Physical Therapy for Stroke Outpatients : Differing Therapeutic Aims of Patients and Therapists May Prolong Outpatient Therapy

本研究では,脳卒中外来理学療法のあり方に示唆を得ることを目的として,1)外来理学療法の長期化の現状,2)外来理学療法に対する脳卒中後遺症者の期待と理学療法士の役割意識,3)外来理学療法と通所リハサービスを併用している者と通所リハサービスのみの利用者との比較の3 点について検討した。調査は在宅脳卒中後遺症者284名と理学療法士200名を対象に郵送アンケート法にて実施した。その結果,外来理学療法が長期化する傾向があること,脳卒中後遺症者の多くが外来理学療法に対して麻痺や身の回りの動作が回復することを期待していること,一方,理学療法士は,機能回復よりも身体機能やADLの維持や確認を主な役割として意識していることが明らかとなった。以上から,患者と理学療法士が外来理学療法における目的を共有することがまず重要である。そうすることによって,地域リハビリテーションにおける外来理学療法の役割が明確化し,外来理学療法が患者の生活の再構築に貢献できることが示唆された。Long-term physical therapy for outpatients with stroke extending beyond the expected recovery period is not uncommon in Japan. The objective of the present study was to clarify the current situation of long-term physical therapy for stroke outpatients, patient hopes and therapist objectives in outpatient physical therapy, and differences between stroke patients who continued physical therapy at hospital and those who terminated therapy. Two questionnaire surveys by mail were conducted, one of 284 stroke survivors and another of 200 physical therapists engaged in outpatient therapy. According to the therapists, physical therapy for stroke outpatients is prolonged in most hospitals (82.5%) and prolongation of therapy is problematic in some of these (42.1%). Although more than 95% of therapists indicated maintenance of function and activity as the aim of outpatient therapy, most patients (95.9%) demanded recovery from paralysis and improvements in physical function, instead of maintenance even 1 year after stroke onset. Stroke patients who continued both physical therapy at hospital and group exercise at community health centers were significantly older at onset of stroke than those who only continued group exercise (p < .001). In addition, using ridit analysis, the former displayed lower mean ridit for Index of Independence scores in activities of daily living (Katz Index) than the latter (p < .05). These results suggest that physical therapists must share the objectives of therapy with stroke patients in order to complete outpatient therapy and establish new independent lifestyles for stroke patients