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Japanese Occupational Therapy Research Volume 39, Issue 3 （June 2020）

作業療法 39巻3号（2020年6月発行）

Japanese English

◆実践報告

生活行為向上マネジメントを用いて作業療法士が地域で介入することで就労が可能となった重症統合失調症患者の一例 The impacts of occupational therapy in community settings using the Management Tool for Daily Life Performance: Work support for a patient with severe schizophrenia 真下いずみ ^1,2,3 , 田中和宏 ³ , 橋本健志 ⁴ Izumi Mashimo ^1,2,3 , Kazuhiro Tanaka ³ , Takeshi Hashimoto ⁴ ¹神戸大学大学院保健学研究科博士後期課程 ²藍野大学医療保健学部作業療法学科 ³一般財団法人長岡記念財団長岡ヘルスケアセンター（長岡病院） ⁴神戸大学大学院保健学研究科 ¹Doctoral Course, Kobe University Graduate School of Health Sciences ²Department of Occupational Therapy, Faculty of Health Science, Aino University ³Nagaoka Health Care Center (Nagaoka Hospital) ⁴Kobe University Graduate School of Health Sciences キーワード：就労支援 , 生活行為向上マネジメント , 地域リハビリテーション , 精神障害 , 多職種連携 , Employment supports , Management Tool for Daily Life Performance , Community rehabilitation , Psychiatric disorder , Interprofessional collaboration Keyword: 就労支援 , 生活行為向上マネジメント , 地域リハビリテーション , 精神障害 , 多職種連携 , Employment supports , Management Tool for Daily Life Performance , Community rehabilitation , Psychiatric disorder , Interprofessional collaboration pp.372-379

発行日 2020年6月15日 Published Date 2020/6/15

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要旨：4年間自閉的生活を送っていた重症統合失調症患者に，生活行為向上マネジメント（MTDLP）を用い，患者の希望する生活行為である「働くこと」を支援した．作業療法士が，就労継続支援B型事業所内（以下，事業所）に出向いて認知機能，精神症状，身体機能を評価した．多職種連携プランを立案し，事業所職員と協働した結果，患者は通所に至った．また介入前後で機能の全体的評定，社会機能評価尺度，WHO/QOL 26の得点が向上した．以上から，重症度によらず患者が希望する生活行為を遂行することが，社会機能と主観的QOLの向上をもたらすと考えられた．作業療法士が地域に出向いて患者が希望する生活行為に介入することの有用性が示された．

　This study investigates the effects of outreach service by an occupational therapist on a patient's social functioning and quality of life. The subject of this study is a patient who suffers from severe schizophrenia and has been withdrawn from society for four years. The outreach service was conducted for four months using the Management Tool for Daily Life Performance (MTDLP). The MTDLP, developed by The Japanese Association of Occupational Therapists, is an intervention tool used in occupational therapy and is a support method that focuses on finding meaningful daily activities for the patient. The MTDLP consists of a series of processes that include acquiring information about the patient's meaningful daily activities, assessment, planning, and intervention. In this study, using the MTDLP, the OT asked the patient about her desired daily life performance, which revealed that the patient would have liked to work. The OT devised a multidisciplinary plan using the MTDLP, which evaluated and intervened at the patient's workplace. As a result, the patient was able to work at the Supported Employment Workshop. Furthermore, the patient's scores on the Global Assessment of Functioning, the Social Functioning Scale, and the World Health Organization Quality of Life 26 improved significantly after the intervention. These results suggest that performing the meaningful daily activities can subsequently improve the social functioning and quality of life. In addition, cooperation between medical and welfare workers in job support for patients with schizophrenia is important.