Influence of motivation on rehabilitation outcomes after subacute stroke in convalescent rehabilitation wards.

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 (ß = -3.1, 95% confidence interval [-5.3, -0.9], p = 0.005) and three (ß = -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.

Development and validation of new evaluation scale for measuring stroke patients' motivation for rehabilitation in rehabilitation wards.

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.

Measuring Community Participation Among Japanese with Serious Mental Illnesses.

Community participation is associated with physical, cognitive, and mental health benefits for people with serious mental illnesses (SMI) and is recognized as a critical component of health functioning. Developing reliable measurement of participation in different cultural contexts and languages is important to expanding knowledge in this area. The aim of this study was to translate a psychometrically sound English-language community participation measure into Japanese and examine its test-reliability with a population of Japanese people with SMI. Self-reported data were gathered twice from 253 individuals within 48 h using the Temple University Community Participation-Japanese version (TUCP-J) at Type-B Continuous Employment Support Centers in Japan between November 2020 and February 2021. Participant responses were similar on four of the five participation subscales. At the item-level, participants provided consistent responses on 26 out of 27 of the items about amount of participation and had high item-level concordance (77-93%) on their ratings of the importance (Yes; No) of each participation activity and their reported participation sufficiency (Enough; Not Enough; Too Much: 73-88%). Overall, the results demonstrated strong evidence of test-retest reliability of the TUCP-J and identified a number of areas that were important to respondents, but where they were reporting not doing enough.

Motivation for Rehabilitation in Patients With Subacute Stroke: A Qualitative Study.

Background: 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. Purpose: This study aimed to examine the factors influencing patients' motivation and to explore the behavioral changes induced by motivation, especially age-related differences. Method: 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 < 65 years), and data were analyzed according to the groups. This study was conducted according to the consolidated criteria for reporting qualitative research. Results: 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. Conclusions: 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.

Work support for working age persons who have experienced a stroke in Japan: cooperation between hospitals and work support agencies.

The number of Japanese working age persons who have experienced a stroke is significantly increasing. In such cases work support is an urgent issue. Although an active cooperation between medical institutions and work support agencies is critical, it has been insufficient, due to an absence of key coordinators with sufficient knowledge in both occupational therapy and work support or vocational rehabilitation. The present paper introduced two case studies to illustrate the importance of the cooperation between medical institutions and work support agencies and discussed reasons why medical institutions have difficulties in supporting persons who have experienced a stroke in their return to work.

Self-perceived knowledge and skills of job coaches in Japan.

OBJECTIVE: The purpose of the study was to assess the self-perceived knowledge and skills of Japanese job coaches and to examine whether their knowledge and skills differed across employment settings. PARTICIPANTS: The 479 job coaches at Work Support Centers or Work Support Agencies comprised the study population. METHODS: A Japanese version of the 80-item Self-Assessment for Students or Counselors (SASC-J) was mailed to all the Work Support Centers and Agencies. RESULTS: There was no significant difference on any of the SASC-J 8 subsystems mean scores between Work Support Agencies and Work Support Centers. The highest mean score of these 2 employment settings was the "Placement Personal" (2.30 and 2.31), and the lowest was the "Education" (1.40 and 1.46). The overall mean score of the SASC-J was 1.82 (SD=0.63). A significant relationship was found between the years of experience and the SASC-J (r=0.30, p < 0.01). CONCLUSIONS: Since the average below 3.0 on the SASC would mean that "you need to read a textbook on placement and/or a course in Placement", the result of the current study suggested that Japanese job coaches, regardless of the employment settings, need to learn more about the systematic placement technique. Further studies are encouraged to assess the training outcome of the job coach.