[Purpose] To clarify the association between physical activity measured using a triaxial accelerometer in early after surgery rehabilitation sessions and short-term walking ability in older adult patients with hip fractures and investigate indicators for determining the appropriate intensity and volume of early mobilization. [Participants and Methods] We analyzed 109 patients aged ≥75 years (median, 88.0 years) with hip fractures who underwent surgical treatment. A triaxial accelerometer was used to quantify physical activity. We investigated the association between physical activity (≥1.6 METs) measured early after surgery and walking ability at 1 and 2 weeks after surgery. [Results] The rehabilitation intervention times were 119.0 [104.7-129.3] min/day. Factors associated with walking independence were as follows: 1 week after surgery, fracture type, cognitive function, and physical activity during rehabilitation sessions; 2 weeks after surgery, surgery type, cognitive function, and physical activity during rehabilitation sessions. The cutoff values for physical activity during rehabilitation sessions for determining walking independence were ≥21.6% and ≥17.8% at 1 and 2 weeks after surgery, respectively. [Conclusion] Physical activity during early after surgery rehabilitation sessions affects short-term walking ability. Our findings emphasize the importance of establishing indicators of physical activity and early mobilization during early after surgery rehabilitation sessions.
[Purpose] Patients with hip osteoarthritis commonly exhibit weakened hip abductor (HA) muscles. Accurate assessment of muscle strength is critical; however, the reliability of HA strength measurements remains underreported. This study aimed to evaluate reliability and measurement error for HA muscle strength values measured with a hand-held dynamometer (HHD). [Participants and Methods] Two physical therapists measured HA muscle strength in 20 healthy adults (40 limbs) using an HHD. Participants were positioned supine, with lower limbs placed in a belt loop. Average and maximum values from the two trials were used for analysis. Reliability was assessed using intra-class correlation coefficients (ICCs). To evaluate changes in HA muscle strength, the minimal detectable change (MDC) of normalized strength values was calculated using an equation. [Results] Inter-rater reliability was excellent, with ICCs of 0.95 and 0.92 for average and maximum values, respectively. The associated standard errors of measurement and MDC values were 1.65 and 8.1 for average values, and 2.25 and 10.9 for maximum values, respectively. [Conclusion] Measuring hip abductor muscle strength using an HHD demonstrated excellent reliability. Using average value effectively reduced inter-rater variability and improved reliability.
[Purpose] This study investigated whether shadow throwing-based form instruction improves the "elbow dropped" position during net and partner throwing drills among youth baseball players who have recovered from throwing related shoulder or elbow injuries. [Participants and Methods] Forty-six right-handed male players (ages: 11-15 years) who exhibited the "elbow dropped" position during shadow throwing were analyzed after returning to throwing without pain following recovery from throwing-related shoulder or elbow injuries. The "elbow dropped" position during shadow throwing, net throwing, and partner throwing was evaluated using the SPLYZA Motion application, and occurrence rates were compared. [Results] The occurrence rates of the "elbow dropped" position were 0.0% for shadow throwing, 13.0% for net throwing, and 58.7% for partner throwing. The rate during partner throwing was significantly higher than during the other throwing conditions. [Conclusion] Shadow throwing instruction is effective for early form correction; however, this effectiveness decreases under actual throwing conditions. Phased instruction that incorporates realistic environmental factors, such as net and partner throwing drills, is necessary to maintain proper throwing mechanics.
[Purpose] In this study, we aimed to examine whether within-person changes in physical function are associated with changes in the social function domain score among community-dwelling older adults participating in a municipal community program. [Participants and Methods] A secondary analysis was conducted using longitudinal data of 191 older adults who completed baseline and 6-month follow-up assessments. The social function domain score was calculated using four items from the Eleven-Check questionnaire. Physical function was assessed using the Short Physical Performance Battery. In addition, handgrip strength, Timed Up and Go, and 4-m maximum-pace gait time tests were performed. Changes in each variable were calculated as the 6-month follow-up value minus the baseline value. In addition, Spearman's rank correlation and multiple linear regression analyses were performed. [Results] Changes in the 4-m usual gait time were significantly correlated with changes in the social function domain score. In a regression model adjusted for age and sex, changes in 4-m usual gait time were associated with changes in the social function domain score. The model explained 9.3% of the variance. [Conclusion] 6-month changes in 4-m usual gait time were associated with changes in the social function domain score among community-dwelling older adults.
[Purpose] To examine short-term changes in frailty status over 3 months in older adults attending a hospital-based frailty outpatient clinic and to identify factors associated with frailty improvement. [Participants and Methods] This retrospective observational study included 100 community-dwelling adults aged ≥60 years who attended a hospital-based frailty outpatient clinic and were classified as frail or pre-frail at baseline. The outpatient care program included medical evaluation, nutritional counseling, and individualized home exercise instruction. Frailty was assessed using the Japanese Cardiovascular Health Study criteria at baseline and after 3 months. [Results] Frailty status improved in 51% of participants after 3 months. Among the frailty components, slow walking speed and exhaustion showed the greatest improvements. In multivariable logistic regression analysis, daily home exercise adherence was independently associated with frailty improvement, whereas exercising several days per week or not exercising was associated with significantly lower odds of improvement. [Conclusion] Frailty status improved in approximately half of the participants during 3 months of multidisciplinary outpatient care. Daily home exercise frequency was independently associated with frailty improvement in this real-world clinical setting.
[Purpose] This pilot trial investigated the effects of action observation training on upper limb function and self-care abilities in individuals with mental disorders. [Participants and Methods] Thirty participants with mental disorders were randomly assigned to an action observation training group or a landscape observation training group. Both groups completed 20 sessions over four weeks. The action observation training group observed videos of self-care-related tasks and practiced the corresponding movements, whereas the landscape observation training group observed landscape images and performed free upper-limb movements. Upper limb function was assessed using the Manual Function Test, and self-care abilities were evaluated using the Korean-Modified Barthel Index and Functional Independence Measure. [Results] Significant within-group improvements in Manual Function Test, Korean-Modified Barthel Index, and Functional Independence Measure scores were observed in the action observation training group. Between-group comparisons of change scores showed greater changes in these outcomes in the action observation training group than in the landscape observation training group. [Conclusion] Action observation training may support upper limb function and self-care abilities in individuals with mental disorders. Further studies with larger samples are needed to confirm these preliminary findings.
[Purpose] This study reports: (Aim 1) a feasibility study of a distributed supervision model (DSG) within a smartphone-guided home stroke rehabilitation program incorporating functional electrical stimulation (FES); and (Aim 2) a retrospective cohort comparison of DSG outcomes against a previously published front-loaded supervision group (FSG). [Participants and Methods] Thirty-one adults with chronic hemiparetic stroke (onset >6 months) completed a 6-week multicomponent home exercise program (3 sessions/week, 1 hour/session) incorporating gait, strength, and balance training with FES delivered via smartphone app. FSG (n=12) received 2 weeks of supervised onboarding followed by 4 weeks of independent home training. DSG (n=19) received one supervised and two independent sessions weekly. Pre- and post-assessments included the 10-Meter Walk Test, Mini-BESTest, Berg Balance Scale, Timed Up and Go, and 30-Second Sit-to-Stand Test. [Results] No adverse events were reported. Both groups demonstrated high adherence (DSG: 90.3 ± 10.2%; FSG: 87.3 ± 8.7%) and significant within-group improvements across all outcomes, exceeding minimal clinically important differences. Between-group comparisons showed significantly greater improvements in the DSG on the 30STS (Welch's t, p<0.001, d=1.57, achieved power=0.98) and TUG (p=0.020, d=0.74, achieved power=0.48); contrasts for BBS, Mini-BESTest, and 10MWT were non-significant with low achieved power (0.05-0.21) and are reported as inconclusive. All findings should be interpreted as preliminary given the retrospective, non-randomized design. [Conclusion] Both supervision models demonstrated high feasibility, safety, and clinically meaningful functional gains. Supervision timing may influence the magnitude of functional gains and warrants investigation in future randomized trials.
[Purpose] This study investigated the biomechanical effects of metatarsal bars (MTB) and heel lifts (HL) on lower-limb kinematics and kinetics during gait. [Participants and Methods] Twenty healthy adults underwent three-dimensional gait analysis. Ankle dorsiflexion angle, internal plantarflexion moment, medial longitudinal arch (MLA) height, and gravity movement (GM) were evaluated at 0%, 12%, 31%, and 50% of the walking cycle (WC) and at peak stance. Data were analyzed using two-way repeated-measures ANOVA (condition × WC), followed by Holm-adjusted post-hoc comparisons. [Results] Compared with HL, MTB significantly increased ankle dorsiflexion and decreased MLA height at 31% and 50% WC. Conversely, HL significantly reduced the plantarflexion moment at 12% WC but increased it at 50% WC and peak stance. No significant differences were found in GM, though MTB tended to shift GM posteriorly and HL anteriorly during the latter half of the stance phase. [Conclusion] MTB and HL exhibit distinct phase-specific biomechanical strategies. MTB increases dorsiflexion and reduces MLA height during mid-to-late stance (31-50% WC), suggesting a shock absorption-oriented strategy. In contrast, HL modulates plantarflexion moments to facilitate forward progression. These findings emphasize selecting orthotic components based on specific biomechanical demands at different gait phases.
[Purpose] To examine the immediate effect of self-mobilization exercise program on spatiotemporal, kinematic, and kinetic parameters in gait. [Participants and Methods] Thirty-two healthy adults were randomly allocated to the Exercise group that performed three warm-up positions and seven small movements or the Control group that lay supine. Before and immediately after the interventions, we assessed participants' gait at their self-selected comfortable speeds to capture spatiotemporal parameters, kinematics, and ground reaction force (GRF). [Results] In the Exercise group, the double-support and right stance phases of gait remained unchanged, whereas the left stance phase revealed significant changes after the intervention. Furthermore, the Exercise group demonstrated significant decreases in peak hip flexion and increases in peak hip extension bilaterally, while maintaining a more upright trunk position. Neither group showed significant changes in GRFs or joint angular velocities. [Conclusion] The exercise program altered the dynamic control of the trunk-hip motion in gait. The kinematic changes without concomitant changes in force and joint angular velocity potentially reflect an adjustment of the movement control strategy.
[Purpose] This pilot feasibility case series examined the safety, tolerability, and implementability of a short-term inpatient supine exercise program using a low-load bicycle ergometer in pediatric patients with orthostatic intolerance (OI). [Participants and Methods] Four adolescents with OI who had difficulty attending school participated in a 10-13-day inpatient rehabilitation program. The intervention consisted of daily supine ergometer exercise (5-min warm-up, 15-min active pedaling, 5-min cool-down). Feasibility outcomes included completion rate, adherence, and adverse events. Exploratory clinical outcomes included heart rate (HR) response during standing tests, perceived exertion using a 100-mm visual analog scale (VAS), and school attendance two weeks after discharge. [Results] All participants completed the program without adverse events, demonstrating good feasibility and safety. Adherence to supervised sessions was high, and all patients performed self-training. Improvements in perceived exertion were observed in all cases, whereas changes in HR responses were variable. School attendance improved in three patients, although only two were able to attend more than three days per week. [Conclusion] A short-term supine ergometer program appears feasible, safe, and well tolerated in pediatric patients with OI. Given the small sample size, lack of controls, and reliance on subjective outcomes, these findings should be interpreted cautiously.
[Purpose] To investigate the associations between dynamic balance performance assessed by the modified star excursion balance test (mSEBT) and multiple physical function factors in healthy university students. [Participants and Methods] Thirty-five students from a single university participated in this cross-sectional study. Dynamic balance was evaluated using the mSEBT in the anterior, posterolateral, and posteromedial directions. Physical function variables included ankle range of motion, knee extension strength, ankle plantarflexion strength, back muscle strength, skeletal muscle index, trunk lean body fat-free mass, lower limb lean body fat-free mass (leg FFM), and indices of muscle quality. Spearman's rank correlation coefficients were calculated, followed by forced-entry multiple linear regression analysis for each reach direction. [Results] Bivariate correlation analysis revealed significant associations between mSEBT performance and multiple physical function variables, including ankle plantarflexion strength and lower leg FFM, across all reach directions. In contrast, multiple regression analyses did not identify any significant independent predictors, although some models demonstrated modest explanatory power. [Conclusion] mSEBT performance in healthy university students may be associated with multiple physical function factors rather than a single determinant. Therefore, dynamic balance performance may reflect the combined influence of several physical functional components.
[Purpose] Extension thrust pattern (ETP) during the stance phase is a common gait deviation after stroke; however, there is no consensus regarding the optimal orthosis, such as knee-ankle-foot orthosis (KAFO) or ankle-foot orthosis (AFO). This study aimed to compare the effects of KAFO and AFO on ETP using an N-of-1 trial design. [Participant and Methods] A 54-year-old male with right thalamic hemorrhage and post-stroke hemiplegia participated in this study. A prospective multiple-crossover N-of-1 trial was conducted. Five intervention periods (3 consecutive days each) of KAFO and AFO use were randomly assigned, with a 1-day washout period between interventions. Hip, knee, and ankle joint angles during mid-stance, 10-m walking time, and step count were measured. [Results] KAFO use significantly reduced ankle plantar flexion compared with AFO. A particularly large effect size was observed for the ankle dorsiflexion angle. Improvements in walking time and step count were also noted with KAFO. [Conclusion] KAFO was more effective than AFO in improving ETP in this patient. Objective evaluation using an N-of-1 trial may support more appropriate orthotic selection in clinical practice.
[Purpose] In normal gait, the knee flexes approximately 60° during the swing phase, and the lower leg's inertial force contributes to knee extension during terminal swing, enabling heel-first initial contact and energy-efficient gait. However, slow-walking individuals with hemiplegia generate insufficient inertial force, resulting in inadequate knee extension during terminal swing and difficulty achieving heel strike. When initial forefoot contact occurs, ankle plantar flexors may become excessively active during loading response, reinforcing abnormal movement patterns. This randomized controlled trial investigated the therapeutic effect of a knee extension aid during terminal swing. [Participants and Methods] We randomized 30 hemiplegic inpatients who could perform gait training using an ankle-foot orthosis in convalescent rehabilitation wards at five facilities in Japan into two groups. The intervention group used the ankle-foot orthosis and knee extension aid during gait training, while the control group used the ankle-foot orthosis alone. We measured knee joint angles during comfortable-speed walking before and after 2 weeks of gait training. [Results] In the intervention group, knee joint angles during terminal swing significantly decreased by approximately 4° after 2 weeks. [Conclusion] The knee extension aid may facilitate heel-first initial contact and reduce abnormal ankle muscle activation by decreasing knee flexion during terminal swing.
[Purpose] This study examined the impact of shoe-foot length mismatch on gait speed and sagittal-plane lower-limb joint motion in healthy adults during comfortable and maximal-effort walking. [Participants and Methods] Thirty healthy adults participated in the study. Four shoe-length conditions were tested: an appropriately fitted condition and oversized conditions in which shoes were 1-, 2-, and 3 cm longer than the appropriate length. Shoe width was standardized to the appropriate-size for each participant. Gait speed was assessed via 10 m gait time under comfortable and maximal-effort conditions. Sagittal-plane motion of the hip, knee, and ankle joints was recorded. [Results] 10 m gait time increased with shoe length. During comfortable walking, 10 m gait time was significantly longer in the 2- and 3 cm longer conditions, whereas no significant difference was observed in the 1 cm longer condition. During maximal-effort walking, 10 m gait time was significantly longer in all oversized conditions. Sagittal-plane joint motion also increased with shoe length, particularly at the hip and knee, with significant increases primarily observed in these joints. [Conclusion] Shoe-foot length mismatch prolonged 10 m gait time and increased sagittal-plane lower-limb joint motion. Clinicians should recognize that even minor shoe-foot length mismatch may reduce gait efficiency.
[Purpose] We evaluated the utilization of a financial incentive for functional electrical stimulation and robot-assisted rehabilitation in Kanagawa Prefecture, and assessed geographic variations and related regional indicators. [Participants and Methods] Participants were from nine secondary medical areas in Kanagawa Prefecture. We used fiscal year 2022 standardized claim ratios from the Cabinet Office dataset and summarized the standardized claim ratios for the financial incentive claimable within 2 months post-onset and evaluated associations with selected regional indicators of demand, service provision, and care settings. [Results] The standardized claim ratio for the financial incentive ranged from 3.3 to 223.3 (mean, 64.0; median, 36.8). Only the standardized claim ratios of Yokosuka-Miura and Yokohama exceeded the national average (standardized claim ratio, ≥100). The standardized claim ratio for the financial incentive showed no statistically significant association with standardized claim ratios for cerebral infarction inpatients, convalescent rehabilitation fees, or cerebrovascular rehabilitation volume. [Conclusion] Utilization of the financial incentive program varied widely across secondary medical areas in Kanagawa Prefecture. The eligibility window of 2 months from symptom onset may have contributed to this variation and may not have fully aligned with the current guideline statements for robot-assisted training for upper limb function.
[Purpose] Craig's Test can be used to measure femoral anteversion/retroversion in lieu of expensive and invasive clinical imaging. It is currently unknown if Craig's Test is reliable before and after exercises that require substantial active hip joint motion. This study sought to evaluate the consistency of Craig's Test before and after a squatting exercise. [Participants and Methods] Thirty-eight participants (18 females, 20 males) underwent Craig's Test before and after a squatting protocol. Craig's Test was repeated 3 times per leg and averaged to achieve a "pre" and "post" score. Scores were compared for the complete sample, females, and males, on both the right and left legs. [Results] All individual comparisons indicated significant differences between pre- and post-squatting Craig's Test scores for the combined sample, females, and males, on both the right and left legs. [Conclusion] These data suggest Craig's Test is sensitive to changes in soft tissue extensibility that accompanies exercises that elicit large active range of motion at the hip joint. Thus, an active warm-up involving movements or stretches requiring large ranges of motion at the hip joint are recommended before performing Craig's Test to determine hip anteversion/retroversion alignment.
[Purpose] We investigated the immediate effects of an ankle-assist device (AAD) on gait speed, stride length, and cadence at postoperative weeks 1 and 2 following total hip arthroplasty. [Participants and Methods] Participants undergoing unilateral total hip arthroplasty were assigned to an AAD-assisted rehabilitation group or a conventional physiotherapy group. Gait speed, stride length, and cadence were measured immediately before and after rehabilitation sessions at postoperative weeks 1 and 2. Immediate effects were calculated as post minus pre changes. [Results] At postoperative week 2, the AAD group showed a significantly greater improvement in gait speed than the control group. Small improvements in stride length and cadence were also observed in the AAD group. [Conclusion] AAD-assisted rehabilitation may enhance immediate gait performance at postoperative week 2 after total hip arthroplasty, however, these findings should be interpreted as preliminary.
[Purpose] This study aimed to explore the workplace climate that supports self-growth among physical therapists (PTs) by comparing their past growth-promoting experiences with conditions in their current workplaces. [Participants and Methods] An online survey was conducted with 357 Japanese PTs. Data were collected on demographics, self-growth experiences, and workplace climate. Workplace climate was evaluated using a four-point Likert scale across 10 factors: bright, exciting, warm, strict, honest, open, diligent, passionate, cooperative, and autonomous. Past growth-promoting environments were compared with current workplace conditions. [Results] Significant differences were found in 8 of the 10 factors between past growth-promoting environments and current workplaces. The largest differences were observed in strictness, honesty, and diligence. [Conclusion] Workplace climate appears to play an important role in PT self-growth. Creating a balanced environment that promotes discipline, honesty, and diligence while avoiding excessive stress may help foster professional development among PTs.
[Purpose] To examine the associations of independent access to transportation with life-space mobility and physical activity among users of day-care rehabilitation facilities. [Participants and Methods] We monitored the physical activity of 24 participants attending day-care rehabilitation facilities using an accelerometer. We categorized activity as sedentary behavior (1.0-1.5 metabolic equivalents [METs]), light-intensity physical activity (1.6-2.9 METs), and moderate-to-vigorous physical activity (≥3.0 METs) and calculated daily averages for each. Life-space was assessed using the Life-Space Assessment scores. Participants were divided into two groups: those with independently available transportation and those without. We compared the life-space and physical activity levels between the groups. [Results] Life-Space Assessment scores were significantly higher among participants with available transportation than among those without available transportation. However, no significant difference was found in overall physical activity. [Conclusion] Transportation availability was associated with a larger life-space but was not significantly associated with physical activity.
[Purpose] To design and develop a new OMNI Exertion Faces Scale (OMNI Faces) that uses universal design criteria to improve acceptability for measuring perceived exertion across age groups, physical activities, and clinical populations. [Methods] The OMNI Faces Scale was developed in collaboration with the original OMNI creator and refined through consultations with educators, speech-language pathologists, clinicians, and feedback from children and adults. Design considerations included universal accessibility, simplified instructions, and alignment with the Heart Rate Reserve method. [Design Features] The OMNI Faces Scale includes five verbal descriptors and five pictorial images to reduce inconsistencies with language, activity-specific visuals, and anchoring among prior versions. The OMNI Faces Scale is non-gendered, non-activity-specific, and has accessible fonts. Instructions were simplified to 71 words relevant for assessing perceived exertion during both aerobic and resistance activities. [Conclusions] The OMNI Faces Scale was designed to provide a versatile and inclusive tool for monitoring exertion in children and adults across a broad range of physical activity applications. Future research will validate its psychometric properties across populations and activity types and explore multilingual adaptations.
