Background: Motivation is essential for patients with subacute stroke undergoing intensive rehabilitation. Although it is known that motivation induces behavioral changes toward rehabilitation, detailed description has been lacking. Motivation can be intrinsic or extrinsic; however, it is unclear which type of factors mainly motivates patients' daily rehabilitation.Purpose: This study aimed to examine the factors influencing patients' motivation and to explore the behavioral changes induced by motivation, especially age-related differences.Method: Twenty participants (mean age 65.8 years [standard deviation 13.7]) who had a subacute stroke and underwent rehabilitation at a convalescent hospital were recruited using convenience sampling. Semi-structured interviews were conducted by an occupational therapist with an interview topic guide regarding factors influencing motivation and how it affects behavioral change. Interviews were recorded, transcribed to text, and analyzed by three occupational therapists using thematic analysis. The participants were divided into two groups: aged patients (aged ≥ 65 years) and middle-aged patients (aged < 65 years), and data were analyzed according to the groups. This study was conducted according to the consolidated criteria for reporting qualitative research.Results: Seven core categories were identified as factors influencing patients' motivation: patients' goals, experiences of success and failure, physical condition and cognitive function, resilience, influence of rehabilitation professionals, relationships between patients, and patients' supporters. The first four and last three core categories were further classified as personal and social-relationship factors, respectively. The categories related to intrinsic motivation such as enjoyment of rehabilitation itself were not derived. In both age-groups, motivation affected the frequency of self-training and activity in daily lives. In some aged patients, however, high motivation restrained their self-training to conserve their physical strength for rehabilitation by professionals. Some aged patients do not express their high motivation through their facial expressions and conversations compared to middle-aged patients; therefore, motivation is not always observable in aged patients.Conclusions: Interventions tailored to extrinsic factors are important for maintaining patients' motivation. Observational evaluation may lead to mislabeling of their motivation, especially for aged patients. Rehabilitation professionals should use validated evaluation scales or patients' narratives to assess patients' motivation.

BACKGROUND: Several studies have shown that the structure of employer attitudes toward employing individuals with psychiatric disabilities was multidimensional, but none has clarified the causal relationships within the employer attitude structure. OBJECTIVE:The purpose of this study was to formulate causal models based on data from two previously published studies of employer attitudes toward employing individuals with psychiatric disabilities, and to examine and verify the models. The models were either for all types of industry or specifically the transport sector. METHODS: The sample was selected to infer the influence factors for employment of individuals with psychiatric disabilities (for all types of industry) and specifically promotional factors (for the transport sector). An analysis of covariance structure was used. RESULTS: For all types of industry, prejudice and fear were shown to be indicators of activity limitation, attention distribution, and employer disincentive for hiring. In the transport sector, recruitment standards based on capacity were shown to be an indicator toward employer motivation for hiring and for making preparations to hire, self-efficacy for managing employment, and prejudice and fear. CONCLUSIONS: The results suggest that having recruitment standards based on capacity might reduce prejudice and fear and increase employer motivation for hiring individuals with psychiatric disabilities.

The current study surveyed 94 Japanese vocational rehabilitation (VR) professionals to determine their perceived self-efficacy, perceived benefits, perceived barriers, and readiness to use evidence-based practice (EBP). VR counselors in Japan generally see the potential benefits of using EBP to improve psychosocial and employment outcomes of people with disabilities. However, responses related to knowledge and skills were mixed with higher confidence reported in the ability to understand basic concepts of rehabilitation research designs, methods, and statistics but less confidence in the use of research databases to find empirically supported interventions and in their ability to understand the best evidence information from systematic reviews/meta-analyses. Perceived barriers to EBP were identified, including lack of support for the use of EBP from colleagues and senior management in the agency and not having supervisors who are experienced in EBP. As expected, Japanese VR counselors also reported EBP was not effectively used in VR service delivery practices. Implications for practice, education, and professional development are discussed

The number of Japanese working age persons who have experienced a stroke is significantly increasing. In such cases work support is an urgent issue. Although an active cooperation between medical institutions and work support agencies is critical, it has been insufficient, due to an absence of key coordinators with sufficient knowledge in both occupational therapy and work support or vocational rehabilitation. The present paper introduced two case studies to illustrate the importance of the cooperation between medical institutions and work support agencies and discussed reasons why medical institutions have difficulties in supporting persons who have experienced a stroke in their return to work.

Abstract.[Purpose] The purpose of this preliminary investigation was to obtain a professional consensus regarding current high-priority research questions (RQs) in the field of physical therapy. [Subjects and Methods] The Delphi method was utilized for 46 physical therapists (39 male, 7 female) who had obtained a master's degree in rehabilitation science from the University of Tsukuba. Subjects were asked to quickly list up to three current high-priority RQs in the field of physical therapy.[Results] A total of 20 questionnaires were returned, and 53 RQs were obtained in total for the study. The highest-ranking RQ was, "Is the difference between natural recovery and the effect of the treatment intervention clear?" [Conclusion] High-ranking RQs were influenced by the background of the promotion of Evidence-Based Medicine in recent years.