The importance of quality of life for work outcomes in patients with ankylosing spondylitis - a cross-sectional study.

AIMS: Work impairment is one of the most important exploration and one of the aims of rheumatologists. We aimed to determine the risk factors for employment state and predictive factors of work outcomes using multi-dimensional measures in patients with ankylosing spondylitis (AS) in this comprehensive study. METHODS: One hundred patients with AS (31 females and 69 males) were included into this study. Demographic properties, local factors, disease activity (BASDAI), functionality (BASFI), spinal mobility (BASMI), radiologic stage (BASRI), quality of life (AS-QoL), cardiopulmonary involvement, exercise stress test and work outcomes were investigated and compared in employed and un-employed patients. The work instability scale (AS-WIS) and work productivity activity impairment scale (WPAI:SpA) were selected as work outcomes. The predictive factors were analyzed using multiple stepwise linear regressions. MAJOR RESULTS: Thirty-two patients (mean age: 42,6±11.7) were unemployed and the risk factors for unemployment state were female sex, lower annual income level, and older age. Work disability was detected only in 5% of patients. Decreased chest mobility (beta: -0.398, p: <0.001), low annual income level (beta:-0.291, p:<0.001), higher co-morbidities (beta:0.237, p:0.004), poorer AS-QoL (beta:0.238, p:0,012) and poorer AS-WIS score (beta:0.289, p: 0,004) were the predictors of work impairment. The predictive factors for work instability were higher work impairment (beta:0.533, p<0.001) and poorer AS-QoL (beta: 0.426, p<0.001) scores. CONCLUSIONS: Employment state mainly depends on contextual factors including male sex, higher income, and younger age. Socioeconomic factors as well as clinical data such as QoL were predictive for work productivity. Poorer AS-QoL was also a predictive factor for work instability.We suggested effective interventions to improve clinical and economic status in patients with AS.

Role of electrical stimulation added to conventional therapy in patients with idiopathic facial (Bell) palsy.

OBJECTIVE: The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. DESIGN: This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. RESULTS: Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. CONCLUSIONS: The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at the 3-mo follow-up in patients with Bell palsy. Further research focused on determining the most effective dosage and length of intervention with electrical stimulation is warranted.