Autore: GRSNMR14

  • Il Fisioterapista Territoriale negli Ospedali di Comunità: Studio di Fattibilità e Analisi Normativa nella Regione Marche

    Territorial Physiotherapist in Community Hospitals: A Feasibility Study and Regulatory Analysis in the Marche Region (Italy)

    Autori

    Grasso Anna Maria (UOC Medicina Fisica e Riabilitazione AST Fermo, Porto San Giorgio, Italy)

    Background and aims

    In recent years, the Italian National Health Service (NHS) has launched a profound reform process, accelerated by the National Recovery and Resilience Plan (PNRR) and key regulatory references such as Ministerial Decrees 70/2015 and 77/2022. Strengthening territorial care, reducing avoidable hospitalizations, and improving care continuity are central objectives of this transformation.

    Within this context, a new professional figure has emerged: the Territorial Physiotherapist (TP), already piloted in Tuscany and under national legislative consideration. This study aims to evaluate the feasibility of integrating the TP into Community Hospitals (CHs) of the AST Ascoli Piceno and AST Fermo in the Marche region.

    Methods

    A two-year organizational feasibility study (2025–2027) was conducted using an observational-descriptive approach. Two CHs were selected based on a high prevalence of chronic patients and the presence of multiprofessional teams. The project included:
    – Initial training of territorial physiotherapists
    – Definition of job descriptions and operational responsibilities
    – Integration into chronic care pathways
    – Monitoring via indicators (access, hospitalization reduction, patient satisfaction)

    Planning and evaluation tools included:
    – SWOT Analysis
    – GANTT Implementation Timeline

    Results

    The implementation phase showed:
    – Increased access to territorial rehabilitation services (projected >30% increase)
    – Estimated 15% reduction in avoidable hospitalizations for chronic conditions
    – High satisfaction levels among patients and caregivers
    – Strengthened team collaboration between TPs, GPs, and community nurses

    Case studies (stroke, COPD, post-surgical, orthopedic patients) showed significant clinical improvements and enhanced functional independence.

    Conclusion

    The Territorial Physiotherapist represents a strategic resource to achieve the objectives of DM 77/2022 and the PNRR: proximity, care continuity, multidisciplinarity, and person-centered care. Results confirm consistency with national and international literature on chronic disease management. However, institutional recognition, dedicated funding, and regional system planning are still needed.

    The integration of the TP has a positive impact on clinical practice, improving rehabilitation outcomes, care appropriateness, and system sustainability. The proposed model is replicable and represents a concrete innovation opportunity for the future of territorial healthcare in Italy.

    REFERENCES

    Italian Ministry of Health. (1994). Ministerial Decree 741/1994: Professional profile of the physiotherapist. Official Gazette of the Italian Republic, No. 6, January 9.

    Italian Ministry of Health. (2015). Ministerial Decree 70/2015: Standards for hospital care. Official Gazette of the Italian Republic, No. 127, June 4.

    Italian Ministry of Health. (2022). Ministerial Decree 77/2022: Organizational models and standards for community healthcare. Official Gazette of the Italian Republic, No. 144, June 22.

    USL Toscana Centro. (2019). Resolution No. 1057: Introduction of the family and community physiotherapist. Florence, Italy.

    Council of State. (2023). Judgment No. 1132: Recognition of the territorial physiotherapist as a new professional figure. Rome, Italy.

    Italian Senate. (2021). Senate Bill No. 2339 (Boldrini) and No. 2257 (Pagano): Legislative proposals on the territorial physiotherapist. Rome, Italy.

    World Health Organization. (2011). Global status report on noncommunicable diseases 2010. Geneva: WHO Press.

    World Health Organization. (2013). Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (WHA66.10). Geneva: WHO Press.

  • Equilibrio come nutrimento: fisioterapia e utilizzo dello specchio digitale in pazienti con disturbo dell’immagine corporea nell’ Anoressia Nervosa.

    Equilibrio come nutrimento: fisioterapia e utilizzo dello specchio digitale in pazienti con disturbo dell’immagine corporea nell’ Anoressia Nervosa.

    Equilibrio come nutrimento: fisioterapia e utilizzo dello specchio digitale in pazienti con disturbo dell’immagine corporea nell’ Anoressia Nervosa.

    Balance as nourishment: physiotherapy and use of the digital mirror in patients with body image disturbance in Anorexia Nervosa.

    Autori

    Grasso Anna Maria (UOC MEdicina Fisica e Riabilitazione AST Fermo, Porto San Giorgio, Italy)

    Malaspina Vissia (UOC MEdicina Fisica e Riabilitazione AST Fermo, Porto San Giorgio, Italy)

    Bragagnolo Matteo (UOC MEdicina Fisica e Riabilitazione AST Fermo, Porto San Giorgio, Italy)

    Introduction

    Body image is a multidimensional construct that includes perceptual, cognitive, emotional and behavioral aspects towards one’s body. 

    A negative body image is a significant factor in Eating Disorder; in eating disorders, this disorder represents a specific symptom of the disease, a triggering cause of the pathology and an obstacle to therapeutic intervention. 

    This study aims to evaluate the effectiveness of using high-tech tools in caring for patients diagnosed with Anorexia Nervosa associated with hyperactivity and body image disturbance. This evaluation was conducted through a qualitative research project which involved a large multidisciplinary team (Physiotherapists, Educators, Dietitians, Physiatrists, Psychiatrists and Psychologists). The rehabilitation protocol was defined using the Walker View and the D-Wall (Tecnobody).

    Methods

    The reporting standards sheet aims to evaluate the containment of hyperactivity and the restoration of fluid, conscious and purposeful motor activity.

    12 girls were recruited according to the inclusion criteria (diagnosis of Anorexia nervosa with hyperactivity, body image disturbance, BMI>16 and acceptance of increased caloric intake); the measurement of the results was carried out through the observation of the researchers and the definition of scales and evaluation tools: for motor activity we chose stabilometric analysis, gait analysis and 6-minute walking test; the psycho-educational staff took care of the administration of SPPB (sarcopenia) and IPAQ questionnaire.

    The treatment protocol was calibrated on the patients with training programs and exergames with the exclusion of the mirror or avatar function; the treatment lasted ten weekly sessions plus two focus group sessions (one in the middle and one at the end of the treatment) led by the Educator of the DCA center.

    Results

    The exercises, based on the exploration of body boundaries and performed excluding the mirror function, led to a greater awareness of the difference between one’s own body and the outside world. The movements, recorded by the instruments used, initially appeared “broken”, lacking harmony and with reduced motor control; compared with those recorded at the end of the treatment, there was greater familiarity with the patient’s own body and his motor potential.

    The specific physiotherapy process had a positive impact on the perception of body image, allowing greater awareness of both somatosensory afferents and the bodily self.

    During the Focus Group, all the participants found that the exercise helped them better manage the anxiety, stress and depression components that are often associated with this condition, promoting greater compliance and also allowing greater adherence to the plan food.

    Discussion and Conclusion

    From a physiotherapeutic point of view, to correctly approach this type of patient, it is necessary to know the physiology and what the alterations the subject may encounter. The treatment allows you to manage purely biomechanical complications (for example muscle hipotrophy, greater risk of fractures, postural alterations, etc.), but also to lay the foundations for restoring correct body perception, a fundamental prerequisite for healing. 

    Physiotherapy aimed at perceptive re-education, supported by the use of high-tech tools, has demonstrated significant improvements that are reported by the patients themselves. However, the actual effectiveness of this approach will need to be further analyzed, given the limited diffusion of high-tech tools and physiotherapy treatment protocols for patients with Anorexia Nervosa.

    REFERENCES

    1. Meyer D. Neill E. Phillipou A. Rossell S.L. Tan E.J Lin Toh W. Van Rheenen T.E. “Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project” International journal of eating disorders Wiley, maggio 2020
    2. Black D.W. and Grant J. E. “DSM-5 Guidebook, first edition” , Raffaello Cortina Editore, 2015.
    3. Wehbe Chidiac. C “An update on the medical consequences of anorexia nervosa” , Current Opinion , Agosto 2019
    4. Purves D. Augustine G.J. Fitzpatrick D. Hall W.C. LaMantina A. White L.E. “Neuroscience” quarta edizione italiana , Zanichelli 2013
    5. Seyed Alireza Hosseini; Ranjit K. Padhy. “Body Image Distortion” Review StatPearls Publishing; 2021 Jan. 2021 Sep 9.84
    6. Probst M. The “Body Experience in Eating Disorders: Research & Therapy” european journal of adapted physical activity, Volume 4, Issue 1 (2005), Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium