慢性閉塞性肺疾患患者に対する作業療法の経験

Occupational therapy for a patient with Chronic Obstructive Pulmonary Disease

要旨：重度のCOPDを呈した70歳代後半男性の作業療法を経験した．労作時の呼吸困難感によりADLに低下を来しており，COPMや認知機能評価を踏まえたADL指導等を計24回実施した．その結果，日常活動時のSpO₂の低下を抑えることができ，呼吸困難感が軽減することで“しているADL”の向上がもたらされ，COPMスコアの改善も得られた．以上より，呼吸リハビリテーションにOTが加わることで，ADLでの呼吸困難感の軽減によるQOLの改善が期待できることが示唆された．今後は，OTの有用性に関するデータベースの蓄積とともに，卒前，卒後教育の充実化による個々の知識の向上や技術の習得，他職種への啓発を行うことが必要である．

　We had an experience of occupational therapy (OT) with an old man, about 80-years old, who suffered from Chronic Obstructive Pulmonary Disease (COPD), classified as grade V of the Fletcher-Hugh-Jones category. He had difficulties with activities of daily living (ADL) because of severe dyspnea. The OT session consisted of ADL exercise, 24 times, based on COPM and cognitive functional evaluation. OT intervention brought improvement of Sp0₂ during ADL and reduction of dyspnea. As a result, there were increases of "practical ADL" and the COPM score.

　It was suggested that the addition to OT in comprehensive pulmonary rehabilitation is able to reduce dyspnea during ADL and improved QOL. In the future, it will be necessary to obtain useful data of OT in comprehensive pulmonary rehabilitation. It is important that skills and knowledge improve, which will enhance education before and after graduation, therefore enlightening all medical staff.