ACTION OBSERVATION AND MOTOR IMAGERY IMPROVE MOTOR IMAGERY ABILITIES IN PATIENTS WITH PARKINSON’S DISEASE – A FUNCTIONAL MRI STUDY

Introduction

Motor imagery (MI) is a motor-learning skill that can be affected in patients with Parkinson’s disease (PD) [1, 2]. We aimed at assessing MI and brain functional changes after an action observation training (AOT) and MI training associated with gait/balance exercises in PD patients with postural instability and gait disorders (PD-PIGD).

Methods

Twenty-five PD-PIGD patients were randomized into two groups: the DUAL-TASK+AOT-MI group performed a 6week gait/balance training combined with AOT-MI; the DUAL-TASK group performed the same exercises while watching landscape videos. Before and after training, MI was assessed using the Kinesthetic-and-Visual-Imagery Questionnaire (KVIQ) and a MI functional MRI (fMRI) task. During fMRI, subjects were asked to watch first-person perspective videos representing gait/balance tasks and mentally simulate to perform them. At baseline patients were compared with 23 healthy controls.

Results

At baseline, there were no significant differences between groups in the MI scores. Both patient groups increased kinesthetic MI score after training, while only DUAL-TASK+AOT-MI group improved in visual MI and total KVIQ scores. At baseline, both PD groups showed reduced fMRI activity of sensorimotor, temporal and cerebellar areas relative to controls. After training, DUAL-TASK+AOT-MI patients increased activity of anterior cingulate, fronto-temporal and motor cerebellar areas, and reduced the recruitment of cognitive cerebellar regions. DUAL-TASK group showed increased recruitment of occipito-temporal areas and reduced activity of cerebellum crus-I. DUAL-TASK+AOT-MI relative to DUAL-TASK group had increased activity of cerebellum VIII-IX. In DUAL-TASK+AOT-MI group, KVIQ improvement correlated with increased activity of cerebellum IX and anterior cingulate, and with reduced activity of crus-I.

Discussion and Conclusion

AOT-MI improves MI abilities in PD-PIGD patients, promoting the functional plasticity of brain areas involved in MI processes and gait/balance control.

REFERENCES

[ 1 ] G. Abbruzzese, et al. Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson’s Disease, Parkinson’s Disease. 2015. Doi: 10.1155/2015/124214

[ 2 ] E. Sarasso, et al. Action Observation and Motor Imagery Improve Dual Task in Parkinson’s Disease: A Clinical/fMRI Study. Movement Disorders. 2021. Doi: 10.1002/mds.28717

Multidisciplinary Approach Based on Frailty Screening in Liver Transplant Candidates at ISMETT: Analysis for Personalized Interventions and Improved Transplant Outcomes

Introduction

Frailty is a debilitating condition in organ transplant candidates. Accurate screening would enhance resource management during the waiting period.

Benefits of screening:

• Improved quality of life
• Impact on healthcare costs
• Precise identification of high-risk patients

Accurate frailty assessment provides indications for activation of territorial services with preventive measures, such as functional recovery programs and balanced diets.

According to the “National Transplant Center” for 2021 (3), there were 2,679 liver transplant registrations, with 1,388 transplants and 8.7% mortality on the waiting list, with a 15.5% drop-out rate.

Identifying frail patients optimizes resource allocation during the waiting period. The study’s aim was to map the liver transplant candidate population at ISMETT, identifying the most fragile subjects.

Methods

ISMETT is a transplant institute in Palermo. In the 2022 report, 91 liver transplants were performed, including 75 from deceased donors. Transplant activity began in 1998, with cadaveric, living donor, and split liver programs.

For liver transplant candidates, the physiotherapist’s evaluation was introduced into the assessment protocol, complemented by the “Liver Frailty Index” test since April 2021. Patients are stratified into three classes: “frail,” “pre-frail,” and “robust.”

Based on the test, frailty reassessment is scheduled at 1, 3, and 6 months for each class, with specific indications for activities and care settings, including ADI service activation, long-term hospitalization, or self-managed physiotherapy exercises using a brochure provided after patient instruction.

Data were collected in an Excel database, and statistical analysis was performed using means, standard deviations, minimum and maximum values, and stratification by gender

Results

A total of 379 consecutive patients were evaluated, excluding 6 due to inadequate test conditions. Male prevalence: 76.1% (n = 284), mean age: 55.23 years (range: 21-71, SD: 10.36), with no significant gender differences. Frailty assessment: mean 3.74 (range: 1.68-6.74, SD: 0.96), with no significant gender differences.

Distribution of patients by frailty classes: pre-frail (n = 183, 49.1%), frail (18.2%, n = 68), with no gender differences.

Analysis of individual test items: 94.9% passed the single-leg balance test, while 7.8% were unable to perform the tandem position test.

Therapeutic indication: A self-managed recovery exercise program through a brochure with predefined or patient-selected exercises was used for 54.2% of evaluated patients.

18.2% were recommended ADI service activation, with 7 preferably hospitalized if available. 26% received no additional activity indications (robust patients)

Discussion and Conclusion

The conclusions of our study allowed an accurate analysis of frailty in liver transplant candidates at ISMETT. Implementing the physiotherapist evaluation protocol and utilizing the Liver Frailty Index provided valuable insights for personalized interventions and a more detailed understanding of liver transplant recipients’ characteristics

A multidisciplinary approach based on frailty screening proves to be a valuable tool for enhancing management and customization of care for liver transplant candidates, aiming to adopt personalized interventions and improve transplant outcomes. However, the current data are partial and lacking in terms of transplant survival and adherence to therapeutic indications, as well as the actual support of territorial services.

Our study offers a crucial knowledge base, but further research and joint efforts are necessary to ensure optimal and personalized treatment for liver transplant candidates

REFERENCES

Haugen CE, McAdams-DeMarco M, Holscher CM, Ying H, Gurakar AO, Garonzik-Wang J, et al. Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates. Ann Surg. 2020 Jun;271(6):1132–6.

Centro Nazionale Trapianti. Rapporto annuale [ Internet ]. Available from: https://www.trapianti.salute.gov.it/imgs/C_17_cntPubblicazioni_506_allegato.pdf

Kwong AJ, Ebel NH, Kim WR, Lake JR, Smith JM, Schladt DP, et al. OPTN/SRTR 2020 Annual Data Report: Liver. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2022 Mar;22 Suppl 2:204–309

Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end‐stage liver disease. Hepatology. 2017 Aug;66(2):564–74

NEURAL CORRELATES OF BRADYKINESIA IN PARKINSON’S DISEASE: A KINEMATIC AND FMRI STUDY

Introduction

Bradykinesia is one of the cardinal signs of Parkinson’s disease (PD) and is usually assessed during repetitive movements [1, 2]. The aim of the study was to investigate the neural correlates of hand tapping performance in patients with PD relative to healthy controls.

Methods

Fifteen PD patients and 15 age- and sex-matched healthy controls were included. All the subjects underwent brain magnetic resonance imaging (MRI) including a hand tapping functional MRI (fMRI) task: subjects were asked to alternatively open and close (hand tapping) their right hand as fast and as ample as possible. Hand tapping speed and amplitude was measured during the fMRI task using an optical fiber data glove.

Results

During the fMRI hand tapping task, patients with PD showed reduced hand tapping amplitude and reduced activity of frontoparietal areas and sensorimotor regions including supplementary motor area (SMA), pre/postcentral gyri, pallidum and cerebellum compared to healthy controls. Decreased activity of SMA, cerebellum lobule VIII and caudate correlated with reduced hand tapping amplitude.

Discussion and Conclusion

As expected, patients with PD showed a worse hand tapping performance in terms of reduced movement amplitude relative to healthy controls. Interestingly, we found a correlation between bradykinesia and brain activity. In particular, areas strongly involved in motor planning such as SMA and caudate correlated with reduced movement amplitude. This study has the major strength of collecting objective motor parameters and brain activity simultaneously, providing a unique opportunity to investigate the neural correlates of bradykinesia in PD. A reduced recruitment of cortical, cerebellar and basal ganglia areas implicated in motor programming is a hallmark of bradykinesia in patients with PD. 

 

Funding: Italian Ministry of Health grant GR-2018-12366005

REFERENCES

[ 1 ] Prange-Lasonder GB, et al. European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. Journal of Neuroengineering and Rehabilitation. 2021. Doi: 10.1186/s12984-021-00951-y

[ 2 ] Holiga S, et al. Accounting for movement increases sensitivity in detecting brain activity in Parkinson’s disease. PLoS One. 2012. Doi: 10.1371/journal.pone.0036271

[ 3 ] Bologna M, et al. Neurophysiological correlates of bradykinesia in Parkinson’s disease. Brain. 2018. Doi: 10.1093/brain/awy155

Wearable devices to Improve Physical Activity: An Overview of Systematic Reviews

Introduction

Physical activity provides benefits in the prevention and treatment of many conditions. A low proportion of the population meets the suggested evidence-based level of physical activity. Wearable devices might contribute to increase physical activity. This study aimed to evaluate the efficacy of wearable devices in increasing physical activity in adults.

Methods

We performed an Overview of Systematic Reviews (SRs). The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022339140). We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5^th, 2023. SRs that evaluated the efficacy of interventions with wearable devices to increase physical activity in adults aged over 18 years. The primary outcome was physical activity measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) and sedentary behaviour (SB).

Results

We included 51 SRs, of which 38 included meta-analyses, and 302 unique primary studies were detected (FIGURE 1). Overall, 72.5% of SRs were rated as critically low quality. With a slight overlap of primary studies (CCA: 3.87% in steps per day, 2.78% in MVPA, 4.06% in SB) and low to moderate certainty of the evidence, wearable devices may increase PA with a median of 1312.23 (IQR 627-1854) steps per day and 12.56 (IQR 7.22 to 48.5) minutes of MVPA with clinical relevance in adults with or without comorbidities (FIGURE 2). Scattered clinically and statistically effect sizes for SB were reported in few SRs and in older adults.

Discussion and Conclusion

Our findings suggest that wearable devices represent valuable options for improving physical activity levels in middle-aged, with or without comorbidities. Further studies are needed to investigate the effects of wearable devices in different follow-up lengths, among older adults and the role of other intervention components.

REFERENCES

• World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. 2018
• 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;6(10):e1077-e86.

Qualitative Characteristics of Vulvodynia: A Cross-Sectional Study on Women’s Vulvar Pain Patterns

Introduction

Vulvodynia is a condition characterized by chronic pain in vulvar region, with a significant impact on women’s quality of life. [1] Its etiology remains poorly understood, and diagnosis is often challenging, relying on the exclusion of other specific causes of genital pain (e.g. infectious, neoplastic, neurological, etc.). [2] The identification of vulvodynia based on type of pain and symptomatic characteristics is crucial for appropriate clinical management. Previous studies have primarily focused on quantitative aspects of  pain, but research on its qualitative characteristics is underexplored. This study aims to address this gap by examining the qualitative features of pain experienced by women with diagnosed vulvodynia using a body chart.

Methods

Following the STROBE guidelines , we conducted an observational cross-sectional study to analyze the qualitative pain characteristics in a population of women with a diagnosis of vulvodynia. Between December 2021 and May 2022, 82 women were recruited from patients attending FISIOS Pelvic-Perineal Disorders Rehabilitation Clinic. Among them, 72 participants met the inclusion criteria (according to the 2015 consensus of ISSVD, ISSWSH, and IPPS) [2] and were informed about the study’s nature before providing written informed and privacy consent forms.

Each participant completed a questionnaire to investigate intensity of pain using the Numeric Pain Rating Scale (NPRS) and associated symptoms. A pain drawing scale was utilized to explore the pain’s qualitative aspects.

Results

The study involved 72 women with vulvodynia presenting comorbidities, e.g. endometriosis (Table 1d). Among them, 19% had provoked vulvodynia, 28% had unprovoked, and 53% had mixed type. Among the participants, 61% underwent the Swab Test, a diagnostic procedure for vulvodynia, resulting in 44% positive and 17% negative outcomes (Figure 1). The body chart was valuable in visualizing pain patterns, revealing a prevalence of burning, stabbing, and dull pain rather than the commonly depicted “pins and needles” sensation (Figure 2, Table 1b and 1c). Concerning pain perception, 39% of patients reported pain in the lumbar region (Table 1a), but only 4.2% mentioned pre-existing low back pain before vulvodynia onset. The NPRS score indicated a significant intensity of pain experienced by the participants (M t0 = 8.667, SD t0 = 1.163).

Discussion and Conclusion

The study found a high percentage of non-execution of the SWAB test, possibly due to confusion regarding different execution methods reported in the literature or doubts about its relevance in confirming vulvodynia. [3] The qualitative presentation of pain differs from the common descriptions. Identifying the pain quality helps understand its type (nociceptive, neuropathic, nociplastic), so physical therapists should be aware that distinct pain types require tailored multimodal and patient-centered treatments.  The experience of referred pain in distant areas and the occurrence of comorbidity suggests potential sensitization (Figure 2 and Table 1d). [ 4 ] In conclusion, this study underscores the importance of a comprehensive assessment of vulvodynia, considering both quantitative and qualitative aspects of pain, to enhance diagnosis and management strategies for affected women.

REFERENCES

1. Chalmers KJ, Catley MJ, Evans SF, Moseley GL. Clinical assessment of the impact of pelvic pain on women. Pain. 2017;158(3):498-504. doi:10.1097/J.PAIN.0000000000000789
2. Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Obstet Gynecol. 2016;127(4):745-751. doi:10.1097/AOG.0000000000001359
3. Vieira-Baptista P, Lima-Silva J, Beires J, Donders G. Women without vulvodynia can have a positive ‘Q-tip test’: a cross sectional study. Journal of Psychosomatic Obstetrics & Gynecology. 2017 Oct 2;38(4):256-9
4. Torres-Cueco R, Nohales-Alfonso F. Vulvodynia—It Is Time to Accept a New Understanding from a Neurobiological Perspective. Int J Environ Res Public Health. 2021;18(12). doi:10.3390/IJERPH18126639

Shock waves modulate corticospinal excitability: a proof of concept for further rehabilitation purposes?

Introduction

Focused extracorporeal shock wave therapy (fESWT) is a physical therapy consisting in the application of a rapid sequence of single acoustic pulses directed to a target area¹. The mechanisms of action has been vastly studied for various musculoskeletal disorders². However, despite this considerable knowledge, the effect of fESWT on the central nervous system is still to be determined³, and the current knowledge comes mainly from studies on spasticity⁴. In this study, we try to elucidate possible neurophysiological mechanisms of fESWT action, both spinal and supra-spinal level, in order to widen the spectrum of its clinical applications.

Methods

In this proof-of-concept clinical study, ten healthy subjects were assessed before (T0), after (T1) and seven days after (T2) a single session of fESWT (1000 impulses to the right tibialis anterior belly muscle). Motor evoked potentials (resting motor threshold – RMT, maximal motor evoked potential and maximal compound muscle action potential ratio – MEP_max/CMAP_max ratio, cortical silent period – cSP, total conduction motor time – TMCT, direct and indirect central motor conduction time – dCMCT and iCMCT) and H-reflex (threshold, amplitude, maximal H reflex and maximal compound muscle action potential ratio – H_max/CMAP_max amplitude ratio, latency) were considered as outcomes. RM-ANOVA with Holm-Bonferroni Post Hoc test was used to assess the effect of the treatment, and Pearson correlation coefficient to evaluate the relationship between the variation of RMT, cSP and Hr threshold.

Results

RMT significantly decreased from T1 (0.53 ± 0.02, mean ± S.E.) to T2 (0.49 ± 0.01, mean ± S.E.) (p < 0.05, Holm-Bonferroni Post Hoc test). H-reflex threshold increase from T0 (10.46 ± 1.64, mean ± S.E.) to T1 (12.61 ± 1.85, mean ± S.E.) (p < 0.05, Holm-Bonferroni Post Hoc test). Analysis disclosed a strong negative correlation between ∆3 cSP (i.e., T2 – T1 recordings) and ∆1 Hr threshold (i.e., T1 – T0 recordings) (r= – 0.66, p< 0.05), and a positive strong relationship between ∆3 cSP and ∆3 Hr threshold (r=0.63, p < 0.05).

Discussion and Conclusion

fESWT modulated the corticospinal tract excitability in healthy volunteers, possibly driving cortical effects as suggested by changes in RMT over time. Overall, from a functional perspective, the excitability of corticospinal pathways seems to have an early inhibition immediately after fESWT with a later facilitation after one week, as suggested by the correlation between Hr and cSP variations among different time intervals. Although preliminary, these results might expand the mechanisms knowledge and clinical use of fESWT.

REFERENCES

1 Choi, M. J. et al. Ultrasonics 110, 106238 (2021)

2 Romeo, P. et al. Med. Princ. Pract. Int. J. Kuwait Univ. Health Sci. Cent. 23, 7–13 (2014)

3 Dymarek, R. et al. Clin. Interv. Aging 15, 9–28 (2020)

4 Yang, E. et al. J. Clin. Med. 10, 4723 (2021)

Agreement among multiple meta-analyses on the effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews

Introduction

Worldwide, stroke is the second leading cause of death and a major cause of disability, with over 12 million new strokes reported each year. With advances in health technologies, the range of interventions for stroke survivors is in continuous expansion. Among these, virtual reality (VR) in neurorehabilitation has proved an engaging, interactive, patient-centred, and relatively inexpensive modality to enhance functional recovery. We aim to conduct an overview of systematic reviews exploring the agreement on the effectiveness and the safety of VR technologies for clinical outcomes in stroke survivors to give a comprehensive balance of effects.

Methods

We searched multiple databases up to 17 January 2023 for systematic reviews comparing any kind of VR technology (with or without conventional therapy) versus conventional therapy alone. The primary outcome was upper limb function and activity. The secondary outcomes were gait, mobility and balance, limitation of activities, participation, cognitive and mental function and adverse events. Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Considering reviews assessing the same clinical questions on the same outcome measurement, we examined concordance and discordance of meta-analyses effects sizes (i.e., effective intervention vs no difference) using a conceptual framework based on the Jadad algorithm.

Results

We included 58 reviews of 345 unique primary studies. Overall, 42 (72.4%) had conducted meta-analysis  Many reviews assessed mixed (e.g., both subacute and chronic) (69%) or chronic onset of stroke (17.2%) and were judged critically low in quality by AMSTAR 2 (77.2%). For the primary outcome, meta-analyses reported discordant findings in the direction of effects. Applying the Jadad algorithm, VR with or without conventional therapy seems to be more effective than conventional therapy alone on upper limb function (Fugl-Meyer Assessment for Upper Extremity [ FMA-UE ]), with low to moderate CoE and possible to definite clinical relevance (Figure 1). For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (Figure 2). A few reviews (n=6) reported the occurrence of mild adverse events.

Discussion and Conclusion

Current evidence suggests that multiple meta-analyses agreed on the superiority of VR combined or not with conventional therapy over conventional therapy on FME-UE. These findings support the hypothesis that VR may help to improve the recovery of upper limb motor function and quality of movement. As a safe intervention, clinicians should consider embed VR technologies into their practice and adapt them according to patients’ needs and preferences. Caution in the interpretation of findings is warranted given the poor methodological quality of the reviews.

REFERENCES

Collaborators, G. B. D. Stroke. “Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019.” Lancet Neurol 20, no. 10 (Oct 2021): 795-820.

Imbimbo, I., D. Coraci, C. Santilli, C. Loreti, G. Piccinini, D. Ricciardi, L. Castelli, et al. “Parkinson’s Disease and Virtual Reality Rehabilitation: Cognitive Reserve Influences the Walking and Balance Outcome.” Neurol Sci 42, no. 11 (Nov 2021): 4615-21.

Jadad, A. R., D. J. Cook, and G. P. Browman. “A Guide to Interpreting Discordant Systematic Reviews.” [In eng]. Cmaj 156, no. 10 (May 15 1997): 1411-6.

Prevention and risk factor assessment of secondary oncologic lymphedema

Introduction

Lymphedema(LE) is a chronic condition and is considered one of the main sequelae of Cancer Survivors. In Italy, the total number of living cancer patients with secondary LE (in the various clinical stages) is about 200,000;  oncological treatment for breast, skin (melanoma), gynecologic and urologic cancers[ 1 ]. In view of the developmental tendency of LE toward the development of irreversible organic damage, treatment should begin as early as possible, and prevention should guide the patient’s entire course of treatment beginning with the diagnosis of cancer to identify risk factors(RF) for the development of LE[ 2 ]. Our study aims to detect from the scientific literature what are the RF and clinical signs of subclinical LE so that the physiotherapist can contribute, within a multidisciplinary approach, to patient surveillance and implement all necessary actions to counteract the development of LE

Methods

A scoping review was performed to examine preventive and risk factors in the assessment of secondary oncologic lymphedema by screening MEDLINE (PubMed) and PEDro databases using the following keywords: prospective surveillance, risk factors, lymphedema. Inclusion criteria: clinical studies, randomized controlled trials, review and systematic review, articles written in English and published in the last 10 years.

Results

Forty-nine articles published since 2013 to date were selected, including 33 related to breast cancer, 9 gynecological cancer, 1 melanoma, and 6 was not relevant to the study objective or not in English language. In breast cancer related lymphedema (BCRL), the RF are: axillary lymph node dissection (ALND) (p < .001), taxane-based chemotherapy (p < .001), regional lymph node irradiation (RNI) (p ≤ .001), BMI >30 ( p = .002), rurality (p = .037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not statistically associated with the risk of BCRL[ 3 ]. In gynecologic cancer a multivariate analysis confirmed that removal of circumflex iliac lymph nodes (hazard ratio [ HR ], 4.28; 95% confidence interval [ CI ], 2.09-8.77; P < 0.0001), cellulitis (HR, 3.48; 95% CI, 2.03-5.98; P < 0.0001), and number of removed lymph nodes (HR, 0.99; 95% CI, 0.98-0.99; P = 0.038) were independent RF for lower limb lymphedema (LLL)[ 4 ].

Discussion and Conclusion

Many risk factors are common to all oncologic procedures requiring lymph node dissection. The etiology of risk factors is multifactorial, and the association of multiple factors increases the likelihood of developing secondary LE. Stratification according to risk: High Risk – immediate treatment: patients undergoing ALND and regional lymph node irradiation (RLNR); Low Risk – developmental monitoring with clinical examination and measurements: patients undergoing Sentinel lymph node biopsy (SLNB). When patients report symptoms in the absence of RVC ≥ 10%, LE diagnosis should not be ruled out. These patients should be considered at high risk for BCRL development and therefore be followed vigilantly and longitudinally[ 5 ].The studies use different methods to assess and grade LE and often the methodology used for determining LLL is poorly described and lacks baseline measurement. [ 6 ]

REFERENCES

1- Linee di indirizzo sul LE ed altre patologie correlate al sistema linfatico, REP-Atti n. 159/CSR del 15 settembre 2016. 2- Damstra RJ, Halk AB. The Dutch LE guidelines based on the ICFunctioning, Disability, and Health and the chronic care model J of Vascular Surgery: Venous and Lympha Disorders Vol 5, Number 5: 576-765. 3-Koelmeyer LA, Gaitatzis K, Dietrich MS, Shah CS, Boyages J, McLaughlin SA, Taback B, Stolldorf DP, Elder E, Hughes TM, French JR, Ngui N, Hsu JM, Moore A, Ridner SH. Risk factors for breast cancer-related lymphedema in patients undergoing 3 years of prospective surveillance with intervention. Cancer. 2022 Sep 15;128(18):3408-3415.4- Hayes SC, Janda M, Ward LC, Reul-Hirche H, Steele ML, Carter J, Quinn M,Cornish B, Obermair A. Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecol Oncol. 2017 Sep;146(3):623-629.

 

COGNITIVE-MOTOR INTERFERENCE DURING DUAL-TASK IN PATIENTS WITH PARKINSON’S DISEASE

Introduction

Most activities of daily living involve performing several tasks at once: for example, walking while talking or carrying an object requires attention to be divided between competing tasks^1,2.

Patients with Parkinson’s Disease (PD) are characterised by loss of automaticity of gait, along with deficits of executive functions and attention; thus, performing concomitant tasks (i.e., dual-task, DT) may cause Cognitive-Motor Interference (CMI).

According to Plummer³, Dual-Task Effect (DTE) is the percentage of change in performance of a task during dual-task, with negative values reporting a decrease in performance under DT conditions and positive values reporting an improvement.

Interference exerted by cognitive tasks on motor performance received attention in the literature, but little is known about motor over cognitive interference.

The current study investigates the prioritisation strategy during cognitive-motor DT in PD through the theoretical framework proposed by Plummer³.

Methods

A cross-sectional analysis of 12 participants (7 women) with mild PD (modified Hoehn and Yahr stages <3.0) was performed. Anamnestic and clinical information was collected. All participants underwent the 3-meter Timed Up and Go test (TUG) and a serial number subtraction cognitive task. Both tasks were performed in single-task and dual-task conditions. Total TUG Duration (TTD, s) and the number of correct subtractions made during the countdown were recorded. The corresponding results were compared between conditions. For the TTD, the Minimal Detectable Change (MDC) in a single subject (a 15% change) was available. Arbitrarily, the same MDC was assumed for the cognitive task.

The cognitive and motor DTE were calculated for each task and then cross-plotted on a Performance Operating Characteristic (POC) type diagram² (Figure 1).

Results

4 patients worsened their cognitive DTE beyond MDC (range -22% to -46%); 4 patients worsened their motor DTE (rage -18% to -53%); 2 patients worsened in both their cognitive (range -17% to -27%) and motor (range -23% to -24%) tasks; in 1 patient the motor DTE worsened (-21%) while the cognitive DTE improved (+67%); in 1 patient the cognitive DTE only, improved (+20%).

Discussion and Conclusion

At least 4 different sub-samples emerge from the POC analysis of the DTE: i) subjects who prioritise the motor task at the expenses of the cognitive one; ii) subjects who worsen in their motor performance with no change in cognitive performance; iii) subjects who improved in their cognitive task as if it was facilitated by the motor one; iv) subjects improving in both cognitive and motor DTE.

While it is recognized that DT exercise may be beneficial in PD⁴, better understanding of the individual mechanisms underlying motor and cognitive performance in DT may lead to the development of more specific treatment approaches in PD.

REFERENCES

1. McIsaac TL, Fritz NE, Quinn L, Muratori LM. Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management. Front Psychol. 2018;9.
2. Kelly VE, Janke AA, Shumway-Cook A. Effects of instructed focus and task difficulty on concurrent walking and cognitive task performance in healthy young adults. Exp Brain Res. 2010;207:65–73.
3. Plummer P, Eskes G. Measuring treatment effects on dual-task performance: A framework for research and clinical practice. Front Hum Neurosci. 2015;9.
4. Xiao Y, Yang T, Shang H. The Impact of Motor-Cognitive Dual-Task Training on Physical and Cognitive Functions in Parkinson’s Disease. Brain Sci . 2023;13:437.

Patient-Reported Outcome Measures to implement routine assessment of cancer survivors’ unmet needs: an overview of reviews and COSMIN analysis

Introduction

The number of cancer survivors (CSs) is increasing worldwide and is expected to reach 75 million by 2030 thanks to advances in treatments, screening techniques, and the ageing of the population.

Cancer care has traditionally focussed on diagnosis and life-saving treatments. However, research has shown that focusing on helping CSs cope with life beyond their acute treatment, i.e. cancer survivorship care, is just as important.

CSs experience a range of physical, psychosocial, spiritual, informational, and practical issues that may result in unmet needs, which are often neither identified nor addressed. Providing services relevant to their specific, unmet needs is crucial.

Patient-reported outcome measures (PROMs) are standardized, validated tools that give value to the information that comes from patients. There are currently various PROMs whose aim is to identify the unmet needs of CSs. Still, limited guidance supports choosing the most appropriate ones for this purpose.

Methods

An Overview of Reviews was conducted to analyse systematic reviews (SRs) focusing on the psychometric properties of PROMs created to identify the unmet needs of adult CSs suffering from non-cutaneous cancer with a 5-year survival of ≥ 65% and an incidence of ≥ 5%.

A literature search was performed on the MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CINAHL databases to identify SRs published between 2012 and January 2023.

The quality assessment of the included SRs was conducted by two independent reviewers using the AMSTAR-2 checklist and that of the primary studies using the COSMIN Risk of Bias checklist; the psychometric properties of all identified PROMs were evaluated according to the COSMIN updated quality criteria for good measurement properties.

These findings were then summarised, and their quality graded by means of the modified GRADE approach for grading the quality of the evidence in SRs of PROMs.

Results

Two SRs, one of “moderate” and one of “low” quality according to the AMSTAR-2, were included. They covered 14 PROMs targeting our population of interest, described in 19 different articles, and tested on 19151 patients.

The methodological quality used to develop all the PROMs was rated as “inadequate”, primarily for not calculating measurement error (93% of the PROMs), since COSMIN Risk of Bias score applies the ‘worst score count’ rule.

Primary studies were inconsistent in reporting the psychometric properties of PROMs. However, those that did were judged positively, resulting “insufficient” in only 3% of the cases.

According to the GRADE approach, the level of evidence ranged from “very low” to “low”, with better grading for the Cancer Rehabilitation Evaluation System, followed by its short form (CARES-SF), and the Needs Evaluation Questionnaire.

Discussion and Conclusion

To exhaustively clarify the quality of psychometric properties of these PROMs, further studies are needed to investigate their incomplete aspects. However, the use of these PROMs in clinical practice and research is supported for those psychometric properties for which we have reliable reporting.

However, we recognize that the selection of the most appropriate PROMs to assess a domain of interest should be informed by the psychometric properties but should go beyond statistics, considering above all the context in which they will be applied.

Context refers not only to the pathology stage and environmental factors, but also to the geographical location, age, language, educational and socioeconomic level, and cultural background of the target population. The present descriptions of the contexts in which these tools have been developed and validated provides additional support in selecting specific PROMs based on content comparison.

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