[in Japanese]

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Introduction:As a growing number of researchers around the world are using mixed methods research, occupational therapy researchers need to know the essentials and power of this investigative approach. The purpose of this article is:1) to review fundamental characteristics of qualitative, quantitative, and mixed methods research approaches, 2) to explain the features of the three core mixed methods designs and illustrate each with exemplar research studies from the field of occupational therapy, and 3) to review integration features across the chosen occupational therapy mixed methods research studies. Results:There were many integration features found among the three exemplar occupational therapy research studies. Examples of integration were found in the titles that conveyed the research as having been conducted using mixed methods procedures. The studies illustrated integrated purpose statements that explicitly or implicitly conveyed that both types of data were to be collected. Each study used a specific mixed methods design name. Across the three exemplar papers, there are excellent examples of the integration intent during the data collection phase, namely, connecting, building, matching, comparing. These papers further feature integration intents and procedures during the analysis, namely, merging, transforming data, and creating joint displays. Discussion:These exemplar studies illustrate how occupational therapy researchers are using many of the latest integration strategies in mixed methods research. This review may be helpful to occupational therapy researchers as they interpret published mixed methods studies conducted by their occupational therapy colleagues, and for harnessing the power of mixed methods research in their own studies.

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We examined whether vibration-induced illusory movement (VIM) tasks improve upper-extremity motor dysfunction in stroke survivors. Motor function was assessed four times:before intervention, after occupational therapy, after the VIM therapies (induced by tendon vibration), and one month after the therapy. The statistically significant results indicated that compared with occupational therapy, VIM therapies improved upper-extremity function and motor imagery ability one month after the therapy. VIM therapies may facilitate motor imagery and motor learning.

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Information and communication technology (ICT) are essential in modern society. This study aims to determine whether patients with rheumatoid arthritis (RA) can operate mobile and smart phones, and to clarify their operational problems. In this survey, 530 questionnaires were sent to Japan RA Friendship Association Hyogo Branch members, 252 anonymous responses were analyzed. The deformity of participants’ hands was classified into three groups according to severity. Compared with general data on the use of mobile and smart phones, middle-aged and elderly people with RA made more calls and sent more emails, while young people tended to use SNS. RA patients’ email usage rate was low among all ages, and the deformation of fingers minimally affected the operation of mobile and smart phones, which may have contributed to the increased use of telephone calls. Mobile and smart phones are important for RA patients, and occupational therapy is expected to require intervention using ICT devices in the future.

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Study design:Systematic review and meta-analysis. Introduction:Occupation-based practice (OBP) uses daily activities as an assessment tool and a treatment modality. Although some studies have reported the effects of the OBP in hand therapy, no reviews have compared their effectiveness to traditional hand therapy. Purpose of the study:To establish the effects (positive and negative) of OBP in treating persons with upper extremity injuries. Methods:Searches of PubMed, Web of Science and the Cochrane Library databases were conducted using predetermined keywords. Studies included in this review described the use of OBP in upper extremity injuries. Two examiners independently reviewed and assessed the quality of each study using the Cochrane risk of bias assessment tool. Outcome measures included self-efficacy measures related to functional performance in the instrumental activities of daily living, physical function, pain, and functional performance. Results:Results of the database searches yielded 335 studies, 4 of which were deemed eligible to include in this review. In persons with upper extremity injuries, overall patient-reported self-efficacy outcomes were significantly improved in the groups that received OBP compared with comparison groups. Discussion:Findings of this review provide preliminary evidence for the use of OBP in patients with upper extremity injuries. However, generalizability of the evidence was compromised due to heterogeneity in study subjects as well as conceptualization, dosage, and delivery of OBP. Level of evidence:1a.

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This qualitative study focused on how to determine the strategies for improving the social interactions of elderly males living alone and highlighted the significance of developing an effective social participation program. For these purposes, semi-structured interviews were conducted with 10 elderly males living alone. The collected data were subsequently analyzed according to the affinity diagram. Results revealed that the males had various tasks such as maintaining natural relationships, establishing and maintaining connections, and preventing one’s community from becoming too narrow. Subsequently, certain aspects were identified, including resistance to support and opposition to rebuilding their living situations. Moreover, the results indicate the necessity of a program which helps elderly males living alone adjust their strategies for social interactions.

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The purpose of this study was to examine how social relationships affect participation in leisure activities among community-dwelling older adults. We conducted a survey by mail among 1,587 older adults living in Ayase City, Kanagawa Prefecture. The analysis revealed that bonding social capital is positively associated with appreciation, music, and tourism activities, but is negatively associated with game activities. In addition, bridging social capital is negatively associated with cultural and tourism activities. In addition, ongoing contact with neighbors is positively associated with sports, cultural, and nature activities. In conclusion, the relationship between leisure activities and social relationships have various aspects. In order to promote leisure activities among community-dwelling older adults, it is important that occupational therapists focus on the characteristics of social relationships of older adults in the target community.

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We provided voluntary practice using ReoGo^®-J (robot therapy) and intervention similar to CI therapy (modified CI therapy) for 5 patients with moderate to severe upper limb paralysis after stroke in the convalescent phase. In this study, we observed the upper limb function and the usage of the paralyzed hand 1 month after discharge. As a result, the upper limb function and the usage of the paralyzed hand improved after the intervention, and were maintained after discharge. Therefore, providing interventions combining robotic therapy and modified CI therapy to patients with severe to moderate upper limb paralysis in the convalescent period leads to efficient functional improvement of paralyzed hand usage, and may maintain the function and usage the of paralyzed hand after discharge.

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The reliability and validity of the Japanese version of the ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE J) was examined. A-ONE J can be used to evaluate both performances of activities of daily living (ADL) tasks (5 domains 22 items) and neurobehavioral problems that interfere with ADL task performances among clients with neurological disorders. Inter-rater and intra-rater reliability were examined among 20 stroke clients, and we found a high kappa coefficient. Concurrent validity was tested with 36 stroke clients. We found moderate and high correlation coefficients between A-ONE J and ADL evaluation, as well as between A-ONE J and neuropsychological tests. Our recommendations for future studies include expansion of composition, including more diverse diagnostic categories other than stroke.

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For a case of thumb amputation, a temporary hand prosthesis was prepared using 3D technology. The preparation period was two days, and the time required for attaching the prothesis was about 25 minutes. Evaluation at 3 months showed improvement in ROM and upper limb function, as well as reduced difficulty in daily life. This production method is inexpensive, and the process is simple, suggesting that creating and fitting temporary prosthetics for finger amputees in the early stage has become easy.

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Occupational therapy was carried out using CMCE with the client in order to enable him to “Enjoying music”. The client suffered from heart failure and cerebral infarction sequela. “Enjoying music” was very meaningful for him, as it lead to a connection with people from a different time, reinforced his identity, created a habit, and helped him forget his pain. Particularly, the foundations of “Client participation” and “Vision of possibilities” were significantly affected by his occupation. The skills “adapt”, “coordinate”, and “coach” were used to promote those foundations. Utilizing CMCE during occupational therapy can result in improved outcomes.

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Cognitive Orientation to daily Occupational Performance (CO-OP) was used with a client suffering from respiratory disease to enable self-management of oxygen devices used in home oxygen therapy and to reduce dyspnea when using the toilet (5 days and 40 minutes/day). As a result, scores of Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS) were improved. Moreover, the client was able to use a portable oxygen cylinder and an oxygen tuner, and thus acquired self-management skills to use the toilet sagely. These results indicate that the CO-OP can improve acquisition of self-management skills in clients with respiratory diseases.

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We carried out occupational therapy on a woman in her teens who underwent hip transposition arthroplasty following resection of pelvic sarcoma combined with temporally external fixation. At the time of diagnosis, she was supposed to go to university, and in the preoperative evaluation, she felt anxious about returning to school. The occupational therapy focused on toilet movement training before removal of the external fixation, and she was able to excrete using a toilet seat 19 days after surgery. After removal of the external fixation, we focused on changing clothes and bathing exercises. 75 days after the operation she was discharged to her home. She was able to get her driver’s license and drive herself to school one year after the treatment. The results indicate the importance of preoperative occupational therapy on the targeted recovery.

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A 60-year-old man with central cervical spinal cord injury (C3-5) with partial quadriplegia underwent repetitive facilitative exercise under continuous neuromuscular electrical stimulation (RFE under cNMES). RFE induced voluntary contraction of the target muscle stimulated by cNMES. The time required to perform tests 8-10 of the Simple Test for Evaluating hand Function, which requires finger dexterity, decreased from 50.7 sec to 13.1 sec (decrease of 37.6 sec) over 14 weeks of RFE under cNMES, and decreased further, from 13.1 sec to 9.6 sec (decrease of 3.5 sec) at 6 months after the end of RFE under cNMES. The score for self-care in the Spinal Cord Independence Measure improved from 9 to 19 points (increase of 10 points) during 9 weeks of RFE under cNMES. This increase was nearly identical to the gains achieved with other treatments in previous reports. RFE under cNMES may be effective for improving upper limb function and activities of daily living in patients with central cervical spinal cord injury. Future studies with a large number of participants will be needed to clarify the efficacy of RFE under cNMES.

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The purpose of this study was to clarify the relationship between work participation (evaluated using SOPI:Self-completed Occupational Performance Index) and stress (evaluated using autonomic nerve activity) in 26 rehabilitated users who returned home. The analysis confirmed the correlation coefficient between the stress index and SOPI. Subsequently, a multiple regression analysis (stepwise method) was performed using the stress index as a dependent variable, and the three areas of SOPI as explanatory variables. Moreover, a multiple regression analysis (stepwise method) was performed with three aspects of SOPI work performance as explanatory variables. Significant correlation was found between stress index and SOPI (r＝-0.495 [p＝0.010]). As a result of the multiple regression analysis, “leisure activity” (R²＝0.224, standardization coefficient β＝-0.473, p＝0.015) and “work control” were extracted as factors related to stress reduction (R²＝0.262, standardization coefficient β＝-0.511, p＝0.008).

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