Individual and group treatment for patients with acquired brain injury in comprehensive rehabilitation.

PRIMARY OBJECTIVE: The aim of this study was to investigate the hypothesis that group rehabilitation is more effective than individual treatments and provides an improvement in clinical outcomes similar to that achieved by individual treatments alone. RESEARCH DESIGN: Two groups of patients were placed in different rehabilitation settings treated using the same rehabilitation approach. One received only individual treatments and the second group received a combination of both individual and group treatments. The independent variables were measured both pre- and post-treatment and compared between the two groups. METHODS AND PROCEDURES: Seventy-four patients treated with a comprehensive rehabilitation approach were divided into two groups: (a) individual treatment only and, (b) combined treatments (both individual and group). The outcome scales were LCF (Rancho Los Amigos Level of Cognitive Functioning), DRS (Disability Rating Scale) and FIM™ (Functional Independence Measure). RESULTS: The whole sample had obtained statistically significant improvements in all of the outcome scales: LCF (χ(2) = 45.26; p < 0.001), DRS (z = -3.92; p < 0.001) and FIM (z = -4.9; p < 0.001). The comparison between groups did not reveal any pre-treatment difference. Analysis of post-treatment, however, showed a greater improvement in the FIM scale for those in combined individual and group treatment (z = -0.2544, p = 0.01). CONCLUSIONS: Group rehabilitation integrated with individual treatments is more effective than individual treatments alone in improving independence measured by the FIM™ scale. Both groups had obtained statistically significant clinical improvements, the improvement in the FIM™ scale was significantly better in the combined treatment group.

The ICF and labour policies project: the first Italian nation-wide experience of ICF implementation in the Labour Sector.

PURPOSE: To describe the first Italian experience of ICF implementation in the Labour Sector by a Ministerial body, and the development of the International Classification of Functioning, Disability and Health (ICF)-based worker checklist. METHODS: Nation-wide training was provided. ICF-based worker checklist was developed by linking Italian legislative procedures and schedules to the ICF, and by adding standard ICF checklist's categories. When a third-level ICF category was linked, the corresponding second-level one was included in the worker checklist too. RESULTS: Eighty-four ICF categories were linked and five were added due to rolling-up procedure: 15 from body functions, 65 from activities and participation and 4 from environmental factors. In total, the dedicated ICF-based worker checklist is composed of 183 ICF categories, 34 of whom are at the third level and 89 from the domain of activities and participation. CONCLUSIONS: The inclusion of the standard ICF checklist's items aimed to complement the information contained in the ministerial schedule, in which ICF categories from environmental factors domain are underrepresented. Future directions include the development of an ICF-based company checklist and an application tool for matching the information derived from the worker and the company ICF-based checklists.

Italian ICF training programs: describing and promoting human functioning and research.

Purpose of the article is to report on 5 years of ICF training experiences in Italy aimed at promoting a consistent approach to ICF's field application. More than 7000 persons participated in around 150 training events: almost half were organised by political bodies, at national, regional or local level, directly linked to implementation experiences. Few training events were organised by the school sector, while training commissioned by NGOs represent a relevant area and, in our opinion, constitute the first step towards a full inclusion of persons with disabilities. Central pillars of our training modules are: the inclusion of all ICF components in the description of functional profiles, the need of providing brief theoretical background information before moving to practical aspects and the importance of providing personalised face to face training modules, in contrast to self-administered learning modules, or web-based protocols. On the basis of our experience, we can conclude that training's objectives are generally reached: trainees improved their knowledge of the ICF and its related tools, and are able to begin practical applications in their contexts.

Randomized, placebo-controlled, double-blind pilot trial of ramipril in McArdle's disease.

McArdle's disease causes limitation in exercise capacity as well as disability, the severity of which has been associated with the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) haplotype-patients with the genotype associated with higher ACE activity show the most severe phenotype. Modulation of ACE activity through the use of inhibitors may thus positively affect disease expression. In a double-blind, randomized, placebo-controlled trial, we assessed the efficacy of an ACE inhibitor (2.5 mg ramipril) in 8 patients with McArdle's disease. End-points were changes in parameters of exercise physiology (cycloergometer and muscle 31P-magnetic resonance spectroscopy), quality of life (QoL) according to the Short Form 36 (SF-36), and disability according to the World Health Organization-Disability Assessment Scale II (WHO-DAS II). Patients had lower QoL and higher disability than controls. Measures of exercise physiology were not changed by ramipril in the whole group, but treatment induced higher peak VO2 (P = 0.017) in ACE D/D patients, yet not in I/D patients. Treatment significantly improved disability (P < 0.05). McArdle's disease is a disabling condition affecting patients' QoL. Treatment with ramipril improves disability and modifies exercise physiology only in D/D patients, raising the possibility of a differential haplotype-linked sensitivity to the treatment.

Disseminating the WHO International Classification of Functioning Health and Disability (ICF) in the Veneto region of Italy.

PURPOSE: To show the feasibility and effect of a large formation effort focused on the International Classification of Functioning, Disability and Health (ICF), which may introduce a revolutionary new conceptual framework for people involved in rehabilitation services. METHODS: We here describe the large information/formation project launched by the Regional Direction for Social Services of the Veneto region (Italy). Here we describe the first of the two steps of the project, aimed to reach 900 health professionals throughout the whole region. They were exposed to a structured modular course consisting of a mix of frontal lectures and workshop sessions. During the workshop sessions the participants were confronted with questions referring to the actual application of ICF in their services. RESULTS: The results show that the attendance (90%) was very high. The workshop sessions provided interesting indications on the possible applications of ICF in the clinical settings, as well as points of strength and potential problems that the implementation of ICF may have in the Regional Health Service. CONCLUSIONS: To our knowledge this is the largest alphabetization effort on ICF attempted in a public health system, and it indicates a possible effective approach to its controlled diffusion and future implementation.

Quality of life, coping strategies, and family routines in children with headache.

OBJECTIVE: To identify the relationship between headache severity, child coping, and quality of life (QoL) in the context of everyday family life. BACKGROUND: In the pediatric headache research only 3 studies have examined children's coping strategies and only 4 studies considered QoL. METHODS: A sample of 48 Italian families with children seeking treatment for primary headaches was interviewed using an adaptation of the Ecocultural Family Interview (EFI). The EFI is a parent interview that explores the daily routines of family life in which the child and parent participate and the main concerns regarding how that routine is organized. RESULTS: As expected the Lisrel analyses consistently showed that QoL is affected by a child's coping abilities in a causal direction. Headache frequency and duration have a significant impact on a child's QoL. The family daily routine influences significantly both the child's coping ability and QoL. Surprisingly enough, children's coping strategies are not related to headache severity. CONCLUSIONS: More research is needed on the causal factors influencing child's ability to cope with pain, and in particular more attention should be devoted to the contextual and family factors related to pediatric headache.