Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
Kimie Fujita Last modified date:2021.09.09

Professor / Clinical nursing / Department of Health Sciences / Faculty of Medical Sciences

1. Sakanashi S, Fujita K, Konno R., Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study, The journal of nursing research, 10.1097/JNR.0000000000000430, 29, 3, e155, 2021.06.
2. Satomi Tanaka, Kimie Fujita, Kiyoko Makimoto, Maki Kanaoka, Kanako Yakushiji. Rumi Tanaka. Noboru Harada, Tomoharu Yoshizumi, Relationships of accelerometer‐determined physical activity with obesity, hypertension, diabetes, dyslipidemia, and health‐related quality of life in patients after liver transplantation, Clinical transplantation, 10.1111/ctr.14117, 34, 12, 1-13, 2020;00:e14117, 2020.10, The contribution of physical activity (PA) to the prevention of metabolic abnormalities following liver transplantation (LT) has not been well documented. We aimed to assess PA in post‐LT patients and to quantify its relationships with the development of postoperative metabolic abnormalities and health‐related quality of life (HRQOL). We recruited 111 patients who had undergone LT ≥ 6 months previously. PA was measured by accelerometry, and HRQOL was evaluated using SF‐8. PA was quantified as the number of steps per day, and the time spent performing moderate‐to‐vigorous PA and light PA per week. The prevalence of hypertension, diabetes, and dyslipidemia increased more than twofold following LT. The proportion of the participants with a sedentary lifestyle (<5000 steps/day) was 36%. Logistic regression analysis showed that postoperative hypertension and obesity were associated with preoperative body mass index and the number of steps taken (in 2000 steps/day increments). Preoperative diabetes was associated with obesity, and PA was associated with physical function‐related HRQOL scores. Thus, increasing the number of steps taken per day has the potential to reduce hypertension and obesity, and PA could improve physical function‐related HRQOL in patients following LT..
3. Kiyoko Makimoto, Kimie Fujita, Rie Konno, Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay, Japan Journal of Nursing Science, 10.1111/jjns.12361, 17, e12361, 2020.08, Aim: The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the postoperative experiences of adult/older patients (age ≥20 years) with osteoarthritis who underwent total hip or knee arthroplasty, focusing on the first 6 weeks following discharge. Methods: A systematic literature search on qualitative studies was conducted using six databases, such as Medline, CINAHL and Mednar. Verbatim interview data and themes or subthemes related to the patients' experience after discharge were extracted. Content analysis was used to code interview data. Codes similar in meaning were grouped, and subcategories were formed. These subcategories were then grouped into categories. Results: Sixteen qualitative studies with 253 participants were analyzed. In total, 136 codes were generated and formed 29 subcategories. Six categories were generated: (a) postoperative pain and medication; (b) difficulty in performing activities of daily living; (c) appreciation for support and difficulties associated with receiving support; (d) variability in recovery process and information-seeking; (e) lack of patient-centered care; and (f) transportation problems and social isolation. Conclusion: Our review suggests that prospective patients and their caregivers need individually tailored presurgical education and advanced planning for postsurgical reduced mobility..
4. Satomi Tanaka, Kimie Fujita, Maki Kanaoka, Kiyoko Makimoto, Kanako Yakushiji, Rumi Tanaka, Noboru Harada, Toru Ikegami, Tomoharu Yoshizumi, Prospective study of objective physical activity and quality of life in living donor liver transplant recipients, Japan Journal of Nursing Science, 10.1111/jjns.12362, in press, 2020.08, Aim: The aims of this study were to: (a) describe the physical activity (PA) and quality of life (QOL) in living donor liver transplant (LDLT) recipients pre-operatively and at 3 months and 6 months post-operatively; (b) compare PA and QOL at 6 months post-operatively with a healthy control group; and (c) explore pre-operative factors that predict PA changes. Methods: Patients over 20 years of age who were undergoing LDLT were recruited. PA was measured based on the number of steps/day and time spent performing moderate-to-vigorous PA (MVPA) during 1 week using an accelerometer. QOL was assessed based on a physical (PCS) and mental (MCS) component summary of the eight-item Short-Form Health Survey. The LDLT and healthy control groups were matched for age (±3 years) and gender. Pre-operative factors predicting a change in PA were calculated using a generalized linear mixed model. Results: Twenty-four patients completed the study. By 6 months post-LDLT, the MCS and PCS were comparable to those in the control group. The number of steps (3,887 steps/day) and MVPA (29.3 min/week) showed significant improvement by 6 months post-operatively, but remained much lower compared with those in the control group. The multivariate analysis showed that younger age (p <.01, p =.04) and higher skeletal muscle mass (SMM; p <.01, p =.03) were predictors of improvement in number of steps and MVPA. Conclusion: This study suggests the need for pre-operative interventions by healthcare professionals that focus on outcomes such as improving low SMM to facilitate post-operative PA recovery..
5. Yuriko Matsunaga, Kimie Fujita, Shuya Ide, Yasuko Tabuchi, Masaaki Mawatari, Kiyoko Makimoto, Changes in actual daily physical activity and patient-reported outcomes up to 2 years after total knee arthroplasty with arthritis, Geriatric Nursing, 10.1016/j.gerinurse.2020.07.006, 41, 6, 949-955, in press, 2020.11, The current study aimed 1) to describe changes in patient-reported outcomes and physical activity measured with an accelerometer preoperatively, 6 months and 2 years postoperatively in older patients undergoing total knee arthroplasty (TKA) for arthritis, and 2) to examine the predictors of the changes in physical activity (PA). This study included 58 patients (mean age 72.6 years, 84.5% women) who completed the Oxford Knee Score (OKS) and the 8-item Short Form Health Survey. Physical activity measured mean steps per day, duration of light physical activity and moderate-to-vigorous physical activity (MVPA) per week. All PA indicators and patient-reported outcomes improved 6 months postoperatively. After 6 months, knee-related pain and function gradually improved, and MVPA increased. The OKS was a sole predictor of improvement in PA during the 2-year study period, suggesting the importance of disease-specific quality of life..
6. Sayori Sakanashi, Kimie Fujita, Development of the empowerment scale for family caregivers of community-dwelling people with dementia in Japan, Japan Journal of Nursing Science, 10.1111/jjns.12311, 17, 2, 2020.04, Aim: This study aimed to develop the empowerment scale for family caregivers of community-dwelling people with dementia (PWD) in Japan (EFCD) and to validate the scale. Methods: The questionnaires were mailed to 820 family caregivers of PWD. The first version of the EFCD based on interviews with family caregivers and elderly care specialists and content validity results was tested. Participants also completed the Revised Scale for Caregiving Self-Efficacy and the General Health Questionnaire. For the EFCD development procedure, construct validity was evaluated by item analysis and exploratory factor analysis. Criterion validity was tested using Spearman's correlations between scores of the three scales. Reliability was evaluated using Cronbach's alpha, intraclass correlation coefficients (ICC), and Bland and Altman analysis. The final model was verified by confirmatory factor analysis. Results: Data from 304 family caregivers were analyzed. Exploratory factor analysis identified a 16-item, four-factor structure for the final version of the EFCD, as follows: (a) Excellent Practice in Dementia Care; (b) Understanding the Essence of Dementia Care; (c) Caring for Oneself as well as for the Person with Dementia; and (d) Having Peers with Shared Support Activities. Reliability and validity of the scale was established using the methods described. Conclusions: The developed EFCD is a reliable and valid measure that provides a simple assessment of empowerment among family caregivers of PWD..
7. Tae Gondo, Kimie Fujita, Mika Nagafuchi, Tsukasa Obuchi, Daisaku Ikeda, Ryuji Yasumatsu, Takashi Nakagawa, The Effect of Preventive Oral Care on Postoperative Infections After Head and Neck Cancer Surgery, Auris Nasus Larynx, 10.1016/j.anl.2020.01.001., 47, Issue 4, 643-649, Volume 47, Issue 4, August 2020, Pages 643-649
, 2020.02, [URL], Objective: This study aimed to investigate the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) in head and neck cancer (HNC) patients and clarify the relationship between oral care and postoperative infection.
Methods: We conducted a retrospective observation survey based on the medical records of 209 HNC surgery patients managed at a University Hospital in 2016-2018. The incidence of PP and SSI were assessed in patients who underwent operations of the nose and paranasal sinuses to the larynx. Factors associated with PP and SSI in a univariate analysis were included in a multiple logistic regression analysis. A Cox proportional hazards model was used analyze the incidence of PP according to time after surgery. The present study was approved by the ethical review board of our Institute.
Results: The rates of PP and SSI in our study population were 20.5% and 23.0%. Operative time (P < 0.01), blood loss (P = 0.004), tracheostomy (P < 0.01), reconstruction (P < 0.01), and preoperative plaque control record (PCR) (P < 0.01) were significantly associated with PP. The PCR depicted the oral hygiene based on the percentage of plaque attached to the tooth neck. A multiple logistic regression analysis indicated that the incidence of PP was significantly higher in patients with PCR values of ≥50% after preoperative oral care (OR=10.174, 95% CI 2.14-48.32, P = 0.004). Tracheostomy (P < 0.01), reconstruction (P = 0.044), a lower preoperative albumin level (P = 0.019), and a lower preoperative hemoglobin level (P < 0.01) were significantly associated with SSI.
Conclusions: The incidence of PP among patients who received oral care was high in those patients with high PCR values, indicating the importance of increasing compliance to preoperative oral care.
Keywords: Head and neck cancer; Oral care; Postoperative pneumonia; Surgical site infection.
Copyright © 2020 Elsevier Ltd. All rights reserved..
8. Matsunaga-Myoji Y, Fujita K, Makimoto K, Tabuchi Y, Mawatari M, Three-Year Follow-Up Study of Physical Activity, Physical Function, and Health-Related Quality of Life After Total Hip Arthroplasty, The Journal of Arthroplasty, 10.1016/j.arth.2019.08.009, 35, 1, 198-203, Volume 35, Issue 1, January 2020, Pages 198-203, 2019.07, Background
Little is known about the long-term changes in physical activity (PA) after total hip arthroplasty (THA). The purpose of this study is to describe the changes in the number of steps and intensity of PA as measured by accelerometers, patient-reported physical function, and health-related quality of life of THA patient preoperatively and at 1 and 3 years after THA.
This study included 153 patients (mean age, 61.4 years; 86.3% women) who wore an accelerometer for 10 consecutive days and completed the Oxford Hip Score (OHS) and the Short Form 8 at the 5-year follow-up after THA. PA was evaluated based on the mean steps per day and the time spent performing moderate-to-vigorous PA (MVPA) per week.
All 5 indicators had significantly increased at 1 year after THA, although only MVPA and OHS had further increased significantly at the 3-year follow-up. The predictor of improvement in the number of steps from baseline to 1 year post-THA was younger age, while those of improvement in MVPA from baseline to 3-year post-THA were younger age, higher OHS, and better Short Form 8 mental component scores using mixed-model analysis. Participation in the PA measurements was high (69.9%) at the 3-year follow-up. No significant changes were observed for these outcomes in the remaining cohort beyond 3 years after THA.
In post-THA patients, MVPA continued to increase for 3 years postoperatively. Therefore, PA must be measured over the medium term to long term following THA..
9. Yuriko Matsunaga-Myoji, Kimie Fujita, Shuya Ide, Yasuko Tabuchi, Masaaki Mawatari, Improved levels of physical activity in patients over 75 years following total knee arthroplasty, Journal of Orthopaedic Surgery, 10.1177/2309499019873363, 27, 3, 2019.09, Purpose: There is insufficient evidence regarding the precise levels of physical activity (PA) in older patients following total knee arthroplasty (TKA). The aims of this study were (1) to describe the changes in the amount and intensity of PA before and after TKA with an accelerometer in older patients, compared with age- and sex-matched healthy participants and (2) to assess the effect of TKA on PA depending on age. Methods: Sixty-six primary TKA patients aged 60 years or over (mean age, 73.3 years) wore an accelerometer (Lifecorder EX) for 10 consecutive days and completed the Oxford Knee Score (OKS) before and at 6 months after TKA. PA was evaluated by mean step count and time spent (min) engaged in PA per day. PA intensity was classified as light (1.5–3 metabolic equivalents (METs)), moderate to vigorous (≥3 METs), and total (≥1.5 METs). Sixty-four healthy participants completed a single assessment of PA. Results: Each of the PA measures and OKS increased significantly after TKA. Compared with healthy controls, light and total PA improved to 100% at 6 months after TKA in patients 75 years or older. By contrast, moderate-to-vigorous PA was 32% of that of the controls and rose to 78% after TKA. PA intensity in patients aged 60–74 years was 31–74% of the controls but did not reach the same level after TKA. Conclusion: TKA in older patients increases the amount of PA, with light and total PA suitable parameters for assessing PA..
10. Miyuki Ushio, Maki Kanaoka, Yumiko Kinoshita, Satoko Maeno, Kimie Fujita, Moderate-to-vigorous physical activity and the risk of stroke recurrence in patients with a history of minor ischemic stroke in Japan
a retrospective analysis, Topics in Stroke Rehabilitation, 10.1080/10749357.2018.1507309, 25, 8, 591-598, 2018.11, Background: Physical activity (PA) is beneficial for stroke prevention; in particular, moderate-to-vigorous physical activity (MVPA). However, few studies have investigated its relationship with recurrent ischemic stroke (RIS). Objectives: To clarify the relationship between MVPA and RIS and the burden of risk factors after a first-ever ischemic stroke. Methods: A total of 45 outpatients (mean age 67.1 ± 10.2 years) who had previously experienced a transient ischemic attack or a minor non-cardioembolic ischemic stroke at a single hospital in Japan (mean 6.4 ± 4.2 years previously), were enrolled between March and June 2016. All patients wore an accelerometer around their hips for 10 days, and their percentage body fat (%BF) and visceral fat level (VFL) were measured by bioelectrical impedance. Retrospective information about the history of RIS and risk factors (blood pressure, lipoprotein cholesterol and estimated glomerular filtration rate) were extracted from the clinical records. Binary logistic regression models were used to estimate the relevance of the RIS history to MVPA and potential risk factors such as sociodemographic and clinical variables (obesity, smoking and hypertension). Results: RIS occurred in 9 patients; they had significantly higher VFL (p = 0.007) and %BF (p = 0.007) values and lower MVPA (p = 0.011) values than patients without recurrence. A multivariate analysis of these factors indicated that age, VFL and MVPA were significant independent predictors of RIS. Conclusions: Patients with a history of mild ischemic stroke had low MVPA and high VFL values, which together may be a risk factor for RIS..
11. Makimoto K, Fujita K, Konno R., Experience of patients following lower limb joint replacement: a systematic review protocol, JBI database of systematic reviews and implementation reports, 2018.04.
12. Lin K, Bao L, Wang J, Fujita K, Makimoto K, Liao X., Validation of the Chinese (Mandarin) Version of the Oxford Knee Score in Patients with Knee Osteoarthritis, Clinical Orthopaedics and Related Research, 10.1007/s11999-017-5495-2, 475, 12, 2992-3004, 2017.12, Background: With the increasing number of patients with knee osteoarthritis undergoing TKAs in China, there is a clear need for a valid, short, joint-specific patient-reported outcome measure such as the Oxford Knee Score (OKS). Questions/purposes: To test the translated and cross-culturally adapted Chinese (Mandarin) version of the Oxford Knee Score (OKS-CV) and its (1) reliability, (2) construct validity, (3) dimensionality, and (4) responsiveness. Methods: Three native Chinese bilingual translators (a professional English translator, an experienced orthopaedic surgeon, an advanced-practice nursing specialist) translated the English-language OKS into Mandarin Chinese. A consensus panel created a synthesis of those efforts, which then was back-translated by two bilingual nonmedical, professional English-language translators. The OKS-CV was developed according to the guidelines of copyright holders. Between March 2013 and March 2015, 253 patients underwent TKAs. Among them, 114 Mandarin-speaking patients with knee osteoarthritis underwent primary unilateral TKA (age, 67 ± 7 years; range, 55–84 years; female, 80%; preoperatively 54% had moderate to severe knee osteoarthritis), completed the preoperative questionnaires, and were followed up, with a mean postoperative followup of 2.7 years (SD, 0.5 years). Eligibility criteria were (1) patients with knee osteoarthritis who were scheduled to have a primary unilateral TKA, (2) patients who were fluent in Mandarin, and (3) consent to participate. The exclusion criteria were: (1) lack of understanding of Mandarin, and (2) inability to comprehend the questionnaires owing to cognitive impairment. To evaluate test-retest reliability, another group of 35 Mandarin-speaking outpatients with knee osteoarthritis (age, 61 ± 10 years; range, 44–84 years; female, 77%) was recruited to complete the OKS-CV twice at a 1-week interval. Reliability was tested using Cronbach’s alpha and intraclass correlation coefficient (ICC). Construct validity was evaluated using Spearman’s rank correlation coefficient to quantify the correlations between the OKS-CV and the WOMAC, Short Form-8 Health Survey (SF-8TM), and EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). Exploratory factor analysis was performed to clarify dimensionality. The eigenvalue indicates the importance of each factor obtained from factor analysis. Responsiveness was determined by standardized response mean (SRM) and effect size (ES) from preoperative and postoperative scores of the OKS-CV. Floor and ceiling effects also were analyzed. Results: The internal consistency (Cronbach’s alpha = 0.89) and test-retest reliability (ICC = 0.93; 95% CI, 0.87–0.97) proved good. Convergent construct validity was supported by moderate to strong correlations between the OKS-CV and the WOMAC (r = −0.80, p < 0.001), the SF-8TM physical component summary (r = 0.65, p < 0.001), and the EQ-5D usual activities (r = −0.41, p < 0.001) and mobility (r = −0.35, p < 0.001). There also were correlations between the OKS-CV and the SF-8TM mental component summary (r = 0.58, p < 0.001) and the EQ-5D anxiety/depression (r = −0.35, p < 0.001). The factor analysis yielded three factors with eigenvalues greater than 1. Responsiveness was excellent (SRM = 1.52; ES = 1.52). No floor or ceiling effect was observed. Conclusions: The OKS-CV showed good acceptability and psychometric properties for the intended population. Future studies are needed to evaluate the mental state of patients with knee osteoarthritis. Clinical Relevance: The OKS-CV appears to be a reliable, valid, and responsive instrument for Chinese patients with knee osteoarthritis. Based on these results we believe the OKS-CV can be used as a valuable tool for the assessment of patient-reported outcomes in Chinese patients with knee osteoarthritis before and after TKA..
13. Sakanashi S, Fujita K., Empowerment of family caregivers of adults and elderly persons
A concept analysis, International Journal of Nursing Practice, 10.1111/ijn.12573, 23, 5, 2017.10, Aim: This concept analysis defined and described the components of empowerment of family caregivers who care for adults and the elderly. Methods: Rodgers evolutionary method of concept analysis was used. Data sources included Pub Med, CINAHL, Scopus, and Igaku Chuo Zasshi. Thirty articles published between 1995 and 2015 focusing on the empowerment of family caregivers providing care to adults and the elderly were selected. Result: The analysis reveals 6 attributes, 5 antecedents, and 5 consequences. In addition, the results reveal structured aspects of family caregivers, care receivers, and other people surrounding them, and their relationships. Empowerment of adults' and elders' family caregivers may be defined as “positive control of one's mind and body, cultivating a positive attitude, proactively attempting to understand one's role as a caregiver to improve caregiving capabilities, focusing on others as well as oneself, supporting the independence of the care receiver, and creating constructive relationships with other people surrounding them.”. Conclusion: The components of empowerment clarified in this research can be used for the measurement of and interventions aimed at improving empowerment among family caregivers. Furthermore, clarifying the definition of empowerment among family caregivers enables researchers to better distinguish empowerment from similar concepts in the future..
14. Lin Pi, Fujita K, Chang Su, Liu Yo., Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty, Open Journal of Nursing, 2016(6):, 6, 6581-671, 2016.06.
15. Fujita K, Makimoto K, Mawatari M., Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty., J Orthop Sci., 10.1016/j.jos.2015.11.004., 21, 2, 191-198, 2016.04, BACKGROUND:In non-Western countries including Japan, activities requiring deep flexion of the hip joint, such as seiza (kneeling with calves tucked under the thighs and buttocks resting on the heels) and using squat toilets are commonly practiced. The purpose of this study was to assess longitudinal changes in traditional health-related quality of life measures and measures of physical functions associated with lifestyle for Japanese patients pre-surgery and after total hip arthroplasty.
METHODS:Consecutive primary total hip arthroplasty patients between July 2003 and November 2006 were eligible. Patients were measured preoperatively and at 6 weeks, 1 year and 3 years postoperatively. Patients completed the EuroQol 5D, the Western Ontario and McMaster Universities Osteoarthritis Index and items related to Japanese lifestyle activities such as squatting. Changes in these scale scores across the four time points were tested, and we examined predictive factors of EuroQol 5D score at 3-year follow-up using multiple linear regression.
RESULTS:Of 1103 eligible patients, 576 completed questionnaires at all four time points. By 6 weeks post-surgery, reductions in pain and improvements in physical function and stiffness became highly significant, and improvements continued to 3 years postoperative. In contrast, improvements were far more limited for items related to Japanese lifestyle functions such as seiza and use of a Japanese squat toilet, even 3 years after surgery. Predictive factors of EQ5D at 3-year post THA were WOMAC pain and physical function, seiza, age and comorbidity measured at 3-year post THA.


The rate of improvement in QOL requiring deep flexion of the hip joint was much slower than that in QOL related to Western lifestyle. Our study suggests a need for lifestyle modification for THA patients in the other countries where kneeling and squatting are commonly performed..
16. Myoji Y,Fujita K,Mawatari M,Tabuchi Y., Changes in sleep-wake rhythms, subjective sleep quality and pain among patients undergoing total hip arthroplasty, International Journal of Nursing Practice, 10.1111/ijn.12345, 21, 6, 764-770, 2015.12, We evaluated nocturnal sleep-wake rhythms and subjective sleep quality on the first postoperative night compared with the preoperative night in 34 patients who had total hip arthroplasty (mean age: 61.9 years; 82.4% female) under spinal anaesthesia. We also examined secondary factors related to sleep disturbances after surgery. Patients wore an accelerometer (actigraph) during the preoperative period and the first postoperative night to track sleep-wake rhythms. Secondary end-points were postsurgical pain and low back pain. Sleep parameters were measured objectively by actigraphy, and subjective sleep quality was measured by the Oguri-Shirakawa-Azumi Sleep Inventory, Middle-Aged and Aged Version and found to worsen significantly after surgery. Actigram data showed a reduction in actual sleep time from 353.7±121.2min preoperatively to 263.8±104.4min postoperatively. The data indicate that normalized continuous sleep time is important for patient healing and well-being and that postoperative sleep disturbance is related to low back pain more than to postsurgical pain..
17. Fujita K,Xia Z,Liu X,Mawatari M,Makimoto K., Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties., Nursing and Health Sciences, 2014.09.
18. Makabe S, Fujita K, Makimoto K, Kozuka K, Miura M, Kanno T, Masuda T, Mawatari M., Impact of Age on Quality of Life and Difficulty with a Japanese Lifestyle for Patients with Total Hip Arthroplasty., Journal of Physical Therapy and Health Promotion, 2 Iss. 4, PP. 51-56, 4, 2014.06.
19. Fujita K,Makimoto K,Tanaka R,Mawatari M,Hotokebuchi T., Prospective study of physical activity and quality of life in Japanese women undergoing total hip arthroplasty., Journal of Orthopaedic Science, 18(1):45–53, 1, 45-53, 2013.01.