認知症の早期評価を目的とした Mini-Mental State Examination の臨床活用に関する研究 : 前頭前野の知見による Mini-Mental State Examination 因子構造の解明

聖隷クリストファー大

The factorial structure of the mini mental state examination (MMSE) in Japanese dementia patients

<p>Abstract</p> <p>Background</p> <p>The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients.</p> <p>Methods</p> <p>30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE.</p> <p>Results</p> <p>Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration.</p> <p>Conclusions</p> <p>Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.</p

本学理学療法学専攻1年次生の学習動機と職業意識

研究報告Original Paper本研究の目的は学習指導の参考とするために、本学理学療法学専攻1年次生がどのような学習動機を持っているか、またそれが理学療法(士)(PT)に村する職業意識とどのように関係するかを明らかにした。調査参加者はPT専攻1年次生全員の33名(男性21名、女性12名)、平均年齢19.2歳(偏差1.5、範囲18-25歳)であった。調査内容は、調査参加者の背景(性、年齢)、学習動機に関するアンケート、PTに対する職業意識に関するアンケートであった。学習動機に関するアンケートは、市川による「学習動機を測定する質問項目」を用いた。PTに対する職業意識に関するアンケートは独自に作成し、1)PTの職業イメージについて、2)PTになりたい気持ちの強さ、3)PTになるための学習意欲、4)本学での満足度、5)将来の具体的なPT像の5項目について調査した。調査集団の学習動機は、学習内容に関与した「内容関与型」の動機が高く、学習の内容自体を重視し、そして職業意識が高いほど、学習の質が高いようであった。このような学生集団に対し、教授者は、学生の職業意識と、内容関与的な学習動機を支える知的好奇心や理解要求、向上心を大切にした教育工夫が必要であると考えられる。The purpose of this study was to clarify the correlation between the learning motivation in first-year physical therapy students and their knowledge and attitude toward physical therapy. Participants included 33 first-year students (21 males, 12 females), 19.2 (range 18-25) years old on average. Questionnaires were used to measure their learning motivation, professional knowledge and attitudes toward the physical therapist. We used the "questionnaire to measure learning motivation" by Ichikawa. Also, fivepoint Likert scale items were used to assess the students\u27 professional knowledge and attitudes toward physical therapy in such areas as 1) image of physical therapy, 2) motivation to become a physical therapist, 3) learning motivation vis a vis the curriculum 4) satisfaction with entering this college, 5) their image of themselves as physical therapists in the future. Results indicated that the participants had a generally high learning motivation, and were knowledgeable about the physical therapist\u27s job. Students who had a higher learning motivation provided positive comments and attitude towards physical therapy. Positive attitudes toward physical therapy may have been reflective of the students\u27 learning motivation. In conclusion, the authors encourage curriculum changes that directly address issues of professionalism, create an active learning environment, and particularly regarding strategies for increasing professional knowledge and positive attitudes toward physical therapy and the therapist

理学療法教育における客観的臨床能力試験(OSCE)の試み

研究報告Original Paper理学療法専攻学生の臨床技能教育を推進することを目的に、学生の臨床技能の習得と、その到達度を客観的に評価する客観的臨床能力評価試験(Objective Structured Clinical Examination;OSCE)を試行した。本研究は、OSCEの試行結果を分析し、その有効性を検討した。対象はPT専攻2年次生全員32名(男性20名、女性12名)、平均年齢19.2歳(偏差1.5、範囲18-25歳)であった。OSCE課題は、1ブース1学生に対し、右変形性股関節症のシナリオで股関節の徒手筋力テストと関節可動域測定の1課題を提示した。評価尺度は4名の教員(模擬患者役1名)が作成し、評価は3名の評価者(教員)が同時に行った。OSCEの評価者間信頼性(ICC;0.84)は高く、評価者間の評価点にも差はなかった。評価項目の評価者間の完全一致率は7割程度であった。学生へのアンケート調査の結果は、OSCEに対する学生の評価は高かった。今回試行したOSCEの信頼性は高く、学生の臨床能力を客観的に把握し得る結果であり、学生の問題点を明確にし、有益なフィードバックが得られると考えられた。BACKGROUND AND OBJECTIVES: The objective structured clinical examination (OSCE) is an examination format with particular emphasis on examining students\u27 clinical and communication skills. The purpose of this study was to examine the feasibility, reliability and validity, and the educational impact of an OSCE for students in the second year of a 4-year physical therapy program. METHODS: Thirty-two students were examined at one OSCE session. The station evaluated skills required for the interaction with patients and physical examination (joint range of motion and manual muscle test) of mimic persons with chronic musculoskeletal conditions. Three examiners recorded an overall judgment of each student\u27s performance (pass, borderline, or fail) and wrote comments on each student\u27s performance using a checklist for each student\u27s performance content. Intraclass correlation coefficient (ICC) among the examiners was analyzed to quantify the intrarater reliability. Intra-observer variations were analyzed by ANOVA. The agreement rate of the examiners was also calculated. A self-administered questionnaire was completed by students immediately after the OSCE at the end of session. This questionnaire was measured the students\u27 perception of examination attributes, which included the quality of performance, authenticity of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. RESULTS: Intrarater reliability ICC was 0.84 ranged from 0.47 to 0.98. No statistically significant differences were found among the three examiners in all the OSCE items. The overall agreement rate among examiners was 72%. The category of Physical examination (60%) was lower than other categories (Interaction with patients; 78%, Knowledge of examination; 79%). Self-administered questionnaire completed by students was excellent acceptance of the OSCE as an assessment instrument. CONCLUSIONS: The OSCE is credible as a test for the evaluation of basic clinical skill and interaction with patients for physical therapy students. The OSCE experience provides students with a rich resource for defining clerkship-related learning needs. Further study is required to improve performance of objectively assessed clinical skills

外来患者のホームエクササイズの実施状況と動機づけの関連性の検討

研究報告Original Articles【はじめに】H-Ex.の実施状況と、動機づけの関連性を検討した。【対象】外来患者24名（平均年齢61±17歳、男性7名、女性17名）とした。【方法】質問紙調査法にて、H-Ex.の実施状況と動機づけの強さおよび個人属性を調査した。動機づけの強さの測定には『Behavioral Regulation in Exercise Questionnaire-2』を一部修正して使用した。【結果】実施状況と動機づけの強さには、有意な相関はなかった。痛みが強いほど、H-Ex.を行わないという有意な相関があった。家族数が多いほど、内発的調整スタイルの得点が低いという負の相関があった。H-Ex.を行わない日が多い群と外的調整スタイルの得点の高い群との間に、有意な分布の差があった。就労形態と、同一視的・取り入れ的調整スタイルとの間にそれぞれ有意な分布の差があった。【考察】H-Ex.の実施状況と動機づけの強さの関係については、両者間に有意な相関がなかった。その要因として、介入そのものが動機づけを強くしたこと、実施状況調査の時期や期間が実施結果を良好にしたのではないかと考えた。[Introduction]The relationship between actual implementation of home exercise programs by outpatients and their motivation to complete these programs was examined.[Subjects]Subjects included 24 outpatients (mean age 61 ± 17years, 7males, 17females).[Method]A questionnaire was distributed to investigate the state of implementation of the H-ex Program. Motivation of participants to complete the program and their personal attributes were also evaluated. A modified version of the Behavioral Regulation in Exercise Questionnaire-2 was used in order to measure the degree of motivation.[Results]No significant correlation was found between actual implementation of the H-ex Program and the extent to which subjects felt motivated to complete the program. Pain was a significant reason for not completing the H-ex Program. The higher the number of family members, the lower the score for “intrinsic regulation” style. A significant difference in distribution was observed between the group with a high tendency toward not completing the H-ex Program and the group with high scores for “external regulation” style. A significant difference in distribution was also noted between the forms of work and the “identified regulation” and “introjected regulation” styles.[Discussion]No significant correlation was found between 　motivation to complete the exercise program and 　actual implementation of the H-Ex Program.The intervention increased motivation, and the duration and timing of the survey helped to improve the frequency of implementation. Because the subjects were outpatients, they may already have felt a strong motivation to adhere to the exercise treatment

歩行条件に応じた歩行時間および歩数の認識について : 歩行時間と歩数の予測値は自己認識指標として有用か?

本研究の目的は、歩行時間と歩数の予測値が自己認識指標として有用であるか否かについて検討することである. 健常成人17名を対象に、20mの直線歩行路を歩行するのに要する歩行時間と歩数の予測値および実測値を計測した. なお、歩行条件は、対象者が任意に設定した「自然歩行」、「遅い歩行」、「速い歩行」の3条件とした. その結果、歩行条件に応じて歩行時間と歩数を変化させなければならないことは自己認識できたものの、歩行時間と歩数を正確に認識することは困難であることが示された. したがって、20mの直線歩行路を歩行するのに要する歩行時間と歩数の予測値を自己認識指標として用いることは、信頼性と妥当性に欠き臨床応用することが困難であると考えられた.The purpose of this study was to determine if estimated walking time and number of steps can be a useful self-reported index for clinical application to improve the safety of individuals with gait difficulty. Seventeen healthy adults were asked to estimate the time and the number of steps needed to walk in a 20m straight line in three different walking conditions, "natural walking","slow walking"and "fast walking", and the estimated values were compared with the actual time and steps taken to walk the distance. The results suggest that, even though subjects were aware that the time taken and steps needed to walk the distance needed to be changed for each condition, they had difficulty estimating the values accurately. Because of tha lack of reliability and validity, the use of estimated walking time and number of steps needed to walk in a 20m straight line as a self-reported index does not appear to be useful for clinical application