAC and Barthel index at BICU and hospital discharges were higher in the PROr group than in the SR group. The PROr program may help in the functional improvement of patients with SBI.
Collapse
Affiliation(s)
- Takahito Kondo
- Department of Rehabilitation Medicine, Iwate Medical University, Japan; Rehabilitation Division, Iwate Medical University Hospital, Japan
| | - Hiroyuki Tsuboi
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | | | - Gaku Takahashi
- Department of Disaster and Emergency Medicine, Iwate Medical University, Japan
| | | |
Collapse
|
2
|
Hashizaki T, Nishimura Y, Kinoshita T, Minami K, Kawanishi M, Umemoto Y, Tajima F. Case report: Rehabilitation course in thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly syndrome complicated by cerebral infarction in the left parabolic coronary region. Front Neurol 2023; 14:1153941. [PMID: 37521296 PMCID: PMC10381932 DOI: 10.3389/fneur.2023.1153941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Although thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly (TAFRO) syndrome was first reported in 2010, its pathogenesis and prognosis are still unknown. Moreover, reports on rehabilitation in patients with TAFRO are limited. In severe cases, dyspnea and muscle weakness could impede improvements in activities of daily living (ADL). However, reports on exercise intensity showed no worsening of TAFRO within the load of 11-13 on the Borg scale. Herein, we describe the rehabilitation and progress in a 61-year-old woman with TAFRO syndrome complicated by cerebral infarction from early onset to discharge. After cerebral infarction onset in the perforating artery, she was admitted to the intensive care unit due to decreased blood pressure and underwent continuous hemodiafiltration. Two weeks following transfer to a general ward, the patient started gait training using a brace due to low blood pressure, respiration, and tachycardia. After initiating gait training, increasing the amount of training was difficult due to a high Borg scale of 15-19, elevated respiratory rate, and worsening tachycardia. Furthermore, there was little improvement in muscle strength on the healthy side after continuous training, owing to long-term steroid administration. On day 100 after transfer, the patient was discharged home with a T-cane gait at a monitored level. The patient had severe hemiplegia due to complications with severe TAFRO syndrome delaying early bed release and gait training; tachycardia; and respiratory distress. Additionally, delayed recovery from muscle weakness on the non-paralyzed side made it difficult for the patient to walk and perform ADLs. Despite these issues, low-frequency rehabilitation was useful. However, low-frequency rehabilitation with gait training, using a Borg scale 15-19 orthosis, did not adversely affect the course of TAFRO syndrome.
Collapse
Affiliation(s)
- Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Shiwa-gun, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Kohei Minami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Makoto Kawanishi
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
3
|
Effect of Three Weeks of High-Intensity, Long-Term Preoperative Rehabilitation for Esophageal Cancer Patients with Stroke Sequelae Who Were Considered Unfit for Surgery Due to Low Activity: A Case Report. Healthcare (Basel) 2023; 11:healthcare11050665. [PMID: 36900669 PMCID: PMC10000851 DOI: 10.3390/healthcare11050665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient's ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient's condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer.
Collapse
|
4
|
Onaka H, Kouda K, Nishimura Y, Tojo H, Umemoto Y, Kubo T, Tajima F, Mikami Y. Standing and supine positions are better than sitting in improving rightward deviation in right-hemispheric stroke patients with unilateral spatial neglect: A randomized trial. Medicine (Baltimore) 2022; 101:e31571. [PMID: 36401369 PMCID: PMC9678496 DOI: 10.1097/md.0000000000031571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
TRIAL DESIGN How body position affects unilateral spatial neglect (USN) is unclear. This cluster randomized trial aimed to examine the effects of different positions (supine, sitting, and standing) on USN in stroke patients. METHODS Twenty stroke patients (hemorrhage [n = 11], infarction [n = 9]) who were right-handed, had left hemiplegia due to right hemisphere damage that occurred within the last 2 years, and were in a state of arousal with a Glasgow Coma Scale score of 15 were included in the study. Table-top pen-and-pencil tests for USN (Bells Test, Line Bisection, Scene Copy, and Star Cancellation) were randomly conducted in the supine, sitting, and standing positions. RESULTS The mean values in each test were significantly smaller in the supine position than were those in the sitting position (P = .015, .047, .015, and <.001), and those in the standing position were significantly smaller than those in the sitting position (P = .007, <.001, =.006, and < .001). The results of the 4 tests in the standing position were similar to those in the supine position. CONCLUSIONS Body position affects USN in stroke patients and that the standing and supine positions improve USN better than the sitting position. Some possible mechanisms are: muscle contractions in the lower limbs and the trunk could have affected results in the standing position, and reduction in gravitational stimulation in the supine position could have played a role.
Collapse
Affiliation(s)
- Hitoshi Onaka
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
| | - Yukihide Nishimura
- Rehabilitation Medicine, Iwate Medical University, Iwate, Japan
- *Correspondence: Yukihide Nishimura, Department of Rehabilitation Medicine, Iwate Medical University, Yahabacho, Idaitoori 2-1-1, Iwate, 0283695, Japan (e-mail: )
| | - Hidenori Tojo
- Department of Rehabilitation Medicine, Akitsu Kounoike Hospital, Gose city, Nara, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
| | - Toshikazu Kubo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
- Kyoto Prefectural University of Medicine, Kyoto city, Kyoto, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama city, Wakayama, Japan
| |
Collapse
|
5
|
Kinoshita T, Nishimura Y, Umemoto Y, Kawasaki S, Yasuoka Y, Minami K, Koike Y, Tajima F. Characteristics of falls occurring during rehabilitation in an acute care hospital in older and non-older patients: A retrospective cohort study. Front Med (Lausanne) 2022; 9:969457. [PMID: 36059848 PMCID: PMC9428505 DOI: 10.3389/fmed.2022.969457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Although falls are often reported in hospitals and are common in older individuals, no reports on falls during rehabilitation exist. This study evaluated patients with falls occurring during rehabilitation and identified the characteristics of older and non-older patients. Materials and methods Our study retrospectively analyzed reports of falls occurring during rehabilitation at a university hospital from April 1, 2020 to March 31, 2022. The survey items included the number of falls in the hospital as a whole and during rehabilitation, age, gender, modified Rankin Scale (mRS) before admission and at the time of fall, functional independence measure (FIM) at admission, patient communication status at the time of fall, and whether a therapist was near the patient. Patients aged ≥ 65 were considered older; aged ≤ 64, non-older; and those with the same age, gender, and clinical department, randomly selected as non-falling patients. Results Thirty-five falls occurred during rehabilitation (14 in the non-older and 21 in the older patients), significantly lower than the 945 for the entire hospital, without any significant difference between non-older and older patients. No significant differences in mRS before admission and FIM at admission were noted for both groups in comparison with the non-falling patient group. Furthermore, gender, mRS, FIM, good communication status, and presence of therapist near the patient were similar between non-older and older patients (non-older 71.4%, older 52.4%). Most falls were minor adverse events that did not require additional treatment. Conclusion The rate of falls during rehabilitation was much lower than that during hospitalization, and many falls had minimal impact on the patient. It was also difficult to predict falls in daily life and communication situations, and there was no difference in characteristics between the older and non-older groups. Since more than half of the falls occurred during training with the therapist, it is necessary to reconsider the training content.
Collapse
Affiliation(s)
- Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan
- *Correspondence: Yukihide Nishimura,
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinji Kawasaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshinori Yasuoka
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kohei Minami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yumi Koike
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
6
|
Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital. J Clin Med 2022; 11:jcm11164706. [PMID: 36012943 PMCID: PMC9410363 DOI: 10.3390/jcm11164706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Adverse events (AEs) during intensive care unit (ICU) rehabilitation and serious AEs during acute care hospital stays have been reported previously. However, no AEs have been reported for all patients needing rehabilitation in a non-ICU setting at an acute care hospital. This study aimed to investigate all AEs during acute-phase rehabilitation. Reports of AEs occurring during acute-phase rehabilitation in a university hospital from 1 April 2021 to 31 March 2022 were retrospectively analyzed. Minor and severe AEs were defined as those that did not require new treatment and those that required intensive treatment and/or prolonged hospitalization, respectively. There were 113 incidences of AEs during rehabilitation. The majority of AEs were minor (93.8%) and did not require new treatment. Only one serious AE was documented. The most common AEs were peripheral intravenous tube removal, decreased level of consciousness, poor mood due to low blood pressure, and falling down. There was no significant correlation between years of experience and the frequency of AEs. The neurosurgery department had the highest cases of AEs. Physical, occupational, and speech-language-hearing therapists had different characteristics and experiences of AEs. Risk management strategies should consider exercise load and targeted disorders due to differences in therapists’ specialties.
Collapse
|
7
|
Tsuboi H, Takahashi K, Sugano N, Nishiyama K, Komoribayashi N, Itabashi R, Nishimura Y. Effect of early mobilization in patients with stroke and severe disturbance of consciousness: Retrospective study. J Stroke Cerebrovasc Dis 2022; 31:106698. [PMID: 35952553 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC). MATERIALS AND METHODS We retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups. RESULTS Among the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group. CONCLUSIONS Early mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.
Collapse
Affiliation(s)
- Hiroyuki Tsuboi
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | | | - Naruki Sugano
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | - Kazunari Nishiyama
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Nobukazu Komoribayashi
- Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, Japan
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan.
| |
Collapse
|
8
|
Kinoshita T, Kamijo YI, Kouda K, Yasuoka Y, Nishimura Y, Umemoto Y, Ogawa T, Mikami Y, Kawanishi M, Tajima F. Evaluation of severe adverse events during rehabilitation for acute-phase patients: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29516. [PMID: 35758395 PMCID: PMC9276444 DOI: 10.1097/md.0000000000029516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Early mobilization decreases the likelihood of negative outcomes for acute-phase inpatients. Adverse events occurring during intensive care unit rehabilitation have previously been reported; however, no study has reported the incidence rates for adverse events during the acute rehabilitation phase. This study aimed to investigate the incidence of severe adverse events during acute-phase rehabilitation and evaluate them in detail.Reports of adverse events occurring during acute-phase rehabilitation in a university hospital from April 1, 2011 to March 31, 2018 were retrospectively assessed.Nine severe adverse events occurred during this period (incidence rate, 0.032%), comprising 2 cardiopulmonary arrests, 2 pulseless electrical activity events, 2 deterioration in consciousness events, 1 deterioration in consciousness event due to cerebral infarction, 1 fracture due to a fall, and 1 event involving removal of a ventricular drain. Pulmonary thromboembolism was implicated in 1 adverse event involving pulseless electrical activity and 1 deterioration in consciousness event. The causes for the 6 other adverse events could not be identified. The mean days from admission and the onset of rehabilitation to adverse event occurrence were 22.0 ± 18.2 and 17.9 ± 13.5 days (mean ± standard deviation), respectively. Four of 9 patients died, and 5 patients were discharged home or transferred to other stepdown facilities. When assessed retrospectively, there were no conflicts between patient conditions and the cancellation criteria of rehabilitation by the Japanese Association of Rehabilitation Medicine.The occurrences of severe adverse event may not be related to early mobilization (or onset time of rehabilitation) and compliance status of cancellation criteria.
Collapse
Affiliation(s)
- Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya city, Saitama, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Yoshinori Yasuoka
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, Iwate, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa, Okinawa, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Makoto Kawanishi
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
- Division of Rehabilitation, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| |
Collapse
|
9
|
Zaiki R, Kamijo YI, Moriki T, Umemoto Y, Mukai Y, Mikami Y, Kouda K, Ogawa T, Nishimura Y, Tajima F. Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study. J Stroke Cerebrovasc Dis 2022; 31:106375. [PMID: 35190306 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We aimed to investigate whether out-patient rehabilitation with the same concept as physiatrist and registered therapist operating rehabilitation (PROr) would improve activities of daily living in out-patients with chronic cerebrovascular disorder and whether the improvements were related to the frequency and/or time of therapy. METHODS Out-patients with chronic cerebrovascular disorder, who visited a clinic affiliated with a university hospital for at least a month between April 2010-September 2020, were retrospectively selected. Changes in the functional independence measure (FIM) from the first visit to the 12th month were calculated. Patients were stratified into two subgroups: improved and non-improved groups. The frequency and time of physical and occupational therapies and total rehabilitation were compared between the groups. RESULTS Initially, 174 patients were selected and 125 were excluded based on the exclusion criteria. Three patients terminated rehabilitation because of improvements. In 18 of 49 patients, FIM improved at the 12th month by 4.9 [3.1-6.8] (mean [95% CI]). The frequency was ∼2 times/week with no differences between the groups. Physical therapy time/day was higher in the improved group (74.7 [66.7-82.7] min) than the non-improved group (50.7 [44.3-57.0] min; P<0. 001). The total rehabilitation time/day was 121.9 [107.8-136.0] min in the improved group, which was higher than the non-improved group: 97.9 [87.7-107.9] (P=0.001). CONCLUSIONS Approximately 40% of the patients displayed improved FIM even during the chronic phase, and the improved out-patients took PROr for at least 108 min/day and twice a week. A longer rehabilitation time would be reinforced by patients' motivation.
Collapse
Affiliation(s)
- Rikito Zaiki
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan; Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| | - Yoshi-Ichiro Kamijo
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan; Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan; Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555 Japan.
| | - Takashi Moriki
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan.
| | - Yasunori Umemoto
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan; Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| | - Yuki Mukai
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan; Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| | - Yukio Mikami
- Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| | - Ken Kouda
- Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| | - Takahiro Ogawa
- Department of Rehabilitation Medicine, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa, 904-2151, Japan.
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidouri, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
| | - Fumihiro Tajima
- Medical Center for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033 Japan; Depaertment of Rehabilitation Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 640-8509 Japan.
| |
Collapse
|
10
|
Kinoshita S, Abo M, Okamoto T, Miyamura K. Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation. Front Neurol 2022; 12:711470. [PMID: 35087461 PMCID: PMC8786721 DOI: 10.3389/fneur.2021.711470] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.
Collapse
Affiliation(s)
- Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takatsugu Okamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, Japan
| | - Kohei Miyamura
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Rehabilitation Medicine, Kawakita Rehabilitation Hospital, Tokyo, Japan
| |
Collapse
|
11
|
The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11020357. [PMID: 35054051 PMCID: PMC8779309 DOI: 10.3390/jcm11020357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
This retrospective cohort study aimed to examine the rehabilitation effect of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU) under mechanical ventilation and included ICU patients from a university hospital who received rehabilitation under ventilator control until 31 May 2021. Seven patients were included, and three of them died; thus, the results of the four survivors were examined. The rehabilitation program comprised the extremity range-of-motion training and sitting on the bed’s edge. The Sequential Organ Failure Assessment score (median (25–75th percentiles)) at admission was 7.5 (5.75–8.5), and the activities of daily living (ADLs) were bedridden, the lowest in the Functional Independence Measure (FIM) and Barthel Index (BI) surveys. Data on the mean time to extubation, ICU length of stay, and ADLs improvement (FIM and BI) during ICU admission were obtained. Inferential analyses were not performed considering the small sample size. The mean time to extubation was 4.9 ± 1.1 days, and the ICU length of stay was 11.8 ± 5.0 days. ΔFIM was 36.5 (28.0–40.5), and the ΔBI was 22.5 (3.75–40.0). Moreover, no serious adverse events occurred in the patients during rehabilitation. Early mobilization of patients with COVID-19 may be useful in ADLs improvement during ICU stay.
Collapse
|
12
|
Kurosaki M, Tosaka M, Ibe Y, Arii H, Tomono J, Tazawa M, Shimizu T, Aihara M, Yoshimoto Y, Wada N. Functional Recovery after Rehabilitation in Patients with Post-stroke Severe Hemiplegia. Prog Rehabil Med 2022; 7:20220039. [PMID: 35975271 PMCID: PMC9346303 DOI: 10.2490/prm.20220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia. Methods: This study included 50 patients with Brunnstrom recovery stage I–II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed. Results: FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses. Conclusions: Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.
Collapse
Affiliation(s)
- Minori Kurosaki
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yoko Ibe
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hironori Arii
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Junichi Tomono
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masayuki Tazawa
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tatsuya Shimizu
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Naoki Wada
- Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| |
Collapse
|
13
|
Kinoshita T, Yoshikawa T, Nishimura Y, Kamijo YI, Arakawa H, Nakamura T, Hashizaki T, Hoekstra SP, Tajima F. Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study. Int J Neurosci 2020; 131:1097-1106. [PMID: 32449874 DOI: 10.1080/00207454.2020.1774578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Previous research indicates a better improvement of functional independence measure (FIM) at discharge in acute-stroke patients who received physiatrist and registered therapist operating rehabilitation (PROr) within 24 hrs compared with those who received after 24 hrs was reported. The aim of this prospective cohort study was to determine whether PROr provided within 24 hrs for new-onset stroke patients affects home-discharge rate at 6 months later. METHODS Acute new-onset stroke patients admitted to our hospital and received PROr (n = 227) and were conducted into 3 categories based on the time until starting PROr; within 24 hrs (very early mobilization; VEM; n = 47), 24-48 hrs (early mobilization; EM; n = 77) and >48 hrs (later mobilization; LM; n = 103). Home-discharge rates as well as changes in FIM, and rates of recurrence and mortality during the 6-month follow-up were assessed. RESULTS A total of 139 patients [VEM (n = 32), EM (n = 43), LM (n = 64)] could be followed throughout the 6-month period. The home-discharge rate was ∼80% and significantly higher by ∼20% in VEM than EM. The gains in the motor subscale of FIM at 6 months were significantly higher in VEM than LM, while the mortality and recurrent rates were not significantly different among the categories. CONCLUSIONS Starting PROr within 24 hrs of new-onset stroke may help to increase home-discharge rates at 6-month follow-up, simultaneously with a higher FIM. Very early mobilization in our hospital did not increase the risks of recurrence or death.
Collapse
Affiliation(s)
- Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tatsuya Yoshikawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideki Arakawa
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sven P Hoekstra
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
14
|
Sawabe M, Momosaki R, Hasebe K, Sawaguchi A, Kasuga S, Asanuma D, Suzuki S, Miyauchi N, Abo M. Rehabilitation Characteristics in High-Performance Hospitals after Acute Stroke. J Stroke Cerebrovasc Dis 2018; 27:2431-2435. [PMID: 29801813 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rehabilitation characteristics in high-performance hospitals after acute stroke are not clarified. This retrospective observational study aimed to clarify the characteristics of high-performance hospitals in acute stroke rehabilitation. METHODS Patients with stroke discharged from participating acute hospitals were extracted from the Japan Rehabilitation Database for the period 2006-2015. We found 6855 patients from 14 acute hospitals who were eligible for analysis in this study after applying exclusion criteria. We divided facilities into high-performance hospitals and low-performance hospitals using the median of the Functional Independent Measure efficiency for each hospital. We compared rehabilitation characteristics between high- and low-performance hospitals. RESULTS High-performance hospitals had significantly shorter length of stay. More patients were discharged to home in the high-performance hospitals compared with low-performance hospitals. Patients in high-performance hospitals received greater amounts of physical, occupational, and speech therapy. Patients in high-performance hospitals engaged in more self-exercise, weekend exercise, and exercise in wards. There was more participation of board-certified physiatrists and social workers in high-performance hospitals. CONCLUSIONS Our data suggested that amount, timing, and type of rehabilitation, and participation of multidisciplinary staff are essential for high performance in acute stroke rehabilitation.
Collapse
Affiliation(s)
- Masashi Sawabe
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan; Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kiyotaka Hasebe
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Akira Sawaguchi
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Seiji Kasuga
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Daichi Asanuma
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Shoya Suzuki
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Narimi Miyauchi
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|