Publications by authors named "Marco Monticone"

99 Publications

Responsiveness and minimal important change of the Pain Catastrophizing Scale in people with chronic low back pain undergoing multidisciplinary rehabilitation.

Eur J Phys Rehabil Med 2021 May 27. Epub 2021 May 27.

Physical Medicine and Rehabilitation Unit, Institute of Lissone, ICS Maugeri, IRCCS, Lissone, Monza Brianz, Italy.

Background: The Pain Catastrophizing Scale (PCS), a widely used tool to assess catastrophizing related to spinal disorders, shows valid psychometric properties in general but the minimal important change (MIC) is still not determined.

Design: Prospective observational study.

Aim: To assess responsiveness and MIC of the PCS in individuals with chronic low back pain (LBP) undergoing multidisciplinary rehabilitation.

Setting: Outpatient rehabilitation hospital.

Population: Two hundred and five patients with chronic LBP.

Methods: Before and after an 8-week multidisciplinary rehabilitation program, 205 patients completed the Italian version of the PCS (PCS-I). We calculated the PCS-I responsiveness by distribution-based methods [effect size, ES; standardised response mean, SRM; minimum detectable change, MDC] and anchor-based methods [receiver operating characteristic (ROC) curves]. After the program, participants completed a 7-point global perceived effect scale (GPE), based on which they were classified as "improved" vs. "stable". ROC curves computed the best cut-off level (taken as the MIC) between the two groups. ROC analysis was also performed on subgroups according to patients' baseline PCS scores.

Result: ES, SRM and MDC were 0.71, 0.67 and 7.73, respectively. ROC analysis yielded an MIC of 8 points (95% confidence interval [CI]: 6-10; area under the curve [AUC]: 0.88). ROC analysis of the PCS subgroups confirmed an MIC of 8 points (95%CI: 6-10) for no/low catastrophizers (score <30, n=159; AUC: 0.90) and indicated an MIC of 11 points (95%CI: 8-14) for catastrophizers (score >30, n=33; AUC: 0.84).

Conclusions: The PCS-I showed good ability to detect patient-perceived clinical changes in chronic LBP post-rehabilitation. The MIC values we determined provide a benchmark for assessing individual improvement in this clinical context.

Clinical Rehabilitation Impact: The present study calculated - in a sample of people with chronic LBP - the responsiveness and MIC of the PCS. These values increase confidence in interpreting score changes, enhancing their meaningfulness for both research and clinical contexts.
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http://dx.doi.org/10.23736/S1973-9087.21.06729-0DOI Listing
May 2021

Active elderly and health-can moderate exercise improve health and wellbeing in older adults? Protocol for a randomized controlled trial.

Trials 2021 May 7;22(1):331. Epub 2021 May 7.

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.

Background: Aging is marked by a progressive rise in chronic diseases with an impact on social and healthcare costs. Physical activity (PA) may soothe the inconveniences related to chronic diseases, has positive effects on the quality of life and biological rhythms, and can prevent the decline in motor functions and the consequent falls, which are associated with early death and disability in older adults.

Methods: We randomized 120 over-65 males and females into groups of similar size and timing and will give each either moderate physical activity or cultural and recreational activities. Being younger than 65 years, inability to participate in physical activity for any medical reason, and involvement in a massive program of physical exercise are the exclusion criteria. The primary outcome measures are: quality of life, walking speed, and postural sway. Participants are tested at baseline, post-treatment, and 6-month (24 weeks) and 12-month (48 weeks) follow-ups.

Discussion: This study aims at improving the quality of life, wellness, and cognitive functioning in the elderly through a low-cost affordable program of moderate physical activity. Given the growing aging of the world population and the social and economic burden of disability in the elderly, our results might have a major impact on future practices.

Trial Registration: ClinicalTrials.gov NCT03858114 . Registered on 28 February 2019.
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http://dx.doi.org/10.1186/s13063-021-05278-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103665PMC
May 2021

Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up.

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

Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research, Lissone, Monza Brianza, Italy.

Background: Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials.

Aim: To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent.

Design: Randomised parallel-group superiority-controlled trial.

Setting: Outpatient rehabilitation hospital.

Population: 150 patients with subacute LBP.

Methods: Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure.

Results: Significant group (p<0.001), time (p=0.002), and time-by-group interaction (p<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up.

Conclusions: The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year.

Clinical Rehabilitation Impact: Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioural and motor lasting changes.
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http://dx.doi.org/10.23736/S1973-9087.21.06696-XDOI Listing
May 2021

Cross-cultural adaptation, reliability and validity of the Fremantle Knee Awareness Questionnaire in Italian subjects with painful knee osteoarthritis.

Health Qual Life Outcomes 2021 Apr 7;19(1):114. Epub 2021 Apr 7.

ICS Maugeri, IRCCS, Physical Medicine and Rehabilitation Unit, Institute of Tradate, Tradate, VA, Italy.

Background And Aim: Growing attention is being given to utilising physical function measures to better understand and manage knee osteoarthritis (OA). The Fremantle Knee Awareness Questionnaire (FreKAQ), a self-reported measure of body-perception specific to the knee, has never been validated in Italian patients. The aims of this study were to culturally adapt and validate the Italian version of the FreKAQ (FreKAQ-I), to allow for its use with Italian-speaking patients with painful knee OA.

Methods: The FreKAQ-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included: internal structural validity by Rasch analysis; construct validity by assessing hypotheses of FreKAQ correlations with the knee injury and osteoarthritis outcome score (KOOS), a pain intensity numerical rating scale (PI-NRS), the pain catastrophising scale (PCS), and the Hospital anxiety and depression score (HADS) (Pearson's correlations); known-group validity by evaluating the ability of FreKAQ scores to discriminate between two groups of participants with different clinical profiles (Mann-Whitney U test); reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC); and measurement error by calculating the minimum detectable change (MDC).

Results: It took one month to develop a consensus-based version of the FreKAQ-I. The questionnaire was administered to 102 subjects with painful knee OA and was well accepted. Internal structural validity confirmed the substantial unidimensionality of the FreKAQ-I: variance explained was 53.3%, the unexplained variance in the first contrast showed an eigenvalue of 1.8, and no local dependence was detected. Construct validity was good as all of the hypotheses were met; correlations: KOOS (rho = 0.38-0.51), PI-NRS (rho = 0.35-0.37), PCS (rho = 0.47) and HADS (Anxiety rho = 0.36; Depression rho = 0.43). Regarding known-groups validity, FreKAQ scores were significantly different between groups of participants demonstrating high and low levels of pain intensity, pain catastrophising, anxiety, depression and the four KOOS subscales (p ≤ 0.004). Internal consistency was acceptable (α = 0.74) and test-retest reliability was excellent (ICC = 0.92, CI 0.87-0.94). The MDC was 5.22 scale points.

Conclusion: The FreKAQ-I is unidimensional, reliable and valid in Italian patients with painful knee OA. Its use is recommended for clinical and research purposes.
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http://dx.doi.org/10.1186/s12955-021-01754-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025485PMC
April 2021

Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up.

BMC Musculoskelet Disord 2021 Mar 20;22(1):293. Epub 2021 Mar 20.

Bicocca University of Milan, Milan, Italy.

Background: General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF.

Methods: By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients' specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05).

Results: Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up.

Conclusions: A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months.

Trial Registration: On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552 .
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http://dx.doi.org/10.1186/s12891-021-04140-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981858PMC
March 2021

Construct validity of the Quebec Back Pain Disability Scale: a factor analytic and Rasch study.

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

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy -

Background: Studies on structural validity of the Quebec Back Pain Disability Scale (QBPDS) showed uncertain unidimensionality.

Aim: To investigate dimensionality and internal construct validity of the QBPDS, using advanced psychometric methods.

Design: Secondary analysis of data from a cross-sectional observational study, SETTING: Outpatient rehabilitation hospital.

Population: 201 patients with chronic Low Back Pain (40% men; mean age 48±12 years).

Methods: Confirmatory (CFA) and then Exploratory Factor Analysis (EFA), and Rasch analysis were used.

Results: CFA could not provide a satisfactory one-factor solution. Thus, according to a preliminary parallel analysis, two factor structures were examined: i) a single-factor solution, that showed good model fit according to Goodness of Fit Index and Comparative Fit Index, acceptable fit according to Root Mean Square Error of Approximation, and poor fit according to Standardized Root Mean Square of Residuals; ii) a bi-factor solution, both showing a good fit in all 4 indices. The Explained Common Variance index was 0.87. Thus, it was considered appropriate to apply Rasch analysis to our QBPDS data. Four items underfit the Rasch model and showed (two by two) local dependency. Removing these 4 misfitting items resulted in an acceptable fit to the Rasch model of the 16 remaining items.

Conclusions: All results pointed towards an essential unidimensionality of the QBPDS. Thus, we suggest to provisionally use the full QBPDS and its global score, pending further research on scale's construct validity. If the suboptimal performance of 4 items would be confirmed, the deletion of some of them could improve the metric quality of the scale.

Clinical Rehabilitation Impact: This study fills an evidence gap on important measurement properties of the QBPDS (namely, dimensionality and internal construct validity), thus representing a useful step towards the definition of the more suitable outcome measures for research and clinical practice in nonspecific chronic LBP.
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http://dx.doi.org/10.23736/S1973-9087.21.06502-3DOI Listing
March 2021

Lymphedema quality of life questionnaire (LYMQOL): cross-cultural adaptation and validation in Italian women with upper limb lymphedema after breast cancer.

Disabil Rehabil 2021 Mar 2:1-6. Epub 2021 Mar 2.

Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.

Purpose: There is growing interest in measures that assess upper-limb lymphedema after breast cancer. Since no validated Italian version of the Lymphedema Quality of Life Questionnaire for upper limbs (LYMQOL-UL) exists, we aimed to culturally adapt and validate an Italian version (LYMQOL-UL-IT) in order to allow its use in Italian patients.

Materials And Methods: The LYMQOL-UL-IT was developed by means of forward-backward translation, review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC), measurement error by calculating the minimum detectable change (MDC), construct validity by confirmatory factor analysis, and evaluation of hypotheses about the correlations between the four LYMQOL-UL domains, single items of the LYMQOL-UL, and measures of health-related quality of life and pain intensity (Spearman's rank correlation coefficient).

Results: The consensus-based version of LYMQOL-UL-IT was administered to 139 patients with upper-limb stable secondary iatrogenic lymphedema after breast cancer. The adapted questionnaire was well accepted as it was completed in less than 10 min, without missing answers or comprehension problems. Internal consistency was acceptable (α = 0.92-0.95). Test-retest reliability was good-to-excellent (ICC = 0.73-0.96). The MDC for the four domains of the questionnaire was as follows: 0.64 scale points for Function, 0.40 for Appearance, 0.53 for Symptoms, and 0.81 for Mood. Factor analysis confirmed a 4-dimensional structure as originally conceived and the hypotheses were met.

Conclusion: The LYMQOL-UL-IT is reliable, sensitive to change and valid in patients with upper-limb stable secondary iatrogenic lymphedema after breast cancer. It can be used for clinical and research purposes.Implications for rehabilitationLymphedema is a frequently unnoticed clinical condition that not only impacts physical functioning but often restricts the health-related quality of life in breast cancer survivors.The Italian version of the Lymphedema Quality of Life Questionnaire for upper limbs (LYMQOL-UL-IT) is reliable, sensitive to change and valid in patients with upper-limb lymphedema after breast cancer.The LYMQOL-UL-IT tool can be recommended for clinical and research purposes.
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http://dx.doi.org/10.1080/09638288.2021.1890842DOI Listing
March 2021

Scale Shortening and Decrease in Measurement Precision: Analysis of the Pain Self-Efficacy Questionnaire and Its Short Forms in an Italian-Speaking Population With Neck Pain Disorders.

Phys Ther 2021 Jun;101(6)

Istituti Clinici Scientifici Maugeri, IRCCS, Physical and Rehabilitation Medicine Unit, Institute of Tradate, Tradate (MB), Italy.

Objective: Short (2- and 4-item) forms of the Pain Self-Efficacy Questionnaire (PSEQ) have been proposed, but their measurement precision at the individual level is unclear.The purpose of this study was to analyze the Rasch psychometric characteristics of PSEQ and its 3 short forms (one 4-item and two 2-item versions) in an Italian-speaking population with neck pain (NP) disorders and compare their measurement precision at the individual level through calculation of the test information function (TIF).

Methods: Secondary analysis of data from a prospective single-group observational study was conducted. In 161 consecutive participants (mean age = 45 years [SD = 14]; 104 women) with NP disorders, a Rasch analysis was performed on each version of the PSEQ (full scale plus 3 short forms), and the TIF was calculated to examine the degree of measurement precision in estimating person ability over the whole measured construct (pain self-efficacy).

Results: In all versions of the PSEQ, the rating scale fulfilled the category functioning criteria, and all items showed an adequate fit to the Rasch model. The TIF showed a bell-shaped distribution of information, with an acceptable measurement precision (standard error <0.5) for persons with a wide range of ability; conversely, measurement precision was unacceptably low in each short form (particularly the two 2-item versions).

Conclusions: The results confirm and expand reports on the sound psychometric characteristics of PSEQ, showing for the first time, to our knowledge, its conditional precision in estimating pain self-efficacy measures in Italian individuals with NP disorders. The study cautions against use of the 3 PSEQ short forms for individual-level clinical decision-making.

Impact: Short scales are popular in rehabilitation settings largely because they can save assessment time and related costs. The psychometric characteristics of the 10-item PSEQ were confirmed and deepened, including its precision in estimating individual pain self-efficacy at different levels of this latent variable. On the other hand, low measurement precision of the 3 PSEQ short forms cautions against their use for individual judgments.
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http://dx.doi.org/10.1093/ptj/pzab039DOI Listing
June 2021

The effectiveness of biofeedback for improving pain, disability and work ability in adults with neck pain: A systematic review and meta-analysis.

Musculoskelet Sci Pract 2021 04 8;52:102317. Epub 2021 Jan 8.

Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School and Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.

Background: Biofeedback is used to optimise muscle activation patterns in people with neck pain.

Objectives: To evaluate the safety and efficacy of electromyographic and pressure biofeedback on pain, disability and work ability in adults with neck pain.

Design: Systematic review and meta-analysis.

Methods: We searched key databases and trial registries to September 2020, using terms synonymous with 'neck pain' and 'biofeedback'. We included randomised controlled trials (RCTs) evaluating biofeedback (against any comparison) for adults with neck pain. Outcomes included pain, disability, work ability and adverse events. Two authors independently selected the studies, extracted data, and evaluated risk of bias. GRADE was applied to each meta-analysis. Data were pooled using random-effects models to determine the standardised mean change (SMC).

Results: We included 15 RCTs (n = 990). Moderate-quality evidence suggests biofeedback has a moderate effect on reducing short-term disability (SMC = -0.42, 95%CI: 0.59 to -0.26, nine trials, n = 627), and a small effect on reducing intermediate-term disability (SMC = -0.30, 95%CI: 0.53 to -0.06, five trials, n = 458). Biofeedback had no effect on pain or work ability in the short- and intermediate-term (low-to moderate-quality evidence). One study reported headaches in 6.7% of participants, but headache frequency was not reported by group.

Limitations: There were a variety of control interventions across studies. Few studies compared biofeedback with no treatment or placebo.

Conclusion: Biofeedback appears to have a small-to-moderate effect on reducing neck pain disability in the short- and intermediate-term, but no effect on pain or work ability. More trials reporting adverse events and comparing biofeedback to placebo are needed.
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http://dx.doi.org/10.1016/j.msksp.2021.102317DOI Listing
April 2021

Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: .

Disabil Rehabil 2020 Dec 27:1-8. Epub 2020 Dec 27.

Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy.

Purpose: To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term.

Methods: By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure.

Results: Significant group ( < 0.001), time ( < 0.001), and time-by-group interaction ( < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively.

Conclusion: The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.
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http://dx.doi.org/10.1080/09638288.2020.1863480DOI Listing
December 2020

Effect of Muscular Exercise on Patients With Muscular Dystrophy: A Systematic Review and Meta-Analysis of the Literature.

Front Neurol 2020 12;11:958. Epub 2020 Nov 12.

Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.

Muscular dystrophy causes weakness and muscle loss. The effect of muscular exercise in these patients remains controversial. To assess the effects of muscular exercise vs. no exercise in patients with muscular dystrophy. We performed a comprehensive systematic literature search in the Medline, Embase, Web of Science, Scopus, and Pedro electronic databases, as well as in the reference literature. We included randomized clinical trials (RCTs) that reported the effect of muscular exercise on muscle strength, endurance during walking, motor abilities, and fatigue. Data were extracted independently by two reviewers. Mean difference (MD) and 95% confidence intervals (CI) were used to quantify the effect associated with each outcome. We performed pairwise meta-analyses and trial sequential analyses (TSA) and used GRADE to rate the overall certainty of evidence. We identified 13 RCTs involving 617 patients. The median duration of exercise interventions was 16 weeks [interquartile range [IQR] 12-24]. In the patients with facio-scapulo-humeral dystrophy and myotonic dystrophy, no significant difference in extensor muscle strength was noted between the exercise and the control groups [four studies, 115 patients, MD 4.34, 95% CI -4.20 to 12.88, = 69%; = 0.32; minimal important difference [MID] 5.39 m]. Exercise was associated with improved endurance during walking [five studies, 380 patients, MD 17.36 m, 95% CI 10.91-23.81, = 0; < 0.00001; MID 34 m]. TSA excluded random error as a cause of the findings for endurance during walking. Differences in fatigue and motor abilities were small. Not enough information was found for other types of dystrophy. Muscular exercise did not improve muscle strength and was associated with modest improvements in endurance during walking in patients with facio-scapulo-humeral and myotonic dystrophy. Future trials should explore which type of muscle exercise could lead to better improvements in muscle strength. CRD42019127456.
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http://dx.doi.org/10.3389/fneur.2020.00958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688624PMC
November 2020

A further Rasch analysis of the Fear-Avoidance Beliefs Questionnaire in adults with chronic low back pain suggests the revision of its rating scale.

Eur J Phys Rehabil Med 2021 Feb 20;57(1):110-119. Epub 2020 Nov 20.

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy -

Background: Low-back pain (LBP) is a common health problem and one of the leading causes of activity limitation and work absence. LBP determines high societal burdens, as it is the most common cause of medically certified sick leave and early retirement, with economic impacts similar to other high-cost conditions such as cancer, cardiovascular and autoimmune diseases.

Aim: The aim of this study was to examine the psychometric properties of the Fear-Avoidance Beliefs Questionnaire (FABQ) and its two subscales, in subjects with chronic low back pain (LBP).

Design: Methodological research based on a cross-sectional observational study.

Setting: Outpatients consecutively admitted to our Rehabilitation Unit were enrolled between January and August 2015, before the beginning of an 8-week program of multidisciplinary rehabilitation.

Population: A convenience sample of 155 Italian subjects with chronic LBP (57% men; mean age: 43±11 years; mean pain duration: 23±32 months) completed the FABQ.

Methods: Rasch analysis was used to investigate dimensionality of the entire scale and key psychometric properties of its two subscales.

Results: The FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W) subscales showed two distinct unidimensional structures. Their 7-option rating categories were malfunctioning, but after collapsing problematic categories and omitting the central one ("unsure") the new 4 categories (completely disagree; disagree; agree; completely agree) functioned as intended. After that and accommodation of local response dependency between two items in a testlet solution, each of the two subscales presented acceptable fit to the Rasch model (just one FABQ-W items was slightly underfitting). Person separation reliability was acceptable, but not high (0.69 for FABQ-PA, and 0.79 for FABQ-W).

Conclusions: FABQ-PA and FABQ-W have adequate unidimensionality. A simplification of the response options of both subscales is strongly recommended to improve the technical quality of the scale. The reliability indexes suggest FABQ-PA and FABQ-W can be used for group judgements about level of fear-avoidance beliefs, but not for clinical decision-making in individuals. The selection of their items is acceptable, although if future studies corroborate our results - there is room for some refinements to improve the general measurement quality.

Clinical Rehabilitation Impact: Fear-avoidance beliefs are associated with reduction of physical activity, and development of disability and deconditioning. This study examined the measurement properties of the two FABQ subscales, showing their essential unidimensionality, recommending the simplification of the rating categories, and discussing strengths and weaknesses of item selection. Our results extend the evidence for FABQ as a satisfactory (but improvable) measure of fear-avoidance beliefs in chronic LBP.
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http://dx.doi.org/10.23736/S1973-9087.20.06328-5DOI Listing
February 2021

Rasch analysis of the Incontinence Impact Questionnaire short version (IIQ-7) in women with urinary incontinence.

Int J Rehabil Res 2020 Sep;43(3):261-265

Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, PRM Unit of Lissone Institute, Lissone, Italy.

Urinary incontinence is a clinical condition that can negatively affect activities, psychosocial well-being, and health-related quality of life. The Incontinence Impact Questionnaire short version (IIQ-7) is useful to quantify quickly the urinary incontinence-related life-impact. Previous psychometric studies on the IIQ-7, using classical test theory methods, demonstrated good internal consistency, test-retest reliability, and a substantial unidimensionality of the tool. This latter property is a prerequisite for performing advanced modern psychometric analyses such as Rasch analysis. In this study, we aimed to examine in depth - through Rasch analysis - some key metric properties of the IIQ-7. We analyzed data from 100 women with urinary incontinence. Results confirmed the correct functioning of the four response categories of the questionnaire and indicated an adequate level of internal structural validity. Given the good fit of the items to the Rasch model, it was possible to obtain a nomogram to transform the total raw scores of the IIQ-7 into linear measure estimates. Our findings obtained through Rasch analysis confirm the substantial unidimensionality and good psychometric properties of the IIQ-7 found in previous studies. They enhance the confidence in the use of this short tool - for group-level decisions - to assess the life-impact related to stress, urge or mixed urinary incontinence among women.
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http://dx.doi.org/10.1097/MRR.0000000000000422DOI Listing
September 2020

Reliability, responsiveness and minimal clinically important difference of the two Fear Avoidance and Beliefs Questionnaire scales in Italian subjects with chronic low back pain undergoing multidisciplinary rehabilitation.

Eur J Phys Rehabil Med 2020 Oct 18;56(5):600-606. Epub 2020 May 18.

Unit of Physical Medicine and Rehabilitation, IRCCS Maugeri, Institute of Lissone, Lissone, Monza-Brianza, Italy.

Background: The Fear-Avoidance Beliefs Questionnaire (FABQ) is a widely used outcome measure. There is still a lack of information concerning responsiveness and minimal clinically important difference (MCID), limiting its use for clinical and research purposes.

Aim: The aim of this study was to examine reliability, responsiveness and MCID of the two FABQ scales in subjects with chronic low back pain.

Design: Methodological research based on a prospective single-group observational study.

Setting: Outpatient, Unit of rehabilitation.

Population: Chronic non-specific low back pain.

Methods: At the beginning and the end of a multidisciplinary program (8-week), 129 subjects completed the FABQ scales. Reliability was determined as internal consistency (Cronbach's alpha) and test-retest reliability (96-hour interval; N.=64; Interclass correlation coefficient [ICC 2.1]). Responsiveness was calculated both by distribution-based and anchor-based methods, using as external criterion the Global Perceived Effect Scale (GPE: 7 levels), rated by each individual.

Results: Cronbach's alpha and ICC(2,1) were respectively: 0.75 and 0.90 for FABQ-Physical Activity Scale (FABQ-PA), and 0.85 and 0.95 for FABQ-Work Scale (FABQ-W). Minimum detectable change (MDC95) values were 3.69 points for FABQ-PA, and 5.95 points for FABQ-W. In receiver-operating characteristic curves, splitting GPE data into null/minimal/moderate improvement vs. large improvement (GPE 0-2 vs. GPE 3): 1) for FABQ-PA, the area under the curve (AUC) was 0.97 and the best cutoff score identifying meaningful change in fear-avoidance beliefs about physical activity was a change of 4 points; 2) for FABQ-W, the AUC was 0.97 and the best cutoff score for meaningful change in fear-avoidance beliefs about work activities was a change of 7 points.

Conclusions: After triangulation of the above results, a change of 4 points for FABQ-PA and 7 points for FABQ-W were selected as MCID. These two values represent cutoffs that seem to accurately identify meaningful change in fear-avoidance beliefs, according to subject's judgement.

Clinical Rehabilitation Impact: The present study calculated - in a sample of people with chronic low back pain - the minimal clinically important change of the two FABQ scales (FABQ-Physical Activity Scale and FABQ-Work Scale). These values increase confidence in interpreting score changes, thus enhancing their meaningful use in both research and clinical contexts.
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http://dx.doi.org/10.23736/S1973-9087.20.06158-4DOI Listing
October 2020

Comments on "The Fear Avoidance Beliefs Questionnaire (FABQ): Does it really measure fear beliefs?" by Aasdahl L et al.

Spine (Phila Pa 1976) 2020 04;45(8):E478-E479

Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy.

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http://dx.doi.org/10.1097/BRS.0000000000003416DOI Listing
April 2020

Manual handling of patients: role of kinesiophobia and catastrophizing in health workers with chronic low back pain.

Eur J Phys Rehabil Med 2020 Jun 25;56(3):307-312. Epub 2020 Feb 25.

Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Cagliari, Italy.

Background: Biomechanical overload due to patients' manual handling represents a relevant contributor to chronic low back pain (LBP). Fear of movement (also known as kinesiophobia) and catastrophising may influence the development of chronic complaints and lower performances also in working environments, despite these issues are poorly investigated.

Aim: The aim of this study is twofold: 1) to evaluate the levels of kinesiophobia and catastrophizing in a sample of health personnel with chronic LBP and employed in activities specifically requiring patients' manual handling; 2) to appraise the influence of these factors on disability.

Design: Cross-sectional observational study.

Setting: Four Italian hospitals.

Population: Sixty-four healthcare workers suffering from nonspecific low back pain, exposed to the spinal risk of biomechanical overload due to patients' manual handling.

Methods: We assessed kinesiophobia, catastrophizing and disability by means of validated questionnaires (the Tampa Scale of Kinesiophobia [TSK], the Pain Catastrophizing Scale [PCS], and the Oswestry Disability Index [ODI], respectively). Values of central tendency and dispersion of the variable of interest were calculated, along with the association among variables through multiple linear regression analysis.

Results: The results showed presence of kinesiophobia (TSK=34.0; IQR=28.2-42.09), catastrophizing (PCS=20.5; IQR=10.2-29.0) and disability (ODI=28.8; IQR=13.5-40.0) in the population enrolled. Disability was significantly predicted by kinesiophobia and catastrophizing (R2=0.529 P=0.00003).

Conclusions: Kinesiophobia and catastrophizing are present in health workers with chronic LBP involved in patients' manual handling and are linked to disability. Further investigations in this field are recommended to investigate a role for cognitive-behavioral strategies aimed at managing catastrophizing and kinesiophobia to increase working abilities.

Clinical Rehabilitation Impact: The assessment of catastrophizing and kinesiophobia is crucial in health workers engaged with patients' manual handling and suffering from chronic LBP.
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http://dx.doi.org/10.23736/S1973-9087.20.06004-9DOI Listing
June 2020

Italian versions of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7: translation and validation in women with urinary incontinence.

Disabil Rehabil 2020 Feb 5:1-7. Epub 2020 Feb 5.

ICS Maugeri, IRCCS, Institutes of Lissone (MB) and Pavia, Pavia, Italy.

To culturally adapt and validate the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 (short forms) for use in Italian-speaking women with urinary incontinence. We developed Italian versions of the two questionnaires through forward-backward translation, expert review and cognitive interviews. We then administered them to 100 women with urinary incontinence (mean age 58.02 ± 11.9 years) to assess the internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient), standard error of measurement, minimum detectable change, and construct validity by hypothesis testing. No difficulties in acceptability emerged. Internal consistency was 0.61 for Urogenital Distress Inventory-6 and 0.88 for Incontinence Impact Questionnaire-7. Test-retest reliability was respectively 0.79 and 0.91. The minimum detectable change was respectively 22.9 and 18.1 points (on a 0-100 scale). Nine out of 10 hypotheses regarding construct validity were confirmed. The Italian versions of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 showed reliability levels in line with the literature and good construct validity. Thus, we think that the present study extends the evidence for both questionnaires as useful tools for assessing women with urinary incontinence.Implications for rehabilitationThe Italian versions of the short forms of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire have never been validated in Italian-speaking women with urinary incontinence.After translation and cross-cultural adaptation, the Italian versions of these two questionnaires showed reliability levels in line with the literature and good construct validity.The Urogenital Distress Inventory-6 produces a summary index of overall symptom distress, whereas the Incontinence Impact Questionnaire-7 is a unidimensional questionnaire measuring the adverse effects of urinary incontinence on health-related quality of life.
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http://dx.doi.org/10.1080/09638288.2020.1720319DOI Listing
February 2020

Does the awareness of having a lumbar spondylolisthesis influence self-efficacy and kinesiophobia? A retrospective analysis.

Arch Physiother 2019 16;9:16. Epub 2019 Dec 16.

4Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.

Background: High pain self-efficacy and low kinesiophobia seem related to a better prognosis in patients complaining of low back pain (LBP). The literature stresses the potential negative effects of anatomical defect diagnosis (e.g. lumbar spondylolisthesis) on the psychological profile. The aim of this study is to investigate the relationships between awareness of having a spondylolisthesis, pain self-efficacy and kinesiophobia.

Methods: A secondary retrospective analysis was done. Ninety-eight subjects with subacute and chronic LBP were included: 49 subjects with diagnosed symptomatic lumbar spondylolisthesis and 49 subjects with diagnosed non-specific LBP. The pain self-efficacy measured with the Pain Self-Efficacy Questionnaire and the fear of movement measured with the Tampa Scale of Kinesiophobia were considered variables to investigate, whereas diagnosis and demographic/clinical variables were considered predictors or potential confounders.

Results: By comparing the two groups, the awareness of having a spondylolisthesis did not significantly influence neither pain self-efficacy ( = 0.82), nor kinesiophobia ( = 0.75). Higher perceived pain reduces pain self-efficacy and increases kinesiophobia in both groups ( = 0.002 and p = 0,031 respectively).

Conclusions: It seems that the awareness of an anatomical defect as spondylolisthesis does not significantly affect the beliefs of carry out activities and movements despite the pain. Other studies with wider samples are required, to confirm these preliminary results.
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http://dx.doi.org/10.1186/s40945-019-0070-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913011PMC
December 2019

The Risk Assessment and Prediction Tool (RAPT) after Hip and Knee Replacement: A Systematic Review.

Joints 2019 Jun 25;7(2):41-45. Epub 2019 Jul 25.

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.

 The Risk Assessment and Prediction Tool (RAPT) is an interesting instrument for predicting the discharge destination and length of stay (LOS) for patients after hip or knee arthroplasty. The aim of this review is to describe its predictive ability, current utilization, and future prospects through the analysis of scientific literature.  The databases of PubMed, Web of Sciences, Cochrane Library, and Pedro were searched for English studies on RAPT prediction capacity. Only original prospective or retrospective articles that analyze specifically the use of RAPT were included, whereas those concerned with other preoperative prediction tools or those only considering other aspects of recovery after joint replacements were excluded.  A total of 27 references were retrieved, and 8 studies were selected. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients. In the intermediate risk category, a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome.  Although contrarily to many of the other scores, the RAPT has been validated in multiple countries with relatively similar results between different institutions; however, its validity has yet to be tested and adapted in every nation context. Further studies confirming the predictive accuracy of RAPT at other institutions are needed as well as studies assessing the effect of using RAPT to identify patients for targeted interventions in terms of LOS, discharge disposition, clinical outcomes, and financial impact.  This is a level IV, systematic review of level III and IV study.
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http://dx.doi.org/10.1055/s-0039-1693459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930846PMC
June 2019

Cross-cultural adaptation, reliability and validity of the Italian version of the craniofacial pain and disability inventory in patients with chronic temporomandibular joint disorders.

BMC Oral Health 2019 11 12;19(1):244. Epub 2019 Nov 12.

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

Background: To develop an Italian version of the Craniofacial Pain Disability Inventory (CFPDI-I) and investigate its psychometric abilities in patients with temporomandibular disorders (TMD).

Methods: The CFPDI was translated following international standards. The psychometric analyses included reliability by internal consistency (Cronbach's alpha) and test/retest stability (intraclass correlation coefficient, ICC); construct validity was investigated by matching (a priori hypotheses) the CFPDI-I with the Italian Neck Disability Index (NDI-I), a pain intensity numerical rating scale (NRS), the Italian Pain Catastrophising Scale (PCS-I), the Italian Tampa Scale of Kinesiophobia (TSK-I), and the Italian Migraine Disability Assessment Score Questionnaire (MIDAS) (Pearson's correlation). Alpha was set at 0.05.

Results: Two hundred and twelve patients with chronic TMD completed the tool. The questionnaire was internally consistent (α = 0.95) and its stability was good (ICCs = 0.91). As hypothesised, validity figures showed CFPDI-I strongly correlated with the NDI-I (r = 0.66, p < 0.05) and moderately correlated with the NRS (r = 0.48, p < 0.05), PCS (r = 0.37, p < 0.05), TSKI (r = 0.35, p < 0.05) and MIDAS (r = 0.47, p < 0.05). Similar estimates were shown by CFPDI-I subscales.

Conclusions: The cross-culturally adapted version of the Craniofacial Pain and Disability Inventory (CFPDI-I) showed satisfactory psychometric properties that replicate those of the original version and, therefore, can be implemented in the clinical assessment of Italian people affected by TMD.
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http://dx.doi.org/10.1186/s12903-019-0927-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852744PMC
November 2019

Is there a relationship between self-efficacy, disability, pain and sociodemographic characteristics in chronic low back pain? A multicenter retrospective analysis.

Arch Physiother 2019 12;9. Epub 2019 Oct 12.

2Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.

Background: Pain-related self-efficacy is defined as the beliefs held by people with chronic pain that certain activities can be carried out despite the pain. Poor self-efficacy is an obstacle to the recovery and predicts long-term disability. The aims of this study are to investigate the prevalence of poor pain self-efficacy in Italian subjects with chronic low back pain (LBP), and to inquire the relationships between self-efficacy, disability, pain, and main demographic and clinical characteristics.

Methods: A secondary multicenter retrospective analysis was done on 310 outpatients with chronic non-specific LBP. The pain self-efficacy measured with the Pain Self-Efficacy Questionnaire (PSEQ), the disability measured with the Roland & Morris Disability Questionnaire, and the pain intensity measured with the Numerical Rating Scale were considered variables to investigate, whereas demographic and clinical variables were considered predictors or potential confounders. A 40/60 PSEQ score was adopted as cut-off to distinguish between good and poor self-efficacy.

Results: 199 subjects (64.2% of the sample) showed poor self-efficacy. The odds of having poor self-efficacy appeared significantly related to female gender (OR = 1.80, 95%CI [1.12;2.90];  = 0.015) and drugs use (OR = 1.68, 95%CI [1.06;2.70];  = 0.029). Significant relationships also emerged between disability and higher age (β = 0.07, 95%CI [0.01; 0.12];  = 0.02), being female (β = 1.80, 95%CI [0.32;3.29];  = 0.018), low educational level (β = - 1.68, 95%CI [- 2.59;-3.29];  < 0.001), higher height (β = - 0.08, 95%CI [- 0.158;-0.002];  = 0.045), pain duration [mos] (β = 0.01, 95%CI [0.001;0.021];  = 0.041), and drugs use (β = 2.86, 95%CI [1.44;4.27];  < 0.001). The amount of pain appeared significantly related to educational level (β = - 0.47, 95%CI [- 0.76;-0.182];  < 0.001), smoking (β = 0.56, 95%CI [0.09; 1.03];  = 0.021), height (β = - 0.03, 95%CI [- 0.05; - 0.002];  = 0.036), and drugs use (β = 0.81, 95%CI [0.399;1.22];  < 0.001). No significant correlation appeared among weight, body mass index, and referred pain neither in relation to self-efficacy, nor in relation to pain/disability.

Conclusions: The majority of our sample, composed of Italian people complained of chronic LBP, shows poor self-efficacy. Female gender and drugs use are significantly related to poor self-efficacy, low educational level negatively influences the amount of perceived pain and disability, and older age and smoking are related to disability and pain intensity, respectively. The knowledge of these sociodemographic and clinical characteristics potentially influencing chronic LBP may be useful to address more efforts towards the most negatively impacted subjects, among the entire population complained of chronic LBP.
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http://dx.doi.org/10.1186/s40945-019-0061-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790029PMC
October 2019

The Italian version of the Quebec Back Pain Disability Scale: cross-cultural adaptation, reliability and validity in patients with chronic low back pain.

Eur Spine J 2020 03 26;29(3):530-539. Epub 2019 Sep 26.

Department of Health Sciences, Amsterdam Movement Sciences Institute, VU University, Amsterdam, The Netherlands.

Background And Aim: Growing attention is being given to physical functioning measures to assess interventions for low back pain (LBP). The Quebec Back Pain Disability Questionnaire (QBPDS) has never been validated in Italian patients, and the aim of the study was culturally adapting and validating the Italian version of the QBPDS (QBPDS-I), to allow its use with Italian-speaking patients with chronic LBP.

Methods: The QBPDS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the prefinal version to evaluate its comprehensibility. The psychometric testing included structural validity by exploratory factor analysis (EFA), reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC 2.1), measurement error by calculating the minimum detectable change (MDC), construct validity by assessing hypotheses of QBPDS correlations with the Roland Morris Disability Scale (RMDQ), the Oswestry Disability Questionnaire (ODI) and a pain numerical rating scale (NRS) (Spearman's correlations).

Results: It took one month to develop a consensus-based version of the QBPDS-I. The questionnaire was administered to 201 subjects with chronic LBP and was well accepted. EFA suggested a one-factor 20-item solution (first factor variance explained = 54.7%). Internal consistency (α = 0.95) and test-retest reliability (ICC = 0.90) were excellent. The MDC was 12 scale points. Construct validity was good as all of the hypotheses were met; correlations: RMDQ (r = 0.40), ODI (r = 0.48) and NRS (r = 0.44).

Conclusions: The QBPDS-I is unidimensional, reliable and valid in patients with chronic LBP. Its use is recommended for clinical and research purposes.
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http://dx.doi.org/10.1007/s00586-019-06153-4DOI Listing
March 2020

A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial.

Eur J Phys Rehabil Med 2020 Feb 26;56(1):24-33. Epub 2019 Sep 26.

Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information Technology, and Bioengineering, Politecnico di Milano, Milan, Italy.

Background: Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke.

Aim: The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery.

Design: Randomized controlled trial (NCT02439515).

Setting: Inpatient rehabilitation facility.

Population: Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old.

Methods: Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale.

Results: Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008).

Conclusions: The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training.

Clinical Rehabilitation Impact: The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
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http://dx.doi.org/10.23736/S1973-9087.19.05847-7DOI Listing
February 2020

The minimal clinically-important difference of the Prosthesis Evaluation Questionnaire - Mobility Scale in subjects undergoing lower limb prosthetic rehabilitation training.

Eur J Phys Rehabil Med 2020 Feb 4;56(1):82-87. Epub 2019 Sep 4.

University Institute of Rehabilitation, Ljubljana, Slovenia.

Background: There is increasing interest in psychometrically sound outcome measures of mobility for people with lower limb amputation (LLA), in order to accurately monitor the impact of the prosthetic training during and after rehabilitation.

Aim: To determine the minimum detectable change (MDC) and minimal clinically important difference (MCID) for the Prosthesis Evaluation Questionnaire-Mobility Scale (PEQ-MS) in people with LLA.

Design: Prospective single-group observational study.

Setting: Two free-standing Rehabilitation Hospitals.

Population: Eighty-seven adult inpatients with LLA undergoing prosthetic rehabilitation.

Methods: Patients completed the self-report PEQ-MS twice, immediately before and after prosthetic rehabilitation training. We administered a 7-point Global Rating of Change scale at the end of training as external anchor, to quantify the effect (improvement/deterioration) of the intervention.

Results: Test-retest reliability of the PEQ-MS (N.=24) was high (ICC2,1=0.90). The MDC at the 95% confidence level was 5.5 points. This value, together with those of the mean-change approach and receiver-operating characteristic-curve analysis (AUC>0.89), suggested the selection of a MCID for PEQ-MS of eight points of change, i.e. 16.7% of the maximum possible score (95% CI: 6.5-9.5).

Conclusions: The PEQ-MS showed a high ability to detect change over time (responsiveness).The above MCID value - derived from a triangulation of distribution (MDC) and anchor-based methods - represents a minimal level of change (perceived as important by the patient) in mobility of people with LLA undergoing prosthetic rehabilitation training.

Clinical Rehabilitation Impact: The PEQ-MS is a widely used and analyzed outcome measure. The present study calculated - in a sample of people with LLA undergoing prosthetic training - both the MDC and MCID of the PEQ-MS, showing the high responsiveness of this tool. These values increase confidence in interpreting change in PEQ-MS values, and can help in clinical decision making.
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http://dx.doi.org/10.23736/S1973-9087.19.05799-XDOI Listing
February 2020

Sexual disability in patients with chronic non-specific low back pain-a multicenter retrospective analysis.

J Phys Ther Sci 2019 Apr 1;31(4):360-365. Epub 2019 Apr 1.

Department of Medical Sciences and Public Health, University of Cagliari, Italy.

[Purpose] Oswestry Disability Index includes an item (Oswestry Disability Index-8) aiming to assess sexual disability associated to low back pain. The aim of this study is to investigate the percentage of participants who answered the Oswestry Disability Index-8, and the relevance and characteristics of sexual disability due to low back pain in Italian patients. [Participants and Methods] Design: multicenter retrospective analysis. Population: six hundred and ninety-seven outpatients with non-specific low back pain. Variables: pain characteristics (amount, localization, and duration of perceived pain), disability, and psychological variables (anxiety, depression, catastrophizing, kinesiophobia, pain acceptance, and pain vigilance and awareness). [Results] Seventy-seven participants (11.05%) did not answer the Oswestry Disability Index-8. The odds of being not responding to the Oswestry Disability Index-8 item appeared related to age (odds=7.50 for over 60), gender (odds=2.65 for females), and marital status (odds=2.33 for not married). Concerning the psychological variables, Activity Avoidance (coefficient=0.071), Depression (coefficient=0.068), and Rumination (coefficient=0.031) showed a positive impact on sexual disability. [Conclusion] In Italian patients, the percentage of not-responding to Oswestry Disability Index-8 was relatively low. In addition, sexual disability was related to depression, activity avoidance, and rumination.
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http://dx.doi.org/10.1589/jpts.31.360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451955PMC
April 2019

Sensitivity to change and minimal clinically important difference of the Locomotor Capabilities Index-5 in people with lower limb amputation undergoing prosthetic training.

Ann Phys Rehabil Med 2019 May 6;62(3):137-141. Epub 2019 Apr 6.

ICS Maugeri, IRCCS, Pavia, Italy. Electronic address:

Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training.

Design: Prospective single-group observational study.

Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48-69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention.

Results: Test-retest reliability of the LCI-5 (n=30) was high (intraclass correlation coefficient [ICC]=0.92). The minimum detectable change at the 95% confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve≥0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating "large improvement" in locomotor capabilities (12.5% and 21.4% of the maximum possible score, respectively).

Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training.
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http://dx.doi.org/10.1016/j.rehab.2019.02.004DOI Listing
May 2019

Aquatic exercise improves motor impairments in people with Parkinson's disease, with similar or greater benefits than land-based exercise: a systematic review.

J Physiother 2019 04 21;65(2):65-74. Epub 2019 Mar 21.

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.

Questions: What are the effects of aquatic exercise on disease severity, (non-)motor impairments, activity performance, fear of falling, and quality of life in people with Parkinson's disease (PD)? Does aquatic exercise have greater effects on these outcomes than other forms of exercise in people with PD?

Design: Systematic review and meta-analysis of randomised controlled trials.

Participants: People with idiopathic PD.

Intervention: Supervised aquatic exercise programs ≥ 2 weeks.

Outcomes Measures: The primary outcomes were disease severity, motor impairments, activity performance, and fear of falling. The secondary outcomes were non-motor impairments and quality of life.

Results: Of the 129 identified records, seven trials met the inclusion criteria and six were meta-analysed (159 participants). One trial assessed the effect of aquatic exercise compared with control and found a significant improvement in the Unified Parkinson's Disease Rating Scale Part III (MD -4.6, 95% CI -7.5 to -1.7) in favour of aquatic exercise. Six studies compared aquatic exercise with land-based exercise after intervention (mean 7.2 weeks of training (SD 2.2); 159 participants). The effect of aquatic exercise was superior to land-based exercise on the Berg Balance Scale (MD 2.7, 95% CI 1.6 to 3.9), the Falls Efficacy Scale (MD -4.0, 95% CI -6.1 to -1.8) and the 39-item Parkinson's Disease Questionnaire (MD -6.0, 95% CI -11.3 to -0.6), with no other significant effects identified. The significant benefit on the Berg Balance Scale was maintained at the follow-up assessment (MD 6.3, 95% CI 2.1 to 10.5, 54 participants).

Conclusion: Aquatic exercise improves motor impairments in people with PD significantly more than no intervention. It also has slightly to moderately greater benefits than land-based exercise on balance capacity, fear of falling, and health-related quality of life. On other outcomes, the benefits of aquatic exercise are similar to those of land-based exercise.

Trial Registration: PROSPERO CRD42017077370.
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http://dx.doi.org/10.1016/j.jphys.2019.02.003DOI Listing
April 2019

Efficacy of two brief cognitive-behavioral rehabilitation programs for chronic neck pain: results of a randomized controlled pilot study.

Eur J Phys Rehabil Med 2018 Dec 6;54(6):890-899. Epub 2018 Jul 6.

Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy.

Background: Current models of pain behavior suggest that kinesiophobia prevents the reacquisition of normal function, promotes the development of maladaptive coping strategies, and contributes to the disability associated with chronic neck pain (NP).

Aim: Comparing two brief cognitive-behavioral programs aimed at managing kinesiophobia to understand which one induces better short-term improvements in disability, fear of movement, catastrophizing, adaptive coping strategies, quality of life (QoL), and pain intensity of chronic NP.

Design: Pilot, randomized, controlled trial, 3-months follow-up.

Setting: Outpatients.

Population: Subjects with chronic NP.

Methods: The population was randomized into two groups: group A (N.=15) underwent four sessions of cognitive-behavioral therapy (CBT) based on the NeckPix© (1-week duration); group B (N.=15) received four sessions of CBT based on the Tampa Scale of Kinesiophobia (TSK) (1-week duration). Afterwards, both groups attended 10 sessions of multimodal exercises (5-week duration). Primary measure: Neck Disability Index (NDI). Secondary measures: NeckPix©, TSK, Pain Catastrophizing Scale, Chronic Pain Coping Inventory, EuroQol-Five Dimensions, and pain intensity Numerical Rating Scale.

Statistics: Linear mixed model analyses for repeated measures for each outcome measure to evaluate changes over time and between group.

Results: A significant effect of time was found for all outcomes, while no outcomes showed group and/or interaction effects. No changes were found in terms of NDI at the end of CBT, while a significant improvement of about 13 points was found for both groups at the end of the motor training (P=0.001). Similarly, in terms of quality of life there was no change after the CBT program, and a significant change at the end of the motor training, with a partial loss at follow-up. From CBT sessions to follow-up both groups showed a progressive reduction in kinesiophobia, with each group achieving a bigger change in the specific scale used for the CBT program.

Conclusions: Two brief cognitive-behavioral rehabilitation programs based on different methodologies of managing fear-avoidance beliefs induced similar short-term improvements in subjects with chronic NP. Clinically significant changes in terms of disability were found in both groups only at the end of a 5-week motor training, regardless of the cognitive-behavioral rehabilitation program previously administrated.

Clinical Rehabilitation Impact: Treatment of chronic NP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral as well as motor lasting changes.
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http://dx.doi.org/10.23736/S1973-9087.18.05206-1DOI Listing
December 2018

Back surface measurements by rasterstereography for adolescent idiopathic scoliosis: from reproducibility to data reduction analyses.

Eur Spine J 2018 09 5;27(9):2130-2138. Epub 2018 Jun 5.

Department of Biomedical Sciences, Laboratory of Human Physiology and Applied Neurophysiology, University of Sassari, Viale S. Pietro 43/b, 07100, Sassari, Italy.

Purpose: Aim of this cross-sectional study was to evaluate the reproducibility of back surface measurements obtained by rasterstereography (RS) in adolescents with idiopathic scoliosis (AIS), and to identify the most informative RS parameters through a multi-step reduction analysis approach.

Methods: Sixty-six AIS were assessed with a RS scanner. The assessment was repeated in the same day 15 min after the first scan and after 1 week. Intraclass-correlation analyses were conducted to verify the consistency of the measurements. A multi-step reduction technique including correlation, principal component analysis (PCA) and regression was employed to extract a core-set of key RS parameters.

Results: Back surface measures were obtained from 66 AIS aged 10-17 years (median 13), with a mild Scoliosis angle < 25 (median 20). The reliability over the 3 sessions proved high to very high, with all the intraclass correlation coefficients ≥ 0.8 and 32 out of 48 coefficients ≥ 0.9. Only 8 of the 12 parameters provided by the RS device showed significant inter-item correlations and were therefore considered for further analyses. PCA extracted 4 of them, which entered the final regression analysis. High beta coefficients were found for 2 predictors: "Surface rotation-rms" and "Side deviation-rms," which were found to be significantly associated with the dependent variable "Scoliosis angle."

Conclusions: Data showed that RS measurements are reliable in AIS with mild severity of scoliosis. "Surface rotation" and "Side deviation" were the best descriptors of the Scoliosis angle and should be considered as key parameters when surveilling AIS with mild curves by RS surface topography. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-018-5645-6DOI Listing
September 2018