Risk factors for falls among community-dwelling older adults during voluntary self-isolation: analysis based on frailty screening index subscales

[Purpose] This study aimed to assess fall-related risk factors among community-dwelling older adults during a period of voluntary self-isolation for preventing the spread of COVID-19. [Participants and Methods] This was a cross-sectional study. Survey questionnaire forms were distributed to 2,586 community-dwelling older adults in Takasaki City, Gunma Prefecture, Japan. Completed questionnaires were returned by mail. [Results] Of the 1,645 people who responded, 1,040 people aged 65 and over who did not apply for long-term care insurance and fully completed the questionnaire were included in this study. Since no in-person measurements were required, we utilized the Frailty Screening Index for the evaluations. We evaluated the relationship between questionnaire responses and fall rates among community-dwelling older adults. Among the results, “yes” responses to “Do you think you walk more slowly than before?” were identified as significantly associated with falls. [Conclusion] One must pay careful attention to subjectively assessing decreases in walking speed as a fall prevention measure during periods of self-restraint to prevent the spread of COVID-19 infection.     

Predicting 12-Month Mortality for Peritoneal Dialysis Patients Using the “Surprise” Question

♦ Background: Studies in hemodialysis patients suggest that the “surprise” question can help to identify a group of patients with a high mortality risk who should receive priority for palliative care interventions. However, the same instrument has not been tested in peritoneal dialysis (PD) patients.♦ Method: We studied 367 prevalent PD patients from a single dialysis center. Three clinicians independently answered the “surprise” question (Would I be surprised if this patient died within the next 12 months?) according to their clinical impression of the individual patient. Patients are then classified into “yes” (yes, surprised) and “no” (no, not surprised) groups. All patients were followed for 12 months.♦ Results: In this cohort, 109 patients (29.7%) were allocated to the “no” group, and 258 (70.3%), to the “yes” group. Patients in the “no” group were older and had high prevalences of pre-existing ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. The “no” group had a higher score on the Charlson comorbidity index and a higher malnutrition-inflammation score. At 12 months, 44 patients had died. Mortality was 24.8% in the “no” group and 6.6% in the “yes” group. Multivariate analysis showed that an opinion of “Not surprised if dies in the next 12 months” was an independent predictor of 12-month mortality, with an associated 3.594 excess mortality risk (95% confidence interval: 1.411 to 9.151; p = 0.007). The positive predictive value of this opinion was 24.8%, and its negative predictive value was 93.4%.♦ Conclusions: The “surprise” question has the potential to help identify a group of PD patients with high short-term mortality. Its use may contribute to a decision to refer PD patients for early palliative care assessment.Key words: Survival, renal failure, uremiaLong-term dialysis is a life-saving treatment for patients with end-stage renal disease (ESRD). However, in a small number of those patients, clinical conditions and the individual’s level of self-sufficiency raise questions about whether dialysis may actually be futile—worsening the person’s quality of life or simply prolonging the dying process (1). In fact, for elderly patients with advanced chronic kidney disease, the risk of death or functional decline within a relatively short time is substantial (2), favoring a conservative approach to the management of those patients.Given the evolving epidemiologic scenario in ESRD, there is a growing need to rely on solid data to decide whether to recommend conservative therapy rather than long-term dialysis (3). Unfortunately, little evidence has been published on how to select patients with advanced chronic kidney disease for conservative treatment (1,4,5). Although dialysis is generally associated with longer survival in patients more than 75 years of age, patients with multiple comorbidities— ischemic heart disease in particular—do not survive longer than those treated conservatively (6,7). However, the relevant studies have not touched on the cardinal problem: How to identify ESRD patients who should be treated conservatively?In nonrenal patients, the “surprise” question (Would I be surprised if this patient died in the next 12 months?) has been recognized as a valid tool for the identification of patients with a poor prognosis who are appropriately offered palliative care (8,9). The “surprise” question has been tested and found to be effective in a primary care population in the Franciscan Health System in Tacoma, Washington, USA (8). Application of the “surprise” question has been well-tested in hemodialysis patients. For example, in a prospective cohort study of 147 patients in 3 hemodialysis dialysis units, Moss et al. (10) found that the “surprise” question was effective in identifying sicker dialysis patients with a high risk for early mortality who should receive priority for palliative care interventions. In another cohort of 512 patients who were receiving long-term hemodialysis at 5 dialysis clinics, Cohen et al. (11) also found that the “surprise” question stood out as an independent predictor of mortality within 6 months, which contributed to an improvement in end-of-life care by providing more accurate prognostic information. However, the applicability of the “surprise” question has not been tested in peritoneal dialysis (PD) patients. The purpose of the present study was to evaluate the clinical characteristics of PD patients who were classified into a “no, I would not be surprised” group in response to the “surprise” question, and to determine the prognostic value of the “surprise” question in identifying PD patients with a high risk for early death.     

Malnutrition is associated with depression in Japanese older adults requiring long-term care or support

[Purpose] To characterize depression related to nutritional status in older adults requiring long-term care. [Participants and Methods] One hundred and six individuals (66 males and 40 females) over the age of 65 who required support level 1/2 or care level 1 and were receiving day care through the long-term care insurance (LTCI) system, were enrolled. The survey items included basic attributes, comorbidities, previous medical history, requiring support/care under Japan’s LTCI system, the Mini Nutritional Assessment–Short Form, the Geriatric Depression Scale 15 (GDS-15), and body mass index (BMI). The factors associated with malnutrition/risk of malnutrition were evaluated. In addition, the relationship between nutritional status and the GDS-15 items was evaluated. [Results] Depression, LTCI, BMI, and gender were identified as related factors for malnutrition/risk of malnutrition. Compared with the favorable nutritional status group, the malnutrition/risk of malnutrition group reported GDS-15 items such as “Dropped activities and interests”, “Feel that life is empty”, “In good spirits most of the time (reversed)”, “Afraid of something bad”, “Prefer to stay at home”, and “Feel full of energy (reversed)”. [Conclusion] The results show certain parameters characteristic of depression in Japanese older adults with malnutrition requiring long-term care/support. These data will help guide future research and interventions.     

Influence of motor instruction words on body movements in step-over motions

[Purpose] To quantitatively analyze the characteristics of movements evoked by certain motor instruction words on the basis of measurements of ankle elevation and related body movements in step-over motion tasks. [Participants and Methods] Sixty-one healthy adult participants were presented with motor instructions and asked to step over an obstacle in accordance with the instructions. The motor instructions were as follows: “Raise your XX (body part) up YY (expression)” in four combinations using “thigh” and “knee” for body part and “high” and “firmly” for expression. Using Kinect to analyze movements, ankle elevation, trunk-anteversion angle, hip-flexion angle, and knee-flexion angle were measured and statistically processed. [Results] With respect to body part, there was no significant difference in the mean and standard deviation (individual variation) values for ankle elevation. With respect to expression, hip joint and knee joint were bent significantly more for “high” than for “firmly”, and although the mean value for ankle elevation was high, ankle elevation standard deviation (individual variation) values were significantly lower for “firmly” than for “high”. [Conclusion] Explicit motor instruction words such as “high” may be effective in improving performance, while ambiguous motor instruction words like “firmly” may be effective in stabilizing movements.     

Assessment of spine pain presence in children and young persons studying in ballet schools

[Purpose] Spine disorders affect various sections of the spine and have a variety of causes. Most pain occurs in the lumbo-sacral and cervical regions. Dance is associated with exercise. High levels of physical activity predispose to back pain occurrence. [Subjects and Methods] The subjects were 237 ballet learners; 80 children (primary school level), mean age 11.24±0.77, mean of years of training ballet 2.14±0.74; 93 students (junior high school level), mean age 14.01±0.84, mean of years of learning ballet 4.64±1.24; 64 students (high school) mean age 17.01±0.77, mean of years of learning ballet 7.47±1.54. Numeric rating scale was used to determine spine pain. [Results] Feelings of pain were analyzed on the basis of “now” and “before” between levels education by using point statistics and statistical tests to compare groups. “Now” exhibited weaker back pain feelings than “before” at all the education levels. There were statistically significant differences in pain feeling for “before” (at any time of learning) and “now” (the day of survey). [Conclusion] All patients reported pain “before” and “now” in cervical, thoracic and lumbar spine. At all levels of education there were statistically significant differences in feelings of pain between “before” and “now”.Key words: Back pain, Ballet     

Sensitivity and specificity of the amer dizziness diagnostic scale (adds) for patients with vestibular disorders

[Purpose] To investigate the sensitivity and specificity of a newly developed diagnostic tool, the Amer Dizziness Diagnostic Scale (ADDS), to evaluate and differentially diagnose vestibular disorder and to identify the strengths and weaknesses of the scale and its usefulness in clinical practice. [Subjects and Methods] Two hundred subjects of both genders (72 males, 128 females) aged between 18 to 60 (49.5±7.8) who had a history of vertigo and/or dizziness symptoms for this previous two weeks or less were recruited for the study. All subjects were referred by otolaryngologists, neurologists or family physicians in and around Jeddah, Kingdom of Saudi Arabia. On the first clinic visit, all the patients were evaluated once using the ADDS, following which they underwent routine testing of clinical signs and symptoms, audiometry, and a neurological examination, coupled with tests of Vestibulo-Ocular Reflex function, which often serves as the “gold standard” for determining the probability of a vestibular deficit. [Results] The results show that the ADDS strongly correlated with “true-positive” and “true-negative” responses for determining the probability of a vestibular disorder (r =0.95). A stepwise linear regression was conducted and the results indicate that the ADDS was a significant predictor of “true-positive” and “true-negative” responses in vestibular disorders (R² =0.90). Approximately 90% of the variability in the vestibular gold standard test was explained by its relationship to the ADDS. Moreover, the ADDS was found to have a sensitivity of 96% and a specificity of 96%. [Conclusion] This study showed that the Amer Dizziness Diagnostic Scale has high sensitivity and specificity and that it can be used as a method of differential diagnosis for patients with vestibular disorders.Key words: Dizziness, Vestibular, Balance     

Fall prediction using decision tree analysis in acute care units

[Purpose] To present an accurate and straight-forward system of fall prediction by performing decision tree analysis using both the fall assessment sheet and Berg balance scale (BBS). [Participants and Methods] The participants in this retrospective study were inpatients from acute care units. We extracted the risk factors for falls from the fall assessment and performed a decision tree analysis using the extracted fall risk factors and BBS score. [Results] “History of more than one fall in the last 1 year”, “Muscle weakness”, “Use of a walking aid or wheelchair”, “Requires assistance for transfer”, “Use of Narcotics”, “Dangerous behavior”, and “High degree of self-reliance” were fall risk factors. The decision tree analysis extracted five fall risk factors, with an area under the curve of 0.7919. Patients with no history of falls and who did not require assistance for transfer or those with a BBS score ≥51 did not fall. [Conclusion] Decision tree-based fall prediction was useful and straightforward and revealed that patients with no history of falling and those who did not require assistance for transfer or had a BBS score ≥51 had a low risk of falling.Key words: Falling, Balance, Decision tree     

Development of Athletic Injury Psychological Acceptance Scale

[Purpose] The world of competitive sports has its own unique subculture which at times works towards covering up psychological problems faced by athletes with injuries. The purpose of this study was to develop an “Athletic Injury Psychological Acceptance Scale (AIPAS)” to screen athletes for serious psychological problems resulting from injury. [Subjects] A total of 189 subjects responded to the survey, of which 168 (mean age= 19.93 years; average number of days unable to participate in sports= 71.84 days, SD = 88.01 days) valid responses were subjected to analysis. [Methods] A provisional version of the AIPAS was created from question items based on face-to-face subject interviews and content validity testing by specialists. In order to test criterion-related validity of the AIPAS, subjects were asked to complete indices that would serve as an external criterion. For this purpose, indices that measure athletic rehabilitation dedication and time perspective were designed. [Results] Item analysis of the provisional AIPAS was conducted to confirm the discrimination of each item. Exploratory factor analysis identified “Self-motivation” and “Focus on the Present” as two factors of the provisional scale. Confirmatory factor analysis supported these results. The Cronbach’s alpha was used to measure the internal consistency. Since α=0.81, the reliability of the scale was confirmed. A significant correlation was found between AIPAS and external indices, indicating criterion-related validity. [Conclusion] AIPAS is a reliable and valid scale composed of two subscales.Key words: Athletic injury psychological acceptance scale (AIPAS), Psychometric properties, Injured athletes     

Causal Relationships between the Psychological Acceptance Process of Athletic Injury and Athletic Rehabilitation Behavior

[Purpose] The purpose of this study was to examine the causal relationships between the psychological acceptance process of athletic injury and athletic-rehabilitation behavior. [Subjects] One hundred forty-four athletes who had injury experiences participated in this study, and 133 (mean age = 20.21 years, SD = 1.07; mean weeks without playing sports = 7.97 weeks, SD = 11.26) of them provided valid questionnaire responses which were subjected to analysis. [Methods] The subjects were asked to answer our originally designed questionnaire, the Psychosocial Recovery Factor Scale (PSRF-S), and two other pre-existing scales, the Athletic Injury Psychological Acceptance Scale and the Athletic-Rehabilitation Dedication Scale. [Results] The results of factor analysis indicate “emotional stability”, “social competence in the team”, “temporal perspective”, and “communication with the teammates” are factors of the PSRF-S. Lastly, the causal model in which psychosocial recovery factors are mediated by psychological acceptance of athletic injury, and influence on rehabilitation behaviors, was examined using structural equation modeling (SEM). The results of SEM indicate that the factors of emotional stability and temporal perspective are mediated by the psychological acceptance of the injury, which positively influences athletic-rehabilitation dedication. [Conclusion] The causal model was confirmed to be valid.Key words: Psychosocial recovery factor, Athletic injury psychological acceptance, Athletic rehabilitation     

Effect of asymmetrical buttock pressure on forces exerted in buttock movement when using a reclining chair

[Purpose] To clarify the effect of asymmetrical buttock pressure on the shear forces exerted on a buttock. [Participants and Methods] Sixteen healthy adult males participated in this study. A cushion 0 or 2 cm high was placed on the left side of the seat for all participants. The 0- and 2-cm height conditions were called “without difference condition” and “difference condition”, respectively. The back support was inclined at increasing angles, starting at the upright position, to a fully reclined position, and back to the upright position. [Results] With the “difference condition”, the force on the left buttock was 147.4% body weight and that on the right buttock was 105.6% body weight. In contrast, with the “without difference condition”, there was no significant difference in the force on the left buttock and right buttock in terms of percent body weight. [Conclusion] Our results suggest that asymmetrical buttock pressure while in the sitting position causes a difference in shear force exerted on the left and right buttocks when using a reclining chair.Key words: Reclining wheelchair, Buttocks pressure, Side inclination of the pelvis     

Assessing the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory

[Purpose] This study attempted to assess the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory (BPI). [Subjects and Methods] A cross-sectional study was conducted. Participants comprised 30 women, aged 30–80 years, who had received treatment for breast cancer (surgery and complementary treatment) at least 12 months prior to the study and had reported chronic pain related to the treatment procedures. [Results] The highest scores were found for “mood” (median: 5.00 points; first quartile: 1.00 points; third quartile: 7.25 points), “normal work” (median: 5.00 points; first quartile: 0.00 points; third quartile: 8.00 points), and “sleep” (median: 4.50 points, first quartile: 0.00 points, third quartile: 8.00 points). [Conclusion] Pain exerts a negative impact primarily on mood, normal work, and sleep among breast cancer survivors.Key words: Pain measurement, Mastectomy, Breast-conserving surgery     

CRITERION VALIDATION OF THE RATE OF RECOVERY,A SINGLE ALPHANUMERIC MEASURE,IN PATIENTS WITH SHOULDER PAIN

Background and Purpose:

The aim of this study was to identify the minimal clinically important threshold score for rate of recovery (RoR) using the Patient Acceptable Symptom State (PASS) as an anchor measure, and to measure the association of the RoR with the raw and percentage change scores of the QuickDASH and the Numeric Pain Rating Scale (NPRS).

Methods:

Threshold measures for RoR and the PASS were examined using a Receiver Operating Characteristic (ROC) Curve. Participants were dichotomized to those who stated “yes” and those who stated “no” on the PASS. Pearson correlation coefficients were performed to determine the relationship between the NPRS and QuickDASH raw and percentage change scores and the RoR at discharge.

Results:

ROC curve statistics suggest that a cut‐point of greater than 87% on the self‐report RoR (SN=0.62, SP=0.73; +LR=2.26: ‐LR=0.56) corresponded to the patient considering their state acceptable. No significant associations existed between either the raw NPRS or the raw QuickDASH, and the RoR scores although percentage change scores were associated with the RoR (QuickDASH r=0.29; p=0.02; NPRS = r=0.30; p=0.02).

Discussion:

Patients reporting greater than or equal to 87% on RoR are likely to have met the Patient Acceptable Symptom State. Although statistically significant, the lack of strong association between RoR and change scores for the NPRS and QuickDASH suggests that the measures capture different constructs.

Level of Evidence:

Level 2C     

Effects of pain-related catastrophic thinking,anxiety, and depression on pain intensity and quality of life in patients with knee and low back pain

[Purpose] We aimed to examine the effects of pain-related catastrophic thoughts and anxiety/depression on pain intensity and quality of life (QOL), and how these effects (relationships) vary with pain location, in outpatients with chronic pain. [Participants and Methods] We recruited 14 participants with low back pain (2 males and 12 females) and 14 with knee joint pain (3 males and 11 females). We used the following evaluation tools: the visual analog scale (to evaluate pain intensity), pain catastrophizing scale (in which scores are categorized into helplessness, rumination, and magnification), Hospital Anxiety and Depression Scale (for psychodynamic evaluation), and a questionnaire for QOL evaluation. [Results] There was no difference in pain intensity between the groups. The “low back pain” group showed a positive correlation between pain intensity and anxiety, while the “knee pain” group showed a positive correlation between pain intensity and helplessness. The “low back pain” group showed a negative correlation between health in QOL assessment items and helplessness, and between health and magnification. However, in the “knee pain” group, there was a negative correlation between health and rumination, between health and anxiety, and between positive mental attitude and magnification. [Conclusion] Mental status varied depending on the pain location, regardless of the intensity of the pain. This suggests that a psychological approach dependent on pain location is needed during physical therapy.     

The Diagnostic Problem of Prescribing Antibiotics in URI

A questionnaire was circulated to 298 Ontario family physicians. They were asked how frequently they prescribed antibiotics for uncomplicated upper respiratory infections; what investigations they used; their choice from a list of absolute and relative indications of antibiotics; and their comments on the problem. Fifteen percent of the 209 respondents stated they “usually” prescribed antibiotics; 43 percent prescribed them about “half the time”; and 42 percent prescribed them “rarely”.     

Muscle activity,time to fatigue,and maximum task duration at different levels of production standard time

[Purpose] This study investigated the variations in muscle fatigue, time to fatigue, and maximum task duration at different levels of production standard time. [Methods] Twenty subjects performed repetitive tasks at three different levels of production standard time corresponding to “normal”, “hard” and “very hard”. Surface electromyography was used to measure the muscle activity. [Results] The results showed that muscle activity was significantly affected by the production standard time level. Muscle activity increased twice in percentage as the production standard time shifted from hard to very hard (6.9% vs. 12.9%). The muscle activity increased over time, indicating muscle fatigue. The muscle fatigue rate increased for the harder production standard time (Hard: 0.105; Very hard: 0.115), which indicated the associated higher risk of work-related musculoskeletal disorders. Muscle fatigue was also found to occur earlier for hard and very hard production standard times. [Conclusion] It is recommended that the maximum task duration should not exceed 5.6, 2.9, and 2.2 hours for normal, hard, and very hard production standard times, respectively, in order to maintain work performance and minimize the risk of work-related musculoskeletal disorders.Key words: Muscle activity, Muscle fatigue, Task duration     

Comparison of the Impact of “Fast Decline” in Residual Renal Function and “Initial Anuria” on Long-Term Outcomes in CAPD Patients

♦ Background: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of “initial anuria” and rapid RRFD on the long-term prognosis of CAPD patients.♦ Method: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the “anuria” group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a “slow decliner” group (n = 114), and a “rapid decliner” group (n = 114). The maximal observation period was 120 months.♦ Results: Logistic regression tests indicated that the “anuria” group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 – 23.28), and female (OR: 0.29, 95% CI: 0.09 – 0.90), while the “fast decliner” group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 – 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 – 1.21), and male (OR: 1.12; 95% CI: 1.04 – 1.21). After adjusting for DCS, the “fast decliner” group (hazard ratio [HR]: 0.37; 95% CI: 0.17 – 0.80) showed a better outcome than that of the “anuria” group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 –.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 – 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 – 0.99) was significant for better survival in CAPD patients with DCS > 0.♦ Conclusion: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.     

Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis

[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words “muscle hypertonia OR spasticity” were used for spasticity, and the key words “shock wave OR ESWT” were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], −0.792; 95% confidence interval [CI], −1.001 to −0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, −0.735; 95% CI, −0.951 to −0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.Key words: Spasticity, Extracorporeal shock wave therapy, Meta-analysis     

Effects of external focus of attention on balance: a short review

[Purpose] The present study reviewed studies that examined the effects of attentional focus on balance. [Methods] Keywords such as “attentional”, “focus”, and “balance” were used to find relevant research papers in PubMed (www.ncbi.nlm.nih.gov/pubmed). Forty-five papers were found, and 18 of them were used for this study, excluding review papers and papers irrelevant to the topic of this study. [Results] Among the papers used for the review, the number of papers in which external focus produced effective outcomes was 15 (83.3%). The number of papers in which both external and internal focus produced effective outcomes was 2 (11.1%). The number of paper in which no instruction about attentional focus was effective was 1 (5.5%), and the number of papers in which internal focus was effective was zero. [Conclusion] This short review suggests clinical implications about how physical therapists can use attentional focus for balance rehabilitation of patients. Instructions about external focus of attention can generally be useful as a method to improve posture and balance control. Furthermore, the present reviews indicates that external focus of attention would be more useful in a rehabilitation stage in which the difficulty level of balance performance is gradually increased.Key words: Attentional focus, External focus, Balance     

Cross-cultural adaptation of the Healthcare Provider-Patient Activation Scale to Japanese

[Purpose] This study aimed to investigate a cross-cultural adaptation of the 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). [Participants and Methods] We followed a guideline for cross-cultural adaptation that recommended using two forward and backward translations. In pilot testing, participants were Japanese physical therapists who provided comments about expression readability. Two authors independently categorized each comment as either “unable to understand” or “suggestion to enhance clarity”, after which Cohen κ and % agreement were used to assess agreement. We then assessed the flooring and ceiling effects, internal consistency, and Spearman ρ between the factor scores of the patient-activation-approach and non-patient-activation-approach. [Results] A total of 58 Japanese physical therapists participated in the pilot test. The agreement on comments was κ=0.44 and 86.5%. We identified the flooring and ceiling effects for most items. In addition, the internal consistency was acceptable for each factor; however, the Spearman ρ between the patient-activation-approach and non-patient-activation-approach factor scores was positive when it should have been negative. [Conclusion] We developed a Japanese version of the HP-PAS which will serve as a foundation for future studies to establish a measurement method for the magnitude of patient activation in the physical therapist population.Key words: Patient activation, Patient centered approach, Self-management