松浦 大輔

Objective: To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients.Design: Single-institution, prospective cohort study.Subjects/Patients: A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission.Methods: Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2–4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis.Results: Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7–100% of patients performed each subtask independently] to the endpoint [73.3–100%]), Cluster 2 (41 patients who showed less independence upon admission [0–26.8%] but gained greater independence at the endpoint [34.1–73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0–26.7%] to the endpoint [3.3–26.7%]).Conclusion: Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.

BACKGROUND: Anxiety and depression in rehabilitation patients can adversely impact clinical outcomes. They may have anxieties about the differences in their physical conditions and living environments compared to before hospitalization. Although medical staff address patients' anxieties, the content of anxieties and the type of intervention have not been clarified. This study aimed to highlight the contents of anxieties and interventions for patients undergoing rehabilitation, based on medical staff's perspectives. METHODS: Seventeen medical staff were interviewed about the anxieties they perceived patients experience at the convalescent rehabilitation ward (early, middle, and late phases of hospitalization) and the corresponding interventions. Text mining and hierarchical cluster analysis were used to classify the contents of anxieties and interventions. This study was conducted based on the consolidated criteria for reporting qualitative research. RESULTS: Patients' anxieties were classified into six clusters. Among the clusters, prospects for rehabilitation plans, hospital life (e.g., unfamiliar hospital environment), and family situation (e.g., concerns about family life at home) were identified in the early to middle phases, and life at home after discharge was identified in the late phase. The prognosis of physical function and prospects of social life (e.g., return to work) were identified throughout all phases. The types of interventions for these anxieties were classified into eight clusters. The medical staff provided information about patients' prospects and helped them contact family members in the early phase. In the middle phase, feedback on patients' improvement in physical function was incorporated. In the late phase, information on social resources was provided to address anxieties about life after discharge. CONCLUSION: This study showed that patients' anxiety and interventions varied according to hospitalization phases. The findings underscore appropriate ways and the timing of interventions to keep patients in a better psychological state, potentially leading to better rehabilitation outcomes.

The efficacy of cognitive stimulation therapy (CST) in patients with vascular cognitive impairment has not been explored, and no studies investigating CST in the convalescent rehabilitation phase have been reported. This study examined the effect of CST on the cognitive function of patients with vascular cognitive impairment. A randomized controlled, assessor-blinded, single-centered trial with two parallel groups was conducted in a convalescent rehabilitation hospital. Twenty participants were randomly allocated to CST (n=10) and control (n=10) groups. Participants in the CST group underwent two CST sessions a day, five times a week for 8 weeks, in addition to conventional rehabilitation. Participants in the control group underwent conventional rehabilitation only. The primary outcome was the Mini-Mental State Examination (MMSE) score, and the outcome between the groups was compared using a generalized linear mixed model (GLMM). The mean (standard deviation) scores of MMSE increased by 3.50 (3.08) points and 4.50 (1.61) points from baseline to the end of the study (week 8) in the CST and control groups, respectively. The GLMM showed a significant effect of TIME on MMSE (F=21.121, P<0.001), whereas no significant effect on MMSE was observed for GROUP (intervention vs. control, P=0.817) or the interaction term (TIME×GROUP, P=0.649). Although a significant improvement in cognitive function was observed in each group, no significant effect of CST was evident. This result indicates that the effect may have been masked by improvements caused by natural history or rehabilitation. Future studies with a sufficient sample size are required to confirm the findings.

Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24 h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.

OBJECTIVES: Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined. DESIGN: We conducted a retrospective cohort study. SETTING AND PARTICIPANTS: We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital. METHODS: Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated. RESULTS: Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition. CONCLUSIONS AND IMPLICATIONS: The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.