橈骨骨幹部骨折術後の偽関節の原因と考えられたノンコンプライアンスに対して役割への支援が有効であった一例

Effects of educational intervention on a non-compliant patient: A case report

要旨：橈骨骨幹部骨折術後の生活指導に対するノンコンプライアンスから，偽関節が生じ再手術となった50歳代男性に，家事や妻の介護など病前の役割を遂行できる手を獲得し，復職することを目標に支援を実施した．初回手術後は，病前の役割を重視するあまり生活指導を守れなかったことが，偽関節を引き起こし，再手術に至った原因と考えられた．生活指導を守る価値を示したことや，症例の役割と生活習慣をもとに生活指導を修正・変更したことが，症例夫婦の生活を再構築することにつながった．外来作業療法において，症例の役割を把握し介入することが信頼関係を構築し，コンプライアンスを高めるために肝要であると考えられた．

　We present the results of lifestyle education on a 50s man with pseudarthrosis caused by non-compliance to his therapy after surgery for radius fracture. The subject's pseudarthrosis may have been caused by misuse of his arms during housekeeping and caring for his wife. Occupational therapy included educational intervention in his daily life, such as “values clarification,” “applied analysis of behavior,” or “graduated regimen implementation,” resulting in improved methods of both his wife's care and housework. These findings suggest that this educational intervention was effective in enhancing the role and performance of activities associated with the daily routine of an originally non-compliant patient.