Does Prehabilitation Reduce Postoperative Length of Hospital Stay after Esophageal Cancer Surgery?

Objectives: At our hospital, prehabilitation has been provided to patients undergoing esophageal cancer surgery since October 2019. This study explored the effects of prehabilitation based on the accumulated database of these patients. Methods: This retrospective cohort study included 621 patients who underwent thoracoscopic subtotal esophagectomy. Multiple linear regression analysis was performed using postoperative hospital stay as the objective variable and age, sex, body mass index (BMI), preoperative ventilatory impairment, left ventricular ejection fraction, preoperative hemoglobin A1c, clinical stage, histological type, operative time, surgical blood loss, postoperative complications, and prehabilitation as explanatory variables. We also performed a multivariate analysis in the subgroup of patients who developed postoperative complications and adjusted for possible confounding factors. Postoperative complications and postoperative hospital stay were compared between patients without (n=416) and with (n=205) prehabilitation. Results: Postoperative complications, age, blood loss, BMI, and ventilatory impairment influenced the overall length of hospital stay. When the analysis was restricted to patients with complications, prehabilitation was added to that list of factors as a substitute for BMI. The rate of postoperative complications was not affected by prehabilitation (P=0.1675). The number of hospital days did not change with or without prehabilitation in the overall population, but when restricted to patients with complications, the number of hospital days was significantly decreased in the prehabilitation group (P=0.0328). Conclusions: Prehabilitation as a perioperative approach has the potential to reduce the postoperative length of hospital stay in patients undergoing esophageal cancer surgery, and active intervention is recommended.

Changes in Testing and Treatment Methods in Osteoporosis Care.

Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.

Relationship between sacral-abdominal wall distance, movement performance, and spinal alignment in osteoporosis: a retrospective study.

BACKGROUND: Aging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to investigate the relationship between the sacral vertebra-abdominal wall distance (SAD) and movement performance using a simple lateral spine X-ray image for measuring the SAD. METHODS: In this retrospective study, we included women aged ≥ 65 years who were attending the outpatient clinic for osteoporosis at our hospital. A total of 287 patients (mean age ± SD, 76.8 ± 7.1 years) with measured SAD were included in the analysis. Patients were divided into two groups based on SAD cutoff (160 mm) and age (75 years), respectively. The patients were examined using the two-foot 20 cm rise test, 3 m Timed Up and Go (TUG) test, two-step test, open-eyed one-leg standing time, and spinal alignment. Normally distributed data are expressed as means (standard deviations) and non-normally distributed data as medians (interquartile range), depending on the results of the Kolmogorov-Smirnov test. Student's t-test and χ2 test were used for between-group comparisons. Regression analysis was performed with SAD as the objective variable. A two-sided p < 0.05 was considered statistically significant. RESULTS: The shorter SAD group performed better in the two-step test, TUG test, and open-eyed one-leg standing time (p < 0.001) as well as in the two-foot 20 cm rise test (p < 0.01) compared to the longer SAD group. Spinal alignment was better in the shorter SAD group than in the longer SAD group, with a shorter sagittal vertical axis (p < 0.001), smaller pelvic tilt (p < 0.001), and greater sacral slope (p < 0.05). CONCLUSION: SAD was associated with posterior pelvic tilt and movement performance parameters. In addition to testing for osteoporosis, movement performance parameters should be evaluated in women with osteoporosis who are aged ≥ 65 and have greater SAD (≥ 160 mm in this study). The SAD is a new assessment method, and further research is required to verify its validity and reproducibility. This is the first attempt to determine how age and SAD affect movement performance in older adults.

Effects of the abacus-based mental calculation training application "SoroTouch" on cognitive functions: A randomized controlled trial.

This study investigated the effect of a home-based computerized cognitive training program that utilizes a digital application for training abacus-based mental calculations, "SoroTouch," on the cognitive functions of healthy middle-aged and older people using a randomized controlled trial. The participants were 20 adults (aged 42-79 years) who were involved in community-based activities for dementia prevention held by a certain organization. The participants were assigned randomly to the intervention (SoroTouch) group or control group. The SoroTouch group received home-based cognitive training with SoroTouch, being asked to use the software every day for 6 months, while the control group did not receive any intervention. To investigate the effect of SoroTouch, CogEvo, a cognitive functions test battery utilizing a tablet device, was administered to all participants once per month during the 6-month intervention period. In addition, before and after the intervention, all participants were asked to take the CogEvo and the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The analyses showed that the SoroTouch group did not improve total scores of the CogEvo and MoCA-J, but large group differences were observed in the two tasks of the CogEvo as follows: 'Follow the order' (modified Trail Making Test) at 2 months after the beginning of the intervention (group differences; 39.4, 95% confidence interval; 7.6-71.2) and 'Route 99' at 6 months (group differences; 39.6, 95% confidence interval; 4.9-74.4). These results provide evidence that a home-based computerized cognitive training program SoroTouch has the potential to improve working memory, attention and planning in healthy middle-aged and older adults.

The use of color-changeable chewing gum in evaluating food masticability.

PURPOSE: We assess masticatory performance using color-changeable chewing gum, which shifts from yellow-green to red upon chewing. Previous studies used a colorimeter to reveal the cut-off a* values of the gum's color (a* represents the degree of color between red and green) to determine which foods are masticable (masticable meat, masticable soft side dish, and inadequate masticatory performance). Since a more convenient method is required, we examined the validity and reliability of visual measurement using a color scale to indicate masticable foods by observing the chewing gum's color. METHODS: Fifty patients (male, 48%), aged ≥ 65 (mean, 82.6) years were enrolled. Using color-changeable chewing gum, three groups were formed according to the cut-off a* values: masticable meat, masticable soft side dish, and inadequate masticatory performance. For the color scale classification, one physiatrist and one dietitian simultaneously, individually, and visually determined the chewing gum color and classified it into one of the three groups. Criterion-related validity was evaluated using the kappa coefficient of agreement between the results from the two methods. Inter-rater reliability was examined using the kappa coefficient of agreement between the three groups judged by the two raters on a color scale. RESULTS: The kappa coefficients of the agreement for the classifications were 0.908 and 0.909 for the physiatrist and dietitian, respectively. The inter-rater agreement between two raters on the color scale was 0.938 for the kappa coefficient. CONCLUSION: The color scale indicated masticable foods without a colorimeter. This method can be useful in older adult facilities and homes.

Association between oral health status and functional independence measure on admission in convalescent hospitalized patients.

BACKGROUND: Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. METHODS: We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. RESULTS: The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42-97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. CONCLUSIONS: The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement.

Diagnosis and evaluation of elderly-onset myasthenia gravis: A case report.

RATIONALE: Patients with elderly-onset myasthenia gravis can have a good prognosis with appropriate diagnosis and response, although it is difficult to differentiate between exacerbations of myasthenia gravis in elderly patients and age-related changes. Therefore, it is important for physicians to understand the clinical characteristics and safe assessment methods for patients with elderly-onset myasthenia gravis. PATIENT CONCERNS: An 82-year-old male diagnosed with myasthenia gravis 6 months prior had no difficulty in daily living. After falling on a golf course, he was diagnosed with a right femoral neck fracture on the 1st day and underwent right total hip replacement surgery on the 12th day, being transferred to our hospital for rehabilitation therapy on the 32nd day. However, immediately after transfer, the patient showed fatigability during training and difficulty swallowing food. DIAGNOSES: This case was diagnosed as an exacerbation of myasthenia gravis. INTERVENTIONS: Pyridostigmine was initiated with the expectation of immediate effect on the 54th day. OUTCOMES: His symptoms and physical functions improved immediately, and walking distance and food intake increased. From this clinical course, it was judged that immunosuppressive therapy was indicated as a transition to generalized myasthenia gravis. For this reason, he was discharged after arranging postdischarge visits to the department of neurology, accordingly. LESSONS: A better understanding of the characteristics of elderly-onset myasthenia gravis may allow for relatively safe assessment of the condition and improve its diagnosis and treatment.

The Association between Oral Health Management and the Functional Independence Measure Scores at the Time of Admission of Inpatients to a Convalescent Hospital.

Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.

Planning and effectiveness of intensive rehabilitation as a treatment for a patient with neurosarcoidosis: A case report.

INTRODUCTION: Neurosarcoidosis tends to prolong the duration of treatment and may result in a decline in physical function requiring rehabilitation. Because of a rare disease, the adjustment of oral steroid dosage, which is the cornerstone of treatment, is highly dependent on professional experience in general. Therefore, the number of hospitals that can perform dosage adjustment is very limited, and it is difficult to provide concurrent intense rehabilitation at the same hospital over a long period of time, and there are no reports that mention this. PATIENT CONCERNS: A 49-year-old man, who presented with impaired consciousness, dysphagia and right hemiplegia, was diagnosed with neurosarcoidosis based on a previous diagnosis of sarcoidosis, laboratory test results, and clinical symptoms. High-dose oral steroid therapy was initiated and he was transferred to our rehabilitation hospital for progressive disuse approximately 2 months after the disease onset. DIAGNOSES: This case was diagnosed as "probable" neurosarcoidosis. INTERVENTIONS: The steroid dose was not reduced during rehabilitation treatment in our hospital considering the risk of relapse of the primary disease due to steroid reduction. His training regimen focused on minimum activities of daily living was performed, and its effectiveness was determined during approximately 60 days after the initiation of rehabilitation. OUTCOMES: Two months after admission, he was independently eating, transferring, and toileting under supervision. He was discharged home 3 months after admission. LESSONS: Intensive rehabilitation can be one of the effective comprehensive treatment strategy for patients with neurosarcoidosis. On the other hand, since there is no consensus treatment method, the duration of rehabilitation and goal setting should be adjusted based on an understanding of the characteristics of the disease and the overall treatment plan.

Decision-making for intensive rehabilitation in patients with Trousseau syndrome: Insights from a case series.

RATIONALE: Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients. PATIENT CONCERNS: The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy. DIAGNOSES: These patients were diagnosed with Trousseau syndrome. INTERVENTIONS: All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined. OUTCOMES: The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month. LESSONS: Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.

Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study.

Since vertebral kyphosis and abdominal circumference are thought to influence sarcopenia and fall risk in osteoporosis, we evaluated sarcopenia and fall risk in patients with different measurements of abdominal circumference and sagittal longitudinal axis (SVA). In this post hoc study, 227 patients aged 65 years or more who visited an outpatient osteoporosis clinic were included in the analysis. Sarcopenia was determined from lean body mass, grip strength, and walking speed by dual energy X-ray absorptiometry; SVA (median 40 mm) and abdominal circumference (median 80 cm) were compared between the four groups, each divided into two groups. Nutritional management, falls, and fall anxiety scores were also examined. The incidence of sarcopenia was significantly increased in those with abdominal circumference < 80 cm in both the SVA < 40 mm and SVA ≥ 40 mm groups (p < 0.05). Nonetheless, the fall scores of those with SVA < 40 mm were lower than those of individuals with SVA ≥ 40 mm (p < 0.01). Based on the results of this study, SVA and abdominal circumference values may predict the risk of sarcopenia and falls. More research is needed before our results can be translated into clinical practice.

Limitation of developmental test to measure functional independence of children: Relationship between the Japanese version of WeeFIM II® and KSPD.

PURPOSE: The purpose of the study was to explore whether a developmental test provides enough information to estimate a child's functional independence. The strength of the relationship between developmental level and functional independence of different skills was investigated. METHODS: The participants were 397 children (age 0-7 years) who were referred to NCCHD for suspected developmental delay. The participants' developmental level was measured with the Kyoto Scale of Psychological Development (KSPD) and their functional independence was assessed through a Japanese version of the WeeFIM II®. To calculate the strengths of the relationship between developmental age (DA) in different domains of the KSPD and WeeFIM II item scores, partial correlation analyses were conducted, controlling for chronological age. RESULTS: Partial correlation coefficients between the score of each of the 18 WeeFIM II items and each of the three KSPD domain DAs (controlling chronological age) fell in the ranges of r = 0.169-0.581 (Posture-Motor; P-M), r = 0.377-0.627 (Cognitive-Adaptive; C-A), and r = 0.332-0.655 (Language-Social; L-S). When the participants were divided into three age groups, the correlations ranged from -0.095 to 0.552 for the youngest group (mean age = 14.21 months), from 0.283 to 0.653 for the middle group (mean age = 32.98 months), and from 0.345-0.692 for the oldest group (mean age = 57.48 months), depending on the combinations of the WeeFIM II items/developmental domains of the KSPD. The results indicated that for most of the daily living skills, its functional independence was only partially explained by the scores of a developmental test, once chronological age was controlled. CONCLUSION: This study showed the limitation of a developmental test as a tool to measure the functional independence of children and the necessity of using an independent tool, such as WeeFIM II, to evaluate the level of required support for each daily living skill.

The Impact of Isolation on Elderly Patients with Mild to Moderate COVID-19.

Objectives: Patients with mild to moderate COVID-19 who require hospitalization are prone to physical inactivity. This study examined the impact of mild to moderate COVID-19 on the activities of daily living (ADLs) of patients who received rehabilitation therapy. Methods: Between February 1, 2020, and January 31, 2021, of 216 patients with mild to moderate COVID-19, 36 were selected for rehabilitation therapy. Of these, 28 received direct rehabilitation therapy, whereas 7 were discharged before rehabilitation therapy could start and 1 carried out indirect rehabilitation. The Barthel Index (BI) scores at the beginning and the end of therapy were compared in 18 patients (10 patients who did not undergo a final BI evaluation were excluded). Results: In total, 27 of the 28 patients receiving direct rehabilitation therapy were more than 65 years of age or had underlying diseases. The BI score decreased in 6 patients and was maintained or improved in 12 patients. However, the 6 patients with decreased BI scores after rehabilitation therapy had significantly higher BI values at the start of therapy (P=0.014). Conclusions: It was considered that the isolated environment of these COVID-19 patients likely resulted in a decrease in activity levels, leading to a decrease in ADLs. Older adults with mild to moderate COVID-19 need to reduce their isolation as much as possible to ensure adequate activity levels.

Immediate effect of different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle on walking ability in individuals with chronic stroke: a randomized crossover trial.

[Purpose] To investigate how different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle affect the walking ability in individuals with chronic stroke. [Participants and Methods] In this randomized crossover study, participants underwent a 10-m walking test and walked on a WalkWay MW-1000 three times under these conditions: (1) without ankle-foot orthosis; (2) with ankle-foot orthosis with an adjustable posterior strut at 5° of fixed dorsiflexion; and (3) with ankle-foot orthosis with an adjustable posterior strut at 5-20° of restricted dorsiflexion. The primary outcome was walking speed on the 10-m walking test. The secondary outcomes were walking speed and spatiotemporal factors measured by the WalkWay MW-1000. [Results] Fifteen individuals (mean [standard deviation] age, 60.9 [8.6] years; male, 12) were enrolled. Walking speeds of the ankle-foot orthosis with fixed and restricted dorsiflexion groups were significantly higher than those without the orthosis; however, no outcomes differed significantly between ankle-foot orthosis with fixed versus restricted dorsiflexion groups. [Conclusion] In individuals with chronic stroke, ankle-foot orthosis function may be less important than the dorsiflexed setting of initial ankle joint angle in the ankle-foot orthosis.

The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and meta-analysis.

OBJECTIVE: To evaluate whether ankle-foot orthosis (AFO) has a beneficial effect on dorsiflexion angle increase during the swing phase among individuals with stroke and patient-important outcomes in individuals with stroke. LITERATURE SURVEY: Randomized controlled trials (RCTs), randomized crossover trials, and cluster RCTs until May 2020 were researched through CENTRAL, MEDLINE, EMBASE, PEDro, CINAHL, and REHABDATA databases. Studies reporting on AFO use to improve walking, functional mobility, quality of life, and activity limitations and reports of adverse events in individuals with stroke were included. METHODOLOGY: Two independent reviewers extracted the data and assessed the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. SYNTHESIS: Fourteen trials that enrolled 282 individuals with stroke and compared AFO with no AFO were included. Compared with no AFO, AFO could increase the dorsiflexion angle of ankle joints during walking (mean difference [MD, 3.7°]; 95% confidence interval [CI], 2.0-5.3; low certainty of evidence). Furthermore, AFO could improve walking ability (walking speed) (MD, 0.09 [m/s]; 95% CI, 0.06-0.12; low certainty of evidence). No study had reported the effects of AFO on quality of life, adverse events, fall frequency, and activities of daily life. CONCLUSIONS: Our findings suggest that AFO improved ankle kinematics and walking ability in the short term; nonetheless, the evidence was characterized by a low degree of certainty.

Characteristics and Management of a Cancer Patient with Stroke: A Case Report.

BACKGROUND: The onset of stroke in patients with cancer worsens their performance status and affects the treatment strategy for cancer. Nonetheless, intensive rehabilitation may be able to restore the once-lost therapeutic indications of cancer patients who have suffered a stroke. However, because the mechanism of stroke in patients with cancer varies widely, it is necessary to understand the patient background, including the cause of stroke, the control of the primary cancer, and the patient's overall condition, so as to determine the appropriate rehabilitation regimen. CASE: A 65-year-old man presented with cerebral infarction. He was suspected of having recurrence or metastasis of bladder cancer just before the stroke. Because the patient's performance status worsened with the onset of stroke, it was judged that there was no indication for further investigation and treatment of the bladder cancer, and priority was given to improving his physical function through rehabilitation. Rehabilitation improved the patient's physical function, but in the meantime, the cancer progressed, and he died of cancerous pleural effusion. DISCUSSION: Intensive rehabilitation can be an effective treatment for patients with stroke associated with cancer, but in convalescent rehabilitation wards, it is not possible to combine rehabilitation and cancer treatment. Therefore, for patients whose physical function takes a long time to recover or whose cancer is not under control, it is necessary to make a careful decision on whether intensive rehabilitation is the optimum approach. To facilitate informed decision making, it is important to share information across departments.

Publication Trends in Physical Medicine and Rehabilitation in Japan from 2001 to 2019.

OBJECTIVES: The aim of this study was to examine, using PubMed, the number of articles in the field of physical medicine and rehabilitation medicine originating in Japan, especially those containing high-quality scientific evidence (randomized controlled trials [RCTs], systematic reviews, meta-analyses) and those published in high impact factor journals. METHODS: We searched the PubMed database to identify articles, RCTs, systematic reviews, and meta-analyses from Japan covering physical medicine and rehabilitation published between 2001 and 2019; we then calculated the proportion of articles from Japan. Additionally, using Journal Citation Reports, we selected the top ten highest impact factor journals on "Rehabilitation" each year between 2001 and 2019. For each year, we searched PubMed for the total number of articles in these top ten journals and for articles originating in Japan. The Cochran-Armitage test was used to evaluate the change in the proportion of publications from Japan over time. RESULTS: The proportion of articles on physical medicine and rehabilitation originating in Japan increased from 2001 to 2019 (P<0.0001). An increase in the percentages of systematic reviews (P=0.046) and meta-analyses (P=0.0013) originating in Japan and a decrease in the percentage of original articles published in the top ten highest impact factor journals were demonstrated (P=0.002). However, there was no change in the percentage of RCTs from Japan over time (P=0.055). CONCLUSIONS: Our findings suggest that the proportion of articles from Japan containing high-quality scientific evidence is increasing. However, there is a need to expand the support system for research while considering the quality of research.

Rehabilitation of a Patient with Pirogoff Amputation and Two-year Follow-up: A Case Report.

BACKGROUND: Pirogoff amputation is a calcaneal amputation invented by Nicolás Pirogoff that involves partial preservation of the calcaneus. CASE: A 59-year-old woman was diagnosed with left Lisfranc and Chopart joint fracture-dislocation 9 months after a fall. The patient underwent debridement together with Pirogoff amputation and surgery to place an Ilizarov external fixator. Five months later, the patient was transferred to a rehabilitation hospital. Because of inadequate bone fusion, for 3 months after the amputation the patient underwent gait training with a patellar tendon weight-bearing orthosis to avoid loading the amputated side. After fusion of the bone, the patient was able to walk using a Syme prosthesis and a cane. Three months after discharge from the rehabilitation hospital, the patient was diagnosed with hallux osteomyelitis of the other foot that was associated with the exacerbation of hallux valgus. The patient underwent hallux correction surgery. Three and a half months after the second hospital admission, the patient was again admitted to the rehabilitation hospital. At the end of the rehabilitation program, the patient was able to walk using a cane and a prosthesis. DISCUSSION: Appropriate orthotic treatment and care of the non-amputated limb are of great importance in patients who have undergone a partial foot amputation.

Effectiveness of gait training with lower limb orthosis for a patient with severe Guillain-Barré syndrome at a Kaifukuki rehabilitation ward.

Tanaka M, Wada Y, Kawate N. Effectiveness of gait training with lower limb orthosis for a patient with severe Guillain-Barré syndrome at a Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2021; 12: 48-52. Introduction: We report the case of a patient with severe Guillain-Barré syndrome (GBS), whose ambulation recovered despite requiring total assistance on admission to a Kaifukuki rehabilitation ward. Gait training using knee-ankle-foot and ankle-foot orthoses was highly effective, based on the improvement in lower extremity muscle strength. Case: A female in her 20s was previously diagnosed with GBS and was transferred to a Kaifukuki rehabilitation ward on hospitalization day 57. On admission, the lower extremities had a manual muscle test grade of 1, and the functional independence measure motor score (mFIM) was 13. She began training to stand upright using a tilt table and a knee-ankle-foot orthosis. Gait training with an adjustable posterior strut ankle-foot orthosis was initiated from 9 weeks after admission, with the fixed, brake, resistance, and freedom settings of the orthosis for the ankle joint adjusted according to the improvement in lower extremity muscle strength. At discharge, she was ambulatory without assistive devices and foot orthoses, and her mFIM had improved to 91. She returned to work 2 months later. Discussion: This report describes the effectiveness of standing and gait training with a foot orthosis in improving ambulation in a severe GBS patient admitted to a Kaifukuki rehabilitation ward. Medical management and high-intensity rehabilitation are essential for patients with severe GBS during Kaifukuki rehabilitation.

Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study.

Watabe T, Abe M, Sako R, Suzuki H, Yoda M, Kawate N. Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study. Jpn J Compr Rehabil Sci 2021; 12: 58-63. Objectives: This study aimed to determine the association between the presence of external ophthalmoplegia with diplopia due to brain injury and Functional Independence Measure (FIM) motor items in a case-control study. Methods: The subjects were patients with brain injury, admitted to a convalescent rehabilitation ward, who were able to walk under supervision and had preserved intellectual function. The correlation between the strabismus angle of the external ophthalmoplegia group and the total points of FIM motor items were examined. In addition, the total points and sub-items were compared between the external ophthalmoplegia group and control group using statistical processing. Results: There were 78 subjects: 34 in the external ophthalmoplegia group and 44 in the control group. Strabismus angle and the total points of FIM motor items of the external ophthalmoplegia group were significantly negatively correlated. Compared with the control group, the external ophthalmoplegia group had significantly lower levels of independence in bathing, dressing (lower body), toileting, transfer to the chair, transfer to the toilet, transfer to the bathroom, and locomotion (walking). Conclusions: External ophthalmoplegia with diplopia is associated with FIM motor items.