ABSTRACT
Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia.Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW).Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301).Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.
ABSTRACT
Tertiary rehabilitation hospitals should not only serve patients with systemic and specialized rehabilitations but also have capabilities in diagnosis/treatment,and even emergency responses.This paper introduced an integrated care mode at a rehabilitation hospital,in practicing in-depth and phased integration of clinical service and rehabilitation.Phase 1 (March 2015-March 2016) witnessed the "two-way" model,with coexisting rehabilitation pathway and clinical pathway.The second phase,from April 2016 to September 2017,witnessed the integrated care mode in which clinicians and physiatrists jointly took care of patients.A comparison between the same period of 2016 with data of 2015,and that of 2017 with data of 2016,found average length of stay was shortened by 0.5 day and 3.6 days respectively,the drug ratio fell by 4.63％ and 8.47％ respectively;the rehabilitation effective percentage was increased from 95.2％ to 98.0％.The percentage of cure or improvement for primary diseases was over 97％.The integrated care mode by both clinicians and physiatrists can shorten the length of stay,lower the drug ratio,raise medical efficiency,and encourage a more reasonable ratio of medical expenses.
ABSTRACT
Objective To generate data on the current medical rehabilitation resources in Hubei province so as to improve the management of rehabilitation quality.Methods Medical institutions on the second level and above were investigated using a questionnaire which covered installations,personnel,equipment and field of operations.Results A total of 176 questionnaires were recovered.Among them,166 (94.3％) of the hospitals had established a department of rehabilitation medicine,and 122 (69.3％) had set up an independent rehabilitation ward,accounting for a total of 3,359 beds.Altogether,there were 1,260 rehabilitation physicians (36.7％ of the assigned personnel),904 therapists (26.3％) and 1,272 nurses (37％).Senior physicians,therapists and nurses were 26％,3.1％ and 28.3％ of the respective totals.Conclusion Rehabilitation medicine in Hubei Province remains relatively poorly developed.It is weak in terms of building the discipline,management and devices,especially in a serious lack of professionals and rehabilitation therapists.