Publications by authors named "Andrea Bernetti"

48 Publications

Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients-A Mini Systematic Review.

Front Neurol 2021 5;12:696276. Epub 2021 Jul 5.

Department of Medical and Oral Sciences and Biotechnologies, University G. d'Annunzio Chieti-Pescara, Chieti, Italy.

Fatigue is a multidimensional symptom with both physical and cognitive aspects, which can affect the quality of daily and working life activities. Motor Imagery (MI) represents an important resource for use during the rehabilitation processes, useful, among others, for job integration/reintegration, of neurological pathologies, such as Multiple Sclerosis (MS). To define the effective rehabilitation protocols that integrate MI for the reduction of fatigue in patients with MS (PwMS), a literary review was performed through August 2020. Five articles were included in the qualitative synthesis, including two feasibility pilot randomized control trials (RCTs) and 3 RCTs with good quality according to the PEDro score and a low risk of bias according to the Cochrane Collaboration tool. The literature suggested that MI, in association with rhythmic-auditory cues, may be an effective rehabilitation resource for reducing fatigue. Positive effects were observed on perceived cognitive and psychological fatigue. PwMS require greater compensatory strategies than healthy individuals, and the use of rhythmic-auditory cues may be useful for optimizing the cognitive processing of MI, which acts as an internal stimulus that is enhanced and made more vivid by outside cues. These findings provide evidence that MI is a promising rehabilitation tool for reducing fatigue in PwMS and return to work strategies.
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http://dx.doi.org/10.3389/fneur.2021.696276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287528PMC
July 2021

Effects of a motor imagery-based exercise protocol on chronic pain and emotional distress in patients with fibromyalgia syndrome: A pilot study.

J Back Musculoskelet Rehabil 2021 Jul 2. Epub 2021 Jul 2.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

Background: Fibromyalgia (FM) is a chronic condition characterized by widespread muscular or musculoskeletal pain of at least 3 months' duration, occurring above and below the waist, on both sides of the body.

Objective: The aim of this study was to evaluate the effectiveness of a rehabilitation program based on motor imagery versus a conventional exercise program in FM in terms of pain, functional and psychological outcomes.

Methods: Twenty-nine female subjects were randomly assigned to a group receiving motor imagery-based rehabilitation (MIG) or to a control group (CG) performing conventional rehabilitation. Outcome assessments were performed before (T0) and after 10 sessions of treatment (T1) and at a 12-week follow-up (T2). Pain, function and psychological measurements were conducted by means of different questionnaires.

Results: Both treatments improved all outcomes at post-treatment (T1) and follow-up (T2). The MIG showed a significant improvement in anxiety disorder associated with FM with respect to the CG, as well as improvements in coping strategies.

Conclusions: Rehabilitation treatment based on motor imagery showed a stronger effect on anxiety and coping behavior than traditional physiotherapy in patients with FM. Integrated psychological support would be desirable in this setting. Further research is needed to explore the aspects investigated in more depth.
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http://dx.doi.org/10.3233/BMR-200328DOI Listing
July 2021

Muscle Energy Technique in the Rehabilitative Treatment for Acute and Chronic Non-Specific Neck Pain: A Systematic Review.

Healthcare (Basel) 2021 Jun 17;9(6). Epub 2021 Jun 17.

Department of Medical, Oral and Biotechnological Sciences (DSMOB), G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.

Background: Non-specific neck pain (NNP) affects 30-50% of the general population, and it often leads to severe disability. Several manual therapy techniques are available to reduce pain and disability and to improve cervical range of motion and functional activities. Muscle Energy Technique (MET) showed more evidence for treating such a disorder. The aim of this current scientific literature analysis was to compare the clinical effects of MET with the other manual or rehabilitative treatments for non-specific acute and chronic neck pain.

Methods: The literature search was conducted using the following databases: PubMed, Medline, PEDro, Cochrane Database, and Google Scholar from 2010 to January 2020. Clinical trials about MET were included. The quality of the trials was assessed according to the PEDro scale.

Results: Twenty-one papers according to inclusion and exclusion criteria were selected: 15 studies about non-specific acute neck pain and 6 studies about non-specific chronic neck pain.

Conclusions: This analysis suggests that the MET approach has a good clinical effect on reducing neck pain in patients with acute neck pain and improves cervical range of motion in patients with chronic neck pain, and is better if combined with a traditional rehabilitative approach. This review's findings should be considered with caution for physiotherapy practice because of the studies' methodologic limitations. On the basis of the current available and limited evidence, clinicians could combine MET with traditional physiotherapy and other manual techniques when treating people with non-specific neck pain.
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http://dx.doi.org/10.3390/healthcare9060746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234422PMC
June 2021

New Viscoelastic Hydrogel Hymovis MO.RE. Single Intra-articular Injection for the Treatment of Knee Osteoarthritis in Sportsmen: Safety and Efficacy Study Results.

Front Pharmacol 2021 28;12:673988. Epub 2021 May 28.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

Viscosupplementation by hyaluronic acid (HA) is recommended for non-surgical management of knee osteoarthritis (OA). This study investigated the efficacy and safety of a single i.a. (32 mg/4 ml) Hymovis MO.RE. injection, a new HA derivative hydrogel, for the treatment of adult regular sports players affected by knee OA arising from overuse injuries. Patients were prospectively enrolled if regularly practicing sports and diagnosed with Kellgren-Lawrence grade I-III OA. They received a single Hymovis MO.RE. intra-articular (i.a.) injection and were evaluated 30, 90, 180, and 360 days thereafter. The assessment involved measuring changes in knee function, pain, the activity of daily living (ADL), and quality of life (QOL) by using the Knee injury and Osteoarthritis Outcome Score (KOOS), GAIT analysis, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee pain (WOMAC A) and function (WOMAC C), and a visual analogue scale (VAS) pain score. The study involved thirty-one patients, 23 women and eight men, whose median age was 49. KOOS function subscore, as well as GAIT cadence and velocity, showed a statistically significant increase at each time-point after injection ( < 0.0001). WOMAC, KOOS pain, symptoms, ADL, and QOL scores also significantly improved at all control visits. No severe adverse events or treatment-related events were detected. A single Hymovis MO.RE. (32 mg/4 ml) intra-articular injection provides a rapid, lasting, and safe response in regular sports players affected by knee OA, possibly representing a viable therapeutic option for this demanding patient subgroup. Further investigations are necessary to confirm these findings.
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http://dx.doi.org/10.3389/fphar.2021.673988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195240PMC
May 2021

Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach.

Neurol Sci 2021 Apr 7. Epub 2021 Apr 7.

Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.

Background: Determine the effects of an integrated rehabilitation protocol, including botulinum toxin and conventional rehabilitation exercise plus end-effector (EE) robotic training for functional recovery of the upper limb (UL) compared to training with the robot alone in post-chronic stroke patients with mild to severe spasticity, compared to training with the robot alone.

Methods: In this prospective, observational case-control study, stroke patients were allocated into 2 groups: robot group (RG, patients who underwent robotic treatment with EE) and robot-toxin group (RTG, patients who in addition have carried out the injection of botulinum toxin for UL recovery). All patients were assessed by Fugl-Meyer Assessment (FMA), Motricity Index (MI), modified Ashworth scale (MAS), numeric rating scale (NRS), Box and Block Test (BBT), Frenchay Arm Test (FAT), and Barthel Index (BI) at baseline (T0), T1 (end of treatment), and T2 (3 months of follow-up).

Results: Forty-four patients were included and analyzed (21RG; 23RTG). From the analysis between groups, the results suggested how there was a statistically significant difference in favor of RTG, specifically ΔT0-T1 and ΔT0-T2 for B&B p = 0.009 and p = 0.035; ΔT0-T1 and ΔT0-T2 for FAT with p = 0.016 and p = 0.031; ΔT0-T1 for MAS shoulder p = 0.016; ΔT0-T1 and ΔT0-T2 with p = 0.010 and p = 0.005 for MAS elbow; and ΔT0-T1 and ΔT0-T2 with p = 0.001 and p = 0.013 for MAS wrist.

Conclusion: Our results suggest, in line with the literature, a good efficacy in the reduction of spasticity and in the improvement of the function of the UL, with the reduction of pain, adopting a rehabilitation protocol integrated with BoTN, robot-assisted training, and traditional physiotherapy.
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http://dx.doi.org/10.1007/s10072-021-05185-3DOI Listing
April 2021

Impact of COVID-19 pandemic on Physical Medicine and Rehabilitation residency: an Italian nationwide epidemiologic survey.

Eur J Phys Rehabil Med 2021 Mar 5. Epub 2021 Mar 5.

Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -

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http://dx.doi.org/10.23736/S1973-9087.21.06844-1DOI Listing
March 2021

Oxygen-Ozone Therapy in the Rehabilitation Field: State of the Art on Mechanisms of Action, Safety and Effectiveness in Patients with Musculoskeletal Disorders.

Biomolecules 2021 02 26;11(3). Epub 2021 Feb 26.

Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy.

In recent years, the interest in oxygen-ozone (OO) therapy application has considerably increased in the field of rehabilitation. Despite its widespread use in common clinical practice, the biochemical effects of OO are still far from being understood, although its chemical properties seem to play a pivotal role in exerting its positive effects on different pathological conditions. Indeed, the effectiveness of OO therapy might be partly due to the moderate oxidative stress produced by O interactions with biological components. OO therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune over-activation, and most musculoskeletal disorders share these pathophysiological processes. The present comprehensive review depicts the state-of-the-art on the mechanisms of action, safety and effectiveness of OO therapy in the complex scenario of the management of musculoskeletal disorders. Taken together, our findings suggest that OO therapy seems to reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis, as reported by several studies in the literature. However, to date, further studies are warranted to clearly investigate the therapeutic effects of this promising therapy on other musculoskeletal disorders in the field of rehabilitation.
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http://dx.doi.org/10.3390/biom11030356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996934PMC
February 2021

Integration of focal vibration and intra-articular oxygen-ozone therapy in rehabilitation of painful knee osteoarthritis.

J Int Med Res 2021 Feb;49(2):300060520986705

Physical Medicine and Rehabilitation, Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.

Objective: To examine the pain-reducing effects of intra-articular oxygen-ozone (OO) injections and mechanical focal vibration (mFV) versus OO injections alone in patients with knee osteoarthritis.

Methods: Patients with chronic pain (>6 weeks) due to knee osteoarthritis (II-III on the Kellgren-Lawrence scale) were consecutively enrolled and divided into two groups: OO (n = 25) and OO-mFV (n = 24). The visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Research Council (MRC) Manual Muscle Testing scale were administered at baseline (before treatment), after 3 weeks of treatment, and 1 month after the end of treatment. Patients received three once-weekly intra-articular injections of OO into the knee (20 mL O, 20 μg/mL). The OO-mFV group also underwent nine sessions of mFV (three sessions per week).

Results: The VAS score, KOOS, and MRC score were significantly better in the OO-mFV than OO group. The within-group analysis showed that all scores improved over time compared with baseline and were maintained even 1 month after treatment. No adverse events occurred.

Conclusion: An integrated rehabilitation protocol involving OO injections and mFV for 3 weeks reduces pain, increases autonomy in daily life activities, and strengthens the quadriceps femoris.
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http://dx.doi.org/10.1177/0300060520986705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923992PMC
February 2021

Rehabilitative Good Practices in the Treatment of Sarcopenia: A Narrative Review.

Am J Phys Med Rehabil 2021 03;100(3):280-287

From the Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy (FA, AB, GDG, MGV, MP, MM, VS); and Department of Neuroscience, University of Padua, Padua, Italy (SM).

Abstract: To date, rehabilitative good practices that analyze all aspects of the rehabilitation management of the patient with sarcopenia are absent in the literature. The purpose of this article is to carry out research and evaluation of the evidence, good practice, and recommendations in the literature relating to the rehabilitative treatment of disabilities associated with sarcopenia. Bibliographic research was conducted on Medline, PEDro, Cochrane Database, and Google Scholar. All articles published in the last 10 yrs were analyzed. The results of this research generated three guidelines, eight meta-analyses, five systematic reviews, a Cochrane review, 17 reviews, and seven consensus conferences. From the analysis of the literature, it seems that most of the works agree in affirming that exercise and diet supplementation are the cornerstones of rehabilitation treatment of patients with sarcopenia. The practice of an adequate lifestyle received numerous high-grade recommendations in the included guidelines. Based on the data obtained, the rehabilitation management of the patient with sarcopenia must be personalized and must include exercise and nutritional supplementation. These factors are important in increasing the autonomy of the elderly essential for safe walking without neglecting stretching exercises that are important for flexibility and balance and coordination exercises.
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http://dx.doi.org/10.1097/PHM.0000000000001572DOI Listing
March 2021

State of the evidence about rehabilitation interventions in patients with dysphagia.

Eur J Phys Rehabil Med 2021 Feb 4. Epub 2021 Feb 4.

Department of Neuroscience, University of Padua, Padua, Italy.

Introduction: Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia.

Evidence Acquisition: The search was carried out through the main databases (Medline, PEDro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included.

Evidence Synthesis: Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised.

Conclusions: The dysphagic patient requires the deployment of a range of skills by a multiprofessional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.
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http://dx.doi.org/10.23736/S1973-9087.21.06716-2DOI Listing
February 2021

Neuropathic Pain and Rehabilitation: A Systematic Review of International Guidelines.

Diagnostics (Basel) 2021 Jan 5;11(1). Epub 2021 Jan 5.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy.

Background: Neuropathic pain is an injury or disease of the central and/or peripheral somatosensory nervous system, and it has a significant impact on quality of life, especially since it is often refractory to treatment. Rehabilitative intervention is considered in various guidelines on neuropathic pain treatment, although not in an organic nor detailed way. The aim of this systematic review was to analyze the most indicated therapeutic strategies, providing rehabilitative recommendations in the management of neuropathic pain.

Methods: A systematic review was performed according to PRISMA guidelines. The scientific search, carried out until July 2020, considered guidelines in English language of the last thirteen years.

Results: Six guidelines were analyzed, from which emerges that a multidisciplinary approach, comprehensive of pharmacologic and nonpharmacologic interventions, should drive neuropathic pain management. A relevant role in non-pharmacological intervention is played by rehabilitation, through an adequate tailored rehabilitation program and physical therapies.

Conclusion: This analysis highlights the importance of rehabilitation but also the lack of evidence on various rehabilitative practices. Arises hence the need for further studies in this field to better define a rehabilitative treatment strategy.
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http://dx.doi.org/10.3390/diagnostics11010074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824970PMC
January 2021

Rehabilitation setting during and after Covid-19: An overview on recommendations.

J Rehabil Med 2021 Jan 5;53(1):jrm00141. Epub 2021 Jan 5.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Italy. E-mail:

Objective: The aim of this review is to identify the best evidence to define rehabilitative approaches to acute and post-acute phases of coronavirus 2019 (COVID-19) disease.

Methods: A literature search (of PubMed, Google Scholar, PEDro and Cochrane databases) was perform-ed for relevant publications from January to April 2020.

Results: A total of 2,835 articles were retrieved, and the search resulted in a final total 31 published arti-cles. A narrative synthesis of the selected articles was then performed. Some studies examine the effect of the pandemic on rehabilitation services and provide suggestions for a new reorganization of these services. Other studies focus on COVID-19 sequelae, formulating recommendations for rehabilitative interventions.

Conclusion: For COVID-19 patients, an integrated rehabilitative process is recommended, involving a multidisciplinary and multi-professional team provid-ing neuromuscular, cardiac, respiratory, and swallowing interventions, and psychological support, in order to improve patients' quality of life. The intervention of a physician expert in rehabilitation should assess the patient, and a dedicated intervention set up after thorough assessment of the patient's clinical condition, in collaboration with all rehabilitation team professionals.
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http://dx.doi.org/10.2340/16501977-2776DOI Listing
January 2021

The reaching movement in breast cancer survivors: Attention to the principles of rehabilitation.

J Bodyw Mov Ther 2020 Oct 30;24(4):102-108. Epub 2020 Jun 30.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Italy. Electronic address:

Introduction: Breast-cancer is leading cause of morbidity and mortality in women. The prognosis and survival rate of women with breast-cancer have significantly improved worldwide; more attention needs to be paid to rehabilitative interventions after surgery. This paper describes use of reaching movement to assess upper limb motorcontrol and functional ability after breast-cancer surgery (BC).

Material And Methods: We conducted a cross-sectional observational study consisting of biomechanical evaluation of upper limb limitations in women BC, versus a controlgroup (CG). Thirty breast-cancer survivors and thirty healthy women participated in this study. Both groups were subjected to clinical evaluation of the shoulder joint ROM on the operated side, as an assessment of the muscular-strength of the shoulder with the MRC-scale. The Functional-Assessment was evaluated by the DASH and Constant-Murley-Score. The EORTC QLQ-C30 and VAS were used to measure the quality of life assessment and pain respectively. A Biomechanical evaluation was performed, using Reaching-Task and Surface-EMG.

Results: Normal Jerk for BC was higher than CG. Target approaching velocity and movement duration BC was lower than CG. Synergy Anterior Deltoid/Triceps Brachii muscles in CG was higher than BC.
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http://dx.doi.org/10.1016/j.jbmt.2020.06.039DOI Listing
October 2020

The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care.

Support Care Cancer 2021 Feb 11;29(2):899-908. Epub 2020 Jun 11.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

Background: Breast cancer (BC) is the most common cancer among women in developed countries. Several types of surgical interventions are commonly used in BC, such as mastectomy and quadrantectomy, followed by radiation or not. Today, BC rehabilitation can help survivors obtain and maintain the highest physical, social, psychological, and vocational functioning possible, within the limits that are created by cancer and its treatments.

Objective: To verify, before and after a specific rehabilitation protocol treatment, the recovery of the fluidity of the reaching movement.

Methods: Patients after BC surgery were enrolled and assigned by cluster randomization into 2 groups through a block randomization list: mastectomy (Mas) and quadrantectomy (Quad). Evaluation scales (DASH and VAS) were administered, and biomechanical evaluations were performed for each group before treatment (T0 = baseline), at the end of the rehabilitative treatment (T1 = 12 sessions, 2/week), and after 3 months of follow-up (T2).

Results: Fifty-nine (Mas group = 29; Quad group = 30) after BC surgery were enrolled. VAS scores improved along the evaluation times at T0-T1 and T0-T2 (p < 0.001), without a statistically significant difference between groups. With regard to the normalized jerk, there was no significant interaction between time group (F = 2.029; p = 0.136). There was a significant decrease between T0-T1 and T1-T2 (F = 60.189; p < 0.001). Velocity improved significantly between T0-T1 and T1-T2 (F = 10.322; p < 0.001). There was a significant interaction for the elbow angle at the end of movement between time and group at T2 (F = 5.022; p = 0.029).

Conclusion: The integrated, low-intensity, rehabilitative intervention is effective, even if it is not performed in the first period after BC surgery, without any difference between mastectomy and quadrantectomy.
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http://dx.doi.org/10.1007/s00520-020-05567-xDOI Listing
February 2021

Movement Analysis with Inertial Measurement Unit Sensor After Surgical Treatment for Distal Radius Fractures.

Biores Open Access 2020 21;9(1):151-161. Epub 2020 May 21.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.

Inertial measurement unit (IMU) has recently been used to evaluate a movement of a body segment to provide accurate information of movement's characteristics. IMU systems have been validated to successfully measure joint angle during upper limb range of motion (ROM). The study aimed to retrospectively evaluate, using an IMU, the ROM recovery of the wrist after surgical treatment for distal-radius fractures with Kirschner wire fixation (KWF) or with volar plate fixation (VPF) and screws. To assess pain in the wrist joint, muscle-fatigue (MF), and functional difficulties in activities of daily living, we evaluated the patients through patient-related wrist evaluation questionnaire (PRWE) scale, disability of the arm, shoulder and hand (DASH) scale, Hand Grip Strength (HGS), and surface electromyography (EMG). We used a single IMU composed of three-axis gyroscope, a three-axis accelerometer, and a magnetometer. We calculated the value of ROM as a percentage with respect to the unaffected wrist. We also recorded surface-EMG signals over biceps brachialis, flexor carpi radialis (FCR), extensor carpi radialis (ECR), and pronator teres muscles. Forty patients were recruited for our study. Ulnar deviation (UD) was significantly higher for VPF than for KWF ( = 0.017); supination was significantly higher for VPF than for KWF ( = 0.031). The percentage of decay of the median frequency of FCR of volar plate was significantly higher than KWF. The HGS of KWF was significantly higher than VPF. In literature, there were no significant differences between the two types of treatment at long-term follow-up. Our results demonstrate a superior efficacy of VPF in terms of ROM improvement in UD and supination, but for these patients, muscle fatigue is greater than the KWF group. Based on the data available, VPF is similar to KWF for the treatment of distal radius fractures. The IMU sensor could be used in the future to evaluate ROM after surgery during patient's rehabilitation and to compare the effects with stratified analysis regarding age and fracture type, paralleled with cost-effectiveness analysis.
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http://dx.doi.org/10.1089/biores.2019.0035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247043PMC
May 2020

Evaluation of plantar fasciopathy shear wave elastography: a comparison between patients and healthy subjects.

J Ultrasound 2020 May 16. Epub 2020 May 16.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy.

Purpose: The aim of this study is to compare elasticity features between patients with plantar fasciitis (PFis) and an asymptomatic healthy control group using shear wave elastography (SWE) and to correlate SWE values with clinical scores.

Methods: Consecutive patients diagnosed with PFis and asymptomatic subjects were enrolled in the present study. Both groups underwent clinical, ultrasound (US), and SWE evaluation. A plantar fascia thickness > 4 mm was considered pathognomonic of PFis. SWE stiffness elasticity (Young's modulus in kPa and shear wave velocity in m/s) was measured 1 cm distally from the calcaneal insertion. Correlations with VAS and the 17-Italian Foot Function Index (17-FFI) were determined.

Results: A total of 19 patients satisfied the inclusion criteria for the patient group and were enrolled in the study, and 21 healthy subjects were used as a control group. Statistically significant differences were found for shear wave velocity between the patient and the control group, with SWE findings of 3.8 (5.1; 1.5) m/s and 4.7 (4.07; 7.04) m/s, respectively (p = 0.006). Strong positive correlations were found between the SWE findings and both the pain and the functional scale (VAS: p = 0.001; FFI: p = 0.012).

Conclusion: SWE allows quantitative assessment of the stiffness of the plantar fascia and can show PFis alterations, increasing the diagnostic performance of B-mode US. In addition, SWE shows a strong correlation with clinical scores, improving patient assessment and follow-up.
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http://dx.doi.org/10.1007/s40477-020-00474-7DOI Listing
May 2020

The recovery of reaching movement in breast cancer survivors: two different rehabilitative protocols in comparison.

Eur J Phys Rehabil Med 2021 Feb 14;57(1):137-147. Epub 2020 May 14.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy.

Background: Breast cancer (BC) is the most common cancer in women in the developed world. The about the sequelae of surgery, especially in case of mastectomy or modified radical mastectomy is grown. Nowadays it is important choose appropriate exercise programs to allow recovery in "quantity" but also in "quality" of the movement of the operated upper limb.

Aim: The aim of this study was to verify whether specific exercises for the scapula may induce changes in fluidity of the reaching movement.

Design: Randomized control-trial double-blind study.

Setting: Exercise training laboratory and gait analysis laboratory.

Population: Sixty-three breast cancer survivors were enrolled.

Methods: Participants randomized to single rehabilitative treatment (ST), or to group rehabilitative treatment (GT). VAS, DASH and a biomechanical evaluation of upper limb were performed for each group before treatment (T0=baseline), at the end rehabilitative treatment (T1) and after three months of follow-up (T2).

Results: Respect within group analysis, in the ST and in the GT, for VAS an improvement along evaluation times were observed, respectively at T0 to T1 and at T0 to T2 (P<0.001) without a statistically significant difference between groups. At the same, for the DASH, the results showed the same trend without a statistically significant difference between groups. For biomechanical parameters, at T2 velocity was statistically significantly greater in the ST than in the GT (P=0.029) in contrast with the duration, that was statistically significantly greater in the GT than in the ST (P=0.010).

Conclusions: Both protocols are effective in reducing pain and for functional recovery of the upper limb. The adoption of a non-intensive rehabilitation program should be implemented at least in the first year after the operation, with the adoption of specific myofascial exercises on the scapulo-thoracic joint with better results in the "qualitative" recovery of the achievement.

Clinical Rehabilitation Impact: Our study emphasizes the importance of rehabilitation in BC survivors after mastectomy, even during the course of radiotherapy and chemotherapy and the adoption of specific myofascial exercises on the scapulo-thoracic joint and specific exercises of muscular stretching on the pectoral muscle. Therefore, the proposed rehabilitation protocol must be "clipped" and "integrated" according to the specific objectives for each individual patient.
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http://dx.doi.org/10.23736/S1973-9087.20.06138-9DOI Listing
February 2021

Telemedicine from research to practice during the pandemic. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.

Eur J Phys Rehabil Med 2020 Jun 24;56(3):327-330. Epub 2020 Apr 24.

Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy.

COVID-19 pandemic is creating collateral damage to outpatients, whose rehabilitation services have been disrupted in most of the European countries. Telemedicine has been advocated as a possible solution. This paper reports the contents of the third Italian Society of Physical and Rehabilitation Medicine (SIMFER) webinar on "experiences from the field" COVID-19 impact on rehabilitation ("Covinars"). It provides readily available, first-hand information about the application of telemedicine in rehabilitation. The experiences reported were very different for population (number and health conditions), interventions, professionals, service payment, and technologies used. Commonalities included the pushing need due to the emergency, previous experiences, and a dynamic research and innovation environment. Lights included feasibility, results, reduction of isolation, cost decrease, stimulation to innovation, satisfaction of patients, families, and professionals beyond the starting diffidence. Shadows included that telemedicine can integrate but will never substitute face-to-face rehabilitation base on the encounter among human beings; age, and technology barriers (devices absence, bad connection and human diffidence) have also been reported. Possible issues included privacy and informed consent, payments, cultural difficulties in understanding that telemedicine is a real rehabilitation intervention. There was a final agreement that this experience will be incorporated by participants in their future services: technology is ready, but the real challenge is to change PRM physicians' and patients' habits, while better specific regulation is warranted.
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http://dx.doi.org/10.23736/S1973-9087.20.06331-5DOI Listing
June 2020

Data of patients undergoing rehabilitation programs.

Data Brief 2020 Jun 16;30:105419. Epub 2020 Mar 16.

Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy.

In this data article, we present a dataset made up of personal, social and clinical records related to patients undergoing a rehabilitation program. Data refers to records registered in the "Acceptance/Discharge Report for the rehabilitation area" (ADR) which implements the Italian law (DGR 731/2005) and refer to hospitalization at the rehabilitation hospital of Rome "San Raffaele" in the years from 2015 to 2018 of patients suffering from orthopedic and neurological pathologies. For each ADR report, the clinical status of the patient at the date of acceptance and discharge is reported using, among other, the Barthel index as a measure of the Activities Daily Living of the patient. These data can be used to understand the influence of many different factors in the rehabilitation progress of clinical patients.
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http://dx.doi.org/10.1016/j.dib.2020.105419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110331PMC
June 2020

Straighten your back! Self-correction posture and postural balance in "non rehabilitative instructed" multiple sclerosis patients.

NeuroRehabilitation 2020 ;46(3):333-341

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

Backgroud: Patients with MS, regardless of the complexity of the activity or sensory conditions, commonly present a significant postural control deficit compared to healthy subjects.

Objective: To investigate which postural self-correction strategies are adopted by patients with Multiple Sclerosis versus a group of healthy-subjects and how self-correction can influence the control of postural balance.

Methods: A case-control prospective observational study was conducted. Person with Multiple Sclerosis and a group of healthy volunteers were enrolled. Patients included were instructed with vocal commands, to reach a self-correction posture, and they were compared to healthy subjects. Clinical assessments including Balance, Stabilometry and Postural evaluation of the spine were performed.

Results: Sixty patients (30: control-group; 30: treatment-group) were enrolled. In the treatment group, the analysis reported a significant statistical difference between path length and center of pressure speed in self-correction posture with closed-eyes (p = 0,049; 0,047) and an improvement in C7 and L3 levels in self-correction posture (p < 0,01-C7; p < 0,01-L3). There are significant statistical differences about path length between the two groups in all examined conditions (p = 0,0001). At sagittal plane evaluation, results show an increase of all measurements in both posture (C7-neutral posture p = 0,0001; L3-neutral posture p = 0,0001; C7-self-correction posture p = 0,0001; L3-self-correction posture p = 0,0001).

Conclusion: Further study should investigate dynamic situations and different Multiple Sclerosis forms to complete balance analysis and to establish a correct rehabilitative program with self-correction exercise as powerful focus.
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http://dx.doi.org/10.3233/NRE-192987DOI Listing
October 2020

Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER).

Eur J Phys Rehabil Med 2020 Jun 16;56(3):316-318. Epub 2020 Mar 16.

Department of Physical and Rehabilitation Medicine, University of Foggia, Foggia, Italy.

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http://dx.doi.org/10.23736/S1973-9087.20.06256-5DOI Listing
June 2020

Sagittal spinal alignment in patients with ankylosing spondylitis by rasterstereographic back shape analysis: an observational retrospective study.

Eur J Phys Rehabil Med 2020 Apr 10;56(2):191-196. Epub 2020 Feb 10.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, La Sapienza University, Rome, Italy.

Background: Ankylosing spondylitis (AS) is a chronic-inflammatory disorder involving the sacroiliac-joints, spine, and spinal ligaments. A proper understanding of the sagittal plane alignment and posture is essential in managing deformities of the spine.

Aim: The aim of this study was to evaluate the differences in sagittal plane alignment between patients with AS and healthy subjects by means of rasterstereography and to analyze the relationship between clinical assessments and postural features.

Design: Observational retrospective study.

Setting: This study took place from January 2012 to April 2014 at the rheumatologic out-patient clinic, Umberto I Hospital, Rome, Italy.

Population: Forty-six healthy subjects and twenty-five AS patients were enrolled in the study.

Methods: Spinal posture was measured by the rasterstereographic system Formetric 4D. Trunk inclination, kyphosis angle, lordosis angle, cervical and lumbar plumbline distance, and sagittal pelvic alignment were analyzed. Differences between the two groups in postural parameters were compared (primary outcomes). Multiple regression analysis was used to evaluate if postural parameters could be predicted by the Bath Ankylosing Spondylitis Metrology Index (BASMI) that is a composite index of spinal mobility, disease duration and body mass index (secondary outcomes).

Results: Patients with AS showed a significant increase in the kyphosis angle and the cervical plumbline distance and a significant reduction in the lordosis angle and the sagittal pelvic alignment when compared to healthy subjects. According to multiple regression analysis, BASMI influenced the kyphosis angle value with a standardized coefficient β of 1.93, the lordosis-angle value with a standardized coefficient β of -2.79 and sagittal pelvic alignment value with a standardized coefficient-β of -2.93.

Conclusions: Rasterstereography has proved to be a valid tool in monitoring change in spinal structure in AS patients and has shown a strong correlation with clinimetric parameters of AS (BASMI). Future studies are needed, with a greater number of patients, in order to better characterize the evidently existing relationship between postural changes in AS patients and rasterstereography.

Clinical Rehabilitation Impact: Rasterstereography has proved to be a valid tool in monitoring postural changes in AS patients and has shown a strong correlation with clinical evaluations. Therefore, the assessment of postural characteristics using the rasterstereographic system before and after a specific exercise program would be a reliable and valid advice without exposing subjects to high doses of radiations.
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http://dx.doi.org/10.23736/S1973-9087.20.05993-6DOI Listing
April 2020

Elastosonographic evaluation after extracorporeal shockwave treatment in plantar fasciopathy.

Med Ultrason 2019 Nov;21(4):399-404

Department of Radiology, "Sapienza", University of Rome, Italy.

Aim: To assess the ultrasound features in patients with plantar fasciopathy before and after extracorporeal shock waves therapy (ESWT), using conventional grey-scale imaging and both strain (SE) and shear wave (SWE) elastosonographic evaluation.

Material And Method: Consecutive patients of both sexes attending our outpatient's clinic, with diagnosis of unilateral plantar fasciopathy, were enrolled. Patients were treated with 3 sessions of ESWT once a week, and underwent clinical and ultrasound evaluation at baseline and at one and three months after treatment. Roles and Maudsley score (RM), visual analog scale (VAS) and 17-Italian Foot Function Index (FFI), were used to assess pain and functional improvement.

Results: Twenty patients (11 female and 9 male) were enrolled in the study. Contralateral asymptomatic healthy plantar fascia was used as a control. At baseline, SWE velocity (SWEv) showed statistically significant difference between affected 3.8 (1.5; 5.1) m/s and healthy side 4.7 (4.07; 7.04) m/s, (p=0.006); no significant difference was found for strain ratio values (p=0.656). SWEv post hoc test results showed a significant difference from baseline 3.8 (1.5-5.1) m/s and three month 5.23 (4.55-6.74) m/s follow up visit (p=0.003). Significant statistical negative correlation was found between the SWEv and VAS (p=0.001) and positive correlation between the SWEv and FFI (p=0.012).

Conclusion: SWE was effective in assessing plantar fascia elasticity and its alteration in fasciopathy. Furthermore, on the basis of the correlation with pain and functional scales, this technique appears to be a useful additional technique to conventional ultrasound for monitoring the efficacy of treatment.
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http://dx.doi.org/10.11152/mu-1976DOI Listing
November 2019

Changes in Spine Alignment and Postural Balance After Breast Cancer Surgery: A Rehabilitative Point of View.

Biores Open Access 2019 30;8(1):121-128. Epub 2019 Jul 30.

Umberto I University Hospital, Rome, Italy.

Breast cancer is the most common malignant tumor in female patients in developed countries. Recent articles indicate that one-sided mastectomy or minor breast surgery to treat breast cancer can have deleterious effects on posture and the musculoskeletal system. The purpose of this study was to investigate the alterations post-breast cancer surgery of the spine alignment associated to the balance not reported by the noninvasive instrumentation. We enrolled 30 women who had undergone treatment for breast cancer (BG) and were on a waiting-list for rehabilitation treatment and a control group of 30 healthy volunteer women (CG), matched by age and body mass index. The stabilometry was performed using a force platform (Kistler Instruments, Winterthur, Switzerland) test during quiet standing with closed-eyes (EC) and open-eyes (EO), recording the position of the center of pressure (CoP) for 51.2 sec. The stabilogram or the time plot of the two coordinates, X and Y, of the CoP was obtained, which represent anteroposterior and midlateral balance. Spinal posture was measured using the Formetric-4D rasterstereographic system (DIERS, International GmbH, Schlangenbad, Germany), and thoracic kyphotic angle, lumbar lordotic angle, and surface trunk rotation were evaluated. Sixty participants were analyzed (CG:30; BG:30). For the spine rasterstereography a statistically significant difference was shown with regard to anterior-posterior flexion of the trunk major in BG; pelvic inclination and twist of half-pelvis decreased in BG; normalized lumbosacral inversion point decreased in BG; surface rotation major in BG; and lateral deviation major in BG. Compared with the values for the stabilometry test with EO and EC, a statistically significant difference was observed, respectively, for ellipse length (mm;  = 0.04) and ellipse area (mm;  = 0.04) with EO and in ellipse area (mm) with EC ( = 0.05), increased in BG for both conditions. No difference was shown for CoP velocity and oscillations between the groups. Breast cancer survivors after prostheses or tissue expanders for mastectomy showed a spine's misalignment present both on the sagittal plane, both on the coronal and frontal plane, increased in BG regard to anterior-posterior flexion of the trunk, surface rotation, and lateral deviation. It is associated with greater energy expenditure for the postural balance control increased in BG with a major ellipse area in EO and EC conditions and major ellipse length in EC condition.
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http://dx.doi.org/10.1089/biores.2018.0045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664823PMC
July 2019

Therapeutic Alliance in a Single Versus Group Rehabilitative Setting After Breast Cancer Surgery: Psychological Profile and Performance Rehabilitation.

Biores Open Access 2019 3;8(1):101-110. Epub 2019 Jul 3.

Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

The survival rate of women after breast cancer has improved significantly worldwide. More attention should be paid to the rehabilitation intervention after surgery. Cancer rehabilitation helps breast cancer survivors maintain the highest possible physical, social, psychological, and vocational function in the limits that are imposed by the cancer and its treatments. The aim of our research was to determine the rehabilitative setting that promotes greater efficacy of the rehabilitation. A double-blind, randomized controlled trial with 45 patients enrolled was conducted. All participants were randomized into two groups: single rehabilitative training ( = 22) and group rehabilitative training ( = 23). Outcomes were assessed for each group before treatment (T0), after first 6 weeks of rehabilitative treatment (T1), and after 3 months (T2). All patients underwent the same rehabilitation treatment, but the setting differed between single and group rehabilitative training, which included four to five patients each and evaluated using Minnesota Multiphasic Personality Inventory (MMPI-2), Working Alliance Inventory Patient form (WAIP), Disabilities of Arm, Shoulder and Hand Questionnaire (DASH), and visual analog scale (VAS). Two patients dropped out in the single treatment group. In the within-group analysis at the three evaluation times, on the VAS, a significant reduction in pain was reported and maintained at the follow-up, as was observed for the DASH and WAIP scales. In the between-group analysis WAIP and Bond scale scores differed significantly in favor of the single treatment. In the group treatment, the Psychopathic Deviate, Masculine/Feminine, and Social Discomfort scales of the MMPI-2 correlated with WAIP Tot at T1. There was an association between the Correction, Hysteria, Paranoid, and Schizophrenia MMPI-2 scales and Δ VAS T0T1 in the total sample. Proposing the same rehabilitative intervention in both breast cancer groups, our results showed significant reduction in pain and good functional recovery of the upper limb, which did not depend on the setting (single or group). However, with single rehabilitation treatment, patients developed a better therapeutic alliance and experienced a more comfortable environment.
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http://dx.doi.org/10.1089/biores.2019.0011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607049PMC
July 2019

Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy.

Int J Biometeorol 2020 Jun 26;64(6):905-914. Epub 2019 May 26.

Department of Physical Medicine and Rehabilitation, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.

Spa therapy is a heterogeneous collection of treatments and methods based on natural resources. It is often considered as an option in the common therapeutic approach to many musculoskeletal disorders, as well as respiratory, vascular, and dermatological disorders. The objective of this paper is to highlight possible interactions between rehabilitation and spa medicine in the field of musculoskeletal disorders, through an analysis of the scientific literature, in order to give the practitioner the ability to integrate good clinical practice in the field of rehabilitation through practical application involving spa therapies. The literature search was conducted using Medline, PEDro, Cochrane Database, and Google Scholar. Only studies published in English and works concerning the implementation of spa thermal treatment in neuro-musculoskeletal diseases were included. Specifically, the publications analyzed dealt with the treatment of diseases such as arthritis, rheumatic arthritis, ankylosing spondylitis, and low back pain through the use of thermal spa therapies. In conjunction with its widespread use in clinical practice, many studies in the literature suggest the effectiveness of crenobalneotherapy for a number of musculoskeletal disorders, generally those which are chronic and debilitating, finding significant clinical improvement both in terms of pain and functional limitations. Some of the guidelines formulated by national and international bodies on the treatment of specific diseases, such as the Italian Rheumatology Society (SIR) and the Osteoarthritis Research Society International (OARSI) guidelines, recognize the value of thermal medicine as a complement, but not a replacement, for conventional therapy (pharmacological or not).
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http://dx.doi.org/10.1007/s00484-019-01731-zDOI Listing
June 2020

Appropriateness of clinical criteria for the use of SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOA). A Delphi Method Consensus initiative among experts in Italy.

Eur J Phys Rehabil Med 2019 Oct 15;55(5):658-664. Epub 2019 May 15.

Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.

Background: Osteoarthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, etiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic information, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations are not made.

Aim: Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA.

Design: Delphi method Consenus Statement.

Population: Italian Physicians having expertise in Osteoarthritis management.

Methods: A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centers specialized in osteoarthritis management took part in a Delphi process which was aimed at obtaining consensus statements among the participants.

Results: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy.

Conclusions: Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses.

Clinical Rehabilitation Impact: This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA.
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http://dx.doi.org/10.23736/S1973-9087.19.05633-8DOI Listing
October 2019

Give me a kiss! An integrative rehabilitative training program with motor imagery and mirror therapy for recovery of facial palsy.

Eur J Phys Rehabil Med 2020 Feb 27;56(1):58-67. Epub 2019 Mar 27.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.

Background: Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another.

Aim: The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach.

Design: This study was designed as a double-blind, randomized, controlled trial.

Setting: This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation of Umberto I Polyclinic Hospital, Rome, Italy.

Population: Twenty-two patients were randomized into two groups: the mirror therapy group (N.=11, MT and MI) and the traditional rehabilitation group (N.=11, mime-therapy and a myofascial-approach).

Methods: Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up).

Results: The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression.

Conclusions: The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic.

Clinical Rehabilitation Impact: The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves.
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http://dx.doi.org/10.23736/S1973-9087.19.05757-5DOI Listing
February 2020

Peroneus Brevis flap in Achilles tendon reconstruction. Clinical, radiological and functional analysis.

Foot Ankle Surg 2020 Feb 23;26(2):218-223. Epub 2019 Feb 23.

Department of Plastic Surgery, Clinica Mater Dei, Rome, Italy.

Background: We would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps.

Methods: Eight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients' outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery.

Results: Effective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests' results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients' quality of life.

Conclusions: In the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site's low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial.
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http://dx.doi.org/10.1016/j.fas.2019.02.004DOI Listing
February 2020

Beyond the gait: a useful approach in assessing motor performance in old people.

Aging Clin Exp Res 2019 Feb 2;31(2):291-292. Epub 2019 Jan 2.

IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy.

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http://dx.doi.org/10.1007/s40520-018-1103-xDOI Listing
February 2019
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