Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study.

Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence ( P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.

A Haptic-Based Perception-Empathy Biofeedback System with Vibration Transition: Verifying the Attention Amount.

In this paper, a perception-empathy biofeedback (PEBF) system is proposed that supplements the foot pressure status of a paralyzed foot with a wearable vibrotactile biofeedback (BF) vest to the back. Improvements in the ankle dorsiflexion and push-off movement in the swing phase and pre-swing phase, respectively, can be expected after using the proposed system. However, the results of the 3 week pilot clinical tests suggest that significant improvement is only observed for the push-off movement. It is assumed that the attention required to recognize the BF was beyond the ability of the patients. In this paper, a dual task (40 s walking and performing mental arithmetic at the same time) was conducted with the following conditions: no vibrations and providing BF to the lower back and the entire back. According to the results, the ankle joint angle of the paralyzed side at push-off under the entire back condition is statistically significant (p = 0.0780); however, there are no significant changes under the lower back condition (p = 0.4998). Moreover, the ankle joint angle of the paralyzed side at the initial contact is statistically significant with respect to the lower back condition (p = 0.0233) and shows a significant trend for the entire back condition (p = 0.0730). The results suggest that the limited attention capacity of hemiplegic patients fails to improve both dorsiflexion and push-off movements; moreover, ankle motion can be promoted if attention is concentrated on recognizing focalized vibratory feedback patterns.

Relationship between first mobilization following the onset of stroke and clinical outcomes in patients with ischemic stroke in the general ward of a hospital: A cohort study.

OBJECTIVE: The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. METHODS: A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study's eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. RESULTS: The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). CONCLUSION: As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.

Development and pilot clinical evaluation of a haptic-based perception-empathy biofeedback device for gait rehabilitation.

Recent studies have shown that haptic feedback on the body, either at or away from the desired gait parameter to be changed, can improve gait performance. Here we introduced a haptic-based biofeedback device to supplement the foot pressure information of a paretic foot with a wearable vibrotactile biofeedback device attached to the back. This system provides information regarding a patient's foot pressure pattern to the patient and physical therapist. Therefore, the biofeedback system can share information regarding abnormal gait patterns between patients and therapists. This pilot study showed that the device immediately improved the stride length during walking, but not walking speed. Furthermore, subjective reports indicated that synchronizing foot pressure pattern information between the patient and therapist induced higher patient motivation for gait rehabilitation.