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Hiroharu Kamioka1, Kiichiro Tsutani2, Yoshiteru Mutoh3, Hiroyasu Okuizum4, Miho Ohta5, Shuichi Handa4, Shinpei Okada6, Jun Kitayuguchi7, Masamitsu Kamada7, Nobuyoshi Shiozawa8, Sang-Jun Park4, Takuya Honda4, Shoko Moriyama41Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan; 2Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, 3Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan; 4Mimaki Onsen (Spa) Clinic, Tomi City, Japan; 5Laboratory of Aqua, Health, and Sports Medicine, 6Physical Education and Medicine Research Foundation, Nagano, Japan; 7Physical Education and Medicine Research Center Unnan, Unnan City, Japan; 8Department of Longevity and Social Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanBackground: The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonrandomized controlled trials (nRCTs).Methods: Study design was a systematic review of nonrandomized controlled trials. Trials were eligible if they were nonrandomized clinical trials. Studies included one treatment group in which aquatic exercise was applied. We searched the following databases from 2000 up to July 20, 2009: MEDLINE via PubMed, CINAHL, and Ichushi-Web.Results: Twenty-one trials met all inclusion criteria. Languages included were English (N = 9), Japanese (N = 11), and Korean (N = 1). Target diseases were knee and/or hip osteoarthritis, poliomyelitis, chronic kidney disease, discomforts of pregnancy, cardiovascular diseases, and rotator cuff tears. Many studies on nonspecific disease (healthy participants) were included. All studies reported significant effectiveness in at least one or more outcomes. However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies. Furthermore, there was the problem of heterogeneity, and we were therefore not able to perform a meta-analysis.Conclusion: Because there was insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of nRCTs, we were unable to offer any conclusions about the effects of this intervention. However, we were able to identify problems with current nRCTs of aquatic exercise, and propose a strategy of strengthening study quality, stressing the importance of study feasibility as a future research agenda objective.Keywords: aquatic exercise, systematic review, nonrandomized controlled trials&nbsp

本研究は,横断研究により,女性介護者における腰痛との関連要因を明らかにすることを目的とした。4カ所の特別養護老人ホームに勤務する女性介護職員88人を対象として,腰痛の有無,経験年数,Body Mass Index(BMI),握力,長座体前屈,指床間距離(Finger-Floor Distance : FFD),抑うつ自己評価スコア(the Center for Epidemiologic Study Depression Scale : CES-D),SF-8による身体的健康度(Physical Health Score : PHS)と精神的健康度(Mental Health Score : MHS),疲労の自覚症状を調査した。腰痛の有無を目的変数とし,その他の変数を説明変数とした多重ロジスティック回帰分析を行った。49人(55.7%)が,慢性的な腰痛を訴えていた。多重ロジスティック回帰分析の結果,腰痛の発生は,身長がオッズ比(OR)1.12,95%信頼区間(95%CI)1.02-1.23,SF-8による身体的健康度(PHS)が,OR : 0.89(95%CI : 0.86-0.97),精神的健康度(MHS)がOR : 0.90(95%CI : 0.81-0.99)で有意であった。本研究は,身長が高いことは中腰姿勢を助長し,腰痛を起こす原因になるかもしれないこと,身体・精神的な健康の程度は,腰痛と関係があることが明らかになった。今後,交代勤務に伴う睡眠障害や慢性疲労との関連性も含めて検討すべきであることが示唆された。, The objective of this cross-sectional study was to reveal the actual conditions and related factors of low back pain among female caregivers in special nursing homes for the elderly.The participants were 88 female caregivers in four facilities for the elderly. We surveyed the existence of low back pain, employment period, Body Mass Index (BMI), grip power, sitting forward flexion, Finger-Floor Distance (FFD), the Center for Epidemiologic Study Depression Scale (CES-D), Physical Health Score (PHS) and Mental Health Score (MHS) by using SF-8 and subjective symptoms of fatigue. Multinomial logistic regression model was used to investigate how far low back pain was related to mental and physical health status, flexibility, power, employment period, and BMI.55.7% (N=46) of the participants notified the presence of chronic lumbago. The result of multinomial logistic regression model showed that the existence of low back pain was significant in the following variables : 1) Odds ratio (OR)=1.12 (95% confidence interval : 95%CI=1.02-1.23) for height, 2) OR=0.89 (95% CI=0.81-0.97) for PHS, 3) OR=0.90 (95% CI=0.81-0.99) for MHS.Our findings suggest that height may reinforce a half-crouching position, thus it can be a cause of low back pain, and that the degree of physical and mental health is related to low back pain. It was also suggested that lumbago prevention and/or reduction strategy should include the relevance of sleep interruption and chronic fatigue with shift work when this problem is examined in future.

本研究は,総務省が平成17年(2005)年に分類した小規模自治体を対象として,次のことを明らかにすることを目的とした。1)保健医療福祉の関連指標について,類似する自治体間で比較を行うこと,つまり地域診断を実施すること,2)介護及び医療費に関連する因子を明らかにすることである。対象となる類似自治体は,総務省類型分類(人口及び産業構造から分類)で,平成17(2005)年度に山梨県小菅村が該当した「町村I-1(人口5,000人未満で,第二,三次産業従事者が80%以上,第三次産業従事者55%未満),54自治体」であった。本研究開始時の平成20(2008)年8月時点において,54町村すべての合併状況を確認した結果,独立して存続している町村は11であった。用いた指標は,老人医療費,入院費,介護費,人口,高齢化率,核家族世帯数,第一次・二次・三次の各産業従事者割合,要介護認定率,平均寿命などあった。11町村の中で,特徴的だった例を4つ列挙する。1)長野県天竜村は平均寿命が長く,医療費と介護費も低い傾向にあった(医療費・介護費併用型)。2)小菅村と山梨県鳴沢村は,医療費や介護費,介護認定率が低かった(医療費・介護費安価型)。3)東京都御蔵島村と群馬県上野村は,医療費は低いが介護費が高かった(介護費依存型)。4)沖縄県北大東村は,寿命は長いが,介護費が高かった(その他型)。重回帰分析の結果,医療費と有意な相関があったのは,入院費であった。介護費と有意な相関があったのは,65歳以上の親族のいる核家族世帯数であった。小規模自治体において,介護保険依存と医療費依存の方向性を有する自治体があり,保健医療福祉の評価には,両者を合わせて検討する必要性が示唆された。サンプルサイズが小さいということや,検討に用いることができたデータの内容について限界はあるが,核家族と入院が介護費用と医療費に影響を及ぼしている可能性があることが示された。, The objectives of this study were to compare medical expenses of similar local governments, and to clarify the factors related to expenses for care and medicine. The subjects of our investigation were local governments with a national classification in fiscal 2005 that was similar to Kosuge village in Yamanashi based on population and industrial structure : the population was smaller than 5000, the total percentage of secondary and tertiary industry was more than 80%, and the percentage of tertiary industry was less than 55%. These criteria were met by 54 local governments. When we started this investigation in August 2008, 11 governments remained unconsolidated. The indices consisted of medical expenses for the aged, hospital expenses, nursing-care expenses, population size, aging population, the number of nuclear families, the industrial structure, the percentage of advanced nursing care, and life expectancy. The outstanding points were as follows : 1) Tenryu village in Nagano showed long life expectancy and low medical and nursing-care expenses (combination type by medical and nursing-care expenses) ; 2) Kosuge and Narusawa village in Yamanashi showed low medical and nursing-care expenses and a low percentage of advanced nursing-care (low-cost type of medical and nursing-care expenses) ; 3) Mikurajima village in Tokyo and Ueno village in Gunma showed low medical expenses and high nursing-care expenses (dependent type by nursing-care expense) ; and 4) Kitadaito village in Okinawa showed long life expectancy and high nursing-care expenses (other type). In multiple regression analysis, only hospital expense was found to explain medical expenses, and the number of nuclear families consisting of the elderly was found to explain nursing-care expenses. These results imply that there are two types of local governments that must be considered in health care analyses : one depends on nursing-care, and the other depends on medicine. In spite of the small sample size as statistical data discussion for interpretation, results from this study suggest that nuclear families and hospitalization affect nursing-care and medical expenses.