二重課題は転倒予測にとってもっとも重要か?

The aim of this study was to clarify the usefulness of assessing dual task performance for fall prediction. In experiment 1, we prospectively investigated the new fall experiences of 108 participants (50 elderly daycare users and 58 fall prevention class participants) and produced a fall prediction model. The fallers represented the subjects who suffered a new fall experience during the follow up 12- month period, whereas the non-fallers did not fall during this period. The two groups were compared with regard to their age, sex, history of falling, medication related to falling, grip strength, gait speed, step length, dynamic standing balance, the Timed Up and Go (TUG) test score, dt-TUG score, %TUG, and mini－mental state examination score. Multivariate logistic regression analyses were performed to produce a fall prediction model. In experiment 2, we investigated the accuracy of the fall prediction model using 39 newly recruited individuals. In experiment 1, 8 (13.8%) of the fall prevention class participants fell within 12 months. Among the fall prevention class participants, there were significant differences in grip strength, gait speed, step length, TUG, and dt-TUG between the fallers and non-fallers. In stepwise logistic regression analysis, two factors were found to have value for fall prediction ; i.e., falling within one year preceding the baseline and TUG. In experiment 2, 12 people were predicted to fall within the 12-month follow-up period ; however, only 5 people actually fell. Three of them were predicted to fall, but 2 of them were not. The success ratio of the fall prediction model was 60%. Nine of the 12 people that were predicted to fall did not. Our result showed that TUG was the most important factor for fall prediction; however, dt-TUG was also related to fall prediction in individuals that were not in receipt of care services. Therefore, dual task performance could be a useful reference factor for fall prediction.　高齢在宅生活者を対象に、転倒予測における二重課題の評価は重要因子となるかを研究 目的とした。今回は、以前評価を行った転倒予防教室参加者５８名、デイケア利用者５０名に 対し、実験１ではその後１年間の転倒有無を追跡調査し、年齢、性別、服薬、歩行速度、 歩幅、動的立位バランス、Timed Up＆Go（以下TUG）、TUGと加算の二重課題（以下dt- TUG）を因子として検討し、転倒予測モデルを作成した。実験２では新たに３９名の対象者 に対して調査し、転倒予測モデルの有用性を検証した。 　結果、実験１では転倒予防教室参加者で転倒した者は８名であり、転倒と各項目の分析 では、握力、歩行速度、歩幅、TUG、dt-TUGの５項目に有意差がみられた。デイケア利用 者は５名の追跡調査ができず、転倒した者は１６名であり、転倒と項目の有意な関連がな かった。転倒予測モデルについて転倒予防教室参加者を用い多重ロジスティック回帰分析 をした結果、TUGと過去１年間の転倒経験が抽出された。実験２では３９名のうち、予測モ デルで転倒が予測された者は１２名であった。追跡調査で転倒した者は５名で、そのうち３ 名は予測できたが、２名は予測できなかった。 　以上より、転倒予測に有用な因子はTUGであり、dt-TUGは参考程度の因子であった。ま た、転倒予測については、今回の項目の身体機能と転倒経験だけでは高い抽出率を得るの は困難と示唆された。[原著:Originals

Limitations to the 6-minute walk test in dermatomyositis with interstitial lung disease in comparison with idiopathic interstitial pneumonia

Although the relationship between muscle strength and exercise capacity has been demonstrated in dermatomyositis without lung dysfunction, little is known about the association between exercise capacity and interstitial lung disease in dermatomyositis. Eleven patients with dermatomyositis with interstitial lung disease without the manifestation of muscle weakness and 12 patients with idiopathic interstitial pneumonia underwent the 6-minute walk test (6MWT). PaO2, creatine kinase, percentage predicted 6MWT distance (6MWD%), and SpO2 at rest were similar between patients. Percentage predicted vital capacity, carbon monoxide diffusing capacity (DLCO%), and SpO2 after 6MWT were higher and exertional dyspnea was lower in patients with dermatomyositis than in patients with idiopathic interstitial pneumonia. SpO2 after 6MWT was positively correlated with 6MWD% in patients with dermatomyositis, while DLCO% and PaO2 were positively correlated with 6MWD% in patients with idiopathic interstitial pneumonia. Lung dysfunction in dermatomyositis might not be a major limitation factor in exercise capacity. © the author(s), publisher and licensee Libertas Academica Ltd

運営システム別にみた通所サービス利用者の自宅と施設の日常生活動作の比較

[Purpose] In elderly daycare facilities, services are provided according to independence support, which is the basic philosophy of Long-Term Care Insurance, to maintain and improve the user s activities of daily living (ADL). However, the efforts aimed at independence support and methods of service vary from facility to facility. In this study, we examined the relationship between the administrations system of the facilities and the user s independence of ADL, comparing two types of elderly daycare that provide different methods of service. Facilities that allowed the users to select the programs and time provided were classified into Group A, and those that provided predetermined sets of services were classified into Group B. [Methods] The subjects were elderly daycare facilities in three prefectures in the Hokuriku region of Japan ; 46 users in two facilities in Group A, and 40 users in three facilities in Group B. Evaluation of ADL at home and at a facility was performed using the Functional Independence Measure (FIM). [Results] There was no significant difference in the total FIM score at home between Groups A and B. In Group A, the total FIM score at the facility was significantly higher than that at home, while it was significantly lower in Group B. When the scores for each item in FIM at home and at the facility were compared, the scores for bladder control, bowel control, bed/chair/wheelchair transfer, bath/shower transfer, stairs, comprehension, and expression were significantly higher at the facility than those at home in Group A. In Group B, scores for grooming, dressing upper body, dressing lower body, bed/chair/wheelchair transfer, comprehension, and expression at the facility were significantly lower than those at home, while score for bath/shower transfer was significantly higher at the facility. [Conclusion] When the users were allowed to select the contents of the program and when the program was offered at elderly daycare facilities, voluntary actions were promoted, which may have increased users independence. The results indicated that when the program contents and the time provided were predetermined, assistance for the users might reduce the independence of the elderly.【はじめに】通所サービスでは自立支援に沿って利用者へのサービスが行われ、利用者の日 常生活能力の維持・向上を図っている。しかし自立支援の取り組みやサービス提供方法は 施設によって異なる。本研究では提供されるプログラムや時間を利用者が選択する運営シ ステムをグループＡ、サービスやその時間が規則的に決められている運営システムをグ ループＢとし、運営システムの違いと利用者のADL自立度の関連性を検討した。【方法】対 象者はグループＡの２施設の利用者46名、グループBの３施設の利用者40名である。自宅 と施設のADLの評価は機能的自立度評価法（以下、FIM）を用いた。【結果】自宅のFIM総 点の比較では両グループ間に差は認めなかった。自宅と施設のFIM総点の比較では、グ ループＡでは施設の得点が高く、グループＢでは施設の得点が低かった。項目別の比較で は、グループＡでは自宅より施設で排尿管理、排便管理、ベッド・椅子・車椅子の移乗、 浴槽・シャワーの移乗、階段、理解、表出の得点が高かった。またグループＢでは自宅よ り施設の整容、更衣上半身、更衣下半身、ベッド・椅子・車椅子の移乗、理解、表出の得 点が低く、浴槽・シャワーの移乗は施設の得点の方が高かった。【結論】通所サービスでの プログラム内容や遂行時間を利用者が自主的に選択できると自立度が高まり、プログラム 内容や提供時間が規則的に決められていると自宅に比べ自立度が低くなることが示された。[原著:Originals

The COPD assessment test as a prognostic marker in interstitial lung disease

The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT), which was developed to measure the health status of patients with COPD, was applied to patients with interstitial lung disease, aiming to examine the CAT as a predictor of outcome. Over a follow-up period of more than one year, 101 consecutive patients with interstitial lung disease were evaluated by the CAT. The CAT scores of 40 in total were categorized into four subsets according to the severity. Patients with higher (more severe) scores exhibited lower forced vital capacity and lung diffusion capacity for carbon monoxide. The survival rate was significantly lower in patients with higher scores (log-rank test, P = 0.0002), and the hazard ratios for death of the higher scores and lower lung diffusion capacity for carbon monoxide were independently significant. These findings suggest that CAT can indicate the risk of mortality in patients with interstitial lung disease. © the authors, publisher and licensee Libertas Academica Limited

Cardiac hemodynamic response to the 6-minute walk test in young adults and the elderly

Abstract Background: Exercise capacity is evaluated using the 6-minute walk test in various diseases. Variety in the distances walked was also shown in healthy subjects. Moreover, age-related influences on cardiac hemodynamic response to the 6-minute walk test have not been clarified. The purpose of this study was thus to investigate the hemodynamic response to the 6-minute walk test and to detect factors related to the distance walked in healthy subjects. Methods: Thirteen young adults (age 20.5 ± 0.7 years, BMI 22.0 ± 4.3) and 26 elderly individuals (age 60.2 ± 6.1 years, BMI 21.7 ± 2.2) were enrolled to measure real-time hemodynamic responses using non-invasive impedance cardiography during the 6-minute walk test. Results: Stroke volume was higher in the young than in the elderly and reached a plateau within 30 s of starting to walk in all subjects. An increase in heart rate took more than 1 min in the elderly, while it took less than 30 s in the young, which resulted in slower increases in cardiac output and cardiac index in the elderly. There was no difference in the distance in the 6-minute walk test between the young and the elderly. The distance walked was correlated with heart rate, cardiac output, and cardiac index, but not with stroke volume, at the end of the 6-minute walk test. Conclusions: The distance walked appeared to depend on increased cardiac output based on heart rate, but did not appear to be limited by stroke volume, in healthy subjects. © 2015 Someya et al

Exercise capacity in relation to autoantibodies in systemic sclerosis patients

Autoantibodies have been detected in systemic sclerosis patients, and typical clinical features regarding organ involvement by each autoantibody have been reported. To reveal differences in exercise intolerance in patients with either anti-topoisomerase-I or anti-centromere antibodies, 53 systemic sclerosis patients were investigated retrospectively. A 6-min walking distance showed no significant differences (P = 0.090) between autoantibodies, while exercise-induced hypoxia during the 6-min walking test was significant in subjects with the anti-topoisomerase-I antibody (P = 0.033). The percent predicted of vital capacity, the diffusion capacity of the lung for carbon monoxide, and the modified Rodnan skin score were affected more in subjects with the anti-topoisomerase-I antibody than the anti-centromere antibody. The main parameter affecting the 6-min walking distance was the percent predicted of vital capacity for each autoantibody, and there was a significant positive relationship for all subjects (R 2 = 0.30, P < 0.0001). Exercise-induced hypoxia was also shown in the more affected subjects in the percent predicted of vital capacity and the diffusion capacity of the lung for carbon monoxide. Lung parameters were suggested to be more important factors determining exercise intolerance and induced hypoxia than detected autoantibodies. © 2012 The Author(s)

Cardiopulmonary factors affecting 6-minute walk distance in patients with idiopathic inflammatory myopathies

金沢大学医薬保健研究域保健学系Idiopathic inflammatory myopathies involve skeletal muscles and can be associated with interstitial lung disease and/or heart dysfunction, which may reduce exercise capacity. We aimed to clarify cardiopulmonary factors affecting the 6-min walk distance in patients who were able to walk without leg pain or fatigue. Twenty-three patients with inactive adult idiopathic inflammatory myopathies, and 18 age- and gender-matched healthy controls were evaluated for hemodynamic responses using noninvasive impedance cardiography during the 6-min walk test. The patients were also examined by the pulmonary function test for forced vital capacity and diffusing capacity for carbon monoxide (DLCO), and by echocardiography for left ventricular ejection fraction and right ventricular systolic pressure. Interstitial lung disease was diagnosed in 19 patients using high-resolution computed tomography. There was no difference in 6-min walk distance or cardiac output after walking between the patients and healthy controls. However, stroke volume during the 6-min walk test was significantly lower in the patients than in healthy controls, suggesting malfunction in the heart. Moreover, the increased heart rate matched the cardiac output. Spearman’s correlation analysis demonstrated a correlation between 6-min walk distance and stroke volume, cardiac output after walking and DLCO, but not left ventricular ejection fraction or right ventricular systolic pressure, as this study lacked the patients with pulmonary hypertension. In conclusion, impaired DLCO due to interstitial lung disease was suggested to be a fundamental parameter affecting exercise capacity, in addition to heart involvement, in patients with idiopathic inflammatory myopathies. © 2018, The Author(s).Embargo Period 12 month

Predictors of exercise-induced oxygen desaturation in systemic sclerosis patients with interstitial lung disease

金沢大学医薬保健研究域保健学系Background: The diffusion capacity of the lung for carbon monoxide (DLCO) is a good marker of disease severity in patients with idiopathic interstitial pneumonia, and is associated with oxygen saturation; however, little is known about DLCO in systemic sclerosis patients with interstitial lung disease. We studied potential predictors of exercise-induced oxygen desaturation in patients with systemic sclerosis. Methods: Data were collected prospectively from 80 of 110 consecutive systemic sclerosis patients with normal oxygen saturation (> 95%) at rest, who could perform the 6-min walk test without physical discomfort, including leg pain. Pulmonary function tests and echocardiography were collected from all subjects. Results: Thirty subjects showed a ≥ 4% decline in oxygen saturation during the 6-min walk test (desaturation group). The other subjects were assigned to the normoxic group. The percent-of-predicted values for FVC, FEV1, total lung capacity, DLCO, and DLCO/alveolar volume were lower, and FEV1/FVC was higher, in the desaturation group. Logistic regression analysis showed the percent-of-predicted DLCO as a highly accurate predictor of exercise-induced oxygen desaturation: the area under the receiver operating characteristic curve was 0.92 (cutoff point 56.3%, sensitivity 0.83, specificity 0.86). Five subjects over the cutoff point of the percent-of-predicted DLCO in the desaturation group could not be distinguished from the normoxic subjects with the lung-volume measurements or right-ventricular systolic pressure. Conclusions: The factor underlying exercise-induced oxygen desaturation appeared to be reduced percent-of-predicted DLCO, which was useful as a predictor in over 80% of the subjects. © 2014 Daedalus Enterprises