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Koizumi S, Ohta A, Kamei M. Homebound older adults who live independently in rural Japan: Prevalence and contributing factors during the COVID-19 pandemic. Prev Med Rep 2024; 39:102640. [PMID: 38370985 PMCID: PMC10873719 DOI: 10.1016/j.pmedr.2024.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Being homebound is a phenomenon of confining older adults to their homes owing to health, social, and psychological factors. During the COVID-19 pandemic, people were requested to refrain from going out to prevent infection. Consequently, the homebound status of older adults was influenced by social and environmental factors, resulting in an increase in the number of homebound older adults during the pandemic. This study aimed to determine the homebound prevalence and related factors among homebound older adults during the COVID-19 pandemic. In 2021, a cross-sectional study conducted in rural Saitama, Japan, included 1,020 participants aged 65 years and above who did not have long-term care insurance certification and were independent in instrumental activities of daily living. Herein, homebound individuals were defined as those who went out once a week or less. The relationships of homebound status with demographic, health, social, and psychological factors in older adults were examined. The prevalence of homebound independent older adults was estimated as 10.4 % (6.6 % males, 13.8 % females). Homebound status was significantly associated with one or more medical histories (odds ratio [OR] = 1.98, 95 % confidence interval [CI] = 1.00-3.90), no social or family roles (OR = 1.95, 95 % CI = 1.09-3.48), and no hobbies (OR = 1.84, 95 % CI = 1.02-3.34). Establishing social or family roles and promoting participation in hobbies may prevent older adults from being homebound. The social environment, which changed during the pandemic, should be improved to encourage older adults to go out.
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Affiliation(s)
- Saori Koizumi
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Midori Kamei
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
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Yajima S, Nakanishi Y, Ogasawara RA, Imasato N, Hirose K, Katsumura S, Kataoka M, Masuda H. Housework participation and mortality in Japanese male patients undergoing cancer surgery: A propensity score-matched study. Prev Med 2024; 180:107896. [PMID: 38360151 DOI: 10.1016/j.ypmed.2024.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Participation in housework and meal preparation are instrumental activity of daily living (IADL) evaluation items that is known to predict prognosis and complications in cancer care. However, these items are often assessed only for females, not for males, in IADL. METHODS We examined the impact of habit of housework and meal preparation on overall survival (OS) in 1025 Japanese male patients who underwent elective urologic cancer surgery at our institution. The study also used a cohort that was matched by propensity score. RESULTS We found that patients who did not prepare meals or do housework had significantly shorter OS (hazard ratio [HR] = 3.34, P = 0.005; HR = 5.01, P < 0.001, respectively). Even in the cohort of 448 patients matched by propensity score and adjusted for age, body mass index, comorbidities, performance status, living status, cancer type, stage groups of cancer, and surgical approach, lack of participation in housework was associated with shorter OS (HR = 2.92, P = 0.04) and was an independent predictor of worse OS in multivariable analysis (HR = 5.13, P = 0.008). CONCLUSIONS Males who did not regularly do household chores before elective cancer surgery had worse life outcomes. Doing more daily physical activities, such as household chores like making the bed and cleaning the room, might have a positive impact on survival when fighting cancer.
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Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan.
| | - Yasukazu Nakanishi
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Ryo Andy Ogasawara
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Naoki Imasato
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Kohei Hirose
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Sao Katsumura
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Madoka Kataoka
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
| | - Hitoshi Masuda
- National Cancer Center Hospital East, Department of Urology, 6-5-1 Kashiwa no ha, Kashiwa City, Chiba 277-8577, Japan
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Kito K, Mori Y, Watanabe D, Onoda H, Fujiyama K, Toda M, Kato M. Relationship between instrumental activities of daily living decline during hospitalization and one-year mortality in elderly patients with heart failure: A multi-center prospective cohort study. Arch Gerontol Geriatr 2023; 110:104985. [PMID: 36948093 DOI: 10.1016/j.archger.2023.104985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND It remains unclear whether instrumental activities of daily living (IADL) decline during hospitalization is related to mortality rates. This study examined the relationship between IADL decline during hospitalization and the one-year mortality rate in elderly heart failure (HF) patients. METHODS Five hundred seventy-six consecutive patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into groups based on changes in IADL during hospitalization: IADL maintained and IADL decline. IADL was assessed by the National Center for Geriatrics and Gerontology-Activities of Daily Living Scale (NCGG-ADL). IADL decline was defined as Δ NCGG-ADL ≤ -1 point. The primary outcome was one-year all-cause mortality rate after discharge. Outcomes were examined using the Kaplan-Meier method with the log-rank test and Cox proportional hazards models using the existing prognostic risk factors for HF. RESULTS Of 576 patients, 20% (n = 113) had IADL decline during hospitalization, and 9.2% (n = 35) and 6.0% (n = 18) died of all-cause and cardiovascular disease within one year after discharge, respectively. The IADL-decline group had significantly higher one-year all-cause mortality rates after adjusting for risk factors (hazard ratio: 1.923, 95% confidence interval 1.085-3.409; P = 0.023). Among the IADL subcategories, outdoor activity items such as "go out by oneself," "take a bus or train," and "shop for necessities" were more likely to change from independent to dependent during hospitalization. CONCLUSION IADL decline during hospitalization was associated with an increased all-cause mortality rate at one-year after discharge in elderly HF patients.
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Affiliation(s)
- Kazuya Kito
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
| | - Yuji Mori
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
| | - Daisuke Watanabe
- Department of Rehabilitation, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshige Onoda
- Department of Rehabilitation, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Keita Fujiyama
- Department of Rehabilitation, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Masahiro Toda
- Department of Rehabilitation, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Michitaka Kato
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan.
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Kariya H, Yamaoka-Tojo M, Hamazaki N, Obara S, Kitasato L, Matsunaga A, Ako J. Association between instrumental activities of daily living frequency and clinical outcomes in older patients with cardiovascular disease. Eur J Cardiovasc Nurs 2023; 22:64-72. [PMID: 35670158 DOI: 10.1093/eurjcn/zvac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
AIMS Impairment in activities of daily living (ADL) is an independent predictor of poor prognosis in older patients. Nevertheless, the effects of instrumental ADL (IADL) frequency on prognosis in older patients with cardiovascular disease (CVD) are unclear. We investigate the associations between IADL frequency and all-cause mortality and hospital readmission due to cardiovascular events in older patients with CVD. METHODS AND RESULTS A total of 638 consecutive outpatients ≥65 years old with CVD were enrolled. A questionnaire, including Frenchay Activities Index (FAI) parameters, was used to determine IADL frequency at the start of the study as the baseline observation. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission for cardiovascular events. We examined the relationship between IADL frequency and each endpoint. Among the 632 patients evaluated {median age 74.0 [interquartile range (IQR) 70.0-78.0] years; 439 males}, there were 39 deaths and 105 cardiovascular events during the median follow-up period of 4.0 (IQR, 2.3-4.0) years. After adjusting for clinical confounding factors, the hazard ratios for all-cause mortality and cardiovascular events in the FAI points were 0.957 [95% confidence interval (CI), 0.920-0.996] and 0.973 (95% CI, 0.950-0.997), respectively. CONCLUSION A higher IADL frequency was independently associated with better outcomes in older patients with CVD, suggesting that the preservation of instrumental activities should be focused on as the components of cardiovascular rehabilitation.
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Affiliation(s)
- Hidenori Kariya
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Minako Yamaoka-Tojo
- Kitasato University Regenerative Medicine and Cell Design Research Facility, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Shinichi Obara
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Lisa Kitasato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Hibino H, Gorniak SL. Dependence and reduced motor function in heart failure: future directions for well-being. Heart Fail Rev 2021; 27:1043-1051. [PMID: 34302579 DOI: 10.1007/s10741-021-10145-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
While patients with heart failure experience a wide range of symptoms, evidence is mounting that patients with heart failure suffer from reduced functional independence. Given that the number of patients with heart failure is rising and considering the adverse outcomes of reduced functional independence, understanding the underlying mechanisms of reduced functionality in patients with heart failure is of increasing importance. Yet, little information exists on how heart failure negatively affects functional independence, including motor function. This article summarizes reports of reduced independence and highlights its significant adverse outcomes in the patients with heart failure. Finally, this article discusses potential causes of reduced independence based on existing reports of impaired central and peripheral nervous systems in the patients with heart failure. Overall, the article provides a solid foundation for future studies investigating motor impairments in patients with heart failure. Such studies may lead to advances in treatment and prevention of reduced independence associated with heart failure, which ultimately contribute to the well-being of patients with heart failure.
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Affiliation(s)
- Hidetaka Hibino
- Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison 104, Houston, TX, 77204-6015, USA
| | - Stacey L Gorniak
- Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison 104, Houston, TX, 77204-6015, USA.
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Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE. PLoS One 2021; 16:e0254128. [PMID: 34214129 PMCID: PMC8253396 DOI: 10.1371/journal.pone.0254128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background Limitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients. Aims This multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF. Methods Four hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = −1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline. Results The ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231–0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the “go out by oneself”, “travel using a bus or train”, “shop for necessities”, “vacuum”, and “manage medication” were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05). Conclusions The present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.
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Kanda M, Tateishi K, Nakagomi A, Iwahana T, Okada S, Kuwabara H, Kobayashi Y, Inoue T. Association between early intensive care or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure. PLoS One 2021; 16:e0251505. [PMID: 33970971 PMCID: PMC8109822 DOI: 10.1371/journal.pone.0251505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023] Open
Abstract
The management of acute decompensated heart failure often requires intensive care. However, the effects of early intensive care unit/coronary care unit admission on activities of daily living (ADL) in acute decompensated heart failure patients have not been precisely evaluated. Thus, we retrospectively assessed the association between early intensive care unit admission and post-discharge ADL performance in these patients. Acute decompensated heart failure patients (New York Heart Association I–III) admitted on emergency between April 1, 2014, and December 31, 2018, were selected from the Diagnosis Procedure Combination database and divided into intensive care unit/coronary care unit (ICU) and general ward (GW) groups according to the hospitalization type on admission day 1. The propensity score was calculated to create matched cohorts where admission style (intensive care unit/coronary care unit admission) was independent of measured baseline confounding factors, including ADL at admission. The primary outcome was ADL performance level at discharge (post-ADL) defined according to the Barthel index. Secondary outcomes included length of stay and total hospitalization cost (expense). Overall, 12231 patients were eligible, and propensity score matching created 2985 pairs. After matching, post-ADL was significantly higher in the ICU group than in the GW group [mean (standard deviation), GW vs. ICU: 71.5 (35.3) vs. 78.2 (31.2) points, P<0.001; mean difference: 6.7 (95% confidence interval, 5.1–8.4) points]. After matching, length of stay was significantly shorter and expenses were significantly higher in the ICU group than in the GW group. Stratified analysis showed that the patients with low ADL at admission (Barthel index score <60) were the most benefited from early intensive care unit/coronary care unit admission. Thus, early intensive care unit/coronary care unit admission was associated with improved post-ADL in patients with emergency acute decompensated heart failure admission.
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Affiliation(s)
- Masato Kanda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Nakagomi
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyo Kuwabara
- Department of Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Inoue
- Department of Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
- * E-mail:
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Kitamura M, Izawa KP, Ishihara K, Yaekura M, Nagashima H, Yoshizawa T, Okamoto N. Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction. Heart Vessels 2020; 36:509-517. [PMID: 33123778 DOI: 10.1007/s00380-020-01718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan
- Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan
| | - Takashi Yoshizawa
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Nobuhiro Okamoto
- Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan
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