Results of New Policies for Inpatient Rehabilitation Coverage in Japan

Miyai, Ichiro; Sonoda, Shigeru; Nagai, Shota; Takayama, Yuko; Inoue, Yasuhiro; Kakehi, Atsuo; Kurihara, Masaki; Ishikawa, Makoto

doi:10.1177/1545968311402696

Cited by 227 publications

(193 citation statements)

References 20 publications

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“…Table 2 shows the basic attributes of the 575 subjects. Other than a shorter period between onset and admission, the subjects were very similar to those recorded in the national survey of convalescent rehabilitation wards in Japan [14].…”

Section: Comparison Of 3 Groups Divided By Mfim Score At Admissionsupporting

confidence: 52%

Comparison of Functional Independence Measure (FIM) Gain between Groups with Extreme Differences in FIM Score at Admission

Tokunaga¹,

Higashi²,

Inoue³

et al. 2017

Int J Phys Med Rehabil

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Objective: There are several methods for inter-hospital comparison of the improvement in Functional Independence Measure (FIM). However, it is not known which method is most suitable. The purpose of this study was to elucidate which of 4 methods can most successfully compare the average improvement in motor FIM (mFIM) at each hospital with the least influenced by the difference of mFIM score at admission. For this purpose, we considered 3 groups divided based on motor FIM score at admission as 3 hospitals. Methods:The subjects were 575 stroke patients hospitalized in a convalescent rehabilitation ward. We divided the subjects into 3 groups based on mFIM score at admission (13 to 38 points, 39 to 64 points, and 65 to 90 points) and investigated whether there were significant differences in the values derived from mFIM effectiveness, corrected mFIM effectiveness, deviation value of mFIM gain, and multiple regression analysis. Result:Significant difference in the improvement in mFIM between 3 groups divided by mFIM at admission was not observed only for the use of the deviation value of mFIM gain. Conclusion:Deviation value of mFIM gain, which is the least liable to the influence of differences in mFIM score at admission, is useful as a method to compare average improvement in mFIM among hospitals.

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Section: Comparison Of 3 Groups Divided By Mfim Score At Admissionsupporting

confidence: 52%

Comparison of Functional Independence Measure (FIM) Gain between Groups with Extreme Differences in FIM Score at Admission

Tokunaga¹,

Higashi²,

Inoue³

et al. 2017

Int J Phys Med Rehabil

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“…The patient received conservative treatments such as anti-hypertensive agents and rehabilitation during acute care and was then transferred to a long-term rehabilitation facility. 5) The rehabilitation program consisted of conventional physical therapy, occupational therapy, and speech therapy for a combined daily total of up to 180 minutes every day, in accordance with Japanese guidelines for the management of stroke. 6) During treatment in the long-term rehabilitation facility, the patient's hearing did not recover.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Hearing Loss after Bilateral Putaminal Hemorrhage: A Diffusion-tensor Imaging Study

Koyama

Domen

2016

PRM

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“…Convalescent rehabilitation units for postacute stroke (Kaifukuki in Japanese) were introduced around the year 2000 by the Japanese National Insurance System, and transfers to this type of unit became mandatory for patients requiring continuous in-hospital rehabilitation. 2 In the convalescent rehabilitation stages, the Functional Independence Measure (FIM) 3 is widely used for assessment of the degree of independence in activities of daily living (ADL) in poststroke patients.…”

mentioning

confidence: 99%

Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke

Senda

Ito

Kotake

et al. 2016

Stroke

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4are widely used as classifications of ischemic stroke subtype. Although the pathologies of these subtypes are described by these criteria, no diagnostic methods or standards exist for neuroimaging and other examinations. The current diagnostic standards for ischemic stroke subtype used in clinical trials are from the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications.5 According to the TOAST classification system, artery-to-artery embolism (A-to-A) can be distinguished from atherothrombosis, 6 and both can be distinguished from CE. However, these concepts are not well Background and Purpose-We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Methods-Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Results-Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional IndependenceMeasure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (P<0.001), whereas in patients with artery-to-artery embolism or cardiogenic embolism and deep white matter hyperintensity grades were associated with Functional Independence Measure cognitive scores (P<0.05). Conclusions-Our study revealed that the degree of leukoaraiosis was associated with inpatient convalescent rehabilitation outcome in patients with ischemic stroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype.

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Results of New Policies for Inpatient Rehabilitation Coverage in Japan

Abstract: Although the organization of KRWs is in flux as the system of hospitals grows, results over the past 8 years suggest that changes in national insurance policies are affecting the quantity and organization of rehabilitation interventions and improvement in patient outcomes.

Cited by 227 publications

References 20 publications

Comparison of Functional Independence Measure (FIM) Gain between Groups with Extreme Differences in FIM Score at Admission

Comparison of Functional Independence Measure (FIM) Gain between Groups with Extreme Differences in FIM Score at Admission

A Case of Hearing Loss after Bilateral Putaminal Hemorrhage: A Diffusion-tensor Imaging Study

Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke

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