リハビリテーション医療における廃用リスクスコアの開発に関する臨床研究

Developing a Weighted Disuse Risk Factor Evaluation and Disuse Risk Score Rating for Disuse Syndrome

要旨：［目的］廃用リスクスコアの開発．［方法］11項目の廃用リスク因子（年齢，悪性腫瘍，心臓機能障害，呼吸機能障害，腎機能障害，疼痛，歩行障害，精神障害，知的能力障害，認知症，BMI）を選定し，各3水準で評価した．Conjoint分析により5段階のリスクグレードに対する各因子の重みを検定した．別に9項目でConjoint分析を再実施し一致度（信頼性）を検定した．［結果］廃用リスクスコア（全体Utility値）とリスクグレードの相関はR＝0.985であった．重要度（％）の高いリスク因子は歩行障害（14.0），悪性腫瘍（11.5），呼吸機能障害（11.0）などであり，精神障害（6.1），腎機能障害（6.6）などは低かった．廃用症候群129例の11項目と9項目の廃用リスクスコアの相関は，R＝0.930であった．［結論］11項目の廃用リスクスコアは信頼性を認め有用であった．試用による改訂が必要である．

Abstract : Objective : To develop a weighted disuse risk score rating. Design : Based on specified selection criteria, items of the disuse risk factor were chosen. Then, a conjoint questionnaire for physicians was created using orthogonal cards with ordinal disuse risk grade. Conjoint analysis (SPSS 15.0) was performed, weighting each item and making a formula for calculating the disuse risk score. Setting : The Rehabilitation Department of a University Hospital. Participants : Forty-one physician respondents and 129 consecutive inpatients referred to the rehabilitation department. Main outcome measures : Agreement of the rated disuse risk grade with the calculated disuse risk score, and the reliability of the calculated disuse risk score of the 129 inpatients. Results : Eleven disuse risk factor items were selected ; age, malignant tumor, heart impairment, respiratory impairment, kidney impairment, pain, gait disorder, psychiatric impairment, intellectual disability, dementia, and body mass index. Forty-one physicians completed and returned a postal questionnaire. Cronbach's α of the rated disuse risk grade was 0.948. The correlation coefficient of the average rated disuse risk grade to the calculated disuse risk score was 0.985 (p＝0.000). Items of high overall importance (％) were gait disorder (14.0％), malignant tumor (11.5％), and respiratory impairment (11.0％). Those of low overall importance (％) were body mass index (6.8％), kidney impairment (6.6％), and psychiatric impairment (6.1％). For the 129 patients, the calculated disuse risk score of the 11-item was correlated to that of the 9-item weighted disuse risk factor (R＝0.930, p＝0.000). Conclusions : Both the 11-item disuse risk factor and the weighted disuse risk score rating were considered reliable and useful.