Tsutomu Iwaya

Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial.

Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, Marui E: Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil 2008;87:258–269. Objectives:To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs). Design:An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale. Results:A total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs. Conclusions:Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.

Long term remote behavioral monitoring of elderly by using sensors installed in ordinary houses

In maintaining the health of elderly people, it can be useful to monitor their health status through their daily routines in their own home. This paper reports on the remote monitoring of the daily routine behavior of elderly patients in their domestic houses. We attempted to monitor the daily behavior of two elderly ladies who live in Mizusawa, Japan. A 74-year-old woman, who lived alone, was monitored for about two years, and another 72-year-old woman who lived alone was monitored for about a year. Several sensors were installed, including infrared sensors to detect human movement, magnetic switches to detect the opening and closing of doors, wattmeters embedded in wall sockets to detect the use of household appliances, a flame detector to detect the use of a cooking stove and a CO, sensor to detect the presence of a subject in a room by monitoring the carbon dioxide expired. An industrial networking system was introduced into each house to combine the sensors. The sensor outputs were recorded on a personal computer located in each house. The data were automatically transferred daily to another site via the Internet using CATV. With the, sensors, a network and data system, the monitoring was fully automatic and did not require the placement of any sensors on the subjects (e.g. electrodes and cuff sensors) or any operations by subjects. Information on several daily behavior patterns, such as the number of door openings, the length of sleep, absences from the house, use of a cooking stove, and time spent watching television were clearly identified either from a single sensor output, or by combining several sensor outputs. Examination of the data allowed some daily behavior, such as worship (in the form of Japanese Buddhism) and the tending of planters to be evaluated. Such monitoring can contribute to the maintenance of health.

Time-Course Action Analysis of Daily Life Investigations in the Welfare Techno House in Mizusawa

In this study, we have examined the possibility of non-intrusive monitoring at home. We describe the experimental results of the relation between an individuals recorded behavior and the actions detected by the sensors during the course of the subjects daily life. Infrared sensors and the opening of doors and windows and the use of appliances were used. In this paper, it is assumed that the subjects were sleeping when there were no responses by the infrared sensors or when only the bedroom sensor was responding. The sensors were able to detect excretion by using the outputs of the infrared sensor and the water valve of the lavatory, even if a subject did not record it in the time-course of daily life during the investigation. Our findings show that the actions of subjects who stayed at Welfare Techno House (WTH) in Mizusawa could be estimated from outside the house, especially for sleeping and excretion.

Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain: the Japan low back pain exercise therapy study.

Study Design. Prospective, randomized, controlled trial. Objective. To investigate the effectiveness of home-based exercise on pain, dysfunction, and quality of life (QOL) in Japanese individuals with chronic low back pain (CLBP). Summary of Background Data. Exercise therapy is a widely used treatment for CLBP in many countries. The studies on its effectiveness have been performed only in Western industrialized countries. The existence of cross-cultural differences and heterogeneity of patients in each country may influence the outcome of interventions for CLBP. Data that would enable researchers to compare the effectiveness of interventions between widely different societies is lacking. Methods. A total of 201 patients with nonspecific CLBP were randomly assigned to either the control or exercise therapy group: 89 men and 112 women with a mean age of 42.2 years. The control group was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and the exercise group performed trunk muscle strengthening and stretching exercises. The primary outcome measures were pain intensity (visual analogue scale) and dysfunction level (Japan Low back pain Evaluation Questionnaire [JLEQ] and Roland-Morris Disability Questionnaire [RDQ]) over 12 months. The secondary outcome measure was FFD (Finger-floor distance). Statistical analysis was performed using Wilcoxon signed-ranks and Mann-Whitney U tests, and estimation of the median with 95% CI was calculated. Results. In both groups, significant improvement was found at all points of follow-up assessment. However, JLEQ and RDQ were significantly more improved in the exercise group compared to the control group (P = 0.021 in JLEQ, P = 0.023 in RDQ). The 95% CI for the difference of medians of the change ratio between exercise and NSAID groups, [Exercise] − [NSAID], was −0.25 to −0.02 in JLEQ, −0.33 to 0.00 in RDQ, and −0.20 to 0.06 in visual analogue scale. Conclusion. The home-based exercise prescribed and monitored by board-certified orthopedic surgeons was more effective than NSAIDs for Japanese patients with CLBP.

Congenital dislocation of the knee reduced spontaneously or with minimal treatment

Six cases of congenital dislocation of the knee (CDK) reduced spontaneously or with minimal treatment were investigated. Reduction was achieved from 4 days to 3 months after birth. Clinical results were good, although in four cases, hyperextension < or = 20 degrees persisted. In view of the perinatal complications and associated anomalies, CDK reduced with no or minimal treatment is supposed to be a category of congenital postural deformity. We believe that it is advisable to wait 1 month for spontaneous reduction of CDK in cases not associated with clubfoot, arthrogryposis multiplex congenita, and Larsens syndrome.

COL2A1-related skeletal dysplasias with predominant metaphyseal involvement

Skeletal dysplasias induced by mutations in the collagen 2 gene (the so‐called “type 2 collagenopathies”) form a wide spectrum in severity and are distinguished by subtle clinical and radiographic differential signs. The unifying features are predominant involvement of the vertebral bodies and the epiphyses of the long bones (“spondylo‐epiphyseal” pattern). A mild degree of metaphyseal dysplasia can be seen in the so‐called Strudwick variant of spondyloepimetaphyseal dysplasia and is generally mild or absent in other forms.

Rhythm of daily living and detection of atypical days for elderly people living alone as determined with a monitoring system

We have developed a system for monitoring the health of elderly people living at home. Infrared and other sensor outputs are collected using a monitoring program installed on a personal computer (PC) in the home at a sampling rate of 1 Hz. Once each day, the data are transferred to a server through the Internet using a cable television (TV) connection. An elderly subject was monitored for a 12-day baseline period and completed a daily questionnaire about her activities. This enabled us to identify the rhythm of daily living (sleeping, 23:00–04:59; getting up/breakfast, 05:00–08:59; indoor activities/going out, 09:00–16:59; and dinner/going to bed, 17:00–22:59) and the average outputs from the sensors in the rooms. The subject was then monitored for a further six months. By identifying sensor output counts outside the limits of mean ±3SD, we were able to detect atypical days. During the six-month monitoring period, 29 atypical days were detected. We suggest that the monitoring system may be effective in tele-rehabilitation.

Long-term remote behavioral monitoring of the elderly using sensors installed in domestic houses

In maintaining the health of elderly people, it can be useful to monitor their health status through their daily routines in their own home. This paper reports on the remote monitoring of the daily routine behavior of elderly patients in their domestic houses. We attempted to monitor the daily behavior of two elderly ladies (a 74-year-old woman and a 72-year-old woman) who live alone in Mizusaws, Japan, over a period of one year. Several sensors were installed, including infrared sensors to detect human movement, magnetic switches to detect the opening and closing of doors, wattmeters embedded in wall sockets to detect the use of household appliances, a flame detector to detect the use of a cooking stove, and a CO/sub 2/ sensor to detect the presence of a subject in a room. An industrial networking system was introduced into each house to combine the sensors. The sensor outputs were recorded on a personal computer located in each house. The data were automatically transferred daily to another site via the Internet using CATV. With our system, the monitoring procedure was fully automated and did not require the placement of any sensors on the subjects or require any operations by the subjects. Information on several daily behavior patterns, such as the number of door openings, the length of sleep, absences from the house, use of a cooking stove, and the time spent watching television were clearly identifiable from the obtained data. Such monitoring techniques can contribute to maintaining the health of selected patients.

Development of a screening program to assess motor function in the adult population: a cross-sectional observational study

BackgroundMotor dysfunction is a major reason why the elderly lose their independence in their daily lives. The concept of locomotive syndrome has been proposed to describe the risk of mobility dependence caused by various locomotive organ disorders. The preservation of locomotive organs is now socially important in the middle-aged and geriatric population. Therefore, it is important to establish a screening program to evaluate motor function and related quality of life in a wide range of ages.MethodsWe propose a new set of pre-existing scales (the Two-Step test, Stand-Up test, and 25-question Geriatric Locomotive Function Scale) as screening tools to identify the population at high risk for locomotive syndrome. We performed a preliminary survey on 777 subjects who had no apparent disorders related to motor function. We also examined the reliability of the Two-Step test and Stand-Up test.ResultsWe found that each scale did not show ceiling or floor effects in various age groups. Because the correlations between the three scales were significant but weak, we assume that each scale covers different aspects of mobility. The test–retest reliability was found to be satisfactory for the Two-Step test and the Stand-Up test.ConclusionOur results suggest that our “Short Test Battery for Locomotive syndrome” is a feasible and reliable tool for screening the adult population as a preventative strategy for locomotive syndrome in a super-aged society.

Pathologic Dislocation of the Hip in von Recklinghausen's Disease: A Report of Two Cases

We report two cases of von Recklinghausens disease in which hip dislocations occurred gradually without trauma. In one case, the right hip joint dislocated at the age of 8 years, and in another case, the left hip dislocated at 2 years and the right hip at 3 years. Each case was accompanied by bone changes around the affected hips, vertebral deformity, and spinal tumor. One case had hemihypertrophy of the involved lower extremity. Both structural changes around the hip joint and paralysis may have resulted in the hip dislocation.