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BACKGROUND: Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making. METHODS: The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement. RESULTS: Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score. CONCLUSIONS: The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.

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A male patient in his 40s was transferred to our hospital for rehabilitation of ataxia after right cerebellar and brainstem infarction. After 3 weeks of conventional physical therapy, his activities of daily life successfully improved with an increase in the functional impedance measure from 101 to 124. However, he still fell short of gaining a higher level of balance function, which was necessary for his job as a standup forklift driver. We introduced virtual reality-guided balance training. The training was performed for approximately 40 min on weekdays for 2 weeks. As a result, the Scale for the Assessment and Rating of Ataxia score decreased from 5 to 1, Functional Balance Scale score improved from 48 to 56, and Mini-Balance Evaluation Systems Test score increased from 20 to 28. The trunk sway disappeared clinically. He regained confidence and returned to work after an additional 2 weeks of physical therapy.

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BACKGROUND: Virtual reality (VR) technology has been recently introduced in a variety of clinical settings, such as physical, occupational, cognitive, and psychological rehabilitation or training. However, the clinical efficacy of VR rehabilitation compared with traditional training techniques remains to be elucidated. CASE: A 90-year-old man underwent VR-guided, dual-task, body trunk balance training in the sitting position using a newly developed medical device (mediVR KAGURA, mediVR, Inc., Toyonaka, Japan) after his physical activity level had plateaued. The patient had difficulty in walking outside the hospital even after having undergone traditional physical training. VR-guided training was performed for 40 min every weekday for 2 weeks. Trunk balance training was performed using reaching tasks, and cognitive stimulation was designed to emulate the cognitive processing involved when walking in a city or town. After the VR-guided training, the patient's 6-min walk distance improved from 430 m to 500 m even though there had been no improvement in muscle strength of the lower extremities. Furthermore, the patient could successfully walk outside the hospital without falling or colliding with obstacles. DISCUSSION: It is noteworthy that the patient's walking ability improved further by the addition of VR-guided, dual-task, trunk balance training carried out in the sitting position. This finding suggests several possible new approaches to overcoming walking disability. Walking requires lower-extremity muscle strength, postural balance, and dual-task processing. Currently, no effective quantitative methods have been identified for postural balance and dual-task training with the patient in the sitting position. Herein, we discuss the possible advantages of VR-guided rehabilitation over traditional training methods.

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OBJECTIVE: To investigate the short-term effects of the life goal concept on subjective well-being and treatment engagement, and to determine the sample size required for a larger trial. DESIGN: A quasi-randomized controlled trial that was not blinded. SETTING: A subacute rehabilitation ward. SUBJECTS: A total of 66 patients were randomized to a goal-setting intervention group with the life goal concept (Life Goal), a standard rehabilitation group with no goal-setting intervention (Control 1), or a goal-setting intervention group without the life goal concept (Control 2). INTERVENTIONS: The goal-setting intervention in the Life Goal and Control 2 was Goal Attainment Scaling. The Life Goal patients were assessed in terms of their life goals, and the hierarchy of goals was explained. The intervention duration was four weeks. MAIN MEASURES: Patients were assessed pre- and post-intervention. The outcome measures were the Hospital Anxiety and Depression Scale, 12-item General Health Questionnaire, Pittsburgh Rehabilitation Participation Scale, and Functional Independence Measure. RESULTS: Of the 296 potential participants, 66 were enrolled; Life Goal (n = 22), Control 1 (n = 22) and Control 2 (n = 22). Anxiety was significantly lower in the Life Goal (4.1 ±3.0) than in Control 1 (6.7 ±3.4), but treatment engagement was significantly higher in the Life Goal (5.3 ±0.4) compared with both the Control 1 (4.8 ±0.6) and Control 2 (4.9 ±0.5). CONCLUSIONS: The life goal concept had a short-term effect on treatment engagement. A sample of 31 patients per group would be required for a fully powered clinical trial.

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