著者

Kohei Tanaka Sho Katayama Kazuki Okura Masatsugu Okamura Keishi Nawata Nobuto Nakanishi Ayato Shinohara

出版者

The Japanese Society of Strategies for Cancer Research and Therapy

雑誌

Annals of Cancer Research and Therapy (ISSN:13446835)

巻号頁・発行日

vol.30, no.2, pp.93-99, 2022-07-21 (Released:2022-08-23)

参考文献数

53

被引用文献数

4

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The skeletal muscle has a significant role on physical functions, and the assessment of the skeletal muscle is important in critically ill patients. Computed tomography (CT), ultrasound examination, bioelectrical impedance analysis (BIA) device, and biomarkers can all be used to assess skeletal muscle mass. CT is useful for accurately measuring skeletal muscle mass, and the measurement is conducted at the third lumbar vertebra level as the gold standard. However, the assessment using CT is done retrospectively because CT involves radiation exposure and requires patients to be transported to the examination room. On the other hand, ultrasound and BIA are noninvasive and can be used at the bedside to assess longitudinal skeletal muscle mass. However, accurate assessment requires knowledge and skills. Assessments using BIA should be carefully interpreted because critically ill patients are under dynamic fluid change and edema. Furthermore, various biomarkers for the assessment of skeletal muscle mass have been recently reported. Appropriate skeletal muscle assessment will contribute to the nutrition and rehabilitation intervention of critically ill patients so that they can return to society.

著者

Masahiro Iwakura Masahiko Wakasa Kazuki Okura Atsuyoshi Kawagoshi Keiyu Sugawara Hitomi Takahashi Takanobu Shioya

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.6, pp.20210008, 2021 (Released:2021-02-06)

参考文献数

29

被引用文献数

2

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Objectives: We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD).Methods: We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant.Results: Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H2 with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H2 for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m2, respectively.Conclusions: QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.

著者

Kazuki OKURA Yusuke TAKAHASHI Kakeru HASEGAWA Kazutoshi HATAKEYAMA Kimio SAITO Chihiro IMAIZUMI Hajime KAGA Naoto TAKAHASHI

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

pp.E10188, (Released:2022-11-09)

参考文献数

21

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Introduction: Early implementation of neuromuscular electrical stimulation (NMES) has been reported to prevent muscle atrophy and physical functional decline in patients requiring mechanical ventilation. However, its effect in patients with acute exacerbation of interstitial lung disease (ILD) remains unclear. We herein report our experience using the NMES combined with mobilization in a patient with an acute exacerbation of rheumatoid arthritis-associated ILD (RA-ILD) requiring mechanical ventilation. Case presentation: A 74-year-old man was admitted to the intensive care unit (ICU) and put on mechanical ventilation due to severe acute exacerbation of RA-ILD. Early mobilization and the NMES using a belt electrode skeletal muscle electrical stimulation system were started on day 7 of hospitalization (day 2 of ICU admission). The NMES duration was 20 min, performed once daily. The patient could perform mobility exercises on day 8 and could walk on day 16. We assessed his rectus femoris and quadriceps muscle thicknesses using ultrasound imaging, and found decreases of 4.5% and 8.4%, respectively, by day 14. On day 27, he could independently visit the lavatory, and the NMES was discontinued. He was instructed to start long-term oxygen therapy on day 49 and was discharged on day 63. His 6-minute walk distance was 308 m and his muscle thickness recovered to levels comparable to those at the initial evaluation at the time of discharge. Conclusion: Combining the NMES and mobilization started in the early phase and continued after ICU discharge was safe and effective in a patient with a severe acute exacerbation of RA-ILD.

著者

Masahiro IWAKURA Kazuki OKURA Mika KUBOTA Keiyu SUGAWARA Atsuyoshi KAWAGOSHI Hitomi TAKAHASHI Takanobu SHIOYA

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

vol.24, no.1, pp.35-42, 2021-04-20 (Released:2021-04-20)

参考文献数

33

被引用文献数

1 21

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Objective: To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD). Method: Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable. Results: Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH2O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH2O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without. Conclusion: The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH2O) should be used with careful consideration, because the value is estimated using distributionbased method.

著者

Kazuki OKURA Kazuyuki SHIBATA Tomohiro SUDA Masahiro IWAKURA Masahiko WAKASA Yoshiaki KIMURA Kyoji OKADA

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

vol.25, no.1, pp.31-34, 2022-04-20 (Released:2022-04-20)

参考文献数

15

被引用文献数

1

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Objective: To investigate the differences in self-efficacy (SE) for walking tasks between older patients with knee osteoarthritis (OA) and older adults without knee OA. Methods: A cross-sectional design was employed. Older patients with radiographic knee OA and community-dwelling older adults without knee OA as controls were enrolled in the study. SE for the walking task was assessed using the modified gait efficacy scale (mGES). A Wilcoxon rank-sum test was used to compare the mGES between the groups of participants. A Tobit regression model was used to estimate the difference in mGES. The presence of radiographic knee OA was used as an independent variable. Sex (women), age, and body mass index were used as potential confounding variables in the model. Results: After exclusion, 78 participants (n=40 with knee OA, n=38 controls) were included. The mGES was lower in patients with knee OA than in controls. In the Tobit regression model adjusted for confounding factors, mGES in patients with knee OA was estimated to be 26.8 (95% confidence interval [CI]: 15.8-37.8) points lower than in controls. Conclusion: This study demonstrated that mGES was lower in older patients with knee OA than in older adults without knee OA.

著者

Kazuki OKURA Kazuyuki SHIBATA Tomohiro SUDA Masahiro IWAKURA Masahiko WAKASA Yoshiaki KIMURA Kyoji OKADA

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

pp.E10128, (Released:2021-12-06)

参考文献数

15

被引用文献数

1

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Objective: To investigate the differences in self-efficacy (SE) for walking tasks between older patients with knee osteoarthritis (OA) and older adults without knee OA. Methods: A cross-sectional design was employed. Older patients with radiographic knee OA and community-dwelling older adults without knee OA as controls were enrolled in the study. SE for the walking task was assessed using the modified gait efficacy scale (mGES). A Wilcoxon rank-sum test was used to compare the mGES between the groups of participants. A Tobit regression model was used to estimate the difference in mGES. The presence of radiographic knee OA was used as an independent variable. Sex (women), age, and body mass index were used as potential confounding variables in the model. Results: After exclusion, 78 participants (n=40 with knee OA, n=38 controls) were included. The mGES was lower in patients with knee OA than in controls. In the Tobit regression model adjusted for confounding factors, mGES in patients with knee OA was estimated to be 26.8 (95% confidence interval [CI]: 15.8-37.8) points lower than in controls. Conclusion: This study demonstrated that mGES was lower in older patients with knee OA than in older adults without knee OA.

著者

Masahiro IWAKURA Kazuki OKURA Mika KUBOTA Keiyu SUGAWARA Atsuyoshi KAWAGOSHI Hitomi TAKAHASHI Takanobu SHIOYA

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

pp.E10049, (Released:2020-10-12)

参考文献数

33

被引用文献数

21

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Objective: To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD). Method: Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable. Results: Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH2O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH2O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without. Conclusion: The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH2O) should be used with careful consideration, because the value is estimated using distributionbased method.