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The Japanese Journal of Rehabilitation Medicine Volume 57, Issue 3 （March 2020）

The Japanese Journal of Rehabilitation Medicine 57巻3号（2020年3月発行）

Japanese English

原著

回復期リハビリテーション病棟における高齢脳卒中患者のADL改善度と在宅復帰の関連性 The Magnitude of ADL Improvement was Associated with Discharge Home among Older Stroke Patients in a Convalescent (Kaifukuki) Rehabilitation Ward 村上達典 ^1,2 , 樋口由美 ¹ , 藤堂恵美子 ¹ , 北川智美 ¹ , 安藤卓 ¹ , 矢田定明 ³ Tatsunori Murakami ^1,2 , Yumi Higuchi ¹ , Emiko Todo ¹ , Tomomi Kitagawa ¹ , Suguru Ando ¹ , Sadaaki Yata ³ ¹大阪府立大学大学院総合リハビリテーション学研究科 ²地域医療機能推進機構星ヶ丘医療センターリハビリテーション部 ³地域医療機能推進機構星ヶ丘医療センターリハビリテーション科 ¹Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University ²Physical Medicine and Rehabilitation Department, Japan Community Health care Organization Hoshigaoka Medical Center ³Department of Rehabilitation Medicine, Japan Community Health care Organization Hoshigaoka Medical Center キーワード：脳卒中 , stroke , ADL改善度 , ADL improvement , 在宅復帰 , discharge home Keyword: 脳卒中 , stroke , ADL改善度 , ADL improvement , 在宅復帰 , discharge home pp.262-270

発行日 2020年3月18日 Published Date 2020/3/18

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要旨

目的：高齢脳卒中患者の回復期リハビリテーション病棟入院中のADL改善度と在宅復帰の関連性について検討すること．

方法：研究デザインは後ろ向きコホート研究．1つの回復期リハビリテーション病棟による検証である．65歳以上の脳卒中患者291名を対象に，入院中のADL改善度と退院先の関連を調べた．入院中のADL改善度の指標には補正運動FIM effectivenessを用いた．

結果：前期高齢者，後期高齢者ともに自宅群は施設等群に比べ，入院中のADL改善度は良好であった（p＜0.01）．ロジスティック回帰分析の結果では，入院時の機能による調整後ではADL改善度は在宅復帰の有意な独立関連因子であったが，退院時の機能による調整後ではADL改善度は在宅復帰と有意な関連を認めなかった．

結論：入院中のADL改善が得られにくいとされている高齢脳卒中患者においても入院中の集中的なリハビリテーション治療によるADL能力の向上は自宅への退院に寄与することが確認された．

Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.

Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and ≥ 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.

Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.

Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.