Treatment strategies for intensive rehabilitation after stroke based on cost-effectiveness analysis

2020 Fiscal Year Final Research Report

• Project/Area Number: 18K17324
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Kanagawa University of Human Services
• Principal Investigator: Hirofumi Nagayama 神奈川県立保健福祉大学, 保健福祉学部, 准教授 (00552697)
• Project Period (FY): 2018-04-01 – 2021-03-31
• Keywords: リハビリテーション / 費用対効果分析

Outline of Final Research Achievements

The purpose of this study was to examine the appropriate rehabilitation intensity (total rehabilitation time/day) in the convalescent rehabilitation ward　for stroke patients from the viewpoint of cost-effectiveness.
In the first phase of the study, the effects of high-intensity rehabilitation (6 or more units per day, 20 minutes per unit) on medical costs and readmission rates one year after discharge were investigated in a regression discontinuity design and natural experiment design using receipt data. The results showed that higher intensity rehabilitation in convalescent rehabilitation wards did not affect the reduction of medical costs and readmission rates compared to lower intensity rehabilitation (Nagayama et al. 2019, Nagayama et al. 2021).　We could acknowledge that our important issue for the future study is the rehabilitation intensity according to patient characteristics and severity.

Free Research Field

作業療法学，リハビリテーション

Academic Significance and Societal Importance of the Research Achievements

本研究の学術的意義としては，高強度のリハが長期的な再入院や退院後の医療費に影響がないことを明らかにした点である．しかしながら，これまでの先行研究では退院時の日常生活活動の自立度向上に影響を与えているといった報告や，短期的な再入院を減少させるといった報告がある．つまり，高強度のリハによって退院時の機能向上には有用であるが，長期的な医療費の軽減にはつながっていない可能性が示唆された．ただし，本研究では，介護費用について検討していない点，直接的な医療費のみの検討である点などの限界がある．さらに，患者特性に応じて適切なリハ密度は異なるのではないかといった臨床的視点での研究課題が残されている．