Purpose: The purpose of this study was to investigate the psychological effects on health-related quality of life (HRQOL) of postoperative range of motion of the shoulder joint and subjective symptoms in patients with breast cancer who underwent rehabilitation.
Methods: In 79 patients with breast cancer surgery who underwent rehabilitation during hospitalization, we investigated temporal changes in the range of shoulder joint function (flexion of shoulder joint/abduction angle), postoperative subjective symptoms (surgical site pain, tightness, and anxiety regarding the disorder), and HRQOL scales (FACT-B and EQ-5D-5L) from before to 6 months after surgery and examined the factors relating to HRQOL.
Results: The range of shoulder joint movement was significantly decreased even from pre-operation to 1 month after surgery, but subjective symptoms had significantly improved at 6 months after surgery. Multivariable regression analysis showed that postoperative feelings of anxiety felt at 1, 3, and 6 months after surgery were a significant variable influencing the FACT-B and EQ-5D-5L scales. The path coefficients of the standard partial regression coefficients of breast cancer patients at 6 months postoperatively by covariance structure analysis were 0.66 for the EQ-5D-5L effective value, 0.94 for FACT-B, 0.47 for shoulder joint function, and −0.64 for postoperative subjective symptoms as the latent variables of HRQOL.
Conclusion: The results suggested the importance of interventions that focus on postoperative subjective symptoms to possibly improve not only patient function but also postoperative HRQOL.
The primary goal of occupational therapy is to enable people to participate in normal everyday activities. To understand and support a client's desired activities, it is necessary to share the meaning of occupation between the therapist and client. One concept that has been used to capture the psychological state for an activity is flow. Therefore, we devised a process of adjusting the challenge-skill balance for occupational therapy based on flow theory.
In this pilot study, we aimed to verify whether adjusting the challenge-skill balance for occupational therapy improved subjective quality of life in a recovery rehabilitation unit. To inform the future design of randomized controlled trials, we therefore compared standard occupational therapy with this new approach. Both interventions took place from recovery rehabilitation unit entry to discharge, and outcomes (continuous variables) were analyzed using a Bayesian approach explored with generalized linear mixed modeling.
Among a total of 22 patients, those receiving the new approach showed a significant improvement in Ikigai-9 (quality of life) compared with those receiving standard occupational therapy. The mean improvement was 4.44 ± 2.17 with a 95% credible interval of 0.104-8.713. The dependence factor, effective sample size, and autocorrelation time were 3.769, 8093, and 6.18, respectively. We conclude that adjusting the challenge-skill balance during occupational therapy could improve a client's subjective quality of life.
We aimed to clarify intervention processes for facilitating patients' living activities by understanding the practical structure of home-based occupational therapy (OT). Study participants were occupational therapists with at least three years of home-based OT experience. Data analysis was based on the grounded theory. For categorisation, MAXQDA 10 was used to conduct continuous comparative analysis. Analysis resulted in the following categories: 1,572 text segments, 195 labels, 40 small categories, 15 medium categories and 6 large categories. The large categories were (a) identifying unique living activities, (b) analysing and predicting living activities, (c) employing practices to confront living activities, (d) creating an environment that fosters living activities, (e) implementing independent living activities and (f) co-operating to realise living activities. Occupational therapists used patients' living spaces to support them in terms of independently performing living activities, accumulating living activity experience in familiar homes and communities.
Objective: The present study aimed to investigate the complex interaction of factors affecting discharge destination after the acute phase of stroke.
Methods: In 304 patients with stroke who required rehabilitation, we focused on three discharge destinations (i.e., home, convalescent rehabilitation ward, and other facility). Sociodemographic, medical, and acute symptoms data, within the first week of stroke onset and discharge destination, were collected from acute stroke wards. The complex interaction of factors relating to discharge destination from an acute stroke ward was investigated by classification and regression tree analysis.
Results: Patients with a total Functional Independence Measure (FIM) score > 35, a Brunnstrom recovery stage of the lower limb > V, and a comprehension FIM score > 5 had a 91.7% chance of home discharge. By contrast, patients with a total FIM score ≤ 35, age ≤ 79.5 years, and > 2.5 family members had an 80% chance of discharge to a convalescent rehabilitation ward. Finally, patients with a total FIM score ≤ 35, age > 79.5 years, and an expression FIM score ≤ 3 had a 78.6% chance of discharge to other facilities.
Conclusion: The interaction of independence on FIM, function of the paralyzed lower limb, age, number of family members, and comprehension or expression function affect the choice of discharge destination from acute stroke wards.