We focused on locomotive syndrome as a low physical function factor that may prevent patients with psychiatric disease from being discharged. The purpose of this study is to clarify the factors, including locomotive syndrome, that prevent discharge from psychiatric long-term care wards. Method: We enrolled 74 patients who were admitted to psychiatric long-term care wards at three different hospitals in Japan. Nurses or medical social workers in the ward were asked whether the planned discharge destination had been decided, and patients were categorized into a decided group and an undecided group. Outcome measures were age, sex, F code in the ICD-10 Classification of Mental and Behavioral Disorders, length of stay, chlorpromazine equivalent dose of antipsychotics, locomotive syndrome test scores (25question GLFS, two-step test, stand-up test), and Barthel Index. Results: Based on the multivariate logistic regression analysis results, the length of stay and the two-step test score significantly explained the difference between the two groups. The odds ratio of a length of stay greater than 10 years was 8.42 times that of a length of stay less than 2 years (P=0.012, 95% CI=1.59, 44.53). Regarding the twostep test, the odds ratio for obtaining stage 2 was 10.62 times that for obtaining stage 0 (P=0.013, 95% CI=1.65, 68.23). Conclusion: Those who with longer length of stays and lower two-step test scores tended not to be decided the planned discharge destination.

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Objective: A total of 183 patients admitted to five hospitals for proximal femoral fractures and psychiatric disorders were examined to determine whether their physical function could be improved by rehabilitation and to identify factors that affected home discharge. Methods: We conducted surveys to collect data regarding patients’ age, sex, type of mental illness, location at time of injury, complications, Charlson Comorbidity Index, Global Assessment of Functioning scale scores, surgical technique, time from surgery to the start of rehabilitation at the target hospital, rehabilitation duration, results of cognitive function tests (e.g., the Mini Mental Status Examination), walking ability before the injury, final walking ability, functional independence measure (FIM) of the patient’s activities of daily living at the start and end of treatments, and discharge destinations. Results: The motor function index showed a significant improvement from an average of 36.0 points at admission to an average of 53.0 points at discharge. Overall, 47.9% of patients who were able to walk before injury could regain gait ability. The discharge rate to the patient’s home was 15.8%. Conclusions: The gait reacquisition rate for patients with femoral neck fractures and mental illness admitted to a psychiatric ward was 47.9%, which was lower than that reported in previous studies, but higher than that for dementia patients. Binomial logistic regression analysis identified the following predictive items for home discharge: whether the fracture occurred at home, FIM cognition item scores at admission, and total and motor item scores at discharge. The derived equation had a high hit rate of 80.9%.

The aim of this cross-sectional study was to determine the status of locomotive syndrome (LS) and the level of physical activity (PA) in long-term inpatients in a psychiatric care ward and to investigate the association between the severity of LS and the level of PA. The study participants consisted of 25 patients aged 55 years or older who had been admitted to a psychiatric care ward for more than one year. The participants’ LS stage was determined and their level of PA was measured using an accelerometer. We also analyzed the correlations between the LS stage test results, level of PA, and values for each assessment item. The LS stage test showed that 84.0% of the participants were at stages 3. The participants’ mean step count was 3089.8 ± 2346.5 steps. The participants’ mean sedentary time was 349.7 ± 68.9 min, which is more than 70% of the total measuring time. Overall, the results indicate that LS stage was significantly correlated to age, ADL, and level of PA. Patients who stay in a psychiatric care ward experience declining motor functioning and lack PA. Deterioration of motor functioning is associated with lack of PA, suggesting the need for physical intervention.

The purpose of this study was to investigate the outcomes of physiotherapy on patients in psychiatric long-term care wards in Japan and to identify the characteristics of patients who have been discharged to the community. Methods: The subjects comprised 50 patients who were admitted to the psychiatric long-term care wards at four different hospitals in Japan and prescribed physiotherapy. General physiotherapy for the patients' diseases was provided. The main outcome was whether a patient was discharged to the community (discharged group) or remained hospitalized (hospitalized group) at the end of physiotherapy. Basic subject characteristics, including age, sex, F-code, classification of the diagnosis that led to physiotherapy, length of hospital stay, and length of physiotherapy, were collected from medical records. The Functional Independence Measure (FIM) tool was administered at the initial and final evaluations. Results: At the end of physiotherapy, there were 14 subjects in the discharged group and 36 subjects in the hospitalized group. There were significant differences in the classification of diagnosis, length of stay (LOS), and classification of LOS between the two groups. Two-way analysis of variance showed interactions between the FIM subitems of selfcare, transfer, and locomotion. Conclusion: The discharged group had higher FIM scores at the start of physiotherapy and a greater FIM gain.