櫻井 宏明

BackgroundMost measures of rehabilitation participation rely on self-report, excluding patients with cognitive impairment or aphasia. The observational Pittsburgh Rehabilitation Participation Scale (PRPS) allows their inclusion; however, whether rehabilitation participation assessed using the PRPS modifies improvement in activities of daily living (ADL) remains unclear.ObjectiveTo determine whether rehabilitation participation assessed using the PRPS modifies the association between baseline ADL and subsequent improvement after stroke.MethodsThis retrospective cohort study included 137 stroke survivors in a subacute rehabilitation ward. Admission rehabilitation participation was assessed by the PRPS. ADL improvement was evaluated using the Functional Independence Measure (FIM) motor effectiveness score. Hierarchical multiple regression analysis included age, days from onset to hospital admission, admission FIM motor and cognitive scores, and admission PRPS score in Step 1, followed by the PRPS × admission FIM motor interaction term in Step 2. Prediction plots were generated for each PRPS score.ResultsThe median admission PRPS and FIM motor effectiveness scores were 5 (interquartile range [IQR], 4-6) and 0.70 (IQR, 0.33-0.88), respectively. Adding the PRPS × FIM motor interaction term in Step 2 significantly improved the model fit (ΔR2 = 0.057, ΔF(1,130) = 16.28, p < .001), resulting in a final model (R2 = 0.545, p < .001). Prediction plots showed steeper slopes with higher PRPS scores.ConclusionsAdmission rehabilitation participation assessed by the PRPS modified the association between baseline ADL and ADL improvement. Observable participation should be interpreted in relation to baseline motor ADL rather than in isolation. Lower participation may indicate a need for additional clinical support.

Background/Objectives: Advanced age in Parkinson's disease (PD) is linked to worse motor function, more severe symptoms, and impaired activities of daily living (ADLs). Lee Silverman Voice Treatment (LSVT)® BIG may be suitable for older patients, as it can be adapted to individual abilities. This study evaluated whether age affects the effectiveness of LSVT® BIG on gait speed, motor symptoms, ADLs, and quality of life (QoL) in PD. Methods: In this retrospective, single-center cohort study, 22 patients with PD were divided into an older group (≥65 years; n = 16) and a younger group (<65 years; n = 6). All participants completed 16 one-hour, face-to-face LSVT® BIG sessions. Gait speed was assessed with the 10-m walk test; motor symptoms with Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III; ADLs with MDS-UPDRS Part II; and QoL with the Parkinson's Disease Questionnaire-39 Summary Index. Two-way mixed-design analysis of variance with aligned rank transformation was used for statistical analysis. Results: Significant improvements were observed for all outcomes (gait speed, motor symptoms, ADLs, and QoL) after the intervention. A significant effect of age group was found for gait speed, with younger patients walking faster overall. No significant interaction between timepoint and group was observed for any measure. Conclusions: LSVT® BIG appears to improve gait speed, motor symptoms, ADLs, and QoL in patients with PD, regardless of age, suggesting it is an effective intervention for both older and younger patients.

OBJECTIVES: This study examined the relationship between pre-licensure academic performance and self-assessed clinical competence, as measured by the Clinical Competence Evaluation Scale in Physical Therapy (CEPT), among novice physical therapists with up to 1 year of clinical experience after graduation. METHODS: The study participants were 37 graduates of a vocational school who had passed the national physical therapy licensure examination and were employed in healthcare or welfare facilities. Pre-graduation performance data included first-year and second-year academic grades, scores in basic and professional foundational subjects, and Clinical Training III evaluations. Self-assessments after graduation were conducted using the CEPT, which contains 53 items across seven competency categories. Correlational analyses were performed to investigate associations between pre-graduation academic metrics and CEPT scores. RESULTS: There were significant negative correlations between first-year and second-year academic performance, scores in basic professional subjects, advanced professional subjects and the combined scores of basic and advanced professional subjects with CEPT domains related to "Knowledge" and "Decision-making skills." Scores in basic professional subjects were the lowest among all categories and exhibited the strongest negative correlation with self-assessment. CONCLUSIONS: Students with higher levels of academic performance tended to rate themselves lower in early self-assessment after graduation, suggesting a possible lack of confidence in their knowledge or difficulties adapting to the complexities of clinical training. These findings highlight the potential value of integrating metacognitive support and self-assessment training into the physical therapy curriculum to foster practical competence and professional growth.

Background/Objectives: Individuals with Parkinson's disease (PD) often experience four major motor symptoms-tremor, rigidity, bradykinesia, and postural instability/gait disorder. Although these symptoms have been shown to affect activities of daily living, their impact on the level of at-home physical activity (PA) in this population remains unexplored. We aimed to investigate the relationship between the four major motor symptoms of PD and at-home PA in these individuals. Methods: This retrospective cross-sectional study included 17 individuals with PD. We examined the relationship between the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale Part 3 score and the time spent in three PA intensities (sedentary behavior, light PA [LPA], and moderate-to-vigorous PA) within the home. Pearson's correlation coefficient was used for statistical analysis. Results: In the initial step analysis, a significant negative correlation was observed between the overall motor symptom score and the time spent in LPA inside the home (rs [95% confidence interval]: -0.72 [-0.93 to -0.25]; p < 0.01). In the second step analysis, a significant negative correlation was observed between the bradykinesia score and the time spent in LPA inside the home (rs: -0.74 [-0.92 to -0.30]; p < 0.01). Conclusions: Among the four major motor symptoms, only the severity of bradykinesia influenced the time spent in LPA inside the home. Thus, rehabilitation treatment focusing on bradykinesia may be beneficial for increasing the time spent in LPA inside the home for individuals with PD.