吉田 太樹

Introduction Qualitative information in the form of written reflection reports is vital for evaluating students’ progress in education. As a pilot study, we used text mining, which analyzes qualitative information with quantitative features, to investigate how rehabilitation students’ goals change during their first year at university. Methods We recruited 109 first-year students (66 physical therapy and 43 occupational therapy students) enrolled in a university rehabilitation course. These students completed an open-ended questionnaire about their learning goals at the time of admission and at 6 and 12 months after admission to the university. Text mining was used to objectively interpret the descriptive text data from all three-time points to extract frequently occurring nouns at once. Then, hierarchical cluster analysis was performed to generate clusters. The number of students who mentioned at least one noun in each cluster was counted and the percentages of students in each cluster were compared for the three periods using Cochran’s Q test. Results The 31 nouns that appeared 10 or more times in the 427 sentences were classified into three clusters: “Socializing,” “Practical Training,” and “Classroom Learning.” The percentage of students in all three clusters showed significant differences across the time periods (p < 0.001 for “Socializing”; p < 0.01 for “Practical Training” and “Classroom Learning”). Conclusion These findings suggest that the students’ learning goals changed during their first year of education. This objective analytical method will enable researchers to examine transitional trends in students’ reflections and capture their psychological changes, making it a useful tool in educational research.

ABSTRACT OBJECTIVE This feasibility study aimed to investigate the feasibility of applying a motivational instructional design model to stroke rehabilitation and its potential physical and mental health effects in occupational and swallowing therapy settings. DESIGN An open-label, single-arm, feasibility study. SETTING Convalescent rehabilitation hospitals. PARTICIPANTS Twenty-five patients with stroke (19 males; mean age 62.4 ± 11.9 years) were recruited from two convalescent rehabilitation hospitals. INTERVENTIONS The intervention was to motivate participants during rehabilitation sessions based on the motivational instructional design model and was delivered to 12 and 13 participants in two hospitals during occupational and swallowing therapy sessions, respectively. The intervention was given for 40–60 min daily, 5 days weekly for 4 weeks (25 sessions). MAIN OUTCOME MEASURES The primary outcome was feasibility, including the drop-out rate, an adverse event, and the participants’ acceptability of the intervention. Additionally, physical (activities of daily living, motor function of the paretic upper extremity, and swallowing ability) and mental health (depressive symptoms and apathy) outcomes were evaluated before and after the intervention. RESULTS No participants dropped out of the intervention or experienced an adverse event. Twenty-one participants (84%) were satisfied with the intervention, and 19 (76%) hoped to continue receiving it. After the intervention, statistically significant improvements with a large effect size were found in physical outcomes (Cohen’s r = 0.68–0.85) but not in mental health outcomes (Cohen’s r = 0.31–0.34). CONCLUSIONS The application of the motivational instructional design model to occupational and swallowing therapies after stroke was feasible with the potential to improve physical outcomes.

Background The motivation for rehabilitation is important in encouraging stroke patients to participate in rehabilitation; however, its relationship with outcomes is not well known. In addition, changes in patient motivation during hospitalization have not been examined. Aim To examine the relationship between motivation and rehabilitation outcomes for subacute stroke patients and to investigate the changes in motivation. Design Prospective cohort study. Setting Subacute rehabilitation hospital. Population The study enrolled a consecutive sample of patients (n = 201) with stroke admitted to a subacute rehabilitation ward from October 2017 to March 2019. Methods The functional independence measure and motivation in stroke patients for rehabilitation scale was evaluated at admission; at one, two, and three months after admission; and at discharge. The effectiveness and efficiency of the functional independence measure were calculated as rehabilitation outcomes. The effect of motivation on outcomes and the change in motivation in stroke patients for rehabilitation scale scores over time were analyzed using a linear mixed model. Results The median (interquartile range) converted motivation in stroke patients for rehabilitation scale scores (converted to a range of 0–100) at admission; one, two, and three months after admission; and discharge was 86 (76–95), 83 (77–94), 81 (74–95), 81 (71–93), and 84 (75–95), respectively. The median (interquartile range) of effectiveness and efficiency of the functional independence measure from admission to discharge was 0.82 (0.68–0.91) and 0.41 (0.30–0.59), respectively. Motivation in stroke patients for rehabilitation scale scores were not significantly associated with the effectiveness and efficiency of the functional independence measure (p > 0.05). Motivation in stroke patients for rehabilitation scale scores were significantly lower at two (β = −3.1, 95% confidence interval [−5.3, −0.9], p = 0.005) and three (β = −4.4, 95% confidence interval [−7.3, −1.6], p = 0.002) months after admission than at admission. Conclusion Motivation might not directly affect rehabilitation outcomes assessed by the functional independence measure. Furthermore, many participants remained highly motivated, although their motivation decreased at one or three months after admission. Clinical rehabilitation impact Assumptions that rehabilitation is ineffective because of low motivation may not be correct. To examine the influence on outcomes, both motivation and daily activities should be considered.

OBJECTIVE: To investigate the long-term cumulative risk and factors associated with fall-related fractures in stroke survivors discharged from convalescent rehabilitation wards. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 786 stroke survivors discharged from a rehabilitation hospital. METHODS: Data regarding fall-related fractures posthospital discharge were collected using self-reported questionnaires. The Kaplan-Meier method was used to calculate the cumulative incidence of fall-related fractures, and risk factors were analysed using Cox proportional hazard regression analysis. RESULTS: Of 1,861 consecutive stroke survivors who had been discharged from hospital, 786 (42.2%) provided information concerning fall-related fractures. Duration from time of discharge to time of collection of questionnaires ranged from 1 to 6 years (mean 38.0 months). The cumulative incidence of fall-related fractures at 1-, 2-, 3-, 4-, and 5-years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. Cox proportional hazard regression analysis indicated that female sex (hazard ratio (HR) 1.69) and moderate lower limb paresis (HR 3.08) were significant risk factors. CONCLUSION: The cumulative risk of fall-related fractures in stroke survivors post-discharge from a rehabilitation hospital was notably high. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis.

Objective This study aimed to develop the Motivation in stroke patients for rehabilitation scale (MORE scale), following the Consensus-based standards for the selection of health measurement instruments (COSMIN). Method Study participants included rehabilitation professionals working at the convalescent rehabilitation hospital and stroke patients admitted to the hospital. The original MORE scale was developed from an item pool, which was created through discussions of nine rehabilitation professionals. After the content validity of the scale was verified using the Delphi method with 61 rehabilitation professionals and 22 stroke patients, the scale’s validity and reliability were examined for 201 stroke patients. The construct validity of the scale was investigated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory analysis. Cronbach’s alpha confirmed its internal consistency. Regarding convergent, discriminant, and criterion validity, Spearman’s rho was calculated between the MORE scale and the Apathy Scale (AS), Self-rating Depression Scale (SDS), and Visual Analogue Scale (VAS), which rates the subjective feelings of motivation. Results Using the Delphi method, 17 items were incorporated into the MORE scale. According to EFA and CFA, a one-factor model was suggested. All MORE scale items demonstrated satisfactory item response, with item slopes ranging from 0.811 to 2.142, and item difficulty parameters ranging from -3.203 to 0.522. Cronbach’s alpha was 0.948. Regarding test-retest reliability, a moderate correlation was found between scores at the beginning and one month after hospitalization (rho = 0.612. p < 0.001). The MORE scale showed significant correlation with AS (rho = -0.536, p < 0.001), SDS (rho = -0.347, p < 0.001), and VAS (rho = 0.536, p < 0.001), confirming the convergent, discriminant, and criterion validity, respectively. Conclusions The MORE scale was verified as a valid and reliable scale for evaluating stroke patients’ motivation for rehabilitation.

<bold>Background:</bold> Motivation is essential for patients with subacute stroke undergoing intensive rehabilitation. Although it is known that motivation induces behavioral changes toward rehabilitation, detailed description has been lacking. Motivation can be intrinsic or extrinsic; however, it is unclear which type of factors mainly motivates patients' daily rehabilitation. <bold>Purpose:</bold> This study aimed to examine the factors influencing patients' motivation and to explore the behavioral changes induced by motivation, especially age-related differences. <bold>Method:</bold> Twenty participants (mean age 65.8 years [standard deviation 13.7]) who had a subacute stroke and underwent rehabilitation at a convalescent hospital were recruited using convenience sampling. Semi-structured interviews were conducted by an occupational therapist with an interview topic guide regarding factors influencing motivation and how it affects behavioral change. Interviews were recorded, transcribed to text, and analyzed by three occupational therapists using thematic analysis. The participants were divided into two groups: aged patients (aged ≥ 65 years) and middle-aged patients (aged &amp;lt; 65 years), and data were analyzed according to the groups. This study was conducted according to the consolidated criteria for reporting qualitative research. <bold>Results:</bold> Seven core categories were identified as factors influencing patients' motivation: patients' goals, experiences of success and failure, physical condition and cognitive function, resilience, influence of rehabilitation professionals, relationships between patients, and patients' supporters. The first four and last three core categories were further classified as personal and social-relationship factors, respectively. The categories related to intrinsic motivation such as enjoyment of rehabilitation itself were not derived. In both age-groups, motivation affected the frequency of self-training and activity in daily lives. In some aged patients, however, high motivation restrained their self-training to conserve their physical strength for rehabilitation by professionals. Some aged patients do not express their high motivation through their facial expressions and conversations compared to middle-aged patients; therefore, motivation is not always observable in aged patients. <bold>Conclusions:</bold> Interventions tailored to extrinsic factors are important for maintaining patients' motivation. Observational evaluation may lead to mislabeling of their motivation, especially for aged patients. Rehabilitation professionals should use validated evaluation scales or patients' narratives to assess patients' motivation.

脳卒中患者におけるリハビリテーション(以下、リハ)のモチベーションに関する知見をシステマティックレビューを用いて整理した。PubMed、CENTRAL、医中誌Webのデータベースから1,930文献が検索され、適格基準・除外基準を満たした13論文が抽出された。脳卒中患者のモチベーション評価には、リハのモチベーションに特化していない尺度や医療者による観察評価が用いられていた。モチベーションとリハの相互作用については、モチベーションに影響を与える要因、モチベーションが機能や活動に及ぼす影響について報告されていたが、報告の質・量共に不十分であった。今後は脳卒中患者のリハに対するモチベーションの概念形成や評価尺度開発が必要である。(著者抄録)

PURPOSE: Older and/or cognitively impaired patients require verbal guidance to prevent accidents during wheelchair operation, thus increasing the burden on caregivers. This study aimed to develop a new portable voice guidance device for manual wheelchairs and examine its clinical usefulness. METHOD: We developed a portable voice guidance device to monitor the statuses of wheelchair brakes and footrests and automatically provide voice guidance for operation. The device comprises a microcomputer, four magnets and magnetic sensors, speaker and battery. Device operation was assessed during the transfer from a wheelchair to bed six times per day over three days for a total of 90 transfers in five stroke patients (mean age: 79.6 years) who required verbal guidance to direct wheelchair operation. Device usability was also assessed using a questionnaire. RESULTS: The device performed perfectly during all attempted transfers (100%). To ensure safety, the assessor needed to add verbal guidance during 33 of 90 attempted transfers (36.6%). Overall, the device usability was favourable. However, some assessors were unsatisfied with the volume of the device voice, guidance timing and burden reduction. CONCLUSIONS: Our device could facilitate wheelchair operation and might potentially be used to reduce fall risk in stroke patients and the burden on caregivers. Implications for Rehabilitation The acquisition of transfer independence is an important step in the rehabilitation of patients with mobility issues. Many patients require supervision and guidance regarding the operation of brakes and footrests on manual wheelchairs. This newly developed voice guidance device for manual wheelchair transfers worked well in patients with hemiplegia and might be helpful to reduce the fall risks and the burden of care.

重度の末梢神経障害を呈したPOEMS(polyneuropathy,organomegaly,endocrinopathy,m-protein,skin changes)症候群で、発症1年5ヵ月後に在宅勤務での復職を果たした患者(39歳男性)に対するリハビリテーションについて報告した。患者は重度の軸索障害が認められ、入院時点で筋収縮が認められない筋については短期的な改善は望めないと判断し、入院当初より車椅子でのADL自立と復職を目指したリハビリテーションを行うとともに、並行して職場との勤務内容の調整などを実施した。早期での復職が可能になった要因として、若年でADLが自立していたこと、ホワイトカラー職種であったこと、職場の受け入れ体制が整っていたことに加え、本人および会社への適切な情報提供を行ったことが、能力に配慮した職務内容・勤務内容の調整につながったと考えた。

中国は高齢化に伴い,急速にリハビリテーション(以下,リハ)医療が発展してきている.日本から中国リハ医療への協力として,中国人治療師の技術向上支援のため日本人療法士が講師を務める講習会について,需要の有無,希望価格帯を調査した.90名の中国人治療師を対象にアンケート調査を実施し,96.7%の中国人治療師が講習会に参加したいと答え,希望価格帯は中国人治療師の平均月給の7.9〜15.8%に相当する300〜600元(5,400〜10,800円/1元=約18円)との回答が最も多かった.中国にて日本人療法士が講師を務める講習会の需要があることが示唆された.今後,中国リハ医療発展のためには,活動と参加に関しての研修会開催が必要と思われる.(著者抄録)