Autore: TMBMTT27

  • EFFICACIA DELL’ESERCIZIO FISICO NEL TRATTAMENTO CONSERVATIVO DELLA ARTERIOPATIA OBLITERANTE PERIFERICA: REVISIONE SISTEMATICA

    EFFECTIVENESS OF EXERCISE IN THE CONSERVATIVE TREATMENT OF PERIPHERAL OBLITERANT ARTERIOPATHY: A SYSTEMATIC REVIEW

    Introduction

    The Peripheral Artery Disease (PAD) is a vascular pathology characterized by a stenosis or a narrowing of the arteries of the lower limb, caused by the atherosclerotic disease with which shares the major risk factor. The primary symptom is claudicatio intermittens (CI), described as cramping pain primarily in the calves, relieved by rest within 10 minutes (1;2). The PAD treatment involves the control of the symptomatology and the interruption of the progression of the atherosclerosis, through prevention and rehabilitation protocols (3). Several studies have demonstrated the fundamental importance of conservative treatment based on supervised exercise training (SET), due to the increased tissue perfusion and angiogenesis it induces, improving circulation to the lower extremities (4). The objective of the study is to evaluate which form of exercise is more specific and effective for the conservative treatment of PAD

    Methods

    The literature search, conducted following the international PRISMA guidelines using the PICO strategy (Figure 1), was carried out through the Medline (via PubMed), Scopus and PEDro databases between December 2022 and January 2023. Common search strings have been formulated for Medline and Scopus. The string Peripheral artery disease was also used on PEDro (Figure 2). Furthermore, the search for the articles was limited using the following filters: year of publication (between 2012 and January 15, 2023), language (English), type of study (RCT). Relevant articles were selected by title, duplicates were eliminated using EndNote software. The articles were then chosen based on the reading of the abstract and ultimately the full text (Figure 3). After inclusion, the methodological quality of the selected RCTs was assessed using the PEDro scale (Figure 4).

    Results

    After the search conducted on the multimedia databases, the studies considered useful and relevant and therefore included in this systematic review were 7, composed only of randomized controlled trials (RCTs). Most of the studies included in the revision have predicted, for the intervention group (WTG), intermittent walking exercises on the treadmill, while the training intensity varied in the different protocols. Some of the studies included, not all have a control group. The studies analysed present, as the most shared outcomes, those relating to 2 macro-areas: cardiovascular function and functional capacity (exercise), which were evaluated in almost all of the studies through the use of heterogeneous scales and instruments. When assessing functional capacity, improvements were noted in nearly all groups undergoing a complete rehabilitation program. In the evaluation of cardiovascular function, however, heterogeneous results were obtained

    Discussion and Conclusion

    According to the AHA/ACC (3) guidelines 2016 on the management of patients with PAD, walking is the first-line therapy. What unites the rehabilitation protocols analyzed is the use of aerobic exercise, based on walking/treadmills and muscle relaxation techniques, to obtain progressive functional improvements and a reduction in the level of disability of the patients. Despite heterogeneous rehabilitation protocols for PAD in the literature, in terms of intensity, timing and duration of exercise, cardiovascular rehabilitation based on the combination of aerobic training at regular or continuous intervals and at high or low intensity, has proved to be able to improve patients’ health, well-being and quality of life (QoL) and enhance the exercise capacity and strength of the walking muscles.

    REFERENCES

    1. Wennberg PW. Approach to the pa­tient with peripheral arterial disease. Cir­culation 2013; https://doi.org/10.1161/CIRCULATIONAHA.
    2. Gerhard-Herman MD, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
    3. Aboyans V, et. al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. European Heart Journal. 2018 Mar
    4. Aboyans V., et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation. 2012

  • TENDINOPATIA DI SPALLA NEI GIOCATORI DELLA NAZIONALE ITALIANA DI SITTING VOLLEY: EFFICACIA DI UN TRATTAMENTO COMBINATO CON TECARTERAPIA®

    SHOULDER TENDINOPATHY FOR SITTING VOLLEYBALL ITALIAN NATIONAL TEAM: EFFICIENCY OF A TREATMENT COMBINED WITH TECARTHERAPY

    Introduction

    Shoulder tendinopathy is a pathology caused by a functional overload typical of the “overhead” athlete, indeed these sports present movements characterized by the search of a forced and repeated motion of the arms above the head (1). This problem is very frequent in Sitting Volleyball players, who also need to play in a sitting position (2). The correlated pain leads to a worsening of daily activities and a decline of sports performance (3).

    There are studies in the literature that demonstrate the usefulness of Tecartherapy® for this pathology (4). The aim of this study is to verify the effectiveness of Tecartherapy® as an adjunctive therapy to classic motor rehabilitation, in order to identify a method of treating shoulder tendinopathy in players of the Sitting Volleyball national team with the aim of increase short-term results concerning the reduction of pain, the increase of the ROM of the shoulder and the improvement of the activities of daily life and sports.

    Methods

    10 players of the Italian men’s sitting volleyball team (2021/22 competitive season) were recruited, with lower limb amputation, clinical diagnosis of shoulder tendinopathy and with age ranging from 25 to 50 (Figure 1). The objectives of the present study is to verify the best treatment both in the short term and after two months. The players were randomly divided into two groups of 5 people. The “experimental group” underwent the physiotherapy treatment in combination with Tecartherapy®, while the “control group” underwent only the physiotherapy treatment. Both groups had 10 treatment sessions and were evaluated as follows: before starting the treatment (T0), in the middle of the treatment (T1), at the end of the treatment (T2) and finally a follow-up was carried out after two months ( T3). Outcome measures were: limb tests for the shoulder ROM measurement, the NRS scale, the SF-12 and the DASH questionnaires.

    Results

    In order to extend the results to a larger sample, we used the 99% confidence interval (Figure 2). The ROM results showed that both therapies had a positive response, more precisely the “experimental group” obtained a superior increase in the majority of movements (Figure 3). The results of the NRS scale showed that a decrease in pain symptoms was found in both groups. The results of the SF-12 show that the “experimental group” obtained a general improvement, while the “control group” increased the physical score but manifested a decrease in the mental component (Figure 4). The DASH results demonstrate that in both groups a lower perception of the degree of disability in the functional, occupational and sports fields was detected. Moreover, the reduction of the value in the workplace in the “experimental group” is of a notable entity.

    Discussion and Conclusion

    The values of the T1 and T3 evaluations were not included in the analysis as they showed no statistically significant or clinically relevant differences. It is legitimate to hypothesize, regarding the T3 values, that this can be attributed to the physical inactivity of the players in the month of August and, therefore, to the forced rest to which they were subjected. From this it can be deduced that both treatments are valid in maintaining the progress obtained. On the basis of the objectives and what is highlighted by the results, it is possible to state that the application of Tecartherapy® positively influences the reduction of pain and the increase of the ROM of the shoulder and, consequently, also the improvement of daily life and sports activities. As a future perspective, it would be recommended to expand the study population in order to verify the results obtained and to have a more defined framework for the treatment of shoulder tendinopathy.

    REFERENCES

    1. S. Brent Brotzman, M.D.; Kevin E. Wilk, P.T., La Riabilitazione in ortopedia, Excerpta Medica Italia Srl, S. Donato Milanese (Mi), 2004
    2. Gaweł, E.; Zwierzchowska, A. Effect Of Compensatory Mechanisms On Postural Disturbances And Musculoskeletal Pain In Elite Sitting Volleyball Players: Preparation Of A Compensatory Intervention. Int. J. Environ. Res. Public Health 2021, 18, 10105. Https://Doi.Org/10.3390/Ijerph181910105
    3. Zwierzchowska, A., Gawel, E., Celebanska, D. Et Al. Musculoskeletal Pain As The Effect Of Internal Compensatory Mechanisms On Structural And Functional Changes In Body Build And Posture In Elite Polish Sitting Volleyball Players. Bmc Sports Sci Med Rehabil 14, 49 (2022). Https://Doi.Org/10.1186/S13102-022-00439-9
    4. Samuel Ribeiro, Bebiana Henriques, Ricardo Cardoso. The Effectiveness Of Tecar Therapy In Musculoskeletal Disorders. International Journal Of Public Health And Health Systems. Vol. 3, No. 5, 2018, Pp. 77-83.