COVID-19パンデミックが脊髄小脳変性症および多系統萎縮症患者の心身機能・活動・参加に及ぼす影響

The Impact of the COVID-19 Pandemic on Three Domains of Functioning of ICF in Participants with Spinocerebellar Degeneration and Multiple System Atrophy in Japan

要旨

目的：COVID-19パンデミックが脊髄小脳変性症（SCD），多系統萎縮症（MSA）患者の生活機能のうち心身機能・活動・参加の各要素に及ぼした影響を明らかにすることを目的とした．

方法：全国患者会会員1,000名を対象として2020年11〜12月に質問紙調査を実施し，回答が得られたSCDおよびMSA患者460名を分析した．多目的データから基本情報に加え，COVID-19に関連する設問を抽出した．COVID-19に関連した各生活機能への全般的な影響は7点尺度で回答を得た．年齢，要介護認定取得状況，リハビリテーション治療機会の制限に基づいて2群に層別化し，χ²検定を用いて各生活機能への影響の群間差を検証した．

結果：SCDで54％，MSAで46％が参加制約を報告し，心身機能低下と活動制限は両疾患とも約20％で報告された．要介護認定未取得または要支援群では要介護群と比較してSCDで心身機能低下，MSAで参加制約を報告した．COVID-19パンデミックの影響として，約24％の対象者でリハビリテーション実施機会の制限が報告され，制限のあったMSA患者では心身機能低下の報告が多くを占めた．

結論：COVID-19パンデミックは，特に生活機能のうち参加の要素に影響を及ぼしていた．要介護認定が軽度あるいはリハビリテーション治療機会の制限がある患者では心身機能あるいは参加の要素に影響を及ぼしている実態が示された．

Abstract

Objective：We aimed to determine the impact of the COVID-19 pandemic on the “body function”, “activity”, and “participation” domains of functioning as defined in the International Classification of Functioning (ICF) for individuals with spinocerebellar degeneration (SCD) and multiple system atrophy (MSA).

Methods：A questionnaire survey was administered to 1,000 members of the SCD/MSA patient association in Japan between November and December 2020. Questions related to COVID-19 were extracted from the multipurpose data, and the degree of COVID-19-related effects on each life function was assessed using a 7-point scale. Results were stratified into two groups based on age, care needs based on long-term care insurance coverage, and limited opportunities for rehabilitation. The χ² test was used to examine differences between pairs of groups regarding impacts on functioning.

Results：Data from 460 participants with SCD and MSA were analyzed. Participation restriction was reported in 54％ of participants with SCD and 46％ of participants with MSA, and impairment and activity limitation in approximately 20％ of participants with both conditions resulting from the COVID-19 pandemic. Participants with low care needs reported more impairment in SCD and more participation restriction in MSA. About 24％ of subjects reported limited opportunities for rehabilitation. MSA participants with these limitations reported greater impairment.

Conclusion：The COVID-19 pandemic has had a particular impact on the participation domain of functioning in participants with SCD and MSA. The domains of body function and participation were found to be affected in participants with low care needs or limited opportunities for rehabilitation.