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タイトル: 在宅パーキンソン病患者における活動量および姿勢動態への 効果的理学療法介入の検討
著者: 中江, 秀幸
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】 The aim of the present study is to assess effective physical therapy interventions on home-care patients with Parkinson’s disease through the following: understanding how they practice therapeutic exercises; clarifying the characteristics of their physical functions and situation of physical activity; and elucidating the effects of therapeutic exercises on their physical functions and situation of physical activity. The study procedures were following: (1) To conduct a visit survey on how home care patients with Parkinson’s disease use nursing care insurance and practice therapeutic exercises (Chapter 1: Step1). (2) To investigate the relationship between problems in daily living and the practice of self-exercise in patients with Parkinson’s disease (Chapter 2: Step2). (3) To demonstrate the characteristics of physical function and 24-h activity in home-care patients with Parkinson’s disease compared with healthy elderly people (Chapter 3: Step3). (4) To understand what kind of impacts two-month interventions on home-care patients with Parkinson’s disease through self-exercise and individual therapeutic exercises have on their physical functions and situation of physical activity (Chapter 4: Step4). 【Step1】 Research on exercise therapy in home-care patients with Parkinson’s disease: Results of home-visit survey on the use of domiciliary service and the implementation of self-practice Objective: This study aimed to obtain insight for the investigation of future intervention and measures by disclosing the conditions of understanding exercise therapy, including self-exercise, and securing the opportunities as well as practical problems at home in home-care patients with Parkinson’s disease. Method: Home-visit survey was conducted by an interview method in which an investigator visited the home of the subjects and interviewed them directly. The major items for the visit survey were the chief complaints in activity of daily living, application to long-term care insurance and self-practice was conducted in 15 home-care patients with Parkinson’s disease. Results: The results revealed that the answers for chief complaints related to sit-to-stand and gait performance such as “slow movement,” “difficulty in prompt action,” “easy to fall,” “leaning body,” and “walking in small steps” ranked high. When divided into two groups based on the presence or absence of the certification of long-term care need, a statistically significant difference was observed in the number of answers of “easy to fall” as determined by χ2 test and in the fear of a fall as determined by t-test. As a result of χ2 test with respect to the presence or absence of a habit of exercise therapy as self-practice, a significant difference was observed in the number of answers of “easy to fall” and “difficulty in toilet activities.” A significant difference was also observed by t-test in the duration from onset, score on fear of a fall, and the Tokyo Metropolitan Institute of Gerontology Index of Competence. Conclusion: This result suggests that it is difficult to accustom exercise therapy as self-discipline in severe patients with difficulty in maintaining standing position, turning around, and visiting the hospital, prolonged duration from onset, increase in the score on fear of a fall, and reduction in activities such as those represented by the Tokyo Metropolitan Institute of Gerontology Index of Competence. 【Step2】 Problems with Daily Living and Performing Home Exercise in Japanese Home-care Patients with Parkinson’s Disease Objective: We investigated the relationship between problems in daily living such as falls and the practice of self-exercise in patients with Parkinson’s disease in Japan, to show the requirements for their effective and sustainable home exercises. Methods: An anonymous questionnaire was sent by mail to 159 Parkinson’s disease patients who were members of the Miyagi Prefecture Branch of the Japan Parkinson’s Disease Association. The questionnaire included questions on Parkinson’s disease symptoms, chief complaints, history of falls, use of the nursing care insurance program, and performance of exercise therapy. Results: The questionnaire response rate was 62.3%. Falls had been experienced by 38 subjects (44.2%) during the month before the survey and by 52 (60.5%) during the 6 months before the survey. More than half (52.3%) of subjects had never undergone exercise therapy at a medical institution, and those who continued to undergo exercise therapy accounted for only 12.8% of all subjects. Thirty-three subjects (38.4%) did not undergo exercise therapy on a regular basis in any setting. Conclusion: To prevent a decrease in activity due to disuse muscular atrophy, it is important to establish more effective self-exercise for home-care Parkinson’s disease patients so that they can do these exercises on a regular basis. 【Step3】 Comparison of Physical Function and Activity in Home-care Patients with Parkinson’s Disease and Healthy Elderly People Objective: To compare physical function and 24-h activity in home-care patients with Parkinson’s disease with those in healthy elderly people. Methods: Physical function (range of motion, muscle strength, activities of daily living, gait, and balance) was measured in 10 home-care patients with Parkinson’s disease (PD group) and 10 healthy elderly subjects (healthy group). As an indicator of the amount of physical activity per day, a triaxial accelerometer was used to measure the 24-h total impulse value; simultaneously, behavior recorders were used to measure 24-h posture. Results: The healthy group scored significantly higher in activities of daily living, walking speed, and balance. No significant difference was observed between groups in terms of range of motion, muscle strength, cadence, amount of physical activity per day, and number of postural changes. However, the PD group spent significantly more time per day standing and in a supine position. Conclusion: In the PD group, the amount of physical activity per day was comparable to that in the healthy elderly group, despite the decreased levels of activity caused by their impaired performance in activities of daily living. Range of motion and muscle strength may have been maintained by these patients’ self-exercise and by training at day-care centers. Our results suggest the importance of practicing postural transfers from the standing and supine positions and of intervention and guidance that aim to improve impaired performance in daily living. 【Step4】 Effects of Therapeutic Exercises by Home-care Patients with Parkinson’s Disease on Their Physical Functions and Situation of Physical Activity. Objective: The aim was to clarify how two-month interventions on home care patients with Parkinson’s disease through self-exercise and individual therapeutic exercises affect their physical functions, daily amount of activity and posture dynamics. Methods: With 10 home-care patients with Parkinson’s disease as a target, we conducted physical therapy intervention that consisted of 2-months self-exercise and individual therapeutic exercise. Before and after the intervention status of implementation of self-exercise, state of fall, and fear of falling were heard from the patients. In addition, physical functions (range of motion, muscle strength, activities of daily living, gait, and balance) of the patients were also evaluated. As an indicator of the amount of physical activity per day, a triaxial accelerometer was used to measure the 24-h total impulse value; simultaneously, behavior recorders were used to measure 24-h posture. Results: The interventions made statistically significant improvements in the following: increase in both the number and duration of self-exercise, decrease in chief complaints, and mitigation of the fear of falling down. As for physical functions, significant increases were noted with respect to the following: angle of shoulder joint flexion and trunk extension, hip flexor muscle strength, and knee extensor muscle strength. However, no significant changes were recognized in the following indicators: Functional Independence Measure, walking speed and cadence, Timed Up and Go test, Functional Reach Test and Functional Balance Scale. Whereas indicators for the amount of physical activity, such as total impulse and the number of posture change did not change significantly, the amount of activity significantly increased due to decrease in the duration of recumbent position per day and increase in the ratio of sitting position. Conclusion: The interventions made as part of the study seemingly had the following effects: habituation of self-exercise; improvements in the joint range of motion, lower limb muscle strength, and balance in upright position; and reduction in the duration of recumbent position. 【Summary】 The results of the study suggest the importance of further rehabilitation measures for home-care patients with Parkinson’s disease. As one example of such measures, it is considered necessary to increase the opportunities for home-care patients with Parkinson’s disease to receive direct coaching from medical professionals and practice therapeutic exercises, thus making the following possible: provision of therapeutic exercises through individual nursing care insurance depending on the symptoms and severity of each patient; and interventions that help patients to conduct self-exercise on a regular basis. Also, the study suggests that interventions including individual therapeutic exercises and coaching on self-exercise have the following effects: habituation of therapeutic exercises, increase in flexibility and lower limb muscle strength, and decrease in the duration of incumbent position. However, the effects of the interventions were not significant enough with respect to increase in the amount of activity and the number of posture change, and decrease in the duration of uptight position. Also, while the duration of incumbent position decreased, that of sitting position was prolonged. It is necessary to consider effective intervention methods for these phenomena from now on.
URI: http://hdl.handle.net/10129/5383
テキストバージョン: ETD
学位授与番号: 11101A41
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
出現コレクション:平成25年度

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