Effect of Collaboration Between Occupational Therapists and Care Managers Using the Management Tool for Daily Life Performance for Stroke Patients

PURPOSE: In stroke rehabilitation in Japan, collaboration between medical care and long-term care professionals is very important (Koga et al., 2011). However, few studies have reported the effects of collaboration between occupational therapists in medical practice and care managers in communities. The Japanese Association of Occupational Therapists (2014) developed the Management Tool for Daily Life Performance (MTDLP) to present the different aspects of occupational therapy that can contribute to comprehensive community care based on a 2008 geriatric health promotion project by the Ministry of Health, Labor, and Welfare (grant-in-aid for the promotion of geriatric health projects). The purpose of this study was to examine the effect of collaboration between occupational therapists and care managers using the MTDLP to measure daily life performance at 1 mo after discharge in stroke patients.

DESIGN: This study was a quasi-experimental design, pre–post intervention study. Inclusion criteria for participation in this study were as follows: (1) diagnosis of stroke, (2) admission to the inpatient the acute ward or the convalescent rehabilitation ward, and (3) planned discharge to home.

METHOD: Fifteen patients (M age = 77.3 ± 7.9) in the acute ward and 22 (M age = 71.7 ± 9.6) in the convalescent ward were evaluated at discharge and 1 mo later as part of an investigation of the effect of collaboration between occupational therapists and care managers using the MTDLP. Collaboration tasks of occupational therapists using the MTDLP include creating and delivering the daily life performance transfer sheet at discharge, patient home visits with the care manager, and attendance at the care service conference before discharge. All patients were assessed with the Barthel Index, Lawton’s Instrumental Activities of Daily Living Scale, self-rated health, and the Health Utilities Index as measures of daily life performance. Comparisons of daily life performance between discharge and 1 mo later in acute and convalescent ward patients were assessed with paired t tests and Wilcoxon signed-rank tests.

RESULTS: Barthel Index scores at 1 mo after discharge were significantly increased in acute ward patients compared with at discharge (p = .044). Moreover, self-rated health at 1 mo after discharge was significantly decreased in acute and convalescent ward patients compared with at discharge (p = .035 and p = .019, respectively). There were no significant differences on other scales of daily life performance at 1 mo after discharge compared with discharge.

CONCLUSION: In a previous study, activities of daily living at 1 mo after discharge in stroke patients tended to worsen (Yoshino, Sasaki, & Usuda, 2008). However, we found that activities of daily living at 1 mo after discharge were significantly improved in acute ward patients compared with discharge. Moreover, self-rated health as an indicator of quality of life at 1 mo after discharge was also significantly improved in acute and convalescent ward patients compared with discharge. Other scale of daily life performance scores at 1 mo after discharge were maintained in acute and convalescent ward patients compared with discharge. These results suggest that collaboration between occupational therapists and care managers using the MTDLP was effective in promoting independent daily living after discharge in stroke patients.

References

Japanese Association of Occupational Therapists. (2014, June 17). Management Tool for Daily Life Performance. Tokyo: Author.

Koga, M., Uehara, T., Yasui, N., Hasegawa, Y., Nagatsuka, K., Okada, Y., & Minematsu, K. (2011). Factors influencing cooperation among healthcare providers in a community-based stroke care system in Japan. Journal of Stroke and Cerebrovascular Diseases, 20, 413–423. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.012

Yoshino, J., Sasaki, Y., & Usuda, S. (2008). [Changes in activities of daily living after discharge from a convalescence rehabilitation ward]. Rigakuryoho Kagaku, 23, 495–499.