理学療法ジャーナル39巻8号

2005年08月発行

特集 脳卒中の理学療法を再考する

脳卒中に対する理学療法の治療効果

著者： 原田和宏¹

所属機関： ¹財団法人岡山県健康づくり財団健康づくり企画支援室

ページ範囲：P.675 - P.682

はじめに

　脳卒中患者に対して理学療法の治療効果が得られることは臨床経験則からは実感される．「理学療法は脳卒中の予後をよい方向に導く」という確信は理学療法士が積極的で質の高いサービスを行うための動機につながるだろう．では，科学的には何が明らかになっていて，何が不明確なのだろうか．例えば，脳卒中発症後早期，あるいはその後の回復期に理学療法士が関わることによる病気の症候改善は客観的に検証されているのか？　退院後，あるいは慢性期は疫学的にみると能力低下を起こしやすいが，理学療法を継続することで機能の維持や向上が可能なのか？

　理学療法の効果判定をする場合は，病気の予後や症候の改善を「理学療法」が制御できるかどうかを検証することとなる．すなわち，「理学療法」を「自分自身が行っている行為」としてみるのではなく，主観的な期待をできるだけ排除し，「患者を取り巻く外部的（環境的）な要因の1つ」として第三者的にみることが求められる．科学的根拠に基づく医療（evidence-based medicine, EBM）の普及で，脳卒中に対する理学療法の効果についても様々なエビデンスが報告されてきた．本稿では，脳卒中の急性期（acute），亜急性期（subacute）と回復期（postacute），そして退院後（after discharge）と慢性期（chronic）における理学療法の治療効果について，強いエビデンスをもたらす無作為比較試験（randomized controlled trials, RCTs）の成績をたどり概観する．

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