Okuda Yoshinobu, Nakata Toshio
Department of Neurology, Tane Neuro-Rehabilitation Hospital, Minato-ku, Osaka, Japan.
Int J Rehabil Res. 2020 Mar;43(1):37-40. doi: 10.1097/MRR.0000000000000381.
Between 2008 and 2012, the intensity of rehabilitation therapy for the recovery phase of stroke was gradually increased at our hospital in line with the policy of Japan's National Insurance System. Training hours increased from 0.8 to 2.5 hours/day without introducing any new techniques, programs, or equipment. The aim of this study was to investigate the effectiveness of the increased intensity of rehabilitation on the improvement of activity of daily living of patients with intracerebral hemorrhage. We retrospectively compared patient outcomes for the periods 2013-2017 (N = 162) and 2003-2007 (N = 116) using the gain in Barthel Index as an indicator of improvement in activity of daily living. The median (interquartile range) gain was significantly higher in 2013-2017 than in 2003-2007 [30 (20-45) vs. 15 (5-30); P < 0.001]. A stratified analysis showed that this improvement was independent of sex, the patient's Barthel Index on admission, or the side of the brain lesion, but it varied with age or time to admission from onset of the disease. These results, based on a considerable difference in the intensity of rehabilitation between the two periods, support the consensus that increased time spent on rehabilitation results in better functional outcome in post-stroke patients. The results also suggest that age and the timing of starting rehabilitation are important factors to examine the effectiveness of intense rehabilitation in patients with intracerebral hemorrhage.
2008年至2012年期间，我院按照日本国家保险制度的政策，逐步提高了脑卒中恢复期康复治疗的强度。训练时长从每天0.8小时增加到2.5小时，且未引入任何新的技术、项目或设备。本研究的目的是调查康复强度增加对脑出血患者日常生活活动能力改善的有效性。我们回顾性比较了2013 - 2017年期间（N = 162）和2003 - 2007年期间（N = 116）患者的预后情况，以巴氏指数的增加作为日常生活活动能力改善的指标。2013 - 2017年期间的中位数（四分位间距）增益显著高于2003 - 2007年期间[30（20 - 45）对15（5 - 30）；P < 0.001]。分层分析表明，这种改善与性别、入院时患者的巴氏指数或脑损伤部位无关，但随年龄或发病至入院的时间而变化。基于两个时期康复强度的显著差异，这些结果支持了这样的共识，即增加康复时间会使脑卒中后患者获得更好的功能结局。结果还表明，年龄和开始康复的时间是检查脑出血患者强化康复有效性的重要因素。
