1.Rehabilitation Improves Both the Prognosis and Activities of Daily Living Scores in Hemodialysis Patients
Hideki TSUKAHARA ; Yuya NAKAMURA ; Takuya MURAKAMI ; Misako ENDO ; Yoshinobu WATANABE ; Yu SHIMANO ; Masaki HARA ; Masatomo MIHARA ; Tatsuo SHIMIZU ; Michiyasu INOUE ; Yoshiyuki MATSUOKA ; Tsutomu ASANO ; Hiromichi GOTOH ; Yoshikazu GOTO
The Japanese Journal of Rehabilitation Medicine 2014;51(11):716-723
Background : The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods : This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results : The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; p<0.0008). Conclusions : Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.
2.Clinical Implications of the Interdisciplinary Psychosocial Approach and Integrative Care for Patients with Advanced Cancer and Family Members in the Nutritional Support and Cancer Cachexia Clinic
Koji AMANO ; Daisuke KIUCHI ; Hiroto ISHIKI ; Hiromichi MATSUOKA ; Eriko SATOMI ; Tatsuya MORITA
Palliative Care Research 2021;16(2):147-152
Food and eating are of great significance to humans, as we are the only creatures that establish relationships and sustain a social network through food and eating. Recent studies revealed that patients with advanced cancer and their family members often experience complicated eating-related distress due to tumors themselves, side effects of cancer treatments, and negative impacts of cancer cachexia. Therefore, we suggested the importance of the integration of palliative, supportive, and nutritional care to alleviate eating-related distress among patients and family members, and the significance of the development of tools to measure their distress in supportive and palliative care settings. No care strategies for eating-related distress experienced by patients and family members have been established, and the development of an interdisciplinary psychosocial approach and integrative care is required. As such, we are planning to start a nutritional support and cancer cachexia clinic in the National Cancer Center, and disseminate a newly developed care program across Japan.