Background: Phase angle (PhA) reflects cellular integrity and muscle quality. However, evidence is limited regarding whether an increase in PhA is associated with improvements in activities of daily living (ADL) and skeletal muscle mass. This study aimed to investigate the association between change in PhA and prognosis in terms of ADL and skeletal muscle mass in post-stroke patients undergoing rehabilitation. Methods: This retrospective cohort study was conducted at a convalescent rehabilitation hospital in Japan. Patients with a PhA at admission below the cutoff values (4.76° for male and 4.11° for female) were included. Patients were categorized into a PhA-increase group (>0) and a non-increase group (≤0). Outcomes included the Functional Independence Measure (FIM)-motor score and skeletal muscle mass index (SMI) at discharge. Multivariate regression was used to assess associations. Results: A total of 253 patients were included (mean age 78.0±10.9 years; 51% females). The median PhA at admission was 3.70° (interquartile range [IQR], 3.20–4.10), and the median change during hospitalization was 0.00° (IQR, -0.20– 0.30). Of these, 119 patients had increased PhA and 134 did not. Change in PhA was independently associated with higher FIM-motor scores (β=0.078, p=0.040) and greater SMI (β=0.454, p<0.001) at discharge. Conclusions In post-stroke patients, an increase in PhA during hospitalization was associated with better functional and muscular outcomes. PhA may therefore serve as a valuable biomarker for assessing the efficacy of rehabilitation.

Background: Evidence on the effectiveness of exercise for cognitive recovery in patients with sarcopenia is limited. This study examined the association between group-based chair-stand exercise and cognitive improvement during convalescent rehabilitation. Methods: This retrospective cohort study included stroke patients with sarcopenia and impaired cognitive level, defined as a Functional Independence Measure (FIM)-cognitive score ≤23, admitted between 2016 and 2023. All patients received standard rehabilitation and participated in group-based chair-stand exercise twice daily. The frequency of exercise during hospitalization was recorded. The primary outcome was FIM-cognitive score at discharge. Secondary outcomes were handgrip strength (HG) and FIM-motor score. Multivariate linear regression analysis was used to examine associations between exercise frequency and outcomes, adjusting for potential confounders. Results: Of the 1,220 patients admitted, 273 sarcopenic stroke patients with reduced cognitive level (mean age 80 years; 48% male) were included in the final analysis dataset; the median frequency of performing chair-stand exercise per day was 43 (interquartile range, 20–71). Higher exercise frequency was independently associated with better FIM-cognitive score at discharge (β=0.217, p<0.001), greater HG (β=0.146, p=0.008), and improved FIM-motor score (β=0.295, p<0.001). Conclusion Frequent participation in group-based chair-stand exercise was associated with improvements in cognitive and physical function in sarcopenic stroke patients. Incorporating simple, repetitive resistance exercises into rehabilitation programs may enhance recovery outcomes in this vulnerable population.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians. METHODS: A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism. RESULTS: Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism. CONCLUSIONS The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.
Humans ; COVID-19/epidemiology* ; Presenteeism ; Japan/epidemiology* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Physicians ; Surveys and Questionnaires