Search Results (56)

Background and Objectives: Discharge planning after hip-related fracture surgery may depend on both the surgical method and functional recovery achieved during convalescent rehabilitation. This single-center retrospective cohort study aimed to determine whether discharge pathways differed according to surgical procedure and whether functional recovery patterns differed according to surgical procedure and discharge pathways among patients admitted for convalescent rehabilitation after hip-related fracture surgery. Materials and Methods: This retrospective cohort study reviewed the EMRs of patients admitted to a convalescent rehabilitation hospital between January 2021 and June 2025 after hip-related fracture surgery. Surgical groups were hip hemiarthroplasty (HA), total hip arthroplasty (THA), and internal fixation (IF). Discharge pathways were classified into three categories: home discharge, transfer to an acute-care hospital, and transfer to a long-term care hospital. In this study, home discharge was operationally defined as discharge to the patient’s home or transfer to a nursing hospital. Functional outcomes included the functional ambulation category (FAC), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE); complete-case analysis was applied for functional outcomes. Results: In the overall postoperative cohort (N = 445), discharge pathway distributions differed across surgical groups. In the complete-case traumatic hip-related fracture cohort (N = 243), all groups showed significant improvements from admission to discharge in FAC, BBS, MBI, and MMSE. Between-group comparisons of change scores by surgical method were generally modest. In contrast, discharge pathways showed clearer associations with recovery. Patients achieving home discharge demonstrated greater improvements in FAC, BBS, and MBI measures than those transferred to acute care or nursing homes. Conclusions: Functional recovery was observed across all surgical groups during convalescent rehabilitation. Discharge disposition appeared to be more closely associated with recovery in gait, balance, and ADL performance than with surgical method alone; however, this finding should be interpreted cautiously because discharge decisions may also be influenced by patient and social factors. Full article

Background: Wrist–forearm orthoses used during self-feeding may alter scapular and shoulder mechanics and increase proximal load, but this has not been quantified. Methods: Seventeen right-hand-dominant young adults performed a spoon-feeding task under free and restricted conditions. A thermoplastic wrist–forearm orthosis positioned the wrist at approximately 30° dorsiflexion at rest and was intended to constrain wrist motion during the task without rigidly immobilizing forearm pronation–supination. Three-dimensional kinematics (scapula, shoulder, trunk, and distal joints) were recorded using inertial sensors, and surface electromyography was obtained from the upper trapezius, middle deltoid, and biceps brachii. Maximum joint angles and mean %MVC over the feeding cycle were compared between conditions (α = 0.05). Results: The restriction condition resulted in a more anteriorly tilted and downwardly rotated scapular posture, greater shoulder abduction and external rotation, and increased thoracic flexion, whereas maximum distal joint angles did not differ, suggesting a functional distal constraint rather than rigid immobilization. Middle deltoid and biceps brachii activities increased significantly, with a nonsignificant trend toward higher upper trapezius activation. Conclusions: In healthy young adults, limited wrist motion and forearm rotation during spoon-feeding were associated with altered proximal coordination, including scapular, shoulder/trunk, and proximal muscle changes. Full article

Background/Objectives: Franz Tappeiner (1816–1902) is often celebrated as a pioneer of alpine medicine and the founder of Tappeiner Promenade in Meran (South Tyrol, Italy). However, his legacy extends far beyond the scenic infrastructure, encompassing a comprehensive vision of physical activity as a public health intervention. His multidisciplinary practice anticipated the principles of contemporary rehabilitation, preventive medicine, and climate-sensitive public health. Methods: This historical public health analysis, combining biographical, contextual, and material–spatial approaches, reinterprets Tappeiner’s writings, institutional engagements, and civic projects through the lens of modern public health frameworks. Drawing on primary materials (e.g., published articles, autobiographical fragments, and commemorative texts) and recent evidence from rehabilitation and environmental health research, these contributions were contextualized. Results: Tappeiner’s early focus on infectious disease prevention (e.g., cholera and tuberculosis) transitioned into a strategic emphasis on recovery and behavioral therapy through environmental design. The walking therapy model of Max Joseph Oertel, locally realized in the Tappeiner Promenade, prefigured modern concepts such as structured green rehabilitation, walkability, and urban-health citizenship. His systematic integration of graded walking into civic infrastructure represents one of the earliest documented examples of embedding physical activity promotion at the population level. He contributed substantial personal funds to the path’s construction, embedding therapeutic gradients, curating vegetation, and promoting inclusive design to support convalescence. Contemporary research supports the intuition that green, low- to moderate-intensity walking improves cardiometabolic health, psychological well-being, and functional capacity. Moreover, his integrative ethos, merging clinical medicine, civic ethics, and spatial intervention, parallels contemporary eco-social models of public health. Conclusions: Franz Tappeiner’s career exemplifies a still-relevant model of physician leadership that is empirically grounded, socially accountable, and ecologically attuned, with physical activity promotion embedded as a central element of his public health vision. His work invites reflection on how medical professionals can shape not only individual care but also urban environments and collective health futures. Full article

Background and Objectives: Phase angle (PhA) derived from bioelectrical impedance analysis reflects muscle quality and cellular integrity and has been associated with functional outcomes after stroke. However, its relationship with functional status at hospital admission and potential sex-based differences remains unclear. This study investigated the association between PhA and functional status at admission in post-stroke patients undergoing convalescent rehabilitation. Materials and Methods: This retrospective study included 250 post-stroke patients admitted to a convalescent rehabilitation hospital. PhA was measured at admission and classified into high and low groups using sex-specific cutoffs. Functional status was assessed using the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Korean version of the Modified Barthel Index (K-MBI). Sex-stratified logistic regression analyses were conducted to examine associations between functional variables and low PhA. Results: Patients with low PhA showed significantly poorer balance, ambulation, and activities of daily living (ADL) than those with high PhA. In men, low balance (BBS < 41) and low ambulation ability (FAC < 3) were independently associated with low PhA. In women, low ADL performance (K-MBI < 75) was independently associated with low PhA, while balance and ambulation were not. Conclusions: PhA was significantly associated with functional status at admission in post-stroke patients, with distinct sex-specific patterns. PhA may serve as a simple and non-invasive adjunct indicator of functional vulnerability when interpreted with consideration of sex differences. Full article

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002–2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129–0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities. Full article

Background: Visual search supports action planning and target selection in daily life. Despite toileting being frequent yet high-risk in rehabilitation, gaze analyses specific to toileting remain limited. This study quantified visual search behavior during the approach phase of toileting. Methods: Twenty inpatients aged 65 years or older in a convalescent rehabilitation ward participated in the study. At the time of hospital admission, their gaze behavior from toilet room entry to arrival at the bowl was recorded using an eye tracker (Tobii Pro Glasses 2). Moreover, we evaluated a toilet-functional independence measure (toilet-FIM), comprising toileting, toilet transfer, and locomotion at discharge. Results: In multiple regression, a longer total gaze time directed towards the toilet seat was associated with a greater toilet-FIM independence (β = 0.446), whereas prolonged gaze to the toilet rim (β = −0.839) and to the right handrail (β = −0.621) were related to lower independence (adjusted R² = 0.715). Conclusions: A toilet seat-oriented gaze implies effective action planning for safe sit-down, whereas toilet rim- or handrail-oriented gazes may reflect responses to visual salience or compensatory visual strategies related to reduced independence. These observations could improve our understanding of older patients’ motor planning and spatial perception in toileting. Full article

Background/Objectives: Sarcopenia and malnutrition are common in post-stroke patients, impairing recovery. Medium-chain triglycerides (MCT) may support muscle metabolism, while chair-stand exercises improve strength and mobility. However, their combined effects remain unclear. This study evaluated the synergistic effects of MCT supplementation and high-frequency chair-stand exercise on physical function and muscle health in post-stroke patients. Methods: A retrospective cohort study included 1080 post-stroke patients categorized into three groups: (1) MCT supplementation alone, (2) chair-stand exercise alone, and (3) both combined. MCT supplementation consisted of ~40 g/day MCT oil or powder. Functional outcomes were assessed using the Functional Independence Measure (FIM-motor), while muscle health was evaluated by handgrip strength (HGS) and skeletal muscle index (SMI). Multiple linear regression analyses were performed, adjusting for confounders. Results: The combined intervention group showed significantly greater improvements in FIM-motor scores at discharge (B = 8.79, 95% CI: 5.64–11.95, β = 0.32, p < 0.001) and FIM-motor gain (B = 6.02, 95% CI: 3.42–8.62, β = 0.29, p < 0.001) compared to the control. Increases in HGS (B = 2.441, 95% CI: 0.483–4.398, β = 0.18, p = 0.015) and SMI (B = 0.194, 95% CI: 0.102–0.419, β = 0.12, p = 0.039) were also observed. Chair-stand exercise was performed a median of 62 times/day and independently improved outcomes, while MCT alone had limited effects. Conclusions: MCT supplementation combined with chair-stand exercise enhances functional recovery and muscle health in post-stroke patients, supporting its role in rehabilitation. Further research is needed to evaluate long-term effects and to examine the pharmacokinetics of MCTs, including blood concentrations, in broader populations. Full article

Post-surgical central nervous system infections (PCNSIs) are a major cause of morbidity, poor functional outcomes and mortality in neurosurgical patients. These infections complicate operations of the CNS or are related to the use of neurosurgical devices or drainage catheters. Gram-negative bacteria, with multiple resistance patterns, are often isolated and these infections are difficult to treat, due to suboptimal antibiotic therapeutic levels in the cerebrospinal fluid (CSF). This is a retrospective study of PCNSIs between 2014 and 2024 in a single center of a tertiary hospital in Thessaloniki, Greece. Out of 2401 neurosurgical procedures, forty-one were complicated by PCNSIs, yielding a total PCNSI prevalence of 1.7%. Thirty-five involved cases with positive CSF culture. The most common interventions were craniotomies for the resection of tumors or other lesions (30.1%). Most cases referred to an EVD infection. Acinetobacter baumannii was the most commonly isolated pathogen (34.1%), followed by coagulase-negative Staphylococcus (22%) and Pseudomonas spp. (14.6%). Colistin and tigecycline were the most prescribed combination regimens. The median time to the first positive CSF culture postoperatively was 11 days (IQR 18 days). Empirical antibiotic treatment was adequate in 26 (63.4%) cases. The mortality rate among these patients was 65.7%. Survivors were significantly younger than non-survivors (p < 0.01) and had a shorter ICU length of stay (p < 0.01). The type of infection, time to infection onset, isolated pathogen, susceptibility to the empirical treatment and Charlson Comorbidity Index did not differ between the two groups. The mortality rate remains high in patients with PCNSIs. An integrated approach including surgical source control, supportive care, combination antimicrobial therapy and subsequent rehabilitation are mandatory to achieve treatment success and neurological convalescence. Full article

Background/Objective: This study aimed to investigate the relationship between rehabilitation effectiveness (RE) and pre-admission Clinical Frailty Scale (CFS) scores and energy intake. Methods: This retrospective observational study included 735 patients (81 ± 10 years; male: 27.5%) with musculoskeletal disorders discharged from convalescent rehabilitation wards between April 2018 and April 2024. The patients were classified into four groups based on their CFS scores (non-frail, CFS 1–3; frail, CFS ≥ 4) and rate of energy intake (energy-sufficient vs. energy-deficient). Group comparisons of RE were conducted, and the relationships between the CFS score, energy intake, and RE were analyzed. Results: The RE was significantly lower in the frail/energy-deficient group (53.6 [41.9–78.1]) than in the non-frail/energy-sufficient (78.5 [61.8–90.7]), non-frail/energy-deficient (70.6 [53.4–87.4]), and frail/energy-sufficient (59.9 [41.9–78.1]) groups. Additionally, the frail/energy-sufficient group had significantly lower RE scores than the non-frail/energy-sufficient and non-frail/energy-deficient groups. A multiple linear regression analysis revealed that age, male sex, CFS score, energy intake, handgrip strength, Functional Oral Intake Scale score, Mini Nutritional Assessment-Short Form score, B-type natriuretic peptide, and creatinine were significantly associated with the RE. Conclusions: Both frailty and inadequate energy intake reduce the rate of improvement in activities of daily living in patients with musculoskeletal diseases. Full article

Background/Objectives: Total hip arthroplasty (THA) is an effective surgical intervention for restoring hip function and alleviating pain caused by osteoarthritis, femoral head avascular necrosis, or fractures. Despite its benefits, postoperative recovery is influenced by various factors, among which sarcopenia plays a critical role. This study aimed to analyze the characteristics of sarcopenia in THA patients admitted to a convalescent rehabilitation hospital and examine its relationship with functional variables such as balance and gait independence. Methods: This cross-sectional study included 84 THA patients, categorized into sarcopenia and non-sarcopenia groups using the Asian Working Group for Sarcopenia 2019 criteria. Data were collected on demographic characteristics (e.g., age, gender, height, weight, range of motion (ROM), manual muscle test (MMT)) and functional variables, including balance (Berg Balance Scale, BBS) and gait independence (Functional Ambulation Category, FAC). Results: The prevalence of sarcopenia among THA patients was 44.05%. Significant differences were observed between the sarcopenia and non-sarcopenia groups in sex, age, height, weight, ROM, MMT, BBS, and FAC (p < 0.05). Logistic regression analysis showed that advanced age increased the likelihood of sarcopenia (OR: 1.072, p < 0.05), whereas higher body weight reduced it (OR: 0.784, p < 0.05). However, sarcopenia was not significantly associated with balance (BBS: p = 0.710) or gait independence (FAC: p = 0.990). Instead, a significant positive correlation was found between FAC and BBS (OR: 0.413, p < 0.001), as well as BBS and FAC (OR: 0.467, p < 0.001), indicating that better balance was associated with greater gait independence and vice versa. Additionally, patients who underwent THA due to fractures had a lower FAC compared to those with osteoarthritis (OR: −0.276, p = 0.018). Conclusions: Sarcopenia is prevalent among THA patients, and functional variables such as balance and gait independence are closely associated. Additionally, age and body weight were identified as key factors related to sarcopenia. These findings emphasize the importance of early detection and management of sarcopenia in rehabilitation hospital settings and highlight the significance of functional variables in recovery. Full article

Background/Objectives: Knowledge about the safety and effectiveness of early post-stroke mobilization and its correlation with various factors is necessary to select an appropriate rehabilitation program and reduce the time of convalescence. Understanding the above processes will help to effectively lower the economic burden. Thus, we conducted a review to assess the safety and effectiveness of early post-stroke rehabilitation and the impact of various factors on the course of therapy. Methods: The analysis included publications meeting the inclusion criteria published in the years 2015–2024 in Web of Science, Scopus, Embase, and PubMed. Finally, 12 studies were qualified for the review. The study group ranged from 37 to 2325 people. Results: The results of studies on early stroke mobilization indicate possible benefits, including reduced time of hospitalization and faster achievement of higher functional scores. It has been shown that the important factors correlating with the effectiveness of therapy include: rehabilitation intensity, age, functional status before the stroke, depression, social support, lesion location, lower extremity deep vein thrombosis, cognitive disorder, dysphagia, and lower limb spasticity. Conclusions: There is a strong need for research into post-stroke rehabilitation to speed up recovery times and reduce the economic burden on the country. Current research findings on the efficacy and safety of early rehabilitation are inconsistent. There is a strong need for international guidelines. Full article

Background/Objectives: Malnutrition significantly hinders recovery in patients undergoing convalescent rehabilitation. Proper nutritional management can improve rehabilitation outcomes. This study aimed to develop a novel nutritional screening method (J-Method) specifically in patients undergoing convalescent rehabilitation and compare it with the widely used Mini Nutritional Assessment Short Form (MNA-SF). Methods: We developed the J-Method for convalescent rehabilitation settings and compared its results with that of the MNA-SF. The J-Method comprised six items derived from various nutritional screening methods and obtained solely from medical records, without patient interviews. Data from 148 patients aged > 65 years with cerebrovascular diseases admitted to a convalescent rehabilitation ward (CRW) were collected. Nutritional status was evaluated using the J-Method and MNA-SF, after which the results were compared. Results: It is possible that the J-Method more precisely identified patients as malnourished than did the MNA-SF (J-Method: MNA-SF = 36/148 (24.3%): 111/148 (75.0%)). In detail, 75 (50.4%) were classified as having malnutrition by the MNA-SF but as non-malnutrition by the J-Method; however, no patients were in the opposite scenario. In addition, the results of nutritional screening using the J-Method identified patients in need of nutritional management intervention and suggested that to improve the rehabilitation effect, nutritional management should be initiated in an acute hospital before admission to a CRW. Conclusions: The J-Method may be more effective than the MNA-SF for nutritional screening in convalescent rehabilitation settings, as it provides a more accurate assessment of malnutrition without requiring patient interviews. Full article

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted with acute stroke patients admitted within 90 days of onset to the rehabilitation hospital. Participants were divided into a stroke with sarcopenia group and a stroke without sarcopenia group. Evaluations were conducted at baseline, 4 weeks, and 8 weeks, including the following assessments: manual muscle testing (MMT), Berg Balance Scale (BBS), functional ambulation category (FAC), and Modified Barthel Index (MBI). Both groups received an identical rehabilitation program for 8 weeks. Results: Significant within-group improvements were observed in both groups across all measures (p < 0.05). However, the stroke with sarcopenia group showed significantly less improvement in MMT, BBS, FAC, and MBI compared to the stroke without sarcopenia group at both 4 and 8 weeks (p < 0.05). Conclusions: These results underscore the significant impact of sarcopenia on functional recovery in stroke patients, despite both groups receiving identical rehabilitation programs. The presence of sarcopenia was a critical predictor of poorer outcomes in muscle strength, balance, ambulation, and activities of daily living. Given these findings, specific rehabilitation strategies targeting sarcopenia are needed to improve recovery in stroke patients. Future research should include larger sample sizes, longer follow-ups, and sarcopenic patient-specific rehabilitation programs. Full article

We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge. Full article

Older adults often experience poor oral functions, hindering rehabilitation post-acute disease treatment. However, characteristics of hospitalized patients who would benefit from professional oral-health management (POHM) have not been clarified. Therefore, we aimed to elucidate systemic and oral characteristics of patients requiring POHM during hospitalization in a convalescent hospital. This study included 312 participants admitted to the rehabilitation department of a convalescent hospital for a year. The patients were categorized according to POHM requirements (no-POHM group: 137 patients; POHM group: 175 patients) by discharge. Age, sex, primary disease at admission, Glasgow coma scale (GCS), Functional Independence Measurement (FIM), Mini nutritional assessment-short form (MNA-SF), Functional oral intake scale (FOIS), number of present and functional teeth, Oral Health Assessment Tool (OHAT) scores, and POHM details provided during patient hospitalization were compared. Binomial logistic-regression analysis identified patients requiring POHM as those who had suffered a stroke and had a low number of present teeth, poor overall oral health, low food form, and low motor skills at admission. A high percentage of POHM interventions comprised oral-hygiene care and denture treatment. In summary, patients whose oral health has deteriorated and those experiencing oral-intake difficulties upon admission to a convalescent hospital may require oral-health management. Full article