The Role of the Physiatrist in Stroke Rehabilitation: A European Survey

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

Association between the number of board-certified physiatrists and volume of rehabilitation provided in Japan: an ecological study

Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered.

Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists.

Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P<0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services.

Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

Assessment on Distributional Fairness of Physical Rehabilitation Resource Allocation: Geographic Accessibility Analysis Integrating Google Rating Mechanism

Identifying and treating co-existing diseases are essential in healthcare for the elderly, while physical rehabilitation care teams can provide interdisciplinary geriatric care for the elderly. To evaluate the appropriateness of demand and supply between the population at demand and physical rehabilitation resources, a comparative analysis was carried out in this study. Our study applied seven statistical indices to assess five proposed methods those considered different factors for geographic accessibility analysis. Google ratings were included in the study as a crucial factor of choice probability in the equation for calculating the geographic accessibility scores, because people's behavioral decisions are increasingly dependent on online rating information. The results showed that methods considering distances, the capacity of hospitals, and Google ratings' integrally generated scores, are in better accordance with people's decision-making behavior when they determine which resources of physical rehabilitation to use. It implies that concurrent considerations of non-spatial factors (online ratings and sizes of resource) are important. Our study proposed an integrated assessment method of geographical accessibility scores, which includes the spatial distribution, capacity of resources and online ratings in the mechanism. This research caters to countries that provide citizens with a higher degree of freedom in their medical choices and allows these countries to improve the fairness of resource allocation, raise the geographic accessibilities of physical rehabilitation resources, and promote aging in place.

Changes in the Characteristics of Rehabilitation Physicians over Two Decades: Analysis of National Physician Census Surveys in Japan

Objective:

The aim of the study was to analyze the demographics of rehabilitation physicians and their retention trends, identify factors related to physician retention, and consider the policy implications.

Methods:

The individual data from 1996 to 2016 from a national census survey administered every two years by the national government of Japan were analyzed. The physician retention trends were then evaluated. Finally, a multivariable logistic regression analysis was performed to identify the factors related to the retention of rehabilitation physicians.

Results:

The total numbers of rehabilitation physicians in 1996 and 2016 were 902 (0.4% of all physicians) and 2484 (0.8% of all physicians), respectively, an increase of 175%. It should be noted that between 1996 and 2016 the number of physicians aged ≤39 years decreased, whereas the number of physicians aged ≥40 years greatly increased to 2118, accounting for 85.3% of all rehabilitation physicians in 2016. The overall annual retention rate of full-time rehabilitation physicians from 1996 to 2016 increased by 6.6%. The odds of continuing to practice as a rehabilitation physician were significantly higher for academic hospital physicians than for clinic physicians.

Conclusion:

The dramatic increase in the number of rehabilitation physicians in Japan has been prompted by policy measures and rapidly increasing demands for rehabilitation due to the aging of society. Ensuring the entry of younger physicians into this career path through efforts such as establishing rehabilitation medicine classes in every school of medicine is necessary to promote the development of specialist rehabilitation physicians in Japan.

Rehabilitation Characteristics in High-Performance Hospitals after Acute Stroke

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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 board-certificated physiatrists on rehabilitation outcomes in elderly patients after hip fracture: An observational study using the Japan Rehabilitation Database

AIM

To clarify the impact on rehabilitation outcomes of board-certificated physiatrists (BCP) as the physicians with primary responsibility for elderly patients in convalescent rehabilitation wards after hip fracture.

METHODS

The present retrospective observational study used 2005-2013 data from the Japan Rehabilitation Database. We identified in-hospital patients with hip fracture admitted to rehabilitation wards. After applying exclusion criteria, 824 patients were eligible. The primary outcome was functional independence measure instrument efficiency.

RESULTS

BCP were responsible for the care of 46% of patients with hip fracture. Patients who were managed by a BCP had significantly higher mean functional independence measure efficiency than patients who were not, both before and after adjustment by inverse propensity-score weighting (0.37 vs 0.26; P = 0.04 and 0.39 vs 0.26; P < 0.01, respectively). Additionally, the mean length of stay was significantly shorter in patients who were managed by BCP than in those who were not, both before and after inverse propensity-score weighting (65 vs 71 days, P = 0.04 and 64 vs 69 days, P < 0.01, respectively).

CONCLUSIONS

Our data suggest that the participation of BCP is associated with good rehabilitation outcomes in patients with hip fracture at convalescent rehabilitation wards. Geriatr Gerontol Int 2016; 16: 963-968.