廃用症候群の急性期入院リハ期間と予後

イスラエルにおける高齢者の廃用症候群の急性期入院リハ期間と予後に関する論文を紹介します。ヘブライ語なので抄録しか読めませんが…。

Guy N, Justo D, Lerman Y, Rabinovich A. [Length and outcome of acute inpatient rehabilitation for hospital-associated deconditioning in the elderly]. [Article in Hebrew] Harefuah. 2012 Sep;151(9):500-4, 558.

対象は廃用症候群と診断された入院高齢患者103人で女性57人、男性46人、平均年齢は83.6歳です。原因疾患として最も多かったのは肺炎、脳出血術後（麻痺なし）、うっ血性心不全の急性増悪でした。退院時の移乗と歩行のFIM点数は5.3点、5.2点でした。

平均リハ期間は20.4日でした。退院時の移乗と歩行のFIM得点、リハ期間はいずれもリハ入院時の移動能力？と有意に関連を認めました。またリハ期間は血清アルブミン値と有意に関連していました。

廃用症候群のアウトカムに関する論文は少ないので貴重です。イスラエルと日本では患者層に大きな違いはなさそうな印象です。アルブミン値とリハ期間に関連があったことより、アルブミン値がリハの予後指標の1つとなる可能性があるといえます。

Abstract

INTRODUCTION:

Acute illness and prolonged bed rest might be associated with loss of muscle mass and significant decline in functional ability and mobility, regardless of a specific neurological or orthopedic insult. This condition is commonly termed hospital-associated deconditioning (HAD). To the best of our knowledge to date, acute inpatient rehabilitation length and outcome for HAD in the elderly have never been studied in Israel.

AIM:

To study which variables are independently associated with the length and mobility outcome of acute inpatient rehabilitation for HAD in the elderly.

METHODS:

A retrospective cross-sectional study was conducted during 2009 at the departments of Geriatric Medicine in the Tel-Aviv Medical Center The medical charts of consecutive elderly (< 65 years) patients admitted for rehabilitation due to HAD were studied for the following measurements: demographics, co-morbidities, causes of HAD, admission albumin serum levels, Mini-Mental Status Examination (MMSE) scores, admission transfer and walking Functional Independence Measure (FIM) scores, discharge transfer and walking FIM scores, and rehabilitation length.

RESULTS:

The cohort included 103 patients: 57 (55.3%) females and 46 (44.7%) males. The mean age for the entire cohort was 83.6 +/- 6.0 years. The three most common causes of HAD were pneumonia, craniotomy due to intracranial bleeding without neurological insults, and congestive heart failure exacerbation. The mean discharge transfer and walking FIM scores were 5.3 +/- 0.9 and 5.2 +/- 0.8, respectively. The mean length of rehabilitation was 20.4 +/- 13.9 days. Linear regression analysis showed that discharge transfer FIM scores, discharge walking FIM scores, and rehabilitation length were all independently associated with mobility upon admission to rehabilitation (p < 0.0001, p < 0.0001, p = 0.024, respectively). Rehabilitation length was also associated with admission albumin serum levels (p = 0.008).

CONCLUSIONS:

The length and mobility outcomes of acute inpatient rehabilitation for HAD in the elderly are associated with mobility upon admission to rehabilitation. Acute inpatient rehabilitation length is also associated with admission albumin serum levels.