脳血管疾患等の患者が自宅退院するために必要な日常生活活動能力

Required abilities for daily living activities for stroke patients before discharge

要旨：本研究は，脳血管疾患等の患者を対象に自宅退院と自宅以外の退院の転帰に影響を及ぼす日常生活活動（以下，ADL）項目を抽出し，その該当項目に最低限必要な能力（以下，下限閾値）を明らかにすることを目的とした．ADL評価には，機能的自立度評価表（FIM）を用いて，動作能力の下限閾値を明らかにするために判別分析を用いて分析した．その結果，自宅退院に影響を及ぼすADL項目は「トイレ動作」，「トイレ移乗」であることが明らかになった．また，自宅退院のためには，これら2つのADL項目で監視以上の動作能力が必要であることが示唆された．

　The purpose of this study was to elucidate abilities of activities of daily living (ADL) for stroke patients before being discharged from the hospital, and to determine the thresholds of ability above which performing ADL is impaired, thus preventing discharge. The subjects were 394 patients who were discharged from a hospital. They were divided into a discharge to home group (HG;n=270) and those who were discharged to a non-home group (NHG;n=124). The non-home group was sent to a nursing home or another hospital. We examined the Functional Independence Measure (FIM) items at the time of discharge. Linear discriminant analysis was used to select the best predictors of the FIM item. Risk thresholds for scoring of a FIM item were determined by identifying the score that optimally discriminated between HG and NHG. The FIM threshold to perform ADL for discharge to home was level 5 (Supervision) for toileting and toilet transfer. These results indicate that the abilities of toileting and toilet transfer are more essential in performing ADL than other FIM items in order to be discharged to home.