Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living.

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95-100 points), moderately disabled (90-65 points), and severely disabled (60-0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.

Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis.

[Purpose] The trunk muscles frequently become weak after stroke, thus impacting overall activities of daily living. However, activities of daily living items closely related with trunk strength remain unclear. This study aimed to clarify the influence of trunk muscle weakness on activities of daily living items. [Subjects] The subjects were 24 stroke patients who fulfilled the following inclusion criteria: first stroke and the absence of severe paralysis, marked cognitive function deterioration, unilateral spatial neglect or apathy. [Methods] According to abdominal strength, the 24 patients were divided into a nonweakness group and a weakness group. For the assessment, we used the stroke impairment assessment set, the Berg balance scale, a simple test for evaluating hand function, grip strength, and functional independence measure scale scores and the results were compared between the groups. [Results] The Berg balance scale score and scores for dressing, toilet use, transfer to bed, and walk items of the functional independence measure were significantly lower in the weakness group than in the nonweakness group. [Conclusion] Our results suggest that weakness of the abdominal muscles adversely impacts the balance of patients with mild stroke as well as their ability to dress, use a toilet, transfer, and walk. Trunk training, including abdominal muscle exercises, can effectively improve the performance of these activities of daily living items.

Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis.

[Purpose] This study aimed to clarify the independent impact of the affected upper and lower limb, trunk, and unaffected side motor functions on activities of daily living in stroke patients using partial correlation analysis. [Subjects and Methods] This retrospective study included 77 stroke patients. Motor functions were assessed using the Stroke Impairment Assessment Set, and the activities of daily living performance was assessed using the Barthel index or Functional Independence Measure. Further, simple and partial correlation analyses were conducted between each motor function and activities of daily living parameter. [Results] Simple correlation analysis identified significant positive correlations for each pair. In contrast, partial correlation analysis only identified significant positive correlations between the affected lower limb or unaffected side functions and the Barthel index or Functional Independence Measure. This discrepancy between the two tests was explained by the significant interaction between the affected upper and lower limb functions and between the trunk and unaffected side functions. [Conclusion] The present study identified the affected lower limb and unaffected side motor functions as the major determinants of activities of daily living performance in stroke patients. These findings suggest that rehabilitation programs can be improved by targeting these areas.

A Case of Acquired Factor V Inhibitor During Bullous Pemphigoid Treatment.

Acquired factor V inhibitor (AFVI) is a rare coagulation disorder caused by the production of anti-factor V antibodies in response to infection, surgery, malignancy, autoimmune disease, antibiotics, or other drugs. Its clinical manifestations vary from asymptomatic to severe; hence, optimal treatment is difficult. Bullous pemphigoid (BP) is an autoimmune disorder caused by autoantibodies against dermal-epidermal junction structural proteins. We describe a patient with BP and AFVI, successfully treated with prednisolone. A 78-year-old Japanese man presented with tense hemorrhagic blisters on his trunk and extremities. Owing to his urinary tract infection and advanced age, oral prednisolone was initiated at 20 mg (0.3 mg/kg/day) for BP. Three weeks after treatment, upper gastrointestinal bleeding, hemorrhagic shock, aspiration pneumonia, and hematuria occurred. An elevated anti-BP180 antibody titer (2050 U/mL) indicated BP, and a prolonged activated partial thromboplastin time (aPTT, >180 seconds) indicated a coagulation disorder; the international normalized ratio was too prolonged to be calculated. Based on low factor V activity (<1%) and an inhibitor pattern in an aPTT cross-mixing test, we diagnosed possible AFVI. Despite BP and AFVI stabilization, prednisolone administration (18 mg/day), and normal aPTT, the patient died of septic shock due to cholangitis. In conclusion, clotting-related tests, including factor V tests, should be performed if coagulation disorders persist during the treatment of autoimmune diseases such as BP. There is a hypothesis that immunoglobulin G4 is associated with AFVI and BP and that there is a homologous sequence between factors Ⅷ and V and the BP180 protein. This may explain the immediate resolution of the disease after prednisolone administration.

Relationship between Activities of Daily Living of Home-Based Rehabilitation Users and Caregiver Burden-Induced Depression: A Retrospective Study.

This study was aimed at determining the cutoff values of activities of daily living (ADL) and the combination of related factors associated with high caregiver burden that induces depression among caregivers. The study participants included 50 pairs of home-based rehabilitation users and their primary caregivers. They were classified into two groups: high-burden and low-burden groups according to the short version of the Japanese version of the Zarit Caregiver Burden Interview score of ≥13 or ≤12, respectively. The cutoff values of ADL and the combination of related factors associated with high caregiver burden were examined using the receiver operating characteristic curve and decision tree analyses. The cutoff value associated with high caregiver burden was 5 points for the controlling bladder item of the Barthel index (BI) (sensitivity: 90%, specificity: 70%). Regarding the decision tree, the controlling bladder item of BI (≤5 or 10 points) was selected as the first layer and the recipient's age (≤78 or ≥79 years) as the second layer. High caregiver burden was identified in 85.7% of the caregivers in whom the score of controlling bladder of BI was ≤5 points and the patient was aged ≤78 years. A score of ≤5 points for the controlling bladder item of BI along with young recipient age was associated with high caregiver burden that induces depression among caregivers. This approach is useful to identify caregivers with high caregiver burden who are at risk for depression.