Tomoko Shimizu

Background and Purpose: Hip fractures are associated with a reduction in activities of daily living (ADL) and require long‐term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light‐ and moderate‐intensity physical activity at the time of rehabilitation admission by determining a cut‐off value predicting ADL independence.Methods: This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65 years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM‐m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product‐moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity.Results: The duration of physical activity at the time of rehabilitation admission was related to FIM‐m at discharge. The cut‐off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135 s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76).Discussion: The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light‐and‐moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.

Objective: To examine activities of daily living (ADL) and physical activity in older adults with heart failure admitted to a rehabilitation ward for subacute musculoskeletal disease.Methods: This study included patients with musculoskeletal disease (aged ≥75 years) who were admitted to the rehabilitation ward. Data on age, ADL, and time for physical activity (metabolic equivalents [METs]) were collected. Patients were divided into groups with or without heart failure, and the differences were compared using Mann–Whitney U-test.Results: This study included 84 musculoskeletal patients, including 25 with heart failure. The heart-failure group had similar levels of ADL independence compared to the without-heart-failure group (p=0.28) but had shorter duration of continuous and sustained physical activities and less total time (p<0.01) of light-intensity physical activity or higher.Conclusion: Older adults with subacute musculoskeletal disease with heart failure do not necessarily require a large amount of physical activity to maintain ADL at the time of discharge. But very low physical activity may increase the risk for developing hospitalization-associated disability. Physical activity in older adults with subacute musculoskeletal disease with heart failure should be monitored separately from ADL.

As the older adult population increases, the number of patients with hip fractures is expected to increase. Hip fractures are a major factor in bedridden patients and decreased activities of daily living. Older adults may have multiple comorbidities, and improving their physical function under comprehensive care is better to meet their needs. Convalescent rehabilitation wards provide comprehensive care and aim to improve the activities of daily living and physical activity in older adults. This study aimed to identify the time of day, including rehabilitation, when physical activities improve in inpatients with subacute postoperative hip fracture, among the many comorbidities of older adults, in comprehensive care, including rehabilitation. This prospective cohort study was conducted in a comprehensive care setting in a subacute rehabilitation ward in a Japanese hospital. Older adult inpatients with a musculoskeletal disease in a subacute rehabilitation ward were divided into the postoperative hip fracture and non-hip fracture patients to examine age, frailty, activities of daily living, and longitudinal physical activity data from objective measures at admission and discharge. Physical activity increased in older adult inpatients with postoperative hip fractures not only during personalized rehabilitation time (P < 0.001) but also during free activity in the ward (P < 0.001), despite their tendency to be older, frailer, and lower activities of daily living. In conclusion, postoperative hip fracture inpatients may improve their fitness after receiving comprehensive care.

Twenty two patients with cervical and axial dystonias were treated with Japanese type A botulinum toxin. Injections were given repeatedly at intervals of 28-30 days to carefully chosen muscles with increased activities, with a maximum dose per session of 300 units. The maximum improvements in subjective and objective ratings were obtained only after repeated injections. No anti-toxin antibodies were detected; nor did any muscle fail to respond to the toxin. During the treatment, previously "silent" muscles were activated to reproduce the original abnormal posture, as if driven by a central motor programme. This resistance to treatment was overcome by injecting the toxin into newly activated muscles. Repeated injections are thus required to override central mechanisms in dystonias or to maximise drug delivery to large muscles. Antibody development may be controlled by the use of a less immunogenic toxin.