人工膝関節置換術後患者に対する『活動日記』を併用した作業療法実践の非ランダム化比較試験による検証

Verification of occupational therapy practice using an “activity diary” for patients after total knee arthroplasty in non-randomized trials

要旨：本研究は，人工膝関節置換術（TKA）後患者における『活動日記』を併用した作業療法（OT）実践が，疼痛と疼痛の心理的要因および活動量に与える影響を，非ランダム化比較試験によって検討した．TKA後患者を対照群15名と日記群15名に分類した．測定指標はカナダ作業遂行測定（COPM），疼痛，破局的思考，不安と抑うつ，自己効力感，活動量を測定し，多重比較検定にて解析し，『活動日記』のコメントをKJ法にて分析した．結果，日記群はCOPM，不安，生活活動量に有意な改善を認め，KJ法ではOT開始時に「痛み」を中心としていたが，終了時は「達成感」へ変化した．TKA後患者に対する『活動日記』を併用したOT実践の有用性が示唆された．

　This study examined the effectiveness of an “activity diary” for occupational therapy practice among pain, psychological factors and activity levels after total knee arthroplasty (TKA) in non-randomized trials. TKA patients were classified into a control group (15) and a diary group (15). The outcome indices were measured using the Canadian Occupational Performance Measure (COPM) for pain, pain catastrophizing, anxiety and depression, and activity levels and were analyzed post hoc. Comments on activity diaries were analyzed by the KJ method. Results from the COPM indicate a significant improvement in anxiety and activity levels, while the KJ method similarly revealed a shift from OT “pain” to OT “accomplishment” at the end. The results demonstrate the effectiveness of the “activities diary” for occupational therapy practice after TKA.