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要旨 目的:われわれの施設では,肢体不自由児とその保護者に入園での集中訓練を提供している.目的や訓練内容は症例ごとに異なり,個別の評価を必要とする.Canadian Occupational Performance Measure(COPM)は作業療法の成果指標だが,今回COPMを用いて入園経過を評価し,結果を検討した.
方法:3年間に入園した親子のうち31例を対象とした.入園者が設定した5つの目標に対し,入園時,4週終了時,退園時に遂行度と満足度を採点した.各平均値を用いて後方視的に解析した.
結果:遂行スコア,満足スコアとも評価を繰り返すごとに有意に上昇し,退園時は入園時より両者とも平均3.9上昇した.医療的ケアあり群はなし群より両スコア変化が大きい傾向にあった.基礎疾患や運動機能,回復期か否かで有意差はなかった.目標別のスコア変化も,療育分野やセラピスト経験年数に影響されなかった.満足度向上と遂行度改善は相関した.
考察:全例で遂行度,満足度の向上が定量的に示され,他の指標では反映し難いような入園効果も判定できた.満足度採点は主観的だが,遂行度変化と相関し,一定の妥当性はあると考えた.
結論:COPMを用いた親子入園評価は,入園者主体の訓練活動の立案とその効果判定にも有用と考えられた.身体機能に限らず,活動や参加を含めて患者の生活を評価する視点は重要であり,COPMは有効と考えられる.
Abstract Objective:Our institute provides inpatient intensive rehabilitation to severely disabled children and their parents. Rehabilitation aims are patient-specific, thus using individual scales to evaluate rehabilitation is essential. Here, we adopted the Canadian Occupational Performance Measure (COPM) to perform this evaluation in thirty-one cases.
Methods:For the COPM, patients set goals in five subjects, and evaluates their performance levels and satisfaction levels on a scale of 1-10, before and after rehabilitation, and the mean scores are compared.
Results:The COPM scores were significantly elevated in all cases at discharge. Patient had an average increase of 3.9 points for both performance and satisfaction scores. The scores of children with medical complexity tended to exceed those who did not require complex medical care. We identified a correlation between satisfaction and performance scores.
Conclusion:We quantitatively measured the development of patients to measure the effectiveness of our intervention for two months using the COPM, which cannot be clarified by other objective evaluation tools for gross motor skills, functional independence, etc.. Although satisfaction scores are subjective, herein, their validity was shown by the correlation to the performance scores. Overall, COPM can contribute to top-down approaches to rehabilitation.
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