Nishioka Shinta, Kokura Yoji, Okamoto Takatsugu, Takayama Masako, Miyai Ichiro
Nutrition Committee, Kaifukuki Rehabilitation Ward Association.
Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital.
J Nutr Sci Vitaminol (Tokyo). 2019;65(5):435-442. doi: 10.3177/jnsv.65.435.
This study aimed to verify the relationship between assignment of professional registered dietitians (RDs) and other healthcare professionals and body weight or functional outcome in underweight patients. This was a secondary analysis of the nation-wide survey data from Kaifukuki (convalescent) rehabilitation wards (KRWs). Data of patients aged ≥20 y with disabilities and body mass index (BMI) <18.5 kg/m and who were discharged from 1,099 KRWs were analyzed. The primary outcome was BMI at discharge. Secondary outcomes were Functional Independence Measure (FIM) at discharge and returning to home. Patients were divided into two groups: those in KRWs with ≥1 or <1 dedicated RD per ward (KRW/RD+ and KRW/RD-, respectively). Of 5,843 eligible participants (female, 63%; median age, 82 y; hip/vertebral/knee fracture, 47%; stroke, 34%; disuse syndrome secondary to acute illness, 11%; others, 8%), 1,288 and 4,555 were from the KRW/RD+ and KRW/RD- groups, respectively. At discharge, KRW/RD+ patients had higher FIM (93 vs. 90) and BMI (17.1 vs. 17.0 kg/m) than did KRW/RD- patients. Multivariable analysis showed that assignment of dedicated RDs (B=0.213, 95% confidence interval [CI], 0.036-0.389), number of nurses (B=0.023, 95% CI, 0.003-0.043), and daily rehabilitation dose were significantly associated with changes in body weight. Furthermore, these factors positively affected BMI at discharge. Number of nurses and rehabilitation dose correlated with FIM, but assignment of RDs did not correlate with FIM. In conclusion, assignment of RDs, nurses, and sufficient rehabilitation dose may contribute to BMI gain. Nurses and daily rehabilitation dose may positively affect functional recovery.
本研究旨在验证专业注册营养师（RD）及其他医疗保健专业人员的配备与体重过轻患者的体重或功能结局之间的关系。这是对来自康复疗养病房（KRW）的全国性调查数据进行的二次分析。分析了年龄≥20岁、患有残疾且体重指数（BMI）<18.5 kg/m²并从1099个KRW出院的患者数据。主要结局是出院时的BMI。次要结局是出院时的功能独立性测量（FIM）及回家情况。患者被分为两组：每个病房配备≥1名或<1名专职RD的KRW中的患者（分别为KRW/RD+组和KRW/RD-组）。在5843名符合条件的参与者中（女性占63%；中位年龄82岁；髋部/脊椎/膝盖骨折患者占47%；中风患者占34%；急性疾病继发的废用综合征患者占11%；其他患者占8%），分别有1288名和4555名来自KRW/RD+组和KRW/RD-组。出院时，KRW/RD+组患者的FIM（93对90）和BMI（17.1对17.0 kg/m²）高于KRW/RD-组患者。多变量分析显示，专职RD的配备（B = 0.213，95%置信区间[CI]，0.036 - 0.389）、护士数量（B = 0.023，95% CI，0.003 - 0.043）和每日康复剂量与体重变化显著相关。此外，这些因素对出院时的BMI有积极影响。护士数量和康复剂量与FIM相关，但RD的配备与FIM不相关。总之，RD的配备、护士及充足的康复剂量可能有助于体重增加。护士和每日康复剂量可能对功能恢复有积极影响。
