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Japanese Occupational Therapy Research Volume 35, Issue 6 （December 2016）

作業療法 35巻6号（2016年12月発行）

Japanese English

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◆研究論文

透析患者の認知機能とリハビリテーション介入効果—〜透析領域での作業療法士介入の現状〜 Positive effects of high cognitive functions on rehabilitation in hemodialysis patients 渡邉佳誠 ¹ , 中村裕也 ² , 村上卓也 ¹ , 松浦弘 ¹ , 後藤博道 ² Yoshinobu Watanabe ¹ , Yuya Nakamura ² , Takuya Murakami ¹ , Hiroshi Matsuura ¹ , Hiromichi Gotoh ² ¹埼友草加病院リハビリテーション科 ²埼友草加病院内科 ¹Department of Rehabilitation, Saiyu Soka Hospital ²Department of Internal Medicine, Saiyu Soka Hospital キーワード：透析 , 認知機能 , FIM , 注意機能 , 作業療法 , Hemodialysis , Cognitive function , Functional independence measure (FIM) , Attention function , Occupational therapy Keyword: 透析 , 認知機能 , FIM , 注意機能 , 作業療法 , Hemodialysis , Cognitive function , Functional independence measure (FIM) , Attention function , Occupational therapy pp.582-591

発行日 2016年12月15日 Published Date 2016/12/15

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要旨：腎不全患者に対し「腎臓リハビリテーション」が新たな治療概念として提唱されているが，透析患者のADL低下因子やリハビリテーション（以下，リハ）介入効果を検討した研究は少なく認知機能への関心も高くはない．今回，当院入院透析患者でADLとリハ介入効果を解析し，FIM総得点は約65.1点から約77.1点に改善しFIM認知項目はFIM総得点改善の有意な関連因子だった．FIM認知項目25点以上群は24点以下群よりFIM総得点非改善患者が半減しMMSEとHDS-Rの注意機能もそれぞれ6倍，4倍と高く，ADL改善には認知機能（特に注意機能）の維持・向上が重要であり理学療法士・作業療法士の2職種介入などの治療戦略も期待される．

　Renal rehabilitation is a recently proposed rehabilitation treatment concept, which is not yet fully established. Very few studies have investigated the effects of rehabilitation on activities of daily living (ADL) in hemodialysis patients. Evidence regarding its effects on cognitive function is also limited. In this study, we investigated the effects of rehabilitation on ADL levels in 182 hemodialysis patients. We assessed the levels of ADL using the functional independence measure (FIM), which is one of the major surrogate markers for ADL. Moreover, we investigated cognitive functions in detail using the MMSE (Mini-Mental State Examination) and the HDS-R (Hasegawa Dementia Scale-revised). Physical therapists (PTs) and occupational therapists (OTs) designed rehabilitation programs as per the patients' daily lifestyles. After rehabilitation, the average total FIM score increased from 65.1 to 77.1. The FIM cognitive item was significantly associated with rehabilitation effects. Among patients whose FIM scores did not increase, the number of patients with FIM cognitive scores 25 was half that of the patients with FIM cognitive scores 24. Moreover, the attention functions of MMSE and HDS-R in patients with FIM cognitive scores 25 were 6 and 4 times higher, respectively, than those in patients with FIM cognitive scores 24. The effectiveness of rehabilitation depends on maintaining improved FIM cognitive scores (particularly in the attention function). Our findings suggest the need for comprehensive strategies such as simultaneous intervention by PTs and OTs, which could increase the level of ADL in hemodialysis patients.