急性期脳卒中患者に対し，ガイドラインを用いたShared decision makingに焦点を当てた上肢機能アプローチを実施した一例

Guideline-based functional upper limb approach focusing on shared decision making for acute-phase stroke patients: A case study

要旨：本邦における脳卒中急性期の作業療法において，目標設定や介入方法に関するShared Decision Making（以下，SDM）を行った報告はきわめて少ない．今回，我々は，麻痺手の使用頻度が低く，目標設定や介入内容の意思決定に消極的な事例に対して，ガイドラインを用いて作業療法介入に関するSDMを行った．その結果，事例の作業療法への積極的な参加が促され，麻痺手の使用頻度も臨床的意義のある最小変化量を超えて向上した．事例の経過は，脳卒中急性期の作業療法においても，目標設定やガイドラインを用いた介入内容のSDMが有益である可能性を示している．

　There are very few reports of shared decision making (SDM) on goal setting and interventions in occupational therapy for the acute phase of stroke in Japan. In this study, we conducted a guideline-based SDM on interventions for a case in which the paralyzed hand was used infrequently, and the patient was reluctant to set goals or make decisions about interventions. As a result, the case was encouraged to actively participate in occupational therapy, and the frequency of use of the paralyzed hand increased beyond the minimal clinically important difference. The results of the case study suggest that SDM on goal setting and guideline-based interventions may be useful in occupational therapy during the acute phase of stroke.