櫻井 宏明

[Purpose] This study examined the contents of supervision needed by novice therapists to develop clinical abilities, focusing on their clinical experience and using an original evaluation table. [Subjects and Methods] An evaluation of clinical abilities basic attitudes, therapeutic skills, and clinical practice-related thoughts was conducted in 29, 21, and 9 therapists with clinical experience of 0-1 (1 year group), 1-2 (2 years group), and 2-3 (3 years group) years, respectively. [Results] There were no significant differences among the 3 groups in basic attitudes. Therapeutic skills markedly varied between the 1 and 3 years groups. In clinical practice-related thoughts, significant differences were observed between the 1 and 3 years groups and between the 2 and 3 years groups. [Conclusion] It may be appropriate for educators to provide technical education regarding skills that are achievable for students in the early stages in consideration of applied movements. Also, education for novices should be provided with importance attached to abilities influenced by clinical experience.

[Purpose] This study examined the reliability of a clinical ability evaluation table developed in a previous study with the aim of clarifying the abilities necessary for therapists to independently implement their duties. [Subjects and Methods] Forty-eight physical therapists with less than 2 years of clinical experience were targeted for evaluation, 48 main supervisors, and 48 sub-supervisors, 144 in total, were studied. [Results] The total score was lower when the evaluation was conducted by the target therapists themselves than when it was conducted by the main or sub-supervisors. Regarding the reliability of the total scores for the entire scale and each category, values representing the intra-rater reliability were higher when the evaluation was conducted by the target therapists or main supervisors, while there were marked differences between high and low values for each item. Regarding the inter-rater reliability, both the total scores for the entire scale and each category, as well as values for each item, were low. [Conclusion] Values representing the intra-rater reliability of the study table were low, indicating the necessity of further improvement.

[Purpose] This study examined the effects of clinical training focusing on level-3 OSCE (analytical and therapeutic skills) items, and compared the achievement levels of physical (PT) and occupational (OT) therapist students. [Subjects] A total of 282 (165 PT and 117 OT) students enrolled at our university between 2008 and 2010 were studied. [Methods] OSCE scores were compared between before and after clinical training focusing on level-3 OSCE items, and between PT and OT students. [Results] Scores for 5 out of the 6 level-3a items were significantly higher after than before clinical training. Increases in scores of 2 or 3 level-3b and -3c items were also observed after clinical training. There were no marked differences between PT and OT students in scores for level-3a, -3b, and -3c items before clinical training. In contrast, after clinical training, OT students' scores for 3a and 3c items related to dressing were higher than those of PT students, and the latter's scores for 3b items related to transfer were higher than those of the former. [Conclusion] The results suggest level-3 OSCE items are effectively taught during clinical training.

[Purpose] The difficulty levels of level-2 OSCE (examination and measurement skills) items were examined, with a view to providing reference data for the determination of students' skills. [Subjects] A total of 284 graduates of physical (PT) and occupational (OT) therapy classes of 2011 (59 and 40), 2012 (46 and 36), and 2013 (61 and 42, respectively) were studied, with PT or OT faculty members as OSCE examiners and a simulated patient. [Methods] Scores for 11 level-2 OSCE items were compared between before and after clinical training. [Results] Scores markedly increased after clinical training. On comparison among the items, scores for sensory examination were the highest, and those for interviews were the lowest. [Conclusion] The results of this study indicate the necessity of considering an appropriate combination of different difficulty levels when adopting OSCE-based educational approaches.

Neuromuscular electrical stimulation (NMES) can be used as treatment for spasticity. The present study examined differences in time-dependent effects of NMES depending on stimulation frequency. Forty healthy subjects were separated into four groups (no-stim, NMES of 50, 100, and 200 Hz). The un-conditioned H-reflex amplitude and the H-reflex conditioning-test paradigm were used to measure the effectiveness on monosynaptic Ia excitation of motoneurons in the soleus (SOL) muscle, disynaptic reciprocal Ia inhibition from tibialis anterior (TA) to SOL, and presynaptic inhibition of SOL Ia afferents. Each trial consisted of a 30-min period of NMES applied to the deep peroneal nerve followed by a 30-min period with no stimulation to measure prolonged effects. Measurements were performed periodically. Stimulation applied at all frequencies produced a significant reduction in monosynaptic Ia excitation of motoneurons in the SOL muscle, however, only stimulation with 50 Hz showed prolonged reduction after NMES. NMES frequency did not affect the amount of disynaptic reciprocal Ia inhibition and presynaptic inhibition of Ia afferents. The results show a frequency-dependent effect of NMES on the monosynaptic Ia excitation of motoneurons. This result has implications for selecting the optimal NMES frequency for treatment in patients with spasticity.

[Purpose] The aim of this study was to examine the applicability of the Objective Structured Clinical Examination (OSCE) to postgraduate education systems for novice and mid-career therapists in workplaces. [Subjects] Physical and occupational therapists with 1 to 5 years of clinical experience took the OSCE to assess their learning, with a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] A Wilcoxon signed-rank test was performed to compare skills between before and after OSCE-based learning, and a Mann-Whitney U test was used to compare them between therapists with 1 to 2 years (novice) and 3 to 5 years (mid-career) of clinical experience. [Results] While no experience-related differences were observed in behavioral aspects, mid-career therapists exhibited markedly higher scores compared with novices in technical aspects, such as skills to guide patients for standing up, transfer, and dressing. [Conclusion] The OSCE may be sufficiently applicable to postgraduate education systems in workplaces.

[Purpose] To examine agreement rates between faculty members and clinical supervisors as OSCE examiners. [Subjects] The study subjects were involved physical and occupational therapists working in clinical environments for 1 to 5 years after graduating from training schools as OSCE examinees, and a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] The agreement rate between the examiners for each OSCE item was calculated based on Cohen's kappa coefficient to confirm inter-rater reliability. [Results] The agreement rates for the behavioral aspects of the items were higher in the second than in the first examination. Similar increases were also observed in the agreement rates for the technical aspects until the initiation of each activity; however, the rates decreased during the middle to terminal stages of continuous movements. [Conclusion] The results may reflect the recent implementation of measures for the integration of therapist education in training schools and clinical training facilities.

[Purpose] To examine the effects of intervention combining individualized and group rhythm (To-balance) exercises on the mental and physical functions of the elderly requiring low level care. [Subjects] A total of 29 elderly persons requiring level 2 assistance to level 2 who were and using outpatient care services participated in this study. [Methods] The participants were randomly allocated to 2 groups: To-balance, and Sitting. The former group performed individualized and To-balance group exercises, while the latter group performed individualized exercise, as well as group exercise while sitting on a chair. The effects were evaluated through somatometric, physical fitness, and mental function measurements before and 3, 6, and 9 months after the initiation of the intervention. [Results] The lower-limb muscle strength and mental function significantly improved in both groups. Particularly, in the To-balance group, early improvement in balance and gait ability were observed. [Conclusion] The To-balance exercise may be useful for quickly improving the elderly's static balance ability.

BACKGROUND: Motor dysfunction after stroke might be improved by neuromuscular electrical stimulation (NMES) combined with 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients with moderate and severe motor dysfunction. OBJECTIVE: This preliminary study tested the effect of this treatment combination. METHODS: Fifteen patients (60.5 +/- 10.3 years old) participated in the study. All patients had been affected by cerebral artery infarction or hemorrhage and had moderate or severe motor dysfunction in their affected hand. The patients received NMES at paretic wrist extensor muscles combined with rTMS over the unaffected M1 hemisphere twice a day, six days/week over two weeks. All participants underwent the following battery of tests to evaluate the motor function of the affected hand: Upper limb Fugl-Meyer Assessment (UFMA), Wolf Motor Function Test (WMFT), and Box and Block Test (BBT). RESULTS: UFMA, WMFT, and BBT scores improved significantly after the study. CONCLUSIONS: These results suggest that NMES combined with rTMS could be useful for recovery of moderate and severe motor function after stroke.

[Purpose] A major issue in physical/occupational therapist education is the improvement of students' clinical techniques. In this study, we introduced an education system using an Objective Structured Clinical Examination (OSCE), and made an attempt at standardization of its evaluation. [Subjects] The subjects were 227 students in the classes of 2008 to 2010 who enrolled at our university between 2004 and 2006, before the introduction of the education system using OSCE, and 221 students in the classes of 2011 to 2013 who enrolled between 2007 and 2009, after the introduction. [Methods] Performances in attitude and skills (performance in clinical training and OSCE) were compared between before and after the introduction of OSCE. OSCE results were compared between before and after clinical trainings at each OSCE Level; and the correlation of between performances in clinical training and OSCE was examined. [Results] Performances in OSCE and clinical training (attitude, skills) were improved by the introduction of the education system using OSCE, but no significant correlation was observed in the relationship between performances in OSCE and clinical training. [Conclusion] Further studies should be conducted aiming at the standardization of clinical skill evaluation in postgraduate education to establish an education system using OSCE.

Abstract. [Purpose] The purpose of this study was to examine the locus of the center of pressure (COP) of standing postures with different feet positions. [Subjects] Sixty healthy young adults participated in the experiments as subjects. [Methods] The COP was measured using a force plate. Subjects stabilized themselves on the force plate, and the change of the COP trajectory was measured for 30 s. The COP was measured in three standing postures: wide-base, tandem, and one-foot standing. The relative center of anterior-posterior sway was examined as a proportion of the base of support length. [Results] Using one foot length, l, measured from the heel to the toe of the foot as a standard, the mean of the center of anterior-posterior sway was 44.5 ± 5.5% of l in the wide-base stance, 50.2 ± 4.4% of l in the one-foot dominant stance, and 50.4 ± 4.3% of l in the one-foot non-dominant stance. Since the length of the feet is 2l in the tandem posture, the mean of the center of anterior-posterior sway was 41.0 ± 7.0% of 2l with the dominant foot in front and 41.5 ± 6.0% of 2l with the non-dominant foot in front. [Conclusion] The mean of the center of anterior-posterior sway was inclined toward the anterior position in single leg standing compared to the wide base standing. In tandem standing, the COP was located on the rear foot. The results of this study might be useful in considering the mechanism of postural control of patients with hemiplegia.

[Purpose] This study examined the validity of admission FIM scores as predictors of functional independence, of "early" and "late" elderly patients with stroke in a post-acute rehabilitation unit. [Subjects] After excluding stroke patients with recurrence and complications, the remaining 286 (150 males and 136 females) patients aged 65 to 84 with stays of more than one month. [Methods] According to the level of ADL independence, based on motor and cognitive admission FIM scores, the patients were divided into 3 groups: completely dependent/maximal assistance; moderate/minimal assistance; and supervision/completely independent. Subsequently, time-dependent changes in FIM scores were analyzed to compare the "early" and "late" elderly, score-based groups, and measurements. [Results] Total motor and cognitive F I M scores on and after admission did not overlap among the three ADL independence groups, and showed linear time-dependent changes. Such changes were not observed in individual FIM item, while differences were shown in the period and degree of ADL improvement between the age-based groups. [Conclusion] Motor and cognitive FIM scores were shown to be valid as predictors of functional independence, regardless of age. Scores of individual items were shown to be generally inappropriate as predictors. As the period and degree of ADL improvement varied between the age-based groups, it may be important to continuously provide approaches not only for motor, but also cognitive functions over a long period of time, while considering the age and type of ADL, as well as the individual needs of each patient.

[Purpose] The objective of this study was to clarify the relationship between the results of the Objective Structured Clinical Examination (OSCE) and academic and clinical training achievements, which may be significant in terms of the establishment of standards for the evaluation of therapists' clinical performance. [Subjects] The study surveyed 46 physical and 43 occupational therapists who enrolled at our university in April 2007 and graduated from it in March 2011. [Methods] The OSCE results and academic and clinical training achievements were scored to examine the relationship between them by calculating Spearman's rank correlation coefficients. [Results] A significant correlation was observed between academic achievements and between clinical training achievements, while the correlation between the OSCE results was shown to be high or low. The correlation between the OSCE results and academic achievements was significant until the third grade (OSCE Level 2) and non-significant in the fourth grade (OSCE Level 3) requiring application. The correlation between the OSCE results and clinical training achievements showed a tendency to be low. [Conclusion] These results suggest the necessity of reconsidering the adoption of an OSCE system focusing on consistency between the contents of clinical training and academic education.

The standing test for imbalance and disequilibrium (SIDE) is a discriminative measure developed for the purpose of identifying balance deficits that may cause falls. The purpose of the present study was to determine the validity of the sequence of postures used in SIDE. Subjects comprised 30 men with a mean (+/- standard deviation) age of 21.9 +/- 3.11 years (range 19-32 years) and 30 women with a mean age of 20.7 +/- 1.24 years (range 19-23 years). Center of pressure (COP) was measured using a stabilometer recording for 30 s with a 20-Hz sampling frequency. The measurement postures that were similar to postures adopted in the SIDE were: standing with feet 20 cm apart: standing with legs close and the insides of both feet touching; two tandem standing positions (with the dominant foot forward and with the non-dominant foot forward); and two single-leg standing positions (on the dominant foot and on the non-dominant foot). We calculated total path length and envelopment area of sway from the COP data. Statistical differences in means were determined using the Tukey-Kramer multiple comparison test. Results indicate that the orders of total path length and envelopment areas of sway in each posture were consistent with the item order of SIDE. Significant differences existed between the means of total path length and envelopment areas of sway in each posture (p <0.05), with the exception of both tandem standing positions and both one-leg standing positions. The item order of SIDE appears to show concurrent validity in terms of the amount of body sway in the adopted postures. (C) 2011 Elsevier B.V. All rights reserved.

【目的】<BR> 近年,透析患者の運動療法介入による身体機能の改善効果を示す報告が多くみられる.しかし，一般的に血液透析患者では運動負荷による合併症リスク増大や新規運動時間の確保が問題となる.その為,透析中の運動が注目され,医師監視下による運動負荷リスク軽減や運動脱落率の低下が報告されている.ただ,従来報告の効果判定では機能改善をADLや運動パフォーマンスの指標から述べるものが多い.このような効果判定指標では臥床時間が延長した血液透析患者では評価する事さえ困難であると考える．その為，効果判定指標を再考し機能面だけでなく,生化学データ所見も併せて疾患特異的な効果判定指標を用いる必要もあると考える.一般的に血液透析患者の筋肉量や栄養指標の一つに％クレアチニン産生速度（以下,％ CGR）がある.本研究では,血液透析患者に対する透析中の運動療法効果判定の一つとして％ CGRを用いて,運動療法開始から2カ月経過した血液透析患者の運動療法の効果判定を検討し,若干の知見を得たので報告する.<BR><BR>【方法】<BR> 対象者は医師が透析中運動療法可能とした16名より,％CGRに影響を及ぼす可能性のある透析状態，栄養状態が不良で入院又は体調不良をきたし継続困難であった7名を除外した計9名である．内訳は入院6名,外来3名，男性4名・女性5名である.平均年齢72.9±10.1歳,平均透析期間47±73か月であった.介入頻度は週3回,運動時間は透析開始後2時間以内とした.運動療法施行時は医師・看護師確認の下，実施した.場所は透析室内でベッド上で行った.内容は関節可動域訓練,背臥位で行える筋力増強訓練,下肢交互屈伸動作による持久力訓練,頚部および胸郭のリラクセーションとした.各運動毎に血圧・脈拍・自覚的疲労度を測定した.評価項目はFIMと血液生化学データから％CGRを算出した.評価時期は透析中運動療法開始前と開始後2カ月のデータを抽出した.なお，％CGRは同年代，同性の非糖尿病透析患者の％CGRの百分率である．運動可能頻度は各個人の透析回数中に運動試行回数を百分率で表した．統計学的分析には対応のあるt検定を用いて有意水準5％未満とした．<BR><BR>【説明と同意】<BR> 本研究の実施手順および内容はヘルシンキ宣言に則り，当院倫理委員会の承諾を得た後に行った．対象者には研究者が口頭および書面にて研究目的，方法，利益や不利益，プライバシー管理につき説明の上，同意を得た後，同意書に署名を頂いた．<BR><BR>【結果】<BR> 運動療法介入前5ヵ月間のFIM運動項目は平均47.4±22.1点,FIM認知項目は平均23.2±7.3点,％CGRは83.3±41.8％,運動療法介入2カ月にてFIM運動項目は平均47.4±22.1点,FIM認知項目は平均23.2±7.3点,％CGRは90.9±41.4％,運動可能頻度は初月78％2か月後93％であった.リハビリ試行中に体調不良および事故発生は0件であった.運動療法介入前と介入後2ヵ月の％CGRでは有意差を認めた(p=0.05)．<BR><BR>【考察】<BR> 血液透析患者に対して,透析中運動療法を施行しADL改善は困難であったが％CGRにて改善を認めた.ADL改善困難な原因は透析中訓練のため,課題特異的でない事と, リスク管理上運動負荷も低い為であると考える.また,FIMは疾患特異的ではなく,寝たきり患者様では効果判定指標として検出し辛いのではないかと考える.％CGR改善に関しては訓練導入前より活動時間が増加し,透析効率の改善も考えられた.さらに, 明らかな訓練頻度の向上により訓練介入にて刺激量が増大しセルフエフィカシーの改善につながったと考えている.まだ,運動介入から2カ月と短期間での評価結果だが,現時点でFIMでは検出不可能であった運動療法介入効果を％CGRを代表とする生化学的データにて示す事が出来た.このような結果から血液透析患者に対して疾患特異的尺度の開発が必要であると同時に,従来の効果判定指標では示せない運動介入による効果判定を行う必要があると考える.<BR><BR>【理学療法学研究としての意義】<BR> 血液透析患者では日常の臨床で運動療法による改善効果が患者の内的情報から聞かれる事は大変多い.しかし,ADLのような疾患特異的では無い評価尺度や,運動パフォーマンス変化を必要とする尺度でのみでは客観的な運動効果を示す事は難事である.本研究では疾患特異的な効果判定尺度を用いて介入効果を検討した.本研究のような視点からの運動療法介入効果を示す事も今後の理学療法において重要と演者らは考え,本研究は臨床的にも意義のあるものと考える.

Teranishi T, Kondo I, Sonoda S, Kagaya H, Wada Y, Miyasaka H, Tanino G, Narita W, Sakurai H, Okada M, Saitoh E. A discriminative measure for static postural control ability to prevent in-hospital falls: Reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE). Jpn J Compr Rehabil Sci 2010; 1: 11-16<br>Purposes: To determine the reliability, validity, and clinical significance of the Standing Test for Imbalance and Disequilibrium (SIDE), a discriminative measure of standing balance, before using it to prevent falls in clinical settings.<br>Methods: In all, 30 patients (18 men and 12 women) with a mean (standard deviation) age of 57.4 (16.97) years (range, 25-85 years) who were admitted to the &ldquo;Kaifukuki&rdquo; rehabilitation ward voluntarily participated in this study. In the reliability study, 2 physiotherapists independently classified the level of static postural control ability by using SIDE. Functional balance control ability was simultaneously evaluated using the Berg Balance Scale (BBS). Cohen's &kappa; statistic was used to determine the inter-rater reliability, and the Spearman rank-correlation coefficient between the BBS score and SIDE level was used to determine the criterion-related validity.<br> Results: Inter-rater reliability of SIDE showed excellent reproducibility (Cohen's &kappa; statistic = 0.76). Criterion-related validity was very high between SIDE levels and BBS scores (Spearman rank-correlation coefficient = 0.93; p < 0.01).<br>Conclusion: SIDE can be used to efficiently and accurately classify balance control ability across individuals and has remarkable concurrent validity in balance evaluation compared to BBS.

【目的】 過去の報告ではADLと難易度についての報告はみられているが、FIM運動項目の中での介助量研究報告は少ない。ADL訓練を行う際の着眼点をみつけることを目的とし今回の研究を行った。 【対象】 研究期間は2009年4月から2009年6月の間に当院に入院していた脳血管障害患者55名（男性：19名 女性：36名）とした。疾患内訳は脳梗塞 41名 脳出血 9名 その他 5名であった。平均年齢は74.9±13.1歳であった。 【方法】 今回、FIM運動項目を評価する際に含まれる内容をさらにFIMに準じて「自立」から「全介助」までの7段階評価（食事では「準備」「口まで運ぶ」「咀嚼、嚥下」「食べ残しを集める」の４項目でFIMは採点を行う。今回はこの4項目それぞれFIMに準じて7段階評価した）を行った。そして、「自立」「修正自立」を自立群、「監視」を監視群、「最小介助」から「全介助」までを介助群とし、自立群、監視群の割合を調査した。 【結果】 食事は「摂食、嚥下」「口に運ぶ」の自立度が高いが、「準備」の自立度が低かった。移乗動作は「立ち上がり」の自立度は高いが、「方向転換」の自立度が低かった。更衣動作(上衣、下衣)は「片腕を通す」など開始動作の自立度が高く、開始動作ができないと残りの項目は自立度が低かった。トイレ動作は「拭く」ことの自立度は高いが、「服の上げ下げ」の自立度は低かった。清拭は遠位にいくほど自立度が低下した。 【考察】 今回の結果では食事の自立度が最も高かった。しかし、食事の項目で「口に運ぶ」ことが出来ない場合は、他のFIM項目の自立度も低下していた。 更衣はFIM3点と4点では「片腕を通す」など開始動作の自立度が変わってくる。これは開始動作がその後の動作に影響したものだと考える。移乗動作はFIM3点と4点では「立ち上がり」の自立度が変わってくる。4点になるかどうかは「立ち上がり」の影響が考えられる。今回の結果から、FIM3点と4点ではポイントとなる項目があった。また、食事で「口に運ぶ」ことが行えないとADLに影響を及ぼすことが示唆された。

中臀筋の筋活動量を高める方法の一環として,トレッドミル上での横歩きを用いて,平地横歩きならびに側臥位股関節外転測定との関係を検討した.健常女性20例を対象とし,評価筋は右側の中臀筋とした.側臥位での股関節外転反復運動時の筋積分値(表面筋電)を測定した.次に,平地・トレッドミルにおいて,左方向への横歩き(後脚EMG)と右方向への横歩き(前脚EMG)を測定した.側臥位での股関節の外転運動の筋積分値は,平地横歩きとトレッドミル横歩きの筋積分値より大きかった.横歩きの4方法間の比較では,後脚EMGの方が前脚EMGより高い傾向がみられ,さらにトレッドミル横歩きは平地横歩きより筋積分値が有意に高い結果となった.中臀筋の筋力増強にはトレッドミル上の横歩きが有効であることが示唆された

トレッドミル歩行分析の一環として,平地歩行との比較を時間・距離的,運動学的,運動力学的因子から検討を加えることによって両歩行の相違を明確にした.トレッドミル歩行と平地歩行の相違点と環境的要因,特にベルトの不安定要因との関係について考察を行った.しかし,力学的には同一歩行と考えられる両歩行に相違が生じたのには,ベルトの不安定要因のみが決定因子となるわけではなく,さまざまな因子が相互的に関連しながら作用しているためと考えられた.さらには,トレッドミルという不安定な床上を歩行することからくる恐怖心や不安感などの心理的な影響も両歩行に相違を生じさせた一因として考えられた.トレッドミルベルトの不安定要因が関与して,健常者においてはいくつかの相違点が生じることが明らかになった

【はじめに】 理学療法士・作業療法士(以下，PT・OT)の養成教育は，態度・知識・技術の習得を目標にしている．その中で，臨床実習における指導形態は，各実習施設の指導者が直接患者を介して指導する形式をとっている．しかし，実際には症例レポートを介しての指導が中心となっており，知識・技術・態度について十分行われていないのが現状である．また，臨床実習の評価結果からは各指導者ごとの採点基準が一定していないことが問題となっている．そこで，我々は臨床に必要な知識・技術・態度の到達度を客観的にとらえるため，近年，医学部教育の中で注目されている客観的臨床能力試験(以下，OSCE)を用い，その有用性について検証ので報告する．【対象】 対象者は，平成14年度に3年次の臨床実習実施中である理学療法科6名・作業療法科5名とした．【方法】 まず，OSCEを3段階に定義付けした．レベル1(1年生対応)は， 医療人として基本的態度をそなえていること，訓練機器および介助法が理解できていること．レベル2(2年生対応)は，各種検査・測定方法を説明でき適切に実施することができる．レベル3(3年生対応)は，患者の状態に応じて適切な訓練を実施することができる（具体的には：口頭指示レベルで訓練を実施する，介助しながら訓練を実施する，患者のリスクを考慮して訓練を実施する）とした．今回は，各レベルから一つずつOSCE項目を設定し実践した．レベル1は，患者との会話を通して適切にコミュニケーションがとれるかを評価目的とした「接遇・態度」，レベル2は，肩関節外転のROM測定，レベル3は，口頭指示による移乗訓練とした．対象者は，1ステーション5分間の評価時間を設けて3箇所行った．評価者はPT・OT合計4名配置し，模擬患者はPTが行った．【結果・考察】 OSCE項目における評価者間の相異において，接遇・態度では，挨拶の有無や視線の高さなど，評価者が判断しやすい項目では一致していたが，声の明瞭度や仕草・表情などにおいて差が生じやすかった．ROM測定では，ゴニオメータの軸の合わせ方など評価者の見る方向に注意が必要であった．また，ROM測定・移乗訓練など技術を必要とする項目においては，各評価者間の到達目標に相異がみられた．今後は，まず評価者において学生だけでなくPT・OT有資格者を評価することにより技術レベルの到達目標を知ることが重要と思われた．また，被験者に対して評価後に技術レベルでのフィードバックをする必要があった．さらに，模擬患者においても同様な患者像を提供できるようトレーニングの必要性を感じた．