Hiroyuki Hashidate

Measuring indoor life-space mobility at home in older adults with difficulty to perform outdoor activities.

Background:Measurement of indoor physical activity at home in older adults who have difficulty performing outdoor activities is a key to documenting baseline physical activity levels to guide physical activity interventions aimed at reducing the rate of decline in mobility. Purpose:The purpose of this study was to describe indoor life-space mobility at home (LSH) and examine the association between LSH and mobility-related physical functions in older adults who have difficulty performing outdoor activities. Methods:The participants were 20 community-dwelling older adults (mean age [SD], 76.6 [5.1] years) receiving home-care rehabilitation. Participants were assessed for LSH and physical function related to mobility. Assessments included isometric knee extensor strength, the Timed Up and Go (TUG) Test, functional status (a 13-item Motor subscale of Functional Independence Measure, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and outdoor life-space mobility (life-space assessment [LSA]). Life-space mobility at home documented how far and how often participants moved from a bedroom to 4 destinations (entrance, dining room, bathroom, and toilet) at home with or without assistance during the week prior to the assessment. Results:Reliability of LSH was high (intraclass correlation coefficient [ICC] (1,1) = 0.80, ICC (1,2) = 0.89). Simple bivariate correlations showed a significant relationship between LSH and isometric knee extensor strength (rs = 0.59, P = .01) and TUG Test (rs = −0.74 P = .01). Life-space mobility at home showed moderate correlations with the Functional Independence Measure (rs = 0.58, P = .01) and Tokyo Metropolitan Institute of Gerontology Index of Competence (rs = 0.49, P = .03), but no significant correlation with the LSA (rs = 0.33, P = .17). Discussion:Regarding intrarater reliability, the ICCs for measuring the LSH indicated high reproducibility. The results suggest that the LSA mainly reflects outdoor life-space mobility and activity rather than indoor life-space whereas the LSH reflects indoor life-space mobility and is considered an indicator of a major decline in indoor activities and physical abilities. Conclusions:The LSH concept can measure with high reliability and concurrent or discriminant validity, and it is a different concept from outdoor life-space mobility. Life-space mobility at home may be an important factor associated with physical functions related to mobility and functional status, and measuring LSH may be useful to assess current indoor life-space activity in older adults who have difficulty performing outdoor activities.

Obtaining Information from Family Caregivers Is Important to Detect Behavioral and Psychological Symptoms and Caregiver Burden in Subjects with Mild Cognitive Impairment

Background: The objectives of this study are to clarify the differences between the difficulties in daily life experienced by patients with both mild cognitive impairment (MCI) and chronic disease and those experienced by healthy elderly individuals. Methods: We assessed (a) cognitive function; (b) gait ability; (c) behavioral and psychological symptoms (observed at home); (d) activities of daily living (observed at home); (e) family caregiver burden, and (f) intention to continue family caregiving of 255 cognitively normal and 103 MCI subjects attending adult day care services covered by long-term care insurance, and compared the two groups. Results: Subjects with MCI display more behavioral and psychological symptoms than cognitively normal subjects, posing a heavy caregiver burden (p < 0.01). Behavioral and psychological symptoms most commonly observed in subjects with MCI are apathy, hallucinations, delusions, agitation, and aberrant motor behavior. Conclusion: Information regarding the behavioral and psychological symptoms displayed at home by patients with MCI can only be obtained from family caregivers living with the patients. To provide early-stage support for elderly patients with MCI, adult day care workers should collect information from family caregivers regarding behavioral and psychological symptoms observed at home.

Reliability of intensity-based physical activity measurement using an activity monitor in people with subacute stroke in the hospital setting: a cross-sectional study

ABSTRACT Background Activity monitors are known to provide quantitative evaluation of physical activity in people with stroke. However, little evidence is available on the test–retest reliability and suitable measuring conditions for evaluating physical activity with an activity monitor in people with subacute stroke at a hospital setting. Objectives To evaluate reliability of physical activity measurement using an activity monitor in different measuring conditions in hospitalized people with subacute stroke according to gait ability. Methods Sixty-nine participants with subacute stroke were categorized based on their gait ability: group 1 (n = 22), could walk independently at sufficient gait speed (≥0.9 m/s); group 2 (n = 11), could walk independently with insufficient gait speed (<0.9 m/s); group 3 (n = 36), required assistance in walking. Physical activity (sedentary behavior, light-intensity physical activity, moderate-to-vigorous physical activity) was measured using an activity monitor (OMRON, HJA350-IT) for seven consecutive days. All physical activity variables were calculated in five conditions defined according to measurement periods (3, 5, or 7 days with or without weekends). Results In groups 1 and 2, intraclass correlation coefficients were high across all measuring conditions in all physical activity variables (>0.7). In group 3, intraclass correlation coefficients were high in all measuring conditions (>0.7) except for three weekdays measuring condition (0.563–0.922). Conclusions In hospitalized people with subacute stroke, the central tendency of intensity-based physical activity could be assessed with good reliability using an activity monitor. For reliable measurement, more measurement days are needed in those with dependent walking compared to those with independent walking.

Difference in independent mobility improvement from admission to discharge between subacute stroke patients using knee-ankle-foot and those using ankle-foot orthoses

[Purpose] To verify differences in independent mobility improvements between people with subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses (AFOs) from admission to discharge, and to identify the relationship between mobility improvements and their characteristics. [Participants and Methods] This study included 381 hospitalized patients with subacute stroke who required complete mobility assistance at admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after admission. The functional independence measure (FIM) score at admission and discharge, FIM gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period from admission to prescription for lower limb orthoses were investigated. [Results] Repeated-measures two-way analysis of variance revealed a significant group × time interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in the scores in the KAFO group were significantly lower than those in the AFO group. Age, BS, FIM at admission, and period from admission to lower limb orthosis prescription significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items. [Conclusion] A more effective intervention using lower limb orthoses with consideration of the influence of age, motor paralysis, and activities of daily living at admission is required to promote the improvements of people with subacute stroke prescribed KAFOs or AFOs.

Differences in activities of daily living between people with subacute stroke who received knee-ankle-foot and ankle-foot orthoses at admission

[Purpose] This study aimed to identify the preferential factor of activities of daily living disabilities for selecting between knee-ankle-foot orthosis and ankle-foot orthosis prescription in the early stage after admission. [Participants and Methods] This study included 442 inpatients who had a subacute stroke and received either knee-ankle-foot orthosis or ankle-foot orthosis after admission (mean age, 69 years). The functional independence measure was investigated within 1 week after admission. [Results] Inpatients who had a stroke and received knee-ankle-foot orthosis had significantly lower scores for all individual functional independence measure items than those who received ankle-foot orthosis. Logistic regression analysis revealed that functional independence measure transfer (bed, chair, and wheelchair) was closely associated with the difference in the prescribed lower limb orthosis after multivariate adjustment. [Conclusion] Compared with ankle-foot orthosis, knee-ankle-foot orthosis was prescribed to inpatients with more-severe disabilities, and the difference in the disability related to performing transfer activities was more noticeable than that in disability related to mobility between inpatients for whom knee-ankle-foot orthosis was prescribed and those for whom ankle-foot orthosis was prescribed. To provide effective rehabilitation for people who had a subacute stroke, for whom use of knee-ankle-foot orthosis or ankle-foot orthosis is recommended. The evaluation and intervention focused on standing performance related to performing transfer such as sit-to-stand, standing, moving while standing, and stepping might be a priority in the early stage after admission.

The known-groups validity of intensity-based physical activity measurement using an accelerometer in people with subacute stroke

[Purpose] This study aimed to assess the known-groups validity of the estimated metabolic equivalents during physical activities using accelerometer, Active Style Pro HJA 350-IT, in people with subacute stroke. [Subjects and Methods] Ten participants with subacute stroke and ten healthy people performed six activities (lying, sitting, standing, sitting with reaching task, standing with reaching task, and walking) and metabolic equivalents were estimated using the accelerometer during each activity. These estimated metabolic equivalents were compared with reported metabolic equivalents through compendiums or previous studies. Additionally, the estimated metabolic equivalents were compared between subacute stroke and healthy control participants. [Results] The estimated metabolic equivalents of both groups during maintaining posture showed significantly lower values in comparison with previous studies. There were no significant differences between the estimated metabolic equivalents during sitting with reaching tasks or standing with reaching tasks when compared with compendium metabolic equivalents across both groups. The estimated metabolic equivalents during walking were inevitable values significantly differed from previous study which conducted with stroke patients with lower gait abilities in both groups. [Conclusion] The estimated metabolic equivalents using accelerometer may be suitable to assess movement activity rather than motionless activity, and accelerometer demonstrated acceptable validity in people with subacute stroke.