Masahiko Wakasa’s research while affiliated with Akita University and other places

This study aimed to investigate the echo intensity (EI) of the pretalar fat pad (PFP) in young individuals with chronic ankle instability (CAI) and clarify the relationship between changes in the PFP and the clinical characteristics of CAI. Using the Identification of Functional Ankle Instability (IdFAI) scores, 26 limbs of 15 participants were divided into CAI (IdFAI score ≥11, male: eight limbs, female: six limbs, age: 21±1 years) and normal (IdFAI score <11, male: nine limbs, female: three limbs, age: 20±1 years) groups. The EI of the PFP was measured, and the luminosity ratio (LR) to the EI of the subcutaneous adipose tissue was calculated. To evaluate ankle joint stability and function, the fibulo-talar separation rate and weight-bearing lunge test (WBLT) values were measured. These parameters were compared between the two groups, and their correlations were statistically analyzed. The median IdFAI score in the CAI group was 15.5. The LR of the PFP was significantly higher in the CAI group than in the normal group (P<0.01). The fibulo-talar separation rate values were significantly higher (P=0.006), and the WBLT values were lower (P=0.011) in the CAI group. A moderate negative correlation was observed between the LR and WBLT values (r =−0.44, P=0.03). The LR of the PFP was high in the CAI group and was related to limited dorsiflexion of the ankle joint in the loaded position. Evaluating the entire ankle joint, including the PFP, is important, even for young individuals with mild CAI.

Purpose Health literacy (HL) is pivotal in managing patients with abdominal cancer and is associated with treatment outcomes and care experience. However, detailed characteristics of HL and their associations with clinical features remain uncertain in the population. Therefore, we aimed to comprehensively investigate HL and its associations with clinical characteristics in older patients with abdominal tumours. Methods We analysed 103 older patients with abdominal tumours prescribed perioperative rehabilitation programs in an acute care hospital. The Japanese version of the European Health Literacy Survey Questionnaire was used to measure comprehensive HL. Multivariate ordinal or linear regression analyses were used to explore the associations between HL and the following clinical characteristics: physical status, physical function, cardiopulmonary function, levels of activities of daily living (ADL), physical activity level, and health-related quality of life (HR-QoL). All regression analyses included patient demographics as covariates. Results Approximately 50%–70% of the participants had difficulty accessing and appraising health-related information, and 20%–45% thought it was difficult to understand and apply the information. The percentage of limited HL levels in general HL, three health-relevant domains, and four competencies ranged from 62% to 83%. Moreover, regression analyses revealed that lower HL was associated with worse physical status/function, lower ADL, and poorer HR-QoL. Conclusion Most older patients with abdominal tumours have limited HL, which may lead them to make treatment decisions without fully understanding what healthcare providers advise. Furthermore, patients with lower HL are at a higher risk of poor treatment outcomes because of their worse clinical characteristics.

This study examined discharge planning and challenges for patients following total hip arthroplasty in Japan. A cross-sectional national survey of 500 hospitals was conducted in May 2019. Discharge planning education tended to include content on dislocation prevention, including prevention while using a squat toilet and crouching down to sit on the floor or sleep on a futon on the floor-activities common in many Asian communities that require a maximum flexion of the hip joint. The challenges of discharge planning included diverse lifestyles, aging issues, lack of assistance at home, lack of consensus on dislocation prevention intervention, limitation of standardized care, interprofessional collaboration, and lack of time to educate family. Tailored discharge planning can be challenging, particularly for aged patients who practice "floor culture", i.e., sleeping, sitting and eating on the floor. Discharge planning needs to be task shifted from the surgeon to the nurse to enhance nurses' empowerment in Japan.

Introduction: Low health literacy (HL) is associated with poor surgical outcomes in patients with abdominal tumors, despite enhanced recovery programs. However, the relationship between HL and postoperative outcomes, including health-related quality of life (HRQOL) and physical functions, has been unclear in patients with abdominal tumors receiving perioperative rehabilitation programs (PRPs). Our objective was to identify associations of HL with postoperative functional and general outcomes in patients with abdominal tumors undergoing surgery and PRPs, controlling for critical covariates. Materials and Methods: The prospective cohort study was conducted from April 2020 to December 2021 in a single acute care hospital in Akita City, Japan. Out of 112 consecutive older adults with abdominal tumors referred to PRPs before surgery for tumors, 101 participated. Three patients declined undergoing follow-up assessment, and thus 97 were analyzed. Demographic data, comorbidities, education, surgical procedure, frailty status, cognitive functions, physical activity, nutritional status, tumor sites, types, and stages were collected as covariates at baseline. All participants underwent PRPs. HL was measured using the Japanese version of the European Health Literacy Survey Questionnaire, a comprehensive HL measurement. Primary endpoints were changes in HRQOL, measured using the EuroQol 5-dimension 5-level (EQ-5D-5L) index and EuroQol-visual analog scale (EQ-VAS), and physical functions (chair-stand ability, usual gait speed, and grip strength) from before surgery to discharge. Secondary endpoints were 90-day readmissions, postoperative complications, and length of hospital stay. Multivariate regression with inverse probability weighting, using propensity scores, estimeted associations of HL with the outcomes. Results: Of the 97 patients (36 [37.1%] women, mean [standard deviation] age 74.4 [6.3] years), 42 (43.3%) reported low HL. At baseline, patients with low HL exhibited worse EQ-5D-5L scores (P = .001), EQ-VAS values (P = .03), chair-stand ability (P = .001), and gait speed (P = .03) than controls. Low HL was associated with a low risk of grip strength declines (risk ratio, 0.13; 95% confidence interval, 0.12–0.99) but not with any other outcome. Discussion: There appeared to be no apparent associations of HL with surgical outcomes in patients with abdominal tumors receiving PRPs. Thus, HL might not be a crucial predictor of surgical outcomes when combined with PRPs.

Background In addition to physical factors, psychological factors such as self-efficacy (SE) reportedly affect physical activity (PA) levels in individuals with knee osteoarthritis (OA). However, the relationship between PA and SE for walking tasks in patients with knee OA remains unclear. The present study aimed to investigate the direct and indirect pathways of SE for walking tasks and the influence of previously reported factors on PA level in individuals with knee OA. Methods A cross-sectional design was employed. Eighty-five individuals with knee OA were enrolled. The daily step count (Steps) was considered an objective level of PA. The SE for the walking task was assessed using a modified Gait Efficacy Scale (mGES). Data on gait speed (GS), the visual analog scale (VAS) score for knee pain, Kellgren–Lawrence (K–L) grade of radiographic severity of knee OA, age, and body mass index were collected. Path analysis was performed to investigate the direct and indirect effects of these variables on Steps. Results After exclusion, 70 participants were included. The alternative model, which included Steps, mGES, GS, VAS, K–L grade, and age, showed a good fit. mGES and age had a direct effect on Steps (standardized path coefficients: 0.337 and −0.542, respectively), while the other variables had indirect effects. Conclusions The SE for walking tasks was directly associated with Steps representative of the PA level. This finding suggests that SE for the walking task may be important in improving PA levels in individuals with knee OA.

Background: The number of incidents related to walking while using smartphones is rising. However, it is not clear how smartphone usage might affect a gait pattern in terms of the foot pressure, and this may address the mechanism leading to incidents while using smartphones. Research question: How do the characteristics of walking while using a smartphone affect foot pressure patterns? Methods: In this cross-sectional study, we recruited 40 healthy young participants and investigated the walking speed, step length, coefficient of variance of the walking cycle (CV), anteroposterior length of the center of pressure (COP) trajectory (%Long), partial foot pressure ratios (% partial foot pressure [%PFP]), and COP existence time (COPexT) under the following four conditions: normal walking, screen gazing, while using social networking services (SNS), and while using a cognitive application. Parameters were compared among the four conditions using a repeated-measures ANOVA. Further, according to the presence or absence of an incident history (e.g. stumbles, collisions), participants were divided into either the incident or non-incident group. Parameters were compared between the two groups using a two-way repeated-measures ANOVA. Results: Under the SNS and cognitive application conditions, the walking speed, step length, %Long, %PFP, and COPexT in the heel were significantly lower, and the CV and %PFP in the metatarsal region were higher than those under normal walking or screen gazing. %PFP in the heel and metatarsal regions showed a significant group-by-condition interaction; the incident group had lower %PFP in the heel region and higher %PFP in the metatarsal region than the non-incident group. Significance: These findings indicate a trend of loading more pressure on the forefoot than on the heel. This pattern was markedly evident in individuals with a history of incidents related to the smartphone usage and may be one of the factors causing stumbles and collisions.

Objectives Although the rotation of individual joints has gained increasing recognition as a risk factor for anterior cruciate ligament (ACL) injury, rotation of a single joint in actual sports movements is rare. This study clarified the influence of lower extremity rotation on the knee during single-leg landing. Design and Setting: We recruited 30 students to perform single-leg landing from a height of 30 cm with their lower extremities in neutral, and externally and internally rotated. The knee abduction, flexion angles, and abduction angular velocity were measured. Furthermore, the abduction angle was analyzed at knee flexion angles of 15°, 20°, 25°, and 30° and compared among the three conditions using a repeated measures analysis of variance with Bonferroni post hoc tests. Results The maximum abduction angle was significantly greater when internally rotated than in the neutral. The maximum abduction angular velocity was significantly greater in the internally rotated compared to in the neutral. Finally, the abduction angle at a knee flexion angle of 30° was significantly greater when internally rotated compared to in the neutral. Conclusion Rotation of the lower extremities affects knee kinematics, and landing on a knee that is internally rotated may increase the risk of ACL injury.

Aims: To present reference values, clinically significant changes (CSC), and prediction equations of lower-limb muscle strength (LMS) and physical performance (PP) in community-dwelling older adults in a rural area. Methods: Quadriceps muscle and toe grip strength were measured as LMS. Maximal gait speed, Timed-Up and Go test, one-legged stand test, and four-square step test were measured as PP. Overall and age-specific reference values for both sexes were presented. CSC was calculated using a distribution-based approach. We conducted multivariate regression analyses to make prediction equations for each variable. The prediction error was checked using 10-fold cross-validation. Results: Three-hundred ninety-two participants (male, n = 116; female, n = 276) were included. LMS was maintained with age, while PS declined linearly. The prediction equations were significant, but the prediction error was high. Conclusions: Reference values and CSC help evaluate the deterioration of LMS and PP and the effectiveness of an intervention on these outcomes.

Objective: To investigate the differences in self-efficacy (SE) for walking tasks between older patients with knee osteoarthritis (OA) and older adults without knee OA. Methods: A cross-sectional design was employed. Older patients with radiographic knee OA and community-dwelling older adults without knee OA as controls were enrolled in the study. SE for the walking task was assessed using the modified gait efficacy scale (mGES). A Wilcoxon rank-sum test was used to compare the mGES between the groups of participants. A Tobit regression model was used to estimate the difference in mGES. The presence of radiographic knee OA was used as an independent variable. Sex (women), age, and body mass index were used as potential confounding variables in the model. Results: After exclusion, 78 participants (n=40 with knee OA, n=38 controls) were included. The mGES was lower in patients with knee OA than in controls. In the Tobit regression model adjusted for confounding factors, mGES in patients with knee OA was estimated to be 26.8 (95% confidence interval [CI]: 15.8-37.8) points lower than in controls. Conclusion: This study demonstrated that mGES was lower in older patients with knee OA than in older adults without knee OA.