脳卒中回復期リハビリテーションへの栄養サポートチーム介入―Functional Independence Measureを用いた効果検証

Validating a Nutrition Support Team's（NST）Effect in Convalescent Stroke Rehabilitation using the Functional Independence Measure

要旨：回復期リハビリテーション病棟での栄養サポートチーム（NST）介入効果をFIMを用いて後方視的に検討した．脳卒中患者304名を対象にNST介入対象者を栄養強化群と減量群に分類し，各々をNST介入非対象者（非NST群）と比較した．FIM利得は栄養強化群17.3±15.9，非NST群16.7±12.5と両群に有意差はなかったが，FIM効率は栄養強化群0.20±0.19，非NST群0.27±0.19と有意差を認めた．入院時FIM得点が54点以下の患者ではFIM利得，FIM効率ともに両群に有意差を認めなかった．入退院時BMI変化とFIM変化の間で一定の傾向を認めなかった．栄養介入を要した栄養強化群は一般的には予後不良の群と判断されるにもかかわらず，非NST群と差がなかった今回の結果は，NSTという栄養介入が有用であった可能性を示唆している．

Abstract : The aim of this study is to validate the effect of a nutrition support team's (NST) interventions in convalescent stroke rehabilitation using the Functional Independence Measure (FIM). Three hundred and four patients were retrospectively divided into an NST-nourishment group, an NST-losing-weight group and a non-NST group. We then compared the FIM gain, the FIM efficiency and the change of body mass index during admission among these three groups. The FIM gain was 17.3±15.9 in the NST-nourishment group and 16.7±12.5 in the non-NST group and there was no significant difference. The FIM efficiency in the NST-nourishment group (0.20±0.19) was significantly lower than the one in the non-NST group (0.27±0.19). Patients with an FIM of 53 or less showed no significant difference in FIM gain and FIM efficiency between the two groups. Since those patients who received NST intervention would tend to have a poor prognosis in general, we assumed that our “no difference” results indicated the effectiveness of the NST intervention. There was no evident relationship between FIM gains and changes in the body mass index.