Japan Rehabilitation Database Research Articles

A Simplified Clinical Prediction Rule for Prognosticating Dependent Daily Living in Patients with Thoracic Spinal Cord Injury: A Multicenter Nationwide Japan Registry Study

Introduction: Clinical prediction rule (CPR) using decision tree analysis is able to show the branching of the variables under consideration in a clear, hierarchical manner, including specific reference values, which can be used as classifiers in clinical practice. However, CPRs developed by decision tree analysis for predicting the degree of independent living of patients with thoracic spinal cord injury (SCI) are few. The purpose of this study was to develop a simplified CPR for prognosticating dependent daily living in patients with thoracic SCI. Methods: We extracted data on patients with thoracic SCI from a national multicenter registry database, the Japan Rehabilitation Database (JRD). All patients with thoracic SCI who were hospitalized within 30 days after the injury onset were included. The independent living was categorized in the JRD as follows: independent socially, independent at home, needing care at home, independent at the facility, and needing care at the facility. These categories were used as the objective variables in classification and regression tree (CART) analysis. The CART algorithm was applied to develop the CPR for predicting whether patients with thoracic SCI achieve independent living at hospital discharge. Results: Three hundred ten patients with thoracic SCI were included in the CART analysis. The CART model identified, in a hierarchical order, patient’s age, residual function level, and the bathing sub-score of Functional Independence Measure as the top three factors with moderate classification accuracy and area under the curve. Conclusions: We developed a simplified, moderately accurate CPR for predicting whether patients with thoracic SCI achieve independent living at hospital discharge.

Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study.

The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.

Development of a clinical prediction rule for patients with cervical spinal cord injury who have difficulty in obtaining independent living

BACKGROUND CONTEXTA simple and easy to use clinical prediction rule (CPR) to detect patients with a cervical spinal cord injury (SCI) who would have difficulty in obtaining independent living status is vital for providing the optimal rehabilitation and education in both care recipients and caregivers. A machine learning approach was recently applied to the field of rehabilitation and has the possibility to develop an accurate and useful CPR. PURPOSEThe aim of this study was to develop and assess a CPR using a decision tree algorithm for predicting which patients with a cervical SCI would have difficulty in obtaining an independent living. STUDY DESIGNThe present study was a cohort study. PATIENT SAMPLEIn the present study, the data was obtained from the nationwide Japan Rehabilitation Database (JRD). The data on the SCIs was collected from 10 hospitals and the data was collected from the registries obtained between 2005 and 2015. The severity of SCI can vary, and patient prognosis differs depending on the damage site. In this study, the patients with cervical SCI were included. OUTCOME MEASURESIn this study, the degree of the independent living at discharge was investigated. The degree of the independent living was classified and listed as below: independent in social, independent at home, need care at home, independent at facility, need care at facility. In this study, the independent in social and independent at home were defined as “independent,” and the other situations were defined as “non-independent.” METHODSWe performed a classification and regression tree (CART) analysis to develop the CPR to predict whether the cervical SCI patients obtain an independent living at discharge. The area under the curve, the classification accuracy, sensitivity, specificity, and positive predictive value were used for model evaluation. RESULTSA total of 4181 patients with SCI were registered in the JRD and the CART analysis was performed for 1282 patients with the cervical SCI. The Functional Independence Measure (FIM) total score and the American Spinal Injury Association impairment scale were identified as the first and second discriminators for predicting the degree of the independence, respectively. Subsequently, the CART model identified FIM eating, the residual function level, and the FIM bed to chair transfer as next discriminators. Each parameter for evaluating the CART model were the area under the curve 0.813, the classification accuracy 78.6%, the sensitivity 80.7%, the specificity 75.1%, and the positive predictive value 84.5%. CONCLUSIONSIn this study, we developed a clinically useful CPR with moderate accuracy to predict whether the cervical SCI patients obtain independent living at the discharge.

Clinical Features for Identifying the Possibility of Toileting Independence after Convalescent Inpatient Rehabilitation in Severe Stroke Patients: A Decision Tree Analysis Based on a Nationwide Japan Rehabilitation Database

Background and purposeIn severe stroke patients, considerable concern should be given to toileting activity in rehabilitative support. Recently, the application of artificial intelligence, including machine learning (ML), has expanded into the stroke medical field, which could clarify the factors affecting toileting independence in severe stroke patients. This study aimed to identify the factors affecting toileting independence in severe stroke patients using ML. MethodsWe used the Japan Rehabilitation Database from 2005 to 2015 to investigate data from 2292 severe stroke patients. We performed the chi-squared automatic interaction detection (CHAID) algorithm with various explanatory variables. ResultsThe CHAID model identified modified Rankin scale (mRS) score as the first discriminator. Among those with an mRS score ≤4, the next discriminator was age (score ≤72, 73–80, or >80). Among those with an mRS score > 4, the next discriminator was also age (score ≤57, 58–72, 73–80, or >80). Interestingly, some patients achieved toileting independence, although this study focused on severe stroke patients. In branches based on age, the percentage of the patients who achieved toileting independence at discharge decreased progressively with age. ConclusionWe identified the influential factors, including reference values, for achieving toileting independence in convalescent severe stroke patients.

Development of a Point System to Predict Discharge to Home for Acute Stroke Patients.

While in an acute hospital setting, it is challenging for clinicians to make discharge decisions due to the multifactorial process and individual patient characteristics. To evaluate and develop a scoring system utilizing the Japan Rehabilitation Database (JRD) to identify acute stroke patients with a high possibility of discharge to home. Retrospective observational cohort study. Thirty-seven acute hospitals in Japan. A total of 10 270 patients admitted to the acute hospitals with stroke were identified. The inclusion criteria were (1) admission within 3 days of onset and (2) admission from home. Exclusion criteria were (1) incomplete data and (2) death in hospital. A total of 4216 patients were included in the study. Not applicable. Discharge destination from acute care hospital, that is, home versus other locations. In the multivariate logistic regression, age, stroke type, Barthel Index on admission, modified Rankin scale on admission, the National Institutes of Health Stroke Scale on admission, and extent of paralysis were retained. When the cutoff point was 33, the scoring system showed a sensitivity of 80.4% and specificity of 80.3%. The area under curve (AUC) was 0.88. On evaluating the predictive performance, the model showed a sensitivity of 78.2% and a specificity of 78.5% with an AUC = 0.86. We developed a point system to identify acute stroke patients with a high possibility of discharge to home using the JRD. This point system may provide useful information for clinicians to plan the discharge of acute stroke patients.

Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Aim: To examine the association of the amount of rehabilitation with functional gains of elderly stroke patients at a convalescent rehabilitation ward using propensity score analysis methods and the Japan Rehabilitation Database.Methods: This study was a retrospective cohort study. From the database, 6875 patients who were admitted to the convalescent rehabilitation wards with stroke were identified. After excluding 4586 patients, 2325 were eligible for the study. Intensive rehabilitation therapy (IRT) was defined as rehabilitation therapy of more than 15 hours per week by a physical therapist, an occupational therapist, and/or a speech therapist. Functional Independence Measure (FIM) gain, discharge rate to home, and FIM efficiency were examined using student's t test and the χ2 test after inverse probability weighting (IPW).Results: IRT was provided to 862 patients (37.1%). The unadjusted data showed that patients in the IRT group had a longer hospital stay, more physical therapy, occupational therapy, and speech and language therapy. After adjustment for IPW, the baseline characteristics were found to be closely matched between the 2 groups. The IRT group showed significantly higher motor FIM gain, cognitive FIM gain, FIM gain, and discharge rate to home.Conclusions: The present study demonstrated that a longer rehabilitation time per week was associated with increased functional gain in elderly stroke patients at convalescent rehabilitation wards.

Effectiveness of acute in-hospital occupational therapy for older patients with hip fracture.

To test the hypothesis that hip fracture patients who receive occupational therapy (OT) have better functional ability than those who do not. This retrospective observational study utilized data from the Japan Rehabilitation Database spanning 2005-2015. In-hospital hip fracture patients admitted to acute hospitals were identified. In total, 1266 patients were eligible based on the exclusion criteria. The primary outcome was motor Functional Independence Measure (FIM) efficiency. Patients who received OT were 50.9% of hip fracture patients. Patients who received OT had significantly higher scores in motor FIM efficiency (mean 0.79 vs 0.70; P = 0.02) and FIM effectiveness (mean 0.49 vs 0.41; P < 0.01) than the patients who did not receive OT. From multivariate linear regression analysis, OT was identified as a significant factor in motor FIM efficiency (coefficient 1.29, 95% confidence interval 1.14-1.47; P < 0.01) and FIM effectiveness (coefficient 1.07, 95% confidence interval 1.02-1.12; P < 0.01). The present cohort analysis showed that OT for hip fracture patients in the acute phase likely contributes to improved functional ability. Geriatr Gerontol Int 2019; 19: 611-615.

Effectiveness of self-exercise on elderly patients after hip fracture : A retrospective cohort study.

The purpose of this study was to clarify the impact of self-exercise for elderly patients in an acute hospital after hip fracture. This retrospective observational study used data from the Japan Rehabilitation Database spanning 2005-2015. This study identified in-hospital hip fracture patients admitted to an acute hospital. After applying exclusion criteria, 375 patients were eligible. The primary outcome was motor Functional Independence Measure (FIM) efficiency. Of the patients with hip fracture, 39% performed self-exercises. Patients who performed self-exercise had significantly higher motor FIM efficiency than those who did not (1.22 vs. 0.79 ; P ?0.01). Multivariable regression analysis showed that motor FIM efficiency was significantly and positively correlated with self-exercise (coefficient, 0.25 ; 95% confidence interval, 0.13 to 0.43 ; P ?0.01). The data suggest that self-exercise is associated with good rehabilitation outcomes in hip fracture patients. J. Med. Invest. 66 : 178-181, February, 2019.

Characteristics of rehabilitation services in high-FIM efficiency hospitals after hip fracture.

Characteristics of rehabilitation services probably explain a large proportion of the variation in clinical outcomes following hip fracture. The aim of this study was to clarify rehabilitation characteristics of high-performance hospitals after hip fracture. This is a retrospective observational study using the Japan Rehabilitation Database for the period 2005-2015. We divided facilities into high-FIM efficiency and low-FIM efficiency hospitals by using the mean of Functional Independence Measure efficiency for each hospital. We compared rehabilitation characteristics between high- and low-FIM efficiency hospitals. We identified 1247 patients with hip fracture from 12 hospitals who were eligible for analysis after applying exclusion criteria. Using one-to-one random matching on admission Functional Independence Measure, 880 pairs of patients were included for final analysis. More patients were discharged home in the high-FIM efficiency hospitals compared with low-FIM efficiency hospitals. High-FIM efficiency hospitals had significantly shorter length of stay. Patients in high-FIM efficiency hospitals received higher amounts of daily rehabilitation, early rehabilitation, and preoperative rehabilitation. Patients in high-FIM efficiency hospitals engaged in more weekend exercise and self-exercise. Our data suggested that the amount, timing, and type of rehabilitation are essential indicators of performance in acute hip fracture. J. Med. Invest. 66 : 324-327, August, 2019.

Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database.

The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.

Developing a clinical prediction rule for discharge home in patients with severe stroke

Even in patients with severe stroke, it is necessary to predict in an early stage whether they can be discharged home from hospital in order to offer the later services at home. The purpose of this study was to develop a clinical prediction rule (CPR) for discharge home after rehabilitation in patients with severe stroke. The subjects were 206 patients with stroke during post-acute phase, registered in the Japan Rehabilitation Database, whose Functional Independence Measure (FIM) scores was 36 points or less. The following potential independent variables at the time of admission to the rehabilitation ward were collected; age, gender, side of lesion, duration since stroke onset, National Institutes of Health Stroke Scale score, cognitive status, speech disorder status, motor/sensory impairment status and scores of each item of FIM. The collected data were evaluated using Classification and Regression Trees (CART) analysis method to develop a CPR for discharge home. Forty-six percent of the patients were discharged home after rehabilitation. The CART analysis found the CPR included age, motor FIM score, motor impairment status of upper limb, functional status of eating, grooming, and memory (sensitivity = 76.6%, specificity = 76.8%, positive predictive value = 73.5%, negative predictive value = 79.6%, accuracy = 76.7%). The best predictor for discharge home was the level of functional status of eating, the next predictors were age and motor FIM score. The CPR with moderate accuracy was developed to predict discharge home after rehabilitation in patients with severe stroke. Further investigation including environmental factors is necessary to improve accuracy of the CPR.

Rehabilitation Characteristics in High-Performance Hospitals after Acute Stroke

Rehabilitation characteristics in high-performance hospitals after acute stroke are not clarified. This retrospective observational study aimed to clarify the characteristics of high-performance hospitals in acute stroke rehabilitation. Patients with stroke discharged from participating acute hospitals were extracted from the Japan Rehabilitation Database for the period 2006-2015. We found 6855 patients from 14 acute hospitals who were eligible for analysis in this study after applying exclusion criteria. We divided facilities into high-performance hospitals and low-performance hospitals using the median of the Functional Independent Measure efficiency for each hospital. We compared rehabilitation characteristics between high- and low-performance hospitals. High-performance hospitals had significantly shorter length of stay. More patients were discharged to home in the high-performance hospitals compared with low-performance hospitals. Patients in high-performance hospitals received greater amounts of physical, occupational, and speech therapy. Patients in high-performance hospitals engaged in more self-exercise, weekend exercise, and exercise in wards. There was more participation of board-certified physiatrists and social workers in high-performance hospitals. Our data suggested that amount, timing, and type of rehabilitation, and participation of multidisciplinary staff are essential for high performance in acute stroke rehabilitation.

Impact of orthotic therapy for improving activities of daily living in individuals with spinal cord injury: a retrospective cohort study.

Retrospective cohort study. To determine the impact of leg orthotic therapy for improving activities of daily living after spinal cord injury. Participating acute care and rehabilitation hospitals across Japan. We retrospectively identified individuals with spinal cord injury admitted to eight participating hospitals in 2015-2016 from the Japan Rehabilitation Database. Data for 293 individuals were analyzed. Propensity score analysis by inverse probability weighting (IPW) was applied to adjust for potential bias and create two comparable groups. Outcomes were compared between the leg orthotic group and the non-leg orthotic group, using IPW. The primary outcome was motor Functional Independence Measure® (FIM) effectiveness score and the secondary outcome was motor FIM score at discharge. FIM was measured on hospital admission and discharge. Leg orthoses were prescribed for 26% of the 293 individuals. Those prescribed leg orthoses had significantly higher motor FIM effectiveness scores than those who were not, before and after IPW (motor FIM effectiveness: 0.54 vs. 0.35, p < 0.01 and 0.45 vs. 0.36, p = 0.02). Discharge motor FIM was significantly higher in individuals who were prescribed leg orthoses than in those who were not, before and after IPW (discharge motor FIM: 64.5 vs. 52.2, p < 0.01 and 58.9 vs. 53.5, p = 0.02). Leg orthoses may improve activities of daily living in individuals with spinal cord injury after the acute phase.

Effectiveness of preoperative physical therapy for older patients with hip fracture.

To clarify the effectiveness of preoperative physical therapy for older patients after hip fracture in an acute care hospital. In the present retrospective observational study, data from the Japan Rehabilitation Database were analyzed for patients admitted to an acute care hospital with hip fracture between 2005 and 2015. In this study, all eligible patients received surgery within 10 days of admission. Propensity score analysis was used to compare outcomes between patients who underwent preoperative rehabilitation and those who did not. The primary outcome was motor Functional Independence Measure (FIM) gain. Of the 681 patients eligible after applying exclusion criteria, 50% underwent preoperative rehabilitation after hip fracture. Both before and after adjustment by inverse probability weighting, motor FIM gain was significantly higher in patients who underwent preoperative rehabilitation (motor FIM gain 31.1 ± 18.2 before weighting, 31.1 ± 18.2 after weighting) than in those who did not (motor FIM gain 24.6 ± 18.1 before weighting, P < 0.01; 26.2 ± 17.6 after weighting, P < 0.02). In addition, motor FIM effectiveness and motor FIM at discharge were significantly higher among patients who underwent preoperative rehabilitation. Our data suggest that preoperative rehabilitation after hip fracture is associated with better rehabilitation outcomes than no preoperative rehabilitation. Geriatr Gerontol Int 2018; 18: 1003-1008.

Clinical Effectiveness of Board-certificated Physiatrists on Functional Recovery in Elderly Stroke Patients During Convalescence: A Retrospective Cohort Study

Summary Background Rehabilitation is an important determinant of functional recovery in elderly stroke patients. The purpose of this study was to clarify the clinical effectiveness of board-certificated physiatrists as responsible physicians on functional recovery in elderly stroke patients during convalescence. Methods In this retrospective study, we analyzed the data of post-stroke patients admitted to rehabilitation wards entered into the Japan Rehabilitation Database between 2005 and 2013. The main outcome was Functional Independence Measure efficiency. For analysis, we used propensity scores and inverse probability weighting adjustment to reduce selection bias. A generalized estimation equation was used to account for confounding by cluster. Results A total of 2873 patients (mean age: 70) were eligible after applying exclusion criteria. The responsible physicians caring for 1214 stroke patients were board-certificated physiatrists. Using inverse propensity score weighting, patients' baseline characteristics were closely balanced between patients who were managed by board-certificated physiatrists and those without board-certificated physiatrists. After adjustment, patients who were managed by a board-certificated physiatrist as a responsible physician had significantly higher scores for Functional Independence Measure efficiency than those without a board-certificated physiatrist (mean: 0.31 vs 0.28; p = 0.035). Conclusions Our results suggest that clinical management provided to elderly stroke patients by board-certificated physiatrists is associated with good functional improvement. Board certification should be encouraged to improve the quality of rehabilitative management of post-stroke patients.

The stratification of motor FIM and cognitive FIM and the creation of four prediction formulas to enable higher prediction accuracy of multiple linear regression analysis with motor FIM gain as the objective variable&amp;horbar;An analysis of the Japan Rehabilitation Database

Tokunaga M, Tori K, Eguchi H, Kado Y, Ikejima Y, Ushijima M, Miyabe S, Tsujimoto S, Fukuda E. The stratification of motor FIM and cognitive FIM and the creation of four prediction formulas to enable higher prediction accuracy of multiple linear regression analysis with motor FIM gain as the objective variable ― An analysis of the Japan Rehabilitation Database. Jpn J Compr Rehabil Sci 2017; 8: 21-29.

Activities of daily living independence level for home discharge in stroke patients based on number of caregivers: an analysis of the Japan Rehabilitation Database.

Purpose This study aimed to calculate cut-off values of activities of daily living independence level for stroke patient home discharge based on the number of family caregivers. Method The subjects comprised 1442 stroke patients (26 hospitals) who were registered of the Japanese Rehabilitation Database. Receiver operating characteristic curves were used to elucidate the BI and FIMⓇ instrument scores necessary for home discharge. Analysis was performed for each subject according to the number of family caregivers, i.e., no caregiver, one person, two persons or more, and overall. Result The BI cut-off points that discriminated between home discharge and other were 65/60 points overall, 75/70 points in patients with no caregiver, 65/60 points in patients with one caregiver, and 60/55 points in patients with two or more caregivers. The FIMⓇ instrument cut-off points were 90/89 points overall, 101/100 points in patients with no caregiver, 87/86 points in patients with one caregiver, and 87/86 points in patients with two or more caregivers. Conclusion Our results indicated that home discharge for patients with many caregivers was possible even with low ADL independence levels, and that there was a large difference in cut-off values depending on the presence or absence of one caregiver.

Association Between 7 Days Per Week Rehabilitation and Functional Recovery of Patients With Acute Stroke: A Retrospective Cohort Study Based on the Japan Rehabilitation Database

ObjectiveTo test the hypothesis that functional outcome of patients with stroke who receive 7d/wk of rehabilitation is generally better than that of similar patients who undergo 5 or 6d/wk of rehabilitation. DesignRetrospective cohort study. SettingAcute hospitals. ParticipantsFrom the Japan Rehabilitation Database, which includes data on 8033 patients with acute stroke collected between January 2005 and December 2013, we included 3072 patients with stroke who were admitted to the acute hospitals and received 7d/wk of rehabilitation. InterventionSeven days per week of rehabilitation was defined as rehabilitation therapy administrated by a physical or occupational therapist on every weekday, Saturday, and Sunday. Main Outcome MeasureFavorable functional independence in daily living, defined as a modified Rankin Scale score of 0 to 2 at the time of discharge. ResultsA total of 1075 (35.0%) patients received 7d/wk of rehabilitation. Univariate analysis demonstrated a significant difference in favorable functional recovery between the 7d/wk rehabilitation group and non–7d/wk rehabilitation group (43.3% vs 37.6%, respectively; P=.002). Multivariate logistic regression analysis using the generalized estimating equations method showed that 7d/wk of rehabilitation was independently associated with favorable functional recovery. ConclusionsOur cohort analysis demonstrated that 7d/wk of rehabilitation in early rehabilitation for patients with acute stroke can lead to functional recovery.

脳卒中データベースからみたリハビリテーション科専門医関与のアウトカムと今後の解析に向けての展望

超高齢社会の到来とともにリハビリテーション（以下，リハ）科専門医のニーズは高まっている．しかし，リハ医療に対する専門医の貢献度を目にみえる形で示しているとは必ずしも言いにくい．リハ科専門医が関与する治療効果のアウトプットが不足していることが一因であると考えられる．本稿の前半では，リハ科医師関与のアウトカムを検討することを目的に日本リハ・データベース（Japan Rehabilitation Database，以下JRD）の脳卒中急性期患者の登録データを解析した結果のアウトラインを示した．専門医が関与する脳卒中急性期患者は，主治医・コンサルタント医いずれにおいても，FIM総得点変化が大きいことが示された．本稿の後半ではJRDを用いたこれまでの脳卒中研究のいくつかを紹介し，データベースの有用性や限界，今後の解析に向けての展望に触れる．

日本リハビリテーション・データベースからの成果と展開

日本リハビリテーション・データベースからの成果と展開