通院透析患者のADL維持を目指した体操とロコモーショントレーニングの効果

The Effectiveness of Calisthenics and Locomotion Training for Maintenance Hemodialysis Outpatients

　本研究の目的は，外来維持透析患者に対するADL維持の一手段として，体操とロコモーショントレーニング（ロコトレ）の有効性を検討することである．A施設の外来維持透析患者27名（ADL自立群18名，要介助群9名）を対象に，週3回透析前または透析後に体操とロコトレを実施した．ADLの指標としてShort Physical Performance Battery（SPPB），Timed Up & Go Test（TUG），Life-Space Assessment（LSA），転倒に対する自己効力感尺度，転倒回数を，運動開始前，3か月後，6か月後，1年後に測定し評価した．運動開始3か月後のSPPBとTUGの結果，要介助群は有意な改善は認めなかったが，ADL自立群のスコアは有意に改善した（SPPB：p＜0.01，TUG：p＜0.01）．6か月以上運動を継続した対象者（n＝17）のLSAのスコアが有意に上昇（p＜0.05）した．1年以上の継続者（n＝14）の転倒に対する自己効力感が有意に上昇し（p＜0.05），転倒回数も有意に減少した（p＜0.05）．これらの結果から，体操とロコトレは介護が必要になる前から始めることで，介護予防としての効果が期待できる．また運動を長く継続するほどADL維持の一手段としてより有効であると考えられた．

　The purpose of this study is to evaluate the effectiveness of calisthenics and locomotion training as a means of keeping up activities of daily living (ADL) for maintenance hemodialysis outpatients. The subjects were 27 maintenance hemodialysis patients in the facility A (18 patients who were able to ambulate without any assistance belong to ADL independent group and 9 patients who needed assistance for ambulation belong to ADL dependent group). We carried out the calisthenics and locomotion training before or after dialysis therapy three times a week. Physical function test such as Short Physical Performance Battery (SPPB), Timed Up & Go Test (TUG), Life-Space Assessment (LSA), fall efficacy scale and frequency of falls were examined before and 3, 6, 12 months after the exercises. Although TUG and SPPB scores were not significantly improved among ADL dependent group, there were significant improvement in the scores of the ADL independent group, three months after participating the exercises (SPPB:p<0.01, TUG:p<0.01). LSA scores of 17 patients who continued the exercises for more than six months significantly rose (p<0.05). Fall efficacy scale scores of 14 patients who continued the exercises for more than one year significantly rose and frequency of falls significantly lessened (p<0.05). From these results, starting the calisthenics and locomotion training since before the long-term care was necessary, was expected to prevent the long-term care. Moreover, as the patients continued the exercises for longer period, the calisthenics and locomotion training were thought to be more effective as a means of keeping up ADL.