地域在住の要介護高齢者に対する「生活行為向上マネジメント」を用いた作業療法の効果─多施設共同ランダム化比較試験─

Effect of occupational therapy using “the management tool for daily life performance”for dependent community-dwelling elderly: A randomized controlled multi-center trial

要旨：全国16の都府県の通所リハビリテーション施設を利用する要支援・要介護高齢者230名を対象に，「生活行為向上マネジメント」を実施した上で提供される，オーダーメイドの作業療法の効果をランダム化比較試験により検証した．介入群には利用者ごとのニーズに合わせたオーダーメイドの作業療法を提供し，対照群には機能訓練を実施した．介入期間は3ヵ月，アウトカムはADL，IADL，健康関連QOLの各指標とした．繰り返しのある二元配置分散分析の結果，健康関連QOLで介入と群分けによる交互作用を認めた（p＜0.001）．本結果より，「生活行為向上マネジメント」を実施することは健康関連QOLの向上に資すると示唆された．

　The purpose of this study is to investigate the effect of made-to-order occupational therapy using “the management tool for daily life performance” for dependent community-dwelling elderly program by occupational therapists. This study comprised a randomized controlled multi-center trial. The subjects were elderly in need of certified long-term care, who used commuting rehabilitation services at facilities in 16 prefectures. The intervention group received occupational therapy of the made-to-order program using “the management tool for daily life performance”. The control group received usual training. The outcomes were measured from activity of daily living (ADL), instrumental activity of daily living (IADL), and health-related quality of life (HRQL). All outcomes were assessed at baseline and after one month by occupational therapists. The outcome data were subjected to repeated two-way ANOVA. There was a significant study group×time interaction on the intervention group by HRQL (p＜0.001). The results demonstrate the effectiveness of made-to-order occupational therapy using “the management tool for daily life performance” for dependent community-dwelling elderly.