Clinical impact of non-lying time on hospital-associated functional decline in older patients undergoing transcatheter aortic valve implantation.

The purposes of the present study were: (1) to investigate the relationship between hospital-associated functional decline (HAFD) and non-lying time and (2) to clarify the optimal cut-off value for non-lying time associated with HAFD in older patients undergoing transcatheter aortic valve implantation (TAVI). From January 2021 to December 2022, patients admitted to a university hospital who underwent trans-femoral TAVI were consecutively recruited. We measured short physical performance battery (SPPB) pre and post-TAVI, and non-lying time from post-operative days 3-5. HAFD was defined as at least 1 point decrease in SPPB during pre and post-TAVI. Among 75 patients (47 female, mean age of 84.5 years) enrolled, 14 patients were classified as having HAFD. Non-lying time was significantly shorter in the HAFD group than in the non-HAFD group (371 min vs. 539 min, P < 0.001). Receiver-operating characteristic analysis determined an optimal cut-off value of 477 min for differentiating the patients more likely to experience HAFD (sensitivity, 75%; specificity, 92%; area under the curve, 0.798). The non-lying time could be one of the associated factors of HAFD in older patients with TAVI. Non-lying time of about 480 min (8 h) during hospitalization may be an initial target for preventing HAFD.

Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component "body functions" and 21 from the component "activities and participation". This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. METHODS: The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters' feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. RESULTS: The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. CONCLUSIONS: In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.

Supporting the clinical use of the ICF in Japan - development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 set, its operationalization through a rating reference guide, and interrater reliability study.

BACKGROUND: The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories. METHODS: The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions. For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyse the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts. After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight. RESULTS: Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters. CONCLUSIONS: The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan.

Effect of Post-stroke Depression on Functional Outcomes of Patients With Stroke in the Rehabilitation Ward: A Retrospective Cohort Study.

Objective: To investigate the prevalence of post-stroke depression in a rehabilitation ward and elucidate its effect on functional improvement and outcomes. Design: Retrospective cohort study. Setting: A convalescent rehabilitation ward at a University Hospital. Participants: A total of 114 patients with stroke (mean [SD] age, 67.2 [13.5] years; men, 76) assessed at 2 weeks after admission using the Mini-International Neuropsychiatric Interview were enrolled. Main Outcome Measure: Functional independence measure (FIM) efficiency during hospitalization in the ward. Results: Eleven patients (9.6%) had depression based on the Mini-International Neuropsychiatric Interview. Total FIM efficiency and FIM efficiency in the subtotal of motor items were significantly higher in the non-depression group than in the depression group (median [interquartile range]: 0.69 [0.39-0.95] vs 0.41 [0.24-0.63], P=.027; and 0.56 [0.38-0.80] vs 0.42 [0.18-0.49], P=.023, respectively). Patients in the non-depression group had higher FIM scores at discharge (median [interquartile range]: 116.0 [104.5-123.0] vs 104.0 [82.5-112.0], P=.013, respectively), and were more likely to be discharged home (80.6% vs 36.4%, P=.003). Furthermore, patients in the depression group also stayed significantly longer in the ward (71.0 [36.1] vs 106.1 [43.3], P=.010). Conclusions: Patients with post-stroke depression showed poorer efficiency of functional recovery than those without depression. A future multicenter study with a larger sample size is needed to verify these findings.

REHABILITATION OUTCOMES IN PATIENTS WITH LOWER LIMB AMPUTATION RECEIVING HAEMODIALYSIS: A RETROSPECTIVE COHORT STUDY.

Objective: To compare the functional outcomes of patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis. Design: A retrospective cohort study. Patients: Patients with lower limb amputation who were admitted to a convalescent rehabilitation ward between January 2018 and December 2021. Methods: The primary outcome was the effectiveness of the Functional Independence Measure (FIM) during hospitalisation in the ward. Secondary outcomes included the total and subtotal (motor/cognitive) FIM scores at discharge, gain in the total and subtotal (motor/cognitive) FIM scores, K-level at discharge, length of hospital stay in the ward, rehabilitation time, and discharge destination. Outcomes were compared between the non-haemodialysis and haemodialysis groups. Results: A total of 28 patients (mean [standard deviation] age, 67.0 [11.9] years; men, 20) were enrolled in this study. Among them, 11 patients underwent haemodialysis. The FIM effectiveness was significantly higher in the non-haemodialysis group than in the haemodialysis group (median [interquartile range], 0.78 [0.72 - 0.81] vs 0.65 [0.28 - 0.75], p = 0.038). The amount of rehabilitation and all secondary outcomes were not significantly different between the groups (p > 0.05). Conclusion: Patients with lower limb amputation who were receiving haemodialysis had poorer FIM effectiveness than those not receiving haemodialysis.

Development and assessment of a home environment checklist to evaluate mismatch between patients' ability and home environment.

BACKGROUND: Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital. OBJECTIVES: We developed a simple screening scale - the home environment checklist (HEC) - to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC. METHODS: The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score. RESULTS: The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2=13.2, P=0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P<.01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC. CONCLUSIONS: The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.

Feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set for inpatient rehabilitation: Selection and validity of a set of categories for inpatients in a convalescent rehabilitation ward.

Funahashi R, Mukaino M, Otaka Y, Senju Y, Yoneda C, Ozeki Y, Shimizu Y, Koike T, Saito E. Feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set for inpatient rehabilitation: Selection and validity of a set of categories for inpatients in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2020; 11: 1-8. Objective: To evaluate the feasibility of the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set for inpatients in a convalescent (Kaifukuki) rehabilitation ward. Methods: Overall, 295 inpatients in convalescent rehabilitation wards were rated using the ICF Rehabilitation Set, and the proportion of missing values was investigated. Categories with missing values <10% were selected, and internal construct validity of the total score of the selected categories was examined using Rasch analysis. Results: Missing values were detected in 25 items, of which seven had missing values of ≥10%. No ceiling or floor effects were noted. Rasch analysis of 23 categories with missing values <10% showed a good fit to the model after applying testlet solution and item splitting, which supported the internal construct validity of the ICF Rehabilitation Set. Conclusion: This identified the set of categories of the ICF Rehabilitation Set that could be used for evaluating rehabilitation inpatients. These categories had good internal construct validity based on Rasch analysis.