Development of prediction models for domestic chores resumption among mild stroke patients three months after discharge from specialized rehabilitation wards: A multi-center prospective cohort study.

BACKGROUND: Whether stroke patients resume domestic chores is one of the major issues associated with their quality of life. Prediction models for domestic chores resumption among stroke survivors can be useful for setting goals and planning rehabilitation. OBJECTIVES: To develop prediction models for individual domestic chores resumption among mild stroke patients three months after discharge from specialized rehabilitation wards. METHODS: Ninety-one stroke patients admitted to specialized rehabilitation wardswere included in the analyses. We assessed the prestroke and three months post-discharge frequencies of six domestic chore items of the Frenchay Activities Index. Demographics and candidate predictors such as paralysis severity, cognitive function, walking speed, and self-efficacy were collected at discharge. Binary logistic regression analyses were performed to build prediction models for individual domestic chores resumption after stroke. RESULTS: The preparing meals model included walking speed (OR = 1.05) and cognitive function (OR = 1.29) as predictors; washing up model, walking speed (OR = 1.04); washing clothes model, walking speed (OR = 1.06), and number of family members living together (OR = 0.42); light housework model, walking speed (OR = 1.06); heavy housework model, walking speed (OR = 1.03), cognitive function (OR = 1.38), and self-efficacy (OR = 1.91); and local shopping model, walking speed (OR = 1.05), age (OR = 0.94), and number of family members living together (OR = 0.61). CONCLUSIONS: Our models may be useful in clinical practice to streamline the setting of goals and development of therapeutic strategies for individual domestic chores resumption among mild stroke patients.

A Pilot Study of a Group Program Focused on Enabling Life Performance for Older Adults Living in the Community.

Background: This study attempts to determine whether a program focused on improving literacy in daily living is effective in preventing physical frailty, and to compare standard treatments for physical frailty. Methods: This study was designed as a pilot intervention study involving two groups. Twenty-five older adults aged 65 to 85 in Ward A, Tokyo, were randomly assigned to the literacy group or the exercise group on a regional basis and were given a 60- to 90-minute program twice a month, eight times over four months. The literacy group mainly used video materials to monitor learning, and the exercise group used a multifactor exercise program. Results: The LSI-Z, GAS-L, Maximum 5 m walking time, and TUG tests showed the main effects before and after the intervention in both groups (p < 0.05, p < 0.01). The WHOQOL26, Maximum 5 m walking time, and TUG tests also showed the main effects across both groups (p < 0.05). Conclusion: Both programs, when implemented independently, showed specific effects on subjective well-being, occupational performance, and physical fitness. However, QOL and physical fitness were significantly higher in the exercise group than in the literacy group. These results should be considered with caution because of the limited sample size of this pilot study.

Developing a Group Program for Older Males to Participate in Social Activities in Japan: A Mixed-Methods Study.

This study analyzes the effect of social participation in a program that encourages participation in social activities as an approach to counteract the social isolation of elderly males in Japan. The design of this study was an open-label, before-and-after trial for a single group using the convergent design of the mixed-methods study. This program led to significant improvement in independent living and interest in society, but it did not help increase satisfaction with social activities. Additionally, a qualitative data identify that this program encouraged subjects to proactivity participate in social activities. While it has been identified that this program may have had a considerable effect by integrating quantitative and qualitative data, it is necessary to improve the program to further promote change in the subjects' social behavior.

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 $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.

[Effectiveness of an occupational therapy program for health promotion among healthy elderly. A randomized controlled trial].

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of an occupational therapy program for health promotion among healthy elderly by a randomized controlled trial. METHODS: Participants were 220 community-dwelling healthy elderly, 65 years of age or older. They were assigned randomly to: an experimental group receiving a 15-session MOHO program consisting of lectures and seminars about personal causation, values, interests, roles, habits, motor skills, process skills, communication and interaction skills, and environment; a control group which received a 15-session crafts program or no treatment. Quality of life was compared between groups using the MOS 36-Item Short-Form Health Survey (SF-36), WHO/QOL-26 (QOL26) and Life Satisfaction Index Z. The Fisher's exact test and the t-test were used to assess differences between the two groups. RESULTS: The follow-up rates for the experimental and control groups were 71% and 72%. The experimental group comprised 80 people (mean age +/- SD, 71.1 +/- 4.68 years) and the control group 79 (71.4 +/- 4.66 years). Mean change of the following items for the experimental group was significantly greater from that of the control group: a BP of SF-36 (P = 0.05); and an environment score of QOL26 (P = 0.02). CONCLUSION: The findings provide evidence that the MOHO program can meet coping and influence needs, thus improving QOL. We further conclude that the MOHO program is an effective interventional method for improvement of literacy about health and occupation.

Evaluating the relationships between the postural adaptation of patients with profound cerebral palsy and the configuration of the Seating Buggy's seating support surface.

We are currently investigating the physiological polymorphism of wheelchair users with profound cerebral palsy and the properties of the Seating Buggy (developed by S. Nishimura, 1998) to clarify important and general elements of wheelchairs for widespread use. Cerebral palsy is a diagnostic term used to describe a group of motor syndromes resulting from disorders in early brain development. Recently, it has been shown that the Seating Buggy produces functional head-neck alignments and active control of sitting balance for people with profound cerebral palsy. The Seating Buggy is a wheelchair for the profoundly disabled and features a wide adjustment range from heights of 120 cm to 175 cm. Its seating support surface is comprised of a sling-seat. To examine the relationships between the postural adaptation of patients with profound cerebral palsy and the configuration of the Seating Buggy's seating, we assessed the postural alignment of the Seating Buggy's user and then measured the configuration of its resulting seating support surface with a three dimensional scanning system. Twenty-one subjects were used for the purposes of this investigation in their everyday environment. Postural adaptation and wheelchair fitting in the Seating Buggy were assessed from the viewpoint of the Active Balanced Seating by a seating expert. The subjects fell into two categories, as follows: 11 for appropriate or nearly appropriate fitting, and 10 for ill-fitting. The depth of thoracic support and the forward distance of lumbar support for those who claimed that it was ill-fitting were significantly reduced compared with that of those who claimed that the Seating Buggy offered an appropriate or nearly appropriate fitting. It was suggested that the properly adjusted depth of thoracic support and distance of the lumbar support were related to the resulting satisfactory head-neck alignment and sitting balance of the patients with profound cerebral palsy.