Naoto Fukutani

Differential Association of Frailty With Cognitive Decline and Sarcopenia in Community-Dwelling Older Adults

OBJECTIVES Frailty in older adults is a serious problem because of various adverse health outcomes in many countries with aging populations, such as Japan. The purpose of this study was to determine whether frailty and pre-frailty are associated with cognitive decline and sarcopenia in community-dwelling older adults. DESIGN This is a cross-sectional study. SETTING Japan. PARTICIPANTS The participants were 273 Japanese community-dwelling older women aged 65 years and older. MEASUREMENTS We used the frailty criteria developed by the Cardiovascular Health Study to define physical frailty. We divided the cohort into nonfrail, prefrail, and frail according to frailty scores. Cognitive decline and memory decline were defined by using the Mini-Mental State Examination and Scenery Picture Memory Test, respectively. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. RESULTS In the multivariate logistic regression analysis by using non-frail participants as the reference, pre-frail elderly individuals were significantly more likely to have sarcopenia than non-frail elderly individuals [odds ratio (OR): 2.77, 95% confidence interval (CI): 1.05-9.26], but not cognitive decline or memory decline. Frail elderly individuals were significantly more likely to have cognitive decline (OR: 5.76, 95% CI: 1.20-27.6), memory decline (OR: 5.53, 95% CI: 1.64-18.7) and sarcopenia (OR: 19.1, 95% CI: 3.73-98.0) than non-frail elderly individuals. CONCLUSIONS Sarcopenia was associated with pre-frailty and frailty, whereas cognitive decline was associated only with frailty.

Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis.

To investigate the association between knee pain during gait and 4 clinical phenotypes based on static varus alignment and varus thrust in patients with medial knee osteoarthritis (OA).

Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis

Background Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). Objective The aim of this study was to investigate the association between varus thrust and 2 subcategories—“pain and stiffness” and “activities of daily living (ADL)”—of the Japanese Knee Osteoarthritis Measure (JKOM). Design This was a cross-sectional study. Methods In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Results Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Limitations Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Conclusions Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.

Clinical Impact of Coexisting Patellofemoral Osteoarthritis in Japanese Patients With Medial Knee Osteoarthritis

To evaluate the clinical impact in knee osteoarthritis (OA) of coexisting patellofemoral (PF) joint OA (PFOA) in Japanese patients with medial tibiofemoral (TF) joint OA (TFOA).

Knee pain during activities of daily living and its relationship with physical activity in patients with early and severe knee osteoarthritis

This study aimed to investigate whether knee pain during various activities of daily living (ADLs) is associated with physical activity in patients with early and severe knee osteoarthritis (OA). We hypothesized that the painful ADLs associated with decreased physical activity differ according to disease severity. This cross-sectional study enrolled 270 patients with medial knee OA, assigned to either the early (Kellgren Lawrence [K/L] grade 1–2) or the severe group (K/L grade 3–4). Physical activity was assessed using a pedometer. Knee pain during six ADLs (waking up in the morning, walking on a flat surface, ascending stairs, etc.) was evaluated using a questionnaire. We performed multiple regression and quantile regression analysis to investigate whether knee pain during each ADL was associated with physical activity. In the early group, the more knee pain they experienced while ascending stairs, the lower their physical activity was (75th regression coefficient = −1033.70, P = 0.018). In the severe group, the more knee pain they experienced while walking on a flat surface or bending to the floor or standing up, the lower their physical activity was (unstandardized coefficients = −1850.87, P = 0.026; unstandardized coefficients = −2640.35, P = 0.010). Knee pain while ascending stairs and while walking on a flat surface or bending to the floor or standing up was a probable limiting factor for physical activity in early and severe knee OA, respectively. These findings suggested that a reduction in task-specific knee pain according to disease severity could improve physical activity levels.

Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study

This cross‐sectional study examined the relationship of flat feet with knee pain, disability, and physical performance in patients with knee osteoarthritis (OA). Orthopedic clinic participants (n = 95; age 61–91 years; 68.4% women) with Kellgren‐Lawrence (K/L) grade ≥1 in the medial compartment underwent evaluation of navicular height and foot length for flat feet. Knee pain intensity, disability, and physical performance were evaluated using the Japanese Knee Osteoarthritis Measure, 10‐m walk, timed up and go, and five‐repetition chair stand tests. Of the 95 enrolled patients, 24 (25.3%) had bilateral flat feet, and significantly higher knee pain compared to patients with no flat feet (11.3 ± 8.23 points vs. 6.58 ± 6.37 points; p = 0.043). A ordinal logistic regression analysis showed that bilateral flat feet were significantly associated with increased knee pain (proportional odds ratio: 5.48, 95% confidence interval: 1.96, 15.3; p = 0.001) compared with no flat feet, adjusted for age, sex, body mass index, and tibiofemoral joint K/L grade, which is consistent across various different cutoffs of the definition of flat feet. Physical performance was similar between patients with and without bilateral flat feet. The presence of unilateral flat feet was not significantly associated with any outcome measures. These findings indicate that bilateral, but not unilateral, flat feet are associated with worse knee pain. A prospective study investigating a causal relationship between bilateral flat feet posture and knee pain as well as disability would be of particular interest to verify the potential adverse effect of altered foot posture.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study

AIM The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects. METHODS A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores. RESULTS Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA. CONCLUSIONS We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

Cognitive impairment is associated with the absence of fear of falling in community‐dwelling frail older adults

The purpose of the present study was to explore the association between cognitive function and fear of falling in frail/non‐frail older adults in a community setting.

Children with flat feet have weaker toe grip strength than those having a normal arch.

[Purpose] This study investigated the relationship between toe grip strength and foot posture in children. [Subjects and Methods] A total of 619 children participated in this study. The foot posture of the participants was measured using a foot printer and toe grip strength was measured using a toe grip dynamometer. Children were classified into 3 groups; flatfoot, normal, and high arch, according to Staheli’s arch index. The differences in demographic data and toe grip strength among each foot posture group were analyzed by analysis of variance. Additionally, toe grip strength differences were analyzed by analysis of covariance, adjusted to body mass index, age, and gender. [Results] The number of participants classified as flatfoot, normal, and high arch were 110 (17.8%), 468 (75.6%), and 41 (6.6%), respectively. The toe grip strength of flatfoot children was significantly lower than in normal children, as shown by both analysis of variance and analysis of covariance. [Conclusion] A significant difference was detected in toe grip strength between the low arch and normal foot groups. Therefore, it is suggested that training to increase toe grip strength during childhood may prevent the formation of flat feet or help in the development of arch.

Effect of Capacitive and Resistive electric transfer on haemoglobin saturation and tissue temperature

Abstract Purpose: This study aims to evaluate the effects of Capacitive and Resistive electric transfer (CRet) and hotpack (HP) on haemoglobin saturation and tissue temperature. Materials and methods: The participants were 13 healthy males (mean age 24.5 ± 3.0). They underwent three interventions on different days: (1) CRet (CRet group), (2) HP (HP group) and (3) CRet without power (sham group). The intervention and measurement were applied at the lower paraspinal muscle. Indiba® active ProRecovery HCR902 was used in the CRet group, and the moist heat method was used in the HP group. Oxygenated, deoxygenated and total haemoglobin (oxy-Hb, deoxy-Hb, total-Hb) counts were measured before and after the 15-min interventions, together with the temperature at the skin surface, and at depths of 10 mm and 20 mm (ST, 10mmDT and 20mmDT, respectively). The haemoglobin saturation and tissue temperature were measured until 30 min after the intervention and were collected at 5-min intervals. Statistical analysis was performed for each index by using the Mann–Whitney U test for comparisons between all groups at each time point. Results: Total-Hb and oxy-Hb were significantly higher in the CRet group than in the HP group continuously for 30 min after the intervention. The 10mmDT and 20mmDT were significantly higher in the CRet group than in the HP group from 10- to 30 min after intervention. Conclusions: The effect on haemoglobin saturation was higher in the CRet group than in the HP group. In addition, the CRet intervention warmed deep tissue more effectively than HP intervention.