Objective: This study aimed to develop a predictive model for early ambulation using clinical indicators obtained immediately after surgery in patients with proximal femoral fractures.Methods: Patients who sustained a proximal femoral fracture and underwent surgery between April 2022 and April 2024, and whose medical records confirmed independent ambulation of at least 10 m before injury, were included. Those who died or had postoperative weight-bearing restrictions were excluded. The outcome variable was the ability to walk 10 meters without assistance at two weeks postoperatively. Predictive features included body mass index (BMI), abbreviated mental test score (AMTS), American Society of Anesthesiologists physical status, use of walking aids pre injury, intraoperative blood loss, and surgical method. A gradient boosting decision tree was used to develop the model.Results: A total of 122 patients were included. Key predictors of ambulation at two weeks were AMTS, BMI, and the use of an intramedullary nail. The model achieved a recall of 72.7%, a precision of 66.6%, and an ROC AUC of 0.80 in an independent test dataset.Conclusion: This study demonstrated the feasibility of a machine learning model to predict early ambulation using immediate postoperative indicators. As walking ability at two weeks is associated with long-term gait recovery and discharge outcomes, this model may aid in optimizing rehabilitation planning and discharge strategies.

Objective: This study aimed to identify the characteristics of cases in which walking level improves even in the later stages of convalescent rehabilitation, and to predict such cases.Methods: The Walking LEVEL Scale (WaLS) was measured over time in 192 patients (brain-related and orthopedic diseases) admitted to a convalescent rehabilitation ward. The “delayed recovery group (DR)” was defined as the group showing improvement of WaLS in the later period, while the “non-delayed recovery group (NDR)” was defined as the group for whom improvement of WaLS did not extend into the same period. Then, changes in WaLS over time and each factor were compared to identify differences between DR and NDR. Using receiver operating characteristic analysis, cutoff values, sensitivity and specificity, likelihood ratios for the relevant factors were calculated and examined for the predictability of DR utilizing Bayesian estimation.Results: WaLS temporal changes showed a sigmoid curve only in the DR of brain-related disease. Other groups showed logarithmic curves. The WaLS score at admission was selected as a significant variable. The positive and negative likelihood ratios for the score at cutoff values of 4 or less were 2.00 and 0.19 for brain-related disease, and 1.49 and 0.63 for orthopedic disease, respectively. Adopting the DR frequency of the participants in this study as the prior probability, the DR posterior probability of brain-related disease was calculated to be 5% using the negative likelihood ratio.Conclusion: The negative likelihood ratio of the WaLS score at admission is useful for predicting DR for brain-related disease.

Objective: Early mobilization is associated with improved mortality rates and is therefore actively implemented in recent years even for patients with severe stroke. Although previous studies reported the effects of early mobilization with stroke, few have fully considered background factors such as severity of stroke. The purpose of this study was to investigate the effects of early mobilization (within 48 hours) on complications of immobility and the functional prognosis in patients with moderate-to-severe stroke.Methods: The study included 83 patients diagnosed with moderate-to-severe stroke (ischemic or hemorrhagic). Patients were categorized into those who underwent early mobilization and those who underwent mobilization after 48 hours. We retrospectively investigated the effects of early mobilization on complications of immobility (pneumonia, urinary tract infection, deep-vein thrombosis, pressure sores, and pulmonary embolism) and functional prognosis (modified Rankin Scale at discharge or moving on to convalescent rehabilitation).Results: The incidence of pneumonia and the percentage of patients with a modified Rankin scale score at discharge was significantly lower in the early mobilization than in the late mobilization group (mobilization after 48 hours)(p<0.01).Conclusion: Early mobilization was of significance for preventing complications associated with immobility, especially pneumonia, and for improvement in functional prognosis.

Objective: Studies have reported that animal-assisted therapy (AAT) intervention can improve patient motivation to complete rehabilitation treatment.Methods: AAT was administered four times for a patient whose rehabilitation treatment was hindered by pain and depression following cervical myelopathy surgery. Ward nurses evaluated the patient's behavior and facial expressions before and during each AAT session using our hospital's own Faces Pain Scale. The AAT intervention was timed to coincide with the implementation of training items that were likely to induce pain.Results: The patient, who underwent cervical myelopathy surgery and whose rehabilitation treatment was severely hindered, reported significantly improved treatment motivation after the AAT intervention. A significantly better treatment response was obtained immediately after the AAT intervention. The Faces Pain Scale score was the worst prior to starting AAT (at 5). However, it peaked at 1 and remained there from the initial intervention to the fourth and final intervention. These results suggest immediate and lasting effects of AAT.Conclusion: Significant changes were observed after the initial AAT intervention, suggesting that its effect was more significant for the awareness of pain and motivation for rehabilitation than for pain relief.

Objective: Early mobilization is associated with improved mortality rates and is therefore actively implemented in recent years even for patients with severe stroke. Although previous studies reported the effects of early mobilization with stroke, few have fully considered background factors such as severity of stroke. The purpose of this study was to investigate the effects of early mobilization (within 48 hours) on complications of immobility and the functional prognosis in patients with moderate-to-severe stroke.Methods: The study included 83 patients diagnosed with moderate-to-severe stroke (ischemic or hemorrhagic). Patients were categorized into those who underwent early mobilization and those who underwent mobilization after 48 hours. We retrospectively investigated the effects of early mobilization on complications of immobility (pneumonia, urinary tract infection, deep-vein thrombosis, pressure sores, and pulmonary embolism) and functional prognosis (modified Rankin scale at discharge or moving on to convalescent rehabilitation).Results: The incidence of pneumonia and the percentage of patients with a modified Rankin scale score at discharge was significantly lower in the early mobilization than in the late mobilization group (mobilization after 48 hours)(p<0.01).Conclusion: Early mobilization was of significance for preventing complications associated with immobility, especially pneumonia, and for improvement in functional prognosis.

Objective: Studies have reported that animal-assisted therapy (AAT) intervention can improve patient motivation to complete rehabilitation treatment.Methods: AAT was administered four times for a patient whose rehabilitation treatment was hindered by pain and depression following cervical myelopathy surgery. Ward nurses evaluated the patient's behavior and facial expressions before and during each AAT session using our hospital's own Faces Pain Scale. The AAT intervention was timed to coincide with the implementation of training items that were likely to induce pain.Results: The patient, who underwent cervical myelopathy surgery and whose rehabilitation treatment was severely hindered, reported significantly improved treatment motivation after the AAT intervention. A significantly better treatment response was obtained immediately after the AAT intervention. The Faces Pain Scale score was the worst prior to starting AAT (at 5). However, it peaked at 1 and remained there from the initial intervention to the fourth and final intervention. These results suggest immediate and lasting effects of AAT.Conclusion: Significant changes were observed after the initial AAT intervention, suggesting that its effect was more significant for the awareness of pain and motivation for rehabilitation than for pain relief.