A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey

Makoto Asaeda; Yukio Mikami; Yukihide Nishimura; Toshio Shimokawa; Hiroshi Shinohara; Takashi Kawasaki; Ken Kouda; Takahiro Ogawa; Hiroyuki Okawa; Hiroyasu Uenishi; Rumi Kuroda; Yasuo Mikami; Fumihiro Tajima; Toshikazu Kubo

doi:10.1097/MS9.0000000000000199

A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey

Ann Med Surg (Lond). 2023 Jan 23;85(1):17-23. doi: 10.1097/MS9.0000000000000199. eCollection 2023 Jan.

Authors

Makoto Asaeda^{1

2}, Yukio Mikami³, Yukihide Nishimura⁴, Toshio Shimokawa⁵, Hiroshi Shinohara⁶, Takashi Kawasaki⁷, Ken Kouda², Takahiro Ogawa⁸, Hiroyuki Okawa⁹, Hiroyasu Uenishi¹, Rumi Kuroda¹⁰, Yasuo Mikami⁷, Fumihiro Tajima², Toshikazu Kubo¹¹

Affiliations

¹ Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care.
² Department of Rehabilitation Medicine.
³ Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima.
⁴ Department of Rehabilitation Medicine, Iwate Medical University, Shiwa-gun, Iwate Prefecture.
⁵ Clinical Study Support Center, Wakayama Medical University, Wakayama.
⁶ Graduate School of Health Science, Aomori University of Health and Welfare, Aomori.
⁷ Department of Rehabilitation Medicine, Graduate School of Medical Science.
⁸ Department of Rehabilitation Medicine, Aichi Medical University, Aichi, Japan.
⁹ Department of Health and Nutrition Sciences, Faculty of Health and Nutrition Sciences, Nishikyushu University, Kanzaki, Saga Prefecture.
¹⁰ School of Nursing, Fukushima Medical University, Fukushima.
¹¹ Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto.

Abstract

There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires.

Materials and methods: This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient.

Results: Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6).

Conclusions: The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.

Keywords: aged; community health services; questionnaires; rehabilitation medicine; surveys.