Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423)and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio:1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years:n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V:n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.

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.