75歳以上の高齢脳梗塞患者に対するリハビリテーション実施量の検討—回復期リハビリテーション病棟での機能改善と関連して

A Study of Suitable Amounts of Rehabilitation Training for Patients Aged 75 Years or Above with Cerebral Infarction in Relation to Functional Improvements in Convalescent Rehabilitation Wards

要旨　75歳以上の脳卒中患者への適切なリハビリテーション実施量に関して，不明な点が多い．回復期リハビリテーション病棟での実施量を検討するために，急性期病棟から回復期病棟に入棟した脳梗塞患者65名（74歳以下28名，75歳以上37名）を調査した．対象者の診療録から，入院日数，入院中のリハビリテーション実施総単位数，ADL能力（FIM総得点）を急性期および回復期で調査した．これらのデータから機能利得，機能獲得度，1日あたりの平均リハビリテーション実施単位数（平均単位数）を算出した．各項目と年齢の相関を算出し，有意な相関があった場合，74歳以下と75歳以上で比較した．機能利得と平均単位数は年齢による差はみられなかったが，機能獲得度は75歳以上が有意に低かった．75歳以上の脳梗塞患者では，平均単位数と退院時FIM総得点に正の相関がみられた．75歳以上の脳梗塞患者には，積極的なリハビリテーション治療を行うことが重要であると考える．

It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.