RESUMEN
Se presenta un estudio de caso con diagnóstico de artritis psoriásica. La propuesta de intervención se articuló desde un enfoque centrado en la persona y basado en las necesidades ocupacionales, atendiendo al posicionamiento institucional de la Federación Mundial de Terapeutas Ocupacionales (WFOT).Objetivo: Evaluar la eficacia de un programa de terapia ocupacional individualizado basado en la ocupación y centrado en un paciente con artritis psoriásica, en términos de mejoría en el desempeño ocupacional y la calidad de vida percibida.Metodología: Se evaluaron problemas del desempeño ocupacional (COPM y DASH), así como la calidad de vida percibida (WHOQOL-BREF). Secundariamente se registraron medidas de dolor (EVA), movilidad articular (goniometría y mediciones centimétricas) y fuerza (dinamometría). Se establecieron objetivos funcionales de intervención desde la metodología SMART y se aplicó un programa de intervención combinando diversas modalidades de tratamiento que vienen acumulando diversos niveles de evidencia científica: férulas, productos de apoyo, ejercicio, protección articular y educación para la salud. Resultados: Se registraron mejoras significativas en desempeño ocupacional (COPM y GAS), así como en satisfacción (COPM) y en calidad de vida percibida (WHOQOL-BREF). Se obtuvieron, igualmente, resultados positivos en el resto de las variables observadas: reducción del dolor, incremento del movimiento articular y de la fuerza muscular.Conclusiones: La intervención propuesta, bajo un enfoque top-down logró cambios significativos no sólo en el desempeño ocupacional y en la calidad de vida percibida, sino también en las deficiencias de funciones corporales.
A case study with a diagnosis of psoriatic arthritis is presented. The intervention proposal was articulated from a person-centered and occupational-based approach, attending to the position statement of the World Federation of Occupational Therapists (WFOT).Aim: To evaluate the efficacy of an individualized occupational therapy program, based on occupation-based and centered on a patient with psoriatic arthritis, in terms of occupational performance improvement, and perceived quality of life.Methodology: Occupational performance problems (COPM and DASH), as well as perceived quality of life (WHOQOL-BREF) were evaluated. Secondarily, pain measurements (VAS), joint mobility (goniometry and centimeter measurements) and strength (dynamometry) were recorded. Functional intervention aims were established from the SMART methodology, and an intervention program was applied combining various treatment modalities that have accumulated scientific evidence: splints, support products, exercise, joint protection and health education.Results: Significant improvements were registered in occupational performance (COPM and GAS), as well as in satisfaction (COPM) and in perceived quality of life (WHOQOL-BREF). Likewise, positive results were obtained in the rest of the variables observed: reduction in pain, increase in joint movement and muscle strength.Conclusions: The proposed intervention, from a top-down approach, achieved significant changes not only in occupational performance and perceived quality of life, but also in deficiencies in body functions.
Asunto(s)
Humanos , Femenino , Adulto , Artritis Psoriásica/rehabilitación , Terapia Ocupacional , Atención Dirigida al Paciente , Calidad de Vida , Evaluación de Programas y Proyectos de Salud , Rendimiento LaboralRESUMEN
The objective of this study is to assess the effectiveness of resistance training in patients with psoriatic arthritis (PsA). The study is a randomized controlled trial with 41 patients aged between 18 and 65 years with diagnosis of psoriatic arthritis (PsA). The patients were randomized into the following: intervention group (IG) and control group (CG). The IG underwent resistance exercise twice a week, for 12 weeks. The CG remained with the conventional drug therapy. The outcome measurements were the following: BASFI and HAQ-S for functional capacity, one maximum repetition test (1RM) for muscle strength, SF-36 questionnaire for general quality of life, and BASDAI and DAS-28 for disease activity. The evaluations were done by a blinded evaluator at baseline (T0) after 6 (T6) and 12 weeks (T12). At baseline, the groups were homogeneous regarding clinical and demographic characteristics. The IG significantly improved functional capacity measured by HAQ-S and disease activity measured by BASDAI, compared to CG, at week 12. Regarding quality of life, the IG improved the domains "pain" and "general health status" compared to CG (p < 0.05). There was improvement in muscular strength in almost all exercises in IG, except in the exercise for biceps. However, there were statistical differences between groups only on exercise "leg extension" in IG compared to CG. Resistance training is effective in improving functional capacity, disease activity, and quality of life of patients with psoriatic arthritis. The clinical improvements were not coupled to significant changes in muscular strength.