回復期リハビリテーション病棟における入院時オンライン家屋訪問の有用性

Usefulness of Early-phase Online Home Visits for Improving Therapy for Inpatients in a Convalescent Rehabilitation Ward

要旨　「入院時オンライン家屋訪問」は通信機器にて家屋と院内をオンライン接続下で入院初期に実施する家屋訪問である．家屋では家族と訪問した理学療法士が参加，院内では患者や医師，療法士，社会福祉士などが参加することで，家屋情報や患者・家族希望を多職種が視覚的にリアルタイムで共有可能となる．今回，入院時オンライン家屋訪問の有用性を検証した．

回復期リハビリテーション病棟から自宅退院に至った運動器疾患患者と脳血管疾患患者から，入院時オンライン家屋訪問を実施した患者25名（オンライン群）と入棟7日以内に従来の家屋訪問を実施した患者50名（従来群）のFunctional Independence Measure（FIM）効率を比較した．また，療法士に入院時オンライン家屋訪問後のリハビリテーション治療内容の変化について聴取した．

その結果，運動器疾患におけるFIM効率はオンライン群（n=14）1.0±0.5点/日，従来群（n=26）0.7±0.45点/日であり，オンライン群のFIM効率が有意に高く（p＜0.05），在棟日数はオンライン群が従来群に比べ有意に短縮していた（p＜0.05）．また，療法士の83.3％が家屋訪問後に治療内容を見直し，生活動線を想起した動作練習を実施していた．

入院時オンライン家屋訪問は映像で家屋状況を把握できることでより自宅環境に見合ったリハビリテーション治療が提供でき，FIM効率の向上および円滑な自宅退院準備の促進に寄与できる介入であることが示唆された．

Abstract　Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.

Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.

Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.

Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.