間質性肺疾患患者における入院関連能力低下の発生率と臨床的アウトカムへの影響 2 施設共同前向き観察研究
【目的】間質性肺疾患は呼吸困難による活動制限を招くが，入院に伴う入院関連能力低下（Hospital-acquired disability；以下，HAD）の発生率や臨床的アウトカムへの影響は明らかでない。【方法】研究参加2 施設による前向き観察研究を実施した。対象は間質性肺疾患を背景とした呼吸不全による入院患者のうち，リハビリテーションを受けた患者とした。退院時Barthel index 合計点数が入院前と比べて5 点以上低下した場合をHAD と定義し，HAD が在院日数に与える影響を検討するために，重回帰分析を行った。【結果】対象者66 例（年齢77 歳，男性47 例）のうち，32 例（48...
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| Published in | 理学療法学 Vol. 48; no. 6; pp. 590 - 597 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益社団法人日本理学療法士協会
2021
日本理学療法士協会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-3770 2189-602X |
| DOI | 10.15063/rigaku.12107 |
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| Abstract | 【目的】間質性肺疾患は呼吸困難による活動制限を招くが，入院に伴う入院関連能力低下（Hospital-acquired disability；以下，HAD）の発生率や臨床的アウトカムへの影響は明らかでない。【方法】研究参加2 施設による前向き観察研究を実施した。対象は間質性肺疾患を背景とした呼吸不全による入院患者のうち，リハビリテーションを受けた患者とした。退院時Barthel index 合計点数が入院前と比べて5 点以上低下した場合をHAD と定義し，HAD が在院日数に与える影響を検討するために，重回帰分析を行った。【結果】対象者66 例（年齢77 歳，男性47 例）のうち，32 例（48%）にHAD が発生した。またHAD は在院日数の独立した規定因子として抽出された（β ＝0.34，95% 信頼区間＝3.86 – 25.52）。【結論】間質性肺疾患患者では高率にHAD が生じ，在院日数を含む臨床的アウトカムに影響を与えることが示唆された。 |
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| AbstractList | 「要旨」【目的】間質性肺疾患は呼吸困難による活動制限を招くが, 入院に伴う入院関連能力低下 (Hospital-acquired disability ; 以下, HAD) の発生率や臨床的アウトカムへの影響は明らかでない. 【方法】研究参加2施設による前向き観察研究を実施した. 対象は間質性肺疾患を背景とした呼吸不全による入院患者のうち, リハビリテーションを受けた患者とした. 退院時Barthel index合計点数が入院前と比べて5点以上低下した場合をHADと定義し, HADが在院日数に与える影響を検討するために, 重回帰分析を行った. 【結果】対象者66例 (年齢77歳, 男性47例) のうち, 32例 (48%) にHADが発生した. またHADは在院日数の独立した規定因子として抽出された (β=0.34, 95%信頼区間=3.86-25.52). 【結論】間質性肺疾患患者では高率にHADが生じ, 在院日数を含む臨床的アウトカムに影響を与えることが示唆された. 【目的】間質性肺疾患は呼吸困難による活動制限を招くが，入院に伴う入院関連能力低下（Hospital-acquired disability；以下，HAD）の発生率や臨床的アウトカムへの影響は明らかでない。【方法】研究参加2 施設による前向き観察研究を実施した。対象は間質性肺疾患を背景とした呼吸不全による入院患者のうち，リハビリテーションを受けた患者とした。退院時Barthel index 合計点数が入院前と比べて5 点以上低下した場合をHAD と定義し，HAD が在院日数に与える影響を検討するために，重回帰分析を行った。【結果】対象者66 例（年齢77 歳，男性47 例）のうち，32 例（48%）にHAD が発生した。またHAD は在院日数の独立した規定因子として抽出された（β ＝0.34，95% 信頼区間＝3.86 – 25.52）。【結論】間質性肺疾患患者では高率にHAD が生じ，在院日数を含む臨床的アウトカムに影響を与えることが示唆された。 |
| Author | 宮原, 拓哉 秋保, 光利 今井, 亮介 青野, ひろみ 白石, 英晶 岩田, 優助 髙橋, 佑太 次富, 亮輔 田中, 秀輝 |
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| References | 11) Sleiman I, Rozzini R, et al.: Functional trajectories during hospitalization: A prognostic sign for elderly patients. J Gerontol A Biol Sci Med Sci. 2009; 64: 659–663. 17) Tsuda T, Suematsu R, et al.: Development of the Japanese version of the COPD Assessment Test. Respir Investig. 2012; 50: 34–39. 10) Fortinsky RH, Covinsky KE, et al.: Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999; 54: M521–M526. 5) Dekhuijzen PN, Decramer M: Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992; 5: 997–1003. 15) Hermans G, Clerckx B, et al.: Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012; 45: 18–25. 23) Prieur G, Combret Y, et al.: Functional Electrical Stimulation Changes Muscle Oxygenation in Patients with Chronic Obstructive Pulmonary Disease During Moderate-Intensity Exercise: A Secondary Analysis. COPD. 2019; 16: 30–36. 22) Granger CV, Dewis LS, et al.: Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. 1979; 60: 14–17. 18) Grufstedt HK, Shaker SB, et al.: Validation of the COPD Assessment Test (CAT) in patients with idiopathic pulmonary fibrosis. Eur Clin Respir J. 2018; 5: 1530028 4) Holland AE, Hill CJ, et al.: Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax. 2008; 63: 549–554. 7) Covinski KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. 12) Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J. 1965; 14: 61–65. 14) 一般社団法人日本呼吸器学会ホームページ 酸素療法マニュアル（酸素療法ガイドライン改訂版）．https://www.jrs.or.jp/modules/guidelines/index.php?content_id=98 （2021年8月30日引用） 20) McCusker, Kakuma R, et al.: Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Md Sci. 2002; 57: M569–M577. 8) Ziesberg A, Shadmi E, et al.: Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. J Am Geriatr Soc. 2015; 63: 55–62. 6) Zelada MA, Salinas R, et al.: Reduction of functional deterioration during hospitalization in an acute geriatric unit. Arch Gerontol Geriatr. 2009; 48: 35–39. 9) Loyd C, Markland AD, et al.: Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc. 2020; 21: 455–461. 2) Bajwah S, Ross JR, et al.: Interventions to improve symptoms and quality of life of patients with fibrotic interstitial lung disease: a systematic review of the literature. Thorax. 2013; 68: 867–879. 13) Palleschi L, Alfieri WA, et al.: Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study. J Am Geriatr Soc. 2011; 59: 193–199. 19) 植木 純，神津 玲，他：呼吸リハビリテーションに関するステートメント．日呼吸ケアリハ会誌．2018; 27: 95–114. 1) Travis WD, Costabel U, et al.: An official American thoracic society/European respiratory society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013; 188: 733–748. 3) Axelsson GT, Putman RK, et al.: Interstitial lung abnormalities and self-reported health and functional status. Thorax. 2018; 73: 884–886. 21) Song JW, Hong S-B, et al.: Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011; 37: 356–363. 16) Thrush A, Rozek M, et al.: The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study. Phys Ther. 2012; 92: 1536–1545. 24) Koyama K, Sakamoto S, et al.: The Activities of Daily Living after an Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Intern Med. 2017; 56: 2837–2843. |
| References_xml | – reference: 17) Tsuda T, Suematsu R, et al.: Development of the Japanese version of the COPD Assessment Test. Respir Investig. 2012; 50: 34–39. – reference: 1) Travis WD, Costabel U, et al.: An official American thoracic society/European respiratory society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013; 188: 733–748. – reference: 20) McCusker, Kakuma R, et al.: Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Md Sci. 2002; 57: M569–M577. – reference: 5) Dekhuijzen PN, Decramer M: Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992; 5: 997–1003. – reference: 3) Axelsson GT, Putman RK, et al.: Interstitial lung abnormalities and self-reported health and functional status. Thorax. 2018; 73: 884–886. – reference: 6) Zelada MA, Salinas R, et al.: Reduction of functional deterioration during hospitalization in an acute geriatric unit. Arch Gerontol Geriatr. 2009; 48: 35–39. – reference: 16) Thrush A, Rozek M, et al.: The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study. Phys Ther. 2012; 92: 1536–1545. – reference: 24) Koyama K, Sakamoto S, et al.: The Activities of Daily Living after an Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Intern Med. 2017; 56: 2837–2843. – reference: 18) Grufstedt HK, Shaker SB, et al.: Validation of the COPD Assessment Test (CAT) in patients with idiopathic pulmonary fibrosis. Eur Clin Respir J. 2018; 5: 1530028 – reference: 13) Palleschi L, Alfieri WA, et al.: Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study. J Am Geriatr Soc. 2011; 59: 193–199. – reference: 7) Covinski KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. – reference: 12) Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J. 1965; 14: 61–65. – reference: 10) Fortinsky RH, Covinsky KE, et al.: Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999; 54: M521–M526. – reference: 15) Hermans G, Clerckx B, et al.: Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012; 45: 18–25. – reference: 21) Song JW, Hong S-B, et al.: Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011; 37: 356–363. – reference: 2) Bajwah S, Ross JR, et al.: Interventions to improve symptoms and quality of life of patients with fibrotic interstitial lung disease: a systematic review of the literature. Thorax. 2013; 68: 867–879. – reference: 8) Ziesberg A, Shadmi E, et al.: Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. J Am Geriatr Soc. 2015; 63: 55–62. – reference: 9) Loyd C, Markland AD, et al.: Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc. 2020; 21: 455–461. – reference: 14) 一般社団法人日本呼吸器学会ホームページ 酸素療法マニュアル（酸素療法ガイドライン改訂版）．https://www.jrs.or.jp/modules/guidelines/index.php?content_id=98 （2021年8月30日引用） – reference: 19) 植木 純，神津 玲，他：呼吸リハビリテーションに関するステートメント．日呼吸ケアリハ会誌．2018; 27: 95–114. – reference: 22) Granger CV, Dewis LS, et al.: Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. 1979; 60: 14–17. – reference: 23) Prieur G, Combret Y, et al.: Functional Electrical Stimulation Changes Muscle Oxygenation in Patients with Chronic Obstructive Pulmonary Disease During Moderate-Intensity Exercise: A Secondary Analysis. COPD. 2019; 16: 30–36. – reference: 4) Holland AE, Hill CJ, et al.: Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax. 2008; 63: 549–554. – reference: 11) Sleiman I, Rozzini R, et al.: Functional trajectories during hospitalization: A prognostic sign for elderly patients. J Gerontol A Biol Sci Med Sci. 2009; 64: 659–663. |
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| Snippet | 【目的】間質性肺疾患は呼吸困難による活動制限を招くが，入院に伴う入院関連能力低下（Hospital-acquired disability；以下，HAD）の発生率や臨床的アウトカムへの影響は... 「要旨」【目的】間質性肺疾患は呼吸困難による活動制限を招くが, 入院に伴う入院関連能力低下 (Hospital-acquired disability ; 以下, HAD) の発生率や臨床的アウトカムへの... |
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| Subtitle | 2 施設共同前向き観察研究 |
| Title | 間質性肺疾患患者における入院関連能力低下の発生率と臨床的アウトカムへの影響 |
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