Publications by authors named "Matteo Paci"

42 Publications

Robot-assisted arm therapy in neurological health conditions: rationale and methodology for the evidence synthesis in the CICERONE Italian Consensus Conference.

Eur J Phys Rehabil Med 2021 Jun 15. Epub 2021 Jun 15.

Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy.

Background: Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions.

Aim: This paper aims to explain the methodology used by the working group dedicated to synthesize evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference.

Design: The methodological approach of the working group.

Setting: All rehabilitation settings.

Population: Patients with disability following a neurological health condition.

Methods: Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions.

Results: WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed.

Conclusions: This paper summarizes the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions.

Clinical Rehabilitation Impact: WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.
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http://dx.doi.org/10.23736/S1973-9087.21.07011-8DOI Listing
June 2021

Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis.

Int J Qual Health Care 2021 Jun;33(2)

IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269 I, Florence 50143, Italy.

Background: To review and meta-analyse the evidence about the prevalence of barriers to evidence-based practice (EBP) reported in physiotherapy.

Methods: Two independent investigators conducted an extensive electronic search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020 and included the retrieved articles if they investigated barriers to EBP among physiotherapy professionals. Subsequently, they extracted data and assessed the methodological quality using a scale described in a similar previous study. The outcome for meta-analysis was frequency of each reported barrier. Sub-analyses were performed grouping studies based on countries where surveys were performed, classified as either developed or developing countries.

Results: Twenty-nine articles were included in the systematic reviews and meta-analysis. Risk of bias assessment of included studies showed a median score: 4 points (interquartile range: 3-4). The findings of meta-analysis revealed that lack of time was the most frequently reported barrier (53.0% [95% confidence interval, 95%CI, 44.0-62.0]), followed by language (36.0% [95%CI 16.0-62.0]), lack of access (34.0% [95%CI 23.0.27]) and lack of statistical skills (31.0% [95%CI 20.0-44.0]). Lack of skills and lack of generalizability were declared as barriers by 27.0% [95%CI 18.0-38.0] and 23.0% [95%CI 15.0-33.0] of responders, respectively. Lack of support and lack of interest are less frequent, with 16.0% [95%CI 11.0-24.0] and 9.0% [95%CI 6.0-15.0] of responses, respectively. Barriers reported in investigations performed in developed countries were less frequent when compared to those performed in developing countries.

Conclusion: Organizational issues and methodological skills seem key issues to allow the implementation of EBP, suggesting the need to adopt or enhance organizational and training strategies to facilitate the implementation of the EBP. Quantitative synthesis showed high heterogeneity for all analyses, and therefore, pooled data should be interpreted with caution.
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http://dx.doi.org/10.1093/intqhc/mzab093DOI Listing
June 2021

Physiotherapy after ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy.

J Back Musculoskelet Rehabil 2021 Apr 28. Epub 2021 Apr 28.

Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.

Background: Rotator cuff calcific tendinopathy (RCCT) is a very frequent and debilitating disease often treated with Ultrasound-guided percutaneous irrigation (UGPI) followed by physiotherapy.

Objective: A multicenter observational clinical study was designed to assess the effects of physiotherapy after UGPI on the functional recovery of the shoulders of patients suffering from RCCT.

Method: One hundred sixty-six patients (mean age 50.7± 7.6 years), 121 women, with painful RCCT were treated with UGPI and assessed at the day of UGPI (T0), and at one (T1), 3 (T2) and 6 (T3) months after treatment by the Constant- Murley Score (CMS), Oxford Shoulder Scale (OSS) and Numerical Rating Scale (NRS). Patients were divided into 2 groups, Physiotherapy (PT+) and not Physiotherapy (PT-) according to the performance of the rehabilitation program based on personal decision.

Results: A significant improvement at T1 in all outcomes in both groups and between T1 and T3 for NRS during movement and OSS was found, but not for NRS at rest and CMS. There was no difference between groups for all outcome measures. In 27,1% of patients symptoms recurred in an average of 13 ± 8 weeks.

Conclusions: Results suggest that post-UGPI not-standardized physiotherapy might not provide additional clinical benefits in short and medium term. Further studies could assess the effectiveness of physiotherapy performed after three months in patients with recurrence of pain.
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http://dx.doi.org/10.3233/BMR-191637DOI Listing
April 2021

Publication productivity of Allied Health Professions in an Italian Local Health Authority: prevalence and bibliometric analysis.

Acta Biomed 2021 03 31;92(S2):e2021017. Epub 2021 Mar 31.

Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Florence, Italy.

Background And Aim Of The Work: Despite Allied Health Professions (AHPs) represent a substantial part of workforce within the health system and they might give a relevant contribution to research, literature on publication productivity of AHPs working in non-research/academic institutions is scarce. The aim of this investigation was to provide point prevalence of AHPs working in a non- research/academic setting who have written at least one article published in indexed journals, in order to describe their scientific productivity.

Methods: A descriptive cross-sectional study was carried out of AHPs working in large Local Health Authority in Italy, who published in journals indexed in Scopus and/or PubMed. H-index, publications and citations number, journal name, publication year, and journal Impact Factor were extracted.

Results: Fifty-two AHP workers were identified as authors, having published 105 articles between 1993 and 2019. The number of papers increased over the years (p < .001). Published papers in journals with Impact Factor were 67.6% (n = 71) of the total, with a median Impact Factor = 2.676 (range = 0.583 - 59.102). The median number of citations was 4 (range = 0 - 99). The prevalence among units ranged from 0.8% to 5.0%, 2.9% in the whole department. There were not significant differences in number of articles (p = .138), citations received (p = .337), and H-Index (p = .661) among units.

Conclusions: In the Local Health Authority under investigation, publication productivity of AHPs workers was found to be low, although it is increasing over time, with no significant differences among units. Further investigations should be carried out to link these results with authors' information and organizational characteristics to study the relationship between authors' profiles and publication productivity.
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http://dx.doi.org/10.23750/abm.v92iS2.11276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138812PMC
March 2021

Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke.

Eur J Phys Rehabil Med 2021 Apr 25;57(2):238-245. Epub 2021 Jan 25.

Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy.

Introduction: Upper limb motor impairment is one of the most frequent stroke consequences. Robot therapy may represent a valid option for upper limb stroke rehabilitation, but there are still gaps between research evidence and their use in clinical practice. The aim of this study was to determine the quality, scope, and consistency of guidelines clinical practice recommendations for upper limb robotic rehabilitation in stroke populations.

Evidence Acquisition: We searched for guideline recommendations on stroke published between January 1st, 2010 and January 1st, 2020. Only the most recent guidelines for writing group were selected. Electronic databases (N.=4), guideline repertories and professional rehabilitation networks (N.=12) were searched. We systematically reviewed and assessed guidelines containing recommendation statements about upper limb robotic rehabilitation for adults with stroke (PROSPERO registration number: CRD42020173386).

Evidence Synthesis: Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 1324 papers that were screened, eight eligible guidelines were identified from six different regions/countries. Half of the included guidelines focused on stroke management, the other half on stroke rehabilitation. Rehabilitation assisted by robotic devices is generally recommended to improve upper limb motor function and strength. The exact characteristics of patients who could benefit from this treatment as well as the correct timing to use it are not known.

Conclusions: This systematic review has identified many opportunities to modernize and otherwise improve stroke patients' upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.
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http://dx.doi.org/10.23736/S1973-9087.21.06625-9DOI Listing
April 2021

Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis.

Neurol Sci 2021 Jan 16;42(1):81-87. Epub 2020 Oct 16.

Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Florence, Italy.

Purpose: The six-minute walking test (6MWT) is a simple and widely used measure of functional capacity. The aim of this systematic review is to summarize findings on reliability of 6MWT in subjects who have had a stroke.

Methods: Two independent investigators conducted an extensive search in multidisciplinary electronic databases from inception to August 2019, and selected complete original studies on the reliability of the 6MWT used to assess individuals with stroke. Two reviewers independently extracted data and evaluated methodological quality. Outcome for meta-analysis was reliability, measured by intraclass correlation coefficient (ICC). In addition, standard error of measurement (SEM) and minimal detectable change (MDC) were recorded.

Results: Of the 241 potentially relevant articles screened, 6 met inclusion criteria and 5 of them were included in meta-analysis. Combined correlation coefficient of .98 (confidence interval .98-.99) was found for test-retest reliability. Only one study investigated inter-rater and intra-rater reliability. SEM and MDC values were rarely reported.

Conclusions: The 6MWT has high test-retest reliability, when used to assess individuals with stroke. Other types of reliability and SEM and MDC need further investigations in populations with a stroke.
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http://dx.doi.org/10.1007/s10072-020-04829-0DOI Listing
January 2021

A two-year multicenter point prevalence study of older patients with hip fractures admitted to rehabilitation units in Italy.

Eur Geriatr Med 2020 08 24;11(4):573-580. Epub 2020 Jul 24.

Geriatric Research Group, Brescia, Italy.

Purpose: To date in Italy we do not have sufficient information on the rehabilitation process of older patients with hip fractures especially in the context of dementia. The main aims of the study were to gather information on the characteristics of older patients with hip fracture admitted to rehabilitation units with a specific focus on geriatric syndromes and the rehabilitation process.

Methods: A national multi-center "point prevalence study" was conducted in Italy over two index days in 2017 and 2018. All patients aged 70 years and older hospitalized on the index day in Rehabilitation Units after a hip fracture were eligible.

Results: A total of 615 patients were included. Most of the hospitals involved were from northern Italy, to a lesser extent from central and from southern Italy. The mean age was 83.08 ± 7.9 years. Almost half of the patients lived alone before the hip fracture. Most of the falls happened at home and while walking. The prevalence of delirium, dementia and malnutrition was 9.1%, 36.6%, and 19.3%, respectively. Antidepressants were prescribed in 27% of the population. The multidisciplinary team was activated as follows: occupational therapist in 18.9% of the cases, psychologists in 14.5%, social workers in 15.3%, and speech therapists in 6.5%.

Conclusion: The study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the correct management of geriatric syndromes in this frail population. Future multicenter longitudinal studies are required to further study this population.
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http://dx.doi.org/10.1007/s41999-020-00363-6DOI Listing
August 2020

Open Access Physical Therapy Journals: Do Predatory Journals Publish Lower-Quality Randomized Controlled Trials?

Arch Phys Med Rehabil 2020 06 28;101(6):969-977. Epub 2020 Jan 28.

University of Florence and Careggi University Hospital, Florence, Italy.

Objectives: To compare the quality of randomized controlled trials (RCTs) published in predatory and nonpredatory journals in the field of physical therapy.

Data Sources: From a list of 18 journals included either on Beall's list (n=9) or in the Directory of Open Access Journals (DOAJ) (n=9), 2 independent assessors extracted all the RCTs published between 2014 and 2017. When journals published more than 40 RCTs, a sample of 40 trials was randomly extracted, preserving the proportions among years. Indexing in PubMed, country of journal publication, and dates of submission or acceptance were also recorded for each journal.

Main Outcome Measures: The PEDro (Physiotherapy Evidence Database) scale and duration of the peer review.

Results: Four hundred ten RCTs were included. The mean PEDro score of articles published in non-Beall, DOAJ journals was higher than those published in Beall journals (mean score ± SD, 5.8±1.7 vs 4.5±1.5; P<.001), with the differences increasing when the indexing in PubMed was also considered (6.5±1.5 vs 4.4±1.5; P<.001). The peer review duration was significantly longer in non-Beall than in Beall journals (mean duration [d] ± SD, 145.2±92.9 vs 45.4±38.8; P<.001) and in journals indexed in PubMed than in nonindexed journals (136.6±100.7 vs 60.4±55.7; P<.001). Indexing in PubMed was the strongest independent variable associated with the PEDro score (adjusted R=0.182), but noninclusion on Beall's list explained an additional, albeit small, portion of the PEDro score variance (cumulative adjusted R=0.214).

Conclusions: Potentially predatory journals publish lower-quality trials and have a shorter peer review process than non-Beall journals included in the DOAJ database.
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http://dx.doi.org/10.1016/j.apmr.2019.12.012DOI Listing
June 2020

Mobilization of the contralateral limb in Slump position: effects on knee extension in healthy adult subjects.

Acta Biomed 2019 09 6;90(3):245-252. Epub 2019 Sep 6.

Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy;.

Background And Aim: In the acute phase of neuropathic pain due to nerve root disorders, the neurodynamic approach proposes the mobilization of the contralateral limb to decrease the pain and increase the range of motion in the affected limb. The aim of this study was to evaluate the effect of the contralateral knee mobilization on the ipsilateral knee extension range of motion in Slump position in healthy adult subjects.

Methods: Thirty-eight healthy subjects underwent a placebo, control and experimental manoeuvres that included a passive contralateral knee mobilization into extension. The knee, hip and cervical angles and distance between glabella and femoral condyle achieved in Slump test position were measured with an optoelectronic motion analysis system before and after each manoeuvre.

Results: Experimental manoeuvre produced a statistically significant increase of the knee extension ROM when compared to the control (p=.017) and placebo (p=.007) manoeuvres. A significant increase of the hip angle and distance between glabella and femoral condyle was detected after the experimental manoeuvres (p<.001), but not after the placebo and control manoeuvres.

Conclusions: The contralateral mobilization in Slump position increases the ipsilateral knee extension ROM. Further research is required to confirm that the knee increment ROM was due to the neural component.
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http://dx.doi.org/10.23750/abm.v90i3.7236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233740PMC
September 2019

Translation, cross-cultural adaptation, and validation of the Italian version of the Oxford Shoulder Instability Score.

Int Orthop 2019 09 8;43(9):2125-2129. Epub 2018 Nov 8.

Azienda Usl Toscana Centro - Sede, Ospedale San Jacopo, Via Ciliegiole, 120, 51100, Pistoia, Italy.

Purpose: The Oxford Shoulder Instability Score (OSIS) is self-reported outcome measurement developed to evaluate shoulder instability taking into account also adaptive strategies. Valid, reliable, reproducible, and user-friendly translations of outcome measure instruments are needed to allow comparisons of international study results.

Methods: The Italian translation and cultural adaptation of the OSIS were completed using a "translation-back translation" method and the final version was administered to a sample of 25 consecutive Italian-speaking patients. The psychometric properties of this adaptation were evaluated in terms of feasibility, reliability, construct validity, and responsiveness.

Results: No major differences occurred between the OSIS translations into Italian and back into English, and no content- or linguistic-related difficulties were reported. The Cronbach's alpha for the total OSIS was 0.897. Intraclass correlation coefficient value for inter-rater reliability was 0.805, while for intra-rater reliability was 0.586. Spearman rank correlation coefficient between the OSIS and the Rowe score was 0.548 (p = 0.005) and between OSIS-I and SF-12 was 0.488 (p = 0.013).

Conclusions: The Italian version of the OSIS is a reliable, valid, and reproducible outcome measure for clinical evaluation of patients affected by shoulder instability, which remains simple and user-friendly as the original version.

Level Of Evidence: Prospective cohort study, Level II.

Clinical Relevance: The availability of a validated translation of the OSIS will help surgeon to share their data on shoulder instability diagnostic and treatment in a more reproducible and comparable fashion.
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http://dx.doi.org/10.1007/s00264-018-4215-1DOI Listing
September 2019

Are they publishing? A descriptive cross-sectional profile and bibliometric analysis of the journal publication productivity of Italian physiotherapists.

Arch Physiother 2018 2;8. Epub 2018 Jan 2.

Unit of Functional Recovery, Azienda USL Toscana Centro, Area Prato, Italy.

Background: In a clinical science-based profession such as physiotherapy, research is mandatory to update knowledge and to provide cost-effective, high quality treatments. This study aimed to provide point prevalence of Italian physiotherapists who are academics, holding a PhD degree, or being authors of scientific papers. The scientific journal productivity of physiotherapists was also thoroughly analyzed.

Methods: A descriptive cross-sectional study was carried out on all Italian physiotherapists. Academics, postdoctoral research fellows, and PhD graduates were identified by searching the Italian Ministry of Education, University and Research (MIUR), Italian Society of Physiotherapy, and university websites. Then, authors of articles indexed in Scopus were searched. The following data were extracted: type of affiliation, authorship order, H-index, number of publications and citations, name of journals, year of publication, and journal's Impact Factor.

Results: The prevalence of academics, physiotherapists holding a PhD, or being author was 0.01%, 0.05%, and 0.56%, respectively. We identified 1083 papers co-authored by Italian physiotherapists, and their number has progressively increased over the years ( < 0.001). There was a significant difference between researchers and clinicians in both publication productivity ( < 0.01), citations (p < 0.01), and H-Index ( = 0.05). Articles were published in 359 different journals, receiving a total of 13,373 citations.

Conclusions: Despite the low prevalence of faculty members and the reduced availability of PhD programs in Italy (forcing some students to study abroad), the quantity and quality of journal productivity is growing fast, and an increasing number of physiotherapists are involved in research activities.
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http://dx.doi.org/10.1186/s40945-017-0042-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759900PMC
January 2018

Botulinum toxin after stroke: A functional point of view.

Authors:
Matteo Paci

J Neurol Sci 2017 11 10;382:185-186. Epub 2017 Oct 10.

Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Sede Prato, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.jns.2017.10.009DOI Listing
November 2017

The Italian version of the Trunk Impairment Scale: development and psychometric properties.

Eur J Phys Rehabil Med 2017 Aug 4;53(4):516-520. Epub 2017 Apr 4.

Functional Rehabilitation Unit, Azienda USL Toscana Centro, Prato, Italy -

Background: The Trunk Impairment Scale (TIS) is a widely-used tool aimed to evaluate trunk motor impairment for stroke patients. A validation trial of a translated form of the TIS was never conducted within an Italian population.

Aim: To describe translation, cultural adaptation, and validation (internal consistency, reliability, and validity) of the Italian version of the TIS (TIS-I).

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

Setting: Inpatient rehabilitation ward.

Population: Sub-acute stroke patients.

Methods: The TIS-I was developed involving forward-backward translation to establish correspondence with the original English latest version. Psychometric testing included internal consistency (Cronbach's alpha) and intra-rater and inter-rater reliability (ICC and Kappa), the standard error of measurement (SEM) and the minimal detectable change (MDC). Concurrent validity was estimated by comparing the TIS-I to the Trunk Control Test, balance subscore of the Fugl-Meyer (FM-BAL) and the mobility section of the Lindmark motor assessment chart (LIND-MOB), and construct validity by comparing the TIS-I to Barthel Index (BI) (Spearman rank correlation coefficient).

Results: The scale was administered to 41 subjects, showing internal consistency ranged from 0.79 to 0.88. ICC values ranged from 0.725 to 0.933 for inter-rater reliability, with the SEM ranging from 0.52 to 1.11, and from 0.770 to 0.911 for intra-rater reliability, with SEM ranging from 0.52 to 1.64. MDC ranged from 1.44 to 4.55. Kappa values ranged from moderate to almost perfect. Spearman rank correlation coefficient between the TIS-I and the BI, LIND-MOB and FM-BAL was 0.63, 0.79 and 0.74 (P<0.001), respectively. Correlation coefficient between the TIS-I and the TCT was 0.81 (P<0.001).

Conclusions: This study supports the reliability and the validity of the TIS-I as measure of motor impairment of the trunk after stroke.

Clinical Rehabilitation Impact: The TIS-I can be used in daily clinical practice and in research.
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http://dx.doi.org/10.23736/S1973-9087.17.04371-4DOI Listing
August 2017

The Salford Gait Tool: Does the clinical experience of the raters influence the inter-rater reliability?

Dev Neurorehabil 2018 Feb 7;21(2):131-132. Epub 2016 Nov 7.

a Unit of Functional Rehabilitation , ASL Toscana Centro , Prato , Italy.

Purpose: The purpose of this study was to verify if the amount of experience or the specific professional field of the raters may influence inter-rater reliability of the Salford Gait Tool (SF-GT).

Methods: Standardized videos of gait of seven children with cerebral palsy were recorded and assessed by three physiotherapists with experience in pediatrics (PPTs), three physiotherapists with experience with adult individuals (n-PPTs), and three students of physiotherapy.

Results: The inter-rater reliability both for joints and gait events was acceptable (ICC ≥ .70) for PPTs and n-PPTs, but not for students.

Conclusions: The inter-rater reliability of the SF-GT can be influenced by the experience of the raters and the amount of clinical experience seems to be more relevant than the specific professional field. Further research should be conducted with larger samples.
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http://dx.doi.org/10.1080/17518423.2016.1247922DOI Listing
February 2018

Differences in motor recovery between upper and lower limbs: does stroke subtype make the difference?

Int J Rehabil Res 2016 Jun;39(2):185-7

aUnit of Functional Rehabilitation, Azienda USL Toscana Centro, Prato bPrivate Practitioner cSchool of Specialization in Physical Medicine and Rehabilitation, Unit of Functional Rehabilitation, Azienda USL Toscana Centro, University of Florence, Florence, Italy.

Previous studies comparing the patterns of recovery for upper (UL) and lower limbs (LL) reported similar patterns of motor recovery of extremities. However, the influence of clinical stroke subtypes on the difference between recovery of extremities has never been investigated. The aim of this study is to compare the time course of the UL and LL in a sample of patients who have had distinct subtypes of ischemic stroke. A total of 443 consecutive patients following ischemic stroke were assessed at admission, discharge, and 1 month after discharge with the arm and leg motor parts of the Fugl-Meyer scale. Separate analyses were carried out for the entire sample and for samples of each stroke subtype classified according to the Oxfordshire Community Stroke Project. All groups showed significant improvements in motor function (P<0.001). Within the group of patients with total anterior circulation infarcts, the LL showed greater improved motor recovery than the UL (P<0.001). No significant difference was found between the time course of UL and LL motor recovery in the entire sample and in the other groups. This study confirms similar motor recovery of limbs in the entire sample, but also shows that the LL has greater recovery than the UL in patients with total anterior circulation infarcts. Functional prognosis should take into account the distinct stroke subtypes.
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http://dx.doi.org/10.1097/MRR.0000000000000172DOI Listing
June 2016

Factors associated with citation rate of randomised controlled trials in physiotherapy.

Arch Physiother 2015 1;5. Epub 2015 Sep 1.

Unit of Functional Rehabilitation, Department of Continuing Care, Azienda USL 4, Prato, Italy.

Background: Despite the use of citation rate as a measure of quality of research is strongly criticized and debated, it remain a widely used method to evaluate performances of researchers, articles and journals. The aim of this study was to test which factors are associated with citation rate of Randomised Controlled Trials (RCTs) published on the physiotherapy field.

Methods: All RCTs abstracted in the Physiotherapy Evidence Database (PEDro), indexed in Scopus database and published in 2008 were included. PEDro score, language of publication, indexing in PubMed database, type of access to articles, subdiscipline, the number of authors, the country where the study was performed, the type of institution where the study was conducted and the number of centres involved in the study (multicentric vs single-centre). and the 2013 5-year impact factor of the publishing journals were considered as independent variables. Citation rate until December 2013 was extracted from Scopus database and used as dependent variable.

Results: Six hundred and nineteen RCTs, published in 283 journals, were included and analysed. The 5-year impact factor was the strongest variable associated with the citation rate and explained approximately 50 % of the variance, and the number of authors explained an additional small part (about 1 %) of variability. The other variables were excluded from the model.

Conclusions: The study highlights that 5-year Impact Factor, not accessibility (language of publication, indexing in PubMed database or the type of access to articles) or reported quality (PEDro score), is a strong predictor of the number of citations for RCTs in the physiotherapy field. Our findings support the increasingly widespread idea that citation analysis does not reflect the scientific merit of the cited work, at least in terms of reported quality.The results of this study need to be confirmed with a publication window larger than one year.
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http://dx.doi.org/10.1186/s40945-015-0009-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759914PMC
September 2015

Reliability of the 36-item version of the Token Test in patients with poststroke aphasia.

Top Stroke Rehabil 2015 Oct 17;22(5):374-6. Epub 2015 Mar 17.

Aim: The purpose of this study was to investigate the intra- and inter-rater reliability of the 36-item version of the Token Test.

Methods: Twenty-four people following stroke with mild disorder of language comprehension were assessed by two speech therapists at a distance of 2  days apart.

Results: The test showed excellent and good inter-rater reliability, while some parts had lower coefficients.

Conclusion: This version of the Token Test can be used to assess mild disorder of oral language comprehension. However, further clearer instructions for administration and scoring may improve the test reliability.
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http://dx.doi.org/10.1179/1074935714Z.0000000049DOI Listing
October 2015

Teaching how to improve activities and participation of elderly subjects: the carelessness of the Italian Academia shown by the national qualification for physiotherapists.

Aging Clin Exp Res 2015 Apr 13;27(2):243-4. Epub 2015 Jan 13.

Laboratory of Analysis and Rehabilitation of Motor Function, Neuroscience Division, San Raffaele Hospital, Milan, Italy,

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http://dx.doi.org/10.1007/s40520-014-0309-9DOI Listing
April 2015

Has the Italian academia missed an opportunity?

Phys Ther 2014 Sep;94(9):1358-60

M. Baccini, PT, MSc, Motion Analysis Laboratory, Unit of Functional Rehabilitation, Azienda Sanitaria di Firenze, Florence, Italy. Mr Baccini is Editor in Chief of the Italian Journal of Physiotherapy and Coordinator of the Bachelor in Physical Therapy degree course, Florence University.

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http://dx.doi.org/10.2522/ptj.2014.94.9.1358DOI Listing
September 2014

The Italian version of the Functional Behavior Profile: reliability in a population of persons with multiple sclerosis.

Neurol Sci 2014 Aug 25;35(8):1293-8. Epub 2014 Jun 25.

School of Physiotherapy, University of Florence, Florence, Italy.

The aims of this study were to translate and investigate the interrater, test-retest reliability and internal consistency of the functional behavior profile (FBP) in an Italian population with multiple sclerosis. The Italian version of the FBP (FBP-I) was developed and the reliability of the final questionnaire was measured. A sample of 22 persons with clinically diagnosed multiple sclerosis was independently assessed by two raters. Interrater and test-retest reliability of the subscores and of the total score of the FBP-I were good to excellent. The internal consistency of the FBP-I was high. The FBP-I showed good psychometric properties and it can be used to assess functional status in Italian-speaking patients with multiple sclerosis.
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http://dx.doi.org/10.1007/s10072-014-1855-9DOI Listing
August 2014

Total hip arthroplasty after hip fracture or osteoarthritis: are there differences in characteristics and outcomes in the early rehabilitative stage?

Orthop Nurs 2014 Jan-Feb;33(1):43-7

Bruna Lombardi, MD, Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy. Matteo Paci, MSc, PT, Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy. Luca Nannetti, MD, Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy. Sandra Moretti, MSc, PT, Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy. Merildo Maritato, MD, Orthopaedic Unit, Prato Hospital, Prato, Italy. Giovanni Benelli, MD, Orthopaedic Unit, Prato Hospital, Prato, Italy.

Background: Despite some practitioner perception of an inferior outcome in patients with total hip arthroplasty (THA) following hip fracture (HF) vs. osteoarthritis (OA), few studies have analyzed this issue.

Purpose: This cohort study compares characteristics and short-term outcomes in patients with THA following HF and OA during the rehabilitative postsurgical period.

Methods: Records of all consecutive patients admitted in a rehabilitation department of a city hospital for THA, following HF or OA, were reviewed. Outcome measures were the Barthel Index, passive range of motion (PROM) for hip flexion and abduction, and length of hospitalization in the rehabilitation department. Participants were assessed at admission to department and at discharge.

Results: Five hundred seven patients were included (353 in the OA group). The HF group had a longer length of rehabilitation hospital stay and more comorbidity, whereas the OA group had higher functional performances at admission. Both groups improved in all clinical outcome measures with less improvement in PROM abduction scores in the OA group.

Conclusions: Patients undergoing traumatic and elective surgery have distinctive clinical characteristics. Results support the idea that OA patient can have a reduced PROM when compared with HF patients.
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http://dx.doi.org/10.1097/NOR.0000000000000022DOI Listing
April 2015

The assessment of subjective visual vertical: comparison of two psychophysical paradigms and age-related performance.

Atten Percept Psychophys 2014 Jan;76(1):112-22

Unit of Functional Rehabilitation, Motion Analysis Laboratory, Azienda Sanitaria di Firenze, Florence, Italy,

Perception of the subjective visual vertical (SVV) is usually assessed by asking to subjects, in complete darkness, to adjust the position of a luminous rod that is variably tilted (i.e., by the method of adjustment [ADJ]). Conversely, the two-alternative forced choice (2AFC) method requires subjects to categorize, as tilted either clockwise (CW) or counterclockwise (CCW), stimuli that are presented on a computer screen and are variably tilted from vertical. In this study, we aimed to compare the results of these two methods and investigate age-related effects on the SVV. SVV was assessed in 102 healthy individuals, 50 women and 52 men, with a mean age of 45.7 (range 20-91), using both ADJ (ten trials, initial 1°, 2°, 4°, 8°, or 12° bar tilts both CW and CCW) and 2AFC (120 stimuli with a 1°-32° variable tilt). Also, 50 of the subjects performed the ADJ test twice, with different bar lengths. We estimated bias and threshold for the two methods, and found that neither measure differed across the methods. Age was a significant predictor of threshold (2AFC, R (2) = .141; ADJ, R (2) = .190; p < .001), implying lower sensitivity with increasing age. Moreover, the ADJ method showed a significant increase of bias when the initial tilt was farthest from vertical, whereas the rod length was irrelevant. SVV measures obtained with the ADJ and 2AFC methods were comparable, but the latter measures were more resistant to artifacts that might affect the measurement. The lower sensitivity found in older persons may have an influence on their ability to interact with the environment and may contribute to impairment of postural control.
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http://dx.doi.org/10.3758/s13414-013-0551-9DOI Listing
January 2014

Randomized controlled trial quality in pediatric physical therapy.

Phys Occup Ther Pediatr 2014 Aug 29;34(3):260-70. Epub 2013 Aug 29.

1Unit of Functional Rehabilitation, Prato Hospital , Prato , Italy.

The aim of this study is to describe the reported quality of randomized controlled trials (RCTs) in pediatric physical therapy (PPT) and changes with time. All RCTs sourced from PEDro database and scored using the PEDro scale were included. RCTs were classified as high- or low quality both with the original cut-off of 6 and a modified cut-off of 5. The relationship between PEDro scores and year of publication was also investigated. One thousand three hundred sixty-seven articles were analyzed. According to the PEDro scale original and modified cut-off, 29% and 56% of the articles were classified as high-quality studies, respectively. The number of RCTs and the average PEDro score increased between 1962 and 2012. However, since some items of the scale could be more frequently satisfied, a further improvement of the quality of RCTs in PPT is recommended.
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http://dx.doi.org/10.3109/01942638.2013.827142DOI Listing
August 2014

Extracorporeal Shock Wave Therapy reduces upper limb spasticity and improves motricity in patients with chronic hemiplegia: a case series.

NeuroRehabilitation 2013 ;33(3):399-405

Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy.

Background: Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown.

Objective: To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia.

Methods: Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale.

Results: MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit.

Conclusions: Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment.
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http://dx.doi.org/10.3233/NRE-130970DOI Listing
June 2014

The subjective visual vertical in patients with pusher behaviour: a pilot study with a psychophysical approach.

Neuropsychol Rehabil 2011 Aug;21(4):539-51

Rehabilitation Department, Prato Hospital, Prato, Italy.

Pusher behaviour (PB) reflects some misrepresentation of verticality. However, its neural mechanisms are still unclear. The aim of this pilot study is to assess the perception of the subjective visual vertical in patients with PB using an orientation discrimination task relying on a psychophysical forced-choice procedure. A sample of eight patients with post-stroke hemiplegia, three of whom with (PB+ group) and five without (PB- group) a clear PB, and 10 matched healthy subjects, was selected. All participants were assessed with an orientation discrimination task based on the objective Two-Alternatives Forced Choice (2AFC) procedure, in which observers are forced to report whether an oriented stimulus that was tilted off-vertical by a varying amount (but never vertical) was tilted clockwise or counterclockwise from vertical. Participants' ability in detecting the visual vertical was estimated by calculation of bias and threshold, which represent deviations of the subjective vertical from the physical vertical and the sensitivity to orientation offsets away from vertical, respectively. While there were no significant differences between groups in terms of bias, statistical analysis showed a significantly higher threshold in the PB+ group compared to both PB- and control groups. Results suggest that vertical misrepresentation might be due to the presence, in patients with PB, of a lower signal-to-noise ratio in coding systems. Implications for clinical practice are discussed.
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http://dx.doi.org/10.1080/09602011.2011.583777DOI Listing
August 2011

Levels of evidence of articles published in Physical and Rehabilitation Medicine journals.

J Rehabil Med 2011 Feb;43(3):264-7

Department of Rehabilitation Medicine, Prato Hospital, Prato, Italy.

Objective: The aim of this study was to quantify and assess the levels of evidence of research and review articles published in professional Physical and Rehabilitation Medicine journals with international circulations.

Design: Quantitative analysis of articles published in Physical and Rehabilitation Medicine journals.

Methods: Selected articles from 7 Physical and Rehabilitation Medicine journals, published over a period of 6 years,were classified according to their level of evidence. Differences in the mean number of each type of article among journals and among years were analysed.

Results: A total of 5,451 articles were included in this study,of which 636 (11.7%) were randomized controlled trials. Articles published with the highest frequency were those classified as Level III (n = 2,424, 44.5%), whereas “systematic reviews”were the least frequent (n = 164, 3.0%). Heterogeneity was found only in terms of distribution over journals.

Conclusion: The distribution of different types of article in Physical and Rehabilitation Medicine journals is similar to that in other disciplines. No increase in articles with a high level of evidence was found in the selected journals over the period of study.
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http://dx.doi.org/10.2340/16501977-0665DOI Listing
February 2011

Reported quality of randomized controlled trials in neglect rehabilitation.

Neurol Sci 2010 Apr 10;31(2):159-63. Epub 2009 Dec 10.

Department of Rehabilitation Medicine, Casa di Cura Villa Fiorita, Prato Hospital, Prato, Italy.

The aim of this study is to assess the reported quality of randomized controlled trials (RCTs) on the effectiveness of neglect rehabilitation using a standardized scale. A search of seven electronic databases was carried out. Selected articles were scored using the PEDro scale and classified as high or low quality study both with the original cut off of 6 and a modified cut off of 5. A linear regression analysis between year of publication and quality rate was used to test whether the quality of the studies improved with time. A total of 18 RCTs were selected. Six articles (33.3%) and 10 articles (55.56%) were classified as having high quality when the original cut off or the modified cut off of the PEDro scale were used, respectively. Analysis shows no time-related changes in PEDro scores. The results show that reported quality is moderate for RCTs in neglect rehabilitation.
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http://dx.doi.org/10.1007/s10072-009-0198-4DOI Listing
April 2010

Types of article published in physiotherapy journals: a quantitative analysis.

Physiother Res Int 2009 Dec;14(4):203-12

Department of Rehabilitation Medicine, Villa Fiorita Hospital, Prato, Italy.

Background And Purpose: The aim of this study was to quantify and assess the types of research and review articles published in physiotherapy professional journals with international circulations.

Method: Selected articles from nine physiotherapy journals in a period of five years were classified according to their study design.

Results: A total number of 1627 articles were included in this study of which 205 (12.60%) were randomized controlled trial (RCT). Articles published with the highest frequency were 'observational/descriptive studies' (n = 305, 18.75%), whereas 'meta-analyses' were the rarest ones (n = 21, 1.29%). Many articles were validation studies (n = 216, 13.28%) and articles classified as 'others' (n = 217, 13.34%). High heterogeneity was found in terms of distribution over years and journals with an improvement of the number of RCTs among years.

Conclusion: The distribution of different types of article in physiotherapy journals is similar to other disciplines. The improvement of RCTs represents an important move in the right direction for evidence-based physiotherapy research.
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http://dx.doi.org/10.1002/pri.447DOI Listing
December 2009

Scale for contraversive pushing: cutoff scores for diagnosing "pusher behavior" and construct validity.

Phys Ther 2008 Aug 10;88(8):947-55. Epub 2008 Jul 10.

Unit of Functional Reeducation, Azienda Sanitaria di Firenze, and Motion Analysis Laboratory, Piero Palagi Hospital, Florence, Italy.

Background And Purpose: Considerable disagreement exists among researchers with regard to the prevalence, pathophysiology, and treatment of "pusher behavior" (PB), partly because of different testing procedures. This study was primarily aimed at establishing cutoff scores for and the construct validity of the Scale for Contraversive Pushing (SCP). The prevalence of PB in people with right- and left-brain lesions also was investigated.

Subjects And Methods: The study subjects were 105 consecutive patients with recent stroke. Two methods were used to diagnose PB: clinical examination and SCP score with 3 different cutoff points--an SCP total score of greater than 0 (Crit_1), subscores in each section of the scale of greater than 0 (Crit_2), and subscores in each section of the scale of > or =1 (Crit_3). Clinical and SCP diagnoses were independently made by different examiners. The Cohen kappa coefficient was used to determine the agreement between clinical and SCP diagnoses. The construct validity of the SCP was estimated by calculation of Spearman rank correlation coefficients for SCP and balance, mobility, and functional scores.

Results: The agreement between clinical and SCP diagnoses was low (kappa=.212) when Crit_1 was used. Crit_2 led to the highest agreement with the clinical diagnosis (kappa=.933). However, only Crit_3, although globally less accurate (kappa=.754), ensured no false-positive results. The construct validity of the SCP was demonstrated by significant (P<.001) moderate to high correlations with mobility (rho=.595), functional (rho=.632), and balance (rho=.666) scores. The prevalence of PB was not influenced by the side of the lesion. A limitation of the study was that the reliability of the clinical examination method was not investigated.

Discussion And Conclusion: The results support the validity of the SCP and suggest the need to choose different SCP cutoff criteria (Crit_2 or Crit_3) according to the aim of the evaluation.
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http://dx.doi.org/10.2522/ptj.20070179DOI Listing
August 2008
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