Clinical practice guidelines for rehabilitation nutrition in cerebrovascular disease, hip fracture, cancer, and acute illness: 2020 update.
Shinta Nishioka, Hideki Aragane, Norio Suzuki, Yoshihiro Yoshimura, Dai Fujiwara, Takashi Mori, Yayoi Kanehisa, Yuki Iida, Keiichiro Higashi, Yuri Yoshimura-Yokoi, Chiaki Sato, Miwa Toyota, Mai Tanaka, Yoshimasa Ishii, Shintaro Kosaka, Naoko Kumagae, Atsushi Fujimoto, Kenji Omura, Sadao Yoshida, Hidetaka Wakabayashi, Ryo Momosaki, Committee of Clinical Practice Guideline, Japanese Association of Rehabilitation Nutrition
Author Information
Shinta Nishioka: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan. Electronic address: shintacks@yahoo.co.jp.
Hideki Aragane: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Norio Suzuki: Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Yoshihiro Yoshimura: Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Dai Fujiwara: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Takashi Mori: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Yayoi Kanehisa: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Yuki Iida: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Keiichiro Higashi: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Yuri Yoshimura-Yokoi: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Chiaki Sato: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Miwa Toyota: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Mai Tanaka: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Yoshimasa Ishii: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Shintaro Kosaka: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Naoko Kumagae: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Atsushi Fujimoto: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Kenji Omura: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Sadao Yoshida: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan.
Hidetaka Wakabayashi: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
Ryo Momosaki: Committee of Clinical Practice Guideline (2018), Japanese Association of Rehabilitation Nutrition, Japan; Committee of Clinical Practice Guideline (2020), Japanese Association of Rehabilitation Nutrition, Japan.
BACKGROUND: Individuals undergoing rehabilitation often experience nutritional problems such as malnutrition, but there are no clinical practice guidelines (CPGs) specifically tailored to the combination of rehabilitation and nutritional care for these patients. The Japanese Association for Rehabilitation Nutrition aimed to develop CPGs for rehabilitation nutrition to support clinical decision making in daily practice. METHODS: A CPG committee and development process based on the Grading of Recommendations Assessment, Development and Evaluation system and the Minds Handbook for Clinical Practice Guideline Development 2014 was established. Four clinical questions were defined for patients undergoing rehabilitation for cerebrovascular disease, hip fracture, cancer, and acute illness. Literatures of randomised control trials (RCTs) up to April 2020 were searched for using the MEDLINE, EMBASE, CENTRAL, and Ichushi-web databases. After screening, full-text papers were assessed for eligibility for analysis. Subsequently, studies included in the systematic review were examined regarding their risk of bias, and underwent meta-analyses. A CPG development committee drafted the guidelines based on the systematic review report. Final recommendations were determined by the panel members. RESULTS: Four recommendations were made based on 4 to 9 RCTs for each disease/condition. The certainty of the evidence ranged from very low to low. Overall, the enhanced nutritional care was weakly recommended for rehabilitation patients with cerebrovascular disease, hip fracture, cancer, and acute illnesses. CONCLUSIONS: This CPG provides tentative recommendations for nutritional care of individuals undergoing rehabilitation. Due to low certainty of evidence and small sample sizes of the included studies, more high-quality and larger RCTs are needed to develop more practical CPGs.
