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: This study investigated and compared the responsiveness of the Walking LEVEL Scale (WaLS), Functional Independence Measure (FIM)-walk item, and Functional Ambulation Category (FAC) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Methods: One hundred three patients participated in this study. Physical or occupational therapists assessed the three scales at two times of admission and discharge to determine the responsiveness. The amount of change, ceiling and floor effect, Effect Size (ES), and Standardized Response Mean (SRM) determined the responsiveness to change from admission to discharge. Their analysis was by severity and disease.Results: The amount of change in WaLS was larger than that of the FIM-walk item and FAC, except for the moderate gait disability group. More ceiling and floor effects were observed in FIM-walk item evaluation. Regardless of severity or disease, all rating scales showed moderate or better responsiveness (ES > 0.5). When ceiling or floor effects were observed, ES tended to be overestimated. The SRM of WaLS was larger than that of the other scales, except for the mild gait disability group.Conclusion: The results support WaLS as the most suitable instrument to detect walking level changes over time for patients in CRW.

Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.

Objective：To evaluate the reliability and concurrent validity of the Walking LEVEL Scale (WaLS) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Design：The WaLS was used as an assessment scale to categorize the walking ability of patients in a CRW.Subjects/Patients：A total of 103 patients in a CRW were included in the study.Methods：Retest and inter-rater reliability were evaluated by using the WaLS to assess patients by the same rater and by two independent raters using the weighted kappa coefficient. Spearman correlation was used to assess the correlation between the WaLS and FIM-walk item scores and the WaLS and FAC scores (i.e., concurrent validity).Results：The retest and inter-rater reliability of the WaLS (weighted kappa coefficient) was 0.989 (p＜0.01) and 0.951 (p＜0.01), respectively. The WaLS scores were also significantly correlated with the FIM-walk item (p＝0.916, p＜0.01) and FAC scores (p＝0.919, p＜0.01)．Conclusion：The WaLS was found to demonstrate good reliability and concurrent validity in patients hospitalized in CRW.

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.

STUDY DESIGN: A retrospective study. PURPOSE: To assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated. OVERVIEW OF LITERATURE: Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation. METHODS: Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis). RESULTS: The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis. CONCLUSIONS: Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.
Bone Development ; Decompression* ; Diagnosis ; Follow-Up Studies* ; Humans ; Laminectomy ; Minimally Invasive Surgical Procedures ; Osteoarthritis, Spine ; Osteogenesis ; Retrospective Studies ; Scoliosis ; Spinal Stenosis ; Spondylolisthesis ; Treatment Outcome ; Zygapophyseal Joint

The Standardized Structured Medical record Information eXchange (SS-MIX) was started in 2006 as the project supported by the Ministry of Health, Labour and Welfare (MHLW) for promoting the exchange of the standardized medical information. Free soft wares developed in the project allow the storage of medical information to receive HL7 messages for prescription, laboratory test results, diagnoses and patient demographics in the hospital information system (HIS). We encourage the use of the SS-MIX standardized storage for postmarketing surveys and clinical studies. The recommendations consist of the following 7 parts. [1] In surveys and clinical studies, the information of drugs and laboratory test results in the SS-MIX standardized storage can be directly transferred to the electronic questionnaire and the investigators may obtain the information with high accuracy and granularity. [2] The SS-MIX standardized storage works as the backup system for the HIS because it can provide the minimum information essential in patient care even under the disastrous condition like earthquake or unexpected network failure. [3] The SS-MIX standardized storage may be useful to conduct a good pharmacoepidemiology study not only because it provides the information in the storage efficiently but also it can be used to identify “new users” who started the drug after some period of non-use.The “new user” design is often essential to have the unbiased results. [4] When the drug company conducts postmarketing surveys according to the current regulation, the use of the SS-MIX standardized storage will facilitate the fast and efficient collection of data to develop the timely measure to minimize the drug-related risk. With the SS-MIX standardized storage, it is also expected that many types of study design can be employed and the quality of data is improved in the survey. [5] The SS-MIX standardized storage maybe also useful to evaluate the risk minimization action plan by comparing the prescription pattern or incidence of the targeted adverse event between two periods before and after the implementation of the action plan. [6] In planning clinical trials, the SS-MIX standardized storage may be used to estimate the size of eligible patients. The storage may also allow conducting cross-sectional studies to know characteristics of diseases or drug treatment. In addition, cohorts of those who had coronary artery angiography, new users of a drug and those with a rare disease may be readily identified. Using such cohorts, investigators can initiate a case-control study nested within the cohort, pharmacogenomic studies and comparative effectiveness researches. [7] The SS-MIX standardized storage may be used as the formal data source in clinical trials in the future when some conditions are satisfied. For instance, the formal agreement should be reached between industry, government and academia on the use of standards of data structure in Clinical Data Interchange Standards Consortium (CDISC) and on the operation of computerized system validation (CSV) in the clinical trials.

Acupuncture treatment was undertaken for 153 cases with dysurea after radical operation for carcinama of uterine cervix. Eighty-four percent of the patients were forties, fifties or sixties. Seventy percent of them underwent acupuncture treatment within two weeks after the operation. The treatment consisted of one or combination of the following methods: direct current acupuncture, in situ acupuncture, low-frequency electro-acupuncture and SSP. Acupoints considered to facilitate metabolism in the pelvic cavity and to be related to diurea were selected. The treatment group (fifty cases) had 19.7 days on which average residual urine was less than 50ml, whereas the control group 24.6 days. “Remarkable effect” and “effect” were obtained with SSP in seventy-seven percent of the cases, and with low-frequency electro-acupuncture in seventy-three percent. With the latter, “no effect” was obtained in only two percent of the cases. SSP therapy was effective and gained patients' favor because it gave no anxiety.

We have been studying the optimal condition of low-frequency electro-acupuncture. In the present paper, clinical effect of music-rhythm low-frequency electro-acupuncture on shoulder stiffness was evaluated. In this therapy, musical rhythms was directly converted to pulse waves.
Subjects were fifty patients with chronic shoulder stiffness who visited the anesthesical department of Osaka Medical College and assented to be a subject of this experiment. Each patient underwent the following three methods in random order: conventional 3Hz continuous-wave low-frequency electro-acupuncture (C method), music-rhythm low-frequency electro-acupuncture without music sound (S method), music-rhythm low-frequency electro-acupuncture with music sound (M method). The acupoints such as “Tianzhu” and “Jianjing”, which were reported by the Acupoint Committee of Japan Acupuncturists' Association as frequently used ones, were selected as basic points. Music-rhythm low-frequency electro-acupuncture was carried out using a special signal discriminating apparatus which output alternating square waves (1-100Hz) sychronizing with a music tape. Electrical stimulation was given for 15 minutes. The music was from an album of Japanese popular songs called Enka. No. 20 needles of 30mm in length were used. The effect of each method was evaluated by the patient immediately after the treatment using a numerical scale. The numerical evaluation was classed into four grades (“remarkably effective”, “effective”, “slightly effective”, “not effective”), and “Remarkably effective” and “effective” cases were counted as effective ones. Comfortableness was rated using a visual analog scale with 11 grade {-5 (discomfort): 0: +5 (comfort)}.
As to the immediate effect, “effective” was seen in 60% cases of C method (30/50), 58% of S method (29/50) and 76% of M method (38/50). M method showed 20% higher effectiveness than C and S method. This was statistically significant. Averaged comfortableness was 2.1 in C method, 1.9 in S method and 2.7 in M method.
We demonstrated the effectiveness of music-rhythm low-frequency electro-acupuncture on shoulder stiffness. To give music sound simaltaneously is necessary to get better physical and psychological results.