Departmental Bulletin Paper 脳血管疾患患者の回復期リハビリテーション病棟入院時の評価結果を用いた在宅復帰予測モデル
Prediction Model at Home Recovery Using Evaluation Results from the Time of Hospitalization for a Recovery Rehabilitation Ward

谷, 哲夫  ,  小林, 昭博

 【目的】本研究は回復期リハビリテーション病棟入棟患者の在宅復帰に必要な条件を入棟時の評価結果から明らかにし在宅復帰予測モデルを提示することである.【対象】2009 年6 月から2012 年6月までに日高病院回復期病棟へ脳卒中連携パス対象患者として入院した患者69 名.【方法】リハカルテや病棟カルテより,回復期リハビリテーション病棟患者の入棟時の身体機能(FIM など)や基本情報(年齢,性別など),環境(同居者人数)などの10 の変数を収集し,帰結先(在宅復帰と非在宅復帰)の2 群に分け各項目について単変量解析を実施し,さらに決定木分析を実施した.【結果】単変量解析ではFIM の16 項目とHDS-R, 配偶者の有無,および同居者人数で2 群間に有意差がみられた.決定木分析では最初にFIM 社会交流,次いで,配偶者の有無,FIM トイレが選択された.【結語】在宅復帰を実現するためには,入院の共同生活がうまくできるよう支援し,自己管理能力を促進すること,そして転倒予防を重視したリハビリ治療が重要である.
 Purpose: This paper presents a decision-making supportive model for the discharge of patients from rehabilitation wards. Moreover, it clarifies factors that determine whether patients in such wards are ready to be discharged. Subjects: We classified subjects into two groups: a discharged group and a non-discharged group. Methods: We examined the subjects’ rehabilitation and ward records. The collected data were subjected to univariate and decision tree analyses. Results:Univariate analysis showed that 10 non-disease factors exhibited significantly higher values in the discharge group. Decision tree analysis indicated that the score for social interaction in the Functional Independence Measure (FIM) should be the first factor considered when deciding whether a patient should be discharged. Subsequently, the presence of a spouse and toilet operations should be considered. Conclusion: Clinicians should check patients’ FIM scores before discharging them from rehabilitation wards. Additionally, we recommend that rehabilitation should begin with social interaction.

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