Unfolding familiarity : re-occupying daily life among older persons with physical disabilities, in Japan.

Older persons increasingly recover from health conditions within their home and community, as opposed to in hospitals and institutions. In this context, a need has arisen to gain a greater understanding of how they resume their daily occupations to aid their transitions of re-establishing satisfactory daily lives. The overall aim of this thesis was to explore and understand how processes of resuming daily occupation unfold for older persons with physical disabilities, in Japan. Study I: In qualitative retrospective interviews, nine persons were asked to narrate their experiences of resuming everyday activities during hospitalization and after returning home. The constant-comparative analysis’ resulted in exposing three themes that expressed, how the participants spend and generated vigor, how they reconciled to requiring assistance, and that they had acted upon moral quests of doing what was the right thing to do (for themselves and for other persons). Study II consisted of participant-observation of daily occupations and complementary interviews with five participants. The aim was to identify meanings given to the actions of participants and other persons involved in observed situations. Through a narrative analysis these meanings were identified as consisting of three complementary strategies. Two of the three strategies aimed to mitigate given problems, one by ‘acting on a plan to achieve one’s goals’, the other by ‘taking a step in a preferred direction by capitalizing on emerging opportunities’. The third strategy focused on avoiding undesirable experiences by ‘modifying problematic situations’. Persons used these approaches flexibly in responding to shifts that mattered in the observed situations and according to their skills, resources and perspectives. Study III was a 9-month longitudinal study of four participants with physical impairments. The aim was to explore and understand how their engaging in daily occupations unfolded over time. Data included qualitative interviews and observations. The findings showed the striving for repertoires of occupations that created familiarity in terms of fulfilling their occupational needs and meanings. Familiarity was also experienced when participants engaged in occupations in line with their expectations. Equally, familiarity was a quality that often assisted participants to deal with ambiguities and challenges in daily life situations. Familiarity unfolded as it was created and adjusted to evolving daily life situations. Study IV was a qualitative study with 15 occupational therapists in two focus groups. Participants narrated and explored experiences of supporting elderly clients to resume daily occupations. The constant-comparative analyses resulted in exposing three themes, showing how resuming occupations were processes of ‘co-creating shared plots’ of pursuing ‘images of client’s future’ by ‘drawing from powers of occupations’. In conclusion, this thesis presents a number of possible understandings of how resuming daily occupation can unfold over time for older persons with physical impairments. The resumption of daily occupation can be understood through a complexity of intertwining dynamics, which are grounded in an occupational context. First, resuming daily occupation is difficult to foretell or to plan. Accordingly, capitalizing on emerging possibilities contributes to the processes of resuming daily occupation. Second, older persons, and others who support them in resuming daily occupations, may resort to the ‘flexible and judicious use of different approaches’. In addition to capitalizing on emerging opportunities, these approaches include pursuing long-term goals. An approach of modifying situations serves to avoid problems that may arise in daily occupations. Third, when other persons, such as occupational therapists, support older persons, then ‘co-creating shared plots’ between them becomes an important contribution to processes of resuming daily occupations. Co-creating shared plots is ongoing as occupational needs, preferences and possibilities for engaging in daily occupation are constantly evolving and changing. Fourth, ‘re-occupying daily life’ allows the older persons to gain experiences that foster improved health and well-being by engaging in daily occupations. Fifth, these transitional processes can be considered as realms of unfolding familiarity which involve re-establishing patterns of daily occupations that fulfill participants’ needs and preferences and which feel familiar to them. In addition, unfolding familiarity pertains to sourcing from familiar ways of dealing with ambiguities and challenges in daily life. Familiarity can also be experienced when events in daily life work because they go according to expectations. In short, resuming daily occupation is facilitated through ‘doing’ and co-creation between the older person with physical impairments and other persons supporting them. It involves experimenting with transforming possibilities into reality, as well as to making meaning from experiences along with re-establishing a sense of familiarity. Resuming daily occupation does not always follow a set course, but rather can proceed in unexpected ways. Consequently, processes involved in resuming occupation are often re-created through the flexible use of different approaches

Examining Minimal Important Change of the Self-Assessment Scale of Clinical Reasoning in Occupational Therapy

The purpose of the study was to establish and quantify the minimal important change (MIC) value necessary to determine gains or losses in clinical reasoning during student fieldwork assignments as measured by the Self-Assessment of Clinical Reasoning in Occupational Therapy (SA-CROT). This multicenter prospective longitudinal study was conducted with students on their occupational therapy fieldwork in Japan. Two anchor-based methods were used to estimate the MIC values: a receiver operating characteristic-based method and a predictive modeling-based method. The MIC was adjusted based on the percentage of participants who exhibited improvement. Administered were the SA-CROT and the Global Rating of Change (GRC) scale as an anchor. A total of 111 students from 11 occupational therapy educational programs in Japan responded (response rate 29%). Overall, there was a significant difference (p \u3c .001, effect size was r = .80) in SA-CROT before and after fieldwork, and 81% of students showed improvement in the GRC scale. The adjusted MIC value was 3.69, with 95% confidence interval of 2.29–4.97. This anchor-based, adjusted MIC value is the most reliable value to interpret the changes in SA-CROT before and after fieldwork. The SA-CROT\u27s MIC value can be used as a cut-off point from a learner-centered perspective when considering educational methods and environments in fieldwork

作業療法におけるクリニカルリーズニングの概念分析

Introduction: Acquiring competence in clinical reasoning is regarded as key to meet the challenges of integrating knowledge into one\u27s practice. Learners and educators need a shared understanding of what is clinical reasoning because they need appropriate means for reflection and feedback. However, the clinical reasoning concept needs revisiting in the current context, which is becoming increasingly diverse and complex. The purpose of this study was to analyse the clinical reasoning concept and develop a common framework. Methods: Rodgers\u27 concept analysis was selected for this theoretical study. Accordingly, a systematically search of multiple databases yielded 903 articles and 135 articles that met the inclusion criteria were extracted, and of these 30 articles randomly sampled for analysis. Data analysis was done following Rodgers\u27 method of thematic analysis. Results: The attributes were four ‘therapeutic thinking processes’ and two ‘professional thinking skills.’ The application contexts were ‘clinical and non-clinical practice settings,’ and ‘professional education.’ Moreover, the antecedents were ‘professional factors’ and ‘practice factors,’ and the consequences were ‘professional developments’ and ‘professional attitudes and behaviours.’ Conclusion: The resulting framework of clinical reasoning can be the basis for developing pedagogies and assessment of clinical reasoning competence acquisition.東京都立大学学位論文甲第1163号　副論

自閉症スペクトラム障害児をもつ母親の日常生活におけるレジリエンス尺度（RDAS）の開発

Indonesian mothers of children with Autistic Spectrum Disorder (ASD) often need support to enhance their resilience, but no scale is available to assess mothers’ resilience in daily activities. Therefore, the aim of this study was to develop a new scale to measure resilience in daily occupation of mothers of children with ASD. Methods: Aspects of resilience in daily activities were generated from literature and developed into 37 questions following a dual-panel methodology. The draft scale was sent to 200 mothers of children with ASD, of which 148 were returned (valid response rate: 74%). Reliability was investigated using classical test theory. A further 30 draft scales were filled out by another 30 mothers twice, 10-15 days apart. Test-retest reliability was evaluated by Spearman’s r. Results: The analysis resulted in the Resilience in Daily Activities Scale (RDAS) consisting of 27 questions, divided into 5 factors. We obtained 0.90 Cronbach’ for the scale, and for the values for each subscale were, achieving life balance 0.88, thinking about child’s future 0.86, families’ supports 0.82, managing daily activities 0.73, understanding children’s condition 0.64. Test-retest reliability was 0.68. Conclusion: RDAS showed appropriate psychometric properties indicating its usability to evaluate resilience in daily activities in Indonesian mothers of children with ASD. In consideration of the sample characteristics, further study is needed, particularly to include mothers from rural regions.首都大学東京, 2015-09-30, 博士（作業療法学）, 甲第620号首都大学東

Validation of the everyday technology use questionnaire in a Japanese context.

Background/Objective The Everyday Technology Use Questionnaire (ETUQ), which evaluates the perceived relevance of and the perceived ability in everyday technology (ET) use, has demonstrated acceptable psychometric properties in Swedish studies of older adults. The aim of this study was to examine the reliability and validity of the ETUQ in a Japanese context in older Japanese adults. Methods A sample of older Japanese adults (n = 164) including persons with (n = 32) and without (n = 132) cognitive impairment was interviewed with the ETUQ, including original items (ETs) and added Japanese context-specific items. Data were analyzed using a Rasch measurement model. Results The analysis demonstrated acceptable functioning of the rating scale, internal scale validity, person response validity, and person-separation reliability of the Japanese ETUQ according to the Rasch model. However, evidence supporting unidimensionality in the Japanese ETUQ was not consistent in this sample. The added Japanese items did not significantly change the estimated individual person measures of perceived ability to use ET. Conclusion The Japanese ETUQ seems to be a sensitive tool to evaluate perceived ability in ET use among elderly people in Japan with and without cognitive impairment. Therefore, it could be used in research and clinical practice. Keywords activities of daily living; everyday technology; Instrumental Activities of Daily Living scale; older adults; Rasch measurement modelThe Swedish Research Council for Health, Working Life and Welfare (FORTE)The Strategic Research Programme in Care Sciences at the Karolinska InstitutetSwedish Brain PowerThe regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and the Karolinska InstitutetThe research was mainly funded by Health and Labour Sciences Research Grant (Japan)Publishe

The Assessment of Awareness of Ability (A3) in a Japanese context : a Rasch model application

The overall aim of this study was to evaluate the validity of the Assessment of Awareness of Ability (A3) in a Japanese context. The A3 (formerly known as the Assessment of Awareness of Disability, AAD) is a standardized 11-question interview used to explore the discrepancy between observed strengths and limitations in the performance of activities of daily living (ADL) according to the Assessment of Motor and Process Skills (AMPS) and the limitations described by the client. In this study, 259 matched Swedish and Japanese A3 data records were analyzed using a Rasch partial credit model (PCM). The analysis of rater consistency and items demonstrated acceptable goodness-of-fit according to the PCM, indicating rater consistency and internal scale validity. The A3 can help clients and therapists understand discrepancies between observed and self-reported performance aspects of various everyday tasks within Japanese and Swedish contexts

(Re-)establishing familiarity : resumption of occupations by older adults with physical disabilities

Background: There is a need for in-depth understanding of how elderly persons resume their occupations while recovering from physical disabilities in their home and community. The aim of this study was to explore and understand how engaging in occupations unfolded over time for some older persons with physical disabilities in Japan. Materials and methods: In this narrative-in-action study four elderly participants were recruited following a mixed purposive and convenience sampling method. Data was gathered at two to three weeks’ intervals over six months, with a follow-up visit at nine months. Qualitative interviews and participant-observations were analyzed using narrative analysis. Results: This study identified the central meaning of resuming occupations as re-establishing former and establishing new familiarity. Familiarity was expressed in three features, namely as repertoires of occupations fulfilling needs and meanings, as performing occupations according to expectation, and as a resource for dealing with problems of engaging in occupation. What was experienced as familiar could be adjusted to accommodate ones changing needs or situation. Conclusion and significance: (Re-)establishing familiarity is a new concept representing transitions from an occupational perspective. Facilitating familiarity can assist older persons to experience health and well-being, even while transitioning after an illness or injury

Adaptation of daily life functioning after disability : the case of Dutch older persons

An extensive geriatric and medical body of knowledge exists to inform occupational therapy practice about possible adaptive strategies used by older people. Usually the focus is on specific disabling conditions, without taking other characteristics of the individuals\u27 situations into account. The purpose of this study was to explore adaptation of functioning in daily life activities from the point of view of older persons with disabilities. For this study, adaptation was defined as "overcoming disabling influences on functioning in daily life activities". Method: Phenomenological (open in-depth) interviews. The informants were eight older Dutch persons with physical disabilities, who were receiving occupational therapy at home or in day-care). Results: 1) Descriptions of adaptation as a process that required these clients\u27 active engagement: The clients used problem-solving strategies familiar from their past and personal resources as well as resources in their social and physical environments. Adaptation started with identifying prospects of potential solutions, followed by creating solutions to overcome constraints on occupational functioning. 2) The phenomenological analysis also resulted in descriptions of outcomes of adaptation. Adaptation was aimed at finding satisfaction through occupations. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations. 3) Finally, the analysis produced four meaning-dimensions that express how personal values influenced the adaptive processes. These were:"quite an endeavor","that\u27s the way I do things","to lose a part of oneself", and "maintaining directorship". Recommendations for supporting older persons with disabilities were formulated, such as fulfillment as outcome-indicator, instilling hope and expectations, practice-situations that include family or other relevant persons, building on familiar problem-solving strategies, and the utility of narrative approaches