Publications by authors named "Francesca Bonetti"

21 Publications

  • Page 1 of 1

Carpal Tunnel Syndrome: A National Survey to Monitor Knowledge and Operating Methods.

Int J Environ Res Public Health 2021 02 18;18(4). Epub 2021 Feb 18.

Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy.

The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents ( = 225/508; 44.3%) are under 29 years old, female ( = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years ( = 213/508; 41.9%). Most of respondents correctly knows about the cause ( = 455/508, 89.6%), main signs and symptoms of CTS ( = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises ( = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient's outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master's degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.
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February 2021

Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities.

Arch Physiother 2020 2;10:16. Epub 2020 Sep 2.

Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health - University of Genova - Campus of Savona, Savona, Italy.

Background And Aim: The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons.

Materials And Methods: An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS.

Results: Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent ( = 470) of the OMPTs and 80.5% ( = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy ( = < 0.001). Twenty point seven % of OMPTs ( = 106) and 4.7% of orthopaedic surgeon ( = 6) stated that the Lift off was the most specific test ( = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination ( < 0.001).

Conclusion: OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
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September 2020

Microsaccades inhibition triggered by a repetitive visual distractor is not subject to habituation: Implications for the programming of reflexive saccades.

Cortex 2020 10 14;131:251-264. Epub 2020 Aug 14.

Center for Mind/Brain Sciences, University of Trento, Italy. Electronic address:

The oculomotor capture triggered by a peripheral onset is subject to habituation, a basic form of learning consisting in a response decrement toward a repeatedly presented stimulus. However, it is unclear whether habituation of reflexive saccades takes place at the saccadic programming or execution stage (or both). To address this issue, we exploited the fact that during fixation the programming of a reflexive saccade exerts a robust but short-lasting phasic inhibition in the absolute microsaccadic frequency. Hence, if habituation of reflexive saccades occurs at the programming stage, then this should also affect the microsaccadic frequency, with a progressive reduction of the inhibitory phase. Conversely, if habituation occurs only at the later stage of saccade execution, the no change in the microsaccadic pattern is expected. Participants were repeatedly exposed to a peripheral onset distractor, and when eye movements were allowed, we replicated the oculomotor capture habituation. Crucially, however, when fixation was maintained the microsaccadic response did not change as exposure to the onset progressed, suggesting that habituation of reflexive saccades does not take place at the programming stage in the superior colliculus (SC), but at the later stage of saccade execution in the brainstem, where the competition between different saccades might be resolved. This scenario challenges one of the main assumptions of the competitive integration model for oculomotor control, which assumes that competition between exogenous and endogenous saccade programs occurs in the (SC). Our results and interpretation are instead in agreement with neurophysiological studies in non-human primates showing that saccadic adaption, another form of oculomotor plasticity, takes place downstream from the SC.
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October 2020

Land Plus Aquatic Therapy Versus Land-Based Rehabilitation Alone for the Treatment of Freezing of Gait in Parkinson Disease: A Randomized Controlled Trial.

Phys Ther 2019 05;99(5):591-600

Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital.

Background: Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). Different land-based rehabilitation approaches based on motor and cognitive strategies can be effective in treating FOG. Although there are data about the efficacy of aquatic therapy in ameliorating this phenomenon, no study has explored the combined effect of land-based therapies plus aquatic therapy in patients with PD who have FOG.

Objective: The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether implementation with aquatic therapy (MIRT-AT) adds further benefits.

Design: The design consisted of a single-blind, parallel-group, 1:1 allocation ratio, randomized trial.

Setting: The Department of Parkinson Disease, Movement Disorders and Brain Injury Rehabilitation at "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como, Italy) was used as the setting.

Participants: Sixty hospitalized patients with PD who had FOG in Hoehn and Yahr stage 2 or 5-3 were included.

Intervention: Sixty patients with PD + FOG were randomly assigned to 2 groups: 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT-AT.

Measurements: The primary outcome measure was the Freezing of Gait Questionnaire; secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale, Timed Up and Go Test, and 6-Minute Walk Test. These measures were assessed both at admission and discharge.

Results: Participants in the 2 groups had similar age, sex distribution, Hoehn and Yahr stage, and most-affected side. At baseline, no difference in outcome measures was observed between the 2 groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time × group interaction was observed. A between-group analysis showed nonsignificant differences between values at T1 and values at T0 for all variables.

Limitations: The limitations were the lack of a control group and follow-up.

Conclusions: We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improves FOG in patients with PD. Although aquatic therapy could be considered a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.
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May 2019

Habituation of oculomotor capture by sudden onsets: Stimulus specificity, spontaneous recovery and dishabituation.

J Exp Psychol Hum Percept Perform 2019 Feb 20;45(2):264-284. Epub 2018 Dec 20.

Center for Mind/Brain Sciences.

Previous studies have confirmed that visual onsets are very powerful in attracting our gaze. The reflexive saccades triggered by sudden onsets have a high adaptive value because they ensure a rapid inspection of potentially appetitive or dangerous events. Here we showed, however, that such exogenously driven saccades are rapidly attenuated as the exposure to the same irrelevant onset progresses. Crucially, we found that such decrement in oculomotor capture conforms to several key features of habituation, an ancestral and widespread form of learning, consisting in a response reduction to a repeated irrelevant stimulation. In addition, we documented both spontaneous recovery and specificity of habituation, the phenomenon of dishabituation, and that habituation of capture was stimulation-frequency dependent. We also found both short-term and long-term habituation of oculomotor capture. Although we cannot exclude the contribution of top-down strategic inhibitory mechanisms to filter the onset distractors, the oculomotor capture reduction that we have documented finds a straightforward explanation in the neural and cognitive mechanisms underlying habituation of the orienting reflex, as originally suggested by Sokolov. Our study lends support to the idea that habituation plays a key filtering role in regulating the exogenous saccadic response triggered by peripheral onset distractors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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February 2019

Development, validity and reliability of the Italian version of the Copenhagen neck functional disability scale.

BMC Musculoskelet Disord 2018 Nov 23;19(1):409. Epub 2018 Nov 23.

Physioup, Via Novacella 19, 00142, Roma, Roma, Italy.

Background: Valid and reliable patient-reported outcome measures support health professionals in evaluating the results of clinical research and practice. The Copenhagen Neck Functional Disability Scale (CNFDS) has shown promising measurement properties to measure disability in patients with neck pain, but an Italian version of this questionnaire is not available. The objective of this study was to cross-culturally adapt the CNFDS into Italian (CNFDS-I), and to assess its validity and reliability in patients with neck pain.

Methods: The CNFDS-I was developed according to well-established guidelines for cross-cultural adaptation of patient-reported outcome measures. A cross-sectional clinimetric study was conducted to evaluate its validity and reliability. Patients with chronic neck pain (pain > 3 months) participated in this study. The following measurement properties (defined by the COSMIN initiative) were assessed: structural validity (exploratory factor analysis), internal consistency (Cronbach's α), construct validity [by testing hypotheses on expected correlations with the Neck Disability Index (NDI), the Neck Bournemouth Questionnaire (NBQ), and pain Visual Analogue Scale (VAS)]. Test-retest reliability [Intraclass Correlation Coefficient for agreement (ICCagreement)], and measurement error [Smallest Detectable Change (SDC)] were also assessed in 50 clinically stable patients. Floor/ceiling effects and acceptability were calculated.

Results: One-hundred and sixty-two patients (mean age = 47.9 ± 14.5 years, 70% female) were included. The CNFDS-I exhibited sufficient unidimensionality (one factor explained 83% of the variability) and internal consistency (α = 0.83). Construct validity was sufficient as all correlations with the other questionnaires were as expected (r = 0.846 with NDI, r = 0.708 with NBQ, r = 0.570 with VAS). Test-retest reliability was excellent (ICCagreement = 0.99, 95% CI from 0.995 to 0.999), while measurement error was equal to 8.31 scale points (27% scale range). No floor/ceiling effects were detected. The average time for filling the questionnaire was two minutes.

Conclusions: The CNFDS-I proved to be a valid and reliable outcome measure to assess disability in patients with chronic neck pain. Head-to-head comparison studies on the CNFDS-I measurement properties against other disability measures for neck pain (e.g. NDI and NBQ) are required to determine the relative merits of these different measures.
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November 2018

Desensitizing the attention system to distraction while idling: A new latent learning phenomenon in the visual attention domain.

J Exp Psychol Gen 2018 Dec 25;147(12):1827-1850. Epub 2018 Oct 25.

Department of Neuroscience, Biomedicine, & Movement Sciences, University of Verona.

For the good and the bad, the world around us is full of distraction. In particular, onset stimuli that appear abruptly in the scene grab attention, thus disrupting the ongoing task. Different cognitive mechanisms for distractor filtering have been proposed, but prevalent accounts share the idea that filtering is accomplished to shield target processing from interference. Here we provide novel evidence that challenges this view, as passive exposure to a repeating visual onset is sufficient to trigger learning-dependent mechanisms to filter the unwanted stimulation. In other words, our study shows that during passive exposure the cognitive system is capable of learning about the characteristics of the salient yet irrelevant stimulation, and to reduce the responsiveness of the attention system to it, thus significantly decreasing the impact of the distractor upon start of an active task. However, despite passive viewing efficiently attenuates the spatial capture of attention, a short-lived performance cost is found when the distractor is initially encountered within the context of the active task. This cost, which dissipates in a few trials, likely reflects the need to familiarize with the distractor, already seen during passive viewing, in the new context of the active task. Although top-down inhibitory signals can be applied to distractors for the successful completion of goal-directed behavior, our results emphasize the role of more automatic habituation mechanisms for distraction exclusion based on a neural model of the history of the irrelevant stimulation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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December 2018

Filtering visual onsets via habituation: A context-specific long-term memory of irrelevant stimuli.

Psychon Bull Rev 2018 06;25(3):1028-1034

Department of Psychology, University of Fribourg, Fribourg, Switzerland.

The fact that we are often immediately attracted by sudden visual onsets provides a clear advantage for our survival. However, how can we resist from being continuously distracted by irrelevant repetitive onsets? Since the seminal work of Sokolov (1963), habituation of the orienting of attention has long been proposed to be a possible filtering mechanism. Here, in two experiments, we provide novel evidence showing that (a) habituation of capture of focused visual attention relies on a stored representation of the distractor onsets in relation to their context, and (b) that once formed such representation endures unchanged for weeks without any further exposure to the distractors. In agreement with the proposal of Wagner (1979) concerning the associative nature of habituation, the results of Experiment 1 suggest that habituation of attentional capture is context specific. Furthermore, the results of Experiment 2 show that to filter visual distractors our cognitive system uses long-lasting memories of the irrelevant information. Although distractor filtering can be implemented via top-down inhibitory control, neural and cognitive mechanisms underlying habituation provide a straightforward explanation for the reduced distraction obtained with training, thus working like an automatic filter that prevents irrelevant recurring stimuli from gaining access to higher stages of analysis.
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June 2018

Patient-reported outcome measures for non-specific neck pain validated in the Italian-language: a systematic review.

Arch Physiother 2016 22;6. Epub 2016 Jul 22.

Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, IRCCS, Veruno, NO Italy.

Background: Patient-reported outcome measures can improve the management of patients with non-specific neck pain. The choice of measure greatly depends on its content and psychometric properties. Most questionnaires were developed for English-speaking people, and need to undergo cross-cultural validation for use in different language contexts. To help Italian clinicians select the most appropriate tool, we systematically reviewed the validated Italian-language outcome measures for non-specific neck pain, and analyzed their psychometric properties and clinical utility.

Methods: The search was performed in MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Library. All articles published in English or Italian regarding the development, translation, or validation of patient-reported outcome measures available in the Italian language were included. Two reviewers independently selected the studies, extracted data, and assessed methodological quality using the COSMIN checklist.

Results: Out of 4891articles screened, 66 were eligible. Overall, they were of poor or fair methodological quality. Four instruments measuring function and disability (Neck Disability Index, Neck Pain and Disability Scale, Neck Bournemouth Questionnaire, and Core Outcome Measures Index), and one measuring activity-related fear of movement (NeckPix©) were identified. Each scale showed some psychometric weaknesses or problems with functioning, and none emerged as a gold standard.

Conclusions: Several patient-reported outcome measures are now available for assessing Italian people with non-specific neck pain. While the Neck Disability Index is the one most widely used, the Neck Bournemouth Questionnaire appears the most promising tool from a psychometric point of view.
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July 2016

Basilar impression presenting as intermittent mechanical neck pain: a rare case report.

BMC Musculoskelet Disord 2016 Jan 11;17. Epub 2016 Jan 11.

Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA.

Background: Neck pain is one of the most common musculoskeletal disorders in clinical practice. However neck pain may mask more serious pathology. Although uncommon in most musculoskeletal physiotherapy practices, it is possible to encounter rare and extremely life-threatening conditions, such as craniovertebral congenital anomalies. Basilar invagination is an abnormality where the odontoid peg projects above the foramen magnum and is the commonest malformation of the craniocervical junction. Its prevalence in the general population is estimated to be 1%. Furthermore, it is a well-recognised cause of neck pain insomuch as it can be easily overlooked and mistaken for a musculoskeletal disorder. Diagnosis is based on the patient's symptoms in conjunction with magnetic resonance imaging (MRI). If life-threatening symptoms, or pressure on the spinal cord are present, the recommended treatment is typically surgical correction.

Case Presentation: This case report describes the history, relevant examination findings, and clinical reasoning used for a 37 year old male who had the chief complaint of neck pain and occipital headache. After the history and the physical examination, there were several key indicators in the patient's presentation that appeared to warrant further investigation with diagnostic imaging: (1) the drop attack after a triggering event (i.e., heading a football), (2) several episodes of facial numbness immediately and shortly after the trauma, (3) the poorly defined muscle upper extremity muscle weakness, and (4) the modification of symptoms during the modified Sharp-Purser test. Therefore, the decision was made to contact the referring neurosurgeon to discuss the patient's history and his physical examination. The physician requested immediate cervical spine MRI, which revealed a "basilar impression".

Conclusion: This case report highlights the need for more research into a number of issues surrounding the prevalence, diagnosis, and the central role of primary care clinicians such as physiotherapists. Furthermore it underlines the importance of including Basilar invagination in the differential diagnosis. Physiotherapists working within a direct access environment must take a comprehensive history and be capable of screening for non-musculoskeletal medical conditions (on a systems, not diagnosis level) in order to avoid providing potentially harmful musculoskeletal treatments (e.g., cervical mobilization or manipulation, stretching, exercise) to patients with sinister medical pathologies, not benign musculoskeletal disorders.
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January 2016

Rasch analysis of the Neck Bournemouth Questionnaire to measure disability related to chronic neck pain.

J Rehabil Med 2015 Oct;47(9):836-43

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy.

Objective: To determine the psychometric properties of the Neck Bournemouth Questionnaire in patients with chronic neck pain, using Rasch analysis.

Methods: A sample of 161 subjects with chronic neck pain was assessed with the Neck Bournemouth Questionnaire. Before performing Rasch analysis, we examined the structure of the scale with factor analysis. The goodness-of-fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items, differential item functioning, person separation index, and mean person's location were assessed.

Results: Both exploratory and confirmatory factor analyses supported the presence of 2 factors. Only Factor 1 needed a modification (item 7 removal) in order to achieve the fit to the Rasch model (χ2 = 10.65, df 8, p = 0.22). The person separation index was 0.80 and the mean location of persons 0.48 (standard deviation (SD) 1.02). Factor 2 (items 4 and 5) fitted the model without modifications (χ2 = 3.86, df 4, p = 0.42). Its person separation index and mean person's location were, respectively, 0.77 and -0.71 (SD 1.57).

Conclusion: The Neck Bournemouth Questionnaire with the purposed modification may provide useful clinical profiles and change scores of subjects with chronic neck pain for research purposes.
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October 2015

A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice.

Chiropr Man Therap 2015 8;23:14. Epub 2015 Apr 8.

Master of Manual Therapy and Musculoskeletal Rehabilitation, Department of Molecular Medicine, University of Padova, Padova, Italy.

Background: Several clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice.

Methods: We searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales.

Results: Six papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97). The diagnostic accuracy of AMP depends on each singular test. The PIT and the PST demonstrated by fair to moderate sensitivity and specificity [PIT sensitivity = 0.71 (95% CI: 0.51 - 0.83), PIT specificity = 0.57 (95% CI: 039 - 0.78); PST sensitivity = 0.50 (95% CI: 0.41 - 0.76), PST specificity = 0.48 (95% CI: 0.22 - 0.58)]. The PLE showed a good reliability (k = 0.76), but this result comes from a single study. The inter-rater reliability of the PIT ranged by slight (k = 0.10 and 0.04), to good (k = 0.87). The inter-rater reliability of the AMP ranged by slight (k = -0.07) to moderate (k = 0.64), whereas the inter-rater reliability of the PST was fair (k = 0.27).

Conclusions: The data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients.
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April 2015

Rasch Analysis of the Italian version of Pain Catastrophizing Scale (PCS-I).

J Back Musculoskelet Rehabil 2015 ;28(4):661-73

Department of Biomedical and Neuromotor Sciences, University of Bologna, PT, Italy.

Objective: The aim of this study was to investigate the psychometric properties of the Italian version of the Pain Catastrophizing Scale (PCS-I) in patients with chronic low back pain.

Methods: In a cross sectional study a total of 150 subjects with chronic low back pain were included. The Italian translation of the PCS was administered to all subjects. The properties of the Italian version of the PCS were explored by a Rasch analysis.

Results: The PCS-I, by means of few modifications, fitted the Rasch model and passed the independent t-test for a unidimensional scale. The response categories for item 2 ``I fell I can't go on'' needed to be collapsed from 4 to 3 levels. Only the item 7 ``I keep thinking to of other painful events'' showed fit residual that exceeded the chosen thresholds of ± 2.5. No Differential functioning (DIF) was observed for age, sex, marital status, BMI and smoking.

Conclusion: The Italian version of PCS, with the purposed modifications, seems to reflect a unidimensional construct of Pain Catastrophizing. The scale seemed to be quite robust across age, sex, marital status, BMI and smoking. Targeting of the scale was moderate. A raw score to metric conversion was proposed.
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July 2016

Rasch analysis of the Italian version of fear avoidance beliefs questionnaire (FABQ-I).

Disabil Rehabil 2015 25;37(2):151-7. Epub 2014 Apr 25.

Department of Translational Medicine and Surgery, Program in Physical Therapy, University of Milan Bicocca , Monza , Italy .

Purpose: To perform a Rasch analysis (RA) of the Fear Avoidance Beliefs questionnaire (FABQ-I) in a sample of chronic non-specific low back pain (CLBP) patients. The RA is expected to provide information about the internal construct validity and all the single items consistency of the FABQ-I and then contributing to the knowledge about the questionnaire's clinimetric properties.

Methods: One hundred and fifty subjects with CLBP were enrolled into the study. The FABQ-I have been studied by means of RA. The sample size needed to obtain stable person, item and rating-scale calibrations for use with the Rasch model was based on the level of error expected in the measure.

Results: RA did not support the total scale as an unidimensional measure of Fear Avodiance Beliefs. Also the analysis of the Physical Activity (PA) and Word (WO) subscales as well as the attempts of manipulation failed in achieving an acceptable fit to the Rasch model.

Conclusion: FABQ-I may be considered to reflect a multiple psychological constructs describing scale. The raw score of the FABQ-I and changes in scores must be interpreted with caution because as a general measure of fear avoid beliefs was not supported.
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September 2015

The Italian version of the Physical Therapy Patient Satisfaction Questionnaire - [PTPSQ-I(15)]: psychometric properties in a sample of inpatients.

BMC Musculoskelet Disord 2014 Apr 23;15:135. Epub 2014 Apr 23.

Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Background: In a previous study we described the translation, cultural adaptation, and validation of the Italian version of the PTPSQ [PTPSQ-I(15)] in outpatients. To the authors' knowledge, the PTPSQ was never studied in a hospital setting.The aims of this study were: (1) to establish the psychometric properties of the Physical Therapy Patient Satisfaction Questionnaire [PTPSQ- I(15)] in a sample of Italian inpatients, and (2) to investigate the relationships between the characteristics of patients and physical therapists and the indicators of satisfaction.

Methods: The PTPSQ-I(15) was administered to inpatients in a Physical Medicine and Rehabilitation Unit. Reliability of the PTPSQ-I(15) was measured by internal consistency (Cronbach's α) and test-retest stability (ICC 3,1). The internal structure was investigated by factor analysis. Divergent validity was measured by comparing the PTPSQ-I(15) with a Visual Analogue Scale (VAS) for pain and with a 5-point Likert-type scale evaluating the Global Perceived Effect (GPE) of the physical therapy treatment.

Results: The PTPSQ-I(15) was administered to 148 inpatients, and 73 completed a second administration. The PTPSQ-I(15) showed high internal consistency (α = 0.949) and test-retest stability (ICC = 0.996). Divergent validity was moderate for the GPE (r = - 0.502, P < 0.001) and strong for the VAS (r = -0.17, P = 0.07). Factor analysis showed a one-factor structure.

Conclusions: The administration of PTPSQ-I(15) to inpatients demonstrated strong psychometric properties and its use can be recommended with Italian-speaking population. Further studies are suggested on the concurrent validity and on the psychometric properties of the PTPSQ-I(15) in different hospital settings or with other pathological conditions.
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April 2014

Cross-cultural adaptation and validation of the Physical Therapy Outpatient Satisfaction Survey in an Italian musculoskeletal population.

BMC Musculoskelet Disord 2013 Apr 5;14:125. Epub 2013 Apr 5.

Department of Biomedical and Neuromotor Sciences (DIBINEM) Alma Mater Studiorum, University of Bologna, Via Pelagio Palagi 9, Bologna 40138, Italy.

Background: Although patient satisfaction is a relevant outcome measure for health care providers, few satisfaction questionnaires have been generally available to physical therapists or have been validated in an Italian population for use in the outpatient setting. The aim of this study was to translate, culturally adapt, and validate the Italian version of the Physical Therapy Outpatient Satisfaction Survey (PTOPS).

Methods: The Italian version of the PTOPS (PTOPS-I) was developed through forward-backward translation, review, and field-testing a pre-final version. The reliability of the final questionnaire was measured by internal consistency and test-retest stability at 7 days. Factor analysis was also used to explore construct validity. Concurrent validity was measured by comparing PTOPS-I with a 5-point Likert-type scale measure assessing the Global Perceived Effect (GPE) of the treatment and with a Visual Analogue Scale (VAS).

Results: 354 outpatients completed the PTOPS-I, and 56 took the re-test. The internal consistency (Cronbach's alpha) of the original domains (Enhancers, Detractors, Location, and Cost) was 0.758 for Enhancers, 0.847 for Detractors, 0.885 for Location, and 0.706 for Cost. The test-retest stability (Intra-class Correlation Coefficients) was 0.769 for Enhancers, 0.893 for Detractors, 0.862 for Location, and 0.862 for Cost. The factor analysis of the Italian version revealed a structure into four domains, named Depersonalization, Inaccessibility, Ambience, and Cost. Concurrent validity with GPE was significantly demonstrated for all domains except Inaccessibility. Irrelevant or non-significant correlations were observed with VAS.

Conclusion: The PTOPS-I showed good psychometric properties. Its use can be suggested for Italian-speaking outpatients who receive physical therapy.
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April 2013

Italian version of the physical therapy patient satisfaction questionnaire: cross-cultural adaptation and psychometric properties.

Phys Ther 2013 Jul 4;93(7):911-22. Epub 2013 Apr 4.

Department of Biomedical and Neuromotor Sciences-DIBINEM, Alma Mater Studiorum, University of Bologna, Bologna, Italy.

Background: Patient satisfaction is an important measure for evaluating interventions in health care. No patient satisfaction questionnaire for physical therapy treatment has been validated to date for use in an Italian outpatient population.

Objective: The aim of this study was to translate, culturally adapt, and validate the Italian version of the Physical Therapy Patient Satisfaction Questionnaire (PTPSQ-I).

Design: A measurement study was conducted.

Methods: The PTPSQ-I was developed through forward-backward translation, final review, and pre-final version. An acceptability analysis was first conducted. Reliability was measured by internal consistency (Cronbach α), and a factor analysis was applied to investigate the internal structure. Divergent validity was measured by comparing the PTPSQ-I with a visual analog scale (VAS) and with a 5-point Likert-type scale evaluating the global perceived effect (GPE) for the physical therapy treatment.

Results: The process for developing the PTPSQ-I required 3 months using data on 315 outpatients. Based on our initial analyses, 5 items were deleted from the PTPSQ-I, which was renamed the PTPSQ-I(15). The PTPSQ-I(15) showed high internal consistency (α=.905). Divergent validity was moderate for the GPE (r=.33) but not significant for the VAS (r=-.07). A factor analysis revealed evidence for a 2-factor structure related to perceived "Overall Experience" and "Professional Impression" that explained 62% of the total variance. A third factor, "Efficiency and Convenience," brought explained total variance to near 70%.

Limitations: It may be necessary to add items to the PTPSQ-I(15) to assess other dimensions not currently represented by these 15 items.

Conclusion: The PTPSQ-I(15) showed good psychometric properties, and its use can be recommended with Italian-speaking outpatient populations.
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July 2013

The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I): cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change.

Spine (Phila Pa 1976) 2012 Mar;37(6):E374-80

Physical Medicine and Rehabilitation Unit, Salvatore Maugeri Foundation Institute of Care and Research (IRCCS), Milan, Italy.

Study Design: Evaluation of the psychometric properties of a translated and culturally adapted questionnaire.

Objective: Translating, culturally adapting, and validating the Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I) to allow its use with Italian-speaking patients with low-back pain (LBP).

Summary Of Background Data: Growing attention is being given to standardized outcome measures to improve interventions for LBP. A translated form of the FABQ has never been validated in Italian patients with LBP.

Methods: The FABQ-I questionnaire was developed by means of forward-backward translation, a final review by an expert committee, and a test of the prefinal version to establish its correspondence with the original English version. The psychometric testing included factor analysis, reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass coefficient correlation), convergent validity by comparing FABQ-I with the Italian version of the Tampa Scale of Kinesiophobia (TSK-I), and discriminant validity by comparing FABQ-I with a visual analogue scale, the Roland Morris Disability Questionnaire, and the Hospital Anxiety and Depression Scale (Pearson correlation).

Results: It took 4 months to develop a shared version of the FABQ-I. The questionnaire was administered to 180 subjects and proved to be acceptable. Factor analysis revealed a 2-factor, 12-item solution (57% of explained variance). The questionnaire showed good internal consistency (α = 0.822) and high test-retest reliability (intraclass coefficient correlation = 0.869). Convergent validity showed a moderate correlation with TSK-I (r = 0.440), and discriminant validity showed moderate-poor correlations with a visual analogue scale (r = 0.335), Roland Morris Disability Questionnaire (r = 0.414), and Hospital Anxiety and Depression Scale (r = 0.258 for the Anxiety score and r = 0.246 for the Depression score). The results of the psychometric analyses of the subscales were similar to those of the scale as a whole.

Conclusion: The FABQ outcome measure was successfully translated into Italian and proved to have a good factorial structure and psychometric properties that replicated the results of other existing versions. Its use is recommended for research purposes.
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March 2012

An updated overview of clinical guidelines for chronic low back pain management in primary care.

Joint Bone Spine 2012 Mar 12;79(2):176-85. Epub 2011 May 12.

Occupational Medicine Unit, Department of Internal Medicine, Geriatrics and Nephrology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, via P. Palagi 9, 40138 Bologna, Italy.

Objectives: In the past decade many countries around the world have produced clinical practice guidelines to assist practitioners in providing a care that is aligned with the best evidence. The aim of this study was to present and compare the most established evidence-based recommendations for the management of chronic nonspecific low back pain in primary care derived from current high-quality international guidelines.

Methods: Guidelines published or updated since 2002 were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the World Wide Web. The methodological quality of the guidelines was assessed by three authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into diagnostic and therapeutic approaches that were supported by strong, moderate or weak evidence.

Results: Thirteen guidelines were included. In general, the quality was satisfactory. Guidelines had highest scores on clarity and presentation and scope and purpose domains, and lowest scores on applicability. There was a strong consensus among all the guidelines particularly regarding the use of diagnostic triage and the assessment of prognostic factors. Consistent therapeutic recommendations were information, exercise therapy, multidisciplinary treatment, and combined physical and psychological interventions.

Conclusion: Compared to previous assessments, the average quality of the guidelines dealing with chronic low back pain has improved. Furthermore, all guidelines are increasingly aligning in providing therapeutic recommendations that are clearly differentiated from those formulated for acute pain. However, there is still a need for improving quality and generating new evidence for this particular condition.
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March 2012

Effectiveness of a 'Global Postural Reeducation' program for persistent low back pain: a non-randomized controlled trial.

BMC Musculoskelet Disord 2010 Dec 16;11:285. Epub 2010 Dec 16.

Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology, University of Bologna, Bologna, Italy.

Background: The aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months).

Methods: According to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned.

Results: Of the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group.The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7).

Conclusions: Our findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects.

Trial Registration: NCT00789204.
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December 2010

Novel carbazole derivatives as NPY Y1 antagonists.

Bioorg Med Chem Lett 2007 Feb 16;17(4):1043-6. Epub 2006 Nov 16.

GlaxoSmithKline Medicines Research Centre, Via A. Fleming 4, Verona 37135, Italy.

The synthesis of a series of carbazole derivatives and their SAR at the NPY Y1 receptor is described. Modulation of physicochemical properties by appropriate decoration led to the identification of a high-affinity NPY Y1 antagonist that shows high brain penetration and modest oral bioavailability.
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February 2007