訪問リハビリテーションにおける日常生活活動と生活空間の向上に関連する要因の検討―茨城県内多施設共同調査より

Factors Related to Improving Activities of Daily Living and Life-Space Mobility through Visiting Rehabilitation Services : A Multi-Institutional Study in Ibaraki Prefecture, Japan

要旨　目的：訪問リハビリテーション（以下，訪問リハ）利用者の生活機能の変化とその関連要因を検討した．方法：6カ月後調査までを完遂した80人を対象とした．FIM，LSA，介護負担感（J-ZBI_8）等について，調査開始時，3カ月後，6カ月後を比較した．そして6カ月間で変化があった変数の関連要因について重回帰分析を行った．結果：発症から1年未満群において，FIM合計が調査開始時平均82.4から6カ月後に87.3へ（p＝0.016），LSA得点が9.9から12.3（p＝0.005）へ有意に向上した．重回帰分析によって，FIM合計の変化量に対して，発症からの期間，認知症高齢者の日常生活自立度，日常生活活動・家事動作目標の有無が有意に関連していた（p＝0.001，R²＝0.32）．また，LSAの変化量に対して，性別，脳血管疾患の有無，発症からの期間，訪問リハ職種数，J-ZBI_8が有意に関連していた（p＝0.0001，R²＝0.36）．結論：効果的な訪問リハの提供には，日常生活活動の目標を設定して働きかけること，複数職種が関与できる体制の構築が重要である．

Abstract　Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods : Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (p＝0.016) and from 9.9 to 12.3 (p＝0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (p＝0.001, R²＝0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (p＝0.0001, R²＝0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.