Context and objectives:This study was to assess the differences in rehabilitation outcomes between the different facilities in Japan, and to determine if there was any variation in patients' functional recovery at hospital discharge across the different facilities. Methods: This study focused on patients in recovery in the rehabilitation ward using the data of 680 patients from 12 hospitals after adjusting for triage at admission obtained from the Rehabilitation Patient Databank in Japan (issued in September, 2009) and compared the therapeutic results of each hospital. We estimate the expected value of levels of activities of daily living (ADL) at discharge for rehabilitation patients using regression analysis. Furthermore, we show the distribution of the expected improvement levels in ADL by hospitals. Findings: At the time of admission, there were no differences among hospitals in their patients' characters. However, outcomes differed widely among the hospitals. The differences in the participation of physicians registered as rehabilitation specialists, conference execution rate, amount of exercise per day, self-exercise without a therapist, and exercise in wards, were statistically significant differences between hospitals. Conclusion: Due to the assessments for health care quality and the publication of results it is expected that health care providers will put in voluntary effort to improve their future health care services. Further studies should analyze the characteristics of high-performing hospitals.

Objective: To develop formulas for predicting Functional Independence Measure (FIM) at the time of discharge from an acute or convalescent hospital ward using multicenter data. Methods: Data from 4,311 acute patients (22 hospitals) and 1,941 convalescent patients (24 hospitals) were divided into two groups (calculation group and verification group). Multiple regression analysis was performed to develop formulas for predicting discharge FIM and test their validity with data from the verification group. Results: The formula derived for predicting discharge FIM for acute patients was 85.04 + (-0.53 × age) + (12.06 × subarachnoid hemorrhage) + (-7.90 × complication present) + (-0.70 × number of days from onset of stroke until admission) + (1.24 × admission GCS) + (-1.08 × admission NIHSS) + (-4.15 × modified Rankin Scale score before stroke) + (0.30 × admission motor FIM) + (1.03 × admission cognitive FIM), with R 2 = 0.78. The formula derived for predicting discharge FIM for convalescent patients was 33.04 + (-0.34 × age) + (-3.88 × complication present) + (-0.11 × number of days from onset of stroke until admission) + (2.44 × admission GCS) + (-1.68 × modified Rankin Scale score before stroke) + (0.53 × admission motor FIM) + (1.25 × admission cognitive FIM) (R 2 = 0.66). Conclusion: Using a large multicenter database, we developed separate formulas for predicting FIM at discharge from an acute ward and from a convalescent ward with proven external validity.

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These results suggest that the appearance of autonomic failure, oral malfunction and some psychological factors in relation to depressed mood, but not anthropometric measurements, are characteristic of prefrailty. Geriatr Gerontol Int 2017; 17: 1568-1574.

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<b><i>Aims:</i></b> As the number of older people with dementia increases, safe pharmacotherapy in this population has attracted attention in recent years. The aims of this study were to clarify the prescribing patterns in older patients who were prescribed anti-dementia drugs and to investigate the association of potentially inappropriate medications (PIMs) with the use of anti-dementia drugs. <b><i>Methods:</i></b> Adults aged ≥65 years, who were prescribed anti-dementia drugs at 585 pharmacies across Japan (<i>N</i> = 7,953), were surveyed. The percentage of prescriptions of anti-dementia drugs and the effect of those prescriptions on PIMs were investigated. <b><i>Results:</i></b> Prescriptions of anti-dementia drugs were found in 4.4% of the entire study population. A multiple logistic regression analysis revealed that the use of anti-dementia drugs reduced the risk of prescribing psychotropic drugs, which represented PIMs, and that a combination of anti-dementia drugs (e.g., cholineesterase inhibitor with memantine) may reduce the risk of prescribing PIMs compared with monotherapy. <b><i>Conclusion:</i></b> The use of anti-dementia drugs was associated with fewer prescriptions of drugs considered as PIMs.

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We investigated changes in the Activities of Daily Living (ADL) of stroke patients in a convalescent rehabilitation ward and a general ward using a Functional Independent Measure (FIM). The subjects were 109 patients hospitalized for rehabilitation purposes at the Oyamada Memorial Spa Hospital. The change in FIM at the time of hospitalization and that at 1 week later was investigated in 81 patients in the convalescent rehabilitation group (CRG) and 28 patients in the control group (CG). In addition, the CRG was investigated again after one month. Intensive rehabilitation service based on ADL and worksheets was introduced in the CRG. On the other hand, these were not introduced in the CG. The total score of FIM increased significantly (p<0.01) in the first week after hospitalization in both groups. The FIM-gain after one week in the CRG was high. With regard to each item, a significant improvement was observed in patients' motor skills while eating, grooming, bathing, dressing the upper body, dressing the lower body, toilet, bladder management, transfer bed/chair, toilet and tub, and walking/wheelchair (11/13). Multiple regressions were used to assess the relationships between FIM-gain (one week, one month), age, rehabilitation intensity and other predictive variables. Better rehabilitation outcomes were observed in patients with lower level of dementia and high rehabilitation intensity. It was thought that planned rehabilitation based on ADL was effective in the CRG, and it was suggested that the CRG's system is effective in the rehabilitation of stroke patients.