Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

Systematic reviews rely on identification of studies, initially through electronic searches yielding potentially thousands of studies, and then reviewer-led screening studies for inclusion. This standard method is time- and resource-intensive. We designed and applied an algorithm written in Python involving computer-aided identification of keywords within each paper for an exemplar systematic review of arm impairment after stroke. The standard method involved reading each abstract searching for these keywords. We compared the methods in terms of accuracy in identification of keywords, abstracts' eligibility, and time taken to make a decision about eligibility. For external validation, we adapted the algorithm for a different systematic review, and compared eligible studies using the algorithm with those included in that review. For the exemplar systematic review, the algorithm failed on 72 out of 2,789 documents retrieved (2.6%). Both methods identified the same 610 studies for inclusion. Based on a sample of 21 randomly selected abstracts, the standard screening took 1.58 ± 0.26 min per abstract. Computer output screening took 0.43 ± 0.14 min per abstract. The mean difference between the two methods was 1.15 min ( P < 0.0001), saving 73% per abstract. For the other systematic review, use of the algorithm resulted in the same studies being identified. One study was excluded based on the interpretation of the comparison intervention. Our purpose-built software was an accurate and significantly time-saving method for identifying eligible abstracts for inclusion in systematic reviews. This novel method could be adapted for other systematic reviews in future for the benefit of authors, reviewers and editors.

Common secondary impairments associated with aging in adults with cerebral palsy (CP) decrease physical functions, including walking and balance ability, and increase the sense of fatigue. This motor dysfunction results in decreased physical activity (PA) and could be associated with obesity and sarcopenia. This study examined the association of daily PA levels with fatigue, physical function, and body composition in 22 adults with CP (age, 37.4 ± 14.7 years; Gross Motor Function Classification System level, I: 6, II: 16). The level of daily PA was divided into percent of sedentary behavior, light PA, and moderate-to-vigorous PA (%MVPA) per day. These outcomes were examined for correlation with the Fatigue Severity Scale, knee extension strength, comfortable and maximum walking speed, Timed-Up-and-Go-Test (TUG), and body fat percentage and skeletal muscle mass using Spearman's rank correlation coefficient. An additional partial correlation analysis with sex and age adjustment was performed. The %MVPA correlated positively with comfortable walking speed (rs = 0.424, P = 0.049) and negatively with TUG (rs = -0.493, P = 0.020). The partial correlation revealed associations of %MVPA with maximum walking speed (r = 0.604, P = 0.022) and TUG (r = -0.604, P = 0.022). The results show that among adults with CP, increased PA is associated with improvements in mobility but not in perceived fatigue or body composition, regardless of sex and age. Maintaining and improving %MVPA and walking and balance ability in adults with CP have a positive impact on each other, and potentially on overall health management.

The objective of this study is to describe the healthcare utilization, and clinical and sociodemographic features of a cohort of 74 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary rehabilitation hospital in Toronto, Canada. A retrospective chart review was performed using 74 charts from patients admitted to a COVID-19 rehabilitation unit between 11 April 2020 and 30 April 2021. Measures of central tendency, SDs, interquartile ranges, frequencies, and proportions were calculated to analyze clinical and sociodemographic data. A total of 74 patients were included in this study, including 33 males and 41 females. The mean age was 72.8 years, with Wave 1 patients being younger than Wave 2 patients. Sixty-six percent of total patients experienced hypertension. Mean functional independence measure score across both waves was 78 at admission and 100 at discharge. Mean length of stay was 14.6 days in Wave 1 and 18.8 days in Wave 2. This study represents some of the first data on the characteristics and outcomes of COVID-19 patients admitted to inpatient rehabilitation in Toronto, Canada across the initial waves of the COVID-19 pandemic.

This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.

The aim of this study was to derive a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis. This prospective cohort study was conducted in four orthopedic clinics. The main outcome measure was falls or nonfalls for 5 months, and the predictors were sex, age, BMI, Kellgren-Lawrence grade, laterality, number of comorbidities, pharmacotherapy, physical therapy period, use of a cane, household, previous history of falls, visual analog scale for pain, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and Frenchay activities index. Ninety outpatients (74 females and 16 males) with a mean (SD) age of 73.1 (9.3) years completed a 5-month follow-up. According to the binomial logistic regression analysis, previous history of falls [odds ratio (OR), 6.85; P = 0.019], OLST (OR, 5.97; P = 0.048), and FTSST (OR, 12.93; P = 0.034) were identified as risk factors for falls, and the clinical prediction rule was derived from these variables. The pretest probability of fallers in this study was 21.1% (19 of 90 participants). When the total screening tool score was three points (the participant scored one point for each item: previous history of falls, yes; OLST, ≤6.84 s; FTSST, ≥8.77 s), the positive likelihood ratio was 16:19, and the posttest probability increased to 81.3%. Therefore, this simple screening tool possesses potential clinical utility for identifying patients with knee osteoarthritis at high risk of falls in the future because it demonstrated sufficient diagnostic test accuracy.

To explore the internal consistency and factor structure of the Neck Disability Index (NDI) among patients undergoing surgery on the cervical spine. This was an observational retrospective cohort study among 392 patients undergoing cervical surgery of any kind in a university hospital between 2018 and 2021. The patients responded to repeated surveys preoperatively, and 3, 12 and 24 months postoperatively. The reliability and validity of the NDI were investigated using Cronbach's alpha and factor analysis. The internal consistency of the NDI was found to be good at 0.86. The exploratory factor analysis demonstrated unidimensionality. The correlations between the main factor 'disability' and all the individual items of the NDI were at least moderate. The highest correlations were observed for pain intensity, reading, driving and recreation. The NDI is an internally consistent and unidimensional scale when applied to a population of patients undergoing cervical surgery. 45: 273-278 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 can lead to acute respiratory distress syndrome. Awake venovenous extracorporeal membrane oxygenation is known to be effective in patients with critical COVID-19 and respiratory failure. This report describes the rehabilitation course and functional progress of a 63-year-old man who contracted severe COVID-19 and underwent awake venovenous extracorporeal membrane oxygenation. He started rehabilitation from the time of isolation while receiving venovenous extracorporeal membrane oxygenation and underwent a 30-day course of inpatient comprehensive rehabilitation. He regained functional independence and cognitive abilities and was able to walk without assistance at hospital discharge without any complications. This study demonstrates the feasibility of starting rehabilitation for COVID-19 early while the patient is on awake venovenous extracorporeal membrane oxygenation and eventually achieving a favorable outcome.

Autonomic imbalance in stroke is characterized by increased sympathetic activity and reduced vagal nerve activity. Physical activity could be a strategy to counteract autonomic control impairments after a stroke. The aim of the study was to evaluate the effect on heart rate variability of a 6-month coaching program in a home setting in subacute stroke patients. Eighty-four stroke patients participated in the study. They were randomly assigned to the experimental group or the control group. The intervention was a coaching program, consisting of physical activity, home visits and a weekly phone call. Patients were evaluated after hospital discharge (T0) and at the end of the 6-month period (T1). Heart rate variability measures were recorded in the supine and orthostatic positions. Time and frequency domain values were treated using Kubios. Distance on 6 minutes walking test (6MWT), Barthel and motricity index and modified functional ambulation categories were evaluated. No effects were found on time and frequency domain values in the supine and orthostatic positions in either group. Walking distance on 6MWT increased significantly between T0 and T1 in experimental group (377 ± 141-448 ± 140 m; P < 0.02) with no effects in control group (373.6 ± 150.6-394.6 ± 176.4 m). No other functional effects were found. A coaching program in a home setting had no effect on heart rate variability, probably due to time of recovery and exercise intensity. Future research is needed to understand the lack of changes in heart rate variability by physical activity in subacute stroke patients.