造血幹細胞移植患者における生活行為の経時的変化

Changes in the daily life performance among recipients of hematopoietic stem cell transplants

要旨：本研究の目的は，造血幹細胞移植患者における同種・自家移植のそれぞれの移植前から退院後の生活行為の経時的変化を明らかにすることである．方法は入院時，退院後4，12，24週のFIMとFAIを前向きに調査した．その結果，FIMは同種・自家移植ともに退院後，天井効果を認めた．FAIは同種移植では退院後4週に比べ24週でFAIが有意に高くなったが，自家移植では有意な差は認められなかった．そのため，入院中の作業療法ではIADLに着目し，病前生活や役割，環境等の情報収集，患者の状態に応じて動作指導や代償方法の検討を行い，退院後は，同種・自家移植ともに外来にてフォローアップの機会を検討する必要性が示唆された．

　In the present study, we examined changes in the daily life performance among recipients of autologous and allogenic hematopoietic stem cell transplants. We prospectively measured the FIM and FAI during hospital admission and at 4, 12, and 24 weeks after discharge. Our results demonstrated a ceiling effect in FIM after discharge for both autologous and allogenic transplant recipients. FAI significantly increased among allogenic transplant recipients 24 weeks after discharge compared to 4 weeks, while there was no significant difference in FAI among autologous transplant recipients after discharge. These findings indicate the need to monitor IADL in occupational therapy during admission, listen to life narratives, roles, and environment, etc. before illness, and examine movement instruction and compensation methods according to the state of the patient. Finally, there should be a follow up on both autologous and allogenic transplant recipients after discharge.