著者

Yoshihiro Yoshimura Hidetaka Wakabayashi Ryo Momosaki Fumihiko Nagano Sayuri Shimazu Ai Shiraishi

出版者

Tohoku University Medical Press

雑誌

The Tohoku Journal of Experimental Medicine (ISSN:00408727)

巻号頁・発行日

vol.252, no.1, pp.15-22, 2020 (Released:2020-08-25)

参考文献数

34

被引用文献数

4 16

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As Japan’s population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)-motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10-20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (β = −0.107, p = 0.024), FILS score at discharge (β = −0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

著者

Ai NISHIYAMA Hidetaka WAKABAYASHI Shinta NISHIOKA Ayano NAGANO Ryo MOMOSAKI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2019-0002, (Released:2019-05-22)

参考文献数

23

被引用文献数

17

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Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.

著者

Miyuki TAKASAKI Ryo MOMOSAKI Hidetaka WAKABAYASHI Shinta NISHIOKA

出版者

Center for Academic Publications Japan

雑誌

Journal of Nutritional Science and Vitaminology (ISSN:03014800)

巻号頁・発行日

vol.64, no.4, pp.251-257, 2018 (Released:2018-08-31)

参考文献数

19

被引用文献数

11 11

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Nutritional complications frequently occur among patients undergoing rehabilitation, and the importance of nutrition in these patients has been emphasized. However, there is not enough evidence available on rehabilitation nutrition. The Japan Rehabilitation Nutrition Database was set up to reflect the real-world clinical practice of rehabilitation nutrition. This paper describes the construction and quality evaluation of the registry database. We constructed a large-scale database that can be used for the clinical research of nutrition for rehabilitation. To verify the data, a simple comparison of the numbers of cases, data loss, data duplication, data type errors, out of range values, and input errors in the option columns was performed. From March 2016 to June 2017, 797 cases were registered in the rehabilitation database from 18 facilities. The variable entry error frequency ranges from 0% to 0.4% and the frequency of a main item missing from 0.4% to 10.9%. Energy intake on hospitalization was missing in 10.9% of cases, and Mini Nutritional Assessment Short Form and Food Intake LEVEL Scale on hospitalization was missing in 9.7% of cases. Stroke accounted for 45.7% of the diseases registered, pneumonia for 36.5%, and proximal femoral fracture for 17.8%. Through the use of this database, research on rehabilitation nutrition can be conducted, and there is a possibility that useful results for future clinical practice may be obtained. Verification of the secondary use of the database is becoming the basis for evidence-based nutritional rehabilitation.

著者

Yumi Yamada Hiroshi Shamoto Keisuke Maeda Hidetaka Wakabayashi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180019, 2018 (Released:2018-11-20)

参考文献数

18

被引用文献数

6

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Background: Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case: A 72-year-old man with Parkinson’s disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient’s body weight was 39.0 kg (−33.8%/4 months, body mass index: 15.3 kg/m2), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient’s swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m2). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion: Sarcopenic dysphagia may be a complication of Parkinson’s disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.

著者

Mariko NAKAMICHI Hidetaka WAKABAYASHI

出版者

Center for Academic Publications Japan

雑誌

Journal of Nutritional Science and Vitaminology (ISSN:03014800)

巻号頁・発行日

vol.62, no.5, pp.330-334, 2016 (Released:2016-12-06)

参考文献数

35

被引用文献数

3

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The purpose was to investigate the association between proton pump inhibitor (PPI) therapy and nutritional status in elderly hospitalized patients. Participants were 190 elderly patients admitted to the long-term care wards, convalescence rehabilitation wards, and community integrated care wards in January 2015. Nutritional status was assessed using the mini nutritional assessment short-form (MNA-SF). The PPI use group was compared with the PPI non-use group regarding nutrition status. Logistic regression analysis was used to examine whether the period of PPI therapy was associated independently with malnutrition following adjustment for covariates including gender, age, and serum albumin level. Forty-one patients were male (22%) and 149 patients were female (78%), with a mean age of 85.4±8.4. Fifty-three patients (28%) took PPIs (with a median prescription period of 91 d, ranging from 51 to 227). With a MNA-SF score of 7 points or lower designated as malnutrition, there was no significant difference in nutritional status between the PPI and non-PPI groups (p=0.172). The median MNA-SF scores in the PPI and non-PPI groups were 9 vs 7 points, respectively. Logistic regression analysis showed that long-term PPI therapy (odds ratio, 0.994; 95% confidence interval 0.990-0.999) was significantly associated with improved nutritional status. The presence or absence of PPI therapy is not associated with malnutrition in elderly hospitalized patients. Longer-term PPI therapy may improve nutritional status.

著者

Masako Kishima Hidetaka Wakabayashi Hideaki Kanazawa Masataka Itoda Toshio Nishikimi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180020, 2018 (Released:2018-12-11)

参考文献数

12

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Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.

著者

Hiroki Maki Hidetaka Wakabayashi Keisuke Maeda Mariko Nakamichi Kazumi Kubota Ryo Momosaki

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.5, no.3, pp.88-94, 2023 (Released:2023-07-04)

参考文献数

22

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BACKGROUNDThe Comorbidity Polypharmacy Score (CPS) is calculated by the number of drugs carried plus the number of comorbidities on admission and divided into three categories (minor, 0–7; moderate, 8–14; and severe, 15+). This study investigates whether CPS can predict the clinical outcomes in older patients with hip fractures undergoing surgery.METHODSThis retrospective longitudinal study used a multicenter hospital-based database containing the Diagnosis Procedure Combination. Consecutive patients with hip fractures (ICD-10 codes S720 and S721) who were aged ≥65 years between April 2014 and August 2020 were included. We evaluated the predictive association between the CPS and Barthel Index (BI) efficiency. The primary outcome was defined as the BI efficiency, and the secondary outcome was the length of hospital stay.RESULTSWe enrolled 11,564 patients, and 80.5% of them were female. The mean age was 83.9 ± 6.5 years. The BI efficiency was the lowest in the CPS severe group with a median [interquartile range] of 0.67 [0.10, 1.43]. The length of hospital stay was the highest in the CPS severe group, with a median of 35 [21, 58]. Additionally, multiple linear regression analysis revealed that the CPS was independently associated with the BI efficiency (β = −0.100, 95% CI: −0.040, −0.029; P < 0.001) and the length of hospital stay (β = 0.047, 95% CI: 0.199, 0.366; P < 0.001).CONCLUSIONSAn increased CPS score is associated with low BI efficiency and longer length of hospital stay in patients with hip fractures.

著者

Takako Nagai Hidetaka Wakabayashi Shinta Nishioka Ryo Momosaki

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.18, no.1, pp.21-27, 2023 (Released:2023-01-06)

参考文献数

33

被引用文献数

1

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Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia.Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW).Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301).Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.

著者

Ayumi Nobematsu Hidetaka Wakabayashi Takuya Hanada Naoko Watanabe Kae Tachibana

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180010, 2018 (Released:2018-05-16)

参考文献数

8

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Background: Acute lithium intoxication is associated with neurological manifestations such as tremor, ataxia, dysarthria, seizures, and in more severe cases encephalopathy and coma; patients experiencing such manifestations require rehabilitation. The authors present a patient who received post-acute rehabilitation for lithium toxicity-associated ataxia. Case: The patient was a man aged 30 years who had been diagnosed with bipolar disorder more than 10 years ago and had been prescribed lithium carbonate by a psychiatrist. The patient was admitted to the hospital with disturbance of consciousness, and physical therapy began on day 6 of hospitalization. Occupational therapy and speech therapy began on day 15. Physical therapy interventions focused on improving balance and coordination, and occupational therapy focused on improving stability while sitting, upper extremity control, and activities of daily living to improve the Functional Independence Measure motor subscale score. Speech therapy focused on dysarthria. On day 27 of hospitalization, the patient was able to walk 5 m with two Lofstrand crutches and could feed himself without assistance. From day 15 to day 30 of hospitalization, the Scale for the Assessment and Rating of Ataxia score improved from 28 to 19, and the Functional Independence Measure score increased from 25 to 77. On day 31, the patient was discharged to a convalescent rehabilitation hospital. Discussion: Post-acute rehabilitation for ataxia caused by acute lithium toxicity may improve ataxia and the ability to perform activities of daily living, and therefore may be of benefit.

著者

Tatsu FUJIURA Hiroshi NAGASAWA Hidetaka WAKABAYASHI

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

vol.23, no.1, pp.39-46, 2020-06-20 (Released:2020-06-20)

参考文献数

26

被引用文献数

5

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Objective: To assess the effect of manual lymph drainage (MLD) on pain in Japanese patients up to 10 days after a total knee arthroplasty (TKA).Methods: This study was a randomized controlled trial performed at a University Medical Center. Patients who underwent unilateral TKA and received once daily MLD for 20 minutes prior to standard physical therapy up to 10 days after TKA were investigated. Pain at rest, knee extension muscle contraction, and maximum load were assessed using the visual analog scale (mm) before surgery, after drain removal, and after the fifth MLD. As secondary outcomes, the circumference, range of motion, muscle strength, walking speed, and walking rate were evaluated.Result: Forty-one patients aged 45-85 participated in this study, 21 of whom were assigned to the intervention (MLD group) and 20 who were not (control group). Ten days after TKA, no significant difference was evident between the MLD and control groups for resting pain [4.5 mm (1.6-10.8) vs 7.0 mm (1.8-25.5), respectively, p=0.17], pain during knee extension muscle contraction [12.3 mm (4.5-24.8) vs 20.8 mm (6.4-31.8), p=0.41], and pain at maximum load [13.0 mm (8.3-39.8) vs 16.0 mm (4.6-32.5), p=0.73]. There were no significant differences between groups in terms of secondary outcomes.Conclusion: This study shows that MLD up to 10 days after TKA does not affect pain.

著者

Tatsu FUJIURA Hiroshi NAGASAWA Hidetaka WAKABAYASHI

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

pp.E9992, (Released:2020-03-25)

参考文献数

26

被引用文献数

5

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Objective: To assess the effect of manual lymph drainage (MLD) on pain in Japanese patients up to 10 days after a total knee arthroplasty (TKA).Methods: This study was a randomized controlled trial performed at a University Medical Center. Patients who underwent unilateral TKA and received once daily MLD for 20 minutes prior to standard physical therapy up to 10 days after TKA were investigated. Pain at rest, knee extension muscle contraction, and maximum load were assessed using the visual analog scale (mm) before surgery, after drain removal, and after the fifth MLD. As secondary outcomes, the circumference, range of motion, muscle strength, walking speed, and walking rate were evaluated.Result: Forty-one patients aged 45-85 participated in this study, 21 of whom were assigned to the intervention (MLD group) and 20 who were not (control group). Ten days after TKA, no significant difference was evident between the MLD and control groups for resting pain [4.5 mm (1.6-10.8) vs 7.0 mm (1.8-25.5), respectively, p=0.17], pain during knee extension muscle contraction [12.3 mm (4.5-24.8) vs 20.8 mm (6.4-31.8), p=0.41], and pain at maximum load [13.0 mm (8.3-39.8) vs 16.0 mm (4.6-32.5), p=0.73]. There were no significant differences between groups in terms of secondary outcomes.Conclusion: This study shows that MLD up to 10 days after TKA does not affect pain.

著者

Hidetaka Wakabayashi Hironobu Sashika

出版者

Japan Primary Care Association

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.12, no.2, pp.69-74, 2011 (Released:2011-12-28)

参考文献数

13

被引用文献数

18

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Background: To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome.Methods: A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m2, hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm3. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI).Results: The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk: 0.72, p=0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk: 0.69, p=0.001), total lymphocyte count>1200 cells/mm3 (relative risk: 0.78, p=0.03), or PNI>35.0 (relative risk: 0.74, p=0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p=0.005).Conclusions: Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.