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Purpose：This study examined functional outcomes and discharge disposition in patients with and without indwelling urethral catheters, who were admitted to a convalescent (Kaifukuki) rehabilitation ward (KRW) following an acute care hospital stay.Subjects and Methods：We retrospectively reviewed the medical records of 113 patients with cerebrovascular disease and traumatic brain injury who had indwelling urethral catheters at the time of admission to the KRW of our hospital between April 1, 2012 and March 31, 2015. We studied the motor score of the Functional Independence Measure (FIM-M) and discharge disposition from our KRW in patients without indwelling urethral catheters.Results：The ratio of patients without indwelling urethral catheters was 75.2％ (85 cases：catheter-free group). The catheter-free group had higher FIM-M scores and a higher rate of living at home, compared to the 28 patients with indwelling urethral catheters. The average duration until urination independence after catheter removal was 17.3 (standard deviation：21.1) days. Urination independence recovered in 80.9％ of the catheter-free group within 4 weeks after catheter removal.Conclusion：Indwelling urethral catheter should be removed to enable discharge to home.
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<p>Objective：In Parkinson's disease and Parkinsonian syndrome (referred to collectively as PD), the progression of functional decline is influenced by complications such as bone fracture or pneumonia. We aimed to assess the efficiency of short-term inpatient rehabilitation therapy for patients with PD in terms of functional recovery and cost-effectiveness.</p><p>Methods：We investigated differences in outcomes of inpatient rehabilitation for 84 patients with PD, in relation to reasons for hospitalization. Patients with complications, including orthopedic diseases (n＝15), and disuse syndrome (n＝16) received therapy for 3 hours/day in Kaifukuki postacute convalescent rehabilitation wards (KRW) or 2 hours/day in other facilities. Fifty-three patients without complications and thus not eligible for admission to KWR were provided with short-term inpatient rehabilitation therapy (training for 2 hours/day, 6 days/week for 1 month).</p><p>Results：In the patients without complications, the efficiency of FIM (FIM gain/hospital stay) was significantly greater (p＝0.03) and the amount of training and the medical expenses needed to improve the FIM score by 1 point, calculated as total training units (1 unit＝20 minutes of therapy as per the Japanese medical insurance system) divided by FIM gain and total medical cost divided by FIM gain, showed a decreasing trend (p＝0.07, 0.10, respectively) in comparison with that in the patients with complications.</p><p>Conclusion：Short-term inpatient rehabilitation for PD patients without complications is beneficial in terms of rehabilitation efficiency and cost-effectiveness, and appears effective at preventing complications and reducing costs. Reconsideration of the medical insurance system may be necessary so that short-term inpatient rehabilitation can be offered in various facilities, including Kaifukuki wards.</p>
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Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (<i>p</i><0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (<i>p</i><0.001). The percentage of patients discharged home also increased significantly from 85.2% to 99.1% (<i>p</i><0.001). Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.
Résumé
A working group, established by the Japanese Board-certified Physiatrist Association to examine the necessary functions for an electronic medical record keeping system for rehabilitation, created a functional evaluation system for electronic medical record keeping in kaifukuki rehabilitation wards. The group conducted a survey to determine how electronic medical records are actually being used in kaifukuki rehabilitation wards. Methods : The group sent questionnaires to 153 hospitals with kaifukuki rehabilitation wards by mail. The questions included the period of usage, how satisfied they were with their system, and a self-evaluation form for their electronic medical record functional evaluation. They asked the respondents to evaluate each item from 1 to 5 points. Results : The group received answers from 82 institutions, with a valid answer rate of 53.6% in total. The median of the electronic record functional evaluation was 60.5 points. The points given varied from 1 to 5 in all items. Conclusion : It was determined that electronic medical records are equipped with a minimum of functions for rehabilitation, but also that there are great functional differences among institutions.
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Our hospital is located in the prefectural capitol of Fukushima, where tremors just below magnitude six were recorded during the Great East Japan Earthquake of March 11, 2011. The building was spared major damage, but for safety, patients hospitalized at the Kaifukuki rehabilitation ward were evacuated within the hospital to rehabilitation rooms in the new annex, where they spent two nights. The day after the earthquake, a group rehabilitation session was conducted, but because patients showed signs of exhaustion from lack of sleep and anxiety, it was switched to individual rehabilitation. On a questionnaire, many patients noted that conversations with the staff helped ease their anxiety. This suggests that, although group rehabilitation can be efficient and effective in providing psychological support to patients, individual rehabilitation tends to be more favorable in disaster situations where patients suffer from exhaustion and psychological stress. Accordingly, disaster rehabilitation should be conducted on a patient-by-patient basis. In comparison with patients from the same time the previous year, the number of rehabilitation intervention units per day was one less, but the period of hospitalization was longer. A similar improvement in FIM was also achieved. At the time of an earthquake, although it is important for hospitals that escape structural damage to accept new patients, it is also important to continue treating the patients who were already there. Furthermore, hospitals should always have stockpiles of meals on hand and form cooperative relationships with the community to ensure that they can continue to provide service after an earthquake.
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After April 2006, the Japanese Ministry of Health and Labor raised the permitted training time from 6 to 9 units (1 unit of training time corresponds to 20 minutes of exercise with a therapist) for patients in a kaifukuki (convalescent) rehabilitation ward. We examined the effect of the increased rehabilitative training time on patients using feeding tubes in a kaifukuki rehabilitation ward after an initial cerebrovascular disorder, with a particular focus on improving swallowing disorders. Our study was comprised of post-stroke patients with feeding tubes who underwent rehabilitation from April 2001 to March 2006 (<i>N</i>=14, 6-unit group) and from April 2006 to March 2009 (<i>N</i>=16, 9-unit group). All patients went to the ward within two months after suffering a stroke. There was no significant difference in the Functional Independence Measure(FIM) efficiency or length of hospital stay between the two groups. Feeding tube removal was more common in the 9-unit group compared to the 6-unit group (81.3% vs. 35.7%, <i>p</i><0.05), and the 9-unit group also had more training time per day. Logistic regression analysis showed that the increased training time per day spent with a speech therapist contributed to improving swallowing disorders (<i>p</i><0.01).
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Currently, there are more than 53,000 beds in kaifukuki rehabilitation wards throughout Japan. The development of kaifukuki rehabilitation wards is proceeding smoothly in terms of quantity. It is suggested that, with this development, the activities of daily living of patients will significantly improve, leading to an increase in the likelihood of patients returning home when a large unit of daily rehabilitation training is provided via one of these kaifukuki rehabilitation wards. The tasks remaining to be completed for the optimal realization of the kaifukuki rehabilitation wards are to reduce the disparity in the number of beds among prefectures, to realize a mature team approach to the rehabilitation program, to encourage full-time ward physicians of the rehabilitation department to exercise leadership, to enhance subacute medical services, to enhance human resources such as nurses and rehabilitation specialists and to improve the education and training system for the staff. Other major tasks remaining are to strengthen the cooperation between kaifukuki rehabilitation wards and acute hospitals, by which such rehabilitation wards will become capable of actively accepting patients from an early stage, and to establish cooperation between kaifukuki rehabilitation wards and the home care system.