Norikazu Kobayashi

A Randomised Clinical Trial of a Wellness Programme for Healthy Older People

Background: With a growing increase in the population of older people worldwide, there is an undeniable need for efficient and cost-effective service delivery in occupational therapy. Method: This randomised clinical trial employed a parallel design, with an experimental and a control group and a pre-test and post-test, to evaluate the effectiveness of a wellness programme based on the Model of Human Occupation (MOHO). Participants were 65 years of age or older, community-dwelling Japanese older people. Data were analysed for 30 experimental participants who received a 15-session MOHO programme and 33 controls who received a 15-session standard care, crafts programme. Quality of life and psychological wellbeing were compared between groups using the Japanese versions of the Life Satisfaction Index — Z (LSI-Z) and the World Health Organisation Quality of Life-26 (QOL26), respectively. Results: The LSI-Z score for the experimental group improved an average of 3.4 points whereas the control groups mean score improved by 0.1 point. The mean change for the experimental group (m.chg = 3.4, SD = 5.8) was significantly different (p = 0.01) from that of the control group (m.chg = 0.1, SD = 4.8) and the effect size (Cohens d) was 0.62 (95% confidence interval = 0.13–1.11). The psychological domain score (QOL26) improved slightly for the experimental group whereas it declined slightly for the control group. The mean change was significantly different (p = 0.02) between the experimental (m.chg = 0.1, SD = 0.5) and control (m.chg = −0.1, SD = 0.3) groups; effect size (Cohens d) was 0.49 (95% confidence interval = 0.02–0.96). Conclusion: The findings support the conclusion that MOHO-based occupational therapy interventions can promote wellness effectively in older people by having an impact on quality of life and sense of wellbeing.

The Model of Human Occupation-Based Intervention for Patients with Stroke: A Randomised Trial

Objective/Background This study examined a group of people with cerebrovascular accidents who were in a chronic phase in a Health Care Facility for the Elderly in Japan. The model of human occupation (MOHO)-driven occupational therapy (OT) intervention was compared with interventions that were based on other theories, for example, biomechanical and neurodevelopmental frames of reference. Methods A total of 36 service users were randomly assigned to either an experimental group (who received MOHO-based OT) or a control group (who received “usual OT”). All the service users were assessed using the Activities of Daily Living (ADL), WHO Quality of Life 26 (QOL-26), MOS-36-Item Short Form Health (SF-36) before and after a 12-week OT intervention. Results Based on the results of our study, we found that the experimental group significantly improved in ADL and QOL scores following the MOHO-based OT intervention; in fact, these scores were higher (p < .05) than before the practice. The control group, however, only improved on ADL scores following OT intervention. In addition, when compared with the control group after the interventions, the experimental group had significantly improved (p < .05) scores in the following: ADL, all five domains of QOL-26, and physical functioning, role physical, bodily pain, general health perception, social functioning of SF-36. Conclusion The MOHO-based intervention was more effective in the improvement of ADL and QOL than non-MOHO-based intervention.

Examining the Psychometric Properties of the Model of Human Occupation Screening Tool–Japanese Version

Objective/Background The Model of Human Occupation Screening Tool-Japanese version (J-MOHOST) was developed, and it was identified that the J-MOHOST did not have any problems in linguistic validation. The purpose of this study is to examine the psychometric properties of the J-MOHOST for the physical disabilities. Methods Forty-four participants were recruited from the rehabilitative wards and data, including demographic variables and the J-MOHOST scores, were obtained. The fit statistics, rating scale characteristics, and reliability index were examined using the Rasch analysis. Results There were no misfitting participants, and the J-MOHOST measures reliably separated the participants into 3.95 statistically distinct strata with a person reliability of .88. The result of item fit showed that it did not have noticeable problem in the items of the J-MOHOST. Moreover, the item reliability was .88. The content of the item difficulty could represent the characteristics of occupational participation of the participants in conformity with the rating system of the J-MOHOST. Conclusion The J-MOHOST rating scale could discriminate the level of occupational participation in physical disabilities. The results indicate that the J-MOHOST is an effective tool for measurement. Further studies are needed to increase the number of participants with a variety of disabilities and settings.

Agreement between long-term care users’ quality of experience in daycare and providers’ perceptions: A cross-sectional study based on the flow model

ABSTRACT Occupational therapists assist individuals by providing suitable activities and skills, making it important to understand the user’s experiences. We explored discrepancies between daycare facility users’ quality of experience (based on the channels of the flow model) and providers’ perceptions of that quality. We obtained the cooperation of 48 daycare facility users and five providers. The results showed that the experience channels differed according to the user for the same activities. Furthermore, providers found it difficult to perceive users’ channels during daycare facility activities; overall, they accurately perceived only 24.5% of users’ channels, even for the easiest for the providers to perceive, agreement occurred in approximately half of the cases. Since it is difficult for health care providers to fully perceive what users are experiencing while participating in activities in their daycare facility, we recommend that providers put further effort into attending to users’ situations and emotions to provide suitable activities.

Cost and outcome of occupation-based practice for community dwelling frail elderly: a pilot study

Purpose The purpose of this pilot study was to determine the effectiveness and costs of the occupation-based practice for community dwelling frail elderly. Design Pilot pre-post design without a control group. Setting A care management center involving 37 local elderly. Subject The final analysis included 26 frail elderly in a community dwelling center. Intervention The intervention was occupation-based practice involving setting of client-centered goals, observation of real living situations, and provision of advice on the individual problem of real occupation. Outcome The outcome was the Frenchay Activities Index (FAI), which is used to evaluate the instrumental activities of daily living (IADL). Additionally, the frequency, duration, and cost of the intervention were calculated. Results Regarding the FAI score before and after the interventions, there were significant improvements in all items except work (P<0.05, effect size [r]: 0.67–0.93). A total of 15 people out of 26 (57.7%) showed improvement in activities of daily living. The frequency of interventions was 3.7 (95% confidence interval [CI]: 2.83–4.48), and the duration was 7.4 weeks (95% CI: 5.27–9.42). The average intervention cost was

Evaluating the Relationships between the Postural Adaptation of Patients with Profound Cerebral Palsy and the Configuration of the Seating Buggy's Seating Support Surface

258 (95% CI: 200.4–317.4). Conclusion The results of this study showed that occupation-based practice has a potential to improve IADL in frail elderly, with low frequency of intervention, within a short-term, and direct cost reduction. We believe that this pilot study will contribute to future clinical studies for frail elderly, and the findings can be easily applied to daily clinical intervention. A well-designed prospective randomized-controlled trial is necessary to verify these results.