Seirei Christopher University

Health-Related Quality of Life (HRQOL) is an essential domain for evaluating the true success of rehabilitation. The EuroQol 5-dimension 5-level (EQ-5D-5L) is a brief and widely used HRQOL measure. However, evidence is currently lacking regarding its responsiveness following rehabilitation for musculoskeletal disorder, particularly in Japan. Assessment of HRQOL is challenging for older patients with musculoskeletal disorders, particularly those with cognitive impairments or frailty, who may have difficulty self-reporting. Therefore, evaluating the reliability of proxy assessments is crucial in this population. Furthermore, the agreement between self-ratings and proxy-ratings is generally reported to be low. In contrast, a previous Japanese study reported high agreement when an Occupational Therapist (OT) acted as a proxy for stroke patients. This study therefore aimed to clarify the change (responsiveness) in HRQOL and investigate the inter-rater reliability between patient self-responses and OT proxy responses using the EQ-5D-5L in patients with musculoskeletal disorders in a Japanese convalescent rehabilitation ward. This was a multicenter, collaborative longitudinal study conducted across five hospitals in Japan. We enrolled 77 participants with musculoskeletal disorders who were capable of self-reporting. The mean age was 77.7 years. Evaluations were conducted at initial assessment (within one week of admission) and re-evaluation (one month later). HRQOL was measured using the EQ-5D-5L. Proxies were clinical OT who were blinded to patient responses during concurrent assessment. Responsiveness was assessed using the Standardized Response Mean (SRM). Inter-rater reliability for the QOL score was assessed using the Intraclass Correlation Coefficient (ICC), and the sub-items were assessed using weighted Kappa. Significant improvement was observed in all outcome measures post-rehabilitation (p < 0.01). The SRM for the QOL score indicated a large effect size for both self-reported (0.90) and proxy-reported (0.95) responses. Inter-rater reliability for the QOL score showed substantial agreement, with the ICC at re-evaluation was 0.72 (95%CI: 0.59; 0.81), which met the threshold for “good measurement properties” (≥ 0.70) as defined by the COSMIN criteria. The kappa coefficients for the five sub-items ranged from 0.31 (95%CI: 0.17; 0.45) to 0.56 (95%CI: 0.40; 0.72) (fair to moderate agreement). The EQ-5D-5L demonstrates high responsiveness and good inter-rater reliability when administered by an OT proxy at the one-month re-evaluation in this patient population. These findings support the use of OT proxy-responses to reliably estimate the HRQOL of patients with musculoskeletal disorders in the convalescent setting, particularly when self-reporting is difficult, providing evidence that proxy assessments can reliably complement patient reports in musculoskeletal rehabilitation settings.

Hearing loss in older adults is a risk factor for depression, cognitive decline, frailty, and other conditions, and it has various negative physical and psychological effects. Hearing loss care requires the support of medical professionals; however, most hearing care education is targeted at professionals working in hospitals and care facilities, with few interventions aimed at visiting nurses. To address this gap, we developed the "Hearing Loss Care Education Program for the Older Adults" to improve visiting nurses' skills in managing hearing loss. This study aimed to evaluate the effectiveness of the program. This cluster randomized controlled trial was registered in the UMIN Clinical Trials Registry (UMIN000053337) and conducted across 22 visiting nursing stations: 11 in the intervention group (60 visiting nurses) and 11 in the control group (42 visiting nurses). The intervention consisted of on-demand lectures and technical exercises, followed by a 3-month follow-up period. The primary outcome was the "implementation of hearing care," whereas the secondary outcomes were "knowledge of hearing care" and "confidence in implementing hearing care." Between-group differences were analyzed using generalized estimating equations. As part of the primary outcome, a significant increase in the implementation of "hearing screening" was observed in the intervention group (odds ratio 8.35, 95% confidence interval 3.60-19.34, p < 0.001). Additionally, the intervention group demonstrated significantly higher "knowledge of hearing care" and "confidence in implementing hearing care." These findings suggest that the program effectively enhanced visiting nurses' knowledge and confidence in hearing care and supports the integration of hearing screening into their routine practice.

Abstract Background This study investigated the prevalence of presenteeism and its associated factors in employed patients undergoing maintenance hemodialysis (HD). Methods A single-center cross-sectional study was conducted involving 33 employed HD patients in Japan. Presenteeism was assessed using the work functioning impairment scale (WFun). Additional evaluations included hemoglobin (Hb) levels, exercise self-efficacy (SE), physical function (grip strength, 10-m walk test, and the short physical performance battery [SPPB]), and dialysis-related parameters. Correlation and multiple regression analyses were performed to identify independent predictors. Results Presenteeism was present in 39.4% of participants. WFun scores showed significant negative correlations with Hb levels, exercise SE scores, and SPPB scores. Multiple regression analyses revealed that lower Hb and SE scores were independently associated with higher WFun scores after adjustment for covariates. Conclusions Presenteeism in HD patients is linked to anemia and low exercise SE. Addressing these factors may support continued employment.

IntroductionVestibular migraine (VM) remains an under-recognized condition despite its relative high prevalence and substantial impact on the interictal burden of migraine. We quantified vestibular dysfunctions and interictal migraine burden and evaluated whether dizziness contributes to the migraine interictal burden of VM.MethodsWe conducted a retrospective observational study of consecutive patients fulfilling the Bárány Society and the International Classification of Headache Disorders, 3rd edition, criteria for VM who attended our outpatient clinic between December 2024 and April 2025. Multidimensional assessments included the Headache Impact Test-6 (HIT-6), Migraine Interictal Burden Scale-4 (MIBS-4), Dizziness Handicap Inventory (DHI), Self-Rating Depression Scale (SDS), Video Head Impulse Test (v-HIT), and posturography (Romberg ratio). Association between MIBS-4 and the other assessments were analyzed using Spearman’s correlation and stepwise multiple linear regression.ResultsSeventy-five patients were included {median age 37 years [interquartile range (IQR): 27–47]; 74.3% female; 26.7% with aura}. The median HIT-6 score was 62 (IQR: 58–65) and the median MIBS-4 was 4.0 (IQR: 1.0–7.0), with 41.3% of patients exhibiting severe interictal burden (MIBS-4 ≥5). The median DHI score was 20 (IQR: 12–36), and the Romberg ratio was 1.45 (IQR: 1.03–1.97). Vestibular-ocular reflex gains were largely normal, whereas 73.3% of patients exhibited catch-up saccade (CUS) abnormalities. In univariable analyses, MIBS-4 correlated positively with HIT-6 (ρ = 0.414, p < 0.001), DHI (ρ = 0.419, p < 0.001), and SDS (ρ = 0.433, p < 0.001). In multivariable analysis, high HIT-6 scores (β = 0.265, p = 0.016) and high DHI total scores (β = 0.250, p = 0.019) independently predicted high MIBS-4.ConclusionIn patients with VM during the interictal period, vestibular functions were largely normal except for abnormalities in the v-HIT CUS, whereas subjective dizziness assessed by DHI significantly contributed to the high degree of migraine interictal burden. The dizziness experienced in VM resembled that of persistent postural-perceptual dizziness. These results indicate that vestibular rehabilitation might be effective in alleviating migraine interictal burden in patients with VM.

To investigate the relationship between the visual field (VF) deterioration and vessel density (VD) around the optic nerve head (ONH) in a sector-wise manner in eyes with retinitis pigmentosa (RP). The present study enrolled the RP patients who demonstrated VF constriction within central 10°. The VD around the ONH was measured with optical coherence tomography angiography (OCTA), using three binarization methods and the relationships between VD and the mean deviation (MD) value were investigated, respectively. Then, the VD in each quadrant (superior, temporal, inferior, nasal) around the ONH was calculated using Otsu method (OVDs: vessel density measured with Otsu method in the superior region, OVDt: vessel density measured with Otsu method in the temporal region, OVDi: vessel density measured with Otsu method in the inferior region, OVDn: vessel density measured with Otsu method in the nasal region). Considering the foveal position relative to the optic disc, angle-corrected binarized OCTA images were created and the VD was measured in each sector (AcOVDs: angle-corrected OVDs, AcOVDt: angle-corrected OVDt, AcOVDi: angle-corrected OVDi, and AcOVDn: angle-corrected OVDn). We investigated the relationship between the MD value and OVDs, OVDt, OVDi and OVDn. Furthermore, the correlation between the MD value and AcOVDs, AcOVDt, AcOVDi and AcOVDn was analyzed. Thirty-six eyes were examined in the current study. Among Niblack, Bernsen and Otsu methods, the VD measured with Otsu method was closely related to the MD value. Among OVDs, OVDt, OVDi and OVDn, the optimal model for the MD value included OVDt and OVDi. On the other hand, among AcOVDs, AcOVDt, AcOVDi and AcOVDn, the optimal model for the MD value included only AcOVDt. The sector-wise VD around the ONH reflects VF deficit severity and is a candidate for improving the assessment of VF deterioration in eyes with RP.

Objectives: Digital Transformation (DX) is bringing innovation to disaster nursing education. This study aims to develop a higher-quality virtual simulation system using generative AI, computer graphics, large displays, projection mapping, and virtual reality, with a focus on disaster scenarios.

This study aimed to examine the effects of intradialytic exercise (IDE) on improving activities of daily living (ADL) and physical function in hospitalized hemodialysis (HD) patients. The research question focused on improving outcomes in ADL and physical function. This study is a single-center, historical cohort study. Subjects were hospitalized HD patients undergoing rehabilitation between April 2017 and February 2023. Patients were divided into two groups: the IDE group, which received IDE, and the non-IDE group, which did not. The outcomes measured were Barthel Index (BI), grip strength, isometric knee extension strength (IKES), 10-meter walking speed (10MWS), and Short Physical Performance Battery (SPPB). Outcome measures were taken at admission and discharge, and changes were analyzed using a linear mixed model. The study included 76 participants (IDE group: 13, non-IDE group: 63). The IDE group showed significant improvements in ΔBI (13.7 [0.96-26.38] points) and Δ10MWS (0.25 [0.05-0.45] m/sec) (p < 0.05). No significant differences were observed between the two groups in ΔGrip strength (2.10 [-0.40 to 4.60] kg), ΔIKES (7.40 [-2.20 to 17.02] %), or ΔSPPB (1.23 [-0.48 to 2.94] points) (p > 0.05). However, the IDE group showed significant pre-post improvements in grip strength (1.55 [1.46-1.65] kg) and SPPB (2.44 [1.34-3.55] points) (p < 0.05). IDE contributed to greater improvements in BI and 10MWS in HD patients. These findings suggest that adding IDE to inpatient rehabilitation may enhance functional recovery in this population.