한국 치매 작업치료 가이드라인 개발

국문 초록 (Abstract)

목적 : 본 연구는 작업치료사가 적절한 평가와 중재의 방향을 설정할 수 있도록 작업치료 실행체계를 토대 로 근거기반의 한국 치매 작업치료 가이드라인을 개발하고자 시행되었다. 연구방법 : 임상진료지침개발과 수용개작의 과정을 통하여 국외의 치매 작업치료 가이드라인 5개를 AGREE Ⅱ(Appraisal of Guidelines for Research & EvaluationⅡ)로 평가하여 1차 가이드라인을 구성하였으며, 국 내 임상에 맞는 권고안을 도출하기 위하여 국내 58개의 작업치료 치매 관련 연구를 분석한 내용을 추가하 여 최종 한국 치매 작업치료 가이드라인을 완성하였다. 결과 : 작업치료 실행체계를 기반으로 6개 영역 66항목으로 가이드라인이 구성되었다. 각 영역별로는 작업의 영역 14개 항목, 수행기술 31개 항목, 수행양상 3개 항목, 물리적 환경 6개 항목, 활동요건 5개 항목, 환자 -보호자 영역 7개 항목으로 가이드라인이 도출되었다. 각 항목에는 권고 강도(A~D)가 부여되었으며, A 또는 B의 권고 강도로 나타난 항목은 42항목이었다. 일상생활활동 평가, 인지기능(기억력, 집중력, 지남력) 평가, 심리상태 평가, 보행과 균형 평가, 신체적 활동, 환경수정, 보호자 교육 및 상담 등에서 권고 강도가 높게 나타났다. 결론 : 본 연구의 한국 치매 작업치료 가이드라인은 다양한 환경에서 치매환자에게 평가와 중재를 제공하는 작업치료사에게 유용하게 활용될 것이며, 치매환자 관리에 있어 작업치료사의 역할을 명확히 하는 근거가 될 것이다.

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study is to develop an evidence-based occupational therapy guideline for Alzheimer’s disease based on the Occupational Therapy Practice Framework in order for occupational therapists to choose appropriate evaluations and interventions and provide effective, economical, and professional services to patients with Alzheime\r’s disease and their caregivers. Methods: 5 occupational therapy guidelines evaluated with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. In order to identify additional evidence on occupational therapy conducted in Korea, conduct a literature review and found 185 articles. Of these, 58 articles on occupational therapy evaluation and intervention were selected and analyzed. Results: The final guideline was completed by combining the first draft and the items obtained through additional literature review based on the Occupational Therapy Practice Framework. The items were combined into domains of area of occupation, performance skills, performance patterns, environment, activity demands, and caregivers. ADL, IDL, cognitive skill, behavioral management, training of physical function, physical environment, and care-giver domains had high recommendation grades (A). Conclusion: Studies with high levels of evidence have been conducted on various intervention methods, thereby confirming the effectiveness of occupational therapy. Moreover, this study suggest grades of recommendation in order for effective approaches to be taken in each domain.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 서론
• Ⅱ. 연구 방법
• 1. 가이드라인 개발을 위한 핵심 질문 선정
• 2. 자료 수집
• 3. 가이드라인 평가
• 4. 가이드라인 권고 통합
• 5. 추가 임상질문 해결을 위한 권고 개발
• 6. 가이드라인 완성
• Ⅲ. 연구 결과
• 1. 자료수집을 통한 가이드라인 평가
• 2. 핵심질문에 따른 가이드라인 요약
• 3. 추가 임상 질문 해결을 위한 문헌 고찰
• 4. 가이드라인 완성
• Ⅳ. 고찰
• Ⅴ. 결론
• References
• Abstract

참고문헌 (Reference)

1 정원미, "지역사회 치매작업치료사의 직무역량을 위한 연구: 치매지원센터 작업치료사 직무분석을 중심으로" 대한작업치료학회 21 (21): 15-29, 2013

2 차유진, "지역보건법에 근거한 지역사회중심재활(CBR) 업무를 담당하는 작업치료사의 직무특성 및 직무지향에 영향을 미치는 요인: 보건소와 치매지원센터를 중심으로" 대한작업치료학회 20 (20): 41-53, 2012

3 Keough, J., "Treating dementia: The complementing team approach of occupational therapy and psychology" 134 : 375-391, 2000

4 Law, M., "The person-environmentoccupation model: A transactive approach to occupational performance" 63 (63): 9-23, 2006

5 Waldemar, G., "Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline" 14 (14): e1-e26, 2007

6 Schaber, P., "Occupational therapy practice guideline for adults with Alzheimer's disease and related disorders" AOTA Press 2010

7 American Occupational Therapy Association, "Occupational therapy practice framework: Domain & process 2nd Edition" 62 : 625-683, 2008

8 Arbesman, M., "Methodology for the systematic reviews on occupational therapy for adults with Alzheimer's disease and related dementias" 65 : 490-496, 2011

9 Kim, S. Y., "Manual for guideline adaptation ver 2.0" 2011

10 Scottish Intercollegiate Guidelines Network, "Management of patients with dementia: A national clinical guideline" 2006

11 Ministry of Health Malaysia, "Management of dementia" Ministry of Health Malaysia 2009

12 Jack, C. R., "Introduction to the recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease" 7 : 257-262, 2011

13 Carl, H. S., "Guidelines for the management of cognitive and behavioral problems in dementia" 25 : 350-366, 2012

14 Kim, S. Y., "Guidance for development of clinical practice guidelines ver 1.0" 2009

15 Henry, H., "Evolution of the American college of cardiology/American heart association clinical guidelines" 65 : 2726-2734, 2015

16 AGREE Collaboration., "Development and validation of an internal appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project" 12 (12): 18-23, 2003

17 The British Psychological Society., "Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care"

18 Kim, S. W., "Dementia management business overview and challenges" 2014

19 British Columbia Guidelines & Protocol Advisory Committee, "Cognitive impairment in the elderly-recognition, diagnosis and management" British Columbia Ministry of Health 2007

20 The National Collaborating Centre for Mental Health, "Clinical practice guidelines for dementia in Australia"

21 Sara, T, "Clinical practice guidelines" 46 : 681-687, 2005

22 Ministry of Health & Welfare., "Clinical practice guideline for dementia"

23 The Ministry of Health, British Columbia, "Best practice guideline for accommodating and managing behavioral and psychological symptoms of dementia in residential care"

24 Warchol, K., "An interdisciplinary dementia program model for long-term care" 20 (20): 59-71, 2004

25 Rabins, P. V., "American psychiatric association practice guideline for the treatment of patients with Alzheimer's disease and other dementias second edition" 164 (164): 5-56, 2007

26 Scottish Intercollegiate Guidelines Network, "A guideline developer's handbook" 2014