Load Auditory Feedback Boosts Crutch Usage in Subjects With Central Nervous System Lesions: A Pilot Study

Background: Crutches are the most common walking aids prescribed to improve mobility in subjects with central nervous system (CNS) lesions. To increase adherence to the appropriate level of crutch usage, providing load-related auditory feedback (aFB) may be a useful approach. We sensorized forearm crutches and developed a custom software to provide aFB information to both user and physical therapist (PhT).

Aim: Evaluate aFB effects on load control during gait by a self-controlled case series trial.

Methods: A single experimental session was conducted enrolling 12 CNS lesioned participants. Load on crutch was recorded during 10 Meter Walk Test performed with and without aFB. In both cases, crutch load data, and gait speed were recorded. Usability and satisfaction questionnaires were administered to participants and PhTs involved.

Results: Reliable data were obtained from eight participants. Results showed that compared to the no FB condition, aFB yielded a significant reduction in the mean load on the crutches during gait (p = 0.001). The FB did not influence gait speed or fatigue (p > 0.05). The experience questionnaire data indicated a positive experience regarding the use of aFB from both participants' and PhTs' perspectives.

Conclusion: aFB significantly improves compliance with crutch use and does not affect gait speed or fatigue by improving the load placed on crutches. The FB is perceived by users as helpful, safe, and easy to learn, and does not interfere with attention or concentration while walking. Furthermore, the PhTs consider the system to be useful, easy to learn and reliable.

A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report

Stroke has significant physical, psychological and social consequences. Recent rehabilitation approaches suggest that cognitive exercises with dual-task (sensory-motor) exercises positively influence the recovery and function of the hemiplegic hand grip. The purpose of this study was to describe a rehabilitation protocol involving the use of a new neurocognitive tool called "UOVO" for hand grip recovery after stroke. A 58-year-old right-handed male patient in the chronic stage of stroke, presenting with left-sided hemiparesis and marked motor deficits at the level of the left hand and forearm, was treated with the UOVO, a new rehabilitation instrument based on the neurocognitive rehabilitation theory of Perfetti. The patient was evaluated at T0 (before treatment), T1 (after treatment) and T2 (2 months of follow-up). At T2, the patient showed improvements of motor functions, shoulder, elbow and wrist spasticity, motility and performance. This case report explores the possibility of improving traditional rehabilitation through a neurocognitive approach with a dual-task paradigm (including motor and somato-sensory stimulation), specifically one involving the use of an original rehabilitation aid named UOVO, which lends itself very well to exercises proposed through the use of motor imagery. The results were encouraging and showed improvements in hemiplegic hand grip function and recovery. However, further studies, in the form of randomized controlled trials, will be needed to further explore and confirm our results.

Efficacy of dietary supplement with nutraceutical composed combined with extremely-low-frequency electromagnetic fields in carpal tunnel syndrome

[Purpose] The aim of this study was to investigate the clinical effects of a nutraceutical composed (Xinepa®) combined with extremely-low-frequency electromagnetic fields in the carpal tunnel syndrome. [Subjects and Methods] Thirty-one patients with carpal tunnel syndrome were randomized into group 1-A (N=16) (nutraceutical + extremely-low-frequency electromagnetic fields) and group 2-C (n=15) (placebo + extremely-low-frequency electromagnetic fields). The dietary supplement with nutraceutical was twice daily for one month in the 1-A group and both groups received extremely-low-frequency electromagnetic fields at the level of the carpal tunnel 3 times per week for 12 sessions. The Visual Analogue Scale for pain, the Symptoms Severity Scale and Functional Severity Scale of the Boston Carpal Tunnel Questionnaire were used at pre-treatment (T0), after the end of treatment (T1) and at 3 months post-treatment (T2). [Results] At T1 and T2 were not significant differences in outcome measures between the two groups. In group 1-A a significant improvement in the scales were observed at T1 and T2. In group 2-C it was observed only at T1. [Conclusion] Significant clinical effects from pre-treatment to the end of treatment were shown in both groups. Only in group 1-A they were maintained at 3 months post-treatment.

Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study

The purpose of this pilot study was to determine the efficacy of an extremely low-frequency magnetic field (ELF-MF) in decreasing chronic pain in fibromyalgia (FM) patients. Thirty-seven females were recruited and randomized into two groups: one group was first exposed to systemic ELF-MF therapy (100 microtesla, 1 to 80 Hz) and then to sham therapy, and the other group received the opposite sequence of intervention. Pain, FM-related symptoms, and the ability to perform daily tasks were measured using the Visual Analog Scale, Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Scale (FAS), and Health Assessment Questionnaire (HAQ) at baseline, end of first treatment cycle, beginning of second treatment cycle (after 1 mo washout), end of second treatment cycle, and end of 1 mo follow-up. ELF-MF treatment significantly reduced pain, which increased on cessation of therapy but remained significantly lower than baseline levels. Short-term benefits were also observed in FIQ, FAS, and HAQ scores, with less significant effects seen in the medium term. ELF-MF therapy can be recommended as part of a multimodal approach for mitigating pain in FM subjects and improving the efficacy of drug therapy or physiotherapy.

New approach to evaluate late arm impairment and effects of dragon boat activity in breast cancer survivors

To verify the applicability of a new approach based on the strength curves (SCs) methodology in late arm impairment in breast cancer (BC) survivors and to evaluate the effects of dragon boat (DB) activity on the late regaining of the muscle strength, upper limb impairment, and quality of life in patients undergoing surgery for BC.Retrospective observational study on 64 subjects (54.5 ± 9.7 years), 47 of them had undergone unilateral mastectomy surgery and were evaluated for late arm impairment. A clinical evaluation of the shoulder and compilation of functional assessment (DASH, Rowe, Constant-Murley) and quality of life (SF-36) scales were carried out. Assessment of muscle strength with SC obtained with isometric assessments and serratus anterior muscle test were performed.Differences between the SC are evident between healthy and operated subjects. Among the 3 groups of operated subjects the difference in strength is maximum at 0°. Statistically significant difference was found between operated and nonoperated only in SF-36 scale. No significant difference was found between groups for shoulder instability and winged scapula.The SC can be used in the study of upper limb impairment after surgery for BC: measurements carried out at 1st degrees of the range of motion are more useful for clinicians. DB activity is useful to reduce the late arm impairment.

The importance of trunk perception during brace treatment in moderate juvenile idiopathic scoliosis: What is the impact on self-image?

BACKGROUND

The perception of body image and the deformity of the trunk in patients with adolescent idiopathic scoliosis (AIS) are a silver lining that has yet to be discussed in the relevant literature during brace rehabilitation treatment.

OBJECTIVE

To determine whether and how the use of the brace changes perception of the trunk in patients with AIS by the drawing test.

METHODS

We observed 32 subjects with AIS from our Rehabilitation outpatient clinic and divided them into the brace treatment (BG-16 subjects) and the non-brace treatment (CG-16 subjects). Trunk perception and quality of life were evaluated using the Trunk Appearance Perception Scale and Scoliosis Research Society-22 questionnaire, and the perception of one's back was measured by the drawing test.

RESULTS

Pain was lower in BG versus CG (p= 0.095). Satisfaction with the treatment was higher in BG than in CG (p= 0.002). Self-image did not differ significantly between the groups in terms of TAPS. Drawings of the most severe cases of scoliosis were made by the group without the brace.

CONCLUSIONS

The use of the brace corrects the function of the trunk and has a positive influence on its perception.

Defocused Shock Wave Therapy for Chronic Soft Tissue Wounds in the Lower Limbs: A Pilot Study

Chronic soft tissue wounds of the lower limbs are debilitating, painful and often unresponsive to advanced dressing treatments. Extracorporeal shock wave therapy (ESWT) could represent an alternative treatment. Ten patients with chronic soft tissue wounds of the legs, unresponsive to advanced dressing treatments for more than 3 mo, underwent three defocused ESWT sessions at 72-h intervals. In every session, the sum of 300 standard pulses + 100 pulses per square centimeter was applied at 0.15 mJ/mm² and 4 Hz over the edge of the wound. The wound size in square centimeters, Bates-Jensen Wound Assessment Tool and visual analogue scale were used as outcome measures. A significant reduction in wound size and Bates-Jensen Wound Assessment Tool and visual analogue scale values from pre-treatment to 90 d was observed. Seven of ten ulcers healed completely and nine of ten patients reported complete pain relief. Defocused ESWT represents a non-invasive, feasible strategy for difficult-to-treat soft tissue wounds of the lower limbs.

Wii Fit is effective in women with bone loss condition associated with balance disorders: a randomized controlled trial

The use of exergame for balance competencies was recently explored in women affected by balance ability reduction with non-conclusive results. The aim of the study was to evaluate the efficacy of a supervised exergame performed with the Wii Fit^® compared to conventional exercises on balance function, quality of life, fear of fall and well-being in women with bone loss. Thirty-eight female participants aged over 65 years, with a bone loss condition, were enrolled and random allocated in the Wii group or control group. Subject enrolled in Wii group performed a balance training with a Wii Fit supervised by a physiotherapist (1 h, 2 days per week, during 8 weeks) while in control subjects performed the same amount of conventional balance exercises. Subject enrolled in experimental group showed significantly higher scores in terms of Berg Balance Scale (p = 0.027). In SF-36 scores, a significant difference was reported for physical activity score after treatment (p = 0.031). Fear of falling and the psychological scales were not significantly different between the two groups. In women with bone loss condition, a supervised Wii Fit training has shown better efficacy in improving balance performance with respect to conventional balance exercises.

MMPI-2 profiles and illness perception in fibromyalgia syndrome: The role of therapeutic exercise as adapted physical activity

BACKGROUND

Control of pain management is an important up-stream process in fibromyalgia (FM) mechanisms.

OBJECTIVE

To investigate whether adapted physical activity (APA) could change the illness perception in relation to the FM personality profile.

METHODS

Thirty-seven women with FM allocated randomly: 19 treatment group (TG) and 18 control group (CG). Interventions: exercises program included ten sessions, two times for week for one hour each and observation for CG. Scales: Illness Perception Questionnaire-revisited (IPQ-r) for the mental representation of the disease, Minnesota Multiphasic Personality Inventory profiles (MMPI-2) for personality tool and Fibromyalgia Impact Questionnaire (FIQ) for function, impact and symptoms. Outcome assessments were performed before rehabilitation treatment (T0) than at the end (T1), and a follow-up 12 weeks after treatment (T2).

RESULTS

APA was efficacy to improve FIQ values in TG at T1 and T2 test days (P = 0.014). Changes in IPQ-R values in T2 were not significant. All patients presented a baseline T-score≥65 in at least one of the basic and content MMPI-2 scales (Hy, D, Hs and Hea and Anx).

CONCLUSION

APA was efficacy in FM, but further research to differentiate between illness experience rather than focus ona strict personality profile are necessary.

Improved interoceptive awareness in chronic low back pain: a comparison of Back school versus Feldenkrais method

PURPOSE

To determine the efficacy of the Feldenkrais method for relieving pain in patients with chronic low back pain (CLBP) and the improvement of interoceptive awareness.

METHOD

This study was designed as a single-blind randomized controlled trial. Fifty-three patients with a diagnosis of CLBP for at least 3 months were randomly allocated to the Feldenkrais (mean age 61.21 ± 11.53 years) or Back School group (mean age 60.70 ± 11.72 years). Pain was assessed using the visual analog scale (VAS) and McGill Pain Questionnaire (MPQ), disability was evaluated with the Waddel Disability Index, quality of life was measured with the Short Form-36 Health Survey (SF-36), and mind-body interactions were studied using the Multidimensional Assessment of Interoceptive Awareness Questionnaire (MAIA). Data were collected at baseline, at the end of treatment, and at the 3-month follow-up.

RESULTS

The two groups were matched at baseline for all the computed parameters. At the end of treatment (Tend), there were no significant differences between groups regarding chronic pain reduction (p = 0.290); VAS and MAIA-N sub scores correlated at Tend (R = 0.296, p = 0.037). By the Friedman analysis, both groups experienced significant changes in pain (p < 0.001) and disability (p < 0.001) along the investigated period.

CONCLUSIONS

The Feldenkrais method has comparable efficacy as Back School in CLBP. Implications for rehabilitation The Feldenkrais method is a mind-body therapy that is based on awareness through movement lessons, which are verbally guided explorations of movement that are conducted by a physiotherapist who is experienced and trained in this method. It aims to increase self-awareness, expand a person's repertoire of movements, and to promote increased functioning in contexts in which the entire body cooperates in the execution of movements. Interoceptive awareness, which improves with rehabilitation, has a complex function in the perception of chronic pain and should be investigated further in future research. The efficacy of the Feldenkrais method is comparable with that of BS for nonspecific chronic low back pain. The physician can recommend a body-mind rehabilitation approach, such as the Feldenkrais method, or an educational and rehabilitation program, such as BS, to the patient, based on his individual needs. The 2 rehabilitation approaches are equally as effective in improving interoceptive awareness.

Management of chronic pain in osteoporosis: challenges and solutions

Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP.

The dynamic motor imagery of locomotion is task-dependent in patients with stroke

PURPOSE

Recently, Motor Imagery (MI) has been associated with the execution of movements miming in part the mentally represented action (dynamic MI, dMI). Preliminary studies have reported as dMI may improve trainings in sport, with imagery timing close to the physical execution one. This study was aimed to investigate time and spatial parameters of dMI with actual locomotion in people with stroke.

METHODS

Twelve patients (stroke group, SG) were compared with twelve healthy elderly (elderly group, EG) and twenty young adults (young group, YG). Subjects performed mental representations of different walking (forward, FW; lateral, LW, backward, BW), accompanied or not by movements imitating walking (dMI and static MI, sMI). Then, they performed actual locomotion (AL). Outcome measures were related to the time and the number of steps spent for completing the tasks for all the given locomotor conditions.

RESULTS

Significant differences were found in patients with respect to healthy subjects, with time in sMI significantly shorter than in dMI (p < 0.004) and AL (p < 0.002), but not between dMI and AL in FW (p = 0.806). In patients, times obtained in sMI and dMI was significantly shorter with respect to those of AL in LW and BW. Patients performed imagery tasks with similar times in all locomotion. Healthy groups did not reveal differences among tasks in BW, while significant differences were found in LW. Analogous results were found in terms of number of performed steps.

CONCLUSIONS

In patients with stroke, a spatiotemporal functional equivalence with AL was found only for dMI, and not for sMI, in forward walking. This could be due to familiarity with this task. These results might have implications for the rehabilitative techniques based on MI.

Tactile and proprioceptive sensory stimulation modifies estimation of walking distance but not upright gait stability: a pilot study

[Purpose] Recently, there has been growing interest in the somatosensory system, but little data exist on the interaction between dynamic postural control and the somatosensory system. The purpose of this study was to determine whether a training program, based on tactile and proprioceptive sensory stimulation of the trunk with the use of perceptual surfaces, improved the estimation of walking distance by healthy subjects, the ability to walk toward a memorized distance without vision, and whether it increases upright gait stability. [Subjects and Methods] Ten healthy subjects with a mean age of 31.9 ± 2.5 years were enrolled and participated in 10 daily sessions of perceptive training using perceptual surfaces, for 45 minutes each session. An experimental indoor test measured the subjects' ability to perceive walking distances to a memorized target in an indoor environment. [Results] After treatment, the distances that were traversed were closer to the target than before treatment. Trunk acceleration did not differ significantly between pre- and post-training and did not increase significantly after training. [Conclusion] Treatment with perceptual surfaces stimulating the trunk midline improves the estimation of walking distance and modifies proprioceptive gait patterns, allowing various corrective strategies to be implemented during ambulation.

Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study

BACKGROUND

the purpose of this study is to compare the therapeutic effects of extracorporeal shock wave therapy (ESWT) to those of cryoultrasound (Cryo-US) therapy in chronic lateral epicondylitis during a 12-month period.

METHODS

single-blinded, randomized, controlled study of 80 participants treated for chronic LE with 3 ESWT sessions at 48/72-hours intervals (n=40) or 12 Cryo-US therapy sessions (4 sessions per week) (n=40). VAS and satisfactory results, considered as the sum of excellent and good scores in the Roles and Maudsley score, were used as outcome measures at baseline and 3, 6 and 12 months post-treatment.

RESULTS

the results show statistically significant differences in VAS between the two groups at 6 (p<0.001) and 12 months (p<0.001) in favour of the ESWT Group. At 12 months, a difference of more than 2 points in the VAS between the two groups is demonstrated in favour of the ESWT Group. Considering satisfactory results, significant differences between the two groups are observed at 6 (p=0.003) and 12 months (p <0.001) in favour of the ESWT Group where patients achieve a satisfactory rate over 50%.

CONCLUSIONS

ESWT has better clinical therapeutic results at 6- and 12-month follow-up as compared to Cryo-US therapy.

LEVEL OF EVIDENCE

1B.

Effects of perceptive rehabilitation on balance control in patients with Parkinson's disease

BACKGROUND

Subjects affected by Parkinson's disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance.

OBJECTIVE

To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living.

METHODS

In this pilot study, we have treated 9 patients with Parkinson's disease undergone rehabilitation aiming to restoring their correct body midline perception, according a schema treatment - no treatment - treatment.

RESULTS

During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale.

CONCLUSIONS

These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinson's disease for reducing both their static and dynamic balance impairments.

Why evidence-based medicine is an insufficient approach to physical and rehabilitation medicine. Antithesis

When philosophers of science demolished the myth of objectivity in the early decades of the 20th century, they undermined the theoretical certainty that a knowledge system comes from the cumulative development of scientific observations: here we find a criticality inherent to evidence-based medicine in relation to its claim of universality and objectivity. EBM relies on quantitative statistical models to define a treatment's effectiveness, and it has an universal character: the treatment effect is measured against the global characteristics of the general population rather than the individuals. Contemporary cognitive neuroscience takes a naturalized approach to mind and behavior, opening new inroads into investigating consciousness, motor image, bodily awareness, and intention. Common to these issues is the emphasis on the importance the person, with his or her own biology and history, as a unique and unrepeatable entity. Hence, its original aim to protect patients against arbitrary treatment notwithstanding, EBM has become largely inadequate to serve physical and rehabilitation medicine (PRM) owing to the peculiarities of its historical and narrative contents. PRM, because of its unique knowledge base, can be fully considered a science anchored in the basic sciences that underlie rehabilitation procedures. Accordingly, PRM exists within a mutual relationship with physics and biology, from which the biomedical model (well represented by EBM) originates, and is interrelated with other disciplines such as philosophy or psychology, from which the bio-psycho-social model was developed in the 1980s, leading to a comprehensive approach to health and disease. Further critical points in clinical practice include: how to translate evidence into clinical decision making; the inability to generalize experimental evidence because most studies involve selected patient samples. Despite the more than 20 years of EBM, long-established therapeutic approaches lacking scientific evidence still survive in rehabilitation. We must strive for an integrative approach to EBM, which would enable PRM, by virtue of its multifaceted theoretical and methodological approaches to persons with disability, to take the lead in redefining biomedical knowledge and, by applying this understanding, put its science into clinical practice and, perhaps, more generally, into outlining a new "ideal of science".

Cross-cultural adaptation and reliability of the Italian version of the Foot Function Index (FFI-I) for patients with plantar fasciitis

AIM

The aim of this paper was to translate and cross-culturally adapt the FFI to the Italian language, and to assess the reliability of the Italian version of the FFI (FFI-I) for plantar fasciitis.

METHODS

Fifty symptomatic patients affected by plantar fasciitis completed the FFI-I scale twice, at interval of one week. The translation of the FFI was performed according to international standards for translation of questionnaires. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC). Internal consistency was measured by Cronbach α coefficient. Ceiling and floor effects were assessed.

RESULTS

The process resulted in an intelligible version of the questionnaire. The reliability of the FFI-I was adequate, with an ICC ranging from 0.86 to 0.98 for test-retest reliability. The FFI-I showed an excellent internal consistency, ranging from 0.93 to 0.99 for all subscales. Three items involving disability and four items involving activities restrictions had highest proportion of floor score.

CONCLUSION

The FFI-I is a reliable and valid instrument to assess clinical severity in patients with plantar fasciitis and it is suitable for daily practice. We suggest evaluating the total FFI-I score along with the distinct scores of the three subscales of the FFI-I in order to interpret more correctly minor changes in patient status during repetitive outcome assessments.

Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: a single-blind randomized controlled clinical trial

BACKGROUND

Traditional rehabilitation improves pain and function in patients with shoulder impingement syndrome. Neurocognitive rehabilitation has shown to be highly effective after surgical reconstruction of the anterior cruciate ligament. However, its effects in patients with shoulder impingement syndrome have not yet been established.

AIM

The aim of the study was to compare the effects of neurocognitive therapeutic exercise, based on proprioception and neuromuscular control, on pain and function in comparison to traditional therapeutic exercise in patients with shoulder impingement syndrome.

DESIGN

Single-blind randomized, non-inferiority clinical trial.

SETTING

Outpatient clinic of Geriatrics and Physiatrics, University Hospital.

POPULATION

Forty-eight patients with shoulder impingement syndrome (Neer stage I) and pain lasting for at least three months.

METHODS

Participants were randomly allocated (1:1) to either neurocognitive therapeutic exercise or traditional therapeutic exercise. Both treatments were provided one-hour session, three times a week for five weeks. The primary outcome measure was the short form of the Disability of the Arm, Shoulder and Hand Questionnaire (Quick-DASH questionnaire) for the assessment of physical ability and symptoms of the upper extremity.

SECONDARY OUTCOME MEASURES

Constant-Murley shoulder outcome score for the determination of range of motion, pain and strength; American Shoulder and Elbow Surgeons Society standardized shoulder assessment form for the evaluation of physical ability in daily-living tasks; a visual analogue scale for pain assessment at rest and during movements; Likert score for the estimation of participant satisfaction.

ENDPOINTS

before treatment, end of treatment, 12 and 24 weeks after the completion of each intervention for all outcome measures, except for the Likert score that was evaluated only at the end of treatment.

FOLLOW-UP

24 weeks.

RESULTS

At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcomes measures relative to baseline values, except for the visual analogue scale at rest that was unaffected by traditional therapeutic exercise. For all outcome measures, changes over time were greater in the neurocognitive therapeutic exercise group relative to the traditional therapeutic exercise group. The level of satisfaction with treatment was higher for participants in the neurocognitive therapeutic exercise group.

CONCLUSION

Neurocognitive rehabilitation is effective in reducing pain and improving function in patients with shoulder impingement syndrome, with benefits maintained for at least 24 weeks.

CLINICAL REHABILITATION IMPACT

skills and function of the shoulder can greatly benefit from neurocognitive rehabilitation.

Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study

BACKGROUND

Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy.

AIM

Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies.

DESIGN

Single-blind randomized clinical trial.

POPULATION

102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies.

METHODS

The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3.

RESULTS

Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; P<0.001), reaching the primary end point. The difference in pain intensity on the VAS scale between the two groups at T1, T2 and T3 was 3.00, 4.35 and 4.81 respectively, showing a statistically significant difference between VAS average scores at all follow-ups in favor of Group A. Scores of at least 66% at the effectiveness index were only achieved in Group A (P values <0.001).

CONCLUSION

Cryoultrasound therapy could be an efficient treatment option for chronic plantar fasciitis.

CLINICAL REHABILITATION IMPACT

Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency, patients' satisfaction, its limited cost and its short and repeatable protocol of use.

Chronic pain and motor imagery: a rehabilitative experience in a case report

BACKGROUND

The "neuromatrix" theory of Melzack and the studies of Decety on motor imagery have opened the way to an alternative rehabilitation method in chronic pain.

AIM

To evaluate the role of motor imagery in chronic shoulder pain rehabilitation.

DESIGN

Case report.

SETTING

University outpatient rehabilitation.

POPULATION

A 49-year-old female with chronic shoulder pain.

METHODS

Neurocognitive approach, which involves the use of a new tool called "naval battle" to achieve chronic pain relief as assessed by the Visual Analogic Scale (VAS) and McGill Pain Questionnaire (MPQ). The Shoulder Rating Questionnaire (SRQ) and Constant Scale (CS) were used to measure functional improvement.

RESULTS

The results indicate significant pain relief (71%) and improvement in functionality (50%).

CONCLUSION

The results seem to confirm the accuracy of the hypothesis on the genesis of chronic pain as a perceptive "discoherency" and that motor imagery can remake a coherence of afferences at central level in chronic pain.

CLINICAL REHABILITATION IMPACT

The use of motor imagery in rehabilitation can be a viable alternative in chronic shoulder pain resistant to other rehabilitation protocols.

Efficacy of group-adapted physical exercises in reducing back pain in women with postmenopausal osteoporosis

PURPOSE

The clinical effects of osteoporosis include pain, fractures, and physical disability, causing a loss of independence and necessitating long-term care. Whereas the effects of exercise therapy in decreasing body mass index and preventing fractures are well established, there is no consensus on back pain and quality of life in women with osteoporosis. The aim of this study was to determine the efficacy of a brief course of rehabilitation, comprising group-adapted physical exercises, with regard to back pain, disability, and quality of life in women with postmenopausal osteoporosis who had no evidence of fractures.

METHODS

The enrolled patients were randomized into two groups: the treatment group underwent ten sessions of rehabilitative exercises, and the control group received an instructional booklet with descriptions and figures of exercises that were to be performed at home.

RESULTS

Sixty patients completed the trial and assessments, including a 6-month follow-up. The treatment was effective versus the control group, significantly improving pain (Visual Analogue Scale: p < 0.001 at the end of the treatment and at the follow-up; McGill Pain Questionnaire: p = 0.018 at the follow-up), disability (Oswestry Disability Questionnaire: p < 0.001 at the end and follow-up), and quality of life (Shortened Osteoporosis Quality of Life Questionnaire: p = 0.021 at the end of treatment; p = 0.005 at follow-up).

CONCLUSIONS

Our results suggest that group rehabilitation reduces back pain and improves functional status and quality of life in women with postmenopausal osteoporosis, maintaining these outcomes for 6 months. The use of physical exercises might strengthen the habit to training.

Effect of Chêneau brace on postural balance in adolescent idiopathic scoliosis: a pilot study

BACKGROUND

Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects. DESIGN TYPE. Case control study.

SETTING

Outpatient clinic of the Complex Operative Unit of Physical Medicine and Rehabilitation of Policlinico Umberto I Hospital.

POPULATION

Thirteen patients (11 females and 2 males, mean age 13.3±1.7 years, mean Cobb angle 32±9, median Risser sign 2) and thirteen healthy adolescents (8 females and 5 males, mean age: 13.0±1.6 years) as age-matched control group were enrolled.

METHODS

Postural ability of the participants was assessed with stabilometry (under open eyes and closed eyes conditions), computing sway length, sway ellipse area, and sway velocities. Static and dynamic baropodometry (open eyes only) was used to measure the limb load, and to compute: walking speed, step length, step cadence and step width. The symmetry of left and right limb values was also investigated.

RESULTS

Patient's group was characterized by significantly higher postural instability than control group (P<0.05) that decreased with brace in terms of limb load symmetry (-12% in eyes open condition), sway length (-12%), velocity in anteroposterior (-16%) and latero-lateral directions (-10%). Significant correlations were found between the changes occurred when wearing Chêneau brace on load symmetry during standing and those on symmetry of gait (R>0.5, P<0.05).

CONCLUSION AND CLINICAL REHABILITATION IMPACT

Our results show slight changes in terms of posture when wearing Chêneau brace according with the severity of pathology and significantly affecting gait parameters. For these reasons, use of postural balance evaluation should be objectively used to verify the efficacy of Cheneau brace on body functioning of adolescents with idiopathic scoliosis.

Perceptive rehabilitation of patients with non-specific chronic low back pain: the role of body midline. A randomized controlled trial

BACKGROUND

Surface for perceptive rehabilitation (Su-Per treatment) is a hopeful therapeutic system in the treatment of non-specific chronic low back pain (CLBP). During treatment, some patients poorly tolerate the presence of the less elastic cones at the back midline.

AIM

To assess the importance of an increased awareness of body midline through higher stimulus at interspinous line during Su-Per treatment for non-specific CLBP.

DESIGN

Single-blind, randomized, controlled trial.

SETTING

Outpatient academic hospital.

POPULATION

Forty patients with non-specific CLBP, for at least 12 weeks before treatment.

METHODS

The patients were distributed in 2 groups: Group A (20 patients) received standard Su-Per treatment; Group B (20 patients) received Su-Per treatment without higher stimulus at interspinous line. Pain was assessed using the Visual Analogue Scale and the Present Pain Intensity and Pain Rating Index of the McGill Pain Questionnaire. Disability was evaluated using the Oswestry Disability Index.

RESULTS

In both groups, a significant reduction of pain and disability scores was observed at the first follow-up (end of treatment), and was maintained at later evaluations (4-weeks, and 12-weeks follow up). No significant difference was observed between the two groups in all outcome measures at all time points (P>0.05 for all).

CONCLUSION

Su-Per treatment is a valid modality in a cognitive-perceptive therapeutic concept for non-specific CLBP. It does not necessarily require external stimulation of the body midline to be effective.

CLINICAL REHABILITATION IMPACT

Modifying the standard distribution of the cones, without less deformable cones along interspinous line, makes the Su-Per treatment more acceptable to patients.

Neck balance system in the treatment of chronic mechanical neck pain: a prospective randomized controlled study

BACKGROUND

Chronic mechanical neck pain (MNP) is a very common condition, that may occur in general population. There is a lack of evidence for most therapies except for exercise therapy with combining methods, whose effectiveness is still moderate.

AIM

The aim of this study was to determine the effect of a novel neck balance system-Dal Monte 2(NBS-DM2) incorporated into a special cap on pain in sufferers of MNP after treatment and at three months follow-up.

DESIGN

Prospective randomized controlled trial.

SETTING

Outpatient clinic of the University of Rome "Foro Italico".

POPULATION

Forty-five volunteers of both sexes affected by grade II MNP were enrolled.

METHODS

NBS-DM2/RW (regular weight), NBS-DM2/NW (negligible weight) and Pulsed Electromagnetic Fields (PEMF) have been used for 8 weeks. Neck Disability Index (NDI), Neck Pain and Disability Scale (NDPS) questionnaires and Visual Analogic Scale (VAS) score were evaluated before, after the treatment period and 3 months after the end of treatment.

RESULTS

NBS-DM2/RW compared with NBS-DM2/NW and PEMF group performed better in the reduction of the three measures at the end and at short term run (p ≤ 0.05).

CONCLUSION AND CLINICAL REHABILITATION IMPACT

When applied to grade II MNP patients, NBS-DM2/RW leads to pain relief and reduction of disability. These effects persist over a short term follow-up period. PEMF therapy was found to have no significant effect on reduction of pain and disability in this study.

Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery

BACKGROUND

Breast cancer (BC) is currently the most frequent tumor in women. Through the years, BC management has evolved towards conservative surgery. However, even minimally invasive surgery can cause neuromotor and/or articular impairments which can lead to permanent damage, if not adequately treated.

AIM

To clinically evaluate upper ipsilateral limb function and the impact of certain post-surgical consequences arising after invasive or breast-conserving surgery for early BC, by intervening, or not intervening, with an early rehabilitation program. To investigate physical morbidity after sentinel (SLND) or axillary lymph node dissection (ALND) and after reconstructive surgery in the treatment of early BC.

DESIGN

Observational prospective trial.

SETTING

Inpatient and outpatient treatment.

POPULATION

Eighty-three females participated in the study: 25 patients did not begin physiotherapy during hospitalization (Group A), 58 patients received early rehabilitation treatment (Group B).

METHODS

The patients of Groups A and B were compared with respect to the following criteria: shoulder-arm mobility, upper limb function, and presence of lymphedema. All patients were assessed at 15-30, 60 and 180 days after surgery.

RESULTS

Statistically significant differences, in favor of Group B, were encountered at the 180-day follow-up visit, especially with respect to articular and functional limitation of the upper limb.

CONCLUSION AND CLINICAL REHABILITATION IMPACT

The results of the present study show that early assisted mobilization (beginning on the first postoperative day) and home rehabilitation, in conjunction with written information on precautionary hygienic measures to observe, play a crucial role in reducing the occurrence of postoperative side-effects of the upper limb.

Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study

BACKGROUND

Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic non-specific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back.

AIM

To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain.

DESIGN

A randomised controlled trial with three and six-month follow-up.

SETTING

Ambulatory rehabilitative university centre.

POPULATION

Fifty patients with chronic non-specific low back pain out of 77 screened patients.

METHODS

Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group received medical assistance (CG, N.=21). Medication was the same in both groups. Then, patients were subgrouped in those with at least an elevation in one scale of MMPI-II, and those without it. The Short Form 36 Health Status Survey for the assessment of quality of life (primary outcome measure), pain Visual Analogue Scale, Waddel Index and Oswestry Disability Index were collected at baseline, at the end of treatment, and at the three and six-month follow-up.

RESULTS

Only the two treated subgroups showed a significant improvements in terms of quality of life, disability and pain. Among treated subjects, only those with at least one scale elevation in MMPI-II showed also a significant improvement in terms of Short Form 36 mental composite score and relevant subscores.

CONCLUSION

These results suggest that Back School program has positive effects, even in terms of mental components of quality of life in patients with scale elevations of MMPI-II. Probably these findings are due to its educational and cognitive-behavioural characteristics.

CLINICAL REHABILITATION IMPACT

Because of its educational purposes, the Back School treatment can have positive effects also on the mental status of patients with low back pain when it affects their psychological features.

Extracorporeal shock wave therapy in early osteonecrosis of the femoral head: prospective clinical study with long-term follow-up

INTRODUCTION

Extracorporeal shock wave therapy (ESWT) may exert beneficial effects in avascular necrosis of femoral head (AVNFH).

PATIENTS

The current study evaluated the effectiveness of ESWT in reducing pain and in slowing down the progression of bone damage in 36 patients with unilateral AVNFH of stage Association Research Circulation Osseous (ARCO) I, II and III. At the beginning of the study, 10 hips were classified as stage I, 11 as stage II and 15 as stage III. Each treatment cycle included four sessions, with 2,400 impulses each administered at 0.50 mJ/mm(2), at 48-72 h intervals. Follow-up examinations were scheduled at 3, 6, 12 and then 24 months.

METHOD

Clinical assessments included assessment of pain scores, Harris Hip Scores and Roles and Maudsley score. Plain radiographs and magnetic resonances of the hip were used to evaluate the size of the lesion, the extent of collapse of subchondral bone, and degenerative changes of the hip joint.

RESULTS

Patients from ARCO stage I group and stage II group achieved significantly better results than patients from ARCO stage III group at all follow-up time points (p < 0.005). During the follow-up period, 10 of the 15 stage III ARCO patients received an arthroplasty. ARCO stages I and II lesions were unchanged on radiographs and on magnetic resonance images.

CONCLUSION

ESWT in ARCO stages I and II may help to prevent progression of the area of avascular necrosis and manage pain.

Neurocognitive rehabilitative approach effectiveness after anterior cruciate ligament reconstruction with patellar tendon. A randomized controlled trial

BACKGROUND

A proper knee rehabilitation after a surgical reconstruction of the anterior cruciate ligament (ACL) should start immediately after the injury and it should be focused on recovery of symmetry, proprioception, swelling reduction, gait training, hyperextension exercises, and even mental preparation.

AIM

Aim of this study was to test a neurocognitive rehabilitative approach based on proprioceptive exercises and proper motor strategy choices, compared with conventional rehabilitation, assessing baropodometric, gait and clinical changes.

DESIGN

Randomized controlled trial.

SETTING

Ambulatory University Centre.

POPULATION

Fourteen subjects (27.9±5.2 years) underwent to a surgical reconstruction of ACL were divided into the two groups.

METHODS

The subjects were randomly assigned into a group who received a specific neurocognitive and perceptive rehabilitation treatment (TG), and into a control group who received the common physical therapy (CG). The following outcome measures were assessed pre-intervention, one, three and six months later: static and dynamic baropodometry, Visual Analog Scale for pain, Short Form SF-36, Range of Motion, trophism of thigh region, edema, Manual Muscle Test, magneto-resonance imaging assessment.

RESULTS

Lower impairment was observed in TG in respect of CG in terms of load asymmetry during static baropodometry (from 7% to 3% vs. from 10% to 7%, interaction time per treatment: P=0.037), less wide steps during gait (effect size=1.05 vs. 0.38 for CG), swelling (treatment effect: P=0.012). A significantly higher improvement (from 35% to 100%) in terms of SF-36 was recorded only in TG for physical activity (P=0.027). CG showed a quite higher walking speed (treatment effect: P=0.049).

CONCLUSION

Even if further studies are needed on larger samples, the obtained results showed that a neurocognitive rehabilitative approach could be an effective treatment after ACL-reconstruction: in TG we observed a more rapid load symmetrization, the reduction of step width and a more rapid resolution of edema.

CLINICAL REHABILITATION IMPACT

Posture, gait, clinical features and quality of life could benefit from a neurocognitive rehabilitation after ACL surgical reconstruction.

Quality of life improved by multidisciplinary back school program in patıents with chronic non-specific low back pain: a single blind randomized controlled trial

STUDY DESIGN

A three and six months follow-up in a randomized controlled trial.

BACKGROUND

Back School has become a widespread exercise program for low back pain (LBP), since its introduction in 1969. Back School could improve quality of life (QoL), but there are controversial data regarding its effectiveness.

AIM

To evaluate the effects of the Back School program on quality of life (primary outcome), disability and pain perceptions (secondary outcomes) in patients with chronic and non-specific low back pain.

SETTING

Rehabilitative specialized centre.

POPULATION

Seventy four patients with chronic non-specific LBP.

METHODS

Patients were randomly placed in a 3:2 form and were allocated into 2 groups (treated-control). Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises (BSG, N.=41), while the control group received medical assistance (CG, N.=29). Medication was the same in both groups. The Short Form 36 Health Status Survey, Waddel Index, Oswestry Disability Index and Visual Analogue Scale were collected at baseline, at the end of treatment, and at the three and six month follow-up.

RESULTS

Quality of life significantly improved along time more in BSG, both in Physical and Mental Composite Score (repeated measure Anova: interaction time per group: P<0.001 and P=0.002, respectively). We also observed a significant improvement in disability scores along time (P<0.001) in BSG with significant differences between groups at three and at six months for Waddell Index (P=0.006 and P=0.009 respectively) and for Oswestry Disability Index (P=0.018 and 0.011 respectively). Moreover, pain perception score VAS showed a reduction in both groups, but it was significantly lower in BSG at end of treatment and both follow-ups (P<0.001).

CONCLUSION

Our Back School program can be considered an effective treatment in people with chronıc non-specıfıc LBP.

Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study

OBJECTIVE

To evaluate the efficacy of a perceptive rehabilitative approach, based on a new device, with regard to pain and disability in patients with chronic nonspecific low back pain.

DESIGN

Single blind, randomized, controlled trial.

SETTING

An outpatient academic hospital.

PATIENTS

Seventy-five patients with chronic low back pain.

INTERVENTIONS

Patients were randomized into three groups. Twenty-five subjects received 10 sessions in one month, based on specific perceptive exercises that were performed on a suitably developed device. Twenty-five patients entered a Back School programme. Twenty-five patients comprised a control group that received the same medical and pharmacological assistance as the other groups.

MAIN OUTCOME MEASURES

Pain was assessed using the Visual Analogue Scale and McGill Pain Questionnaire. Disability was evaluated using the Oswestry Disability Index and Waddell Disability Index. All measurements were recorded before treatment, at the end of the study, and at 12 and 24 weeks.

RESULTS

General pain relief was recorded in all the groups, which was elicited more quickly in the perceptive treatment group; significant differences in pain scores were observed at the end of treatment (P < 0.001 for visual analogue scale and P = 0.001 for Questionnaire) versus the other groups. Disability scores in the perceptive group did not differ significantly from those in the other group, whereas these scores significantly differed between Back School and control groups at the follow-ups (P < 0.01 for both scales).

CONCLUSION

Perceptive rehabilitation has immediate positive effects on pain. Back School reduces disabilities at follow-up.

Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial

OBJECTIVE

The goal of this study was to compare the effects of trigger point (TRP) mesotherapy and acupuncture (ACP) mesotherapy in the treatment of patients with chronic low back pain.

DESIGN

Short term randomized controlled trial.

SETTING

62 subjects with chronic low back pain were recruited at outpatients Physical Medicine and Rehabilitation Clinic at the University of Rome "La Sapienza" in the period between July 2006 and May 2008.

INTERVENTION

Study subjects were assigned to receive 4 weeks treatments with either trigger point mesotherapy (TRP mesotherapy, n=29) or acupoints mesotherapy (ACP mesotherapy, n=33).

MAIN OUTCOME MEASURES

Pain intensity with a pain visual analogic scale (VAS) and verbal rating scale (VRS) and pain disability with McGill Pain Questionnaire Short Form (SFMPQ), Roland Morris Disability Questionnaire (RMQ) and Oswestry Low Back Pain Disability Questionaire (ODQ).

RESULTS

ACP mesotherapy shows a more effective results in VRS and VAS measures in the follow-up (p(VRS)=<.001 and p(VAS)=<.001). The SF-MPQ measure shows a better results for ACP instead of TRP with statistically significant differences between groups and time (p=.035). Participants reported a slight discomfort at the time of the inoculation, and 15% reported slight neck pain in ACP mesotherapy group.

CONCLUSIONS

Our results suggest that the response to ACP mesotherapy may be greater than the response to TRP mesotherapy in the short term follow-up. This technique could be nevertheless a viable option as an adjunct treatment in an overall treatment planning of CLBP.

Kinematic and kinetic features of normal level walking in patellofemoral pain syndrome: more than a sagittal plane alteration

Patients with patellofemoral pain syndrome (PFPS) often report discomfort and pain during walking. To date, most of the studies conducted to determine gait alterations in PFPS patients have focused on sagittal plane alterations. Physiological and biomechanical factors, however, suggest that frontal and transverse plane alterations may be involved in PFPS. We therefore decided to conduct a kinematic and kinetic evaluation on all three planes in 9 PFPS subjects and 9 healthy sex- and age-matched controls. General gait characteristics were similar in patients and controls, with the exception of swing velocity, which was lower in PFPS patients. Patients also displayed an increased knee abductor and external rotator moments in loading response, and reduced knee extensor moment both in loading response and in terminal stance. We speculate that these findings may be linked both to a pain-avoiding gait pattern and to alterations in the timing of activation of different components of the quadriceps muscle, which is typical of PFPS. The relevance for clinicians is this gait pattern may represent a biomechanical risk factor for future knee osteoarthritis. We therefore recommend that treatments aimed at PFPS should also attempt to restore a correct walking pattern.

[Assessment and monitoring of organizational appropriateness of inpatient rehabilitation facilities in Lazio region: tools and working methods, results and comparison with other regional experiences]

Aim of this paper is to analyze the tools and working methods, used in the Lazio Region, to assess organizational appropriateness in the context of Inpatient Rehabilitation Facilities, and the results obtained. It illustrates also the regional experiences of Veneto and Lombardia, which characterized by dynamism and originality in an attempt to overcome the obvious place for the critical assessment of this area of care.