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MTDLP: Japan's Management Tool for Daily Life Performance

By Hiroemon · Last updated: 2026-08-02

This is an independent explainer by one practicing therapist, not an official JAOT resource. It does not represent the views of the Japanese Association of Occupational Therapists; neither I nor this site is certified, affiliated, or endorsed by JAOT. Rules change — confirm details with the primary sources linked below.

I'm a licensed occupational therapist practicing in Japan. I have completed both stages of MTDLP training through Japan's prefectural OT associations — the basic course and the practitioner-level course — and have used the MTDLP sheets with real clients. I am not a JAOT-certified MTDLP instructor — the tier above those trainings — so read this as a practitioner's guide, not an authority's. More about me is on the about page.

Why should an English reader care about a framework with almost no English footprint? Because MTDLP is a natural experiment in a question every national association faces: what happens when a professional body designs an occupation-based framework from the top down and asks the field to follow? Japan has run that experiment since 2008. This page, part of OT Japan, is my report from inside it.

What Is MTDLP?

MTDLP stands for Management Tool for Daily Life Performance — the English rendering used by JAOT and the peer-reviewed literature. In JAOT's definition, summarized in my own words: the therapist focuses on the daily life activities a person wants to do, needs to do, or is expected to do; shares goals with that person; draws them into their own recovery as an active participant; and works through the life problems standing in the way. The pivotal term, seikatsu kōi (生活行為, daily life activities), is deliberately wider than ADL: everything a person does to live a life, from bathing to gardening to neighborhood roles.

JAOT developed the framework from fiscal 2008 onward, in research projects funded by the health ministry's rōken jigyō (老健事業, older-adult health program). And the association's own case-report handbook is candid about the motive: MTDLP was developed, it says, as a tool for the mieruka (見える化, “making visible”) of occupational therapy — showing the public plainly what occupational therapy does (my translation). Keep that word in mind; it is the key to my verdict at the end of this page.

The MTDLP Process and the Eight Sheets

The process will look familiar to any occupational therapist: listen, assess, plan, do, hand over. What is distinctive is that every step is standardized on official forms, with the first three stages consolidated onto one master form, the Management Sheet. Here is the flow as I map it:

The MTDLP workflow drawn as a five-step pipelineFive boxes in a row: listen, assess, plan, do and monitor, hand over. Arrows connect them left to right. A dashed arrow loops back from the fourth box to the second, labeled reassess as needed. A bracket under the first three boxes notes that stages one to three are consolidated on the Management Sheet.reassess as needed1Listen聞き取りinterview and theinterest checklist2Assessアセスメントanalyze the target activity;forecast improvement3Planプランshared goals, programs,who does what4Do & monitor実行run the plan andtrack progress5Hand over申し送りpass goals and resultsto the next teamstages 1–3 are consolidated on the Management Sheet（生活行為向上マネジメントシート）
The MTDLP workflow as I practice it: listen, assess, plan, do, hand over — with reassessment as needed. Author's conceptual diagram, drawn from process knowledge as an original composition for this article — not the official JAOT figure, and not a reproduction of its layout.

JAOT publishes eight official sheets as downloadable PDFs on its process-and-sheets page. I describe rather than show them: each carries an explicit notice reserving copyright to JAOT and prohibiting unauthorized use, reproduction, or modification — and since a translation is an adaptation, no English versions appear here. (The name 生活行為向上マネジメント itself carries a ™ mark on the sheets.) Descriptively, the set is:

  • Interview sheet (生活行為聞き取りシート) — a structured intake for what the person wants, needs, or is expected to do.
  • Interest and concern checklist (興味・関心チェックシート) — an inventory of 46 everyday activities that clients mark as doing, wanting to try, or interesting — a net for goals people never volunteer.
  • Assessment exercise sheet (生活行為アセスメント演習シート) — guides analysis of why the target activity is not happening, and a forecast of improvement.
  • Improvement-plan exercise sheet (生活行為向上プラン演習シート) — turns the assessment into programs, dividing the work among therapist, team, family, and the person.
  • Management Sheet (生活行為向上マネジメントシート) — the master form consolidating stages one through three: interview, assessment, plan.
  • Task-analysis sheet (生活行為課題分析シート) — a finer-grained breakdown of the target activity itself.
  • Handover sheet (生活行為申し送り表) — carries goals and progress to the next provider when support changes hands.
  • Medical handover sheet (医療への生活行為申し送り表) — the same idea, formatted for handing over to medical teams.

One of the eight has had a remarkable second life: the interest and concern checklist was adopted by the Ministry of Health, Labour and Welfare as Annex Form 1 — besshi yōshiki 1 (別紙様式1) — among its official rehabilitation-management forms for long-term care; it is literally the first page of the ministry's own PDF. An association's worksheet becoming a government form is about as concrete as recognition gets. The obvious question: how far does it go?

The State Endorsement, Measured Precisely

Japan's kaigo hoken (介護保険, long-term care insurance) fee schedule includes an item whose name could have been drafted by MTDLP's authors: a kasan (加算, add-on fee) for “daily-life-activity improvement rehabilitation.” Per an industry guide updated for the 2024 fee revision, it pays day-care rehabilitation providers 1,250 fee-schedule units per month (562 preventive) for at most six months, requires roughly monthly home visits to evaluate daily life activities where the person lives — and its staffing rule names an occupational therapist with specialized knowledge first, before trained PTs or STs. Few fee items in Japan's system put occupational therapists at the head of the sentence.

Now the precision. The add-on's requirements do not mention MTDLP by name — not once. The connection is philosophical — goal-setting around daily life activities, home visits, a time-limited “graduation” design — plus the checklist's adoption as an official form. MTDLP was born in a ministry-funded program, so the alignment is no accident; but “the state adopted our thinking” and “the state adopted our tool” are different claims, and only the first is true.

Then there is uptake. In materials prepared for the ministry's fee-setting subcommittee, uptake in day-care rehabilitation was reported at roughly 0.05% — five in ten thousand — based on April 2017 claims, under the heavier pre-2021 version of the add-on (2,000 units, with a fee reduction after the program ended). As of October 2016, only 7.5% of facilities had even filed to offer it; 62.3% of non-filers lacked the prerequisite rehabilitation-management add-on II. And the top reason for skipping that prerequisite was the difficulty of securing physicians' participation in the required rehabilitation conferences (56.2%).

I read those numbers as one lesson. State endorsement is regulatory approval, not adoption — and the features that make MTDLP rigorous (home visits, conferences, physician involvement, time limits) made the fee code too heavy for most providers to lift. Hold on to that word, heavy; it returns below at the individual level.

How Widely Is MTDLP Actually Used?

My only direct usage figures come from one small, non-peer-reviewed source — a 2016 graduation research project at a vocational college that surveyed 239 clinical OTs (average 3.7 years of experience). Reported use was 30% among community-based respondents (18 therapists) and 14% among hospital-based respondents (25). The most common reason for not using it: “it takes too much time” (55%). The most common reason for using it: it makes goal-setting and program planning faster (27%). A student survey is a sketch, not a measurement — but notice its shape: the same tool is too slow for non-users and a time-saver for users. That is the signature of a steep learning curve.

You can read 30% and 14% two honest ways: as proof that MTDLP is not the profession's common language, or as respectable penetration for a demanding framework still young at the time. Either way there is a structural ceiling. Training runs through JAOT and the todōfuken shikai (都道府県士会, prefectural OT associations) — and per JAOT's 2024 membership statistics (as of March 31, 2025), Japan had 118,465 licensed occupational therapists, of whom 63,352 — about 53.5% — were members. Nearly half the license stands outside the system that teaches MTDLP. (JAOT does not appear to publish cumulative completer totals.)

The ladder itself is carefully built. Prefectural associations run a basic course — kiso kenshū (基礎研修, basic training) — and a practical course — jissen kenshū (実践研修, practical training; formerly “practitioner training”) — with certificates issued by JAOT. Above them sits the certified MTDLP instructor: both courses, registered-OT status, and a practice report defended in an oral examination. And the strongest counterargument to my own skepticism: in 2025 JAOT published a guideline for using MTDLP in entry-level OT education, covering curriculum, teaching, and clinical placements. If new graduates arrive with MTDLP as their default vocabulary, the “not a common language” verdict may simply be ten years early. This page describes 2026, not 2036.

What MTDLP Taught Me

Now the part no statistic can carry. When I used the MTDLP sheets with clients, I was a staff-level therapist with no formal authority — no standing to redesign anyone's program on my own say-so. The standardized sheets changed what I could do: they let me run an occupation-based trial in an orderly, documented way, and — more important — explain and defend it to people who outranked me. The forms did the arguing my position could not.

That experience is why the usual framing of MTDLP — a toolkit that makes practice easier — misses the point. Its real concept is the one JAOT named at its birth: mieruka, making occupational therapy visible. Here is the central paradox. An occupational therapist with genuine will and motivation already does most of what MTDLP prescribes — hears the person's real goals, forecasts, plans, hands over — half-unconsciously, as clinical instinct. But practiced that way, the reasoning stays anmokuchi (暗黙知, tacit knowledge): real, effective, and locked invisibly in one practitioner's head. What MTDLP adds is a mechanism of metacognition — a forced inventory of judgments you were already making — and that inventory turns private competence into something you can show, share, and defend.

So let me say plainly what the surveys hint at: the tool itself is not convenient. It is slow and demanding; the respondents who said it takes too much time are not wrong, and neither are the other professions and families who find its outputs hard to parse — I have watched both struggle. But through use something else happens: the user's proficiency rises, and with it the user's ability to explain their own practice. MTDLP is not a convenient tool. It is a tool that trains its user — I mean that as its highest compliment and its honest limitation at once.

One more observation, strictly personal opinion: the MTDLP case reports I encounter are, with striking consistency, high in quality — enough that I read MTDLP itself as a beacon: where it is used seriously, you tend to find a passionate practitioner. Whether the filter is self-selection or the oral examination doing its job, the result is the same — a curated case literature, and a signal of who cares.

Two Ecosystems: MTDLP and the Kawa Model

Japan has given occupational therapy two home-grown frameworks that could hardly have grown more differently. The Kawa model was grassroots and open: born in clinical conversation, declared open for anyone to use and write about, carried abroad by individuals — and, as I wrote in my guide to the Kawa model, nearly invisible in Japan's clinical mainstream. MTDLP is the mirror image: association-built, copyright-protected, certification-laddered, wired into national policy — and nearly invisible in English. In that article I speculated — as opinion, then and now — that MTDLP occupies the institutional slot the Kawa model might have filled at home; the reverse also seems true: Kawa holds the open, global slot MTDLP's controlled ecosystem has never reached. To understand Japanese OT you need both stories — one story told from opposite ends.

The Evidence Base in English

For a Japan-born framework, MTDLP has something unusual: peer-reviewed literature readable in English, including randomized controlled trials — most Japanese frameworks never clear the language barrier.

  • An RCT in cardiovascular patients with depressive symptoms (n = 36): the MTDLP group improved on both depression scores and instrumental ADL (Frenchay Activities Index, P = 0.003) — Fukui et al. (2019), open access.
  • A multicenter RCT of home-visit OT using MTDLP for severe mental illness (n = 60): significantly better vocational and social functioning in the MTDLP group — Mashimo et al. (2020).
  • A one-year, participation-based case report following acute stroke — Iwasaki and Nagayama (2025), online first.
  • A controlled (non-randomized) trial adding individualized MTDLP programs in schizophrenia, with gains in occupational performance and satisfaction — Kosaka and Imai (2019; Japanese, English abstract).

Read it for what it is — small samples, heterogeneous populations, early days. But the door is open, and every study is one click away below.

Key Takeaways

  • MTDLP is JAOT's standardized, occupation-based process framework, developed from 2008 in a ministry-funded research program to make occupational therapy visible (mieruka).
  • Its state endorsement is precise: an add-on fee echoes its philosophy and its checklist became an official ministry form — but the regulations never name MTDLP.
  • Adoption is partial — roughly 0.05% add-on uptake (2017, old design), 30% / 14% usage in one small 2016 survey, a 53.5% organization rate as ceiling — yet the English evidence base includes two RCTs.
  • In my experience, MTDLP is not a convenient tool but a tool that trains its user — its deepest product is a therapist who can explain their own practice.

Resources in English and Japanese

Official sources (in Japanese) first, then the research (English unless noted).