Objective: The objective of this study is to investigate the outcome-determining factors of stroke patients treated in our hospital which is the largest hospital in Ibaraki Prefecture with more than 1,000 beds.Methods: Ninety two patients (62 with cerebral infarction and 30 with hemorrhage) who were hospitalized for stroke for the first time between January and June in 2004, and underwent rehabilitation. The patients were classified into two groups according to their outcomes: Group 1 patients who were directly discharged to home and Group 2 patients who were transferred to other hospitals or nursing homes. We investigated the severity of paresis, high cortical functional disorder as complication, functional outcome, and family background of these patients, and analyzed the outcome-determining factors.Result: Among the patients, 65.2% were directly discharged to home. Their paresis was not severe in most cases, and 70% of them could walk independently (with or without canes and devices). There were no significant differences in age or family size between the two groups. Fifteen patients did not choose to go home, even though they were physically able to do so. They all had higher brain dysfunction or difficulty in accepting their disability. For such patients, the shortage of caregivers was not necessarily considered as a factor in their decision not to go home.Conclusion: The severity of paresis and walking ability (locomotion) are the key factors in determining of whether the patients can be discharged to home or not.
Cerebrovascular accident ; Paresis ; Impaired health ; Hospitals ; agreement

Objective：In Parkinson's disease and Parkinsonian syndrome (referred to collectively as PD), the progression of functional decline is influenced by complications such as bone fracture or pneumonia. We aimed to assess the efficiency of short-term inpatient rehabilitation therapy for patients with PD in terms of functional recovery and cost-effectiveness.

Methods：We investigated differences in outcomes of inpatient rehabilitation for 84 patients with PD, in relation to reasons for hospitalization. Patients with complications, including orthopedic diseases (n＝15), and disuse syndrome (n＝16) received therapy for 3 hours/day in Kaifukuki postacute convalescent rehabilitation wards (KRW) or 2 hours/day in other facilities. Fifty-three patients without complications and thus not eligible for admission to KWR were provided with short-term inpatient rehabilitation therapy (training for 2 hours/day, 6 days/week for 1 month).

Results：In the patients without complications, the efficiency of FIM (FIM gain/hospital stay) was significantly greater (p＝0.03) and the amount of training and the medical expenses needed to improve the FIM score by 1 point, calculated as total training units (1 unit＝20 minutes of therapy as per the Japanese medical insurance system) divided by FIM gain and total medical cost divided by FIM gain, showed a decreasing trend (p＝0.07, 0.10, respectively) in comparison with that in the patients with complications.

Conclusion：Short-term inpatient rehabilitation for PD patients without complications is beneficial in terms of rehabilitation efficiency and cost-effectiveness, and appears effective at preventing complications and reducing costs. Reconsideration of the medical insurance system may be necessary so that short-term inpatient rehabilitation can be offered in various facilities, including Kaifukuki wards.