回復期病棟におけるリハビリテーションシステムの変更によるアウトカムの変化—入院時の治療期間・ゴール設定に基づいた起立訓練・ADL訓練を中心とした短期集中リハビリテーション

Rehabilitation Outcomes in a Convalescent Rehabilitation Ward (Kaifukuki Rehabilitation Ward) in Japan: Efficacy of Intensive Rehabilitation with Standing Up Exercises and ADL Training Toward the Goal and the Length of Stay Estimated at Admission

要旨　目的：回復期病棟のリハビリテーション（以下，リハ）システムの変更による治療成績を検証した．方法：治療期間・ゴールを設定し起立訓練とADL訓練中心の病棟訓練に変更した．変更前の6カ月間の入院患者54名と変更後4年間の同時期の入院患者679名の在院日数，FIM利得，FIM効率，自宅退院率を比較し，脳卒中，大腿骨近位部骨折，廃用症候群に層別化し同様に検討した．結果：全体で在院日数は96.5日から4年目には29.2日に短縮した（p＜0.001）．FIM利得は有意差はなかったが，FIM効率は0.22から0.91に上昇した（p＜0.001）．自宅退院率は85.2％から99.1％に上昇した（p＜0.001）．脳卒中患者と大腿骨近位部骨折患者でも同様に在院日数は有意に短縮し，FIM効率は有意に上昇した．廃用症候群は症例数が少なかったが在院日数は有意に短縮した．結論：リハシステム変更により在院日数，FIM効率，自宅退院率が改善した．

Abstract　Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (p＜0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (p＜0.001). The percentage of patients discharged home also increased significantly from 85.2％ to 99.1％ (p＜0.001)． Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.