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認知症高齢者の大腿骨近位部骨折に対する術後リハビリテーションの強度とアウトカムの関連

宇田, 和晃 東京大学 DOI:10.15083/0002006975

2023.03.24

概要

[課程-2]
審査の結果の要旨
氏名 宇田 和晃
本研究は全国規模の診療情報データベースを利用したコホート研究により、認知症高齢
者の大腿骨近位部骨折に対する術後リハビリテーションの開始時期や頻度、1 日あたりの
量と Barthel index(BI)で評価する日常生活動作の入院時から退院時までの変化量(BI
利得)との関連について明らかにすることを目的とした。対象者は大腿骨近位部骨折の診
断で入院し、入院後 7 日以内に手術を受け、術後リハビリテーションを受けた認知症高齢
者(n = 43,206)とした。本研究の結果、以下の結果を得た。
1. 多変量回帰分析により患者背景および術前リハビリテーションの有無を調整した結
果、術後からリハビリテーション開始までの期間が 1 日遅延するごとに BI 利得の平均
値は 0.50 点(95%信頼区間:0.22 to 0.77 点)低くなること、術後リハビリテーショ
ンの頻度が週 3 日以下の場合と比較して、週 3.1–4.0 日では BI 利得は 2.92(95%信頼
区間:0.27 to 5.57)点高く、週 4.1–5.0 日では 5.71(95%信頼区間:3.18 to 8.23)点
高く、週 5.1–6.0 日では 7.53(95%信頼区間:4.91 to 10.15)点高く、週 6.1 日–7.0
日では 10.13(95%信頼区間:7.09 to 13.16)点高くなること、術後リハビリテーショ
ン 1 日あたりの単位数が 1 単位−2 単位未満の場合と比較して、2 単位−3 単位未満では
BI 利得は 4.24(95%信頼区間:3.08 to 5.41)点高く、3 単位以上では 5.80(95%信
頼区間:4.11 to 7.50)点高くなること、が示された。
2. 上記の結果は認知症を患っていない群、認知症高齢者の日常生活自立度判定基準ラン
ク I–II 群、ランク III–IV/M 群、いずれのサブグループにおいても同様の結果が示さ
れた。さらに入院後続発症の影響を調整した場合やリハビリテーションの強度の定義
を変更した場合の解析においても同様であることが示された。
以上、本論文は認知症高齢者の大腿骨近位部骨折に対して、より早期に開始し、より頻
回で、より 1 日あたりの量が多い術後リハビリテーションは、急性期での良好な BI 利得
と関連することを明らかにした。本研究の新規性はこれまで除外対象やサブグループ解析
のみの対象とされることが多かった認知症高齢者を主要解析の対象としたこと、さらに術
後リハビリテーションを開始する時期、頻度、1 日あたりの実施量の効果について、それ
ぞれの要素について検討できた点である。認知症高齢者の大腿骨近位部骨折術後のリハビ
リテーションの標準化に対して重要な貢献をなすと考えられる。
よって本論文は博士(医学 )の学位請求論文として合格と認められる。

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参考文献

1. Cooper C, Campion G, Melton LJ, Hip fractures in the elderly: A world-wide projection.

Osteoporos Int. 2: 285–289. 1992.

2. Gullberg B, Johnell O, Kanis JA, World-wide Projections for Hip Fracture. Osteoporos

Int.7: 407–13. 1997.

3. The IOF CSA Working Group on Fracture Epidemiology, C. Cooper, Z. A. Cole, C. R.

Holroyd, S. C. Earl, N. C. Harvey, E. M. Dennison, L. J. Melton, S. R. Cummings, and J.

A. Kanis, Secular trends in the incidence of hip and other osteoporotic fractures.

Osteoporos Int. 22: 1277–1288. 2011.

4. Cheung, Ching-Lung, Seng Bin Ang, Manoj Chadha, Eddie Siu-Lun Chow, Yoon-Sok

Chung, Fen Lee Hew, Unnop Jaisamrarn, Hou Ng, Yasuhiro Takeuchi, Chih-Hsing Wu,

Weibo Xia, Julie Yu, and Saeko Fujiwara, An updated hip fracture projection in Asia: The

Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia. 4: 16–21.

2018.

5. Bhandari M, Swiontkowski M, Management of Acute Hip Fracture. N Engl J Med. 377:

2053–2062. 2017.

6. 日本整形外科学会, 日本骨折治療学会, 大腿骨頚部/転子部骨折診療ガイドライン

(改訂第 2 版): 2011.

61

7. for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group,

Suzanne M. Dyer, Maria Crotty, Nicola Fairhall, Jay Magaziner, Lauren A. Beaupre, Ian

D. Cameron, and Catherine Sherrington, A critical review of the long-term disability

outcomes following hip fracture. BMC Geriatr. 16: 158-176. 2016.

8. Tajeu, Gabriel S., Elizabeth Delzell, Wilson Smith, Tarun Arora, Jeffrey R. Curtis,

Kenneth G. Saag, Michael A. Morrisey, Huifeng Yun, and Meredith L. Kilgore. Death,

Debility, and Destitution Following Hip Fracture. J Gerontol Ser A. 69A: 346–353. 2014.

9. Papadimitriou, Nikos, Konstantinos K. Tsilidis, Philippos Orfanos, Vassiliki Benetou,

Evangelia E. Ntzani, Isabelle Soerjomataram, Annemarie Künn-Nelen, Ulrika PetterssonKymmer, Sture Eriksson, Hermann Brenner, Ben Schöttker, Kai-Uwe Saum, Bernd

Holleczek, Francine D. Grodstein, Diane Feskanich, Nicola Orsini, Alicja Wolk, Andrea

Bellavia, Tom Wilsgaard, Lone Jørgensen, Paolo Boffetta, Dimitrios Trichopoulos, and

Antonia Trichopoulou, Burden of hip fracture using disability-adjusted life-years: a

pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public

Health. 2: e239–46. 2017.

10. Liang Y, Wang L. Alzheimer's. Disease is an Important Risk Factor of Fractures: a Metaanalysis of Cohort Studies. Mol Neurobiol. 54: 3230–3235. 2017.

11. Stark SL, Roe CM, Grant EA, Hollingsworth H, Benzinger TL, Fagan AM, Buckles VD,

Morris JC. Preclinical Alzheimer disease and risk of falls. Neurology. 81: 437–43. 2013.

62

12. van Doorn C, Gruber-Baldini AL, Zimmerman S, Hebel JR, Port CL, Baumgarten M,

Quinn CC, Taler G, May C, Magaziner J, Epidemiology of Dementia in Nursing Homes

Research Group. Dementia as a risk factor for falls and fall injuries among nursing home

residents. J Am Geriatr Soc. 51: 1213-8. 2003.

13. Epstein NU, Guo R, Farlow MR, Singh JP, Fisher M. Medication for Alzheimer's disease

and associated fall hazard: a retrospective cohort study from the Alzheimer's Disease

Neuroimaging Initiative. Drugs Aging. 31: 125-9.2014.

14. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of

dementia: a systematic review and metaanalysis. Alzheimers Dement. 9: 63-75. 2013.

15. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa

K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M,

Alzheimer's Disease International. Global prevalence of dementia: a Delphi consensus

study. Lancet. 17: 2112-2117.2005.

16. Seitz, Dallas P., Nikesh Adunuri, Sudeep S. Gill, and Paula A. Rochon, Prevalence of

Dementia and Cognitive Impairment Among Older Adults With Hip Fractures. J Am Med

Dir Assoc. 12: 556–564. 2011.Givens, Jane L., Tara B. Sanft, and Edward R.

Marcantonio, Functional Recovery After Hip Fracture: The Combined Effects of

Depressive Symptoms, Cognitive Impairment, and Delirium. J Am Geriatr Soc. 56:

1075–1079. 2008.

63

17. Givens, Jane L., Tara B. Sanft, and Edward R. Marcantonio, Functional Recovery After

Hip Fracture: The Combined Effects of Depressive Symptoms, Cognitive Impairment,

and Delirium. J Am Geriatr Soc. 56: 1075–1079. 2008.

18. Sheehan, K J, L Williamson, J Alexander, C Filliter, B Sobolev, P Guy, L M Bearne, and

C Sackley, Prognostic factors of functional outcome after hip fracture surgery: a

systematic review. Age Ageing. 47: 661–670. 2018.

19. Hartley, Peter, Nathalie Gibbins, Amanda Saunders, Kerry Alexander, Eimear Conroy,

Rebecca Dixon, Joseph Lang, Jasmine Luckett, Tim Luddington, and Roman RomeroOrtuno, The association between cognitive impairment and functional outcome in

hospitalised older patients: a systematic review and meta-analysis. Age Ageing. 47: 661670. 2017.20.

20. Smith, Toby O, Anthony W Gilbert, Ashwini Sreekanta, Opinder Sahota, Xavier L

Griffin, Jane L Cross, Chris Fox, and Sarah E Lamb, Enhanced rehabilitation and care

models for adults with dementia following hip fracture surgery. Cochrane Dementia and

Cognitive Improvement Group, editor. Cochrane Database Syst Rev. 2020.

21. Jonah Hebert-Davies, G-Yves Laflamme, and Dominique Rouleau, Bias towards

dementia: Are hip fracture trials excluding too many patients? A systematic review.

Injury.43: 1978–1984.2012.

64

22. Chudyk, Anna M., Jeffrey W. Jutai, Robert J. Petrella, and Mark Speechley, Systematic

Review of Hip Fracture Rehabilitation Practices in the Elderly. Arch Phys Med Rehabil.

90: 246–262. 2009.

23. Handoll, Helen HG, Catherine Sherrington, and Jenson CS Mak, Interventions for

improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev.

2011.

24. Stenvall, Michael, Monica Berggren, Maria Lundström, Yngve Gustafson, and Birgitta

Olofsson, A multidisciplinary intervention program improved the outcome after hip

fracture for people with dementia—Subgroup analyses of a randomized controlled trial.

Arch Gerontol Geriatr.54: e284–289. 2012.

25. Jones, C. Allyson, Gian S. Jhangri, David H. Feeny, and Lauren A, Cognitive Status at

Hospital Admission: Postoperative Trajectory of Functional Recovery for Hip Fracture. J

Gerontol A Biol Sci Med Sci. 72: 61–67. 2017.

26. Allen, Jennifer, Adriana Koziak, Sarah Buddingh, Jieyun Liang, Jeanette Buckingham,

and Lauren A. Beaupre, Rehabilitation in Patients with Dementia Following Hip

Fracture: A Systematic Review. Physiother Can. 64: 190–201. 2012.

27. Susan W. Muir and Abebaw M. Yohannes, The Impact of Cognitive Impairment on

Rehabilitation Outcomes in Elderly Patients Admitted with a Femoral Neck Fracture: A

Systematic Review. Journal of Geriatric Physical Therapy. 32: 24-32. 2009.

65

28. Beaupre, Lauren A., Jay S. Magaziner, C. Allyson Jones, Gian S. Jhangri, D. William C.

Johnston, Donna M. Wilson, and Sumit R, Rehabilitation After Hip Fracture for Nursing

Home Residents: A Controlled Feasibility Trial. J Gerontol Ser A. 74: 1518–1525. 2019.

29. Huusko, Tiina M., Pertti Karppi, Veikko Avikainen, Hannu Kautiainen, and Raimo

Sulkava, Randomised, clinically controlled trial of intensive geriatric rehabilitation in

patients with hip fracture: subgroup analysis of patients with dementia. BMJ. 321: 11071111. 2000.

30. Roberts, Karl C., and W. Timothy Brox, AAOS clinical practice guideline: management

of hip fractures in the elderly. AAOS-Journal of the American Academy of Orthopaedic

Surgeons. 23: 138-140. 2015.

31. The Chartered Society of Physiotherapy, Hip fracture rehabilitation in physiotherapy

practice. Available at: https://www.csp.org.uk/publications/hip-fracture-rehabilitationphysiotherapy-practice. Accessed 09 November 2020.

32. National Clinical Guideline Centre, The management of hip fracture in adults. Available

at: https://www.nice.org.uk/guidance/cg124. Accessed 09 November 2020.

33. Hall, A. J., I. A. Lang, R. Endacott, A. Hall, and V. A. Goodwin, Physiotherapy

interventions for people with dementia and a hip fracture - a scoping review of the

literature. Physiotherapy.103: 361-368. 2017.

66

34. Prommik, Pärt, Helgi Kolk, Ülo Maiväli, Mati Pääsuke, and Aare Märtson, High

variability in hip fracture post-acute care and dementia patients having worse chances of

receiving rehabilitation: an analysis of population-based data from Estonia. Eur Geriatr

Med. 11: 581–601. 2020.

35. Seitz, Dallas P., Sudeep S. Gill, Peter C. Austin, Chaim M. Bell, Geoffrey M. Anderson,

Andrea Gruneir, and Paula A. Rochon, Rehabilitation of Older Adults with Dementia

After Hip Fracture. J Am Geriatr Soc. 64: 47–54. 2016.

36. Hall, A., James Fullam, I. Lang, R. Endacott, and V. Goodwin, Community

physiotherapy for people with dementia following hip fracture: Fact or fiction? A

qualitative study. Dementia. 2019.

37. Bellelli, Giuseppe, Giovanni B. Frisoni, Marco Pagani, Francesca Magnifico, and Marco

Trabucchi, Does cognitive performance affect physical therapy regimen after hip fracture

surgery? Aging Clin Exp Res. 19: 119–24. 2007.

38. Jette, Alan M, The Importance of Dose of a Rehabilitation Intervention. Phys Ther. 97:

1043–1043. 2017.

39. Hideo Yasunaga, Real World Data in Japan: Chapter II The Diagnosis Procedure

Combination Database. Ann Clin Epidemiol. 1: 76-79. 2019.

67

40. Matsuda, Tomoyuki, Masao Iwagami, Toshiki Suzuki, Xueying Jin, Taeko Watanabe, and

Nanako Tamiya, Correlation between the Barthel Index and care need levels in the

Japanese long-term care insurance system. Geriatr Gerontol Int. 19: 1186–1187. 2019.

41. Meguro, Kenichi, Naofumi Tanaka, Mari Kasai, Kei Nakamura, Hiroyasu Ishikawa,

Masahiro Nakatsuka, Masayuki Satoh, and Yoshitaka Ouchi, Prevalence of dementia and

dementing diseases in the old-old population in Japan: the Kurihara Project. Implications

for Long-Term Care Insurance data: Dementia in Japan’s old-old population.

Psychogeriatrics. 12: 226-234. 2012.

42. Koh GC, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their

independent predictors: a systematic review. BMJ Open. 24:e003483.43. 2013.

43. Yagi M, Yasunaga H, Matsui H, Morita K, Fushimi K, Fujimoto M, Koyama T, Fujitani

J. Impact of Rehabilitation on Outcomes in Patients With Ischemic Stroke: A Nationwide

Retrospective Cohort Study in Japan. Stroke. 48: 740-746. 2017.

44. Mahoney FI, Barthel DW, Functional evaluation: The Barthel Index: A simple index of

independence useful in scoring improvement in the rehabilitation of the chronically ill.

Md State Med J. 14: 61–65. 1965.

45. Quan, Hude, Bing Li, Chantal M. Couris, Kiyohide Fushimi, Patrick Graham, Phil Hider,

Jean-Marie Januel, and Vijaya Sundararajan, Updating and Validating the Charlson

68

Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using

Data From 6 Countries. Am J Epidemiol. 173: 676–682. 2011.

46. World Health Organization. Global Database on Body Mass Index.. Available at:

http://www.assessmentpsychology.com/icbmi.htm. Accessed 04 February 2021.

47. Hubbard, Alan E., Jennifer Ahern, Nancy L. Fleischer, Mark Van der Laan, Sheri A.

Lippman, Nicholas Jewell, Tim Bruckner, and William A. Satariano, To GEE or Not to

GEE: Comparing Population Average and Mixed Models for Estimating the Associations

Between Neighborhood Risk Factors and Health. Epidemiology. 21: 467–474. 2010.

48. Aloisio, Kathryn M., Nadia Micali, Sonja A. Swanson, Alison Field, and Nicholas J.

Horton, Analysis of Partially Observed Clustered Data using Generalized Estimating

Equations and Multiple Imputation. Stata J. 14: 863–883. 2014.

49. Tsuda Y, Yasunaga H, Horiguchi H, Ogawa S, Kawano H, Tanaka S. Association between

dementia and postoperative complications after hip fracture surgery in the elderly:

analysis of 87,654 patients using a national administrative database. Arch Orthop Trauma

Surg. 135: 1511-1517. 2015.

50. Penrod, J.D., Boockvar, K.S., Litke, A., Magaziner, J., Hannan, E.L., Halm, E.A.,

Silberzweig, S.B., Sean Morrison, R., Orosz, G.M., Koval, K.J., Siu, A.L, Physical

Therapy and Mobility 2 and 6 Months After Hip Fracture: PHYSICAL THERAPY

AFTER HIP FRACTURE. J Am Geriatr Soc. 52: 1114–1120. 2004.

69

51. Oldmeadow, Leonie B., Elton R Edwards, Lara A Kimmel, Eva Kipen, Val J. Robertson,

and Michael J Bailey, NO REST FOR THE WOUNDED: EARLY AMBULATION

AFTER HIP SURGERY ACCELERATES RECOVERY. ANZ J Surg. 76: :607–611.

2006.

52. Siu, Albert L., Joan D. Penrod, Kenneth S. Boockvar, Kenneth Koval, Elton Strauss, and

R. Sean Morrison, Early Ambulation After Hip Fracture: Effects on Function and

Mortality. Arch Intern Med. 166: 766-771. 2006.

53. Sawaguchi A, Momosaki R, Hasebe K, Chono M, Kasuga S, Abo M. Effectiveness of

preoperative physical therapy for older patients with hip fracture. Geriatr Gerontol Int.

18: 1003-1008 2018.

54. Song F, Jerosch-Herold C, Holland R, Drachler Mde L, Mares K, Harvey I. Statistical

methods for analysing Barthel scores in trials of poststroke interventions: a review and

computer simulations. Clin Rehabil. 20: 347-356. 2006.

55. Walters SJ, Campbell MJ, Lall R. Design and analysis of trials with quality of life as an

outcome: a practical guide. J Biopharm Stat. 11: 155-176. 2001.

56. Cohen ME. Analysis of ordinal dental data: evaluation of conflicting recommendations. J

Dent Res. 80: 309-313. 2001.

70

57. Dhamoon MS, Cheung YK, Gutierrez J, Moon YP, Sacco RL, Elkind MSV, Wright CB.

Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. Stroke. 49:

549-555. 2018.

58. Hagino H, Endo N, Harada A, Iwamoto J, Mashiba T, Mori S, Ohtori S, Sakai A, Takada

J, Yamamoto T. Survey of hip fractures in Japan: Recent trends in prevalence and

treatment. J Orthop Sci. 22: 909-914. 2017.

59. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures.

Lancet. 18: 1761-1767. 2002.

60. Thomas, Susie, Shylie Mackintosh, and Julie Halbert, Determining Current Physical

Therapist Management of Hip Fracture in an Acute Care Hospital and Physical

Therapists’ Rationale for This Management. Phys Ther. 91: 1490–1502. 2011.

71

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