高齢入院患者の回復期リハの量依存効果

高齢入院患者の回復期リハの量依存効果に関する台湾の前後研究を紹介します。

Wei-Ju Lee, et al: Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit. Archives of Gerontology and Geriatrics doi:10.1016/j.archger.2011.11.012

抄録しか見ていませんが、PECOにすると以下の通りです。

P：何らかの急性疾患で入院しその後回復期リハ病棟（Post-acute care unit）に入院した高齢者に、
E：1日80分、週5回の訓練を行うと、
C：1日40分、週5回の訓練と比較して、
O：CGAの機能改善が大きい。

2007年7月から2009年3月までは1日40分、2009年4月から2010年12月までは1日80分という前後研究です。結果ですが、ADL、抑うつ気分、疼痛コントロールは1日80分群で有意に改善し、認知機能と栄養状態（BMI）には有意差を認めませんでした。これより1日80分のリハは身体機能、精神機能の回復を促進するという結論です。

今回の対象患者の多くは廃用症候群だと考えます。そうだとすれば栄養状態に大きな問題がなく、栄養管理が適切であれば、訓練時間が長いほうが効果が高くなると思います。今回の研究ではBMIの変化で栄養評価もしているところに意味があると感じました。

Abstract
Post-acute care (PAC) is of great importance to promote functional recovery of older patients, which should be provided by the interdisciplinary team. In PAC services, rehabilitative therapy plays a key role, but the optimal intensity for rehabilitative therapy remained unclear. Between July 2007 and December 2010, all patients with functional decline after acute illness hospitalization admitted to the PAC unit of a community hospital in Taiwan were enrolled. Usual rehabilitation program, 40-min per day and five days a week, was provided to all patients before April 2009. After April 2009, the rehabilitative therapy was increased to 80 min per day. Functional improvement was measured by comprehensive geriatric assessment (CGA) at admission and 4 weeks after admissions to the PAC unit. Overall, 458 patients (mean age: 83.4 ± 5.5 years, all males) completed PAC services. Compared of all dimensions in CGA, increased dosage of rehabilitative therapy showed significantly better improvement in daily living activities (Barthel index (BI): 28.8 ± 18.4 vs. 20.0 ± 14.6, p < 0.001), depressive mood (geriatric depression score short form (GDS): −0.5 ± 1.0 vs. −0.1 ± 0.5, p < 0.001), and pain reduction (numerical rating scale (NRS): −2.0 ± 2.2 vs. −0.9 ± 2.1, p = 0.01); but not in cognitive function (mini-mental status examination (MMSE): 2.9 ± 3.3 vs. 3.3. ± 5.2, p = 0.305), and nutritional status (body mass index (BMI): 0.3 ± 0.9 vs. 0.3 ± 2.5, p = 0.9). In conclusion, intensive rehabilitative therapy significantly promote physical and psychological function with pain reduction, which deserves further investigations to evaluate whether there is a ceiling effect of rehabilitative therapy in PAC services.