Hirofumi Nagayama

Aims: To develop and validate the 12-item short form of the Participation Questionnaire for Preschoolers (PQP-12). Methods: In a cross-sectional study (n = 164 aged 3-6 years), 12 items (three per factor) were selected based on item-total correlations while retaining the four-factor structure; confirmatory factor, internal consistency, and construct validity analyses were conducted. In a cohort study (n = 275 aged 5-6 years), confirmatory factor and internal consistency analyses were reperformed in an independent sample, and test-retest reliability (intraclass correlation coefficients [ICCs]), measurement error (standard error of measurement [SEM], minimal detectable change [MDC]), and responsiveness were examined. Results: The four-factor model fit well in both samples (comparative fit index = 0.999/0.996) and was superior to the one-factor model. Cronbach's α was 0.75 and 0.80 (subscales: 0.46-0.92), with Factor 2's low value likely reflecting ceiling effects in the older sample. The PQP-12 correlated strongly with the original PQP (r = 0.86-0.95); 78% of construct-validity hypotheses and 80% of responsiveness hypotheses were supported. Test-retest reliability was good (ICC = 0.79-0.90), with SEM and MDC being reported. Conclusion: The PQP-12 preserves the original PQP's structure and measurement properties while reducing respondent burden.

Background Older adults requiring emergency surgery for acute tibial fractures are vulnerable to hospital-associated complications (HACs), but admission-time risk stratification tools are lacking. We aimed to characterize HACs and develop both an ensemble prediction model and a simplified bedside risk score. Methods This retrospective cohort study used the Japanese Diagnosis Procedure Combination database provided by JMDC Inc. Patients aged ≥ 65 years emergently admitted for tibial fracture (ICD-10: S82, 2014–2025) who underwent surgery within 5 days, with stay > 5 days, were included. The primary outcome was composite HACs during index hospitalization. Missing data were handled with multiple imputation. A Super Learner ensemble was developed and evaluated on held-out test data, and a simplified scorecard was derived using analysis of variance (ANOVA)-based feature selection and Weight-of-Evidence transformation. Results Among 53,186 admissions, 5,193 met eligibility criteria. HACs occurred in 851 patients (16.4%), most commonly delirium (7.5%) and falls/trauma (5.7%). The Super Learner achieved a test-set area under the receiver operating characteristic curve (AUC) of 0.740 (95% CI 0.707–0.772), higher than conventional linear logistic regression (0.724). The most influential predictors were Hospital Frailty Risk Score, dementia, Barthel Index, comorbidity burden, and days to surgery. The simplified 7-variable scorecard achieved a test-set AUC of 0.736 (95% CI 0.703–0.769), stratifying patients into five risk groups (HAC rate: 3.45%–38.64%). Conclusions HAC risk after emergency tibial fracture surgery in older adults was driven primarily by geriatric vulnerability rather than fracture-specific factors. A simplified admission-time score may support targeted prevention, pending external validation.

Background: It remains unclear which patient and treatment characteristics are associated with greater cognitive and functional gains from individualised occupational therapy (IOT) in schizophrenia. Aims: To explore predictors of changes in cognition and functioning and their maintenance among patients with schizophrenia who received IOT. Method: This secondary analysis used data from a randomised controlled trial and its follow-up. Participants allocated to the group occupational therapy plus IOT arm who received IOT during their hospital stay and had available outcome data were included ( n = 34; with follow-up data available for 32 participants). Changes in cognition (Brief Assessment of Cognition in Schizophrenia) and functioning (modified Global Assessment of Functioning – social functioning subscale) were examined. Linear mixed-effects models were used to evaluate patient- and treatment-related predictors of change and maintenance. Results: Greater improvement in cognition was associated with lower baseline cognition ( β = −0.40, p = 0.003). Maintenance of cognitive improvement was associated with fewer prior hospital stays ( β = −0.21, p = 0.031) and better post-treatment quality of life ( β = 5.61, p < 0.001). Greater improvement in functioning was associated with lower baseline functioning ( β = −0.50, p < 0.001) and fewer physical comorbidities ( β = −8.43, p = 0.004), whereas maintenance of functional improvement was associated with better post-treatment cognition ( β = 2.27, p = 0.014) and greater engagement in self-monitoring ( β = 0.27, p = 0.026). Conclusions: Both patient characteristics and engagement in specific IOT components were associated with variability in changes in outcomes and their maintenance. These findings may inform more personalised occupational therapy strategies for schizophrenia.

Importance: Schizophrenia typically requires long-term treatment, making cost-effective interventions essential, yet the cost-effectiveness of individualized occupational therapy (IOT) remains unclear. Objective: To compare the cost-effectiveness of IOT plus group occupational therapy (GOT) with GOT alone for inpatients with schizophrenia over 2 yr. Design: Secondary analysis of data from a multicenter, two-arm, parallel randomized controlled trial. Setting: Fourteen clinical facilities. Participants: Sixty-two inpatients with schizophrenia who completed 2-yr follow-up. Intervention: GOT alone or IOT+GOT during 3 mo of hospitalization. Outcomes and Measures: Quality-adjusted life-years (QALYs) and total medical costs from a health care payer perspective over 2 yr. Results: Compared with GOT alone (n = 30), IOT+GOT (n = 32) produced greater cumulative QALYs (M difference = 0.156) and lower total medical costs (M difference = −¥290,784). The incremental cost-effectiveness ratio was −¥3,304,420 per QALY gained. Incremental net benefit was positive at willingness-to-pay thresholds of ¥5,000,000 and ¥6,000,000 per QALY. The cost-effectiveness acceptability curves showed a 94.2% probability of cost-effectiveness at a threshold of ¥6,000,000. Cost data were complete for approximately 40% of participants; missingness was addressed using multiple imputation, with complete-case sensitivity analysis yielding directionally consistent findings. Conclusions and Relevance: IOT+GOT was more cost-effective than GOT alone over 2 yr, supporting its wider adoption as an economically sound rehabilitation strategy for clients with schizophrenia. Given the extent of missing cost data, the results should be interpreted with appropriate caution. These findings offer long-term economic evidence to inform mental health policies and resource allocation in psychiatric care. Plain-Language Summary: Schizophrenia often requires long-term treatment, resulting in substantial health care costs. This study examined whether adding individualized occupational therapy to standard group occupational therapy offers a more cost-effective approach for inpatients with schizophrenia. Sixty-two patients were followed for 2 years after receiving either group occupational therapy alone or a combination of individualized occupational therapy and group occupational therapy during hospitalization. The results indicated that patients who received individualized occupational therapy and group occupational therapy experienced greater improvements in quality of life and slightly lower total medical costs. Furthermore, the cost-effectiveness analysis showed a 94.2% probability that the intervention would be cost-effective under Japan’s commonly accepted willingness-to-pay threshold. These findings suggest that individualized occupational therapy combined with group occupational therapy is a potentially cost-effective strategy for schizophrenia rehabilitation. This evidence supports the integration of individualized occupational therapy into standard psychiatric rehabilitation programs and may inform future mental health policy and resource allocation.

Aim: Autistic children have a high but varied prevalence of internalizing and externalizing problems. This study aimed to identify the subtypes of internalizing and externalizing problems among autistic preschool children in Japan, examine their temporal stability, and investigate differences in participation in daily life and family outcomes across these subtypes. Methods: A prospective cohort study was conducted with 275 caregivers of autistic children aged 51–75 months. Internalizing and externalizing problems were assessed using the Strengths and Difficulties Questionnaire. Results: Latent transition analysis identified five subtypes: Low-symptom, High-emotional, Externalizing, Comorbid, and Peer-difficulty groups. Membership in the High-emotional and Externalizing groups was relatively stable over time, whereas the Peer-difficulty group showed frequent transitions to subtypes with higher levels of internalizing or externalizing problems. Significant differences in participation in daily life and family outcomes were observed across subtypes, but these patterns were inconsistent with a simple gradient of symptom levels. Conclusions: The novel findings that the temporal stability of subtype membership varied and that differences in participation in daily life and family outcomes were observed across the subtypes suggest that the heterogeneity of internalizing and externalizing problems may be associated with variations in children’s participation in daily life and family outcomes over time. Plain Language Summary: Autistic preschool children often experience emotional and behavioral difficulties, but the way these difficulties manifest varies widely across individuals. This study aimed to identify the patterns of these difficulties, examine how they change over time, and investigate how participation in daily life and family outcomes differ across autistic preschool children. We conducted a study with 275 caregivers of autistic children aged 4–6 years in Japan. From caregiver reports of children’s emotional and behavioral difficulties, five distinct patterns were identified: a group with mainly emotional difficulties, a group with mainly behavioral difficulties, a group with both types of difficulties, a group with relatively low levels of difficulties, and a group characterized primarily by peer-related difficulties. Our findings suggest that different patterns of emotional and behavioral difficulties are associated with differences in children’s participation in daily life and family outcomes. These differences could not be explained simply by the overall severity of difficulties but rather reflect distinct patterns based on the type of difficulty. The results indicate that autistic children face diverse difficulties that change over time.

Background: Interprofessional education (IPE) is a key strategy for enhancing collaboration and patient safety. While evidence for student populations is abundant, studies focusing on licensed physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) remain limited. In contemporary rehabilitation practice, continuous IPE is increasingly important to address professional burnout and the growing complexity of patient needs. Objective: This scoping review aimed to systematically map and synthesize the educational formats, content domains, and reported outcomes of IPE programs specifically targeting licensed PTs, OTs, and SLPs. Methods: Following Joanna Briggs Institute and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we searched the PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Educational Resources Information Center databases through December 31, 2025. The eligibility criteria were based on the population, concept, and context framework, including peer-reviewed, English-language studies of licensed PTs, OTs, and SLPs (population) participating in structured IPE interventions (concept) within clinical or community settings (context). Studies focusing solely on students or prelicensure trainees were excluded. Following the screening of 3234 records by independent pairs of reviewers, 9 studies were ultimately selected for inclusion. Methodological quality was appraised using Joanna Briggs Institute critical appraisal checklists and the Mixed Methods Appraisal Tool. Data were synthesized using an evidence gap map to visualize research density across domains relative to established competency frameworks. Results: A total of 9 studies from Australia, the United States, Canada, and the Philippines were included, with sample sizes ranging from 8 to 197. Most used single-group pre-post or mixed methods designs; notably, no randomized controlled trials were identified. Methodological quality was generally high, though limited by the lack of control groups. Systematic mapping identified 7 educational formats, with lectures and discussions being the most dominant across all competency domains. Primary content domains included communication and role clarification. Specific successful interventions included pharmacist-led medication safety workshops and the Kawa model for team building. While participants reported immediate improvements in role understanding and collaborative confidence, simulation-based training showed inconsistent effects on long-term clinical behavior. A substantial evidence gap was identified in experiential learning approaches targeting collaborative leadership. Conclusions: This scoping review adds a novel perspective by focusing exclusively on licensed rehabilitation professionals (PTs, OTs, and SLPs), highlighting learning needs distinct from those of prelicensure students. It brings to the field a clearer understanding of a potential “leadership gap” and the current overreliance on didactic methods for experienced clinicians. Real-world implications suggest the need for health care institutions to transition toward systematic, practice-integrated IPE models that incorporate objective behavioral assessments. By addressing identified gaps in collaborative leadership and team functioning through longitudinal programs, health care institutions may contribute to more resilient team cultures, ultimately improving patient safety and the quality of rehabilitation care.

This study aimed to identify sensory subtypes in preschool children on the autism spectrum in Japan and examine their associations with participation and family functioning. A total of 264 caregivers of preschool children aged 3–6 years on the autism spectrum participated in the study. Data were collected from 56 child development centers and medical institutions across Japan. Sensory features were assessed using the Japanese version of the Short Sensory Profile, and five sensory subtypes were identified: Taste/Smell Sensitive, Extremely Atypical, Mixed Sensory, Gravitational Insecurity and Motor Difficulty, and Adaptive. These subtypes were associated with distinct participation restrictions, such as activities of daily living (ADL)-related challenges in the Mixed Sensory group, leisure-related difficulties in the Taste/Smell Sensitive group, and limitations across all domains in the Extremely Atypical group. Significant differences in family functioning were also observed in domains related to interaction with the external environment of the family, with the Extremely Atypical group showing support needs. These findings underscore the importance of developing tailored intervention strategies for each sensory subtype. Lay This study examined the impact of differences in sensory processing on the daily lives of preschool children with autism spectrum disorder in Japan, as well as how these differences influence their families. Caregivers of children aged 3–6 years from 56 centers and medical institutions took part in the study. Through a questionnaire, we identified five sensory types among the children: those sensitive to taste and smell, those with highly unusual sensory responses, those with a mix of sensory challenges, those struggling with balance and movement, and those with more adaptive sensory responses. Each sensory type encountered specific challenges in daily activities. For example, children with mixed sensory challenges had difficulties with basic tasks such as eating or dressing, while those sensitive to taste and smell faced challenges in leisure activities. Children with highly unusual sensory responses experienced difficulties in all areas of daily life. These challenges also impacted family dynamics, especially in how families engaged with their surroundings. Families of children with highly unusual sensory responses often required additional support. Our findings emphasize the necessity for personalized support and intervention strategies tailored to each child’s unique sensory subtype, which can enhance their participation in daily activities and promote their family’s well-being.

Background/Objectives: Predicting comprehensive patient characteristics is essential for optimal individualized rehabilitation plans for acute stroke patients. However, current models primarily predict single outcomes. This study aimed to assess the applicability of latent class analysis (LCA) in rehabilitation practice by identifying comprehensive characteristics and associated predictors in acute stroke patients. Methods: We conducted a retrospective observational study using the Japan Association of Rehabilitation Database, including 10,270 stroke patients admitted to 37 acute-care hospitals between January 2005 and March 2016. Patients were classified using LCA based on outcomes at discharge, including Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS) subscales for upper-extremity function, length of hospitalization, and discharge destination. Predictor variables at admission included age, FIM scores, NIHSS subscales for upper-extremity function, stroke type, and daily rehabilitation volume. Results: 6881 patients were classified into nine distinct classes (class size: 4–29%). Class 1, representing the mildest cases, was noted for independent ambulation and good upper limb function. Class 2 comprised those with the most severe clinical outcome. Other classes exhibited a gradient of severity, commonly encountered in clinical practice. For instance, Class 7 included right-sided paralysis with preserved motor activities of daily living (ADLs) and modified dependence in cognitive functions, such as communication. All predictors at admission were significantly associated with class membership at discharge (p < 0.001). Conclusions: LCA effectively identified unique clinical subgroups among acute stroke patients and demonstrated that key admission variables could predict class membership. This approach offers a promising insight into targeted, personalized rehabilitation practice for acute stroke patients.

BACKGROUND Patient safety remains a global priority, with preventable adverse events—often caused by communication failures among healthcare professionals—posing serious risks. Interprofessional education (IPE) is a promising strategy to improve collaboration and communication, thereby enhancing care quality and patient outcomes. While IPE has been widely studied in student populations, limited evidence exists regarding its implementation and effectiveness for licensed rehabilitation professionals such as physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). OBJECTIVE This scoping review aimed to comprehensively map the implementation, content, and effects of interprofessional education (IPE) targeting groups including licensed physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). METHODS This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines. Searches were performed using PubMed, Web of Science, CINAHL, MEDLINE, and ERIC databases, targeting studies published up to March 2024. The study population consisted of licensed PTs, OTs, and SLPs. Regarding concept, we targeted studies in which IPE was provided to groups with at least one licensed PT, OT, or SLP. Regarding context, we included studies reporting the effects of IPE in clinical settings. Controlled vocabulary (e.g., MeSH) for terms such as IPE, PT, OT, and SLP was used to develop the search strategy. Eight reviewers extracted data and identified eligible studies. RESULTS Of the 3,389 records identified, eight were included. Mapping revealed that IPE implementation primarily involved lectures, discussions, and team-based practices. The content covered theories and concepts, treatment, and workplace problem-solving. Regarding effects, the results demonstrated that IPE improved role understanding, collaboration skills, knowledge, and confidence in the long term. However, simulation training did not improve interprofessional attitudes or network expansion. CONCLUSIONS IPE targeting licensed PTs, OTs, and SLPs was structured in a way that combined multiple implementation methods to enable comprehensive learning, with the content adjusted to meet participant needs. Future studies should consider systematic reviews and meta-analyses to identify recommended combinations of IPE implementation and content. CLINICALTRIAL Not applicable.

Purpose This study aimed to evaluate the test−retest reliability, responsiveness, and interpretability of the Preschool Questionnaire for Participation (PQP), a tool for assessing participation in preschool children with autism spectrum disorder (ASD). Methods A cohort study was conducted with data collected at four time points over six months from children with ASD aged 51–75 months. Test−retest reliability was examined using intraclass correlation coefficients (ICCs) for 275 participants who completed the study. Responsiveness was examined by analyzing correlations between changes in PQP scores and changes in multiple scales based on four predefined hypotheses. To assess interpretability, the Global Rating of Change (GRC) Scale was used as an anchor to analyze receiver operating characteristic curves and estimate the minimal important change (MIC). Results ICCs ranged from 0.80 to 0.92 for individual factors and reached 0.93 for the total score. Three of the four hypotheses for responsiveness were supported within the expected range. However, the correlation between the GRC Scale and changes in PQP scores was below 0.3, preventing MIC calculation. Conclusion While the MIC could not be calculated, the PQP demonstrated test−retest reliability equivalent to or better than existing participation measures. Given the limited verification of responsiveness for other tools, the PQP’s strong longitudinal reliability and validity provide a foundation for future research.