Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training.

Background: Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. Aims: To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants' license status. Methods: A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0-1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. Results: The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p < 0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p < 0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Conclusion: Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model's goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.

Association between physical activity and health literacy in patients with Parkinson's disease: an online web survey.

BACKGROUND: For patients with Parkinson's disease (PwPD), promotion of habitual physical activity (PA) assists in the prevention of disease progression. Patients' health literacy (HL) is integral for meeting PA standards and turning it into a habit. This study evaluated the association between PA level and each HL domain in PwPD. METHODS: Online web-based assessment instruments and self-administered questionnaires, including the PA Questionnaire (IPAQ) Short Form and the Functional, Communicative, and Critical Health Literacy (FCCHL) scale, were used to assess PA levels and health literacy domains of PwPD. RESULTS: The mean age of PwPD (n = 114) was 65.9 (SD = 11.6) years; 59.6% female, and the mean duration of disease was 6.4 (SD = 5.1) years. Of participants, 47.4% met the recommended criteria for PA. When comparing each HL domain by PA level, participants with lower PA had significantly lower critical HL (p = 0.03). Logistic regression analysis revealed that PA level correlated with critical HL (OR = 2.46; 95% CI = 1.16-5.19; p = 0.02). CONCLUSIONS: Adherence to recommended PA standards was associated with critical HL, but not other HL domains. Proactive attitudes to critically evaluate and utilize as well as understand health information may positively influence the promotion of PA.

Impact of COVID-19 on Clinical Education for Occupational Therapy Students: A 3-Year Longitudinal Study on Fall Risk Prediction Ability.

This study aimed to examine if there were disadvantages to student learning and application when clinical education is canceled due to factors such as COVID-19 pandemic that occurred between 2020-2021. Forty occupational therapy students participated in the study, and they were classified into two groups: those with clinical education (clinical education group) and those without clinical education (inexperienced group). TP-KYT, which assesses a client's ability to predict risk related to falls, was administered in the first and final year. The inexperienced group showed less ability to predict risk related to client falls than the clinical education group.

Evaluation of Clinical Practice Guidelines for Rare Diseases in Japan.

Introduction: The insufficient quantity and quality of clinical epidemiological evidence in the field of rare diseases have posed methodological challenges to develop clinical practice guidelines (CPGs). Guideline development groups struggle to provide patients and their families with beneficial guidance, such as that for medical care and in complex circumstances. Motivated by the challenges, we focused on information on resources for supporting the daily and social life to improve the CPGs for users. We aimed to assess the methodological quality of CPGs for rare diseases in Japan and to evaluate information on resources to support the daily and social life in the CPGs. Methods: We conducted a systematic search using PubMed, three electronic Japanese databases, and two hand-searched sources in Japan. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument with six domains was used to assess the methodological quality of the CPGs. A content analysis of the CPG text was conducted using five keywords as information on non-medical resources, e.g., "Intractable Disease Consultation Support Center," "Japan Intractable Disease Information Center," and "Patient Association." Results: A total of 55 CPGs met the inclusion criteria. Among four domains of AGREE II with low scores (Stakeholder Involvement, Rigor of Development, Applicability, and Editorial Independence), Rigor of Development had the lowest median score. As for information on non-medical resources, 41 CPGs included at least 1 of the 5 keywords, while 14 CPGs included none. Conclusions: At the Rigor of Development domain, methodological challenges may have resulted in an insufficient description of items regarding the translation evidence to recommendations. As the sufficiency of five keywords as information on non-medical resources could be improved, the information will be advocative as clues to provide pragmatic guidance, particularly for rare diseases with limited medical evidence.

Factorial validity and internal consistency of a practitioners' checklist for therapists in rehabilitation.

AIMS: The current study aimed to assess the validity and internal consistency of a 20-item checklist to help provide rehabilitation based on effective and clear goal setting. METHODS: A questionnaire survey was conducted regarding rehabilitation practices followed by physical, occupational, and speech-language therapists over the past month. The questionnaire was based on a checklist covering the following four areas, each comprising five items: goal setting based on patient and family intent and therapist perspective including long-term and short-term goals; therapist's specialized analysis and focalization of problems using the International Classification of Functioning, Disability and Health to clarify work processes and behaviors that hinder high-priority activities; proposal of plans considering the evidence and environment, which clarifies options for resolution methods (plans) and evidence; and formulation and implementation of plans including patient and family intent, which determines plan frequency and implementation period. The checklist was prepared based on medical records and previous studies by two occupational therapists who had experience in providing hospital and home-visit rehabilitation. To test the factorial validity of the 20-item checklist, confirmatory factor analysis was performed, and Cronbach's α coefficients were calculated. RESULTS: The participants' mean age was 28 (25-75th percentile, range: 25-32) years. Of the 385 participants, 163 were home-visit rehabilitation therapists. Our model revealed a fair fit to data (χ2 statistic = 602.0) and standardized path coefficients ranged from 0.67 to 0.95. Path coefficients were at least 0.41 for all 20 items. Cronbach's α for goal setting, problem analysis, problem solving method proposals, and formulation and implementation of specific plans were 0.896, 0.890, 0.935, and 0.925, respectively. CONCLUSION: Based on the assessment of therapists' practice over 1 month using the developed checklist, the factorial validity and internal consistency of these checklist items were considered acceptable. Education based on these checklist items might support goal setting and planning and improve patient outcomes.

Surveying Therapists on Seating Approaches for Patients with Muscular Dystrophy in Japan.

Patients with muscular dystrophy (MD) need fitted wheelchairs. This study aimed to ascertain physiotherapists and occupational therapists' opinions about the current wheelchair seating process for patients with MD in Japan. We identified 266 academic papers published between August 2014 and July 2019 with the keywords "muscular dystrophy" and either "physiotherapy" or "occupational therapy." We then sent survey requests to 140 physiotherapists and occupational therapists (who were among the authors of the aforementioned papers), of whom 41 agreed to partake in this study. We found that the time required for each seating was 30-60 min for three types of MD, and the most commonly reported time to trial fitting was 1-3 months. In addition, health insurance reimbursements for seating were considered part of disease-specific rehabilitation in most cases, and most therapists were more or less satisfied with the current seating procedure. Physiotherapists had the highest degree of reflection of their views (wishes) regarding seating, followed by MDs and their families. In Japan, seating has been regarded as a medical practice since 2017. In the future, we would like to investigate the seating concept for individual therapists in detail.

[Current issues in access to care services for the elderly in Japan focusing on special permanent residents and foreign-born Japanese: A report by the Monitoring Report Committee of the Japanese Society of Public Health].

　Japan is currently one of the countries with a long life expectancy, in which a great number of older people need care for their daily living. Japan has become increasingly internationalized due to an increase in foreigners and international marriages. As the number of elderly foreigners and foreign-born Japanese increase, older adults who do not use Japanese as their first language will need more opportunities to receive care.　We examined characteristics such as country of origin, language spoken, lifestyle, living environment, and cultural background of elderly people who were either foreign permanent residents living in Japan or foreign-born Japanese (hereinafter referred to as elderly with an international background, in short, EIB) receiving care support. Ichushi-web, a medical literature database, was used [last search date: June 2, 2018]. These searches extracted 205 papers. After the first and second extraction procedures, only two papers matched this theme. These two reports were for Korean residents in Japan, so-called special permanent residents, and repatriates from China and their spouses, many of whom were aged 75 years old and above.　The number of permanent residents in Japan who speak a foreign language as their first language is increasing. Inhibition of communication between EIB and healthcare welfare service providers is expected to be an obstacle while accessing care support services. For this reason, we must provide them with information related to Japanese healthcare services. Medical interpretation efforts are scattered and the response to EIB in the event of disasters has been discussed. From the perspective of multicultural coexistence, it is necessary to provide long-term care insurance services and medical services to EIB. Such efforts may include development and sharing of tools and the placement of staff who can communicate with non-Japanese speakers. Staff must also understand various illness- and health awareness-related issues.　In the future, considering the increasing number of EIB who may require care services, we must consider cultural backgrounds and language diversification for EIB. These issues require clarification and development of acceptable solutions.

Occupation-based differences in shared perceptions of older resident needs within multidisciplinary care teams: a cross-sectional study of care workers, nurses, and therapists linked to older residents.

[Purpose] To examine whether the needs of older individuals are commonly understood by multidisciplinary team members at elderly care facilities. [Subjects and Methods] A questionnaire survey with care workers, nurses, and therapists linked to residents and structured interviews with residents were conducted at eight facilities in Japan. The questionnaire comprised 25 items regarding basic activities of daily living, instrumental activities of daily living (IADL), environment and lifestyle (EL), and emotion. [Results] The data of 88 residents (83.0% female, 86.4% aged ≥75 years) and 125 staff members (63 care workers, 36 nurses, and 26 therapists) were analyzed. Perceptions regarding the subjective needs of residents differed significantly by occupation with regard to pace of eating, pace of dressing, and freedom to brush at any time; shaving or putting on make-up; personal space, role performance, and health exercises; and feeling good. All three occupations underestimated the subjective needs of residents for household chores. [Conclusion] Staff members had insufficient understanding of the subjective needs of residents, with a tendency to underestimate IADL and EL needs. Perceived subjective needs also differed by occupation. Sharing the understanding of subjective needs of older individuals within multidisciplinary care teams is desired.

Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients.

BACKGROUND: The Barthel Index (BI) is a measure of independence in activities of daily living (ADL). In the modified Barthel Index (MBI), a five-point system replaced the original two or three or four point rating system. Based on this modified measure, the performance evaluation tool MBI (PET-MBI) was developed in Japan. Although the reliability and validity of PET-MBI have been verified for older people, the use of this tool in stroke patients has not been evaluated. This study investigated the validity and reliability of PET-MBI for stroke patients. METHODS: Ten raters independently determined the BI and PET-MBI scores of stroke patients by direct observation. These patients' ADL were videotaped, and 10 other raters then evaluated the videos privately and assigned PET-MBI scores twice, one month apart. The criterion-related validity of the PET-MBI against the BI was evaluated using the correlation coefficients for their total scores. Furthermore, to assess inter- and intra-rater reliabilities from the results of the first and second sessions, Fleiss' intraclass correlation coefficients (ICCs) were calculated for the total scores, with the lower limits of the 95% confidence interval (95%CI), along with weighted kappa (κw) coefficients for agreement in individual tasks of this evaluation tool. ICC and κw coefficients of 0.81-1.00 were considered to be "almost perfect" agreement. RESULTS: The mean age of the 30 patients (23 men, 7 women) was 71.9 (standard deviation 10.5) years. One patient had diplegia, 14 had right hemiplegia, and 15 had left hemiplegia. For the total scores obtained by direct evaluation, Pearson's and Spearman's correlation coefficients of the BI versus the PET-MBI were both 0.95 (lower limit of the 95%CI, 0.90). The ICC representing inter-rater reliability for the first session was 0.99 (lower limit of the 95%CI, 0.98]. For intra-rater reliability, the mean value of the ICCs was 0.99 (range, 0.99-1.00). For individual tasks of the PET-MBI, inter-rater κw coefficients for the first session ranged from 0.77 to 0.94, with intra-rater κw coefficients from 0.85 to 0.96. CONCLUSIONS: PET-MBI showed strong criterion-related validity against the BI, with high reliabilities. This scoring system may become a convenient tool allowing anyone to assess ADL.

Evaluation of facilitative factors for preventing cognitive decline: A 3-year cohort study of community intervention.

AIM: We conducted a cohort study to elucidate paticipants' facilitative factors that may help to prevent cognitive decline. METHODS: This study followed 100 participants (average age: 74.1 ± 5.8; 10 men, 90 women) for 3 years; participants had previously been part of the Taketoyo Project (n = 366) in 2007-2011. The end-point was defined as reduced cognitive function in elderly community residents participating in a preventive intervention for dementia. The presence or absence of reduced cognitive function at the end of the third year of intervention was the dependent variable, and all evaluation items were considered explanatory variables. After Fisher's exact test (P < 0.15), stepwise multiple logistic regression analysis (P < 0.05) was performed, and facilitative factors for prevention of cognitive decline were extracted. RESULTS: Items with a significant adjusted odds ratio (OR) based on multiple logistic regression analysis were the three-word delayed recall test (OR: 0.330, 95% confidence interval (CI): 0.142-0.767; P < 0.05), word fluency (OR: 0.565, 95%CI: 0.359-0.891; P < 0.05), frequency of going out (OR: 2.790, 95%CI: 0.803-6.380; P < 0.05) and number of friends with whom they engaged in activities (OR:0.344, 95%CI: 0.127-0.932; P < 0.05). CONCLUSION: Subjects who had maintained a certain level of cognitive function, engaged in activities with friends, and went out frequently at baseline were extracted. In other words, the results suggested that enhancement of social networks and leisure activities prompted by recreational centre participation had a positive effect on maintaining cognitive function. The results also suggest that to improve the effectiveness of preventive interventions for cognitive dysfunction, support for social factors and leisure activities, in addition to cognitive function, may improve the long-term effectiveness of maintaining cognitive function.

Gaps between the subjective needs of older facility residents and how care workers understand them: a pairwise cross-sectional study.

BACKGROUND: To promote active daily living and improve the quality of life of older facility residents, it is important that care staff understand their day-to-day activities and needs. However, only a few studies have examined the needs of older residents and how care workers understand them. This study aimed to examine the subjective needs of older residents at aged care facilities, care workers' understanding of these needs, and the gaps that exist between them. METHODS: Structured interviews with older residents with no severe cognitive impairment in ten Japanese aged care facilities and a questionnaire survey of care workers were conducted in 2008 regarding resident subjective needs. The questionnaire, which had satisfactory factorial validity, internal consistency, and reproducibility, consisted of seven items on basic activities of daily living (BADL), five items on instrumental ADL (IADL), eight items on environment and lifestyle (EL), and five items on emotion (EM). Pair-wise analyses were performed to compare responses. RESULTS: Responses of 115 pairs were analyzed (residents ≥75 years, 85 %; 21 men, 94 women). Median proportions of residents with IADL (66 %) and EL (69 %) needs were lower compared with those with BADL (83 %) and EM (91 %) needs. Median proportions of care workers understanding IADL (55 %) and EL (60 %) needs were lower compared with those understanding BADL (87 %) and EM (87 %) needs. Less than half of the care workers understood IADL needs for household chores (30 %) and money management (43 %), and an EL need for playing a role (41 %). CONCLUSIONS: Gaps were found between resident subjective needs and how care workers understood them. Specifically, care workers underestimated older residents' IADL and EL needs, especially with regard to playing a role. These results highlight the need for care workers to set goals based on each resident's subjective needs and plan strategies for care provision accordingly.

Differences between home-visit rehabilitation users and providers in their understanding of the content and subjective effects of rehabilitation practices.

[Purpose] This study aimed to clarify differences between home-visit rehabilitation users and providers in their understanding of the content and subjective effects of this practice. [Subjects] The subjects of this study were home-visit rehabilitation users and providers. [Methods] Home-visit rehabilitation users and providers were given self-administered questionnaires regarding home-visit rehabilitation, such as the content and subjective effects. The McNemar's test was used for statistical analysis. [Results] Responses of 34 pairs meeting the inclusion criteria were analyzed. Mean user age was 75.2 ± 9.2 years, and 58.8% (20/34) of respondents were female. In terms of home-visit rehabilitation content, users believed that the following 3 items had been "implemented" to a greater extent than that estimated by providers: paralysis improvement exercise, floor sitting and standing, and self-care activities. No significant differences in awareness were identified between users and providers regarding the maintenance/improvement effects of home-visit rehabilitation. [Conclusion] Users tend to consider that programs aimed at relieving symptoms and pain and improving mobility are being implemented to a greater extent than that considered by providers. Providers need to explain the aims of home-visit rehabilitation programs in a way that can be understood by users.

Differences in understanding and subjective effects of home-visit rehabilitation between user families and rehabilitation providers.

[Purpose] This study aimed to clarify differences in understanding and subjective effects of home-visit rehabilitation between user families and rehabilitation providers. [Subjects] The subjects were home-visit rehabilitation providers and user families. [Methods] Home-visit rehabilitation providers and user families completed a self-administered questionnaire regarding the content and subjective effects of home-visit rehabilitation. For statistical analysis, the McNemar's test was used. [Results] Fifty pairs of responses met the inclusion criteria. The mean age of user families was 65.0 ± 11.2 years, and 58.0% (29/50) were spouses of users (user mean age, 77.7 ± 10.2 years; 48.0% (24/50) female). With regard to home-visit rehabilitation content, user families thought that paralysis improvement exercise, massage, and self-care activities were implemented to a greater degree than did rehabilitation providers. With regard to the subjective effects of home-visit rehabilitation, a higher proportion of user families noticed "maintenance/improvement" effects on symptoms and sequelae, as well as pain and suffering, compared with providers. [Conclusion] User families believed that rehabilitation would also improve users' symptoms and pain. Care providers should explain the aims of home-visit rehabilitation to users and their families, both of which require a strong understanding of home-visit rehabilitation in order to achieve rehabilitation goals.

Assessment of the validity and internal consistency of a performance evaluation tool based on the Japanese version of the modified barthel index for elderly people living at home.

[Purpose] This study aimed to examine the validity and internal consistency of the Japanese version of a performance evaluation tool for activities of daily living (ADL) based on the modified Barthel Index (PET-MBI) among elderly people at home. [Subjects] The subjects were elderly people living at home in Japan. [Methods] A cross-sectional study was performed at five home care facilities for elderly people in Japan. ADL performance was evaluated for 128 participants using the PET-MBI, which included 10 self-care items. We used confirmatory factor analysis to estimate the factorial validity. We assessed data model fitness with the χ(2) statistic, the Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), and Root Mean Square Error of Approximation (RMSEA). Cronbach's alpha coefficient was used to determine the internal consistency. [Results] The mean age of the participants was 79.1±8.9 years. Among the 126 participants included in the analysis, 67 were women (53.2%). The single-factor model demonstrated a fair fit to the data, with the χ(2) statistic = 74.9 (df =35), GFI = 0.88, AGFI = 0.81, and RMSEA = 0.096, and the path coefficients of each item ranged from 0.44 to 0.95. The alpha coefficient of the 10-item scale was 0.93. [Conclusion] The PET-MBI for elderly people at home was well validated.

Internet use for health-related information via personal computers and cell phones in Japan: a cross-sectional population-based survey.

BACKGROUND: The Internet is known to be used for health purposes by the general public all over the world. However, little is known about the use of, attitudes toward, and activities regarding eHealth among the Japanese population. OBJECTIVES: This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, and to examine the effects on user knowledge, attitudes, and activities with regard to Internet use for health-related information in Japan. We examined the extent of use via personal computers and cell phones. METHODS: We conducted a cross-sectional survey of a quasi-representative sample (N = 1200) of the Japanese general population aged 15-79 years in September 2007. The main outcome measures were (1) self-reported rates of Internet use in the past year to acquire health-related information and to contact health professionals, family, friends, and peers specifically for health-related purposes, and (2) perceived effects of Internet use on health care. RESULTS: The prevalence of Internet use via personal computer for acquiring health-related information was 23.8% (286/1200) among those surveyed, whereas the prevalence via cell phone was 6% (77). Internet use via both personal computer and cell phone for communicating with health professionals, family, friends, or peers was not common. The Internet was used via personal computer for acquiring health-related information primarily by younger people, people with higher education levels, and people with higher household incomes. The majority of those who used the Internet for health care purposes responded that the Internet improved their knowledge or affected their lifestyle attitude, and that they felt confident in the health-related information they obtained from the Internet. However, less than one-quarter thought it improved their ability to manage their health or affected their health-related activities. CONCLUSIONS: Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved users' health-related knowledge and attitudes but seldom changed their health-related abilities and activities. To encourage communication between health providers and consumers, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia.