The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.
Purpose] We confirmed the effect to combining task-oriented training (TOT) and neuromuscular electrical stimulation (NMES) of abdominal muscles to improve trunk function and basic ADL performance (rolling in and rising from bed). [Participants and Methods] A patient with bilateral hemiplegia due to 2 cerebrovascular events admitted to a post-acute rehabilitation ward. Her physical function and FIM score improved until 2 months after admission. However, as such improvements were not observed in the subsequent month, the patient was treated with TOT focusing on basic ADL performance and simultaneous NMES of abdominal muscles for 1 month. [Results] The patient's basic ADL performance improved, with a promoted trunk function. [Conclusion] Combining TOT and NMES of abdominal muscles may be effective to improve basic ADL performance and trunk function. 要旨: 〔目的〕体幹機能および起居動作能力の向上を目的とした,腹部筋への神経筋電気刺激(NMES)と起居動作 の課題指向型トレーニング(TOT)における併用効果を検証すること. 〔対象と方法〕2 度の脳卒中により両片麻痺 を呈し回復期リハビリテーション病棟へ入院した患者 1 名.入院後 2 ヵ月時までは身体機能や FIM に改善を認めた ものの,2 ヵ月時から 3 ヵ月時までは,改善が得られていない状態であった.3 ヵ月時から 1 ヵ月間,腹部筋への NMES を行うと同時に, 起居動作の TOT を行った. 〔結果〕起居動作の獲得に至るとともに, 体幹機能の向上を認めた. 〔結語〕腹部筋への NMES と TOT の併用は, 起居動作および体幹機能の向上に有効な手段である可能性が示唆された. キーワード:起居動作,神経筋電気刺激,課題指向型トレーニング 1) 社会福祉法人農協共済 別府リハビリテーションセンター:大分県別府市鶴見
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