Post-discharge sedentary behavior and light-intensity physical activity-associated stroke recurrence in patients with minor ischemic stroke: A preliminary retrospective observational study.

BACKGROUND AND PURPOSE: Evidence regarding whether reducing sedentary behavior and increasing physical activity levels to prevent stroke recurrence is insufficient. Therefore, this study preliminarily investigated whether post-discharge sedentary behavior and physical activity levels in patients with minor ischemic stroke were associated with stroke recurrence. METHODS: This retrospective observational study included 73 patients (aged 72.0 years) with minor ischemic stroke from a previous study. The outcome was recurrent stroke 2 years after stroke onset, assessed using medical records. Exposure factors including sedentary behavior and physical activity levels 6 months post-discharge were measured using accelerometers; patients were classified into the recurrence or non-recurrence groups. Logistic regression analyses were then conducted to determine whether sedentary behavior and physical activity 6 months after discharge were associated with stroke recurrence. RESULTS: Six patients experienced stroke recurrence (recurrence rate, 8.2%). The recurrence group showed greater sedentary behavior (recurrence group 68.0%, non-recurrence group 52.0%, p = 0.007) and less light-intensity physical activity (LPA) (recurrence group 21.0%, non-recurrence group 37.0%, p = 0.002) than in the non-recurrence group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.083, 95% confidence interval = 1.007-1.165, p = 0.032) and LPA (odds ratio = 0.874, 95% confidence interval = 0.785-0.975, p = 0.015) were independent factors for recurrence of stroke. DISCUSSION: Post-discharge sedentary behavior and LPA in patients with minor ischemic stroke were associated with stroke recurrence. Results suggest that reducing post-discharge sedentary behavior and increasing LPA may be crucial for reducing the risk of stroke recurrence in patients with minor ischemic stroke.

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study.

PURPOSE: Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. METHODS: This 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. RESULTS: Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027). CONCLUSIONS: Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke. METHODS: This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention). RESULTS: Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found. CONCLUSION: Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.

Effects on sedentary behaviour of an approach to reduce sedentary behaviour in patients with minor ischaemic stroke: A randomised controlled trial.

OBJECTIVES: To determine the effects on sedentary behaviour of an approach that promotes reduction in sedentary behaviour in patients with minor ischaemic stroke after intervention and at follow-up. DESIGN: A randomised controlled trial. SETTING: During hospitalisation and after hospital discharge. SUBJECTS: In total, 86 patients with minor ischaemic stroke admitted to an acute care hospital were assigned to the intervention (n = 43) and control (n = 43) groups. INTERVENTION: An intervention group that received an approach to reduce sedentary behaviour upon hospital admission until 3 months after discharge (education, self-monitoring, phone calls, etc.) and a control group that received the usual care during hospitalisation. From 3 to 6 months after discharge, no group received any intervention. MAIN OUTCOME: The primary outcome was the change (%) in sedentary behaviour from baseline to post-intervention (3 months after discharge) and follow-up (6 months after discharge). Sedentary behaviour was measured at baseline (upon hospital admission), post-intervention, and at follow-up using accelerometers. RESULTS: At the post-intervention stage, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, -22.7%; control group, -14.9%; P = 0.013; effect size = 0.58). At follow-up too, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, -20.4%; control group, -13.6%; P = 0.025; effect size = 0.54). CONCLUSIONS: An approach to reduce sedentary behaviour in patients with minor ischaemic stroke effectively reduces sedentary behaviour, which is sustained up to follow-up. TRIAL REGISTRATION: This study is registered at www.umin.ac.jp/ctr/index/htm UMIN000038616.

Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study.

BACKGROUND: The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not. OBJECTIVE: This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities. METHODS: The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates. RESULTS: After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04). CONCLUSION: Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.

Association between physical activity levels and depressive symptoms in patients with minor ischemic stroke.

OBJECTIVE: Post-stroke depression is associated with stroke recurrence and it is necessary to identify its influencing factors. The study aims to determine whether physical activity during hospitalization, as measured by accelerometer, was associated with depression after discharge in patients with minor ischemic stroke. MATERIALS AND METHODS: This prospective observational study assessed 76 patients with minor ischemic stroke (aged 71.2 years) admitted to an acute care hospital. Depressive symptoms 3 months after discharge from the hospital was assessed using a questionnaire sent by mail. Baseline was set during hospitalization, and accelerometers were used to measure sedentary behavior, light and moderate-to-vigorous physical activities during hospitalization. RESULTS: Three months after hospital discharge, 14 patients (18.4%) were placed in the depressive symptom group, with significantly more sedentary behavior (p = 0.021), less light physical activity (p = 0.016) and more depressive symptoms during hospitalization (p = 0.005) than in the non-depressive symptom group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.130, 95% confidence interval = 1.013‒1.281, p = 0.028) and light-intensity physical activity (odds ratio = 0.853, 95% confidence interval = 0.746‒0.976, p = 0.021) were independent factors for depressive symptoms at three months after discharge. Moderate to vigorous physical activity was not an independent factor. CONCLUSIONS: Sedentary behavior and light-intensity physical activity during hospitalization were associated with depressive symptoms in patients with minor ischemic stroke after discharge. Reducing sedentary behavior and increasing light-intensity physical activity as part of inpatient rehabilitation may help prevent post-stroke depression.

Sarcopenia Affects Functional Independence Measure motor Scores in Elderly Patients with Stroke.

OBJECTIVES: There is no unified view of the relationship between sarcopenia and the activities of daily living (ADL) in stroke patients. This study aimed to determine whether sarcopenia affects the ADL in elderly patients with stroke. MATERIALS AND METHODS: This case-control study included 472 stroke patients aged ≥ 65 years who were admitted to the convalescent rehabilitation ward. Sarcopenia was defined as a decrease in both the skeletal muscle mass index and handgrip strength, based on the Asian Working Group for Sarcopenia 2019 criteria cut-off, which was assessed on admission. ADL was assessed using the Functional Independence Measure-motor (FIM-m) score at discharge. The Charlson comorbidity index, Mini Nutritional Assessment-Short Form, Brunnstrom recovery stage of the upper limb, Brunnstrom recovery stage of the lower limb and total amount of rehabilitation during hospitalization were evaluated as confounding factors. To clarify whether sarcopenia affects the ADL in patients with stroke, we conducted a multiple regression analysis with the presence of sarcopenia as the independent variable and FIM-m at discharge as the objective variable. RESULTS: The final analysis included 283 patients; among them, 163 (57.6%) patients had sarcopenia at the time of admission to the convalescent rehabilitation ward. In the multiple regression analysis, sarcopenia was independently associated with FIM-m at hospital discharge, even after adjusting for confounders (ß = -0.100, p = 0.034). CONCLUSIONS: Sarcopenia at admission in elderly patients with stroke affected the FIM-m at discharge, even after adjusting for multiple confounders.

Approaches to Promote Reduction in Sedentary Behavior in Patients With Minor Ischemic Stroke: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to determine whether an approach that promotes reduction in sedentary behavior (SB) during hospitalization and after hospital discharge reduces SB in patients with minor ischemic stroke (MIS) compared with an approach that promotes an increase in physical activity levels. DESIGN: Randomized controlled trial design. SETTING: During hospitalization and after hospital discharge. PARTICIPANTS: We randomly assigned patients (N=61) with MIS (average age, 71.3±8.3y; 65.6% men) admitted to an acute hospital to either the intervention group (reduced SB, n=31) or the control group (increased physical activity levels, n=30). INTERVENTIONS: During hospitalization, the intervention group received education on reducing SB, goal setting for SB after hospital discharge, and self-monitoring of SB and step count. In contrast, the control group received education on increasing physical activity levels and self-monitoring of step count. Patients in both groups wore an accelerometer during hospitalization until 3 months after hospital discharge. The intervention group received self-monitoring of SB and step count, stickers including information about reducing their SB, and phone calls once every 2 weeks for encouragement and feedback. The control group only wore the accelerometer. MAIN OUTCOME MEASURES: The primary outcome was SB (in percentage) at 3 months after hospital discharge. RESULTS: There was an interaction between the 2 groups for SB. Compared with the control group, the intervention group showed a significantly reduced SB (intervention group: baseline, 70.5%; 3 months after hospital discharge, 48.6%; control group: baseline, 71.5%; 3 months after hospital discharge, 57.5%; F value=5.981; P=.018). CONCLUSIONS: The results suggested that an approach that promotes SB reduction during hospitalization and after hospital discharge is effective in reducing SB in patients with MIS 3 months after hospital discharge.

Depression Is Associated with Chronic Pain in Disabled Older Adults.

BACKGROUND: The association between depression and chronic pain has been clearly demonstrated in healthy older adults, but not in older adults with disabilities. This study thus aimed to clarify the association between depression and chronic pain in older adults with disabilities. METHODS: In total, 92 older adults aged 65 years or older subscribed to Japanese long-term care insurance services were included in this study. Depression was assessed using the Geriatric Depression Scale-Short Version-Japanese (GDS-S-J) and was diagnosed among respondents who scored 6 or more points. Chronic pain was assessed using a questionnaire and defined as a "pain that persists in the present and has lasted for more than three months." RESULTS: Chronic pain was associated with depression in older adults with disabilities (odds ratio: 3,355, 95% confidence interval: 1,232-9,135, p = 0,018). There was a strong association between severe chronic pain and depression (odds ratio: 3,699, 95% confidence interval: 1,345-10,173, p = 0,011). CONCLUSION: Our findings suggest that it is necessary to focus on intensity of chronic pain to improve depression in older adults with disabilities who are more difficult to treat than healthy older adults.

Chronic pain in the frail elderly mediates sleep disorders and influences falls.

AIM: Previous studies have highlighted the causation between chronic pain and falls in the elderly, but the mediator variables between chronic pain and falls in the frail elderly have not been identified. The purpose of this study was to identify the mediator variable of chronic pain and falls. METHODS: This study is a prospective cohort study. Participants were 116 frail elderly individuals living in a community. Chronic pain (pain lasting more than 3 months) was assessed using a questionnaire, and the occurrence of falls was tracked using a falls calendar. Using logistic regression, a model was created with falls as the dependent variable and chronic pain and confounders as independent variables. The mediation analysis was conducted with chronic pain as the independent variable, falls as the dependent variable, and factors that showed significant differences between the chronic pain group and the non-chronic pain group as candidate mediators. RESULTS: Even after adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.004, 95% CI [1.226, 7.363], p=0.016). The results of mediation analysis showed a significant direct effect between chronic pain and falls, and a significant indirect effect (partial mediation) of sleep disorders on the relationship between chronic pain and falls. CONCLUSIONS: Chronic pain in frail elderly mediates sleep disorders and influences falls. It is suggested that interventions for chronic pain and sleep disorders should focus on preventing falls in the frail elderly.

Sleep efficiency affecting the occurrence of falls among the frail older adults.

The purpose of this study is to clarify whether reduced sleep efficiency affects the occurrence of falls among the frail older adults. This was a prospective cohort study. The subjects were frail older adult individuals living within a community, attending an older adult care center. Variables assessed include sleep efficiency, walking ability, history of cerebrovascular disease, depressive symptoms, cognitive impairment, chronic pain, frequency of sleeping medication use, and frequency of nocturnal urination. A fall calendar was used to record daily falls over a 6-month period beginning after administering a baseline survey. The Mann-Whitney U test was used to analyze the association between sleep efficiency and the occurrence of falls. Logistic regression analysis showed a significant association between falls and sleep efficiency. In conclusion, after adjusting for multiple confounders, reduced sleep efficiency did affect the occurrence of falls. Accordingly, approaches for improving sleep efficiency could offer new strategies toward fall prevention.