Yasumitsu Fujii

Background: Locomotive syndrome (LS) is a clinical condition used to describe reduced mobility caused by musculoskeletal dysfunction and is highly prevalent among patients with cancer. The fat-free mass index (FFMI) is an indicator of nutritional status and muscle mass, and has been associated with malnutrition and prognosis in this population. This study investigated the relationship between FFMI and LS in patients with cancer and determined sex-specific FFMI cutoff values associated with severe LS. Methods: This study included patients hospitalized for cancer treatment who were referred for rehabilitation therapy. Patient characteristics, laboratory data, body composition, and grip strength were collected. LS was assessed using the stand-up test, two-step test, and 25-Geriatric Locomotive Function Scale. FFMI was measured using bioelectrical impedance analysis. Results: Overall, 144 patients (102 men and 42 women; mean age, 63.9 ± 15.8 years) were analyzed. Ordinal logistic regression analysis demonstrated that FFMI was independently associated with LS severity (odds ratio [OR], 0.597; 95% confidence interval [CI], 0.434–0.821). The optimal FFMI cutoff values associated with severe LS (grade ≥ 2) were 16.99 kg/m² in men and 15.25 kg/m² in women, with areas under the curves of 0.806 (95% CI, 0.720–0.890) and 0.760 (95% CI, 0.596–0.925), respectively. Conclusions: FFMI was associated with mobility function in patients with cancer. The proposed sex-specific cutoff values may help identify patients with impaired mobility who could be considered for referral to rehabilitation therapy.

Background: In rehabilitation medicine, efficient gait analysis is crucial for evaluating postoperative recovery and frailty, especially given the increasing burden on clinicians due to an aging population. Objectives: This study aims to conduct preliminary validation of an automated linear walking evaluation system using 2D AI posture tracking. By evaluating the basic accuracy of the system on healthy individuals, we aim to establish a technical foundation for future introduction into clinical rehabilitation settings. Methods: In this observational study, we utilized a standard visible light camera for practical use. To evaluate accuracy, we compared 2D AI tracking against a gold-standard three-dimensional (3D) motion capture system during normal walking trials with 10 healthy participants. Specifically, we employed Dynamic Time Warping (DTW) to temporally align the asynchronous data streams from the 2D and 3D systems, ensuring precise comparison of joint angles. Results: Following the DTW-based alignment, the similarity with the 3D system was 0.806 ± 0.094 overall (Left: 0.797 ± 0.101, Right: 0.814 ± 0.086). Conclusions: In this preliminary validation, the proposed 2D AI posture tracking showed good agreement with the gold standard 3D motion capture for gait in healthy individuals. While the average systematic bias was within clinically acceptable limits, the observed limits of agreement suggest that this system is currently optimal as a foundational tool for gait screening. These results establish a technical foundation for the clinical application of this system.

Background: Locomotive syndrome (LS), a condition characterized by impaired mobility due to locomotive organ dysfunction, is highly prevalent among patients with cancer. The phase angle (PhA), measured via bioelectrical impedance analysis (BIA), reflects cellular health and nutritional status. This study aimed to investigate the association between LS and the PhA in patients with cancer. Methods: This cross-sectional study included hospitalized patients who underwent cancer treatment. The assessed variables included age, sex, body mass index (BMI), gait speed, grip strength, PhA, and the outcomes of LS risk assessment using the stand-up test, two-step test, and the 25-Geriatric Locomotive Function Scale (GLFS25). Results: A total of 190 patients (57 females, 133 males; mean age, 62.6 ± 17.2 years) were analyzed. The PhA was significantly negatively correlated with the LS stage (rs = −0.507, p < 0.001). Similarly, a significant negative correlation was observed between the PhA and each LS risk test, namely, the stand-up test, two-step test, and GLFS25. Furthermore, the PhA was identified as an independent and significant factor associated with LS progression (odds ratio, 0.361; 95% confidence interval, 0.221–0.588; p < 0.001). More effective and rapid than completing the full range of LS risk tests, measuring the PhA represents a convenient and practical tool for the early screening of mobility decline. Conclusions: The PhA is a simple and effective parameter for assessing mobility decline in patients with cancer. It is a potential clinical indicator for initiating rehabilitation interventions aimed at preventing the onset and progression of LS.

Background and Objectives: Changes in activities of daily living (ADL) and quality of life (QOL) of patients with bone metastasis who underwent surgical treatment through Bone Metastasis Cancer Boards (BMCBs), a recent multidisciplinary approach for managing bone metastases, have been reported; however, no reports exist on patients who undergo conservative treatment. In this study, we aimed to evaluate these patients’ ADL and QOL and examine the factors influencing changes in these parameters. Materials and Methods: We retrospectively reviewed 200 patients with bone metastases who underwent conservative therapy through BMCBs between 2013 and 2021. A reassessment was conducted within 2–8 weeks after the initial assessment. Patients’ background and changes in performance status (PS), Barthel Index (BI), EuroQol five-dimension (EQ-5D) scores, and Numerical Rating Scale (NRS) scores were initially assessed. Furthermore, we categorized patients into two groups based on improvements or deteriorations in ADL and QOL and performed comparative analyses. Results: Significant improvements in EQ-5D (0.57 ± 0.02 versus [vs.] 0.64 ± 0.02), NRS max (5.21 ± 0.24 vs. 3.56 ± 0.21), and NRS average (2.98 ± 0.18 vs. 1.85 ± 0.13) scores were observed between the initial assessment and reassessment (all p < 0.001). PS (1.84 ± 0.08 vs. 1.72 ± 0.08) and BI (83.15 ± 1.68 vs. 84.42 ± 1.73) also showed improvements (p = 0.06, and 0.054, respectively). In addition, spinal cord paralysis (odds ratio [OR]: 3.69, p = 0.049; OR: 8.42, p < 0.001), chemotherapy (OR: 0.43, p = 0.02; OR: 0.25, p = 0.007), and NRS average scores (OR: 0.38, p = 0.02; OR: 0.14, p < 0.001) were independent factors associated with ADL and QOL. Conclusions: Patients with bone metastases who underwent conservative treatment through BMCBs exhibited an increase in QOL without a decline in ADL. The presence of spinal cord paralysis, absence of chemotherapy, and poor pain control were associated with a higher risk of deterioration in ADL and QOL.