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tdh_39_takahashi.pdf本文1.06 MBAdobe PDF
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tdh_39_takahashi_a2.pdf審査結果要旨521.8 kBAdobe PDF
タイトル: 脳卒中片麻痺者の歩行自立判定に関する研究
著者: 髙橋, 純平
著者所属: 弘前大学大学院保健学研究科
発行日: 20-Mar-2014
抄録: [Introduction] Physical therapists must often ascertain whether hemiparetic patients can walk independently. However, no criteria exist, so decisions are often left to individual physical therapists. The study procedures were the following. (1) Investigation of methods used by physical therapists to assess walking independence of hemiparetic stroke patients, and walking-independence related factors (Chapter 1) (2) Exploration of how physical therapists ascertain whether a hemiplegia patient can walk independently in a ward or not (Chapter 2) (3) Evaluation of the reliability and validity of a scale to assess walking independence of hemiplegia patients (Chapter 3) [Chapter 1] Review of determination of walking independence in hemiparetic stroke patients. [Method] English-language and Japanese-language studies were identified through searches of MEDLINE and ICHUSHI through December 2011. [Result] Inclusion criteria were satisfied by 39 trials. The test batteries used to determine walking independence were FIM, FAC, and doctors and physical therapist decisions. Factors related to walking independence were walking ability, lower extremity function of the affected side, cognitive disorder, and higher cerebral dysfunction. However, their values and significance were not defined. [Conclusion] Results of this review suggest that determination of walking independence in stroke patients is used for qualitative evaluation. Therefore, comprehensive evaluation scales are necessary for physical therapists to ascertain walking independence clearly. [Chapter 2] Clinical reasoning of physical therapists regarding in-hospital walking independence of patients with hemiplegia. [Methods] The subjects were 15 physical therapists with experience of stroke patients’ rehabilitation. We interviewed them using semi-structured interviews related to the criteria of the states of walking in the ward of hemiparetic patients. The interviews were transcribed in full, and the texts were analyzed by coding and grouping. [Results] From the results of the interviews, PTs determined patients’ independence of walking in hospital by observation of behavior during walking or treatment. The majority of PTs focused on the patients’ state during walking, higher brain function, and their ability to balance. In addition, they often asked ward staff about patients’ daily life, and self-determination. [Conclusions] We identified the items examined by physical therapists when determining the in-hospital walking independence of stroke patients. Further investigation is required to examine which of these items are truly necessary. [Chapter 3] Reliability and validity of a scale to assess walking independence of hemiplegia patients [Methods] Subjects were 7 hemiparetic stroke patients and 14 physical therapists. We evaluated stroke patients using the check list presented in Chapter 2. Additionally, we asked PTs about the importance of items using a questionnaire. Intra-rater and inter-rater reliability were measured, as was internal consistency. [Results] The intra-rater coefficient and internal consistency exhibited good reliability, but the inter-rater coefficient was low. Results of the questionnaire, items related to crouching and walking over different levels were not important determinants of walking independence. [Conclusions] We identified the intra-rater reliability and scale validity. Results show that items related to squat and gait must be re-examined.
URI: http://hdl.handle.net/10129/5381
テキストバージョン: ETD
学位授与番号: 11101A39
学位授与年月日: 2014-03-20
学位名: 博士(保健学)
学位授与機関: 弘前大学

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