脊椎圧迫骨折に対するリハビリテーション治療提供量が機能予後に与える影響

The Impact of the Amount of Rehabilitation Provision on Functional Outcome in Vertebral Compression Fractures

要旨　はじめに：脊椎圧迫骨折患者では，疼痛や安静臥床に伴う不活動により筋力低下などを引き起こしやすく，身体機能や日常生活動作（activities of daily living：ADL）を低下させる可能性が高い．今回，脊椎圧迫骨折患者において，リハビリテーション治療提供量が機能予後に与える影響を検討した．

方法：JMDCの多施設データを用い，65歳以上の脊椎圧迫骨折患者18,174例を対象とした．入院中のリハビリテーション治療提供量が1日平均1単位以上であった患者群（高提供群）と，1日平均1単位未満（低提供群）との間で，Barthel index（BI）利得，BI効率，退院時ADL自立（BI≧95），自宅退院を比較した．

結果：高提供群は4,145例，低提供群は14,029例であった．高提供群ではBI利得，BI効率が高く，退院時ADL自立割合（41.6％），自宅退院割合（79.1％）も高かった．また，重回帰分析において，高提供群ではBI利得が高く（回帰係数：2.423），BI効率も高かった（回帰係数：0.043）．多重ロジスティック回帰分析では高提供群では，自宅退院割合が高く（オッズ比：1.26），退院時ADL自立割合が高かった（オッズ比1.17）．

結語：脊椎圧迫骨折患者において，リハビリテーション治療提供量が機能予後に影響を与えている可能性がある．

Abstract　Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.

Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).

Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423) and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio: 1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).

Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.