ARE CLINICAL SENSORY TESTING (CST) SO ACCURATE TO EVALUATE SOMATOSENSORY SYSTEM DISORDERS? A SYSTEMATIC REVIEW

Autori

ROSSI FEDERICO [Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy]
[Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy]

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

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

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

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

PELLICCIARI LEONARDO [IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy]

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

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

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

Introduction to clinical case

The somatosensory system detects and interprets stimuli from both the external and internal environment through receptors, neural pathways, and cortical areas, enabling perception of touch, temperature, proprioception, and pain. Quantitative Sensory Testing (QST) is the gold standard for assessing somatosensory function and identifying dysfunctions such as hypoesthesia, allodynia, and hyperalgesia. Although effective, QST is costly and requires specialized training, limiting its routine clinical use. As an alternative, Clinical Sensory Testing (CST), or bedside sensory testing, has been developed as a more accessible and low-cost tool to evaluate sensory thresholds and predict treatment outcomes. This systematic review aims to assess the diagnostic accuracy of CST in identifying somatosensory disorders compared to standard laboratory methods.

Methods

This systematic review will follow PRISMA-DTA guidelines and the Cochrane Handbook, including all relevant studies regardless of time, language, or location. Based on PICO criteria, it will evaluate the diagnostic accuracy (sensitivity and specificity) of Clinical Sensory Tests (CSTs) for somatosensory disorders, comparing them to other diagnostic tools like QST or skin biopsy. Bibliographic databases including Medline, CINHAL, PEdro, Web of Science, Cochrane Library, Scopus, Scholar and EMBASE will be consulted to investigate potentially relevant studies.The results of the bibliographic search will be uploaded to Rayyan. Two independent reviewers will handle study selection, data extraction, and risk of bias assessment, with a third reviewer resolving disagreements. Results will be synthesized narratively and in tables.

Results

Several Clinical Sensory Tests (CSTs) have shown varying levels of diagnostic accuracy in detecting somatosensory dysfunctions. The Semmes-Weinstein Monofilament Test and von Frey filaments demonstrated high specificity, especially when compared to gold standards like Nerve Conduction Studies and MRI. Tools like the Neuropen, tuning forks, Q-tip, and temperature-based tests also showed promising sensitivity or specificity depending on the context. However, many CSTs showed a trade-off between sensitivity and specificity, and outcomes varied based on methodology and condition assessed.

Discussion and clinical relevance

Identifying somatosensory dysfunctions is essential for improving diagnosis and treatment. Many authors stress the importance of developing fast, low-cost tests that can assess all nerve fiber types without requiring complex equipment. Tests like the SWMT and StEP showed good sensitivity and specificity, but other tools yielded inconsistent results. However, population heterogeneity and lack of standardization in test administration currently limit CSTs from being considered fully reliable diagnostic methods.

REFERENCES

1. Zhu GC, Böttger K, Slater H, Cook C, Farrell SF, Hailey L, Tampin B, Schmid AB. Concurrent validity of a low-cost and time-efficient clinical sensory test battery to evaluate somatosensory dysfunction. Eur J Pain. 2019 Nov;23(10):1826-1838.
2. Scholz J, Mannion RJ, Hord DE, Griffin RS, Rawal B, Zheng H, Scoffings D, Phillips A, Guo J, Laing RJ, Abdi S, Decosterd I, Woolf CJ. A novel tool for the assessment of pain: validation in low back pain. PLoS Med. 2009 Apr 7;6(4):e1000047. doi: 10.1371/journal.pmed.1000047. Epub 2009 Apr 7. PMID: 19360087; PMCID: PMC2661253.
3. Aithal, V., Bhat, S. Semmes Weinstein monofilament test for detection of diabetic peripheral neuropathy: sensitivity and specificity. Egypt J Neurol Psychiatry Neurosurg60, 6 (2024).
4. Ridehalgh C, Sandy-Hindmarch OP, Schmid AB. Validity of Clinical Small-Fiber Sensory Testing to Detect Small-Nerve Fiber Degeneration. J Orthop Sports Phys Ther. 2018 Oct;48(10):767-774. doi: 10.2519/jospt.2018.8230. Epub 2018 Jun 22. PMID: 29932873.
5. Lin, JH., Hsieh, YC., Chen, YC. et al.Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root. Sci Rep 7, 10598 (2017).

THE BOOK POWER: HOW BIBLIOTHERAPY CAN HELP ONCOLOGICAL PATIENTS. A SCOPING REVIEW

Autori

Francesca Sposito

Francesco Bonanno

Antonio Di Dio

Giada Di Marco

Silvia Saraceno

Filippo Cavallaro

Introduction to clinical case

The impact of cancer is not limited to its physical pathology; it also profoundly disrupts psychological well-being. The literature highlights the importance of enhancing resilience in oncology patients to preserve mental health and quality of life (1). Whitin the spectrum of verbal therapy techniques (including expressive writing and video narratives), bibliotherapy is defined as the utilization of books as a form of therapy in the context of physical or mental disorders (2). Recommended books should feature narratives with a background like the patient’s life. Bibliotherapy is based on the concept of ‘catharsis’, defined as liberation from suffering. The patient is required to achieve complete immersion in the reading material and empathize with the character. Bibliotherapy represents a form of self-help that oncology patients can utilize to address diagnosis, communicate with family and friends, adapt to change, and establish a new sense of normalcy.

Methods

Authors searched English articles published from 2015 to 2025 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The electronic databases PubMed, Scopus, Cochrane Library were investigated, using the following key words, which were combined to achieve maximum search strategy sensitivity: (“bibliotherapy”) AND (“oncology”). First, articles were screened by title and abstract, using the following inclusion criteria for selection: (1) written in English language; (2) published on indexed journals; and (3) dealing with bibliotherapy and oncology patients. The exclusion criteria were (1) reviews; (2) papers written in other languages than English; and (3) data not dealing with bibliotherapy and oncological setting. Second, the full texts of the selected articles were screened with further exclusions according to the previously described criteria. A PRISMA flowchart of the selection and screening method is provided in Figure 1.

Results

Figure 2 summaries the principal key point of each article analyzed. All the authors proposed different books to improve patients’ quality of life and to reinforce relationship and meditation skills. These results highlight the central role of bibliotherapy as a valid method for accompanying and guiding the oncological patient throughout his treatment pathway.

Discussion and clinical relevance

Based on literature research, the authors have defined the contribution of bibliotherapy in the non-pharmacological management of mental health in oncology patients. Reading materials recommended by specialists have been associated with an enhanced perception of intrapersonal functioning and decreased suffering in individuals affected by cancer (3). The role of bibliotherapy is not curative; instead, it supports the patient in achieving enhanced adaptation to their disease.

REFERENCES

1. Tamura S, Suzuki K, Ito Y, Fukawa A. Factors related to the resilience and mental health of adult cancer patients: a systematic review. Support Care Cancer. 2021 Jul;29(7):3471-3486. doi: 10.1007/s00520-020-05943-7. Epub 2021 Jan 29. PMID: 33512578.
2. Jones JK, Evans JF, Barfield RC. The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. Front Pediatr. 2021 Feb 4;9:579003. doi: 10.3389/fped.2021.579003. PMID: 33614548; PMCID: PMC7889798.
3. Keenan E, Morris R, Vasiliou VS, Thompson AR. A qualitative feasibility and acceptability study of an acceptance and commitment-based bibliotherapy intervention for people with cancer. J Health Psychol. 2024 Apr;29(5):410-424. doi: 10.1177/13591053231216017. Epub 2023 Dec 29. PMID: 38158736; PMCID: PMC11005316.

Perceived motor discomfort after the exposure to high temperatures: hypothesis of an evaluation form

Autori

Francesca Sposito

Francesco Bonanno

Antonio Di Dio

Patrizia Maenza

Giada Di Marco

Silvia Saraceno

Filippo Cavallaro

Introduction to clinical case

The experience of a clinical case with motor disorders due to high temperature exposure and heat collapse led us to search in literature guidelines or recommendations. Unfortunately, not finding useful data and documents, we decided to describe the proposed therapeutic physiotherapy intervention and set ourselves the task of gathering more information on the motor discomfort perceived in the exposure to high temperatures by setting up an evaluation form to be proposed to those who had been exposed in the same event with the clinical case mentioned.

Methods

The scale proposed was the Belding-Hatch heat stress index, in order to identify the Heat Stress Index (HSI). Considering that sweat is the main mechanism by which the body transfers heat to maintain homothermia, this parameter was combined with the other aspects such as heart rate, respiratory performance, blood pressure, cramps, headache, nausea or vomiting. Clothing and the use of personal protective equipment (PPE) were also considered.

Results

We proposed a simple form composed by 20 questions (13 of them with closed yes or no answers and 7 open ones to better define 4 questions that had already been answered yes or no) (Fig.1). The initial master sheet enabled each respondent to be identified by survey code, job title, sex and age. This sheet was presented to the subject after he or she agreed to participate in the study. A second set of questions was asked by the interviewer on the amount and timing of hydration and on the duration of working hours before being able to go and lie down in a safe place.

Discussion and clinical relevance

The scale, being easy to use, could have the advantage of being included among the tools for assessing motor discomfort in conditions of exposure to the risk of high temperature. It could be used in risk assessment and to give greater awareness to people who most frequently confronted with the heat problem such as fires, or furnaces.

REFERENCES

Mario Lizza – la fatica di essere sani – Seusi

https://www.messinamedica.it/2023/12/noterelle-riabilitative-del-padre-del-libraio-fiamme/

REhabilitation Arm Clinical pracTice (REACT). Development of a Delphi-based survey on clinical practice in upper limb rehabilitation after stroke

Autori

Rossi Federica [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Amadei Maurizio [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Vetere Andrea [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy]

Caronni Antonio [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy – Department of Biomedical Sciences for Health, University of Milan, Milan, Italy]

Perucca Laura [Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy – Department of Biomedical Sciences for Health, University of Milan, Milan, Italy]

Background and aims

Upper limb motor recovery after stroke remains one of the most challenging and heterogeneously managed aspects of neurorehabilitation. Clinical experience suggests that physiotherapists often recognize a discrepancy between what is considered optimal care and what is implemented in routine clinical practice [1]. Difficulties in achieving meaningful functional recovery, variability in clinical approaches, and uncertainty about the most effective treatment strategies highlight the complexity of upper limb rehabilitation and the need for greater clarity and consistency [2]. Although numerous guidelines exist, real-world practice, clinical reasoning, and professional perspectives are still poorly defined [3]. The REACT project explores current practice, beliefs, and challenges to identify areas for improvement and innovation.

Methods

REACT will adopt a modified two-step Delphi-based methodology involving panels of expert physiotherapists and multidisciplinary rehabilitation specialists.

• Formation of a steering workgroup responsible for study coordination, panel selection, and thematic scope and areas.
• Recruitment of a first panel (Panel 1), who will participate in structured meetings to generate survey statements. Thematic areas include clinical assessment, clinical conditions, rehabilitation interventions, physical modalities, planning and delivery of care, intensity of rehabilitation, drugs, team composition, and prognosis.
• Recruitment of a second panel (Panel 2) to rate and validate the statements produced by Panel 1 for relevance, clarity, and appropriateness using Likert-scale evaluations.
• Final selection of ~30 core items to construct the definitive survey.

The workgroup will oversee data processing, duplicate removal, content validation, and thematic coverage analysis between Delphi rounds.

The final version of the survey will be disseminated through the official channels and professional networks of AIFI (Associazione Italiana di Fisioterapia) to ensure a broad national reach and optimal engagement among practising physiotherapists.

The protocol will undergo ethics committee approval before administering the survey .

Results

The project will develop a survey designed to reflect current physiotherapy practice in upper limb stroke rehabilitation accurately. The findings will identify dominant approaches, underused interventions, and perceived barriers.

Results will be shared through peer-reviewed publications, professional society channels (e.g., AIFI), and scientific conferences.

Conclusion

The REACT Survey serves as a structured starting point for exploring physiotherapy practice in upper limb stroke rehabilitation. By capturing routine clinical practice in upper limb rehabilitation following a stroke, REACT will enable the identification of needs and areas for development in research into this common and significant condition within physiotherapy practice.

REFERENCES

1. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014 Nov 12;2014(11):CD010820. doi: 10.1002/14651858.CD010820.pub2. PMID: 25387001; PMCID: PMC6469541.
2. Hayward KS, Kramer SF, Thijs V, Ratcliffe J, Ward NS, Churilov L, Jolliffe L, Corbett D, Cloud G, Kaffenberger T, Brodtmann A, Bernhardt J, Lannin NA. A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke. Syst Rev. 2019 Jul 25;8(1):187. doi: 10.1186/s13643-019-1093-6. PMID: 31345263; PMCID: PMC6657039.
3. Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP; Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Investigative Team. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. 2016 Feb 9;315(6):571-81. doi: 10.1001/jama.2016.0276. PMID: 26864411; PMCID: PMC4795962.

The Experience of Peer Tutoring During Clinical Internships of Physiotherapy Students: A Meta-Synthesis of Qualitative Studies

Autori

Salvitti Simone [Unit of Cardiorespiratory Physiotherapy, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) and Department of Medicine, University of Udine – Udine, Italy]

Colado Gimeno Isabel [Unit of Pediatric Physiotherapy, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) – Udine, Italy]

Palese Alvisa [Department of Medicine, University of Udine – Udine, Italy]

Mansutti Irene [Department of Medicine, University of Udine – Udine, Italy]

Di Bari Mauro [Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi and Department of Experimental and Clinical Medicine, University of Florence – Florence, Italy]

Background and aims

Clinical internships are fundamental for the development of clinical competence and professional identity, yet they often overlook psychodynamic and adaptive skills, which are essential in high-pressure environments. Organisational variability and the lack of adequately trained clinical tutors further exacerbate the issue. In this context, peer tutoring emerges as a promising strategy: more experienced students support junior peers, fostering mutual learning, confidence, and emotional resilience.

While several qualitative and mixed-method studies exist on this topic, no systematic synthesis had been conducted prior to this work. A meta-synthesis is therefore needed to guide the development of innovative and sustainable educational models capable of addressing the challenges of an evolving healthcare system.

The aim of this study was to identify, analyze, and synthesize qualitative findings regarding the experiences of Physiotherapy students participating in a peer tutoring program during their clinical internships. Specifically, the study addresses the following research questions:

• What experiences of junior students (mentees) during clinical internships supervised by fellow students have been documented to date?
• What are the experiences of senior students (mentors) during clinical internships when acting as mentors to their peers?

Methods

The SPIDER approach, specifically tailored for qualitative and mixed-methods research, was used to frame the research question for the database searches as an alternative to the PICO framework. A qualitative meta-synthesis was carried out, including studies evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Data were analyzed through inductive thematic analysis, and the GRADE-CERQual tool was used to assess confidence in the findings. Reporting followed Cochrane Qualitative Evidence Synthesis guidelines. The research protocol was registered in PROSPERO (CRD420251004431).

Results

Out of 686 identified articles, four were included in the final analysis. Two central themes emerged: 1) Mentees reported a desire to engage in patient care, viewing mentors as role models; 2) Mentors focused on their own personal and professional development, embracing a reciprocal, non-competitive learning dynamic. The integrative synthesis also revealed four broader themes: a) Indirect impact of clinical tutors on peer relationships; b) Barriers to peer collaboration; c) Peer tutoring as a driver of personal growth; d) Easing the difficulties of working independently.

Conclusion

A well-structured peer tutoring can benefit both mentors and mentees, enhancing learning and skill development. However, the dual role of the clinical tutors as both supervisors and evaluators may strain peer relationships and contribute to increased anxiety and stress among students.

REFERENCES

1. Laitinen-Väänänen, S., Talvitie, U., & Luukka, M. R. (2007). Clinical supervision as an interaction between the clinical educator and the student. Physiotherapy theory and practice, 23(2), 95-103.
2. Sevenhuysen, S., Thorpe, J., Molloy, E., Keating, J., & Haines, T. (2017). Peer-assisted learning in education of allied health professional students in the clinical setting: a systematic review. Journal of allied health, 46(1), 26-35.
3. Price, D., & Whiteside, M. (2016). Implementing the 2: 1 student placement model in occupational therapy: Strategies for practice. Australian Occupational Therapy Journal, 63(2), 123-129.
4. Campbell, I. E., Larrivee, L., Field, P. A., Day, R. A., & Reutter, L. (1994). Learning to nurse in the clinical setting. Journal of advanced nursing, 20(6), 1125-1131.
5. Hunt, C. W., & Ellison, K. J. (2010). Enhancing faculty resources through peer mentoring. Nurse educator, 35(5), 192-196.