To compare occupation-based and impairment-based approaches in occupational therapy and determine the feasibility of patient recruitment and retention. A multicenter, randomized, controlled pilot trial with a single blind assessor. Ten subacute rehabilitation units in Japan. Fifty-four patients with subacute stroke. The experimental group used the iPad application, Aid for Decision-making in Occupation Choice, to establish occupation-based goals, and evaluation and intervention were conducted mainly through real occupations. The control group was evaluated according to patients’ generic abilities and activities of daily living (ADL), and the intervention mainly involved the impairment-based approach. Short Form-36, Functional Independence Measure, Brunnstrom recovery stages, The Client Satisfaction Questionnaire, and length of hospital stay. Of the 1465 potential participants, 54 (3%) subacute stroke patients were enrolled over 16 months and 68% (n = 36) were retained to the 2-month assessment: experimental group (n = 16); control group (n = 21). Although there was no significant intergroup difference for any outcomes, the experimental group had a small effect size advantage on the Short Form-36 “General health” (d = 0.42) and “Role emotional” (d = 0.43) subscales relative to the control group. A sample of 118 subacute stroke patients per group would be required for a lager study. Results suggest that the occupation-based approach has more potential to improve “General health” and “Role emotional” scores on the Short Form-36 than the impairment-based approach. Further investigation of study protocol with interventions and recruiting is needed prior to a larger trial.

Purpose: The iPad application aid for decision-making in occupation choice (ADOC) was developed to measure the client’s satisfaction with individualized occupational performance of meaningful and purposeful activities. The present study examined the reliability and validity of individualized satisfaction measurement using the ADOC. Method: The Japanese version of the ADOC was used by 36 occupational therapists on 92 of their clients (44 males, 48 females, mean age 66.4 ± 17.8 years). Convergent and discriminant validity were examined using Pearson’s correlation between ADOC satisfaction score and the Life Satisfaction Index K (LSIK) factors: Factor 1 (satisfaction with life), Factor 2 (optimistic and positive disposition) and Factor 3 (evaluation of own aging). Test–retest reliability was assessed using the intraclass correlation coefficient (ICC). Results: Ninety-two clients completed the validation study. Satisfaction with ADOC significantly correlated with LSIK Factor 1 (r = 0.297, p < 0.01), but not with Factors 2 or 3 (r = −0.045 and −0.089, respectively). Of the 92 clients, 78 participated in the test–retest reliability study. Good to moderate correlation was revealed (ICC = 0.712, p < 0.001). Conclusions: The Japanese version of the ADOC is a valid and reliable instrument for measuring client satisfaction with individualized occupational performance.

Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial. In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months. Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost. We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1. The results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible. UMIN Clinical Trials Registry UMIN000012994

Purpose: To determine a quantifiable measure to identify patients with dementia who can choose an illustration of meaningful activity using an iPad application, Aid for Decision-making in Occupation Choice (ADOC). Method: We recruited 116 patients from 5 institutions in Japan. Occupational therapists interviewed patients with dementia to determine meaningful activities using ADOC. The most meaningful activity was confirmed by their primary caregivers. The cut-off was estimated from Mini-Mental State Examination (MMSE). Results: Receiver operating characteristic analysis indicated that an MMSE score of 8 was the cut-off for choosing meaningful activities using ADOC. Sensitivity and specificity was 91.0% and 74.1%, respectively, and the area under the curve value was 0.89. Conclusion: ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia.

Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.