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Background <p>Exercise is recommended to prevent dialysis; however, the involvement of physical therapists is not a criterion for reimbursable medical fee calculation in Japan. Consequently, eligible patients may not receive appropriate exercise guidance. We aimed to clarify the extent of physical therapist participation in dialysis-prevention interventions reimbursed under the current Japanese healthcare system and to identify reasons for non-participation related to reimbursement criteria.</p> Methods <p>In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.</p> Results <p>Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were “Inclusion of physical therapists is not a strict requirement for medical fee reimbursement,” “Insufficient personnel or time,” and “No role assigned by the dialysis-prevention team.”</p> Conclusion <p>Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.</p>

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Participation of physical therapists in medical fee-based dialysis-prevention interventions: a nationwide survey in Japan

  • 期刊论文

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  • 发表日期：

    2025年9月19日

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  • Yuma Hirano,
  • Kenichi Kono,
  • Ren Takahashi,
  • Yuma Tamura,
  • Momo Takahashi,
  • Shinsuke Imaoka,
  • Takuo Nomura,
  • Makoto Igaki

摘要

Background

Exercise is recommended to prevent dialysis; however, the involvement of physical therapists is not a criterion for reimbursable medical fee calculation in Japan. Consequently, eligible patients may not receive appropriate exercise guidance. We aimed to clarify the extent of physical therapist participation in dialysis-prevention interventions reimbursed under the current Japanese healthcare system and to identify reasons for non-participation related to reimbursement criteria.

Methods

In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.

Results

Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were “Inclusion of physical therapists is not a strict requirement for medical fee reimbursement,” “Insufficient personnel or time,” and “No role assigned by the dialysis-prevention team.”

Conclusion

Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.