金田 嘉清

Background Most measures of rehabilitation participation rely on self-report, excluding patients with cognitive impairment or aphasia. The observational Pittsburgh Rehabilitation Participation Scale (PRPS) allows their inclusion; however, whether rehabilitation participation assessed using the PRPS modifies improvement in activities of daily living (ADL) remains unclear. Objective To determine whether rehabilitation participation assessed using the PRPS modifies the association between baseline ADL and subsequent improvement after stroke. Methods This retrospective cohort study included 137 stroke survivors in a subacute rehabilitation ward. Admission rehabilitation participation was assessed by the PRPS. ADL improvement was evaluated using the Functional Independence Measure (FIM) motor effectiveness score. Hierarchical multiple regression analysis included age, days from onset to hospital admission, admission FIM motor and cognitive scores, and admission PRPS score in Step 1, followed by the PRPS × admission FIM motor interaction term in Step 2. Prediction plots were generated for each PRPS score. Results The median admission PRPS and FIM motor effectiveness scores were 5 (interquartile range [IQR], 4–6) and 0.70 (IQR, 0.33–0.88), respectively. Adding the PRPS × FIM motor interaction term in Step 2 significantly improved the model fit (ΔR ²  = 0.057, ΔF(1,130) = 16.28, p  < .001), resulting in a final model (R ²  = 0.545, p  < .001). Prediction plots showed steeper slopes with higher PRPS scores. Conclusions Admission rehabilitation participation assessed by the PRPS modified the association between baseline ADL and ADL improvement. Observable participation should be interpreted in relation to baseline motor ADL rather than in isolation. Lower participation may indicate a need for additional clinical support.

Background/Objectives: Advanced age in Parkinson’s disease (PD) is linked to worse motor function, more severe symptoms, and impaired activities of daily living (ADLs). Lee Silverman Voice Treatment (LSVT)® BIG may be suitable for older patients, as it can be adapted to individual abilities. This study evaluated whether age affects the effectiveness of LSVT® BIG on gait speed, motor symptoms, ADLs, and quality of life (QoL) in PD. Methods: In this retrospective, single-center cohort study, 22 patients with PD were divided into an older group (≥65 years; n = 16) and a younger group (<65 years; n = 6). All participants completed 16 one-hour, face-to-face LSVT® BIG sessions. Gait speed was assessed with the 10-m walk test; motor symptoms with Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III; ADLs with MDS-UPDRS Part II; and QoL with the Parkinson’s Disease Questionnaire-39 Summary Index. Two-way mixed-design analysis of variance with aligned rank transformation was used for statistical analysis. Results: Significant improvements were observed for all outcomes (gait speed, motor symptoms, ADLs, and QoL) after the intervention. A significant effect of age group was found for gait speed, with younger patients walking faster overall. No significant interaction between timepoint and group was observed for any measure. Conclusions: LSVT® BIG appears to improve gait speed, motor symptoms, ADLs, and QoL in patients with PD, regardless of age, suggesting it is an effective intervention for both older and younger patients.

OBJECTIVES: This study examined the relationship between pre-licensure academic performance and self-assessed clinical competence, as measured by the Clinical Competence Evaluation Scale in Physical Therapy (CEPT), among novice physical therapists with up to 1 year of clinical experience after graduation. METHODS: The study participants were 37 graduates of a vocational school who had passed the national physical therapy licensure examination and were employed in healthcare or welfare facilities. Pre-graduation performance data included first-year and second-year academic grades, scores in basic and professional foundational subjects, and Clinical Training III evaluations. Self-assessments after graduation were conducted using the CEPT, which contains 53 items across seven competency categories. Correlational analyses were performed to investigate associations between pre-graduation academic metrics and CEPT scores. RESULTS: There were significant negative correlations between first-year and second-year academic performance, scores in basic professional subjects, advanced professional subjects and the combined scores of basic and advanced professional subjects with CEPT domains related to "Knowledge" and "Decision-making skills." Scores in basic professional subjects were the lowest among all categories and exhibited the strongest negative correlation with self-assessment. CONCLUSIONS: Students with higher levels of academic performance tended to rate themselves lower in early self-assessment after graduation, suggesting a possible lack of confidence in their knowledge or difficulties adapting to the complexities of clinical training. These findings highlight the potential value of integrating metacognitive support and self-assessment training into the physical therapy curriculum to foster practical competence and professional growth.

In individuals with Parkinson’s disease (PD), bradykinesia severity is related to physical activity (PA) inside homes. We aimed to investigate the effectiveness of the Lee Silverman Voice Treatment (LSVT)® BIG intervention in increasing at-home PA in individuals with PD. To evaluate the effect of the intervention, we compared pre- and post-intervention scores on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts 3 and 2, as well as the time spent at home in three categories of PA intensity. For statistical testing, paired t-tests were used when the data met the assumptions of normality, and the Wilcoxon signed-rank test was applied otherwise. Differences were considered statistically significant at p < 0.05. This preliminary retrospective observational study included 10 eligible individuals with PD (4 males). The participants’ mean age was 71.0 ± 10.8 years, with median Hoehn and Yahr stage 3 [interquartile range: 1 to 4]. The MDS-UPDRS Part 3 score, bradykinesia score calculated from a part of that score, and the MDS-UPDRS Part 2 score significantly improved after the intervention (Wilcoxon signed-rank test, p < 0.05). The time spent in sedentary behavior (SB) significantly decreased from 516.4 ± 72.6 to 484.0 ± 70.0 min, whereas that spent in light PA (LPA) significantly increased from 137.8 ± 46.2 to 169.5 ± 32.1 min (paired t-test, p < 0.05). The time spent on moderate-to-vigorous PA (MVPA) did not change significantly (paired t-test, p = 0.533). The results suggested that LSVT® BIG is an effective intervention for increasing at-home PA in individuals with PD. In addition, regarding the specific details of the increase, the time spent on MVPA may not change, and the increase may be mainly attributed to increased LPA and reduced sedentary time.

BACKGROUND: Newly graduated physical therapists require effective training to enhance their clinical skills. On-the-job training (OJT) and off-the-job training (Off-JT) are commonly used methods, but their comparative effectiveness remains unclear. This study aimed to compare the effectiveness of OJT and Off-JT in improving the clinical competencies of newly graduated physical therapists. MATERIAL AND METHODS: A crossover study was conducted involving 13 newly graduated physical therapists. Participants alternated between OJT and Off-JT interventions. The objective-structured clinical examination assessed four key skills—joint range of motion measurement, muscle testing, assistance in getting up, and assistance in transferring. Evaluations were conducted at four time points. A Mann–Whitney U -test was used to compare the change in average scores between the two groups from Assessment 1 to Assessment 2. A two-way analysis of variance was conducted to analyze the interaction effects of training methods and assessment timing. RESULTS: Off-JT was more effective than OJT in improving clinical skills, especially in muscle testing and patient assistance tasks. Both training methods enhanced joint range of motion measurement skills; however, no significant differences were found between the groups. Some tasks showed performance declines in the final assessment, indicating the necessity of continued practice. CONCLUSIONS: Off-JT provides a more effective approach for improving clinical skills, particularly for tasks that require specialized knowledge and structured learning. However, OJT remains valuable for reinforcing routine clinical tasks. Future research should explore the long-term effects of these training methods on various clinical competencies.