CREDENZE E PROSPETTIVE DEI SOGGETTI E DEI CLINICI RIGUARDO ALLA SPALLA CONGELATA: ERANO IN ACCORDO? UNO STUDIO TRASVERSALE

SUBJECTS AND CLINICIANS BELIEFS AND PERSPECTIVES REGARDING FROZEN SHOULDER: WERE THEY IN AGREEMENT? A CROSS SECTIONAL STUDY

Autori

Brindisino Fabrizio [Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy]

Sciscione Sara [Riabilita, private practice, Sabaudia (LT), Italy]

Andriesse Arianna [Medical Translation Private Practice c/o Andriesse Medical Translator, Lecce, Italy]

Cioeta Matteo [IRCCS San Raffaele Roma, 00166 Rome, Italy]

Struyf Filip [Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium]

Feller Daniel [Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy] [Centre of Higher Education for Health Sciences of Trento, Trento, Italy] [Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands]

Introduction

Frozen Shoulder (FS) is a complex condition that affects the shoulder joint causing pain, restriction of shoulder motion, and disability. Physiotherapists (PTs) are the first contact clinicians involved in FS management, and no study has previously investigated if PTs knowledge and management skills complied with what subjects suffering from FS needs and expectations. The aim of this study is to compare knowledge, skills and operative strategies of Italian PTs with the needs, perceptions and beliefs of subjects with FS searching also on what PTs believe and their own assisted expected from FS rehab, and highlight common points and divergences for improving subjects taking care, comprehension and health assistance.

Methods

The reporting of this exploratory survey followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist, and STROBE guidelines. A 2-sections survey was developed and available from the 1st of May to the 1st of August 2023.

Results

A total of 501 PTs and 110 subjects with FS completed the surveys. Most pf PTs answered that they are skilled about pathoanatomical conditions and also careful to the psychological aspects (88.4%) and explain pathology evolution in 3 stages (39.5%). Moreover, the majority of PTs (89.6%) stated that education was important, and that FS should be better managed if in collaboration with other professional (82.2%). Most of PTs believed that priority of patients was to be reassured (32.3%), and 35.8% assessed psychological domain with extemporaneous questions. Subjects suffering from FS were suggested not to have imaging in 23.4% and would like an expert but also empathetic PT in 73.4%. FS course was explained in 3 phases in 29.9% of subjects, but 26.36% of subjects stated that they were not properly informed about FS. Most of subjects stated that the priority should be range of motion recovery (93.64%) and night pain decrease (91.82%). Fearful thoughts were often present and 27.37% would prefer corticosteroid for better manage the painful phase.

Discussion and Conclusion

The results showed a general agreement between the groups examined, with respect to some issues such as therapeutic relationship characterizing aspects, importance of education and management of pathology. However, main target of treatment, subjects’ priorities, and importance to psychological assessment were noticeable different. PTs should get pathology-specific updating and educational skills, better taking into account the subjective needs and expectations of individuals with FS in order to improve the outcome of subjects and the comprehension of the complexity of the pathology.

REFERENCES

Lewis J. Frozen shoulder contracture syndrome – Aetiology, diagnosis and management. Man Ther. 2015 Feb;20(1):2-9. doi: 10.1016/j.math.2014.07.006. Epub 2014 Jul 18. PMID: 25107826.

Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31. doi: 10.2519/jospt.2013.0302. Epub 2013 Apr 30. PMID: 23636125.

Jones S, Hanchard N, Hamilton S, Rangan A. A qualitative study of patients’ perceptions and priorities when living with primary frozen shoulder. BMJ Open. 2013 Sep 26;3(9):e003452. doi: 10.1136/bmjopen-2013-003452. PMID: 24078753; PMCID: PMC3787409.

King WV, Hebron C. Frozen shoulder: living with uncertainty and being in “no-man’s land”. Physiother Theory Pract. 2023 May;39(5):979-993. doi: 10.1080/09593985.2022.2032512. Epub 2022 Feb 14. PMID: 35164645.

  1. Riconcettualizzare il concetto di Prognosi del recupero motorio dopo riabilitazione dell’arto superiore in pazienti con ictus

Reconceptualizing the concept of Prediction of rehabilitation-induced upper limb motor recovery, after stroke: a multi-dimensional and multi-modal research project.

Autori

Silvia Salvalaggio (IRCCS San Camillo Hospital, Venice, Italy)

Simone Gambazza (University of Milan, Italy)

Silvia Gianola (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)

Greta Castellini (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)

Nicola Filippini (IRCCS San Camillo Hospital, Venice, Italy)

Marco Zorzi (University of Padova, Italy)

Andrea Turolla (University of Bologna, Italy)

Introduction

Prognosis of recovery has always covered an important role in medicine, due to its relevance for monitoring and interpreting patients’ achievements over time. After stroke, clinicians, patients and caregivers always ask what is likely to be expected for their clinical conditions and life in the future, and what the best therapeutic options might be for them. Even research in rehabilitation has always attempted to predict motor recovery by studies assessing and measuring functional aspects of movement. What is missing so far, is that we do not know how rehabilitation interventions may change the pattern of recovery, causing uncertainty on the potential of recovery of each patient, in response to specific interventions. In this perspective, being familiar with interpreting initial signs and symptoms, selecting the most appropriate assessment strategy and using prediction models is pivotal to be timely and clinically efficient.

Methods

With the aim of introducing a novel concept of prediction, focused on the expected recovery in response to rehabilitation rather than spontaneous recovery, I conducted three types of studies (i.e. work-packages, WP) designed to identify potential predictive factors and investigate the impact of different doses and modalities of therapy. In particular:

  • WP1: Systematic Review with Proportional meta-analyses. Longitudinal-single-cohort studies on patients undergoing rehabilitation after stroke  were included. Predictive features investigated in the included studies were reported. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity, and effect sizes (ES) of different rehabilitation doses were calculated.
  • WP2: Retrospective study design. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received.
  • WP3: Longitudinal cohort study. Stroke survivors were assessed before and after a period of rehabilitation, using motor, cognitive, magnetic resonance imaging and transcranial magnetic stimulation measures. We investigated the association between dose of rehabilitation and UL-response (i.e. FMA-UE), using ordinary least squares regression as primary analysis. To obtain unbiased estimates, adjusting covariates were selected using directed acyclic graph.

Results

Discussion and Conclusion

All the results of this doctoral thesis can be summarised in the following key findings for stroke rehabilitation and recovery:

REFERENCES

Daly JJ, McCabe JP, Holcomb J, et al. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair 2019; 33: 523-537. 2019/05/28. DOI: 10.1177/1545968319846120.

Coupar F, Pollock A, Rowe P, et al. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil 2012; 26: 291-313. 2011/10/26. DOI: 10.1177/0269215511420305.

Oltre il Proportional Recovery Rule per l’arto superiore: il ruolo della riabilitazione per la prognosi del recupero motorio dopo ictus

Beyond the Proportional Recovery Rule for upper limb after stroke: rehabilitation modality matters.

Autori

Silvia Salvalaggio (IRCCS San Camillo Hospital, Venice, Italy)

Simone Gambazza (University of Milan, Italy)

Silvia Gianola (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)

Greta Castellini (IRCCS Istituto Ortopedico Galeazzi, Milan, Italy)

Luisa Cacciante (IRCCS San Camillo Hospital, Venice, Italy)

Gianluca Ossola (Aulss 3, Venice, Italy)

Martina Andò (Fondazione Don Gnocchi, Roma, Italy)

Marco Zorzi (University of Padova, Italy)

Andrea Turolla (University of Bologna, Italy)

Introduction

Upper limb (UL) motor impairment is common among people with stroke (PwS). Previous attempts to develop models predicting UL motor recovery have faced methodological challenges, such as overlooking rehabilitation interventions or inadequate prediction capabilities. This study investigated the association between rehabilitation dose and UL function recovery, using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), across various rehabilitation modalities (Priming, Augmenting, Task-oriented) and stroke phases.

Methods

This is a cross-sectional-meta-research study of longitudinal-single-cohort observational-studies within a systematic-review on predictive factors of UL recovery. Selection criteria included adult PwS undergoing UL rehabilitation with FMA-UE as primary outcome. Individual patient data, including rehabilitation dose, pre-and-post-rehabilitation FMA-UE scores, and stroke phase, were extracted. Studies were categorized by rehabilitation modality. A semiparametric-ordinal-regression model was fitted to assess the association between FMA-UE scores and covariates, validated through bootstrapping.

Results

Fifty-four studies encompassing 13774 records were included. The model, incorporating dose, phase, modality, baseline FMA-UE, and dose-phase interaction, was statistically significant (χ2=837.7, p<0.001). Baseline FMA-UE and treatment modality were associated with higher FMA-UE scores. Beyond 40 hours of rehabilitation, increased dose showed minimal changes. Task-oriented rehabilitation yielded the highest probability of achieving notable to full UL function, especially in chronic phases.

Discussion and Conclusion

Task-oriented rehabilitation is crucial for enhancing UL motor outcomes in PwS, offering significant recovery chances. Efforts to optimize rehabilitation should prioritize Task-oriented interventions, preferably up to 40 hours, during subacute and chronic phases. Future research should comprehensively assess motor impairment and other relevant factors to better understand treatment effects on diverse stroke phenotypes.

REFERENCES

Prabhakaran S, Zarahn E, Riley C, Speizer A, Chong JY, Lazar RM, et al. Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair. 2008;22(1):64-71.

Daly JJ, McCabe JP, Holcomb J, Monkiewicz M, Gansen J, Pundik S. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair. 2019;33(7):523-37.

Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, et al. Bringing proportional recovery into proportion: Bayesian modelling of post-stroke motor impairment. Brain. 2020;143(7):2189-206.

A population-based survey of beliefs about neck pain and its associated disorders: a cross-sectional study.

A population-based survey of beliefs about neck pain and its associated disorders: a cross-sectional study.

Autori

Mirella Forte (Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy).

Stefano Schiavone (Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy).

Federica Nasti (Orthopedic Department, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy)

Fabio Cataldi (Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy)

Daniel Feller (Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. – Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy. – Centre of Higher Education for Health Sciences of Trento, Trento, Italy.

Firas Mourad (LUNEX, 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg. – Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg).

Introduction

The combined socio-economic burden from neck pain and whiplash is disproportionately high, with relevant costs due to healthcare use and lost work (Safiri et al., 2020; Wu et al., 2024). Nontraumatic and traumatic neck pain are the fourth leading cause of years lived with disability globally (Shin et al., 2022). It is alarming that this rank has not changed since the 1990s but rather a significant rise of incidence and prevalence is forecasts (Wu et al., 2024). This suggests that prevention and management research over the past 30 years has had minimal impact on its global burden. Negative prognostic factors between these two conditions considerably overlap (Blanpied et al., 2017; Carroll et al., 2008a; Sterling et al., 2011). High initial pain and disability, longer duration of symptoms, reduced range of motion, and psychosocial factors have been reported the more prevalent predictors of poor outcomes (Beales et al., 2016; Carroll et al., 2008a; Shearer et al., 2016; Sterling et al., 2011). Psychological prognostic factors are broadly classified into three dimensions: cognitive (e.g., attitude, belief, perception), emotional (e.g., distress), and behavioral (e.g., coping) (Kazeminasab et al., 2022). Social factors are particularly relevant for workers: their influence is divided under the perception of work and workplace factors (Kazeminasab et al., 2022). These contribute to altering central pain processing and commonly manifest as remote hyperalgesia (Blanpied et al., 2017; Xie et al., 2020) and altered behaviors (Hill and Fritz, 2011; Lang et al., 2012; Nicholas et al., 2011; Vargas-Prada and Coggon, 2015; Vlaeyen and Linton, 2012). However, the mechanisms behind the persistence of symptoms are not yet fully understood and findings are not yet translated into better outcomes (Elliott and Walton, 2017).

Understanding recovery pathways is challenging but insight about the transition to ongoing persistent symptoms will contribute to develop appropriate interventions for those at risk of poor outcomes. Patient-centered care is the practice of caring and respecting the individual patient’s own terms to promote positive outcomes (Cook et al., 2021). However, little attention has been spent around patient perspectives. The whiplash beliefs questionnaire (WBQ) is a questionnaire designed to evaluate subjects’ expectations of recovery and beliefs about neck pain and whiplash injury which has been demonstrated to possess adequate reliability (Symonds et al., 1996). Bostick et al. (Bostick et al., 2009) administered the WBQ to survey laypersons (healthy subjects) in Canada, finding more pessimism about recovery than from work-related neck pain. Ng et al. (Ng et al., 2013) found mostly positive expectations regarding recovery with small cultural differences between laypersons from Australia and Singapore. Although findings from survey research can be difficult to interpret, they have the potential to provide relevant insight not from researchers’ perspective but from the patients one.

To the best of our knowledge, no previous study has investigated and compared the beliefs of healthy people, or those with a history of neck pain and whiplash. Therefore, the objective of our study is to investigate the beliefs of the general Italian population about neck pain and whiplash.

Methods

An online survey was developed using the online platform Survey Monkey (SVMK Inc., San Mateo, USA) addressed to the Italian general population. Our study is reported in line with the “Checklist for Reporting Results of Internet Surveys” (CHERRIES) and the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) guidelines (von Elm et al., 2007). This study was approved by the Technical-Scientific Committee of the Università degli studi del Molise on the 11/10/2023, with approval protocol n. 23/2023. The authors followed the principles outlined in the Declaration of Helsinki for this study (General Assembly of the World Medical Association, 2014).

 

QUESTIONNAIRE DEVELOPMENT

The WBQ was translated and adapted from the most recent version used in a cross-cultural comparison between Australian and Singaporeans layperson’s expectations of recovery (Ng et al., 2013) (appendix 1a and 1b). Two Italian specialized musculoskeletal physiotherapists revised the questionnaire to strengthen the transcultural Italian adaptation and conceptual ambiguity. Then, the questionnaire was piloted by a sample from the general population for additional feedback on wording, response logic and fulfillment duration. Using the original questionnaire and the feedback provided by the pilot stage, respectively strengthened the content and the face validity. To increase the social desirability and reduce the fulfilment duration (i.e., strengthen the response rate), the survey was designed with 27 closed-ended questions (Faletra et al., 2022; Maselli et al., 2021a; Mourad et al., 2021a).

The survey is structured in two sections. The first section investigate sociodemographic information, education level, employment duties, and risk factors, such as having previously suffered from neck pain (i.e., never, in the last 3 months, or for more than 3 months), having a history of whiplash, and having related arm pain using close-ended questions; the second section was designed using the 14-item WBQ to investigate the beliefs on neck pain/whiplash (Ng et al., 2013). In line with the study of Ng et al. (Ng et al., 2013), we also assessed the expectation of recovery with two additional questions and the experienced anxiety and stress with two other additional questions adapted from the Survey of Pain Attitudes (SOPA-35) (Turner et al., 2000). Participants were asked to state their agreement on each item using a 5-point Likert scale (1=strongly disagree; 3=not sure; 5=completely agree). All questions were presented in the same order; responses to all questions were mandatory to consider the survey completed. The questionnaire could be completed on any electronic device with Internet access and its completion took approximately 5 minutes.

 

SETTING AND RECRUIMENT

A web link to the survey was distributed via social media (Facebook and Instagram) from October 2nd, 2023, to February 5th, 2024. To increase the response rate, several invitations were posted, and the survey was shared once a week. A priori sample size was calculated using Dillman’s electronic survey formula (Needham and Vaske, 2008). At the time of the survey, the Italian population was 58.990.000 (Istat, 2023); therefore, the required sample size for this study was 385. As Survey Monkey was used without collecting respondents’ IP addresses, recruitment was anonymous and voluntary; furthermore, the same IP was not allowed to access the survey more than once. No compensation or refunds were offered.

 

DATA PROCESSING AND ANALYSIS

The final dataset was collected on an encrypted computer, which researchers could access only for the analysis. No sensitive information was collected. The dataset was exported to Microsoft Excel 2020 for the descriptive analysis (frequencies, mean, and standard deviation (SD)).

OUTCOME

For the dependent variables we considered the total WBQ score and four factors that arise from the combinations of questions.

The total WBQ score was calculated from the sum of each question from 1 to 14. To maintain consistency, the scores of items 5 and 13 were reversed as they had been formulated. The maximum score that could be obtained was 70. Higher scores are interpreted as more negative or pessimistic beliefs about the condition.

A previously factorial analysis of the modified version of the WBQ found 4 factors (Bostick et al., 2009). These factors exist within 10 common items in each questionnaire. The items considered for the creation of factors were questions 1 to 14. The four factors are labeled as “recovery pessimism” (sum of questions 2, 6, 10), “beliefs about active coping” (questions 5, 12, 13), “beliefs about passive coping” (questions 11, 14), and “treatment pessimism” (questions 1, 4).

Questions that investigated the expectation of recovery were 15 and 16. Questions that investigated the experienced anxiety and stress were 17 and 18.

 

PREDICTORS

We identified some predictors of the outcome that, in relation to the WBQ score, could explain the results. These predictors were a history of neck pain, a history of whiplash, and symptoms associated with the conditions. Also, the stage of the condition was considered (i.e., recent or persistent). With associated symptoms we referred to symptoms in the shoulders, arms and hands such as pain, tingling, numbness, loss of strength. Gender, age, marital status, employment, and main type of job were considered confounding factors.

STATISTICAL METHODS

Descriptive statistics are presented as frequency and percentages for categorical variables and mean with the standard deviation for continuous variables.

We investigated the association of neck pain, whiplash, and associated symptoms, with the following dependent variables: total score at the WBQ; the factors “recovery pessimism”, “beliefs about active coping”, “beliefs about passive coping”, “treatment pessimism”; expectation of recovery (questions 15 and 16); anxiety (question 17) and stress (question 18).

We investigated the multivariable association of the independent variables (neck pain, whiplash, and associated symptoms) with all the dependent variables reported above, adjusting by the cofounding variables (i.e., gender, age, marital status, employment, and main type of job). We used a linear regression for the total score of the WBQ and its factors, while for the questions from 15 to 18, we used a proportional odds logistic regression.  All the statistical analyses were performed using R (R Core Team, 2021).

Results

DESCRIPTIVE ANALYSIS

RESPONDENT CHARACTERISTICS

A total of 1034 participants gave their consent and completed the survey. Among the responders the majority were women (65%, n=673) between 35-50 years of age (37.6%, n=389). Most respondents reported working more than 6 hours per day at the terminal (39.7%, n=411). The majority reported a history of neck pain (60.2%, n=791), and 34.9% (n=361) had whiplash. Only 9.4% (n=98) did not report having suffered from any of the conditions (namely, laypersons). For further sociodemographic baseline details, refer to Table 1.

WORK (items 2 and 10)

42.8% (n=339) of neck pain and 45.3% (n=163) of whiplash sufferers reported to disagree (disagree or strongly disagree) with the sentence “neck pain/whiplash injury will eventually stop you from working”; similarly, 44.9% (n=44) of the laypersons reported to disagree.  When asked if “neck pain/whiplash injury means long periods of time off work”, 38.1% (n=301) of neck pain sufferer reported to disagree, while the 38.1% (n=137) of whiplash responders reported to agree (agree and strongly agree); more than one third of laypersons (36.7%, n=36) reported not to be sure and (36.6%, n=36) to agree (appendices 2-5).

TRUST IN HEALTH CARE PROVIDERS (items 4)

42% (n=262) of neck pain and 45.7% (n=165) of whiplash responders reported to strongly disagree with the sentence “doctors/physiotherapists cannot do anything for neck pain/whiplash injury”; accordingly, almost half of laypersons (49.0%, n=48) reported to strongly disagree (appendices 2-5).

MEDICATIONS AND TREATMENTS (items 7, 9, 11, and 14)

When asked if “alternative treatments are the answer to neck pain/whiplash injury”, 34.1% (n=213) of neck pain responders reported not to be sure; 35.7% (n=129) of whiplash responders reported to agree or not to be sure (32.6%, n=118 not sure); most laypersons (37.8%, n=37) reported not to be sure. When asked if “medication is the only way of relieving neck pain/whiplash injury”, responders reported disagreement (neck pain, 70.9%, n=561; whiplash, 68.9%, n=248; laypersons, 61.2%, n=60). Accordingly, most neck pain and whiplash responders disagree (54.6%, n=432; 52.8%, n=190) to the question “simple painkillers are usually enough to control most neck pain/whiplash injury”; laypersons were mostly not sure (40.8%, n=40) (appendices 2-5).

MANAGEMENT AND QUALITY OF LIFE (items 1, 5, 6, and 13)

Most of the responders disagreed with the question “there is no real treatment for neck pain/whiplash injury”(neck pain, 68.2%, n=539; whiplash, 67.5%, n=244; laypersons, 64.2%, n=63). Instead, most of the responders reported to agree when asked “a bad neck/whiplash injury should be exercised” (neck pain, 64.9%, n=513; whiplash, 63%, n=227; laypersons, 65.3%, n=64). Similarly, responders reported to agree with the question “neck pain/whiplash injury makes everything in life worse” (neck pain, 65.1%, n=515; whiplash, 64.7%, n=233; laypersons, 53.1%, n=52). When asked “if you have neck pain/whiplash injury you should try to stay active”, most neck pain patients reported to agree (38.9%, n=307); however, a high number also reported not to be sure (34.5%, n=273). Most whiplash patients reported to agree (40.3%, n=145.4), but a high number also reported not to be sure (30,7%, n=111). Most laypersons (40.8%, n=40) reported not to be sure (appendices 2-5).

RECOVERY EXPECTATION (items 15 and 16)

Whiplash patients reported to disagree (45.9%, n=363) to the question “most neck pain/whiplash injury settles quickly (a few days to a few weeks)”. Most laypersons (48.0%, n=47) reported not to be sure. Most neck pain (43.7%, n=345) and whiplash (46.2%, n=166) patients agreed to the question “you get on with normal activities such as going to work soon after neck pain/whiplash injury”. Laypersons mainly reported to not be sure (35.7%, n=35) (appendix 6-9).

ANXIETY AND STRESS (items 17 and 18)

Most of the responders agreed with the question “anxiety increases the pain you feel”

 (neck pain, 75%, n=539; whiplash, 59.2%, n=213; laypersons, 70.4%, n=69) and to the question “stress in your life increases the pain you feel” (neck pain, 83.7%, n=662; whiplash, 81.1%, n=293; laypersons, 73.5%, n=72) (appendix 6-9).

INFERENTIAL STATISTICAL ANALYSIS

Inferential statistical analysis is summarized in table 2 and 3.

TOTAL WBQ SCORE

A statistically significant difference was only found between laypersons and those with recent neck pain with a mean difference of -1.82 points on the WBQ total score (p<0.01; 95%CI -2.99 to -0.66) (Table 2).

RECOVERY PESSIMISM (items 2, 6, and 10)

A statistically significant difference was found for participants reporting associated symptoms compared to participants who did not report associated symptoms (mean difference=0.44; p=0.01; 95%CI 0.09 to 0.79) (Table 2). Also, we found a statistically significant difference between laypersons and those with recent neck pain (mean difference=-0.51; p<0.01; 95%CI –0.96 to -0.06), and between laypersons and those with neck pain for more than 3 months (mean difference=-0.48; p<0.01; 95%CI –0.87 to -0.09) (Table 2).

ACTIVE COPING, PASSIVE COPING, AND TREATMENT PESSIMISM

No statistically significant differences were found between participants with neck pain, whiplash, or associated symptoms, compared to laypersons (Table 2).

RECOVERY EXPECTATION (items 15 and 16)

A statistically significant difference was found for subjects reporting associated symptoms for the question “most neck pain/whiplash injury settles quickly (a few days to a few weeks)” (odds ratio (OR) 1.38; 95%CI 1.09 to 1.76; p<0.05); however, no difference was found after adjustment for possible confounding factors (OR 1.22; 95%CI 0.94 to 1.59; p>0.05). Furthermore, a statistically significant difference at the unadjusted analysis was also found for participants reporting a history of persistent neck pain (OR 1.37; 95%CI 1.05 to 1.79; p<0.05). However, even in this case, the association was no longer statistically significant in the adjusted analysis (Table 3).

ANXIETY AND STRESS (items 17 and 18)

At the univariable analysis, a statistically significant difference was found for participants reporting recent (OR 1.45; 95%CI 1.01 to 2.09; p<0.05) and persistent neck pain (OR 1.62; 95%CI 1.20 to 2.19; p<0.05) for the question “stress in your life increases the pain you feel”. After adjustment for possible confounding factors, only participants reporting persistent neck pain showed a statistical difference in this item (OR 1.49; 95%CI 1.08 to 2.06; p<0.05) (Table 3).

Discussion and Conclusion

To the best of our knowledge, this is the first study assessing beliefs and perceptions about neck pain and whiplash between patient and layperson. Similarly to Singaporeans, participants of our study were more pessimistic about the items ‘taking time off work’ and ‘eventually stopping one from working’. A lower proportion of the Italian responders agreed that surgery and medication are effective in relieving neck pain and whiplash injury compared to Australians and Singaporeans, but a higher proportion agreed that alternative treatment is effective compared to the Australian sample. Like the Australians and Singaporeans, most Italian responders were positive about exercise and staying active. Similarly to the Canadian sample, more than 60% of the Italian responders agreed with the statement ‘whiplash injury makes everything in life worse’. Like Australians and Singaporeans, less than 25% of the Italian responders disagree that they will return to normal activities soon; while only 23% of Italians agreed to recover quickly like Canadians. Beliefs about anxiety and stress were similar, with more than 70% of participants agreeing that anxiety and stress increased the experience of pain. Although this does not reflect the differences in the prevalence of neck pain and whiplash injury, these differences could be a reflection of cultural nuances between countries. Differences between healthcare and compensation systems could also have had an influence. Italy provides universal public health care and some form of social security benefits to people with injuries  that may have impacted the beliefs and expectations of responders compared to other counties.

Overall, few significant findings with large confidence intervals were found. There was a statistically significant lower total score of the WBQ for respondents with recent neck pain compared to laypersons. Although the minimal detectable change for WBQ score is still unknown, the Back Belief Questionnaire (BBQ), from which the WBQ was developed, has a minimal detectable change that ranges from 5.9 to 10.5 points. The mean difference after adjustment of -1.82 points we found does not seem to be an important clinical difference. Moreover, although some studies assess beliefs in other back pain conditions in different countries, only few studies compared beliefs between patients and laypersons. Bostick et al. found no difference in in BBQ scores between those with and without a history of back pain. Our results are also in line with Urquhart et al. who found no relationship between beliefs and pain intensity when comparing no and low pain intensity groups. Many factors contribute to persistent musculoskeletal pain, including biological, psychological, social, and epigenetic factors. However, no firm boundaries among these factors are present. Although psychological factors are commonly investigated separately, all interact with each other. Self-efficacy, psychological distress, and fear were identified as intermediate factors related to the experience of neck pain and developing disability. Particularly, self-efficacy was observed to be consistently associated with disability, affective distress and pain severity. Active coping has been observed to be associated with self-efficacy, while low self-efficacy with passive coping. However, we did not find any differences among conditions nor stage from responders’ perspectives.

Negative recovery expectations, depression or anxiety symptoms, coping, and multiple sites of pain or associated symptoms were found associated with pain intensity/persistence and to predict poor general outcome. Positive recovery expectations were reported to be strongly associated with better work participation in people with low back pain. Interestingly, we found no association for recovery expectation in neck pain/whiplash patients but recovery pessimism was higher for responders with associated symptoms, and in responders with neck pain compared to laypersons. Although no causal inference can’t be done because of the cross-sectional design of our study, this may be due to what items 2, 6 and 10 mean. These items reflect a more pessimist view and the presence of more symptoms could have led to poor recovery. The relationship between mental health symptoms (i.e., anxiety and stress) and diseases is well-established. Stress is mediated by the meaning that person attribute to a disease, the impact of the daily living, and the personal and social resources that the person perceives. We found stress statistically significant higher for responders with persistent neck pain with an OR after adjustment of 1.48 points (95% CI 1.07 to 2.05). Together with stress, anxiety were found to be positively associated with neck pain (with and without associated symptoms) and poorer outcomes. Although not statistically significant, most of the responders of our study agreed that anxiety influences the perception of pain. In our study we only collected the personal perception/beliefs about anxiety, but it should be considered that when anxiety reaches a clinical level it often causes significant social and health impairments.

The biopsychosocial model contributed to raise the issue of the complexity of the concept of health, highlighting the central role of the patient. Therefore, providing emphasis to the person means also to consider the subjective perspective. Prognostic factors and their mutual manifestation are not yet fully understood. Our results challenge and open new perspectives on the influence of psychological (e.g., stress, anxiety, coping and self-efficacy) and social (e.g., healthcare systems and culture) factors on the person thoughts/perception commonly observed in subjects with pain on the cervical spine. The non-linear interaction of these factors with the pain experience of the single person may have been influenced by multiple mediators in a non-controlled setting, leading to the heterogeneous expression of our results.  

The high response rate is a strength of our study and confirms the willingness of the population to participate in this study. Unlike previous studies, we also run a multivariable statistical analysis to adjust for potential confounders. One limitation was that the older population could not be easily reached as they use social networks to a lesser extent. Thus, our method of recruitment could have led to selection bias. Another limitation may be the absence of a transcultural validation of the WBQ. A further limitation of the study is the cross-sectional nature of the design: this does not allow to determine causal relationships between observed beliefs and outcomes. Furthermore, in our survey what constitutes a clinically meaningful difference in beliefs is unknown.

 

CONCLUSION

Compared to other countries, Italian responders reported more pessimism regarding the impact of neck pain/whiplash on work but more positive thoughts about alternative treatments to relieve pain. Our study is the first investigating beliefs in both neck pain/whiplash patients and laypersons, highlighting a heterogeneous and non-linear interaction between pain and responders’ perspectives. Recovery pessimism seems to be perceived more by individuals reporting having a history of neck pain and whiplash. Further studies are needed to understand the influence of anxiety and stress in neck pain/whiplash.

REFERENCES

1.        Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, et al. Assessment of Neck Pain and Its Associated Disorders: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine. febbraio 2008;33(Supplement):S101–22.  

2.        Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, et al. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. luglio 2014;73(7):1309–15.  

3.        Shin DW, Shin JI, Koyanagi A, Jacob L, Smith L, Lee H, et al. Global, regional, and national neck pain burden in the general population, 1990–2019: An analysis of the global burden of disease study 2019. Front Neurol. 1 settembre 2022;13:955367.  

4.        Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. dicembre 2010;24(6):783–92.  

5.        Beales D, Fried K, Nicholas M, Blyth F, Finniss D, Moseley GL. Management of musculoskeletal pain in a compensable environment: Implementation of helpful and unhelpful Models of Care in supporting recovery and return to work. Best Pract Res Clin Rheumatol. giugno 2016;30(3):445–67.  

6.        Areerak K, van der Beek AJ, Janwantanakul P. Recovery from nonspecific neck pain in office workers. J Back Musculoskelet Rehabil. 13 settembre 2018;31(4):727–34.  

7.        Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck Pain: Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. luglio 2017;47(7):A1–83.  

8.        Bier JD, Scholten-Peeters WGM, Staal JB, Pool J, van Tulder MW, Beekman E, et al. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. Phys Ther. 1 marzo 2018;98(3):162–71.  

9.        Walton DM, Elliott JM. An Integrated Model of Chronic Whiplash-Associated Disorder. J Orthop Sports Phys Ther. luglio 2017;47(7):462–71.  

10.      Guez M. Chronic neck pain. An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders. Acta Orthop Suppl. febbraio 2006;77(320):preceding 1, 3-33.  

11.      Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 15 febbraio 2008;33(4 Suppl):S83-92.  

12.      Sleijser-Koehorst MLS, Coppieters MW, Heymans MW, Rooker S, Verhagen AP, Scholten-Peeters GGM. Clinical course and prognostic models for the conservative management of cervical radiculopathy: a prospective cohort study. Eur Spine J. novembre 2018;27(11):2710–9.  

13.      Casey PP, Feyer AM, Cameron ID. Course of recovery for whiplash associated disorders in a compensation setting. Injury. novembre 2015;46(11):2118–29.  

14.      Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 15 settembre 2008;138(3):617–29.  

15.      Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study. Pain. luglio 2010;150(1):22–8.  

16.      Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 1 luglio 2016;25(7):2000–22.  

17.      Bussières AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, et al. The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. ottobre 2016;39(8):523-564.e27.  

18.       Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 26 marzo 2020;368:m791.  

19.       Xie Y, Jun D, Thomas L, Coombes BK, Johnston V. Comparing Central Pain Processing in Individuals With Non-Traumatic Neck Pain and Healthy Individuals: A Systematic Review and Meta-Analysis. J Pain. 2020;21(11–12):1101–24.  

20.      Parikh P, Santaguida P, Macdermid J, Gross A, Eshtiaghi A. Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC Musculoskelet Disord. dicembre 2019;20(1):81.  

21.      Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. giugno 2012;153(6):1144–7.  

22.      Lang J, Ochsmann E, Kraus T, Lang JWB. Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies. Soc Sci Med 1982. ottobre 2012;75(7):1163–74.  

23.      Hill JC, Fritz JM. Psychosocial influences on low back pain, disability, and response to treatment. Phys Ther. maggio 2011;91(5):712–21.  

24.      Vargas-Prada S, Coggon D. Psychological and psychosocial determinants of musculoskeletal pain and associated disability. Best Pract Res Clin Rheumatol. giugno 2015;29(3):374–90.  

25.      Elliott JM, Walton DM. How Do We Meet the Challenge of Whiplash? J Orthop Sports Phys Ther. luglio 2017;47(7):444–6.  

26.       Sterling M, Carroll LJ, Kasch H, Kamper SJ, Stemper B. Prognosis after whiplash injury: where to from here? Discussion paper 4. Spine. 1 dicembre 2011;36(25 Suppl):S330-334.  

27.       Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 3 gennaio 2022;23(1):26.  

28.       Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R. Physical and psychological factors predict outcome following whiplash injury. Pain. marzo 2005;114(1):141–8.  

29.       Cook CE, Denninger T, Lewis J, Diener I, Thigpen C. Providing value-based care as a physiotherapist. Arch Physiother. 20 aprile 2021;11(1):12.  

30.       Bostick GP, Ferrari R, Carroll LJ, Russell AS, Buchbinder R, Krawciw D, et al. A population-based survey of beliefs about neck pain from whiplash injury, work-related neck pain, and work-related upper extremity pain. Eur J Pain Lond Engl. marzo 2009;13(3):300–4.  

31.      Ng TS, Bostick G, Pedler A, Buchbinder R, Vicenzino B, Sterling M. Laypersons’ expectations of recovery and beliefs about whiplash injury: A cross-cultural comparison between Australians and Singaporeans: Laypersons’ whiplash beliefs. Eur J Pain. settembre 2013;17(8):1234–42.  

Variazione sulla qualità di vita di adolescenti con leucemia dopo attività motoria in tele-riabilitazione: analisi preliminare di uno studio di coorte prospettico monocentrico longitudinale

Change in Quality of Life in Adolescents Affected by Leukemia after a Home-Based Remote Motor Rehabilitation Program: Preliminary Review of a Monocentric Prospective Longitudinal Cohort Study.

Autori

Elena Gasbarri (ISPRO (Institute for Study, Prevention and Oncology Network), Florence, Italy)

Margherita Cerboneschi (Rehabilitation Unit, Meyer Children’s Hospital IRCCS, Florence, Italy)

Marta Cervo (Rehabilitation Unit, Meyer Children’s Hospital IRCCS, Florence, Italy)

Diletta Innocenti (Rehabilitation Unit, Meyer Children’s Hospital IRCCS, Florence, Italy)

Introduction

Pediatric tumors are rare but are an important cause of morbidity and mortality for people under 15 years old. The most common ones include leukemias (ALL) (1).

The treatment for ALL lasts about two years and usually consists of induction, consolidation and maintenance therapy (1, 2).

Side effects may well present months after the end of the treatment. The most common ones during the medical treatment are weakness, motor and sensory disorders, balance problems, reduced cardiorespiratory fitness, fatigue, anxiety, reduced motor and physical performance, social isolation, deterioration in quality of life (3).

Studies support the need for further research to investigate the benefits of motor activity in adolescents affected by tumors, through more consistent and specific studies in terms of age, disease and kind of training, and with higher methodological quality (4).

Methods

The primary aim of this non-profit pilot study, is to compare the change in the global quality of life in adolescents affected by ALL after a personalized 8-week remote motor rehabilitation program, carried out with the software Physiotools Trainer and evaluated with the questionnaire PedsQL 4.0.

The secondary aims include:

An evaluation was made before the physical training (T0) and then after 8 weeks (T8). The 8-week training was made of aerobic/anaerobic part and muscle-strengthening part appropriate for every patient (5).

The criteria for inclusion was adolescent (11-18yo), with ALL in maintenance/off therapy phase.

Results

3 patients enrolled in the study, 2 of which completed the 8-week remote rehabilitation training. Table 1 shows the main characteristics of both participants.

Both the patient showed improvement in the questionnaires (PedsQL) (figure 1).

Modified shuttle walking test scores improved:

– As for the first patient from 77% (T0) to 94.5% (T8) compared to predicted;

– As for the second from 70% (T0) to 78% (T8) compared to predicted.

FAAP-O score non change from T0 to T8.

Discussion and Conclusion

The study will be going on until May 2025 so the conclusions are incomplete and the preliminary results are limited. The current results shows an improvement in the quality of life, a reduction of fatigue and more resistance to physical exercise. More results will be available in the next months.

REFERENCES

  1. Seth R., Singh A. “Leukemias in Children”. Indian J Pediatr. 2015 Sep;82(9):817-24
  2. Chamorro-Viña C., Keats M., Culos-Reed SN. “POEM Versione Italiana”. Published by Health & Wellness Lab Facoltà di Chinesiologia, Università di Calgary 2500 University Drive N.W. Calgary, Alberta, T2N 1N4, https://www.aieop.org/web/wp-content/uploads/2021/09/POEM-italian-version-7.5.18.pdf
  3. Yildiz Kabak V., Ipek F., Unal S., et al. “An evaluation of participation restrictions and associated factors via the ICF-CY framework in children with acute lymphoblastic leukemia receiving maintenance chemotherapy”. Eur J Pediatr. 2021 Apr;180(4):1081-1088.
  4. Munsie C, Ebert J, Joske D, et al. The Benefit of Physical Activity in Adolescent and Young Adult Cancer Patients During and After Treatment: A Systematic Review. J Adolesc Young Adult Oncol. 2019 Oct;8(5):512-524.
  5. Beller R, Bennstein SB, Götte M. Effects of Exercise Interventions on Immune Function in Children and Adolescents With Cancer and HSCT Recipients – A Systematic Review. Front Immunol. 2021 Sep 27;12:746171.

FISIOTERAPIA IN ACQUA: COME VIENE INSEGNATA E IMPIEGATA IN ITALIA

AQUATIC THERAPY: HOW IT IS BEING TAUGHT AND USED IN ITALY

Autori

Rossi Marlene (libero professionista, Roma)

Introduction

Aquatic therapy is a rehabilitative modality that represents an area of increasing interest proving broad therapeutic potential and clinical adaptability in the treatment of acute and chronic pathologies.[1] The Network di Interesse Specifico (N.I.S.) group aims precisely at promoting national scientific development in the field of rehabilitation in the aquatic environment.

The N.I.S. group has conducted a survey entitled “Aquatic therapy: how it is being taught and used in Italy” among the members of the Italian Society of Physiotherapy (A.I.FI.) to know the diffusion of clinical practice, academic offer and training needs related to aquatic therapy on the national territory. The N.I.S. group intends to use the gathered data to pursue its objectives of information, training and scientific research addressed to physicians, physiotherapists, and patients.

Methods

The Google Forms survey was embedded in an email newsletter to all physiotherapists registered with the A.I.FI. and filled out on a voluntary and anonymous basis. It was active from the 27th of September to the 29th of November 2023 to have a sufficiently representative sample of the regional realities within the national territory. The survey consisted of twelve multiple-choice questions, in addition to an open-ended question. The areas of enquiry of the survey covered the following aspects of respondents: their provinces of origin; years of their work experience; hours worked per week; types of facilities where their activities are being carried out; their training level in this field; training methods they would prefer to adopt; modalities in which aquatic therapy is being performed; the degree of current specific academic offer on the national territory.

Results

For the two months in which the survey has remained online, the response rate of members of the A.I.FI. in that period was reported as equal to 3.5%. It is observed that 64.1% of respondents predominantly performed aquatic therapy in one-on-one session. Moreover, 63.3% of respondents assisted patients by being in the water with them, 28.1% carried out aquatic therapy activities between five and ten hours per week (Fig.1), and 55.5% worked mainly in private facilities. It is noteworthy that 60.9% of survey respondents were not trained on aquatic therapy during their three-year bachelor’s degree programme (Fig.2), whereas 43% of them attended specific postgraduate training on aquatic therapy offered by providers present throughout the national territory (Fig.3). Almost all respondents, precisely 97.7% of them, considered that it is useful to extend academic offer in this field (Fig.4).

Discussion and Conclusion

Aquatic therapy is a very useful tool in the set of core competencies of a physiotherapist, yet its clinical practice remains underused in regard to its therapeutic potential, with little evidence for some pathologies that are frequently treated in the water environment, although the literature shows aspects of great significance.[2][3] Currently, a basic aquatic therapy training within degree courses in physiotherapy appears to be insufficient and inhomogeneous on the national territory.[2] It follows that aquatic therapy training should be included both in undergraduate and postgraduate academic offer. Hence, the importance of the presence of the N.I.S. group on the national territory to meet training needs increasingly geared towards individuals’ needs and advanced competences required for the professional profile of a physiotherapist.[2]

REFERENCES

1. Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009 Sep;1(9):859-72.

2. Rocco M. L’insegnamento della fisioterapia in acqua nei corsi di studio italiani di fisioterapia: studio osservazionale. 2022; 5-6:10-11:22-23.

3. Colibazzi V,Coladonato A, Mangiarotti M A,Cavuoto F,Mollica R, Magaletti M, Romanini E, Evidenza scientifica e pratica clinica in idrokinesiterapia: c’è concordanza? Un vaglio della letteratura e un questionario tra gli idrokinesiterapisti italiani. The Journal of SPORTANDANATOMY JSA 2015; I:102-107.

Proprietà psicometriche del Wolf Motor Function Test (WMFT) e delle sue versioni modificate: una revisione sistematica con meta-analisi

Psychometric properties of the Wolf Motor Function Test (WMFT) and its modified versions: a systematic review with meta-analysis

Autori

Notturni Francesco [CRT, Clinica di Riabilitazione Toscana, Montevarchi (AR), Italy]

Ugolini Alessandro [Independent research, Empoli (FI), Italy]

Piscitelli Daniele [Department of Kinesiology, University of Connecticut, Storrs, CT, USA]

Pometti Lorena Sabrina [IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy]

Ferrarello Francesco [Unit of Functional Rehabilitation, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato, Italy]

Coppari Andrea [Physical and Rehabilitation Medicine Unit, Azienda Sanitaria Territoriale, Jesi (AN), Italy]

Caselli Serena [Azienda Ospedaliero-Universitaria di Modena, Modena, Italy]

La Porta Fabio [IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy]

Pellicciari Leonardo [IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy]

Introduction

Individuals with stroke commonly experience upper extremity (UE) sensorimotor deficits, which impact quality of life. Deficits persist in about 80% of survivors. The Wolf Motor Function Test (WMFT, 17 items) is widely used to assess UE function post-stroke; it assesses both motor capacity (subscale, Functional Ability Scale [FAS]) and performance time (subscale, TIME). Additional versions of the WMFT have been proposed. The Graded WMFT (gWMFT, 13 items) was developed for the accurate assessment of moderate to severe UE impairment, and a short form version of WMFT, the Streamlined WMFT (sWMFT, 6 items), targeted people with stroke at different stages of recovery (subacute and chronic). To date, a comprehensive evaluation of the WMFT psychometric properties is lacking. Therefore, we aimed to perform a systematic review (SR) with meta-analysis to assess the reliability, validity, and responsiveness of the WMFT when utilized to assess individuals with stroke.

Methods

Six databases (i.e., MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, Web of Science) were searched to retrieve studies investigating WMFT psychometric properties, as defined by the COSMIN taxonomy domains. Two independent reviewers performed literature search, study selection, data extractions, and quality assessment (according to the COSMIN Risk of Bias checklist).To pool the data, we considered Cronbach’s alpha for internal consistency, the intraclass correlation coefficient (ICC), Cohen’s kappa, and weighted linear (or quadratic) kappa for intra- and inter-rater reliability. Measurement error was assessed by the standard error of measurement (SEM) and minimum detectable change (MDC). For construct validity, Pearson or Spearman correlation coefficients were examined. For responsiveness, effect size (ES) and standardized response mean (SRM) were considered. The level and grading of evidence were defined for each psychometric property according to the COSMIN modifed GRADE approach.

Results

Out of 4127 titles screened after removing the duplicates, 25 studies involving 2009 individuals with stroke were included in the SR, and 23 in the meta-analysis. Table 1 shows the pooled results. FAS and TIME WMFT’s subscales internal consistency (alpha≥0.88) intra- (ICC≥0.97) and inter-rater (ICC≥0.92) reliability, construct validity (strong correlation with Fugl-Meyer Assessment for upper limb [FMA-UL] and Action Research Arm Test [ARAT]), and responsiveness (ES≥0.48) were rated with quality of evidence ranging  from very low to high, as well as the structural validity of FAS and the measurement error of TIME subscales (Table 1). Measurement error for FAS was assessed as inconsistent with moderate quality of evidence. Cross-cultural validity was rated as indeterminate with very low quality of evidence. Content validity and structural validity for TIME were not assessed in the included studies. Pooled findings on gWMFT reliability and sWMFT responsiveness are showed in Table 1.

Discussion and Conclusion

Most studies focused on the WMFT, demonstrating its strong psychometric properties, while fewer explored the gWMFT and sWMFT. The SR provides valuable insights into the reliability, validity, and responsiveness of WMFT, supporting its clinical utility in individuals with stroke. The reliability of the WMFT is well-established for the FAS and the TIME subscales. Strong correlations with other established motor function assessments, such as the FMA-UL and ARAT, support construct validity. Few studies have evaluated the psychometric properties of the gWMFT and sWMFT; therefore, their reliability and validity are not well-established as those of the original WMFT. Studies that reaserched the sWMFT and gWMFT are promising, but the evidence for their psychometric properties is currently insufficient for widespread recommendation. Future research should focus on enhancing the content and cross-cultural validity of the WMFT, and the psychometric properties of WMFT’s modified versions.

REFERENCES

Gagnier JJ, Lai J, Mokkink LB, Terwee CB. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res. 2021 Aug;30(8):2197-2218. doi: 10.1007/s11136-021-02822-4.

 

Wolf SL, Lecraw DE, Barton LA, Jann BB. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol. 1989 May;104(2):125-32. doi: 10.1016/s0014-4886(89)80005-6.

Approcci innovativi alla mobilità degli Studenti in Partenza nei Corsi di Laurea in Fisioterapia: uno studio comparativo dei Modelli Organizzativi nella Regione Veneto

Innovative approaches to Outgoing Student Mobility in Physiotherapy Degree Program: a comparative study of Organizational Models in the Veneto Region

Autori

Coppola Lucia [Physiotherapy Degree Course, Padua University, Padua, Italy]

Cecchin Enrica [Physiotherapy Degree Course, Verona University, Verona, Italy]

Quinci Antonio [Physiotherapy Degree Course, Padua University, Padua, Italy]

Marini Gabriella [Physiotherapy Degree Course, Padua University, Padua, Italy]

Introduction

The international process of Italian universities involves exchange student projects between foreign universities and Italian universities of the same study course. In the future, we will have foreign lecturers teaching in Italy and Italian lecturers teaching abroad. Currently, the most stable and widespread form of cultural exchange is the presence of foreign students for varying periods attending classes and internships in the Physiotherapy Degree Programs of universities with established collaborative relationships, known as partner universities.

The international projects that currently involve the two universities in Veneto, the University of Padua and the University of Verona, to which all six Physiotherapy Degree Program locations in Veneto are linked, are Erasmus Plus and Ulysses Overseas. The increasing number of students and the complexity of the educational and administrative processes in each university have necessitated the creation of a dedicated organizational model, which we have decided to present.

Methods

We describe the organizational models adopted by the two degree programs to manage outgoing students, excluding the phenomenon of incoming students, which is also present. The number of students, not divided by gender, who have actually departed (and not just won grants) from the 2021-2022 academic year to the allocations for the 2024-2025 academic year for earning curricular credits is recorded. Students who leave after graduation in the first post-graduation year are excluded, even though they still fall under student exchange projects but follow different administrative paths.

Results

The number of students involved is shown in Table 1. The various countries are shown in Table 2. This is followed by a description of the two organizational models.

The Verona Model:

The Physiotherapy Degree Program at the University of Verona is organized into three locations: Verona, Vicenza, and Rovereto (TN), accommodating a total of 240 students, with an intake of 25 students for the Vicenza and Rovereto (TN) branches and 30 students for the Verona branch. In their second year, students can participate in a call for the allocation of Erasmus mobility grants to complete part of their academic program abroad during the third year (ranging from 2 to 4 months, earning a minimum of 12 credits). Students can choose to attend courses at one of the partner university locations or engage in internships, obtaining recognition for the exams and credits earned. This educational opportunity is managed by the International Mobility Office, which reports to the Academic Services and Student Services Directorate. The service collaborates with the Faculty of Medicine’s Internationalization Delegate and an Erasmus Coordinator for all health professions, utilizing contacts for each degree program to manage Erasmus exchange activities with each partner university. For the Physiotherapy Degree Program, it has been decided to maintain the initial single Erasmus Contact, who is also the Coordinator of one of the three academic branches.

The Padua Model:

The Physiotherapy Degree Program at the University of Padua is organized into four locations: Venice, Padua, Schio (VI), and Conegliano (TV). The various locations have different student numbers, totaling 300 students across the first, second, and third years and four locations, all within the Veneto Region. Students participate in Ulysses or Erasmus calls while attending the second year, with departures allowed from the second semester of the third year, having acquired clinical skills to better understand the different working contexts they will encounter outside Italy. This way, they have earned credits for classroom lessons in Italy and will earn a minimum of 12 to a maximum of 18 credits related to internships abroad. In reality, the scholarships include one theoretical exam in conjunction with the internship, so winning students will enroll in a course abroad, attend this course, and complete the internship. However, having already completed classroom training gives students the freedom to attend a course worth 1 credit or more credits abroad, depending on the availability of the foreign location. From the 2023-2024 academic year, it has been possible to participate in a call to complete only the thesis abroad, for a total of 6 credits. Administrative aspects are managed by the International Mobility Office, which reports to the Academic Services and Student Services Directorate.

As an internal organizational model for the Degree Program, there is a Course Internationalization Contact and four persons in charge: each of them (one coordinator and three location tutors) maintains contacts with two foreign university partners. This way, winning students at a location refer to the person managing the foreign location, and over the years, the foreign location can build privileged relationships with a single person in charge.

Discussion and Conclusion

We can see positive aspects in both models. The Verona model is very linear, as all students, all foreign locations, and the International Mobility Office report to a single person for all exchanges. On the other hand, the workload is placed on a single person. The Padua model is more complex, involving four people, one for each location (Venice, Schio (VI), Conegliano (TV), and Padua), coordinated by the single Internationalization Project Contact for the Degree Program, but the commitment for each person in charge is less.

REFERENCES

https://www.unipd.it/en/erasmus-studies-out

https://www.univr.it/en/our-services/-/servizi/opportunities-abroad-for-students-and-staff

Ottimizzazione dell’attività fisioterapica nei Reparti di Area Medica dell’Azienda ospedaliero-universitaria Senese

Optimization of physiotherapy activity in the Medical Area Departments of the Azienda ospedaliero-universitaria Senese

Autori

Baldo Niccolò (Azienda ospedaliero-universitaria Senese – Strada delle Scotte, 14, 53100 – Siena (SI) – Italy)

Introduction

Disability rates are increasing worldwide (1, 2, 3) and the main aim of rehabilitation is to maximize functionality despite disability, impacting the quality of life of individuals and caregivers (1, 4). The extension of life causes an increase in hospitalizations in the Medical Area and, since these are mostly frail elderly people, therefore with increased vulnerability and limited functional reserve, stress factors such as hospitalization can also worsen any disability already present (5, 6). These characteristics determine the need to activate early physiotherapy management in the acute phase of hospitalization and highlight the need to optimize the use of the increasingly limited personnel resources present.

Methods

The objectives of this work were the optimization of the care of patients hospitalized in the Medical Area of the Azienda ospedaliero-universitaria Senese, the definition of priority and appropriateness criteria and the optimization and standardization of Physiotherapists’ workloads. To carry out the project, the logical path set on the phases defined by the Six Sigma’s acronym DMAIC was followed (DEFINE: Problem’s identification through the creation of a Project Charter that defines and plans the entire project; MEASURE: Measurement and collection of data, focusing attention on the type of patients, characteristics of the inpatient Departments, organization of the Rehabilitation Health Professions Unit and activities of the Physiotherapist staff at the Medical Area in question; ANALYZE: Interpretation of data and analysis of the root causes of the problem; IMPROVE: Generation and implementation of corrective actions; CONTROL: Monitoring and standardization of the optimized system).

Results

From the analysis of the measured data, critical issues emerged such as: 1) The time dedicated to the patient, considering direct and indirect activities, is lower than that defined by comparisons with other facilities, in the absence of shared standards, and compared to the needs and characteristics of the patients; 2) Some initial assessments carried out 4-5 days after the request due to the high volume of consultations activated; 3) A high percentage of assessments carried out in which treatment was not activated due to inconsistent requests; 4) Differences in the percentage of requests for evaluation on the total hospitalizations for pathology between the 2 Units of the Medical Area of the Azienda ospedaliero-universitaria Senese which denoted different rehabilitation culture.

Discussion and Conclusion

Starting from the analysis of the root causes, the countermeasures to be implemented were identified, the improvement actions were found and their implementation was designed and planned with the related times and responsibilities. The main ones were the creation of a culture on the importance of early physiotherapy management and patient handling, the setting up of a flow-chart for patient stratification and the definition of a shared communication tool on functional abilities. The expected advantages concerned both the users, since evaluating and treating the right patient in the right time and with the right modality provides a better quality of the intervention and better outcomes, and the organization, influencing hospitalization times and guaranteeing workloads for the Physiotherapists who allow you to work in quality and safety. Data collection is underway to verify the achievement of the set indicators.

REFERENCES

1 Chan L, et al. Disability and health care costs in the Medicare population. Arch Phys Med Rehabil 2002; 83:1196.

2 Vos T, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2163.

3 Murray CJ, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197.

4 Gobbens RJ, et al. The predictive validity of the Tilburg Frailty Indicator: disability, health care utilization, and quality of life in a population at risk. Gerontologist 2012; 52:619.

5 Fried LP, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56:M146-56.

6 Rockwood K, et al. Frailty in Relation to the Accumulation of Deficits. J Gerontol A Biol Sci Med Sci 2007; 62:722-7.

Effetti del trattamento robotico con dispositivo Hunova® sul controllo del tronco e sulle attività della vita quotidiana in pazienti acuti con lesione midollare: uno studio preliminare

Effects of robotic training with Hunova® on trunk control and ability to perform activities of daily living in acute spinal cord injury patients: a preliminary study

Autori

Serafino Francesca (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Ricci Lucia (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Sabatelli Simona (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Materazzi Francesco Giuseppe (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Baldarelli Fabio Alessandro (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Menna Laura (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Ciardulli Francesca (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Cinotti Maria Giulia (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Rucci Paola (Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy); Di Staso Rossana (Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy)

Baroncini Ilaria (Montecatone Rehabilitation Institute, Imola (BO), Italy); Simoncini Laura (Montecatone Rehabilitation Institute, Imola (BO), Italy)

Introduction

Patients with spinal cord injury (SCI) have impaired trunk and postural control (both static and dynamic), often with a major impact on activities of daily living (ADL) 1. Therefore, improving trunk mobility and strengthening trunk control are primary rehabilitation goals. Nowadays, robotic therapy can be added to conventional rehabilitation to improve trunk control, balance and proprioception in the seated position2.

The aim of this preliminary study is to evaluate the effects of intensive robotic therapy with the Hunova® device (Movendo Technology, Italy) on trunk control and ability to perform ADL in individuals with acute SCI. Specifically, we analysed the changes after robotic training with Hunova® on the following outcomes: Trunk Control Test for SCI (TCT-SCI), Self-care and Overall mobility subscales of the Spinal Cord Independence Measure-III (SCIM-III) and measurements from the Hunova evaluation tests.

Methods

21 SCI patients hospitalised at the Montecatone Rehabilitation Institute from March 2023 to May 2024 with acute (<6 months post-injury) motor complete (n=9) or incomplete (n=12) lesions (NLI level between C4 and L2) underwent robotic training for 1 hour a day, 5 days a week, for 2 weeks, in addition to conventional rehabilitation treatment. The robotic rehabilitation training included static and dynamic trunk control exercises and dual-task exercises. The following parameters were measured before (T0) and after (T1) robotic treatment and analysed retrospectively: TCT-SCI and SCIM-III for clinical assessment, centre of pressure (COP) related parameters and trunk range of motion (ROM) as recorded by Hunova®.

Analysis of variance for repeated measures (ANOVA) was performed to assess the overall change of parameters over time and differences in the trend of the scores according to the level of completeness. Statistical analyses were performed using JASP v.0.18.3 software with a significance level of p=0.05.

Results

The clinical scales scores TCT for SCI, SCIM III Self-care and SCIM III Overall mobility and the measurements recorded by Hunova® regarding the right and left ROM of the trunk improved significantly after the robotic rehabilitation sessions (p<0.05 from the ANOVA analysis at T0 and T1 of all considered outcomes).

Furthermore, when scores were analysed according to the level of completeness of the lesion, the TCT for SCI scale and the measurements of right and left ROM were significantly lower at T0 and T1 in the complete subjects than in the incomplete subjects (p<0.05 for TCT and ROM outcomes).

Discussion and Conclusion

The results of this study provide preliminary evidence of patients’ improvement in trunk control and mobility based on clinical evaluation scales and quantitative measurements recorded by the robotic device These improvements indicate that the robotic training has a beneficial effect in acute spinal cord injury patients.

REFERENCES

  1. Milosevic M, Masani K, Kuipers MJ, et al. Trunk control impairment is responsible for postural instability during quiet sitting in individuals with cervical spinal cord injury. Clin Biomech (Bristol, Avon). Jun 2015;30(5):507-12. doi: 10.1016/j.clinbiomech.2015.03.002
  2. Payedimarri AB, Ratti M, Rescinito R, Vanhaecht K, Panella M. Effectiveness of Platform-Based Robot-Assisted Rehabilitation for Musculoskeletal or Neurologic Injuries: A Systematic Review. Bioengineering (Basel). 2022 Mar 22;9(4):129. doi: 10.3390/bioengineering9040129.