当院における呼吸リハビリテーションプロトコル導入 標準化と対象者層別化の試み
呼吸リハビリテーション（PR）は慢性閉塞性肺疾患（COPD）患者において不可欠な治療介入である．しかしながら，その介入内容にはスタッフの経験によって差を認める．また，本邦のCOPD患者は欧米と比較して高齢・虚弱であることが多く，国際的なエビデンスベースのPRよりも個人の生活に焦点を当てたPRを優先すべき症例も少なくない．当院では，これらの問題点に対して，PRの標準化および対象患者の層別化を目的としたPRプロトコルを作成・導入した．本研究は，当該取り組みについて，その導入前後のPRの効果を比較することを目的とした．PRプロトコル導入前（CR群）および導入後（PC群）においてPR前後の各臨床指標の...
Saved in:
| Published in | 日本呼吸ケア・リハビリテーション学会誌 Vol. 34; no. 3; pp. 233 - 240 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本呼吸ケア・リハビリテーション学会
25.08.2025
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1881-7319 2189-4760 |
| DOI | 10.15032/jsrcr.24-17 |
Cover
| Abstract | 呼吸リハビリテーション（PR）は慢性閉塞性肺疾患（COPD）患者において不可欠な治療介入である．しかしながら，その介入内容にはスタッフの経験によって差を認める．また，本邦のCOPD患者は欧米と比較して高齢・虚弱であることが多く，国際的なエビデンスベースのPRよりも個人の生活に焦点を当てたPRを優先すべき症例も少なくない．当院では，これらの問題点に対して，PRの標準化および対象患者の層別化を目的としたPRプロトコルを作成・導入した．本研究は，当該取り組みについて，その導入前後のPRの効果を比較することを目的とした．PRプロトコル導入前（CR群）および導入後（PC群）においてPR前後の各臨床指標の変化を比較した．その結果，PC群はCR群と比較して健康関連QOLの改善が大きかった．PR評価・介入の標準化および患者層別化を目的としたPRプロトコル導入は，COPD患者の健康関連QOL改善効果を高める可能性が示された． |
|---|---|
| AbstractList | 呼吸リハビリテーション（PR）は慢性閉塞性肺疾患（COPD）患者において不可欠な治療介入である．しかしながら，その介入内容にはスタッフの経験によって差を認める．また，本邦のCOPD患者は欧米と比較して高齢・虚弱であることが多く，国際的なエビデンスベースのPRよりも個人の生活に焦点を当てたPRを優先すべき症例も少なくない．当院では，これらの問題点に対して，PRの標準化および対象患者の層別化を目的としたPRプロトコルを作成・導入した．本研究は，当該取り組みについて，その導入前後のPRの効果を比較することを目的とした．PRプロトコル導入前（CR群）および導入後（PC群）においてPR前後の各臨床指標の変化を比較した．その結果，PC群はCR群と比較して健康関連QOLの改善が大きかった．PR評価・介入の標準化および患者層別化を目的としたPRプロトコル導入は，COPD患者の健康関連QOL改善効果を高める可能性が示された． |
| Author | 一木 克之 加藤 香織 津田 徹 池内 智之 森 駿一朗 森 大地 河野 哲也 松尾 聡 新貝 和也 井元 淳 自見 勇郎 |
| Author_xml | – sequence: 1 fullname: 森 駿一朗 organization: 長崎大学大学院医歯薬学総合研究科医療科学専攻理学療法学分野 – sequence: 1 fullname: 池内 智之 organization: 長崎大学大学院医歯薬学総合研究科医療科学専攻理学療法学分野 – sequence: 1 fullname: 松尾 聡 organization: 霧ヶ丘つだ病院呼吸リハビリテーションセンター – sequence: 1 fullname: 自見 勇郎 organization: 霧ヶ丘つだ病院呼吸器内科 – sequence: 1 fullname: 津田 徹 organization: 霧ヶ丘つだ病院呼吸器内科 – sequence: 1 fullname: 一木 克之 organization: 霧ヶ丘つだ病院呼吸器内科 – sequence: 1 fullname: 河野 哲也 organization: 霧ヶ丘つだ病院呼吸器内科 – sequence: 1 fullname: 井元 淳 organization: 九州栄養福祉大学リハビリテーション学部 – sequence: 1 fullname: 新貝 和也 organization: 長崎大学大学院医歯薬学総合研究科医療科学専攻理学療法学分野 – sequence: 1 fullname: 森 大地 organization: 霧ヶ丘つだ病院呼吸リハビリテーションセンター – sequence: 1 fullname: 加藤 香織 organization: 霧ヶ丘つだ病院呼吸器内科 |
| BookMark | eNo9kL1KA0EcxBeJ4BnT-RoX9_N2rwxBjRCw0XrZu-xqjhjlLo1lsiiioIYUYiuIYBAECy3i0_y5wrcwRrGZ-cHAwMwqqvSP-xahdYLrRGBGN7IiT_M65SGRSyigRMUhlxGuoIAoRULJSLyCakXRTTBmWEipZIBa5efk6_4BhlMYXsJwDKOrcjwrbz_AP4O_AT9ZwDn4GYzewT-BfwN_B_4F_AWM5jwtX6_Ls8c1tOxMr7C1P6-i_a3NvWYrbO9u7zQb7TAjRJgwjRKhJJOER4JRImzawUS4OLLKJM46IVNKZeRcTBPBBI-5xNLG8wEKdzhzrIoav71ZMTAHVp_k3SOTn2qTD7ppz-rFC5pxzX6Eck3kf5Yemlxnhn0D5Chydw |
| ContentType | Journal Article |
| Copyright | 2025 一般社団法人日本呼吸ケア・リハビリテーション学会 |
| Copyright_xml | – notice: 2025 一般社団法人日本呼吸ケア・リハビリテーション学会 |
| DOI | 10.15032/jsrcr.24-17 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2189-4760 |
| EndPage | 240 |
| ExternalDocumentID | article_jsrcr_34_3_34_24_17_article_char_ja |
| GroupedDBID | ALMA_UNASSIGNED_HOLDINGS JSF KQ8 RJT |
| ID | FETCH-LOGICAL-j115a-c6b5873714653215ecd015f96e8abfef57c2276ff92b535494707e988180d43f3 |
| ISSN | 1881-7319 |
| IngestDate | Mon Sep 01 00:08:30 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | false |
| Issue | 3 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j115a-c6b5873714653215ecd015f96e8abfef57c2276ff92b535494707e988180d43f3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jsrcr/34/3/34_24-17/_article/-char/ja |
| PageCount | 8 |
| ParticipantIDs | jstage_primary_article_jsrcr_34_3_34_24_17_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2025/08/25 |
| PublicationDateYYYYMMDD | 2025-08-25 |
| PublicationDate_xml | – month: 08 year: 2025 text: 2025/08/25 day: 25 |
| PublicationDecade | 2020 |
| PublicationTitle | 日本呼吸ケア・リハビリテーション学会誌 |
| PublicationTitleAlternate | 日呼ケアリハ学誌 |
| PublicationYear | 2025 |
| Publisher | 一般社団法人 日本呼吸ケア・リハビリテーション学会 |
| Publisher_xml | – name: 一般社団法人 日本呼吸ケア・リハビリテーション学会 |
| References | 28) Dong J, Li Z, Luo L, et al.: Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: Evidence based on nineteen randomized controlled trials. Int J Surg, 73: 78-86, 2020. 29) Hajiro T, Nishimura K, Tsukino M, et al.: Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 157: 785-790, 1998. 18) Holland AE, Spruit MA, Troosters T, et al.: An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J, 44: 1428-1446, 2014. 15) Jones PW, Quirk FH, Baveystock CM, et al.: A self-complete measure of health status for chronic airflow limitation. The St. George’s respiratory questionnaire. Am Rev Respir Dis, 145: 1321-1327, 1992. 22) Jones PW: St. George’s respiratory questionnaire: MCID. COPD, 2: 75-79, 2005. 1) McCarthy B, Casey D, Devane D, et al.: Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev: CD003793, 2015. 30) Molinier V, Alexandre F, Heraud N: Effectiveness comparison of inpatient vs. outpatient pulmonary rehabilitation: a systematic review. BMC Health Serv Res, 22: 1028, 2022. 7) Takahashi S, Betsuyaku T: The chronic obstructive pulmonary disease comorbidity spectrum in Japan differs from that in western countries. Respir Investig, 53: 259-270, 2015. 27) Manifield J, Chaudhry Y, Singh SJ, et al.: Changes in physical activity, sedentary behaviour and sleep following pulmonary rehabilitation: a systematic review and network meta-analysis. Eur Respir Rev, 33: 230225, 2024. 3) Global Initiative for Chronic Obstructive Lung Disease (GOLD): global strategy for the diagnosis, management and prevention of COPD 2023 report. https://goldcopd.org/2023-gold-report-2/. Accessed: 1 Novermber 2024. 17) Zigmond AS, Snaith RP著，北村俊則訳：Hospital Anxiety And Depression Scale（HAD尺度）．精神科診断学，4: 371-372, 1993. 11) Langer D, Charususin N, Jácome C, et al.: Efficacy of a novel method for inspiratory muscle training in people with chronic obstructive pulmonary disease. Phys Ther, 95: 1264-1273, 2015. 31) 西村浩一，月野光博：包括的呼吸リハビリテーションの現状と課題 ガイドラインの作成に向けて COPDにおける呼吸リハビリテーションの健康関連QoLに対する効果．日呼吸管理会誌，11: 239-243, 2001. 5) Puhan MA, Gimeno-Santos E, Cates CJ, et al.: Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 12: CD005305, 2016. 4) 植木 純，神津 玲，大平徹郎，他：呼吸リハビリテーションに関するステートメント．日呼ケアリハ学誌，27: 95-114, 2018. 9) Group CW: Pulmonary rehabilitation for patients with chronic pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser, 12: 1-75, 2012. 10) Kataoka K, Nishiyama O, Ogura T, et al.: Long-term effect of pulmonary rehabilitation in idiopathic pulmonary fibrosis: a randomised controlled trial. Thorax, 78: 784-791, 2023. 13) Nishiyama O, Kataoka K, Ando M, et al.: Protocol for long-term effect of pulmonary rehabilitation under nintedanib in idiopathic pulmonary fibrosis. ERJ Open Res, 7: 00321-2021, 2021. 23) Li G, Roberts M, Wheatley J, et al.: Exercise and quality-of-life outcomes of two versus three weekly sessions of pulmonary rehabilitation. J Cardiopulm Rehabil Prev, 42: 252-257, 2022. 8) Bishop JA, Spencer LM, Dwyer TJ, et al.: Changes in exercise capacity and health-related quality of life at four and eight weeks of a pulmonary rehabilitation program in people with COPD. COPD, 18: 612-620, 2021. 24) Casaburi R, Patessio A, Ioli F, et al.: Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis, 143: 9-18, 1991. 2) Holland AE, Cox NS, Houchen-Wolloff L, et al.: Defining modern pulmonary rehabilitation. An official American Thoracic Society workshop report. Ann Am Thorac Soc, 18: e12-e29, 2021. 20) Burtin C, Mohan D, Troosters T, et al.: Objectively measured physical activity as a COPD clinical trial outcome. Chest, 160: 2080-2100, 2021. 16) Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand, 67: 361-370, 1983. 19) Laveneziana P, Albuquerque A, Aliverti A, et al.: ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J, 53: 1801214, 2019. 26) Burge AT, Cox NS, Abramson MJ, et al.: Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev, 4: CD012626, 2020. 12) 日本呼吸ケア・リハビリテーション学会，日本呼吸器学会，日本リハビリテーション医学会，他：呼吸リハビリテーションマニュアル—運動療法—，改訂第2版，東京，照林社，2012. 21) Araújo Oliveira AL, Andrade L, Marques A: Minimal clinically important difference and predictive validity of the mMRC and mBorg in acute exacerbations of COPD. European Respiratory Journal, 50: PA4705, 2017. 14) Mahler DA, Ward J, Waterman LA, et al.: Patient-reported dyspnea in COPD reliability and association with stage of disease. Chest, 136: 1473-1479, 2009. 6) 日本理学療法士協会：統計情報-会員の分布．https://www.japanpt.or.jp/activity/data/. Accessd: 1 Novermber 2024. 25) Bishop JA, Spencer LM, Dwyer TJ, et al.: Patterns of physical activity of people with COPD during participation in a pulmonary rehabilitation program. Respir Med, 231: 107724, 2024. |
| References_xml | – reference: 16) Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand, 67: 361-370, 1983. – reference: 3) Global Initiative for Chronic Obstructive Lung Disease (GOLD): global strategy for the diagnosis, management and prevention of COPD 2023 report. https://goldcopd.org/2023-gold-report-2/. Accessed: 1 Novermber 2024. – reference: 8) Bishop JA, Spencer LM, Dwyer TJ, et al.: Changes in exercise capacity and health-related quality of life at four and eight weeks of a pulmonary rehabilitation program in people with COPD. COPD, 18: 612-620, 2021. – reference: 20) Burtin C, Mohan D, Troosters T, et al.: Objectively measured physical activity as a COPD clinical trial outcome. Chest, 160: 2080-2100, 2021. – reference: 10) Kataoka K, Nishiyama O, Ogura T, et al.: Long-term effect of pulmonary rehabilitation in idiopathic pulmonary fibrosis: a randomised controlled trial. Thorax, 78: 784-791, 2023. – reference: 28) Dong J, Li Z, Luo L, et al.: Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: Evidence based on nineteen randomized controlled trials. Int J Surg, 73: 78-86, 2020. – reference: 30) Molinier V, Alexandre F, Heraud N: Effectiveness comparison of inpatient vs. outpatient pulmonary rehabilitation: a systematic review. BMC Health Serv Res, 22: 1028, 2022. – reference: 24) Casaburi R, Patessio A, Ioli F, et al.: Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis, 143: 9-18, 1991. – reference: 13) Nishiyama O, Kataoka K, Ando M, et al.: Protocol for long-term effect of pulmonary rehabilitation under nintedanib in idiopathic pulmonary fibrosis. ERJ Open Res, 7: 00321-2021, 2021. – reference: 23) Li G, Roberts M, Wheatley J, et al.: Exercise and quality-of-life outcomes of two versus three weekly sessions of pulmonary rehabilitation. J Cardiopulm Rehabil Prev, 42: 252-257, 2022. – reference: 19) Laveneziana P, Albuquerque A, Aliverti A, et al.: ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J, 53: 1801214, 2019. – reference: 11) Langer D, Charususin N, Jácome C, et al.: Efficacy of a novel method for inspiratory muscle training in people with chronic obstructive pulmonary disease. Phys Ther, 95: 1264-1273, 2015. – reference: 22) Jones PW: St. George’s respiratory questionnaire: MCID. COPD, 2: 75-79, 2005. – reference: 5) Puhan MA, Gimeno-Santos E, Cates CJ, et al.: Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 12: CD005305, 2016. – reference: 31) 西村浩一，月野光博：包括的呼吸リハビリテーションの現状と課題 ガイドラインの作成に向けて COPDにおける呼吸リハビリテーションの健康関連QoLに対する効果．日呼吸管理会誌，11: 239-243, 2001. – reference: 7) Takahashi S, Betsuyaku T: The chronic obstructive pulmonary disease comorbidity spectrum in Japan differs from that in western countries. Respir Investig, 53: 259-270, 2015. – reference: 12) 日本呼吸ケア・リハビリテーション学会，日本呼吸器学会，日本リハビリテーション医学会，他：呼吸リハビリテーションマニュアル—運動療法—，改訂第2版，東京，照林社，2012. – reference: 2) Holland AE, Cox NS, Houchen-Wolloff L, et al.: Defining modern pulmonary rehabilitation. An official American Thoracic Society workshop report. Ann Am Thorac Soc, 18: e12-e29, 2021. – reference: 18) Holland AE, Spruit MA, Troosters T, et al.: An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J, 44: 1428-1446, 2014. – reference: 29) Hajiro T, Nishimura K, Tsukino M, et al.: Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 157: 785-790, 1998. – reference: 9) Group CW: Pulmonary rehabilitation for patients with chronic pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser, 12: 1-75, 2012. – reference: 6) 日本理学療法士協会：統計情報-会員の分布．https://www.japanpt.or.jp/activity/data/. Accessd: 1 Novermber 2024. – reference: 21) Araújo Oliveira AL, Andrade L, Marques A: Minimal clinically important difference and predictive validity of the mMRC and mBorg in acute exacerbations of COPD. European Respiratory Journal, 50: PA4705, 2017. – reference: 4) 植木 純，神津 玲，大平徹郎，他：呼吸リハビリテーションに関するステートメント．日呼ケアリハ学誌，27: 95-114, 2018. – reference: 25) Bishop JA, Spencer LM, Dwyer TJ, et al.: Patterns of physical activity of people with COPD during participation in a pulmonary rehabilitation program. Respir Med, 231: 107724, 2024. – reference: 26) Burge AT, Cox NS, Abramson MJ, et al.: Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev, 4: CD012626, 2020. – reference: 27) Manifield J, Chaudhry Y, Singh SJ, et al.: Changes in physical activity, sedentary behaviour and sleep following pulmonary rehabilitation: a systematic review and network meta-analysis. Eur Respir Rev, 33: 230225, 2024. – reference: 15) Jones PW, Quirk FH, Baveystock CM, et al.: A self-complete measure of health status for chronic airflow limitation. The St. George’s respiratory questionnaire. Am Rev Respir Dis, 145: 1321-1327, 1992. – reference: 17) Zigmond AS, Snaith RP著，北村俊則訳：Hospital Anxiety And Depression Scale（HAD尺度）．精神科診断学，4: 371-372, 1993. – reference: 1) McCarthy B, Casey D, Devane D, et al.: Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev: CD003793, 2015. – reference: 14) Mahler DA, Ward J, Waterman LA, et al.: Patient-reported dyspnea in COPD reliability and association with stage of disease. Chest, 136: 1473-1479, 2009. |
| SSID | ssib003057787 ssj0003304649 ssib044754472 |
| Score | 2.0047975 |
| Snippet | ... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 233 |
| SubjectTerms | プロトコル 呼吸リハビリテーション 層別化 慢性閉塞性肺疾患 標準化 |
| Subtitle | 標準化と対象者層別化の試み |
| Title | 当院における呼吸リハビリテーションプロトコル導入 |
| URI | https://www.jstage.jst.go.jp/article/jsrcr/34/3/34_24-17/_article/-char/ja |
| Volume | 34 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 日本呼吸ケア・リハビリテーション学会誌, 2025/08/25, Vol.34(3), pp.233-240 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwzR1NaxUxcCn14kUUFb_pwZweW_cj2STektctRUEQWuht2d23C75DldpevLWLIgpq6UG8CiJYBMGDHurB3xLewX_hTDb7ulQFqwjCI8xLZmZnMoTMDMnE867yIB_JIGd-nAS1T5mofcnq0I9KESQQbJeitKd8byVLK_TGKludmf3aO7W0uVHMlw9-eq_kT6wKfWBXvCV7BMtOmUIHwGBfaMHC0P6WjUnKiF4gMiapJFISFZE0Bt-QKO0AoRwgQwtERGikgr96aIGAaGGHYqKUA8SiA5DzoaHEAUhuGWre4XSA7qjkdGihIxcd1ZSzlUcHRKQICEYU63vMJE2Qj2IWGBI1_IX8wLPT0c0DSKL_gWoM1VGATBFTArlAJmKab0ZJFRClA7QL0OpFiyzwWEmrheR9ZBBcBVb7BCZgYHEk0cpSSTBZH1kuEJ26OdP4CWEtHh7gQAe3agkUU-iBZa2xF-RBTdN-sidimL1uL4bb5dkTVqDFcMqBIXXflRq1Q7FhFplFVvAb_P-W6u3AQoQ-j90-Wtk-cEOlT3n78ES3bbsc-J1-Vqfdg9vKKs6di9pqYD94CiyIsfTw-P56uT4fUb-9QXyo9rpb2ZnFymKaxdhENAt51o3h7chsDCHasYhze1Lk5u1-BoPxXvkrLK9Juwcb0FnEdGJig_Sp4u56Dgp4rSceuMhjCBi7w6bW_10-6Z1wgeucauU55c2M89Pe0uTL7rdXr83Wntl6YrZ2zPbTyc7-5MVn07wzzXPT7FrgkWn2zfYn07w1zUfTvDTNe9M8NtsA700-PJs8fHPGW1lMl4dLvnubxR9DDJn7ZVIwwbHcZ8JiCBuqcgSBRS2TSuRFXdWMl1HEk7qWUcFiRiXlAa-kwNISIxrX8Vlvdu3uWnXOm2NFFNQwCSNWVbQoyjzMgzAvaZIEdJRzcd673iqe3WsL8GRHMMuFvyG-6B0_WISXvNmN9c3qMsQgG8UVa-Xv-jDl-A |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E5%BD%93%E9%99%A2%E3%81%AB%E3%81%8A%E3%81%91%E3%82%8B%E5%91%BC%E5%90%B8%E3%83%AA%E3%83%8F%E3%83%93%E3%83%AA%E3%83%86%E3%83%BC%E3%82%B7%E3%83%A7%E3%83%B3%E3%83%97%E3%83%AD%E3%83%88%E3%82%B3%E3%83%AB%E5%B0%8E%E5%85%A5&rft.jtitle=%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E3%82%B1%E3%82%A2%E3%83%BB%E3%83%AA%E3%83%8F%E3%83%93%E3%83%AA%E3%83%86%E3%83%BC%E3%82%B7%E3%83%A7%E3%83%B3%E5%AD%A6%E4%BC%9A%E8%AA%8C&rft.au=%E6%A3%AE+%E9%A7%BF%E4%B8%80%E6%9C%97&rft.au=%E6%B1%A0%E5%86%85+%E6%99%BA%E4%B9%8B&rft.au=%E6%9D%BE%E5%B0%BE+%E8%81%A1&rft.au=%E8%87%AA%E8%A6%8B+%E5%8B%87%E9%83%8E&rft.date=2025-08-25&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E3%82%B1%E3%82%A2%E3%83%BB%E3%83%AA%E3%83%8F%E3%83%93%E3%83%AA%E3%83%86%E3%83%BC%E3%82%B7%E3%83%A7%E3%83%B3%E5%AD%A6%E4%BC%9A&rft.issn=1881-7319&rft.eissn=2189-4760&rft.volume=34&rft.issue=3&rft.spage=233&rft.epage=240&rft_id=info:doi/10.15032%2Fjsrcr.24-17&rft.externalDocID=article_jsrcr_34_3_34_24_17_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1881-7319&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1881-7319&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1881-7319&client=summon |