Shinya Yamauchi

Gender differences in health‐related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo‐HSCT).

Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients

PurposeThe aim of this study was to investigate the relationship between corticosteroid dose and degree of physical function decrease in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during the early stage of recovery. We further investigated the confounding factors affecting loss of physical function.MethodsThe study included 113 patients who underwent allo-HSCT between July 2007 and April 2012 at Hyogo College of Medicine Hospital in Japan. Physical function was assessed using tests for hand-grip strength, knee-extensor strength, and the 6-min walk test (6MWT). Fatigue was measured using the Piper Fatigue Scale. Total corticosteroid dose, frequency of physical therapy, body weight, and nutritional status were also collected from medical records.ResultsTotal corticosteroid dose was correlated with decrease of hand-grip and knee-extensors strength (P < 0.01) but was not correlated with 6MWT performance. Results of multivariate analysis confirmed that low physical function was associated not only with high corticosteroid dose but also with low frequency of physical therapy, increase in fatigue, and body weight loss (P < 0.05). Also, hemoglobin levels were associated with 6MWT (P < 0.05).ConclusionsThis study showed the relationship between corticosteroid dose and declines in physical function and also showed other clinical factors affecting loss of physical function among allo-HSCT patients. Our results indicate that the effectiveness of rehabilitation may be influenced by corticosteroid treatment.

Rating of Perceived Exertion for Quantification of the Intensity of Resistance Exercise

Rating of perceived exertion (RPE) is widely used in exercise tests using cycle ergometers (incremental aerobic exercise) for patients with cardiovascular and metabolic diseases such as hypertension and type 2 diabetes. On the other hand, RPE has also been used widely for determining the intensity of resistance exercise for healthy subjects. RPE anchoring is associated with percentage of 1 repetition maximum or the percentage of maximal voluntary contraction. This short communication explains a concrete method of RPE to quantify the intensity of resistance exercise. Physicians, physical therapists, and medical staff should use RPE for determining the intensity of resistance exercise in clinical practise.

Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation

A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6 min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.

A five-year follow-up of a patient with fulminant myocarditis who underwent a stepwise and goal-oriented individualized comprehensive cardiac rehabilitation program

A 39-year-old man developed fulminant myocarditis and was transferred on mechanical ventilation and a ventricular-assist device to our hospital. On Hospital Day 10, he was weaned from all medical engineering devices, and bedside rehabilitation was initiated. Although a multidisciplinary cardiac rehabilitation team had intervened since Hospital Day 3, he could not be encouraged to begin ambulation because of hypotension and tachycardia. Moreover, he complained of loss of self-confidence and anxiety regarding physical strength, and expansion of activities was difficult. Exercises reflecting his immediate desires and daily activities were used as activity goals, and we developed an individualized exercise program with stepwise increase in load to motivate him to perform rehabilitation. At the time of discharge, his cardiac function recovered to nearly normal levels; however, muscle strength and respiratory function had not recovered. While the intervention was continued at the cardiac rehabilitation outpatient unit, improvement was observed in physical health and mental health-related scale scores. The patient returned to work 4 months after onset of his myocarditis. Moreover, the cardiac rehabilitation team provided support to him for his long-term overseas assignment in the fifth year after myocarditis onset. Long-term comprehensive support by the cardiac rehabilitation team was feasible and useful. <Learning objective: Comprehensive intervention by a cardiac rehabilitation team from the acute phase may be helpful for motivating patients not only to participate in rehabilitation during hospitalization, but also to continue it on an outpatient basis after discharge. Moreover, continuous outpatient intervention can lead to recovery of physical/mental function in patients that is not achievable with only inpatient intervention, and support can be provided to patients for setting new life goals.>.

Poster 203 Allogeneic Haematopoietic Stem Cells Decrease Muscle Strength Immediately after Transplantation

Disclosures: A. Navarasala: I Have No Relevant Financial Relationships To Disclose. Case Description: A 73-year-old man with history of recurrent pneumonia complicated by sepsis presented with fevers, chills, and cough to the acute care setting. Chest x ray showed basilar infiltrates in ED suggestive of pneumonia. Following admission ID was consulted and merrem, vancomycin, and micafungin were started. During the hospital course blood cultures were positive for E. coli. On transfer to the rehabilitation hospital the patient was on chopped diet with thin liquids due to dysphagia. Video-fluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) were performed and a Zenker’s diverticulum was discovered. Studies demonstrated penetration and aspiration on initial swallow worse with nectar thick than thin liquid from the diverticulum. Setting: Acute inpatient rehabilitation hospital. Results or Clinical Course: The FEES showed residuals in the valleculae, throughout the pharynx, A-E fold, and the intraarytenoid space. Swallowing strategies including chin tuck and multiple swallow cues improved clearance, but residual penetration and aspiration did not trigger cough. Aspiration occurred silently with nectar thick liquids vs. thin liquids, likely due to inadequate clearing. Follow up with a barium esophogram for more detailed assessment was recommended. The patient worked with speech therapy and strategies learned included alternating liquid/solid, throat clearing, controlling rate, and amount. Discussion: Zenker’s diverticulum is a rare complication in the elderly population that has a prevalence of 0.01 e 0.11% in the population. It is common in the male population during the 7th to 9th decades. Symptoms include dysphagia, sensation of food or medications sticking in the throat, unexplained weight loss, and chronic halitosis. This patient presented with complications of recurrent pneumonia with sepsis and a long history of pill dysphagia. Conclusion: In the elderly population with chronic dysphagia and the sensation of food sticking in the throat, a Zenker’s diverticulum must be ruled out. VFSS and FEES are screening methods that can be done in the rehabilitation setting to rule out mechanical causes of dysphagia which can prompt additional studies and surgical necessity. This patient was subsequently scheduled for barium swallow and surgical evaluation by an ENT specialist.