Gender impact on physical activity in musculoskeletal disorders prevention: a survey-based cross-sectional study in Lombardy Region, Italy (WeMoveForHealth)

Autori

Bargeri Silvia [IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy]

Palladino Chiara [University of Milan, Italy]

Guida Stefania [IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy]

Bernardelli Giuseppina [Exercise Medicine Unit, Istituto Auxologico Italiano IRCCS, 20135 Milan, Italy; DISCCO Department, Dipartimento di Eccellenza 2023–2027 – University of Milan, 20122 Milan, Italy – IRCCS Istituto Auxologico Italiano – Servizio di Medicina dell’Esercizio, 20135 Milano, Italy]

Banfi Giuseppe [IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy]

Background and aims

Musculoskeletal disorders (MskDs) are among the leading causes of disability worldwide, with women experiencing a disproportionately higher burden. Although the preventive benefits of physical activity are well established by the World Health Organization (WHO), gender disparities in participation remain, particularly in Southern Europe. This study aims to examine gender differences in adherence to WHO physical activity recommendations in the Lombardy region, Italy.

Methods

We are conducting a cross-sectional online survey among adults aged 18–64 in the Lombardy region (Italy), launched in February 2025. The study was registered on ClinicalTrials.gov (NCT06747052) and approved by the Ethics Committee. The questionnaire was disseminated through flyers and online channels with support from Ospedale Galeazzi-Sant’Ambrogio, Milan. The primary outcome was adherence to WHO physical activity recommendations. We also collected socio-environmental variables, awareness about physical activity and MskD prevention, and perceived barriers. This preliminary analysis reports descriptive data from the first three (out of six) months recruitment.

Results

Preliminary results show that 723 participants answered the survey (55% of the estimated sample size) and 78% of them completed it fully. The sample included 69% women, 31% men, and 0.5% non-binary individuals, with a median age of 39 years. Most lived in medium-density urban areas (47%) and held a university degree (64%). Good health status was reported by 89%, and 50% reported at least one MskD. Overall, 61% of participants met WHO physical activity recommendations, with higher adherence among men (66%) than women (60%) and non-binary individuals (33%). Gender differences were found in household task division (73% women vs. 20% men), caregiving roles (14% women vs. 10% men), and full-time employment (69% women vs. 81% men). Awareness of physical activity’s preventive role was high across all groups (99%). Reported barriers included lack of time (69% women vs. 31% men), lack of motivation (65% women vs. 33% men vs. 2% non-binary), tiredness due to multiple commitments (76% women vs. 24% men), and family care responsibilities (75% women vs. 25% men).

Conclusion

Preliminary findings highlight gender disparities in physical activity participation. These insights can guide the development of inclusive and gender-sensitive strategies for the prevention of MskD, with particular attention to the needs and barriers faced by women and gender minorities.

REFERENCES

Liu S, Wang B, Fan S, Wang Y, Zhan Y, Ye D. Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study. BMJ Open. 2022 Jun 29;12(6):e062183.

Cule M, Guliani H. Are there gender based differences in participation and time spent in physical activity in Albania? Evidence from 2017-18 demographic and health survey. Arch Public Health. 2022 Aug 11;80(1):187.

Ding D, Lawson KD, Kolbe-Alexander TL, Finkelstein EA, Katzmarzyk PT, van Mechelen W, Pratt M; Lancet Physical Activity Series 2 Executive Committee. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016 Sep 24;388(10051):1311-24.

Oliveira AJ, Lopes CS, Rostila M, Werneck GL, Griep RH, Leon AC, Faerstein E. Gender differences in social support and leisure-time physical activity. Rev Saude Publica. 2014 Aug;48(4):602-12.

Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018 Oct;6(10):e1077-e1086.

Exploring the definitions of gender bias in healthcare literature: a scoping review

Autori

Bargeri Silvia [IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands]

Schaap Laura [Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, the Netherlands; Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands]

Innocenti Tiziano [Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; GIMBE Foundation, Bologna, Italy]

Ostelo Raymond [Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands]

Tomaiuolo Rossella [IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy]

Vidal-Itriago Andres [Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands]

Rubinstein Sidney [Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands]

Background and aims

There is a lack of clarity how gender bias is defined and understood in the literature, despite growing recognition in healthcare. Theoretical and conceptual definitions vary widely, and little is known about their relevance and transferability in different clinical contexts, including the musculoskeletal field. We aimed to systematically explore how gender bias is defined and characterized.

Methods

Study design: scoping review prospectively registered on Open Science Framework (https://osf.io/qxrwh). We searched MEDLINE, EMBASE, and Scopus up to January 2025, including studies providing structured definitions or conceptual frameworks to define and/or understand gender bias in any healthcare contexts. Analysis: General characteristics (e.g., healthcare populations, contexts) were extracted and definitions were grouped by main themes emerged. A checklist on gender constructs was adapted to describe relevance from an analytical perspective (e.g., inclusion, intersectionality) and potential for implementation (e.g., transferability in different contexts).

Results

The selection of studies has not yet been completed, however, based on the first half of full texts assessed for eligibility, 7 studies were included. All were conducted in high-income countries between 2008 and 2024. Most were theoretical papers or theory-guided reviews (71%). Gender bias was examined in multi-specialty fields (e.g., musculoskeletal, cardiology) (29%), pain-related conditions (e.g., back pain) (29%), and health systems-levels (43%). Two main themes emerged: (i) gender bias as unjustified clinical assumptions about sex or gender differences, reflected in stereotypes (e.g., brave man, emotional women) or gender neglect (43%); (ii) gender bias as structural issue driven by institutional norms and systemic inequality (e.g., embedded gender norms) (43%). From an analytical perspective, the studies on health-systems contexts used intersectional perspectives and inclusive language beyond male-female binary. In terms of potential for implementation, two studies proposed potentially transferable frameworks to other contexts.

Conclusion

Preliminary findings suggest that existing definitions of gender bias in healthcare vary in conceptual focus, with few providing inclusive, non-binary and potentially transferable frameworks for clinical context. These gaps highlight the need to better understand how gender bias is conceptualized and addressed within health systems and clinical practice, such as in the musculoskeletal field.

REFERENCES

1. Miani C, Wandschneider L, Niemann J, Batram-Zantvoort S, Razum O. Measurement of gender as a social determinant of health in epidemiology-A scoping review. PLoS One. 2021;16:e0259223.
2. Hamberg K. Gender bias in medicine. Womens Health (Lond). 2008;4:237-43.
3. Risberg G, Johansson EE, Hamberg K. A theoretical model for analysing gender bias in medicine. Int J Equity Health. 2009;8:28.
4. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Scoping Reviews (2020). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. Available from: https://synthesismanual.jbi.global. Accessed on 24/11/2024.
5. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169:467-73.

The impact of an Italian student led physiotherapy clinic on student clinical reasoning

Autori

Sabot Raffaele Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Buoite Stella Alex Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Galmonte Alessandra Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Turolla Andrea Department of Biomedical and Neuromotor Sciences – DIBINEM, Alma Mater Studiorum Università di Bologna, Bologna, Italy; Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Canton Gianluca University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Murena Luigi University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Deodato Manuela University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Background and aims

Student-led clinics represent innovative academic-service models that enhance clinical reasoning (1) and practice through collaborative interactions among physiotherapy students, patients, and academic supervisors within dedicated clinical environments. Clinical reasoning constitutes a fundamental competency in physiotherapy education, enabling students to transition from theoretical knowledge to effective clinical decision-making (2,3). For bachelor-level students, developing robust clinical reasoning skills supports the delivery of safe, individualized, and evidence-based care. Previous research has demonstrated that clinical reasoning among physiotherapy students was significantly improved in student-led clinics compared to traditional educational models (4, 5). Consequently, the primary aim of this study was to evaluate and compare the impact of a student-led clinic model versus conventional clinical placement settings on clinical reasoning development in physiotherapy students.

Methods

A quantitative cross-sectional survey following STROBE guidelines was conducted among second- and third-year BSc physiotherapy students from University of Trieste who completed internships in both the Professional Development (PD) student-led clinic and traditional clinical settings. The study utilized a newly developed “Evaluation of Clinical reasoning during internship” questionnaire assessing eight domains of clinical reasoning, with responses scored from 1 (definitely not) to 5 (definitely). Data collection occurred between May-December 2024. Statistical analysis employed chi-square tests comparing “Good outcomes” (scores 4-5) versus “Bad outcomes” (scores 1-3), with significance set at p<0.05. The questionnaire demonstrated excellent internal consistency (α=0.921) and good test-retest reliability.

Results

A total of 102 students completed the questionnaire anonymously. The sample consisted of 38 women (37.25%) and 64 men (62.75%), with a mean age of 22.8 years (SD ± 2.1). The PD model demonstrated statistically significant superior student-perceived effectiveness compared to traditional models (territorial rehabilitation systems, hospitals, private centers, sports facilities, and elderly residences) across nearly all assessed domains. Specifically, the PD model showed substantial advantages in medical history taking, physiotherapy assessment and goal setting (25-30% higher positive responses), treatment progression and patient education (87% vs. 57-60% positive scores), discussion with peers (91.8% vs. 41.4%) and student-perceived autonomy in clinical reasoning (89% vs. 56.5%).

Conclusion

This study provides the first investigation of an Italian student-led physiotherapy clinic’s impact on clinical reasoning development. The PD model significantly enhanced clinical

reasoning across seven of eight evaluated domains compared to traditional placement models. These findings support previous research recognizing student-led clinics as sustainable, innovative models benefiting both regional healthcare systems and universities, while demonstrating their superior effectiveness in developing critical clinical reasoning skills among physiotherapy students.

REFERENCES

1. Daniel M, Rencic J, Durning SJ, Holmboe E, Santen SA, Lang V, et al. Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. Vol. 94, Academic Medicine. 2019.

2. Furze JA, Black L, Mcdevitt AW, Kobal KL, Durning SJ, Jensen GM. Clinical Reasoning: The Missing Core Competency in Physical Therapist Education and Practice. Vol. 102, Physical Therapy. 2022.

3. Gilliland S, Wainwright SF. Patterns of clinical reasoning in physical therapist students. Phys Ther. 2017;97(5).

4. Wynne D, Cooper K. Students’ perceptions of a UK physiotherapy student-led clinic. Clinical Teacher. 2023;20(6).

5. O’Connor A, Liston E, O’Donnell M. Student-led community placement in physiotherapy. Clinical Teacher. 2019;16(6).

Pilot study for the validation of the design and development process of customized upper limb prostheses and orthoses using 3D printing.

Autori

Azzurra Speroni [Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy]

Fabrizio Taffoni [Advanced Robotics and Human-Centered Technologies Research Unit – Creo lab, Università Campus Bio-Medico di Roma, Rome, Italy]

Maurizio Petrarca [Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy]

Francesca Cordella [Advanced Robotics and Human-Centered Technologies Research Unit – Creo lab, Università Campus Bio-Medico di Roma, Rome, Italy]

Claudia Bigas [Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy]

Gessica Della Bella [Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy]

Loredana Zollo [Advanced Robotics and Human-Centered Technologies Research Unit – Creo lab, Università Campus Bio-Medico di Roma, Rome, Italy]]

Background and aims

The human hand is crucial for performing daily activities, and its loss or functional impairment can significantly reduce an individual’s autonomy. Amputation may lead to a disability rating of up to 54% [1], while trauma- or congenital-related dysfunctions of individual fingers can result in variable functional limitations. Robotic prostheses and orthoses represent a promising approach to compensate for these deficits, despite most existing devices lack patient-centered design. Customization and affordability remain key challenges, especially in pediatric applications. The 3D-AID study addresses these issues by focusing on the customization of the mechanical structure of hand prostheses and orthoses, with the goal of improving wearability and reducing production costs.

Methods

The 3D-AID pilot study aims to define a procedure for acquiring data useful for identifying inter-joint coupling patterns and anatomical shapes for customized mechanical design. These data are also used to evaluate the quality and effectiveness of the resulting design. Two groups will be recruited: healthy pediatric volunteers (Group Vp), for kinematic data acquisition and 3D limb scanning to test motion reconstruction protocols and CAD parameterization; and pediatric patients with hand agenesis or transradial amputation (Group Ap), divided into three age groups (3–5, 6–10, and 11–14 years). In the first phase, anthropometric and unassisted flexion-extension kinematic data will be collected through digital scanning and stereophotogrammetry (BTS). In the second phase, these data will be used to design personalized virtual prototypes, which will be fabricated using Selective Laser Sintering (SLS) technology. Each device will undergo technical and functional evaluation to validate and optimize the proposed methodology. [2,3]

Results

The study collected pediatric hand anthropometric data and flexion-extension trajectories [4], using conventional methods and the EINSCAN HX 3D scanner, generating digital models through EXScanHX software for CAD integration. Flexion-extension trajectories were recorded with an 8-camera stereophotogrammetric system (SMART-DX, BTS) using reflective markers. Key parameters included finger joint angles, range of motion (ROM), and inter-joint angular couplings. [5] These initial data enabled the establishment of reliable protocols and baseline metrics for the customized design of pediatric prostheses.

Conclusion

Preliminary results of the 3D-AID study confirm the feasibility of combining 3D scanning, biomechanical analysis, and additive manufacturing to generate quantitative data for device customization, including pediatric applications. The proposed setup enables a data-driven manufacturing workflow for patient-specific designs. These findings support future clinical validation and highlight the potential to enhance personalization, functionality, and accessibility of upper limb assistive technologies in children.

REFERENCES

[1] Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Archives of Physical Medicine and Rehabilitation 2008;89(3):422-429.

[2] Cordella F, Zollo L, Salerno A, Accoto D, Guglielmelli E, Siciliano B. Int J Adv Robot Syst 2014;11(3):37

[3] Cordella F, Ciancio AL, Sacchetti R, Davalli A, Cutti AG, Guglielmelli E, Zollo L. Front Neurosci 2016;10:209.

[4] Nini L, Ceccarelli A, Tagliamonte NL, Zollo L, Taffoni F. Parametric 3D modeling of a customized prosthetic hand finger for additive manufacturing. In: 2024 10th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob). IEEE; 2024:1328–1333.

[5] Lapresa M, Ceccarelli A, Taffoni F, Tagliamonte NL, Zollo L, Cordella F. Analysis of hand intra-finger couplings during flexion movements in the free space. IEEE Access 2023; 11:90084–90093.

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

Autori

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

Background and aims

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

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

Methods

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

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

Results

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

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

Conclusion

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

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

REFERENCES

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

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

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

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

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

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

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

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

A CASE REPORT: TREATMENT OF REVERSE SHOULDER PROSTHESIS WITH DRY METHODS AND HYDROKINESIOTHERAPY

Autori

Bruschini Marco (Università Sapienza di Roma e Ospedale Pediatrico Bambino Gesù – S. Marinella)

Lanciotti Giulia (Laureata Università Sapienza di Roma)

Introduction to clinical case

The reverse shoulder prosthesis is now considered a surgical solution for patients with pathologies not treatable with anatomical prostheses, such as serious lesions of the rotator cuff. Hydrokinesistherapy, thanks to the water and its unique properties, has established itself as a valid method as support for dry post-operative rehabilitation. The objective of this study is to evaluate the effectiveness of hydrokinesitherapy integrated with dry rehabilitation in improving functional recovery and quality of life of patients undergoing reverse shoulder prosthesis. The protocol provides a combination of exercises adapted to the aquatic environment to promote an optimal return to function.

Methods

A case report was conducted on a 55-year-old patient who underwent reverse shoulder prosthesis and was subsequently included in a mixed rehabilitation program, including hydrokinesitherapy and dry therapy. The clinical evaluation was carried out in three moments (T0, T1, T2) through the scales NRS for pain and DASH for functionality, in addition to qualitative observations.

Results

The results show a significant improvement in pain and disability scores, with a progressive recovery of mobility and joint stability. The patient reported a reduction in pain already after the first sessions of hydrokinesitherapy, with a continuous improvement in movement control and ROM.

Discussion and clinical relevance

Hydrokinesistherapy, integrated with traditional rehabilitation, has proven to be an effective method in the post-operative recovery process for patients with reverse shoulder prosthesis, favoring the rehabilitation process. The results show a clear improvement between T0 and T1, highlighting how this approach can be considered as a valid therapeutic option, especially in the early stages of rehabilitation, but also adaptable to more advanced phases. In the proposed study, results were compared with contemporary scientific literature. In the first line it is noted that there are not a large number of articles on this subject and that they also involve other pathologies such as the reconstruction of the rotator cuff.

REFERENCES

Lädermann, A., Cikes, A., Zbinden, J., Martinho, T., Pernoud, A., & Bothorel, H. (2024). Hydrotherapy after Rotator Cuff Repair Improves Short-Term Functional Results Compared with Land-Based Rehabilitation When the Immobilization Period Is Longer. Journal of Clinical Medicine, 13(4), 954.  https://doi.org/10.3390/jcm13040954

Cikes, A., Kadri, F., Van Rooij, F., & Lädermann, A. (2023). Aquatic therapy following arthroscopic rotator cuff repair enables faster improvement of Constant score than land‐based therapy or self‐rehabilitation therapy. Journal of Experimental Orthopaedics, 10(1), 2. https://doi.org/10.1186/s40634-022-00554-z

Dufournet, A., Chong, X. L., Schwitzguébel, A., Bernimoulin, C., Carvalho, M., Bothorel, H., & Lädermann, A. (2022). Aquatic Therapy versus Standard Rehabilitation after Surgical Rotator Cuff Repair: A Randomized Prospective Study. Biology, 11(4), 610. https://doi.org/10.3390/biology11040610

Burmaster, C., Eckenrode, B. J., & Stiebel, M. (2016). Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.  https://doi.org/10.2522/ptj.20140178