福島県立医科大学 学術機関リポジトリ

Title

Home-visit rehabilitation in a repopulated village after the
Fukushima nuclear disaster

Author(s)Saito, Yuta; Sato, Keiichiro; Itagaki, Tatsuya; Omata, Fumiya;
Sawano, Toyoaki; Kobashi, Yurie; Nishikawa, Yoshitaka;
Tsubokura, Masaharu; Hoshi, Wataru

Citation

Fukushima Journal of Medical Science. 68(2): 71-77

Issue Date

2022

URL

http://ir.fmu.ac.jp/dspace/handle/123456789/1869

Rights© 2022 The Fukushima Society of Medical Science. This
article is licensed under a Creative Commons [AttributionNonCommercial-ShareAlike 4.0 International] license.

DOI

10.5387/fms.2021-30

Text Version publisher

This document is downloaded at: 2024-10-16T11:32:04Z

Fukushima Medical University

Home-visit rehab after nuclear disaster

Fukushima J. Med. Sci.,
Vol. 68, No. 2, 2022

71

[Original article]

Home-visit rehabilitation in a repopulated village after
the Fukushima nuclear disasterYuta Saito1), Keiichiro Sato1)2), Tatsuya Itagaki1)2), Fumiya Omata3), Toyoaki Sawano4)5),
Yurie Kobashi3)4), Yoshitaka Nishikawa3), Masaharu Tsubokura3)4) and Wataru Hoshi1)
1)

Department of Rehabilitation, Hirata Central Hospital, Fukushima, Japan, 2)Seireikai Home Nursing
Station Hirata, Fukushima, Japan, 3)Department of Internal Medicine, Hirata Central Hospital, Fukushima, Japan, 4)Department of Radiation Health Management, Fukushima Medical University School of
Medicine, Fukushima, Japan, 5)Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan(Received November 8, 2021, accepted April 1, 2022)

Abstract
Following the evacuation of areas affected by Japan’s 2011 Fukushima Daiichi Nuclear Power Plant(FDNPP) accident, Kawauchi Village was one of the first municipalities repopulated. Although rehabilitation resources were limited, a healthcare facility near the municipality initiated home-visit
rehabilitation in 2016. To the best of our knowledge, reports of home-visit rehabilitation in repopulated villages that were evacuated following a nuclear accident are lacking.
This article describes a case study of home-visit rehabilitation in Kawauchi Village. The purposeof this study was to explore how users of home-visit rehabilitation services in Kawauchi Village perceive home-visit rehabilitation, and whether it had a positive impact on their daily life. A questionnaire survey was conducted, and their ability to perform activities of daily living was assessed, tounderstand the living conditions of the visiting-rehabilitation service users.
We studied 10 rehabilitation-service users, with a mean age of 86.8 years, who had used the services
for an average of 591.4 days. Themes that emerged from the open-ended questionnaire were “established exercise habits and improved physical functions,” “the joy of returning to the village,”“challenges in the mountainous areas” and “changes in relationships due to the earthquake or evacuation.”
In conclusion, home-visit rehabilitation was successfully implemented in the repopulated village,
and helped maintain the users’ physical functions. This may thus be a viable choice for rehabilitation care in repopulated areas after disasters.
Key words : Fukushima Nuclear Disaster, home-visit rehabilitation, community healthcare, community dwelling, older adults, case study

itation enables elderly people to receive care athome, which helps them maintain their dignity andlive independently1). Additionally, rehabilitation
plays an important role in enabling independent living in many countries around the world2 5). In ruraland remote areas, there is a lack of sufficient medi-

Introduction
Home-visit rehabilitation is an important formof home-based rehabilitation that supports the lives
of, and provides care for, individuals who are unable
to visit rehabilitation facilities. Home-visit rehabil--

Corresponding author : Yoshitaka Nishikawa, MD, PhD.   E-mail : ynishikawa-tky@umin.ac.jp©2022 The Fukushima Society of Medical Science. This article is licensed under a Creative Commons [Attribution-NonCommercial-ShareAlike 4.0 International] license.
https://creativecommons.org/licenses/by-nc-sa/4.0/71

Y. Saito et al.

72

cal resources, and access to healthcare is affected bycost, distance to facilities, and information barriers,in addition to the limited availability of therapists6,7). Disaster evacuation and repopulation are
known to be complex situations that affect access tovarious healthcare services, such as emergency
medical services8). However, there is a lack of information regarding the provision of rehabilitation inlimited-resource areas, the distance to the patient’s
home, the number of staff available, and the frequency of rehabilitation activities. It is important thatrecovery areas provide rehabilitative care to community members returning to their homeland after adisaster evacuation.
In Fukushima Prefecture, Japan, residents of 12
municipalities within a 20 km radius were forced toevacuate due to the Fukushima Daiichi Nuclear
Power Plant (FDNPP) accident caused by the Great
East Japan Earthquake of March 11, 20119). The
FDNPP accident had a significant impact on the
medical system in Hamadori, the coastal region of
Fukushima Prefecture. Before the nuclear accident, there were 80 operational medical institutionsin Hamadori’s Futaba County ; however, by August
1, 2016, only 15, i.e., 18.75% of these institutions,were operational10).
Kawauchi Village, located 10-30 km from the
FDNPP (Figure 1), was one of the first municipalities to be repopulated after the evacuation in April
2012. Before the disaster, Kawauchi Village had

Fig. 1. Location of Kawauchi Village, Hirata Village,
Hirata Central Hospital (HCH), and Fukushima
Daiichi Nuclear Power Plant (FDNPP). This map
was created using R version 3.5.0 (http://www.rproject.org) and R Package “jpndistrict” (https://cran.r-project.org/web/packages/jpndistrict/index.
html), which derives its geographical plotting datafrom National Land Numerical Information (http://
nlftp.mlit.go.jp/ksj-e/index.html).

only one medical facility, the National Health Insurance Clinic11). Rehabilitation resources were limited by the closure of medical facilities in neighboringmunicipalities after the disaster.
In March 2016, the Healthcare Corporation
Seireikai was started as a home-visit rehabilitation
service in Kawauchi Village to provide access to rehabilitation care. However, contemporary reports
on home-visit rehabilitation in repopulated villages
after an evacuation following a nuclear accident havebeen scarce. Kawauchi Village is an important area
to understand the feasibility of home-visit rehabilitation in the repopulated areas, and how rehabilitation
care was conducted in a real-life situation.
Hence, this report describes a case study ofhome-visit rehabilitation in Kawauchi Village. The
purpose of this study was to explore how the usersof home-visit rehabilitation services in Kawauchi
Village perceive home - visit rehabilitation andwhether it has a positive impact on their daily life.

Methods
Setting
Kawauchi Village is a hilly and mountainous areawith an elevation of 400-600 m. In the 2010 census,
before the disaster, its population was 2,820, with theelderly (> 65 years old) comprising 35.2%. In 2015,
after the earthquake, the population was 2,021 withthe elderly comprising 37.9% of the total.
Home-visit rehabilitation was widespread in Japan before the earthquake, but Kawauchi Village did
not have such services. In March 2012, after theearthquake, Healthcare Corporation Seireikai signed
a medical welfare agreement with Kawauchi Village
to provide visiting rehabilitation services, but without any financial support. Since October 2020, we
have been the only institution providing visiting rehabilitation services in Kawauchi Village. There
was no relationship between Kawauchi Village and
Healthcare Corporation Seireikai before the disaster. Furthermore, there are only a limited numberof facilities in neighboring cities, towns, and villages
that provide visiting rehabilitation services in theformer evacuation zone.
The institute is located approximately 33 km
away from Kawauchi Village in Hirata Village, Fukushima Prefecture (Figure 1). The Japanese government has been promoting the establishment of acomprehensive regional support and service provision system within a 6 km radius by 2025. However, since the FDNPP disaster, it has been difficult toHome-visit rehab after nuclear disasterprovide home-visit rehabilitation services to the affected areas within this radius.
Case of Seireikai Home Nursing Station Hirata
Seireikai Home Nursing Station Hirata, Healthcare Corporation Seireikai, is currently operated bythree nurses (including one part-time nurse), fourphysical therapists (including one part-time therapist), and one part-time speech therapist. The percentage of home-care users in Kawauchi Village isapproximately 20%. Due to the limited availabilityof rehabilitation resources, the nursing home station
covers an approximate area of 30 km 2, including
Ishikawa County, a part of Futaba County, and a partof Iwaki City.
Three physical therapists were dispatched to
Kawauchi village thrice a week. The average number of visits per week was five, and the average
number of visits per patient was 1.3 per week. The
average travel distance from the office to the firstsite was 31.2±2.6 km, and the average travel timewas 39.3±2.7 minutes. As a reference, nationally
aggregated data showed an average travel distanceto the farthest user’s home of 23.6±11.5 km, with atravel time of 30.9±9.5 minutes, according to Japan’s Ministr y of Health, L abour and Welfare12). The average total distance traveled, which
included a round trip to and from Kawauchi Village
and between the residences, was 86.0 km, and theaverage travel time was 124.0 minutes.
Participants and design
This case study was an observational study ofhome-visit rehabilitation users who lived in Kawauchi Village during the study period. We conducteda review of the medical records and a questionnaire
survey of the home-visit rehabilitation users. The
participants of this study were all users of the homevisit rehabilitation service of the visiting nursing
station Hirata in February 2019. The users’ data
was reviewed in retrospect from the time they began using the home-visit rehabilitation service. A
questionnaire survey was conducted by home-visit
rehabilitation staff from February to March 2019, to
explore users’ opinions on home-visit rehabilitationand the repopulated village itself.
Analytical methods
To clarify the actual conditions of home rehabilitation users, the following items were extracted
from their medical records : gender, age, nursing
care level, number of days, daily life independence
level, degree of independence in daily living for el-73

derly with dementia, and Barthel Index (BI). To
evaluate the daily life activities of the users, themean and standard deviation of BI were calculated
from the first day of use to February 2019, the mostrecent date of the rehabilitation service. A thematic analysis was conducted based on the responses tothe open-ended questionnaire13). The authors assigned the first coding based on the written comments. The coding framework, developed by thetwo present authors, combined the codes into categories and themes to interpret the underlying factors related to home-visit rehabilitation and life in
the repopulated village. The themes were refined
through discussion, commented on by each participant, and checked against the entire dataset. All
co - authors reviewed the coding, categories, andthemes, discussed them, and resolved any disagreements through discussion.
Data management and coding of the descriptive
statistics and thematic analyses were performed using Excel for Windows 2016.
Ethical Considerations
The study was approved by the Ethics Committee of Hirata Central Hospital (approval no. 20170321-1) as well as the Fukushima Medical University Ethics Committee (reference number : General
2019-064). Accordingly, written explanations were
provided and informed consents were obtained fromthe study participants.

Results
As of February 2019, there were 15 home-visit
rehabilitation users. From this sample, five users
did not provide consent, and were, therefore, excluded. The ten consenting study participants included three men and seven women. Table 1
shows the users’ backgrounds. Their mean age
was 86.8 years (standard deviation (SD) 4.57). The
mean usage period was 591.4 days (SD 413.60). The
BI (mean) was 82/100 points (SD 11.66) at the beginning of each user’s rehabilitation, and 82/100 points(SD 10.54) at the end of February 2019. Within thesample, two had improved physical activity, six maintained their physical activity, whereas two had decreased physical activity.
Table 2 shows the themes, subthemes, and categories identified through the thematic analysis of
the questionnaire survey. Four main themes wereidentified :(1) Establishment of exercise habits and improvement of physical functions :Y. Saito et al.

74
Table 1.

No.

GenderAge

1Female79

2Female

88

3

Male

84

4

Female

87

5

Male

88

6

Female89

7Female91

8Female

85

9

Male

80

10

Female88

Background of home-visit rehabilitation users

Nursing care
level

Number ofdays

Level ofindependence
in daily life

Independence
degree in dailyliving for
elderly withdementia

Barthel Index(at the start)

Barthel Index(as ofFebruary
2019)

Nursing carelevel 3
Nursing carelevel 4
Nursing carelevel 5
Nursing carelevel 2
Nursing carelevel 2
Nursing carelevel 2
Nursing carelevel 2
Nursing carelevel 1
Nursing carelevel 2Requiring
help 2

1094

A2

I

80

80

966

B1

IIb

50

55

261

J2

I

90

90

512

A1

IIa

80

75

512

A1

IIIa

90

85

966

A2

IIIb

85

85

1094

B1

I

85

85

169

J2

I

85

90

28

A1

IIb

80

80

30

J2

I

95

95

Table 2. Coding tables with the opinions on home-visit rehabilitation in the repopulated village
ThemesCategory

Establishment of exercise habits and improving
physical functions

Establishment of exercise and activity habits

The joy of returning to the village

The goodness of life in our home

Improvement in physical function

The goodness of hometown
Resumption of interactions with local residents
Challenges in the mountainous areas

Lack of living infrastructure

Changes in relationships due to the earthquakeor evacuation

Changes in the family environment after theearthquake
Farewell to acquaintances at the evacuation site

The users stated that they established exercise habits, and their physical functions had improved.
“I am able to play ground golf.” (P3, a man in his
80s).
“My body movement is getting better.” (P1, female in her 80s).
(2) Joy of returning to the village :The users expressed a sense of security in theirhomes and the joy of reconnecting with their neighbors.
“This is good because it is my hometown. I do notthink there is a better place than here.” (P4, female in her 80s).
“I can have tea with my acquaintances. They comehere, and I go there by myself.” (P10, female inher 80s).
(3) Issues in the mountainous areas
Some users mentioned the lack of medical and commercial facilities.
“It is difficult to go to the hospital.” (P10, female inher 80s)“I have to travel far for shopping.” (P3, male in his
80s).
(4) Changes in human relationships due to theearthquakes or evacuation :Some users mentioned meeting and parting withfamily members and people they had become friends
with at the evacuation site.

Home-visit rehab after nuclear disaster“To be honest, I did not want to leave because I became friends with volunteers.” (P7, female in her
80s).
“I was separated from my grandchildren.” (P1, female in her 80s).

Discussion
To the best of our knowledge, there have been
no reports on home-visit rehabilitation in the settingof repopulated villages after an evacuation. In thisstudy, we found that users of home-visit rehabilitation were able to maintain their daily lives, social interactions, and activities. These results suggestthat the use of home-visit rehabilitation and living ina familiar home may contribute to the maintenanceof users’ physical functions and participation in activities in the community. Home-visit rehabilitation, even from 30 km away, may help improve access to rehabilitation services in a post-evacuationarea.
Our results suggested that the provision ofhome visit rehabilitation in the repopulated village
area contributed to the maintenance of users’ physical functions. According to a previous study, living
in temporary housing is associated with a high riskof disease due to chronic pain and a decrease in theamount of social activity and going out, due to theweakening of ties among local residents14,15). In thepresent study, the questionnaire survey showed an
improvement in individuals’ physical function andmaintenance of BI, which can be attributed to theexercise habits established. These results suggestthat home- visit rehabilitation may be effective inmaintaining individual physical function after returning to the village.
There were opinions that indicated an increasein social activities in the repopulated village, such as
playing ground golf and having tea with neighbors.
Elderly people living in rural areas have been reported to be less socially active than those living inurban areas16). Rehabilitation has been reported tolead to improvements in social participation17). Additionally, while some users regretted the change inhuman relationships due to the return from evacuation, some said that they were able to reunite withold friends and live in a familiar environment after
returning to the village. Therefore, receiving
home- visit rehabilitation in a repopulated village
may lead to improvements in users’ social lives,
such as going out and interacting with others.
For home-visit rehabilitation, we showed that it
was possible to conduct home- visit rehabilitation

75

from outside the living area. Hence, we suggest it
is feasible to provide home-visit rehabilitation, evenfrom areas distant (about 30 km from the main facility) compared with the mean distance based on Japan’s Ministry of Health, Labour and Welfare statistics (mean 23.6±11.5 km). Home-visit rehabilitation
users stated that medical and commercial facilities
were scarce in the village. Rehabilitative care wasprovided through home- visits. However, due tothe transportation burden on the service provider,
the frequency of service was limited to 1.2 times per
week on average for each user. Even with such infrequent visits, there was no deterioration in physical function, and the users were able to participate in
the community.
Our study had a few limitations. First, thisstudy was conducted under limited circumstances in
the areas affected by the FDNPP accident. The
area was already depopulated to a degree, with few
medical resources, and the earthquake accelerated
the decline in medical resources. Family support
decreased due to the decrease in the number of family members living together after evacuation. Furthermore, there might be a decrease in activity level
due to evacuation or avoiding radiation exposure after the disaster. For these reasons, it was not possible to generalize the study to other municipalities. Second, there were some themes with small
samples in the thematic analysis. However, thisstudy included all consenting home-visit users andused all the available information. Third, as thiswas a descriptive observational study, a clear causal
relationship could not be established. Because thequestionnaire survey was conducted by the therapist, there may have been observer bias leading to
the collection of more positive opinions than negative ones. Fourth, in clinical practice, we did notassess daily life activities at every visit. The evaluation of the daily activities may not be sufficient for
rigorous data analysis. However, the results of thisstudy suggest that home-visit rehabilitation may beeffective as a means to cope with the depletion of rehabilitation resources that would follow a disaster. Provision of visiting- rehabilitation services
from nearby facilities may lead to the expansion ofrehabilitation services in rural and remote areas.
Healthcare Corporation Seireikai continues to provide medical care, amenable to further investigation. To the best of our knowledge, this study, limitations notwithstanding, is a useful first report abouthome rehabilitation services provided in an area repopulated after the FDNPP accident in Japan.

Y. Saito et al.

76

Conclusion
In a village repopulated after the FDNPP accident, home-visit rehabilitation has been successfully
conducted and may contribute to the establishmentof exercise habits and the maintenance of physicalfunctions for the elderly. Home-visit rehabilitation
may be useful for rehabilitation in day-to-day environments for enhancing social activities, such as going out and interacting with others. Thus, it may
be a viable option for providing rehabilitation care in
repopulated villages in disaster-affected areas.

6.

7.

8.

Conflicts of interest
Masaharu Tsubokura received grants from the
Ministry of Environment, Japan, and Nuclear Regulation Authority, Japan.

Acknowledgements
The authors would like to thank all the staff
members involved in this study. This work was
supported by the research project on the Health Effects of Radiation organized by the Ministry of Environment, Japan.

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