上肢整形外科疾患患者に対する作業を基盤とした実践の効果—システマティックレビュー・メタアナリシス

A systematic review and meta-analysis of occupation-based practice in hand therapy

要旨：上肢整形外科疾患患者に対する作業を基盤とした実践（Occupation-based practice）の有効性を検証することを目的に，システマティックレビューとメタアナリシスを実施した．PubMed，Web of Scienceを使用し全335編を精読し，4編が適合論文となった．機能障害を測定する効果指標においては，対照群との有意な改善は認められなかった．一方で，Disability of the Arm, Shoulder, and Handやカナダ作業遂行測定など，活動・参加を測定する効果指標において有効性が認められた．本研究から，上肢整形外科疾患患者に対する作業に焦点を当てた介入の効果が示唆された．

　Study design: Systematic review and meta-analysis. Introduction: Occupation-based practice (OBP) uses daily activities as an assessment tool and a treatment modality. Although some studies have reported the effects of the OBP in hand therapy, no reviews have compared their effectiveness to traditional hand therapy. Purpose of the study: To establish the effects (positive and negative) of OBP in treating persons with upper extremity injuries. Methods: Searches of PubMed, Web of Science and the Cochrane Library databases were conducted using predetermined keywords. Studies included in this review described the use of OBP in upper extremity injuries. Two examiners independently reviewed and assessed the quality of each study using the Cochrane risk of bias assessment tool. Outcome measures included self-efficacy measures related to functional performance in the instrumental activities of daily living, physical function, pain, and functional performance. Results: Results of the database searches yielded 335 studies, 4 of which were deemed eligible to include in this review. In persons with upper extremity injuries, overall patient-reported self-efficacy outcomes were significantly improved in the groups that received OBP compared with comparison groups. Discussion: Findings of this review provide preliminary evidence for the use of OBP in patients with upper extremity injuries. However, generalizability of the evidence was compromised due to heterogeneity in study subjects as well as conceptualization, dosage, and delivery of OBP. Level of evidence: 1a.