障害児入所施設における入院リハビリテーションによるThe Canadian Occupational Performance Measure（COPM）の変化

Canadian Occupational Performance Measure (COPM) Changes in Children during Inpatient Rehabilitation in an Institute for Physically Handicapped Children

要旨　目的：近年，障害児入所施設（旧肢体不自由児施設）にリハビリテーション目的で入園してくる患者は，重症化してきている．そのため，従来の評価法では，リハビリテーションの効果を判定することが困難となってきている．我々は，Canadian Occupational Performance Measure（COPM）を用いて，入院前後の変化を調べ，入園リハビリテーションの効果判定の指標としての有用性を検討した．方法：当院に1カ月以上入院し，リハビリテーションを行った81例に対しCOPMを実施した．結果：COPM遂行スコアは入院時3.4から退院時5.7，満足スコアは入院時3.22から退院時5.88とともに有意に改善した．GMFCSレベルは，各スコアに影響を与えなかった．結論：COPM従来の評価法では判定しきれない子供独自の問題点を評価できるため，比較的短期の入院リハビリテーションにおける効果判定に有用である可能性が示唆された．

　Abstract　Objective : Recently, children with more severe disabilities are being hospitalized for inpatient rehabilitation. Therefore, it is becoming more difficult to adequately assess the effect of rehabilitation by conventional methods alone. The objective of this study is to evaluate the usefulness of the Canadian Occupational Performance Measure (COPM), which is an open-ended questionnaire that allows patients to prioritize their needs and rate their performance in different tasks of daily living as well as their satisfaction in performing them. Methods : The COPM performance and satisfaction scores of 81 patients hospitalized for over one month were measured at admission and discharge. Changes during inpatient rehabilitation were evaluated in each case. Results : The mean age at admission was 8.2 yrs. The mean length of inpatient stay was 56.2 days. The children included 31 girls and 50 boys. The distributions according to the Gross Motor Function Classification System (GMFCS) were Levels Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ in 3.7%, 8.6%, 28.4%, 32.1%, and 27.2% of patients, respectively. The mean COPM performance score and satisfaction score increased from 3.41 to 5.71 and 3.22 to 5.88 respectively with significant difference. The GMFCS level did not affect the changes in COPM scores. Conclusion : The COPM may work as a useful assessment method for relatively short-term inpatient rehabilitation children since it identifies child-unique problems that are mostly not assessed by conventional methods.