Current practices and factors affecting evidence-based occupational therapy practice for patients with dementia in Japan.

OBJECTIVE/BACKGROUND: The rapidly increasing incidence of patients with dementia in Japan is creating an urgent demand for evidence-based occupational therapy (EBOT), which has been reported to improve clinical efficacy. This study aimed to examine the current practice of EBOT for patients with dementia in Japan and clarify factors influencing its application. METHODS: We conducted an anonymous, self-administered questionnaire survey by mail. The participants were 432 occupational therapists treating patients with dementia at 432 designated medical institutions nationwide. Descriptive statistics were calculated, and multiple regression analysis was performed to clarify the factors influencing the present application of EBOT. RESULTS: The response rate was 31.3%. Among the participants, 46.3% responded 'somewhat frequently' or more (5, 6, and 7 on a 7-grade scale) to a question on the frequency of practice of EBOT. Using multiple regression analysis with the stepwise method, we selected the model with the highest degree of fit. This model extracted three factors, namely, ability to understand scientific papers, sufficiency of means of getting information, and availability of advice, which had standardized partial regression coefficients (ß) of 0.419, 0.214, and 0.158, respectively. CONCLUSIONS: The three factors extracted using the multiple regression analysis indicate that in order to encourage EBOT for patients with dementia, occupational therapists need to acquire reading comprehension skills, so that they can assess the quality of scientific papers. Furthermore, it is important to create environments where they have access to publications and can discuss research with superiors and colleagues.

Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study.

PURPOSE: Meanings of movement for stroke survivors could give therapists significant insights, especially during maintenance phase. The purpose of this study was to examine how post-stroke users of a long-term elderly care facility had experienced changes in movement resulting from hemiplegia. METHOD: The participants of this study were 18 stroke survivors using a long-term elderly care facility. Based on phenomenology, between two and three interviews were conducted with each participant about their experiences with hemiplegia. Data analysis consisted of the following phases: 'data immersion', 'data transformation' and 'thematic analysis'. This study was approved by the ethics committee of the authors' institution. RESULTS: Participants experienced seven themes resulting from hemiplegia, perceiving themselves differently from the way they did before the stroke. The themes were as follows: 'inescapable dependence', 'sense of incompetence', 'lack of autonomy', 'symbol of deviation from normal', 'licence for amae', 'security of self-worth' and 'proof of effort'. CONCLUSIONS: The first four themes attempt to express participants' pain and difficulty in living with their present body; the last three attempt to express methods for coping with the present body in the company of others. Results will assist therapists to understand the significant needs of their clients in the maintenance phase. Implications for Rehabilitation Hemiplegia is paralysis of half of the body; it represents one kind of physical disability caused by stroke. Re-interpretation of how patients had experienced the changes of their movements after they had hemiplegia is helpful for the therapists to understand the significant needs for their clients. It may be especially relevant for therapists working with stroke survivors in the maintenance phase, whose functional recovery of physical movements is not expected to occur to a greater extent.

Randomised controlled pilot study in Japan comparing a home visit program using a Functioning Improvement Tool with a home visit with conversation alone.

AIM: This study aimed to determine the effect of a home visit program using a Functioning Improvement Tool (FIT) compared with a home visit using conversation alone. METHODS: Twenty-eight participants (mean age, 78.6 ± 7.5 years) were randomly assigned to an intervention (n = 13) or control (n = 15) group for 3 months. The intervention group received a 60-minute FIT home visit program; the control group received a 30-minute home visit using common conversational techniques. Measures were Mini-Mental State Examination, Frontal Assessment Battery (FAB) and Geriatric Depression Scale. RESULTS: The FAB score was significantly improved in the intervention group compared with the control group (2.5 vs -0.5, P = 0.02). CONCLUSIONS: Our FIT home visit program improved cognitive function. Further studies with larger samples and longer follow-up periods are needed to assess the long-term effectiveness of a FIT home visit program on cognition.

A randomized controlled trial of a Functioning Improvement Tool home-visit program and its effect on cognitive function in older persons.

OBJECTIVE: The aim was to determine whether mini mental state examination (MMSE) scores improved in older participants of a Functioning Improvement Tool (FIT) home-visit program. METHODS: Two hundred fifty-two participants aged 65 years or older living at home and receiving preventive services or a community long-term care prevention project according to the Japanese social long-term care insurance system were enrolled and randomly assigned to an intervention group (n = 128) or a control group (n = 124). Intervention group subjects received a 60-min FIT home-visit program for 3 months, which included guidance, assistance, and help in writing and teaching calculation in order to complete the FIT. Control subjects did not receive any home visits. Cognitive function was evaluated by MMSE. Analysis of covariance was used to examine the effects of the FIT adjusting for baseline MMSE scores, age, and sex. RESULTS: Fifty-three subjects were excluded because of withdrawal, hospitalization, death, relocation, or missing data of MMSE; 199 subjects (60 men, 139 women; age 78.6 ± 7.4 years) were analyzed. The baseline MMSE scores did not differ between the intervention and control groups (24.2 ± 4.3 vs. 24.1 ± 4.7, p = 0.90). After the study period, the change in the MMSE score was significantly better in the intervention group than in the control group (0.8 ± 0.3 vs. -0.1 ± 0.2, p = 0.04). Stratified analyses showed that the intervention strategy was most effective in subjects with mild cognitive decline, with baseline MMSE scores from 18 to 23 points (1.9 ± 0.5 vs. -0.1 ± 2.8, p = 0.04). CONCLUSIONS: Our FIT home-visit program improved MMSE scores in older participants with mild cognitive decline.