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

---

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

Shinta NISHIOKA Yoji KOKURA Takatsugu OKAMOTO Masako TAKAYAMA Ichiro MIYAI

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.65, no.5, pp.435-442, 2019-10-31 (Released:2019-10-31)

参考文献数

29

被引用文献数

4 4

---

This study aimed to verify the relationship between assignment of professional registered dietitians (RDs) and other healthcare professionals and body weight or functional outcome in underweight patients. This was a secondary analysis of the nation-wide survey data from Kaifukuki (convalescent) rehabilitation wards (KRWs). Data of patients aged ≥20 y with disabilities and body mass index (BMI) <18.5 kg/m2 and who were discharged from 1,099 KRWs were analyzed. The primary outcome was BMI at discharge. Secondary outcomes were Functional Independence Measure (FIM) at discharge and returning to home. Patients were divided into two groups: those in KRWs with ≥1 or <1 dedicated RD per ward (KRW/RD+ and KRW/RD−, respectively). Of 5,843 eligible participants (female, 63%; median age, 82 y; hip/vertebral/knee fracture, 47%; stroke, 34%; disuse syndrome secondary to acute illness, 11%; others, 8%), 1,288 and 4,555 were from the KRW/RD+ and KRW/RD− groups, respectively. At discharge, KRW/RD+ patients had higher FIM (93 vs. 90) and BMI (17.1 vs. 17.0 kg/m2) than did KRW/RD− patients. Multivariable analysis showed that assignment of dedicated RDs (B=0.213, 95% confidence interval [CI], 0.036-0.389), number of nurses (B=0.023, 95% CI, 0.003-0.043), and daily rehabilitation dose were significantly associated with changes in body weight. Furthermore, these factors positively affected BMI at discharge. Number of nurses and rehabilitation dose correlated with FIM, but assignment of RDs did not correlate with FIM. In conclusion, assignment of RDs, nurses, and sufficient rehabilitation dose may contribute to BMI gain. Nurses and daily rehabilitation dose may positively affect functional recovery.

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

---

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

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

---

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.