Kawasaki University of Medical Welfare

ABSTRACTObjectives:Non-older adults are at risk of developing sarcopenia, and exercise and increased physical activity are effective preventive interventions. Digital interventions, including gamification, may enhance the effects of exercise interventions. This systematic review and meta-analysis examined the effects of digital health interventions on muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia.Methods:We conducted a systematic review of randomized controlled trials that evaluated the effects of digital health interventions on outcomes related to sarcopenia. Literature searches were performed in MEDLINE (Ovid), Web of Science Core Collection, and CENTRAL databases. Risk of bias was assessed according to established guidelines, and meta-analyses were conducted. The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.Results:In total, 28 studies were analyzed. The pooled results indicated that digital health interventions led to improvements in grip strength, performance in the chair-stand test, walking speed, Dynamic Gait Index, and Timed Up-and-Go test. In contrast, lower limb muscle strength and lean body mass did not show meaningful improvements. Although no major risks of bias were identified, the strength of the evidence remained limited because of the small number of studies and participants included.Conclusions:This systematic review suggests that digital health interventions may lead to modest improvements in muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia, although the current evidence remains inconclusive. Further studies are needed to establish their effect.

• Frailty subtypes were assessed using the Kihon Checklist in older adults. • Housebound status independently predicted future fractures in a 9-year cohort. • A single KCL item on going out weekly identified high fracture risk. • KCL may serve as a simple screening tool for fracture prevention in the community. • Findings support including social frailty in fracture risk assessment models. This study aims to determine whether frailty, assessed using the simple multidimensional frailty assessment tool, the Kihon Checklist (KCL), is associated with future fractures and, if so, to identify which frailty subtypes exhibit the strongest association with fracture incidence. This study recruited local residents who visited government-organized examination sites for specific health check-ups for older adults, conducted over a three-day period each year and 468 community-dwelling older adults from 2014 to 2023 in Hino Town, Tottori Prefecture, Japan. Characteristics, physical structure and performance, and frailty were assessed at the baseline assessment. Frailty was assessed using KCL and categorized into six subtypes: lower motor function, malnutritional, lower oral function, housebound, reduced cognitive function, and possible depression. Self-Reported incidence fracture was determined through annual follow-up surveys. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the association between frailty subtypes and fracture incidence. A total of 352 participants were followed for fracture incidence over a mean period of 6.9 years. During the follow-up period, 41 participants experienced at least one fracture, resulting in an incidence rate of 1.69 per 100 person-years. Both lower motor function and housebound were significantly associated with fracture incidence. However, after adjusting for previous fall history, and lower bone mass, housebound (HR = 2.436, 95 % CI: 1.125–5.271) remained significantly associated with fracture incidence. Unlike previous studies emphasizing musculoskeletal frailty, our findings highlight housebound status as a factor associated with fractures. Fracture prevention strategies should integrate social engagement interventions alongside conventional musculoskeletal management.

ObjectiveThis study aimed to extract incident and accident reports associated with high-flow nasal cannula (HFNC) therapy from the publicly available database maintained by the Japan Council for Quality Health Care (JCQHC) and to identify contributing factors using the P-mSHEL model (Patient-management-Software-Hardware-Environment-Liveware), with the goal of providing insights for improving HFNC safety.MethodsAmong 94,069 incident reports (defined as cases without patient harm) and 56,783 accident reports (cases with patient harm) submitted between 2010 and 2023, a total of 170 HFNC-related cases (131 incidents and 39 accidents) were identified. Quantitative variables included the time of occurrence, patient demographics, and involvement of healthcare professionals. Qualitative data were classified into six categories (P, m, S, H, E, L) using the P-mSHEL model. For accident cases, the presence or absence of sequelae was analyzed using logistic regression.ResultsIn accident cases, the Patient (P) factor (odds ratio = 2.65, p = 0.006) and the Management (m) factor (odds ratio = 2.46, p = 0.033) were significantly associated with the occurrence of sequelae. In incident cases, the Liveware (L) factor (i.e., human error) was involved in 80.2% of reports, and the Hardware (H) factor (i.e., medical devices) in 52.7%, highlighting the critical roles of human and device-related factors.ConclusionTo ensure the safe use of HFNC, it is essential to implement risk mitigation strategies targeting the Patient and Management factors, such as comprehensive patient screening and strengthened organizational systems. Furthermore, given the high involvement of the Liveware and Hardware factors, structured educational programs and practical interventions for medical device operation are warranted.

要旨: 聞き取り困難 (LiD) に対して包括的評価を行い, 「聞こえにくさのチェックシート」との間にどのような関連があるのかについて検討を行った。

Dysphagia is prevalent among elderly and neurologically impaired individuals, causing serious complications such as aspiration pneumonia. Interferential Current Stimulation (IFC), a non-invasive sensory method, may improve swallowing by reducing reflex latency. This study aimed to investigate the effects observed during active IFC stimulation of IFC on swallowing function using Laryngeal Elevation Delay Time (LEDT), Stage Transition Duration (STD), and Penetration-Aspiration Scale (PAS). Forty-six participants (ages 29-98) undergoing videofluoroscopic swallowing studies received IFC stimulation with electrodes bilaterally placed on the thyroid cartilage. Swallowing parameters were analyzed frame-by-frame using ImageJ software. LEDT measured the time from contrast arrival at the bottom of the piriform sinus to maximum laryngeal elevation. STD was the interval from oral bolus transit to pharyngeal swallow initiation. PAS assessed penetration and aspiration severity. LEDT significantly improved from baseline (median [IQR]: 0.15 [0.00-0.35] s) to 10min during IFC stimulation (0.00 [0.00-0.19] s; p = 0.02, r = 0.46, 95% CI [0.11-0.76]). No significant changes were found in STD (STD1: p = 0.37; STD2: p = 0.37) or PAS scores (PAS1: p = 0.20; PAS2: p = 0.71). Responder analysis indicated substantial individual variability: approximately 70% improved in LEDT, while only 37-45% improved in STD. Higher responder rates were noted among participants with respiratory and cerebral disorders. IFC stimulation significantly shortened swallowing reflex latency (LEDT), suggesting its potential benefit for dysphagia rehabilitation. However, it did not significantly alter stage transition duration (STD) or penetration-aspiration safety (PAS). Further studies should explore long-term effects and optimal stimulation parameters.

目的：嚥下造影検査（VF）は嚥下障害の診断や治療法の決定において重要な情報源となる．現行の評価法は主観的要素が強く，客観的評価の臨床活用が望まれる．本研究では嚥下障害の対照群と疾患群との比較研究から，疾患群の嚥下障害の病態を定量的に示すことを目指した．

Although an acute bout of peristaltic pulse external pneumatic compression (EPC) of the lower extremities can improve vascular function, its effect on arterial stiffness remains unclear. This study aimed to investigate the acute effect of lower-limb peristaltic pulse EPC on segmental arterial stiffness. Nineteen healthy young adults (12 males and 7 females) (age: 20 ± 1 years) were allocated to undergo two experimental trials using a randomized crossover design. EPC treatment delivered at 70-80 mmHg (EPC trial) or non-compressed sham treatment (sham trial) was performed for 30 min. At baseline (Pre) and after the 30-min treatment (Post), arterial stiffness indices, including the heart-brachial pulse wave velocity (PWV) (hbPWV), brachial-ankle PWV (baPWV), heart-ankle PWV (haPWV), and the cardio-ankle vascular index (CAVI) were measured simultaneously. All parameters in the EPC trial exhibited a significant decrease (p < 0.05) at Post compared to Pre, including hbPWV, baPWV, haPWV, and CAVI. However, no such changes were observed in the sham trial. The study findings demonstrate that a single 30-min bout of lower-limb peristaltic pulse EPC can decrease arterial stiffness in healthy young adults. The observed EPC-induced decrease in arterial stiffness in various segments suggests that the beneficial vascular effect could be elicited systemically.

We assessed the immediate effects of a home-based rehabilitation (HBR) program on the balance performance and toe-grip strength of 29 older adults (mean±SD age of 75.1±9.9; 16 males, 13 females) who were participating in HBR services provided by Japan's nursing care insurance system. Their toe-grip strength and balance performance were measured before and after the HBR program. The subjects' toe-grip strength was significantly improved after the treatment. The subjects who had had a stroke showed a significant improvement after HBR. Contrarily, no significant difference was observed in the subjects' functional reach results or their one-leg standing time. These results indicate that the exercise regimen provided in the HBR program led to increased excitability of motor units and immediately enhanced the subjects' toe-grip strength.