多施設回復期リハビリテーション病棟における脳卒中患者の転倒要因と転倒状況―転倒リスクアセスメントシートの開発

Incidence and Consequence of Falls among Stroke Rehabilitation Inpatients in Convalescent Rehabilitation Ward : Data Analysis of the Fall Situation in Multi-institutional Study

要旨：回復期リハビリテーション病棟の脳卒中患者の転倒に関する大規模データを収集し解析を行った．1,107名の入棟者中374名が転倒を経験し，χ²検定にて転倒と関連のあった16因子が挙げられた．多要因から注目すべき項目を抽出するために16因子についてロジスティック回帰分析を実施し，入棟時に適確に初回転倒の危険度を予測できるアセスメントシート開発を試みた．有意な8因子［転倒歴，中枢神経麻痺，視覚障害，感覚障害，尿失禁，中枢神経作用薬，移動手段，認知機能障害］をアセスメントシート項目とした．スコアは10点満点で転倒者（6.4±1.5）が非転倒者（5.1±1.9）に比し高値（p＜0.001）であった．リスク1（スコア0～3），リスク2（4～6），リスク3（7～10）に類別すると，各リスクグループ間にKaplan-Meier生存曲線にて差異（p＜0.001）を認めた．

Abstract : We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (p＜0.001). When the subjects were classified into three groups, a significant difference (p＜0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.