Yuki Saito

Introduction: A client-centred approach ensures that individuals can express what’s most important to them, with therapists providing collaborative support. This study examined factors influencing the quality of collaborative relationships between clients and occupational therapists and explored how the strength of these relationships affects therapy outcomes. Method: A prospective longitudinal observational study was conducted at day care centres across Japan, with participants followed for 1 year. Occupational therapists delivered occupational therapy guided by a client-centred approach. Outcomes, including daily activities and health-related quality of life, were measured before and after the intervention. The Collaborative Relationship Scale (CRS) was used to assess baseline relationship quality. Results: Among 101 participants (aged 47–93 years), CRS scores categorised them into good, neutral, and poor relationship groups. Logistic regression revealed that goal achievement and clients’ understanding of occupational therapy were associated with relationship quality. Over 50% of participants in the good relationship group had activities of daily living goals, whereas more than 50% in the poor relationship group had mobility goals. Conclusion: Strong collaborative relationships may positively influence occupational therapy processes and outcomes. These findings highlight the importance of goal setting within occupational therapy guided by a client-centred approach in enhancing therapeutic relationships.

Importance: The demand for effective home-based rehabilitation is increasing with the aging global population. Occupational therapy supports older adults in maintaining and improving activity and participation; however, standardized intervention approaches, consistent outcome measures, and goal-setting frameworks are still lacking. Objective: To systematically map current home-based occupational therapy interventions aimed at enhancing activity and participation among community-dwelling older adults and identify research gaps in intervention methods, evaluations, and designs. Data Sources: PubMed, Web of Science, Scopus, Ichushi Web, and J-Stage were searched without time restrictions. Additional relevant studies were identified manually. Study Selection and Data Collection: Studies involving community-dwelling adults age 65 yr or older were included. Data on intervention strategies, outcome measures, and research designs were extracted and categorized by using qualitative methods. Findings: Fifty-four studies were included. Interventions ranged from activities of daily living (ADLs) and instrumental ADLs (IADLs) training and environmental modifications to structured programs such as Community Aging in Place—Advancing Better Living for Elders (CAPABLE) and Reablement. However, outcome measures were highly diverse (126 unique tools), and 16 nonstandardized assessments were identified, mostly in case reports. Although many studies showed positive effects, the diversity of study designs and limited use of remote interventions hindered generalizability and long-term evidence building. Conclusions and Relevance: Home-based occupational therapy can positively affect older adults’ activity, participation, and quality of life. However, standardized evaluation methods, integration of remote approaches, and culturally tailored intervention programs are needed to strengthen evidence and guide clinical practice. Plain-Language Summary: This review examined studies on home-based occupational therapy for older adults. Interventions often targeted activities of daily living, instrumental activities of daily living, and environmental adaptations. Most occupational therapy interventions showed benefits in everyday function and well-being. However, a lack of standardized tools and goal-setting methods, variation in study quality, and limited evidence on remote rehabilitation remain challenges.

This study aimed to clarify the longitudinal goal negotiation and collaboration process of achieving activity- and participation-level goals. We conducted a qualitative study using the trajectory equifinality model. Nine occupational therapists with experience in setting and achieving activity- and participation-level goals were recruited and interviewed about their clients. We identified two phases and four pathways in the setting and attainment process for activity- and participation-level goals. Throughout the longitudinal goal-setting process, when the occupational therapist and client had difficulty discussing activity- and participation-level goals, the therapist respected the client’s expectations, explained the purpose of occupational therapy in detail, and conducted individual face-to-face interviews. When it was difficult to provide work-based interventions, the occupational therapist made flexible use of functional training, elemental movement training, occupation-based practice, and environmental modifications. The results of this study may assist in supporting clients to improve their activity and participation in home rehabilitation.

This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients.A total of 100 clients and 79 OTs were recruited from seven subacut...

[Purpose] This study aimed to examine the effects of differences in the goals recognized by the client and the occupational therapist on patient outcome. [Participants and Methods] A retrospective case-control study was conducted to compare rehabilitation outcomes of cases wherein the occupational therapy goals were matched/unmatched (control) with those of the patients in seven subacute rehabilitation wards in Japan. The outcomes were Functional Independence Measure, number of days of hospitalization, occupational therapy, and total medical cost. [Results] The motor Functional Independence Measure scores in the matched-goal group were significantly higher than those of the unmatched-goal group, and the home discharge rate showed a tendency to increase. It was speculated whether the client had received an explanation about the goal. [Conclusion] Rehabilitation outcome may vary depending on whether occupational therapy goals are matched.