Hirano Yuma, Kono Kenichi, Takahashi Ren, Tamura Yuma, Takahashi Momo, Imaoka Shinsuke, Nomura Takuo, Igaki Makoto
Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City, Shizuoka, Japan.
Working Group of Research and Development, Japanese Society of Physical Therapy for Diabetes Mellitus, Minato-Ku, Tokyo, Japan.
Clin Exp Nephrol. 2025 Sep 19. doi: 10.1007/s10157-025-02763-z.
Exercise is recommended to prevent dialysis; however, the involvement of physical therapists is not a criterion for reimbursable medical fee calculation in Japan. Consequently, eligible patients may not receive appropriate exercise guidance. We aimed to clarify the extent of physical therapist participation in dialysis-prevention interventions reimbursed under the current Japanese healthcare system and to identify reasons for non-participation related to reimbursement criteria.
In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.
Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were "Inclusion of physical therapists is not a strict requirement for medical fee reimbursement," "Insufficient personnel or time," and "No role assigned by the dialysis-prevention team."
Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.
建议进行运动以预防透析；然而，在日本，物理治疗师的参与并非可报销医疗费用计算的标准。因此，符合条件的患者可能无法获得适当的运动指导。我们旨在明确在当前日本医疗体系下，物理治疗师参与可报销的透析预防干预措施的程度，并确定与报销标准相关的未参与原因。
2025年1月，向在日本物理治疗师协会注册的所有机构代表发放了一份包含30个项目的问卷，以调查透析预防方面的医疗费用及物理治疗师的参与情况。透析预防干预措施定义为日本医疗体系下可报销的措施：生活方式相关疾病管理、糖尿病透析预防指导与管理（包括重度肾功能损害患者的指导）以及慢性肾脏病（CKD）透析预防指导与管理。
在接受调查的10285个机构中，1322个（12.9%）做出了回应。其中，物理治疗师分别参与了4.8%、3.5%和2.3%的机构的生活方式相关疾病管理、糖尿病透析预防指导与管理以及CKD透析预防指导与管理。最常被提及的排除原因是“物理治疗师的参与并非医疗费用报销的严格要求”、“人员或时间不足”以及“透析预防团队未分配角色”。
物理治疗师参与透析预防干预措施的程度有限，主要是由于当前的医疗费用报销标准。修订医疗体系以促进他们的参与可能会加强基于运动的预防保健服务的提供。
