Asaeda Makoto, Mikami Yukio, Nishimura Yukihide, Shimokawa Toshio, Shinohara Hiroshi, Kawasaki Takashi, Kouda Ken, Ogawa Takahiro, Okawa Hiroyuki, Uenishi Hiroyasu, Kuroda Rumi, Mikami Yasuo, Tajima Fumihiro, Kubo Toshikazu
Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care.
Department of Rehabilitation Medicine.
Ann Med Surg (Lond). 2023 Jan 23;85(1):17-23. doi: 10.1097/MS9.0000000000000199. eCollection 2023 Jan.
There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires.
This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient.
Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; <0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6).
The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.
通过长期护理保险进行的维持性/社区康复似乎缺乏一致性。我们旨在通过问卷调查来阐明是否可以通过长期护理保险进行连贯的康复治疗。
本研究是一项横断面研究，在全国范围内对完成特定疾病康复且需要通过长期护理保险进行维持性/社区康复的康复工作人员和护理对象进行调查。使用Fisher精确检验比较康复的一致性。使用κ系数评估在医疗和长期护理保险下进行的康复评估和治疗的一致性。
对护理对象和工作人员的600份问卷进行了分析。在康复工作人员中，264人（44%）从医疗机构获得了康复计划。通过Fisher精确检验，“来自同一医疗公司的转诊”和“获得康复计划”的回答之间存在显著差异（优势比：3.242；<0.001）。医疗保险下的大多数康复治疗包括步行或使用平行杠/手杖进行训练[498例患者（83%）]，454例患者（76%）接受了长期护理保险的四肢和脊柱伸展及活动范围训练。肌力评估是医疗保险和长期护理保险下最常进行的项目[分别为383例（73%）和487例（83%）]。除特定疾病评估外，评估和治疗内容的一致性较低（κ系数≤0.6）。
康复计划的提供率较低，医疗保险和长期护理保险下的评估和治疗内容不一致。我们的结果提醒人们注意在特定疾病康复与维持性/社区康复之间需要连贯的康复计划。
