Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury.

Return to work (RTW) for people with acquired brain injury (ABI) represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology) in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state) at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery) between admission and discharge was assessed by Functional Independent Measure (FIM) gain, through the Montebello Rehabilitation Factor Score (MRFS), which was obtained as follows: (discharge FIM-admission FIM)/(Maximum possible FIM-Admission FIM) x 100. The cut-off value (criterion) deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%). Considering the Mini Mental State Examination (MMSE) and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself.

Occupational therapy integrated with a self-administered stretching program on systemic sclerosis patients with hand involvement.

OBJECTIVES: To evaluate the effect of occupational therapy (OT) intervention, integrated with a self-administered stretching program on the hands of patients with SSc, after one and three months of treatment. METHODS: We enrolled 31 patients with SSc, randomly allocated to the occupational group (15 patients) or to the control group (16 patients). Each patient received specific outcome measures: Canadian Occupational Performance Measure (COPM), HAQ, Short-Form Health Survey (SF-36), Duruoz Hand Index (DHI), reassessed after 1 (T1) and three months (T2). RESULTS: At T1 and T2 we found a statistically significant improvement from baseline values of COPM Performance and COPM Satisfaction in the OT group compared to baseline. At T2 HAQ values and Mental SF36 were also significantly improved. In the control group we found a statistically significant improvement of HAQ values and Mental SF36 at T1, confirmed at T2. COPM Performance was also significantly improved. The comparison between the two groups showed a greater improvement in the OT group concerning COPM Performance at T1 and T2. Mental SF-36 score greater improved in the control group at T1. CONCLUSIONS: Our results indicate that a rehabilitation program including OT and self-administered stretching exercises may be effective to improve and maintain hand function in patients with SSc.

Occupational therapy in ankylosing spondylitis: Short-term prospective study in patients treated with anti-TNF-alpha drugs.

OBJECTIVE: To assess the effect of occupational therapy (OT) on functional status in ankylosing spondylitis (AS) patients treated with anti-TNF-alpha drugs in a short-term open controlled prospective study. METHODS: Twenty-seven AS subjects treated with anti-TNF-alpha drugs, were allocated to OT (n=14) or control (n=13) group. At the study entry and at the 16th week we evaluated the following outcome parameters including BASFI, BASDAI, BASMI, Short-Form Health Survey (SF-36), pain, erythrocyte sedimentation rate (ESR), C-reactive protein CRP) and the adherence reported using self management methods, related to joint protection and energy conservation. RESULTS: At baseline, OT and control group had similar demographic and clinical features. After 16 weeks, we found that the changes from baseline of BASFI (p<0.05), BASDAI (p<0.02), SF-36 CMS (p<0.02) and pain (p<0.02) score improved more significantly in OT group than in control group, where the scores remained invariable. After 16 weeks from baseline, the OT group reported a significantly more frequent use of self management methods, related to joint protection and energy conservation, than the control group. CONCLUSION: Our controlled study indicates that a combination treatment with anti-TNFalpha agents and OT was beneficial for patients with AS, with synergistic effects on pain, function and disability. Thus OT intervention could be also considered when the disease is stable and well controlled with drugs because it may represent a further tool to improve the health status of patients.