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 18

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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

Yoshihiro Yoshimura Ayaka Matsumoto Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220025, 2022 (Released:2022-05-14)

参考文献数

133

被引用文献数

25

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Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

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

Yoshihiro Yoshimura Ai Shiraishi Yuri Tsuji Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220019, 2022 (Released:2022-04-12)

参考文献数

15

被引用文献数

19

著者

Ryo Momosaki Shoji Kinoshita Wataru Kakuda Naoki Yamada Masahiro Abo

出版者

徳島大学医学部

雑誌

The Journal of Medical Investigation (ISSN:13431420)

巻号頁・発行日

vol.63, no.3.4, pp.153-158, 2016 (Released:2016-09-17)

参考文献数

26

被引用文献数

8

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The purpose of this study was to review the best available evidence of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) for dysphagia after acquired brain injury. We searched randomized controlled trials that compared noninvasive brain stimulation with control used to improve dysphagia after acquired brain injury. We assessed dysphagia severity rating scales and penetration-aspiration scale as outcomes immediately after intervention. We calculated the pooled estimate of the standardized mean difference (SMD) to combine individual results. We included 8 published studies. Two heterogenous trials of 48 patients showed that rTMS was associated with a significant improvement in the dysphagia severity rating scale score (SMD 2.95). Three homogeneous trials of 88 patients showed a significant effect of rTMS on the penetration-aspiration scale score (SMD 0.77). Two homogeneous trials of 34 patients showed that tDCS was associated with a significant improvement in the dysphagia severity rating scale score (SMD 1.20). The review provided low-quality evidence for the effectiveness of noninvasive brain stimulation in improving dysphagia after acquired brain injury. Further trials of larger sample sizes are needed to determine the most appropriate noninvasive brain stimulation protocol. J. Med. Invest. 63: 153-158, August, 2016

著者

Yuki Kato Shinsuke Hori Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220041, 2022 (Released:2022-08-20)

参考文献数

23

被引用文献数

2

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Objectives: This study reviewed the effect of vocal exercise on patients with cervical spinal cord injury (SCI).Methods: An electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase databases was conducted for relevant studies published between 1980 and 2022. The review included studies that used randomized controlled trials to examine the effects of vocal exercise on people with cervical SCI.Results: We screened 1351 articles, of which 4 studies were eligible for inclusion. Vocal exercises were conducted two or three times a week for 12–24 weeks. Random sequences were adequately generated in all studies. All studies used respiratory function as the main outcome, and three studies used vocal quality as an outcome. In all studies, there were no dropouts other than those caused by unexpected illness. Vocal exercises were reported to have a positive effect on respiratory function in all studies and on voice quality in three studies. Meta-analysis was not possible because of the heterogeneity of the studies.Conclusions: Vocal exercise for SCI is a sustainable method that does not require special equipment or skills. More studies with large sample sizes are needed to confirm the effects of vocal exercises in patients with cervical SCI.

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

Toshikazu Ito Issei Kameda Naoki Fujimoto 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.17, no.4, pp.221-227, 2022 (Released:2022-10-22)

参考文献数

19

被引用文献数

1

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Objective: This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan.Materials and Methods: Regional disparities were investigated by comparing the number of cardiac rehabilitation units in each of 47 prefectures in Japan based on the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labour, and Welfare. The relationships between the numbers of inpatient and outpatient cardiac rehabilitation units and the numbers of registered instructors of cardiac rehabilitation, board-certified physiatrists, and board-certified cardiologists were examined.Results: The region with the highest and lowest numbers of inpatient units showed 11,620.5 and 1,650.2 population-adjusted cardiac rehabilitation units adjusted per 100,000 population, respectively, corresponding to a 7.0-fold difference. Meanwhile, 4,865.3 and 238.6 units were present in the regions with the highest and lowest numbers of outpatient units, respectively, corresponding to a 20.4-fold regional disparity. Our analysis showed that the population-adjusted number of inpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.647, P<0.001) and board-certified cardiologists (r=0.445, P=0.002) but only marginally associated with the population-adjusted number of board-certified physiatrists (r=0.329, P=0.024). Moreover, the population-adjusted number of outpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.406, P=0.005) and board-certified cardiologists (r=0.450, P=0.002) but not with the population-adjusted number of board-certified physiatrists (r=0.078, P=0.603).Conclusion: Large regional disparities were observed during the implementation of cardiac rehabilitation. Increased numbers of cardiac rehabilitation instructors and cardiac rehabilitation practices are expected to eliminate these regional differences in cardiac rehabilitation practices.

著者

Shinsuke Hori Kenta Ushida 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.17, no.3, pp.125-130, 2022 (Released:2022-07-01)

参考文献数

27

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Objective: Many countries have recently established registration databases in the field of rehabilitation to clarify their current status. However, these databases are primarily created for inpatients, with only a few large-scale databases for outpatients. The present study aimed to clarify secular changes, age distribution, and regional disparities in the implementation of outpatient rehabilitation in Japan using the National Database of Health Insurance Claims.Materials and Methods: Using the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labor, and Welfare, the number of outpatient rehabilitation units from 2014 to 2018 were extracted and examined.Results: The total number of units for outpatient rehabilitation increased gradually from 2014 to 2018. Orthopedic rehabilitation accounted for more than 80% of the total number of units for outpatient rehabilitation in 2018. The total number of units for outpatient rehabilitation according to age was highest among those in their late 70s, while cerebrovascular and dysphagia rehabilitation had the highest number of units in children.Conclusion: The total number of units for outpatient rehabilitation gradually increased from 2014 to 2018; whereas the number of total units for outpatient rehabilitation according to age was the highest among those in their late 70s. However, cerebrovascular rehabilitation and dysphagia rehabilitation had the highest number of units in children. The implementation status of rehabilitation in each region varied greatly among prefectures, suggesting the need for policy planning to eliminate regional disparities.

著者

Yuki Kato Miho Shimizu Shinsuke Hori Kenta Ushida Yoshinori Yamamoto Ken Muramatsu 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.17, no.2, pp.73-78, 2022 (Released:2022-04-06)

参考文献数

19

被引用文献数

2

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Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered.Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists.Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P<0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services.Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

著者

Wataru Kakuda Ryo Momosaki Naoki Yamada Masahiro Abo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.23, pp.3515-3519, 2016-12-01 (Released:2016-12-01)

参考文献数

20

被引用文献数

2 11

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Structural and functional abnormalities of the prefrontal cortex seem to correlate with fatigue in patients with chronic fatigue syndrome (CFS). We consecutively applied facilitatory high-frequency repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) of seven CFS patients over three days. Five patients completed the 3-day protocol without any adverse events. For the other two patients, we had to reduce the stimulation intensity in response to mild adverse reactions. In most of the patients, treatment resulted in an improvement of fatigue symptoms. High-frequency rTMS applied over the DLPFC can therefore be a potentially useful therapy for CFS patients.