アブストラクト
Japanese
| Title | 急性期脳卒中患者の自宅退院支援に向けたFIM評価の活用 |
|---|---|
| Subtitle | 原著 |
| Authors | 古賀翔†, 溝口忠孝**, 牧園征也, 横道信之, 星野瑠璃*, 田口裕子*, 田川直樹**, 森興太**, 桑城貴弘**, 杉森宏**, 矢坂正弘**, 梶原秀明, 岡田靖** |
| Authors (kana) | |
| Organization | 国立病院機構九州医療センター 臨床研究センター リハビリテーション部, *看護部, **臨床研究センター 脳血管・神経内科, †言語聴覚士 |
| Journal | 医療 |
| Volume | 77 |
| Number | 1 |
| Page | 4-9 |
| Year/Month | 2023 / 2 |
| Article | 原著 |
| Publisher | 国立医療学会 |
| Abstract | 「要旨」【背景】急性期脳卒中患者では発症後の神経症状が残存し, 自宅退院を支援すべきか回復期病院への連携を支援すべきかの判断が難しいケースがある. Functional Independence Measure(FIM)はActivities of Daily Living(ADL)の介助量を評価する方法の1つで, 急性期脳卒中患者はどの程度のADLで自宅退院しているかFIMを用いて検討した報告は少ない. 【目的】急性期脳卒中患者で急性期病院から自宅退院し得る患者のADLの特徴を入院7日目のFIM評価を用いて明らかにする. 【方法】2020年7月-2021年1月の間に国立病院機構九州医療センター(当院)脳血管・神経内科に入院した発症7日以内の急性期脳卒中患者のうち, 入院7日目に療法士によるFIM評価が可能な患者を対象とした. 自宅退院群と非自宅退院群(転院群)の2群に分類し, 自宅退院群のFIMの特徴を検討した. 【結果】対象患者176例のうち脳梗塞患者が144例, 脳出血患者が32例であった. そのうち自宅退院群は90例(中央値74[四分位範囲62-80]歳, 女性36例[40%]), 転院群は86例(78[68-84]歳, 女性32例[37%])で転院群が高齢であった. 自宅退院群患者は, 転院群と比較して脳卒中病型では脳梗塞が多く(82例[91%]対62例[72%], p<0.01), 入院時National Institutes of Health Stroke Scale(NIHSS)(1.5[1-3]対7[4-14], p<0.01)は軽症で, 入院前modified Rankin Scale(mRS)(0[0-0]対0[0-2], p<0.01)はより軽度で在院日数(13[11-16]日対21[17-25]日, p<0.01)も短かった. 入院時7日目FIM(123[106-126]対66[29-94], p<0.01)は自宅退院群で有意に高かった. Receiver Operating Characteristic Curve AnalysisではArea Under the Curve(AUC)は0.87で自宅退院群と転院群のカットオフ値はFIM 104点(感度78%, 特異度85%)であった. FIM下位項目各々の自宅退院のカットオフ値は食事, 整容, 清拭, 更衣(上半身・下半身), トイレ動作, 排尿・排便管理, ベッド・椅子・車椅子, トイレ, 歩行・車椅子, 認知項目においては5点以上であり, 見守り以上の自立をしているが, 浴槽・シャワーと階段の項目は4点の軽介助であった, 【結論】脳卒中急性期患者の発症7日目のFIMは独立した自宅退院予測因子で, 患者ADLの把握が可能であり, 退院支援の補助となる. 入浴や階段動作が軽介助であってもその他のFIM項目が自立していることが確認できれば, 自宅退院も視野に入れて退院先を検討し得る. |
| Practice | 医学総合 |
| Keywords | 急性期脳卒中, Functional Independence Measure, 自宅退院, acute stroke, discharged home |
English
| Title | Usefulness of Functional Independence Measurement to support home discharge for acute stroke patients |
|---|---|
| Subtitle | Original Article |
| Authors | Sho Koga, Tadataka Mizoguchi**, Seiya Makizono, Nobuyuki Yokomichi, Ruri Hoshino*, Yuko Taguchi*, Naoki Tagawa**, Kota Mori**, Takahiro Kuwashiro**, Hiroshi Sugimori**, Masahiro Yasaka**, Hideaki Kajiwara, Yasushi Okada** |
| Authors (kana) | |
| Organization | Department of Rehabilitation, Clinical Research Institute, *Department of Nursing, Clinical Research Institute, **Department of Nursing, Cerebrovascular Medicine and Neurology, Clinical Research Institute, NHO Kyushu Medical Center |
| Journal | IRYO (Japanese Journal of National Medical Services) |
| Volume | 77 |
| Number | 1 |
| Page | 4-9 |
| Year/Month | 2023 / 2 |
| Article | Original article |
| Publisher | Japanese Society of National Medical Services |
| Abstract | [Abstract] [Background and Purpose] It is difficult to decide whether stroke patients should be supported in home-discharged or transferred to another hospital. The aim of the study was to clarify the Activities of daily living (ADL) of patients with acute stroke who home-discharged from an acute care hospital using Functional Independence Measurement (FIM) measured on the 7th day of admission. [Methods] We enrolled patients who were admitted to our hospital within 7 days of acute stroke between July 2020 and January 2021. Patients were classified into two groups according to their destination following discharge from our hospital : home-discharged and non-home-discharged groups. [Results] Enrolled were 176 subjects, of whom 90 were home-discharged and 86 were not non-home-discharged. FIM on day 7 of admission was higher in the home-discharged than non-home-discharged group (123 [106-126] vs. 66 [29-94], p<0.01). The cutoff value for the home-discharged and non-home discharged groups was 104 FIM points (sensitivity 78%, specificity 85%). The cutoff value for each of the FIM sub-items was >=5 points for most items, and 4 points for the bath/shower and stairs items. [Conclusions] Evaluation of FIM in the acute phase of stroke is useful for understanding patients' ADL and supports discharge from the hospital |
| Practice | General medicine |
| Keywords | acute stroke, Functional Independence Measure, discharged home |
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残りの14件を表示する
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