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.

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.