Effects of weekend rehabilitation on vertebral compression fractures in the elderly

INTRODUCTION

This retrospective cohort study aimed to investigate the effect of rehabilitation and without weekend therapy on Activities of daily living (ADL) and readmission in vertebral fracture patients aged 60 years and older.

METHODS

The present study used a hospital-based database created by JMDC Inc. The JMDC hospital-based database is an epidemiological database that has been storing medical claims and Diagnosis Procedure Combination survey data. This study included 40,743 admitted patients aged 60 years or older who were admitted for rehabilitation purposes with a diagnosis of compression fracture of the thoracic and/or lumbar spine based on a previous diagnostic survey. We extracted the medical information from the database. Patients who received rehabilitation 7 days a week were classified into two groups: the "weekend rehabilitation group" and "nonweekend rehabilitation group." To reduce confounding effects related to differences in patient background, we used propensity score with multiple logistic regression models. Analysis of the JMDC database was conducted with the approval of the Institutional Review Board (approval number: 1228-1). Because all data were anonymized, informed consent was not required.

RESULTS

Propensity score matching resulted in 13,790 cases being included in the analysis. Barthel index (BI) at discharge, change in BI, and readmission were significantly different between the weekend rehabilitation and nonweekend rehabilitation groups. Multiple logistic regression analysis suggested a reduced odds of readmission with weekend rehabilitation (odds ratio = 0.907, 95% confidence interval [CI] = 0.843-0.975, p-value = 0.008). Furthermore, greater changes in BI and BI at discharge were associated with the effect of weekend rehabilitation (unstandardized [B] = 3.922, 95% CI = 2.925-4.919), (unstandardized [B] = 3.512, 9% CI = 2.424-4.6), respectively.

CONCLUSIONS

Weekend rehabilitation was considered as an important part of the treatment program to acquire ADL and to prevent readmission.

Echo Intensity of Gastrocnemius Is Independently Associated with 6-Minute Walking Distance in Male Patients with Peripheral Arterial Disease

Background and Objectives: This study aimed to examine the differences in the thickness and echo intensity (EI) of the gastrocnemius muscle measured via ultrasonography between healthy adults and patients with peripheral arterial disease (PAD) and to determine the associations of gastrocnemius thickness (GT) and EI within a 6 min walking distance (6MD) in patients with PAD. Materials and Methods: This cross-sectional study targeted 35 male patients with PAD (mean age, 73.7 years; mean body mass index [BMI], 23.5 kg/m2) and age- and gender-matched 73 male healthy adults (mean age, 73.2 years; mean BMI, 23.3 kg/m2). The gastrocnemius thickness (GT) and EI were measured using ultrasound. Both legs of patients with PAD were classified based on higher and lower ankle brachial pressure index (ABI), and the GTs and EIs with higher and lower ABI were compared with those of healthy adults. Multiple regression analysis incorporated 6MD as a dependent variable and each GT and EI with higher and lower ABI, age, and BMI as independent variables. Results: This study showed that GT was considerably greater in healthy adults than in both legs with higher and lower ABI (median values, 13.3 vs. 11.3 vs. 10.7, p < 0.01), whereas EI was lower in healthy adults than in the lower ABI leg (72.0 vs. 80.8 vs. 83.6, p < 0.05). The 6MD was shown to be substantially related to EI in both legs with higher and lower ABIs (p < 0.01) but not in the GT. Conclusions: In patients with PAD, the GT was lower, and EI was higher than in healthy adults. In addition, EIs in both legs with higher and lower ABIs were independently associated with 6MD in male PAD patients. This study showed that the EI measured via ultrasonography could become an important indicator for treatments for patients with PAD.

Does locomotive syndrome severity predict future fragility fractures in community-dwelling women with osteoporosis?

OBJECTIVES

We investigated whether the locomotive syndrome (LS) severity affects future fragility fractures in osteoporosis patients.

METHODS

In this retrospective cohort study, 315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed, of whom 244 were included in the analysis. At baseline, we obtained medical information, bone mineral density of the lumbar spine and femoral neck, and sagittal vertical axis. Additionally, LS risk was assessed using the two-step test, stand-up test, and 25-question geriatric locomotive function scale scores. The LS risk test results were used to classify LS severity, which was rated on a 4-point scale from stage 0 (robust) to 3 (worsening). Cox proportional hazards regression analysis was used to determine the association of the severity with future fragility fracture.

RESULTS

Fragility fractures occurred in 37 of 315 participants (11.8%). This study showed that sagittal vertical axis (hazard ratio = 1.014; 95% confidence interval, 1.005-1.023; p value = 0.003) and LS severity (hazard ratio =1.748; 95% confidence interval, 1.133-2.699; p = 0.012) were independent risk factors for incidence of fragility fracture.

CONCLUSIONS

This study revealed the LS severity to predicted fragility fractures. We suggested that the progression of LS associated with osteoporosis increases the fracture risk.

Sagittal alignment cut-off values for predicting future fall-related fractures in community-dwelling osteoporotic women

PURPOSE

Determining the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures is essential for understanding fracture risk and informing clinicians and physical therapists. We determined the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures in this study.

METHODS

In the retrospective cohort study, we enrolled a total of 255 women aged ≥ 65 years who visited an outpatient osteoporosis clinic. We measured participants' bone mineral density and sagittal alignment, including sagittal vertical axis (SVA), pelvic tilt, thoracic kyphosis, pelvic incidence, lumbar lordosis, global tilt, and gap score at the initial visit. The cut-off value for sagittal alignment that was significantly associated with fall-related fractures was calculated after using multivariate Cox proportional hazards regression analysis.

RESULTS

Ultimately, 192 patients were included in the analysis. After a mean follow-up of 3.0 years, 12.0% (n = 23) had fractures due to falls. Multivariate Cox regression analysis confirmed that SVA (hazard ratio [HR] = 1.022, 95% confidence interval [CI] = 1.005-1.039) was the only independent predictor of fall-related fracture occurrence. The predictive ability of SVA for the occurrence of fall-related fractures was moderate (area under the curve [AUC] = 0.728, 95% CI = 0.623-0.834), with a cut-off value of 100 mm for SVA. SVA classified by cut-off value was also associated with an increased risk of developing fall-related fractures (HR = 17.002, 95% CI = 4.102-70.475).

CONCLUSION

We found that assessing the cut-off value of sagittal alignment would be useful information in understanding fracture risk in postmenopausal older women.

Clinically Optimal Neuropsychological Tests for Postoperative Cognitive Dysfunction in Heart Valve Surgeries

BACKGROUND

Postoperative cognitive dysfunction (POCD) is widely recognized and reported, but the lack of a uniform definition makes it difficult to evaluate its clinical impact. The aim of this study is to establish the optimal neuropsychological tests and definition of POCD relevant to clinical outcomes in heart valve surgeries.Methods and Results: Between June 2015 and December 2019, 315 patients undergoing elective heart valve surgeries (age ≥65 years) were enrolled. The Mini-Mental Status Examination, Montreal Cognitive Assessment (MoCA), and the Trail Making Test A and B were performed to evaluate cognitive function. Clinical endpoints were defined as readmission and death. The postoperative readmission and death rate were 17% and 3% (54/315 and 8/315; follow-up 266-1,889 days). By multivariable Cox hazard analysis, Short Physical Performance Battery (adjusted hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.49-0.98, P=0.001), MoCA change rate (adjusted HR: 0.64, 95% CI: 0.01-1.22, P=0.024), and intensive care unit stay (adjusted HR: 0.55%, 95% CI: 0.99-1.12, P=0.054) were detected as independent risk factors for combined events. The cutoff value was -12% in the change rate of MoCA.

CONCLUSIONS

MoCA was the only neuropsychological test that predicted the clinical impact on complex events and has the potential to define POCD.

Association with sagittal alignment and osteoporosis-related fractures in outpatient women with osteoporosis

The baseline sagittal vertical axis (SVA) and pelvic tilt (PT) are independent risk factors of osteoporosis-related fractures in women with osteoporosis. We clarified the SVA and PT to predict the incidence of osteoporosis-related fractures.

PURPOSE

Sagittal alignment with osteoporosis women deteriorates with advancing age and sagittal alignment may indicate osteoporosis-related fractures in the future. However, whether the sagittal alignment predicts future osteoporosis-related fracture in patients with osteoporosis has not been clarified. We aimed to investigate the association between sagittal alignment and future osteoporosis-related fractures.

METHODS

This was a retrospective cohort study. Of the 313 participants (mean follow-up period, 2.9 years), 236 were included in the analysis. At baseline, we measured bone mineral density (BMD) of the lumbar spine and the femoral neck, sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis, sacral slope, pelvic tilt (PT), geriatric locomotive function scale (GLFS), two-step value, and stand-up test. The information on medications and the duration of treatment were reviewed from the medical records. Additionally, participants reported their history of falls at baseline. Multiple logistic regression analysis was used to determine the association of future osteoporosis-related fracture, and adjusted Odds ratios (OR) and 95% confidence interval (CI) were calculated with all predictors as covariates. All continuous variables were calculated using standardized OR (sOR).

RESULTS

Osteoporosis-related fractures occurred in 33 of 313 participants (10.5%). Multiple logistic regression analysis showed that a history of falls (OR =4.092, 95% CI: 1.029-16.265, p =0.045), SVA (sOR =4.228, 95% CI: 2.118-8.439, p <0.001), and PT (sOR =2.497, 95% CI: 1.087-5.733, p =0.031) were independent risk factors for future osteoporosis-related fractures.

CONCLUSIONS

This study revealed the SVA and PT to predict osteoporosis-related fractures.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

UMIN000036516 (April 1, 2019).

Effects of in-hospital rehabilitation on preventing hospital readmissions in patients with cirrhosis: a retrospective cohort study

OBJECTIVES

To investigate the impact of rehabilitation on hospital readmissions in patients with cirrhosis.

DESIGN

A retrospective cohort study SETTING: Acute hospitals.

PARTICIPANTS

Patients hospitalized due to cirrhosis (n = 6485) INTERVENTIONS: We defined rehabilitation as any type and intensity of rehabilitation administered by physical, occupational, and/or speech therapists.

MAIN OUTCOME MEASURES

Readmission within 30 days after discharge.

RESULTS

Rehabilitation was provided to 1177 patients (19.0%). After propensity score matching, rehabilitation was associated with 30- and 90-day readmissions.

CONCLUSIONS

The present study demonstrated that rehabilitation is associated with lower proportions of 30- and 90-day readmissions in patients with cirrhosis. Therefore, rehabilitation may be one way to reduce the risk of readmission in patients hospitalized for cirrhosis.

Stand-up test predicts occurrence of non-traumatic vertebral fracture in outpatient women with osteoporosis

INTRODUCTION

The purpose of this retrospective study was to clarify the incidence of non-traumatic vertebral fracture among outpatient women with osteoporosis and to determine whether the stand-up test predicted the occurrence of non-traumatic vertebral fracture.

MATERIALS AND METHODS

A total of 242 postmenopausal women over 60 years of age who received outpatient osteoporosis treatment at our hospital between November 2013 and July 2020 were longitudinally evaluated in this study. We obtained medical information and radiographic parameters, including sagittal vertical axis, thoracic kyphosis, pelvic incidence, lumbar lordosis, pelvic tilt, and sacral slope at baseline. Additionally, we measured physical parameters, including height, weight, body mass index, lumbar bone mineral density, visual analog scale score for pain, and the stand-up test.

RESULTS

Vertebral fractures occurred in 20 of 242 participants (8.3%), and accounted for 48.8% the 41 total fractures in the study group. Among vertebral fractures, eight (40.0%) were traumatic, resulting from falls, and 12 (60.0%) were non-traumatic. Cox multivariate logistic regression analysis adjusted for age, body mass index, lumbar bone mineral density, and the time to non-traumatic vertebral fracture showed that the sagittal vertical axis (HR = 1.013, 95% CI 1.001-1.026), stand-up test score (HR = 3.977, 95% CI 1.156-13.683), and presence of difficulty with standing from a 20-cm-high seat using both legs (HR = 3.329, 95% CI 1.625-6.82) were independent risk factors for the occurrence of non-traumatic vertebral fracture.

CONCLUSION

The stand-up test may be useful as a simple screening tool for non-traumatic vertebral fracture in patients with osteoporosis.

Association of height loss with falls and sarcopenia in community-dwelling older women

Objectives

Height loss is associated with vertebral fracture risk and osteoporosis. We assumed that height loss may indicate the risk of falls because the presence of osteoporosis is significantly associated with sarcopenia development. We studied the association of height loss with falls and sarcopenia.

Methods

This study included 610 community-dwelling women. We measured the height, weight, appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed. Additionally, we recorded the individual’s tallest height, and the presence or absence of single or multiple falls during the preceding 12 months. The participants were classified into nonheight loss, 2- to 3-cm height loss, 3- to 4-cm height loss, and over 4-cm height loss groups. The association of height loss with falls and sarcopenia were examined using multiple logistic regression analysis.

Results

We found that 3- to 4-cm height loss and over 4-cm height loss were significantly associated with falls (odds ratio [OR], 1.637; 95% confidence interval [CI], 1.023–2.619; P = 0.04), (OR, 1.742, 95% CI, 1.054–2.877; P = 0.03), respectively. Additionally, over 4-cm height loss was significantly associated with sarcopenia for ASMI calculated by participant’s tallest recalled height squared (OR, 2.676; 95% CI, 1.122–6.284; P = 0.026).

Conclusions

We found that the risk of falls was advanced at 3- to 4-cm height loss and over 4-cm height loss, and sarcopenia started at over 4-cm height loss. Height loss may be a useful indicator of the risk of falls and sarcopenia.

Gastrocnemius thickness by ultrasonography indicates the low skeletal muscle mass in Japanese elderly people

BACKGROUND

This study aimed to examine the relationship between gastrocnemius thickness by ultrasonography and the skeletal muscle mass in Japanese elderly people.

METHODS

The total of 195 healthy Japanese aged ≥65 years participated (average age, 72.4 ± 4.3y; male, n = 72). The skeletal muscle mass index (SMI) was measured using the bioelectrical impedance analysis (BIA) and the gastrocnemius thickness and collected echo intensity (CEI) were measured using ultrasonography. The low SMI was defined as <7.0 kg/m² in men and <5.7 kg/m² in women, and participants were classified into the low SMI and the normal group. Association of the gastrocnemius thickness with the low SMI was analyzed by the logistic regression analysis after adjusting age, gender, body mass index (BMI), physical performances and CEI. The cut-off value of gastrocnemius thickness to indicate the low SMI was calculated by a receiver operating characteristic curve analysis.

RESULTS

The low SMI rate was 16.9％ (n = 33). BMI was significantly lower (19.9 vs 22.5 kg/m²; p < 0.01), the gastrocnemius thickness lower (11.0 vs 13.3 mm; p < 0.01), and CEI higher (97.5 vs 87.0; p = 0.02) in the low SMI group than those in the normal group. The gastrocnemius thickness was independently associated with the low SMI (OR, 0.584; 95% CI, 0.416-0.818; p < 0.01). The cut-off value of gastrocnemius thickness was <11.6 mm (AUC, 0.83; sensitivity, 0.83; specificity, 0.73; p < 0.01).

CONCLUSION

Gastrocnemius thickness by ultrasonography was associated with low skeletal muscle mass, and the cut-off value to indicate the low skeletal muscle mass was revealed.

Postoperative atrial fibrillation is associated with delayed early rehabilitation after heart valve surgery: a multicenter study

OBJECTIVE

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery.

METHODS

We enrolled 302 patients (mean age, 69±10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge.

RESULTS

Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052).

CONCLUSIONS

POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lower-extremity function during hospitalization.

Changes in the amount of physical activity in minimally invasive cardiac surgery

[Purpose] This study aimed to compare the amount of physical activity in a minimally invasive cardiac surgery (MICS) group with that in a conventional surgery (median sternotomy) group. [Subjects and Methods] Between November 2010 and December 2011, 39 consecutive patients who underwent elective surgery for valvular disease were prospectively enrolled. The amount of physical activity before and after surgery was measured in 22 cases. The daily in-hospital physical activity level was measured continuously using a triaxial accelerometer. The results were compared in terms of change in the amount of physical activity pre- and postoperatively. [Results] There was no significant difference between the two groups in the amount of physical activity before surgery. However, the amount of physical activity after surgery was significantly higher in the MICS group compared with the conventional surgery group. The number of steps after surgery was significantly increased in the MICS group, and the rate of change in the amount of physical activity was significantly higher in the MICS group than that in the conventional surgery group. [Conclusion] The MICS approach is associated with improvement in postoperative physical activity over median sternotomy.

Clinical characteristics of functional recovery after coronary artery bypass graft surgery in Japanese octogenarians

[Purpose] This study aimed to elucidate characteristics of postoperative physical functional recovery in octogenarians undergoing coronary artery bypass graft surgery. [Subjects and Methods] This was a multi-center, retrospective study. Nine hundred and twenty-seven elective isolated coronary artery bypass graft surgeries were evaluated (746 males and 181 females, mean age: 68.6 years, range: 31–86 years). Participants were stratified according to age < 80 years (n = 840; mean age, 67.1; range, 31–79) or > 80 years (n = 87; mean age, 82.2; range, 80–86). Patient characteristics and postoperative physical functional recovery outcomes were compared between groups. [Results] There was no significant difference between groups when considering the postoperative day at which patients could sit on the edge of the bed, stand at bedside, or walk around the bed. The postoperative day at which patients could walk 100 m independently was later in octogenarians, when compared with non-octogenarians (6.1 ± 3.2 days vs. 4.9 ± 3.9 days). In octogenarians, the percentage of patients who could walk 100 m independently within 8 days after surgery was 79.5%. [Conclusion] A postoperative target time in octogenarians for independent walking, following coronary artery bypass grafting, can be set at approximately 6 days.

Effect of in-hospital physical activity on cardiovascular prognosis in lower extremity bypass for claudication

[Purpose] This study aimed to evaluate the effect of in-hospital physical activity on patient prognosis after lower extremity bypass surgery for peripheral arterial disease. [Subjects and Methods] A total of 13 patients (16 limbs; 11 males and 2 females; mean age [standard deviation], 72.8 [5.9] years) who underwent lower extremity bypass surgery for Fontaine stage 2 peripheral arterial disease were included in this study and assigned to either an active group (n = 6) to perform increased physical activity after surgery or an inactive group (n = 7) to perform decreased physical activity after surgery. Daily in-hospital physical activity levels were measured continuously with a triaxial accelerometer. The occurrence of adverse cardiovascular events within a 2 year follow-up period was compared between groups. [Results] At discharge, the patients in the active group were able to walk more steps daily than those in the inactive group. The incidence of adverse events was 16.7% in the active group and 71.4% in the inactive group. [Conclusion] A higher in-hospital physical activity level was associated with a better long-term prognosis after lower extremity bypass surgery in patients with peripheral arterial disease.

[Determinants of prolonged mechanical ventilation after cardiac surgery]

PURPOSE

This study aimed to examine factors that delay weaning from ventilation after cardiac surgery.

METHODS

A retrospective examination was made on 1,033 patients who had undergone cardiac surgery through a midsternal incision between January 2009 and July 2011. The items examined were duration of postoperative ventilation, patient's background, and other surgical information. If patients were weaned within 24 hours from intensive care unit (ICU) admission, they were included in the timely weaning group. If patients required 24 hours or more to be weaned, they were included in the delayed weaning group.

RESULTS

There was a relationship between prolonged ventilation and the following factors: emergency surgery, history of arrhythmia, history of motor system disorder, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) classification, preoperative left ventricular ejection fraction (LVEF), operative method, operative time, blood loss, intraoperative fluid management, and number of days from surgery until achievement of independent gait. The independent factors delaying extubation were emergency surgery, preoperative NYHA classification, preoperative LVEF, operative method, operative time, blood loss, and intraoperative fluid management(p<0.05).

CONCLUSION

Surgical invasiveness and preoperative heart failure were involved in the prolonged ventilation after cardiac surgery.