“Evaluation of an Occupational Therapy Program…” by Pillastrini et al.

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Table of Contents

Study Purpose
Literature
Design
Sample
Outcomes
Intervention
Results
Conclusions and Clinical Implications
Reference

Study Purpose

The purpose of the study is to evaluate the effectiveness of the occupational therapy program provided in combination with a course of neuromotor rehabilitation measuring the levels of functional improvement and independence the patients with the injuries of spinal cord demonstrated after the first hospitalization.

Literature

The introduction of the study defines and describes occupational therapy as a type of treatment and its multiple functions and effects that make it an extremely useful and beneficial approach. Further, the negative consequences of spinal cord injuries are described to show the need for occupational therapy for the patients to achieve a higher level of personal independence. As a result, the authors illustrate the need for the evaluation of the effectiveness of occupational therapy for patients with spinal cord injuries as it is crucial for them to return to normal life through the treatment of the highest quality. The authors support their statements with multiple references to the prior studies all of which are relevant and recent dating back to the 1990s and the early 2000s.

Design

The study is a randomised controlled trial that was held at the Rehabilitation Institute of Montecatone, Italy; namely in its Spinal Cord Unit. The design was appropriate for the study as it was based on the comparison of the improvements in the patient’s conditions comparing two groups of participants.

The researchers had no obvious biases. However, it is worth mentioning that all the subjects included in the trial were male which could be perceived as a deliberate exclusion of females.

Sample

The 36 male participants of the trial were included based on the following conditions: an ability to remain in a sitting position for over three hours in a row, being younger than 60 years, with a complete paraplegia in thoracic-lumbar level, and being on their first hospitalisation for the injury. Only the patients who agreed to participate were included. The sample was divided into two groups. The experimental group (24 men) went through the neuromotor

rehabilitation accompanied with several OT sessions. The 12 control subjects chose to undergo only neuromotor rehabilitation under the supervision of their doctors. The participants were similar in age, residence, marital status, profession, and the term of hospitalisation.

Outcomes

The measured outcome was the level of personal independence. It was assessed two times – after the admission to the trail and after the discharge of the participants. The Valutazione Funzionale Mielolesi (VFM) scale was employed as an assessment tool. This scale was recognised as a validated tool for measuring the outcomes of the patients with spinal cord injuries. Nine domains were included in the scale were the following: standing, walking, eating, social skill, use of wheelchair, bathing and grooming, transfers, and bed mobility. Each domain was evaluated based on the participants’ performance of several specific tasks where they could score 0 to 4 points. Two physical therapists who were not the staff members of the Institute were asked to administer the tool and collect data.

Intervention

The study focused mainly on the estimation of the effectiveness of the occupational therapy for the patients with spinal cord injuries resulted in paraplegia. The development and application of an intervention were not a part of the study design.

Results

The statistically significant results in the experimental group as compared to those of the control group were observed in three of the following domains: wheelchair use with p=0.005, transfers domain with p less than 0.0001, and for the total score with p=0.007. Besides, a statistically insignificant improvement was observed in the areas of social skills and grooming (p=0.089 and p=0.071 accordingly). Overall, the improvement demonstrated by the unmarried patients was of a higher level than that of the participants who were married.

There were no drop-outs mentioned in the study.

Conclusions and Clinical Implications

The authors concluded that the use of occupational therapy paired with neuromotor rehabilitation produced better results in terms of patient outcomes than those of neuromotor rehabilitation applied alone. Moreover, the researchers pointed out that the significant improvements in the areas of wheelchair use and transfers could have been explained by the patient’s understanding of the high level of importance of these functions. The limitations of the study were time (too few OT sessions, type of patients (paraplegic with complete injuries), and limited factors of functional independence.

Reference

Pillastrini, P., Mugnai, R., Bonfiglioli, R., Curti, S., Mattioli, S., Maioli, M. G.,… Violanti, F. S. (2008). Evaluation of an occupational therapy program for patients with spinal cord injury. Spinal Cord, 46, 78-81.

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