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Yuri Ferreira M, Oliveira LB, Porto Júnior S, Semione G, Palavani LB, Batista S, Pari Mitre L, Borges PGLB, Abrantes Barros E, Andreão F, Porto Sousa M, Gomez D, Bertani R, Hakim F. Enhancing the quality of evidence, comparability, and reproducibility in ventriculoatrial shunt research for normal pressure hydrocephalus: A systematic review and VAS-NPH reporting guideline. J Clin Neurosci 2024; 126:328-337. [PMID: 39024937 DOI: 10.1016/j.jocn.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Ventriculoatrial shunt (VAS) is an important treatment option for normal pressure hydrocephalus (NPH). However, clinical studies reporting the use of VAS for NPH lack sufficient standardization for meta-analytic comparisons that could provide robust evidence regarding its use. This study aims to assess the quality of reporting in these studies and develop a reporting guideline checklist to standardize terminology, concepts, and reporting while reinforcing the essential elements to ensure comparability and reproducibility. METHODS This is a systematic literature review that followed the PRISMA guidelines with the search in Medline, Embase, and Web of Science databases, with no timeframe restriction. The level of evidence of the studies was assessed using the GRADE system, and the rigor used in the publication of the results was assessed concerning adherence to the guidelines indicated by the EQUATOR Network Group. Furthermore, the studies were scrutinized focusing on eight domains: (1) Characteristics of the included studies and baseline characteristics of the patients; (2) Reporting methodology; (3) Pivotal concepts definition; (4) Adverse events assessment; (5) Data writing and reporting; (6) Detailed outcomes reporting; (7) Specific clinical outcomes assessment and reporting; and (8) Complications reporting. RESULTS A total of 14 studies with 734 patients and 753 shunts were included in this review, and the assessment exposes notable deficiencies in reporting, specifically in baseline patient details, methodology, and outcome assessments. Only two studies followed reporting guidelines, prompting concerns about comprehensive reporting of adverse events and intraoperative complications. Varied reporting completeness existed for shunt-related issues. The absence of standardized definitions for key concepts and insufficient intervention details were observed. A VAS-NPH reporting guideline, encompassing 36 items across eight domains, was developed to address these shortcomings. CONCLUSION This systematic review reveals significant deficiencies in methodological rigor and reporting quality. The proposed VAS-NPH Reporting Guideline covers all essential aspects and is a potential solution to rectify these shortcomings and increase transparency, comparability, and reproducibility. This initiative aims to advance the level of evidence and enhance knowledge regarding the use of VAS in NPH.
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Affiliation(s)
- Marcio Yuri Ferreira
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | | | | | | | - Savio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lucas Pari Mitre
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Pedro G L B Borges
- Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Filipi Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Diego Gomez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
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Colella F, Speciali D, Bernal M, de Godoy W, Politti F, Lucareli PRG. Are we supererestimating gait assessments of patients with idiopathic normal-pressure hydrocephalus? Gait Posture 2019; 72:12-15. [PMID: 31129388 DOI: 10.1016/j.gaitpost.2019.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by a triad composed of cognitive alteration, urinary incontinence, and gait impairment associated with ventricular enlargement and normal cerebrospinal fluid pressure. Gait impairment is among the earliest symptoms; however, the reliability of the evaluation is not well-established and no consensus has been reaching regarding variables that should be analyzed and which parameters should be considered to accurately assess post-intervention improvement. RESEARCH QUESTION Are the degree of repeatability, standard error of measurement, and minimum detectable change considered to detect changes in gait variables in iNPH patients? METHODS A total of 84 iNPH patients with a mean age of 77.1 (±6.4) years were analyzed. Gait deviation index (GDI), speed, cadence, cycle time, stride length, single support, and first and second double support were chosen as the variables to be analyzed. Statistical analysis was performed by an independent evaluator, with gait repeatability assessed by the intraclass correlation coefficient (ICC) and the standard error of measure (SEM). RESULTS ICC values were 0.76-0.85 with excellent repeatability, while SEM demonstrated that the variables with best repeatability were the GDI (mean, 4.94; 95% confidence interval (CI), 4.63-5.43), representing a 7.65% mean relative error of the measurement (mean, 0.05 m; 95% CI, 0.05-0.06), and stride length (mean 0.05 m; 95% CI, 0.05-0.06), with a 7.69% mean relative error. SIGNIFICANCE We concluded that GDI and stride length were the variables with the best repeatability and lower variability in the gait of iNPH patients.
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Affiliation(s)
- Fernanda Colella
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Danielli Speciali
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Milena Bernal
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Wagner de Godoy
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil
| | - Fabiano Politti
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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Lopes MIR, Tornai JB, Jeng FLDM, Lopes BDV, Mendes GADS, Oliveira MFD, Pinto FCG. Development of the Brazilian Portuguese version of the "Grading scale for idiopathic normal pressure hydrocephalus": cross-cultural adaptation, reliability and validity. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:692-696. [PMID: 30427509 DOI: 10.1590/0004-282x20180108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The current study translated to Portuguese and validated the normal pressure hydrocephalus (NPH) scale originally developed in English as the Grading Scale for Idiopathic Normal Pressure Hydrocephalus. METHODS Following Guillemin's validation protocol, the last version of the Portuguese NPH scale was applied to 121 consecutive patients with a diagnosis of normal pressure hydrocephalus (73 men and 48 women) from the Group of Cerebral Hydrodynamics from July 2010 to March 2012. RESULTS The mean age was 71.09 years old, ranging from 35 to 92 years. The rate of agreement and reproducibility was high, as confirmed by Cohen's Kappa coefficient, with excellent intraobserver correlation for the NPH scale items individually evaluated: gait (0.80), dementia (0.90) and incontinence (0.87). CONCLUSIONS The Portuguese version of the Grading Scale for Idiopathic Normal Pressure Hydrocephalus was successfully translated and validated for use in Brazilian patients.
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Affiliation(s)
- Maria Izabel Romão Lopes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Juliana Benevenuto Tornai
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Fernanda Letkaske de Miranda Jeng
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
| | - Bianca di Virgilio Lopes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brasil
| | - Gabriel André da Silva Mendes
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brasil
| | - Matheus Fernandes de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurocirurgia, São Paulo SP, Brasil
| | - Fernando Campos Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brasil
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Bovonsunthonchai S, Witthiwej T, Ngamsombat C, Sathornsumetee S, Vachalathiti R, Muangpaisan W, Hengsomboon P, Thong-On S, Jankhum S, Yangyoo P. Effect of spinal tap test on the performance of sit-to-stand, walking, and turning in patients with idiopathic normal pressure hydrocephalus. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:53-60. [PMID: 29581614 PMCID: PMC5857501 DOI: 10.18999/nagjms.80.1.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The aim of the study was to investigate the effect of the spinal tap test on sit-to-stand (STS), walking, and turning and to determine the relationship among the outcome measures of STS, walking, and turning in patients with iNPH. Twenty-seven patients with clinical symptoms of iNPH were objectively examined for STS, walking, and turning by the Force Distribution Measurement (FDM) platform connected with a video camera. Assessments were performed at before and 24 hours after spinal tap. Motor abilities were assessed by the STS time, time of walking over 3 meters, and time and number of steps when turning over 180 degrees. Significant improvements were found in the STS time (p = 0.046), walking time (p = 0.048), and turning step (p = 0.001). In addition, turning time was improved but not statistically significant (p = 0.064). Significant relationships were found among all outcome measures (p < 0.001). The relationship among these outcome measures indicated that the individuals had similar ability levels to perform different activities. This may serve as a new choice of outcome measures to evaluate the effect of intervention in different severity levels of patients with iNPH.
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Affiliation(s)
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Chanon Ngamsombat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sith Sathornsumetee
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,NANOTEC-Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Supattra Jankhum
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pusanisa Yangyoo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kim MI, Oh J, Cho WH, Kim DS, Jung CW, You YD, Gwon JG, Lee JM. Causes of Failure during the Management Process from Identification of Brain-Dead Potential Organ Donors to Actual Donation in Korea: a 5-Year Data Analysis (2012-2016). J Korean Med Sci 2018; 33:e326. [PMID: 30534034 PMCID: PMC6281958 DOI: 10.3346/jkms.2018.33.e326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
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Affiliation(s)
- Mi-im Kim
- Transplantation Center, Korea University Anam Hospital, Seoul, Korea
| | - Jaesook Oh
- Korea Organ Donation Agency, Seoul, Korea
| | | | - Dong-Sik Kim
- Department of Acute Care Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Woong Jung
- Department of Transplantation and Vascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Dong You
- Department of Acute Care Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun-Gyo Gwon
- Department of Transplantation and Vascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-myeong Lee
- Department of Acute Care Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Ryding E, Kahlon B, Reinstrup P. Improved lumbar infusion test analysis for normal pressure hydrocephalus diagnosis. Brain Behav 2018; 8:e01125. [PMID: 30259701 PMCID: PMC6236248 DOI: 10.1002/brb3.1125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/26/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Constant infusion lumbar infusion test (LIT) is an important way to find which patients, of those with signs and symptoms corresponding to normal pressure hydrocephalus (NPH) who will improve from shunt operation. LIT is a stress test on the ability for cerebrospinal fluid re-absorbtion. The aim of this study is to show how the information from LIT can be improved by quantitative analysis and avoidance of methodological pitfalls. MATERIAL AND METHODS The potential pitfalls, and the analysis method, are described in detail. The analysis was applied on pre-operative constant infusion LIT from 31 patients operated for NPH, with known outcome. The pre- and post-operative walking speed was used to grade pathology progression or improvement. RESULTS The maximal, plateau, intra-spinal pressure at constant infusion LIT is an ambivalent indicator for NPH: while low maximal pressure indicates no cerebrospinal fluid (CSF) absorbtion pathology, too high pressure (≥47 mmHg) may mean no diagnosis, because of stenosis of the Sylvian aqueduct. When subjects with too high intra-spinal pressure were excluded, the new analysis gave a couple of diagnostic volume parameters, of which one appears to be an optimal LIT parameter for identifying NPH patients with 14% better accuracy than plateau pressure. CONCLUSION By avoiding methodological pitfalls, and optimal analysis of the results from lumbar infusion test, the number of NPH patients who do not have a successful outcome after shunt operation may be further decreased.
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Affiliation(s)
- Erik Ryding
- Department of Clinical Neurophysiology, Skane University Hospital, Lund, Sweden
| | - Babar Kahlon
- Department of Neurosurgery, King Feisal Hospital, Riad, Saudi Arabia
| | - Peter Reinstrup
- Department of Neurosurgery, Skane University Hospital, Lund, Sweden
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Abstract
As the worldwide prevalence of dementia increases, there is a greater and more urgent need for all health care providers to understand how to evaluate and manage cognitive impairment. Many people presenting with a dementing illness have one or more reversible underlying conditions that worsen prognosis and, if treated, can improve cognitive function. This article reviews the major potentially reversible dementias, including the basic workup and management of each condition.
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Affiliation(s)
- Milta O Little
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University Health Center, 1402 South Grand Boulevard Room M238, St Louis, MO 63104, USA.
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Scully AE, Lim ECW, Teow PP, Tan DML. A systematic review of the diagnostic utility of simple tests of change after trial removal of cerebrospinal fluid in adults with normal pressure hydrocephalus. Clin Rehabil 2018. [PMID: 29514517 DOI: 10.1177/0269215518760126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To synthesize the evidence regarding the diagnostic value of simple ancillary tests post cerebrospinal fluid drainage in normal pressure hydrocephalus. DATA SOURCES MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Cochrane library databases; last searched on 12 September 2017. REVIEW METHODS This review was performed applying the steps of the PRISMA statement. The QUADAS 2 tool was used to assess the risk of bias. Prospective and retrospective trials were systematically reviewed, and data on diagnostic accuracy were extracted. Meta-analysis (where possible) was performed. Hierarchical summary receiver operating characteristic package was used to calculate pooled estimates of included diagnostic studies. RESULTS Seventeen trials (with 812 subjects in total) were identified for inclusion in the meta-analyses for the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test. The summary estimates of sensitivity and specificity for the 18-meter walk test was 0.83 (95% CI 0.57 to 0.99) and 0.67 (95% CI 0.33 to 0.95), video-recorded gait performance was 0.85 (95% CI 0.47 to 0.99) and 0.68 (95% CI 0.33 to 0.96), cognitive test was 0.82 (95% CI 0.41-0.99) and 0.75 (95% CI 0.39-0.99), and Timed Up and Go Test was 0.89 (95% CI 0.79-0.95) and 0.63 (95% CI 0.24-0.90), respectively. CONCLUSION This review highlights the diagnostic value of the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test in predicting shunt outcomes among adults with normal pressure hydrocephalus.
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Affiliation(s)
| | | | - Pei Pei Teow
- Department of Physiotherapy, Singapore General Hospital, Singapore
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Kitade I, Kitai R, Neishi H, Kikuta KI, Shimada S, Matsumine A. Relationship between gait parameters and MR imaging in idiopathic normal pressure hydrocephalus patients after shunt surgery. Gait Posture 2018; 61:163-168. [PMID: 29413784 DOI: 10.1016/j.gaitpost.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/18/2017] [Accepted: 01/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A few previous studies have reported a change in gait motion in idiopathic normal pressure hydrocephalus (iNPH) patients after shunt surgery compared with before shunt surgery; however, there has been no detailed quantitative investigation of gait, including kinetic and kinematic parameters. Furthermore, the relationship between gait parameters and magnetic resonance (MR) imaging has not been confirmed. RESEARCH QUESTION We investigated the gait motion in patients with iNPH, and evaluated the relationship between kinetic gait parameters and MR imaging before and after shunt surgery. METHODS The subjects were 12 patients with iNPH who could walk 10 m without aids. A three-dimensional motion analysis system was used to obtain the spatiotemporal, kinetic, and kinematic parameters before and after surgery. Relationships between each gait parameter and MR imaging were assessed. RESULTS The post-shunt walking speed and step length were increased compared with pre-shunt values. The post-shunt evaluation showed increased range of motion of the hip, knee, and ankle joints in the sagittal plane during the gait cycle. The peak flexion moment of the hip during the stance phase was greater after shunt surgery. The improvement rate of the Evans index was significantly correlated with the improvement rate of walking speed, and the total ranges of motion of the hip and ankle joints in the sagittal plane. SIGNIFICANCE The propulsive force of the hip and ankle joints was regained after shunt surgery. Normalization of the Evans index could predict improvement in propulsive force after shunt surgery in iNPH.
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Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
| | - Ryuhei Kitai
- Department of Neurosurgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Hiroyuki Neishi
- Department of Neurosurgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Ken-Ichiro Kikuta
- Department of Neurosurgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Seiichiro Shimada
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Akihiko Matsumine
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Orthopaedic Surgery, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
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