Categoria: Congresso 2023

  • Sviluppo di un nuovo modello riabilitativo in ambiente tecnologico:soddisfazione e monitoraggio del recupero funzionale nel paziente neurologico.Studio longitudinale pilota:risultati preliminari

    Development of a new advanced technological neurorehabilitation model:patient satisfaction and functional recovery monitoring in neurological patients.Preliminary results of a pilot longitudinal study

    Introduction

    Robotic and virtual reality devices have shown promising results in improving motor recovery in several neurological conditions. Additionally, the use of motion detection sensors and environmental control systems is rapidly advancing. Indeed, the possibility of applying motion detection and home-automation sensors in technological rehabilitation rooms may allow the synchronization of environmental data with patients’ clinical history, with the goal to facilitate the monitoring of patients’ functional recovery. In HoSmartAI project (EU Horizon, grant No. 101016834) we have been testing the level of productivity, functional recovery, and patients’ perception of a new technological solution, resulting from the installation of home-automation sensors in a technologically advanced room for motor neurorehabilitation.

    Methods

    The study is a pilot longitudinal study conducted in IRCCS San Camillo Hospital (Venice, Italy) within the EU Horizon project HoSmartAI. We enroll adult patients with diagnosis of neurological pathology and motor impairment. The treatment consists of one hour/day for 15 days of motor treatment in the HoSmartAI room using technological devices.

    The primary outcome is productivity, while secondary outcome include clinical and patients’ experience measures, such as: Trunk Control Test (TCT), Reaching Performance Scale (RPS), Box and Blocks Test (BBT), Nine-hole Pegboard Test (NHPT), Berg Balance Scale (BBS), 10-meter walking test, Functional Ambulation Categories (FAC), number of falls, System Usability Scale (SUS), Short Form Patient Satisfaction Questionnaire (PSQ-18), User Experience Questionnaire (UEQ) and EuroQol questionnaire (EQ-5D-3L).

    Results

    In the preliminary analysis, we included 12 patients, on average 60.66 ±12.52 years old, with diagnosis of: Stroke (n=4), Parkinson(n=3), Multiple Sclerosis (n=2), Neuropathy (n=1), Genetic Paraparesis (n=1) and Spinal Cord ischemia (n=1).  Inferential analyses of the variables indicated a significant improvement in the following measures BBS (T0: 34.90 + 18.98; T1: 40.00 + 16.28, p=0.14) and FAC (T0: 2.80 + 1.98; T1: 3.40 + 1.83, p= 0.04). Moreover,  the level of perceived quality of life was improved (EQ-5D vas score: T0: 47.91+ 20.50; T1: 61.66 + 11.9, p= 0.04). Finally, patients referred a good level of usability (SUS: 78.75 +17.04).

    Discussion and Conclusion

    Despite the small sample size, preliminary data collected so far suggest that undergoing a rehabilitation pathway in a technologically advanced environment could increase functionality status of patients, in addition to enhancing awareness and self-perception of health status. As more data become available, we will define the productivity increasing the number of patients treated in the same time. Moreover, future implications will be needed to understand the clinical features of those patients who may work safely in a co-presence setting. It will also be essential to analyze the usability of the room and technologies to identify those that are most manageable and user-friendly for the patients.

    REFERENCES

    Langhorne, P.; Coupar, F.; Pollock, A. Motor recovery after stroke: a systematic review. Lancet Neurol 2009,
    8, 741-754, doi:10.1016/S1474-4422(09)70150-4.

    Molteni, F.; Gasperini, G.; Cannaviello, G.; Guanziroli, E. Exoskeleton and End-Effector Robots for Upper
    and Lower Limbs Rehabilitation: Narrative Review.

    Abbruzzese, G.; Marchese, R.; Avanzino, L.; Pelosin, E. Rehabilitation for Parkinson’s disease: Current
    outlook and future challenges. Parkinsonism & Related Disorders 2016, 22, S60-S64,
    doi:https://doi.org/10.1016/j.parkreldis.2015.09.005.

    Manuli, A.; Calabrò, R.S. Effects of domotics on cognitive, social and personal functioning in patients with
    Parkinson’s disease: A pilot study.

    Maggio, M.G.; Maresca, G.; Russo, M.; Stagnitti, M.C.; Anchesi, S.; Casella, C.; Zichitella, C.; Manuli, A.; De
    Cola, M.C.; De Luca, R.; et al. Effects of domotics on cognitive, social and personal functioning in patients
    with chronic stroke: A pilot study

  • Valutazione della cinematica della colonna vertebrale durante il cammino utilizzando sistema optoelettronico: uno studio pilota su persone sane

    Assessment of the spine kinematics during walking using the optoelectronics system: a pilot study in healthy people

    Introduction

    Today spinal disorders in children are very important and widely analyzed with several methods. However, understanding spine kinematics to improve treatment decisions and outcomes is still to be fully exploited [ 1 ]. Stereo-photogrammetric motion analysis in static and dynamic tasks is the gold standard method to assess the real functional limitation [ 2 ]. The functional evaluation of the spine during  gait is a growing research area, besides no standard protocols have been developed [ 3 ]. The aim of this study is to analyze the reliability of a new multifactorial analysis protocol of movement to assess the kinematics of   spine and its segments (lumbar spine, lower dorsal spine, upper dorsal spine) during   gait, on the three anatomical planes, in terms of intra and inter operator variability.

    Methods

    Healthy subjects, without a history of low back pain or spine related pathology and with age greater than 5 years were admitted to the study. The acquisition procedure use the Smart DX (BTS Bioengineering), and consisted in :

    • positioning the markers (30) on the selected body landmarks,
    • acquisition of Standing trial: the subject maintains the standing position for at least 5 seconds,
    • acquisition of 5 Walking trials: for every trial the subject walks at his preferred speed, for 5 meters.

    Every subject repeated 2 sessions with 2 different operators (20 walking trials for every subject). The data collected were elaborated to calculate the ROM of different spine segments, normalized on gait cycle. The interclass correlation coefficient (ICC) (two-way mixed effects model, absolute agreement, average measurements) was calculated, to assess the intra and inter reliability of the protocol.

    Results

    We assessed 4 healthy subjects: their age was 7.8 yrs, 26.1 yrs, 5.5 and 33.1 yrs (2 males and 3 females).We were able to quantify the spine angles in all the trials acquired. The normal distribution of data was confirmed (Shapiro-Wilk test p>0.5). The ICC values of the ROM of different spine segments assessed, about  intra operator and inter operator reliability, are showed in the figure 1 and figure 2. The ICC value  0.5 and 0.75 indicate moderate reliability, values between 0.75 and 0.9, indicate good reliability, and values greater than, 0.90 indicate excellent reliability [ 4 ].

    Discussion and Conclusion

    We were able to quantify spine angles in healthy subjects in 100% of the acquisitions. The preliminary data confirm that the protocol is reliable in term of intra and inter variability, indeed show good to excellent validation in most of the calculated angles. Further research with a large sample is required and ongoing to confirm these preliminary results. This study was supported by “5 per mille” funds for biomedical  research, in particular for the project “5×1000/2023 – Sviluppo di nuovi protocolli di valutazione funzionale multifattoriale e relativi indici per l’età pediatrica” awarded to Prof. Giuseppe Andreoni.

    REFERENCES

    [ 1 ]         R. Haddas, K. L. Ju, T. Belanger, and I. H. Lieberman, “The use of gait analysis in the assessment of patients afflicted with spinal disorders,” Eur. Spine J., vol. 27, no. 8, pp. 1712–1723, 2018, doi: 10.1007/s00586-018-5569-1.

    [ 2 ]         A. Leardini, F. Biagi, C. Belvedere, and M. G. Benedetti, “Quantitative comparison of current models for trunk motion in human movement analysis,” Clin. Biomech., vol. 24, no. 7, pp. 542–550, 2009, doi: 10.1016/j.clinbiomech.2009.05.005.

    [ 3 ]         S. Negrini et al., “Trunk motion analysis: A systematic review from a clinical and methodological perspective,” Eur. J. Phys. Rehabil. Med., vol. 52, no. 4, pp. 583–592, 2016.

    [ 4 ]         T. K. Koo and M. Y. Li, “A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research,” J. Chiropr. Med., vol. 15, no. 2, pp. 155–163, Jun. 2016, doi: 10.1016/j.jcm.2016.02.012.

  • PRATICA CLINICA FISIOTERAPICA INFORMATA DALLA TERAPIA BASATA SULL’ACCETTAZIONE E L’IMPEGNO (ACT) NEL NON-SPECIFIC CHRONIC LOW BACK PAIN (NSCLBP): A CASE-REPORT

    ACCEPTANCE AND COMMITMENT THERAPY (ACT) INFORMED PHYSIOTHERAPY PRACTICE IN NON-SPECIFIC CHRONIC LOW BACK PAIN (NSCLBP): A CASE-REPORT

    Introduction

    Non-specific chronic low back pain (NSCLBP) is a common condition and source of significant suffering, disability and healthcare costs1.

    In this case-report we show the results of a combined physiotherapy treatment with the third wave generation of Cognitive Behavioural Therapy (CBT), the Acceptance and Commitment Therapy (ACT)2.

    ACT has been shown to have positive effects in chronic pain3, and meta-analyses of ACT for chronic pain showed improvements in pain intensity, physical functioning, depression and anxiety, and quality of life (QoL)4.

    Methods

    48-year-old male industry worker with CLBP for one year.

    Recently divorced, he lives with his young daughter.

    His general health is fine and he enjoys cycling in the weekend.

    One year ago at job during heavier work than usual, constant LBP (NRPS 5/10 at rest) spreading to the right buttock without legs’ irradiation. At MRI discal bulging from L3 to S1, without evidence of herniation.

    He has continued to work (NRPS 8/10 at worst).

    Aggravating factors: sitting and spine loading during lifting tasks.

    Only rest reduces pain and no further neurological symptoms are present.

    Psychosocial factors: worries and fear about job, guarding behaviours and notes of kinesiophobia. His sleep is disrupted because of pain.

    PROMs (t0 – 6/12 follow-up): OMPSQ, RMDQ, FABQ, TSK, PSEQ and CPAQ as shown in the tables: [ A1 ]

    Main request: “to get strategies to manage pain and to re-establish work capacity”.

    Results

    The diagnostic triage5 excluded red flags for serious pathologies6 and absence of neural findings tips for diagnosis of NSCLBP.

    Under a dispositional framework7,8 the clinical picture -persistent stage, pain features related to mechanical behaviour with nociceptive contribution9, psychosocial aspects of fear-avoidance behaviour10 about work capacity, kinesiophobia and low self-efficacy- can be depicted in a graph with arrows  showing the dispositions that tend towards manifestation and maintaining of the condition or that are preventive under a causal lens[ A2 ]

    The vectorial model shows treatment goals at a glance11; it lasted 6 months, in 9 sessions, with main goals:

    # make sense of pain and disability12

    # expose gradually to provocative movements13

    # set therapeutic path in a narrative way14 through principles of ACT, to restore patient’s autonomy and foster self-management strategies[A3,4]

    Discussion and Conclusion

    After different and failed rehabilitation attempts, in our episode of care it has been possible to exclude serious pathologies – and through a causal dispositionalist framework that sets apart a person-centred approach – he has been able to recover his functional levels and implement a self-management15,16 program that consent him to cope successfully with his complaint, under a shared clinical decision-making and personal empowerment lens. Further, be acquainted in ACT’s core principles, directly reduces avoidance and promotes openness, bringing the possibility to build present-focused awareness, and coordinate greater engagement in goal-oriented and values-based activities.

    REFERENCES

    1. Murray CJL. Lancet 2012.
    2. Hayes SC. Behavior therapy 2004.
    3. Hann KEJ, McCracken LM. J Context Behav Sci 2014.
    4. Veehof MM. Pain 2011.
    5. Bardin LD. Med J Aust 2017..
    6. Finucane LM. J Orthop Sports Phys Ther 2020.
    7. Anjum RL, Copeland S, Rocca E. Rethinking causality, complexity and evidence for the unique patient: A CauseHealth resource for healthcare professionals and the clinical encounter. Springer 2020.
    8. Smart KM. Clin J Pain 2011.
    9. Vlaeyen JWS. Pain 2016.
    10. Lin I. Br J Sports Med 2020.
    11. Low M. J Eval Clin Pract 2017.
    12. Caneiro JP. Braz J Phys Ther 2021.
    13. Caneiro JP. Phys Ther 2022.
    14. Launer J. Narrative based practice in health and social care: conversations inviting change. 2018. Routledge, London.
    15. Hutting N. J Orthop Sports Phys Ther 2019.
    16. Hutting N. Musculoskelet Sci Pract 2022.

  • Fisioterapia in paziente con mielopatia cervicale dopo microdiscectomia cervicale, Gait Analisys e stabilometria: un caso clinico

    Physical Therapy in patient with cervical mielopathy following cervical microdiscectomy, gait analysis and stabilometry results: a case report

    Introduction

    Degenerative cervical myelopathy (DCM) is a progressive, degenerative condition, which is a consequence of degeneration and structural changes of the intervertebral disks that may lead to structural and vascular changes to the spinal cord.1 Symptoms may present as hyperreflexia, clumsiness in gait,neck stiffness, shoulder pain, paresthesias, or radiculopathic signs.1 Surgical intervention is recommended for patients with moderate and severe DCM.2 There are no rigorous studies evaluating if physiotherapy causes benefit or harm after surgical decompression in patients with DCM.3
    With this case report we describe the results obtained in a patient with DCM after surgical decompression who received standard physiotherapy for trunk control according to the Bobath concept, global muscle strengthening especially in the lower limbs and balance training and gait training associated to Virtual Reality.

    Methods

    A 68 year old man, with severe DCM, MJOA 12 (modified Japanese Orthopaedic Association scale), arrived after surgical intervention. At T0 the patients had a slight left hemiparesis, Mingazzini positive for LL levelling, F4 proximal sthenic deficit, reported left hand paraesthesia. He could walk with a 4-wheeled walker, had reduced LL major control on the left. The tests included: open/closed eyes balance with stabilometric platform (D-Wall, Tecnobody), the outcomes included parameters of center of pressure (COP) during quiet standing; Gait Analysis (WALKER VIEW, Tecnobody) was possible leaning on the handrail, the outcomes included velocity, stride length and joints Range of Motion. The treatment (lasted 3 months, three days a week) focused on balance training with real time biofeedback on stabilometric platform, stable and unstable surfaces; gait training through treadmill with real-time feedback.

    Results

    The stabilometric parameters have improved: there was reduction of the oscillation area OE 21% and 57% in OE and CE test (mm²: T0 OE 945.92 CE 2959.33 – T1 OE 742.99 CE 1263.97). Romberg index decreased (Area CE/OE T0 313, T1 170). The average speed AP decrease about 34% OE and 17% EC (mm/s T0 OE 17,78 CE 28,24 T1 OE 12,58 CE 23,60). The average speed LL decrease about 17% OE and 8% CE (mm/s T0 OE 15,55 CE 23,09 T1 OE 12,99 CE 21,24) Gait analysis shows better trunk position in the sagittal plane (flex-ext T0 14.7°, T1 6 ,5°) and less oscillation in the frontal plane (lat-flex T0 -2.5°, T1 -0.8). An increased of the 180% of the speed (km/h: T0 1.2, T1 2.2). Improved length gait of 130% for the left, 32% right (cm: T0 l 19 r 28, T1 l 44 r 37). Improvement of parameters of step (flex-ext in stance [°] T0 l 0.5 r 4.4 T1 l 13.3 r 10 ,7, flex-ex in toe off [°] T0 l -38,5 r -30,0 T1 l -34,8 r -44,6. MJOA improved from 12 to 15.

    Discussion and Conclusion

    Gait impairment constitutes the most prominent clinical manifestation of cervical myelopathy, and thus its amelioration may have tremendous impact on the recovery of patients’ functionality.4 Individuals with DCM shown a greater postural sway with increased muscle activation in the trunk and lower extremities during quiet standing.The treatment through a real time biofeedback stabilometric platform, and through gait training led to an improvement in the kinematic parameters of the gait and in the parameters related to the COP. All this has allowed the rehabilitation team and the patient himself to objectively verify the changes obtained throughout the training to direct the treatment towards the limits identified during the sessions and allowing the patient to establish active coping strategies. Future works may provide follow-ups to verify the maintenance of the obtained results.

    REFERENCES

    1. Cook, Chad E., et al. “Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review.” Journal of manipulative and physiological therapeutics 34.8 (2011): 539-546.

    2. Fehlings, Michael G., et al. “A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression.” Global spine journal 7.3_suppl (2017): 70S-83S.

    3. Tetreault, Lindsay, et al. “Significant predictors of outcome following surgery for the treatment of degenerative cervical myelopathy: a systematic review of the literature.” Neurosurgery Clinics 29.1 (2018): 115-127.

    4. Siasios, Ioannis D., et al. “The role of gait analysis in the evaluation of patients with cervical myelopathy: a literature review study.” World Neurosurgery 101 (2017): 275-282.

  • Un caso clinico: un percorso di riabilitazione neuromotoria individualizzato e “patient centered” in un quadro di disabilità grave

    A case report: an individualized and “patient centered” neuromotor rehabilitation path in a context of severe disability

    Introduction

     

    Intro

    GF 22 y/old M is a patient admitted in residential care at the Seraphic Institute a Neurorehabilitation Center in Assisi that offer comprehensive rehabilitation-educational interventions including neuromotor treatment.  GF presents with blindness, tetraparesis with spasticity most evident at lower limbs, a flexed head and trunk posture in both standing and sitting position, and severe right convex dorsolumbar scoliosis. At beginning of treatment in April 2022 he patient was able to move independently  with a standard wheelchair ; he needed verbal and sustained physical support for postural transfers and transitions ; in sitting position the subject had  good head and trunk control;  he was able to use effectively both upper limbs  predominantly  the right one; he could keep the standing position with bilateral or anterior support for a few seconds, and he could walk  with a walker with posterior support.

    Methods

    Neuromotor rehabilitation consisted in treatments carried out in a therapeutic pool and gymnasium; it was based on exercises aimed to allow GF acquiring a stable upright station, strengthening the muscles of the lower limbs, and urging autonomous ambulation that would improve autonomy in performing ADLs and facilitation in social participation. Exercises offered in gymnasium stressed upright position without supports, with different podal support surfaces and walking with the tetrapod. The activities performed in the swimming pool consisted of Sit to Stand, jumping, leg beats and walking performed with unstable supports and obstacles to overcome during walking.

    Results

    During the year of individualized treatment, GF showed significant improvements in different motor skills. By the end of treatment, he was able to keep: the sitting position with excellent head and trunk control; in the transition from sitting to standing he required only minimal support as well as to keep standing position. The patient showed improvement in trunk control during ambulation, particularly in hydrokinesiotherapy although he needed reinforcement to improve the gait pattern and internalization of the correct sequence and coordination of moments.

    Discussion and Conclusion

    This case highlights that in persons with complex disability, individualized and tailored treatment proves to be the best tool for implementing an intervention that places the individual at the centre of his or her rehabilitation program in order to achieve functional motor results impacting patient’s quality of life. The neuromotor rehabilitation pathway on a bi-weekly basis is lacking to be able to achieve consolidated results in line with the set goals; certainly greater cooperation in stimulating the user’s motor autonomy by the educational figures of the Institute, with whom he spends more time, would reinforce the achievements made in the gym.

    REFERENCES

    “Proposte riabilitative nelle paralisi cerebrali infantili”, Adriano Ferrari, ed. Del Cerro 2003

    “Elementi di riabilitazione nella disabilità plurima”, F. Marchionni et al., ed. Istituto Serafico 2006

    “Riabilitazione in acqua. Esercizi terapeutici”, A. Broglio e V. Colucci, Edi. Ermes 2001

    “Cerebral Palsy: An Overview”, Vitrikas, Dalton and Breis, 2020

    “Sit-to-stand training for self-care and mobility in children with cerebral palsy: a randomized controlled trial”, Chaovalit et al. 2021

  • Educazione terapeutica in seguito a chirurgia al seno. Sviluppo di supporto informativo audiovisivo.

    Therapeutic education after breast surgery: implementation of audio-visual informational support.

    Introduction

    Therapeutic education is an essential element in all peri-operative stages and are key for patient engagement when administering self-care programs. Existing literature clearly states that an informed participation on behalf of patients during the course of treatment reduces the risk of complications, shortens recovery time, and consequently optimizes the use of healthcare resources [1,2].

    At Azienda USL-IRCCS of Reggio Emilia, the “Breast-PDTA” (Therapeutic Diagnostic Care Path) involves structured therapeutic educational interventions led by both nursing staff and physiotherapists. This is often done both verbally, by giving routine notions on standard care, and with pamphlets and brochures.

    PDTA monitoring data has on average 450 cases/year. Unfortunately, less than 65% of patients participate in therapeutic education group sessions led by PTs. Based on patients’ feedback, we created an audiovisual support to facilitate the therapeutic and educational process.

    Methods

    At first, we collected and reviewed the material already available at the services involved in the Breast-PDTA of our Institution and on The Web. Then, we conducted a focus group involving women previously treated for breast cancer according to the Breast-PDTA. The sample was recruited voluntarily by local patient associations. Data collection and analysis was conducted according to the methodology for qualitative studies. Based on the information on patient needs gathered via the focus group, a multi-professional group created the storyboard of the audiovisual material. This was created to be also used at other institutions in Emilia-Romagna for the years to come.

    Results

    The qualitative survey highlighted the users’ needs for additional information and more practical suggestions on how to become more self-sufficient including everyday activities especially in the immediate postoperative period, when exercising and during job-related activities. Users stated they would prefer to receive this information during the pre-surgical stage, rather than after surgery when issues related to surgical wound management and drainage may arise.

    An in-depth analysis of available materials revealed a large but haphazard informational support available in PDF format. However, this information is difficult to access for both professionals and patients alike. All available information was now reordered onto a single internet page that can be reached by a link or a QR-Code (See Figure). The storyboard has been created and the audiovisual support is scheduled to be published in the fall of 2023 on the same webpage.

    Discussion and Conclusion

    The focus group revealed a partial discrepancy between the content put forward by the healthcare professionals and the real informational needs of the users, who were primarily interested in being self-sufficient in their ADLs, addressing the potential need for assistance, and wished to resume physical exercise and job-related activities.

    The new audiovisual support does not replace the role of health professionals in the educational process. On the contrary, it can empower the professionals’ role by freeing up time to devote to listening to patients. This may help women become more aware and prepared to face the therapeutic process, right from the pre-surgical stages.

    The reorganization and improvement of the existing information on a single webpage is consistent with the user-friendly digitization process the healthcare system is currently undergoing. The reorganization of material and audiovisual publication will be the subject of future analysis as part of PDTA monitoring.

    REFERENCES

    1. Gyawali B, Bowman M, Sharpe I, Jalink M, Srivastava S, Wijeratne DT. (2023) A systematic review of eHealth technologies for breast cancer supportive care. Cancer Treatment Reviews. 2023; 114: 102519
    2. Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, Tu Q, Tat-Ko J, Sum SCM, Sherman KA, Elder E, Redfern J. Electronic Health Interventions for Patients with Breast Cancer: Systematic Review and Meta-Analyses. Journal of Clinical Oncology. 2022; 40: 2257-2270.

  • Effetti del protocollo “Home Covid Rehab” (HCR) sul quadro clinico di pazienti Covid post ospedalizzazione: uno studio longitudinale retrospettivo

    Effetti del protocollo “Home Covid Rehab” (HCR) sul quadro clinico di pazienti Covid post ospedalizzazione: uno studio longitudinale retrospettivo

    Introduction

    Il Covid-19 è una malattia che si è diffusa in modo pandemico nel mondo come definito dall’OMS nell’arco temporale fra 11 marzo 2020 e 5 maggio 2023. Le sequele dell’infezione non possono essere trascurate dato che i pazienti lamentano spesso disturbi come dispnea, ridotta capacità fisica, polmonare e cardiaca, riduzione della forza e peggioramento della qualità di vita. In una situazione dove è d’obbligo ridurre al minimo le fonti di contagio la tecnologia ci viene incontro. La tele-riabilitazione ci ha permesso infatti di erogare servizi riabilitativi, a livello ospedaliero tramite il Sistema Sanitario Nazionale, in totale sicurezza e raggiungere gli obiettivi terapeutici prefissati. Viene protocollato in Azienda ULSS 2 – Marca Trevigiana (Regione Veneto), Distretto di Pieve di Soligo, U.O.C. R.R.F di Vittorio Veneto e di Conegliano il programma “Home Covid Rehab” (HCR).

    Methods

    Lo studio analizza l’evoluzione dei parametri di dispnea e performance muscolare in pazienti COVID-19 post-ospedalizzazione, sottoposti a tele-riabilitazione con il protocollo Home Covid Rehab. Indicatori utilizzati: Barthel Dyspnea Index (BDI) e 30-second chair stand test (30CST). Follow-up settimanali per 4 settimane post-dimissione. Reclutati 293 pazienti, 78 esclusi per ineligibilità. Analisi dati su 200 persone, suddivise per genere (119 uomini, 81 donne) e tipo di ricovero (172 no TI, 28 TI). Intervento: Home Covid Rehab con brochure e videochiamate entro 48 ore dalla dimissione. Programma di 30 minuti di esercizi al giorno, livelli di difficoltà variabili, da ripetere due volte al giorno per 4 settimane. Pazienti ricevono programma cartaceo e accesso a canale YouTube per istruzioni e monitoraggio dei sintomi e dei criteri di interruzione dell’allenamento.

    Results

    Alla dimissione sono emersi i seguenti punti ai 2 indicatori di outcome:

    1) La media dei punteggi alla BDI è rispettivamente a: t0: 81,61 (+/-9,8), t1: 89,16 (+/- 8,75), t5: 95,48 (+/- 5,83), con p-value al t-test appaiato <0.001;

    2) La media al 30CST è stata di 10.55 (+/-3,49). Con l’inizio dei follow up e degli incontri telematici, le misurazioni sono state rispettivamente a: t1: 11.71 (+/-3,68), t2: 12.92 (+/-3,83), t3: 13.83 (+/- 4,21), t4: 14.49 (+/- 4,41), t5: 15.04 (+/- 4,48), con p-value al t test appaiato <0.001.1).

    Il delta espresso in termini percentuali è il seguente: +17% nel BDI e +42,56% al 30CST.

    Discussion and Conclusion

    Lo studio ha evidenziato miglioramenti nei sintomi post-COVID. Pazienti adulti trattati per 4 settimane han mostrato riduzione della dispnea durante le ADL e maggior capacità fisica. La popolazione ha registrato un miglioramento medio del 17% al BDI e del 42,56% al 30CST, avvicinandosi ai livelli di una popolazione sana. Sono emerse correlazioni significative tra età e durata del ricovero, e tra gli outcome. Tali correlazioni non si sono verificate nel gruppo di pazienti in terapia intensiva. È importante notare che lo studio ha utilizzato un gruppo di controllo basato sui risultati riportati in letteratura per soggetti sani, poiché non era possibile avere un gruppo di controllo adeguato a causa della situazione pandemica. Sono necessari ulteriori studi con gruppi di controllo per confermare l’efficacia e la sicurezza del protocollo riabilitativo Home Covid Rehab tramite tele-riabilitazione.

    REFERENCES

    Di seguito proponiamo le tre principali, ai fini invece dello studio realizzato sono stati inseriti 61 articoli.

    • Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 13 marzo 2020;7(1):11.
      – Clicca qui per aprire la pubblicazione
    • Stam HJ, Stucki G, Bickenbach J, European Academy of Rehabilitation Medicine. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 15 aprile 2020;52(4):jrm00044.
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    • Nabavi N. Long covid: How to define it and how to manage it. BMJ. 7 settembre 2020;370:m3489.
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