Japan University of Health Sciences

About: Japan University of Health Sciences is a education organization based out in Satte, Japan. It is known for research contribution in the topics: Rehabilitation & Stroke. The organization has 21 authors who have published 35 publications receiving 163 citations. The organization is also known as: Nihon Hoken Iryō Daigaku.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke

Abstract: Background Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke currently remain uncertain. This is an update of the review published in 2017. Objectives To assess the effects of rPMS in improving activities of daily living and functional ability in people after stroke. Search methods On 7 January 2019, we searched the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); Occupational Therapy Systematic Evaluation of Evidence (OTseeker); the Physiotherapy Evidence Database (PEDro); ICHUSHI Web; and six ongoing trial registries. We screened reference lists, and we contacted experts in the field. We placed no restrictions on the language or date of publication when searching electronic databases. Selection criteria We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. Data collection and analysis Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias, undertook data extraction, and used the GRADE approach to assess the quality of evidence. We contacted trial authors to request unpublished information if necessary. We resolved all disagreements through discussion. Main results We included four trials (three RCTs and one cross-over trial) involving 139 participants. Blinding of participants and physicians was well reported within all trials. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We observed a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03; P = 0.03; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-quality evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the quality of evidence related to the primary outcome as low, owing to the small sample size of the studies. Authors' conclusions Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Abstract: Aim To examine the association of the amount of rehabilitation with functional gains of elderly stroke patients at a convalescent rehabilitation ward using propensity score analysis methods and the Japan Rehabilitation Database. Methods This study was a retrospective cohort study. From the database, 6875 patients who were admitted to the convalescent rehabilitation wards with stroke were identified. After excluding 4586 patients, 2325 were eligible for the study. Intensive rehabilitation therapy (IRT) was defined as rehabilitation therapy of more than 15 hours per week by a physical therapist, an occupational therapist, and/or a speech therapist. Functional Independence Measure (FIM) gain, discharge rate to home, and FIM efficiency were examined using student's t test and the χ2 test after inverse probability weighting (IPW). Results IRT was provided to 862 patients (37.1%). The unadjusted data showed that patients in the IRT group had a longer hospital stay, more physical therapy, occupational therapy, and speech and language therapy. After adjustment for IPW, the baseline characteristics were found to be closely matched between the 2 groups. The IRT group showed significantly higher motor FIM gain, cognitive FIM gain, FIM gain, and discharge rate to home. Conclusions The present study demonstrated that a longer rehabilitation time per week was associated with increased functional gain in elderly stroke patients at convalescent rehabilitation wards.