BackgroundCare-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.MethodIn 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.Main Outcome MeasuresShort Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost.ResultsWe 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.ConclusionThe 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.Trial RegistrationUMIN Clinical Trials Registry UMIN000012994

Abstract.[Purpose] The aim of this study was to investigate whether the performance of a combination of observation and motor imagery of chopstick use (complex task) increased corticospinal excitability more than the performance of observation alone. [Subjects and Methods] We recruited 10 healthy subjects with no history of neurological diseases. Corticospinal excitability was assessed with the participants seated in front of a computer screen performing three tasks: (1) control, the subjects were instructed to relax; (2) OBS, the subjects were told to observe an action depicted in the video, and (3) OBS + IMG, the subjects were told to imagine performing an action depicted in a video. During tasks (2) and (3), a video was displayed on the computer screen showing the hand of a male subject using chopsticks to move small items of food from one dish to another (first person perspective). Imagery was performed kinesthetically.[Results] The MEP amplitude in the first dorsal interosseous was significantly increased during OBS+IMG relative to that in the control condition, but not that in the OBS condition. The MEP amplitude in the thenar muscles was significantly different between OBS and OBS+IMG. [Conclusion] These results suggest that the combination of observation and motor imagery of a complex task may be more effective than observation alone for motor rehabilitation purposes.

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.

The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.

ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia. Implications for Rehabilitation As dementia progresses, difficulty in expressing needs or desires regarding meaningful activity may increase. The iPad application (Aid for Decision-making in Occupation Choice; ADOC) can be useful to promote shared decision-making through a systematic goal-setting process involving a choice of 95 illustrations describing daily activities. Mini-Mental State Examination (MMSE) score greater than 8 points is required to use the ADOC to choose most meaningful activities. ADOC provides individual information regarding meaningful activities for patients with moderate dementia.