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Background: A monthly systematic review update is carried out to maintain the currency of scientific literature on rehabilitation of patients with COVID-19 and/or describing consequences due to the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. Objectives: To provide an updated summary of the available evidence published in August 2020. Methods: An extensive search on the main medical literature databases from August 1st, 2020 to August 31st, 2020 was performed, according to the methodology described in the second edition of the Cochrane Rehabilitation 2020 rapid living systematic review. Results: After removing duplicates, 1136 papers were identified, and 51 studies were finally included. According to OCEBM 2011 Levels of Evidence Table, they were Level 4 in most cases (76.5%) and Level 3 in the remaining (23.5%). Randomized controlled trials (RCTs) were not found. Thirty-two studies (62.7%) included COVID-19 patients who were assessed in the acute (20/32) or post-acute phases (12/32). The other studies reported data on the impact of COVID-19 infection (7/19) or on the effect of lockdown restrictions (12/19) on subjects with pre-existing health conditions. Conclusions: The scientific literature of August 2020 mainly focused on limitations in functioning of nervous system structure and related functions. Albeit the increased availability of data from analytical studies (both cohort and cross-sectional), there is still a lack of well-.conductedLevel 2 studies, to improve the knowledge on the effects of rehabilitation in COVID-19 patients. ispartof: European Journal Of Physical And Rehabilitation Medicine vol:56 issue:6 pages:839-845 ispartof: location:Italy status: Published online

Background: The COVID-19 outbreak response requires identifying and understanding the longterm consequences of this new pathology, and how to manage these. This living systematic review presents the most current and seminal information coming from the scientific literature. It is the monthly update of the second edition of the rapid living systematic review 2020 conducted by Cochrane Rehabilitation REH-COVER Action Steering Committee. Objective: The aim of this review is to update the monthly COVID-19 and rehabilitation literature research up to September 30th, 2020. Methods: Methodology described in the second edition of the rapid living systematic review 2020 conducted by Cochrane Rehabilitation REH-COVER Action was applied. The most important medical databases were searched, and papers related to COVID19 and rehabilitation were retrieved and summarized descriptively. Results: The database search retrieved 2526 publications. Duplicates were removed, and 1150 unique records were screened for inclusion. After screening titles, abstracts and full-texts, 37 papers were included in the present review. According to OCEBM 2011 Levels of Evidence Table, most studies (78.4%) fall within the level of evidence 4 category, while the remainder (22.6%) are categorized as level of evidence 3. Most studies described patients in acute (51.4%) or subacute (35.0%) phase, while no studies described the chronic consequences of COVID-19. Just one study dealt with rehabilitation interventions regarding COVID-19, and two discussed reorganization of rehabilitative services. Conclusions: The most recently published COVID-19 research focuses more on describing the clinical presentations and the natural history of the pathology, rather than rehabilitation interventions or service delivery. Studies with high levels of evidence regarding the efficacy of interventions, longterm monitoring, or new organization models remain lacking. ispartof: European Journal Of Physical And Rehabilitation Medicine vol:56 issue:6 pages:846-852 ispartof: location:Italy status: Published online

Introduction: This paper is the first update of the second edition of the rapid living systematic review on the latest scientific literature informing rehabilitation of patients with COVID-19 and/or describing consequences of the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. The aim of this study was to report data of a systematic search performed on papers published in July 2020. Evidence acquisition: The methodology described in the second edition of the rapid living systematic review was applied to search eligible papers included in the databases between July 1, 2020 and July 31, 2020. Evidence synthesis: Eight-hundred-ninety-two papers were identified through database searching (after removal of duplicates); of these, only 23 studies were included. According to OCEBM 2011 Levels of Evidence Table, they were level 3 in 30.5% cases and level 4 in 69.5%. No RCT was found. Nineteen papers studied COVID-19 patients, assessed in the acute (10 studies), post-acute (8 studies) and chronic phase (one study). Four studies reported data on the impact of COVID-19 on subjects with pre-existing health conditions. Conclusions: The current literature production still focuses more on describing all the possible aspects and complications of the pathology than on interventions or new organization models to deal with it. Albeit evidence on handling COVID-19 from a rehabilitative point of view is improving each month, further studies are still mandatory to report the role of rehabilitation in this scenario. ispartof: European Journal Of Physical And Rehabilitation Medicine vol:56 issue:5 pages:652-657 ispartof: location:Italy status: published

In the context of the White Book on Physical and Rehabilitation Medicine (PRM) in Europe this paper deals with the scope and competencies of PRM starting from its definition as the “medicine of functioning.” PRM uses the rehabilitative health strategy as its core strategy together with the curative strategy. According to the complexity of disabling health conditions, PRM also refers to prevention and maintenance and provides information to the patients and other caregivers. The rehabilitation process according to the so- called rehabilitation cycle including an assessment and definition of the (individual) rehabilitation goals, assignment to the rehabilitation program evaluation of individual outcomes. PRM physicians treat a wide spectrum of diseases and take a transversal across most of the medical specialties. They also focus on many functional problems such as immobilization, spasticity, pain syndromes, communication disorders, and others. The diagnosis in PRM is the interaction between the medical diagnosis and a PRM-specific functional assessment. The latter is based on the ICF conceptual framework, and obtained through functional evaluations and scales: these are classified according to their main focus on impairments, activity limitations or participation restrictions ; environmental and personal factors are included as barriers or facilitators. Interventions in PRM are either provided directly by PRM physicians or within the PRM team. They include a wide range of treatments, including medicines, physical therapies, exercises, education and many others. Standardized PRM programs are available for many diseases and functional problems. In most cases rehabilitation is performed in multi-professional teams working in a collaborative way, as well as with other disciplines under the leadership of a PRM physician and it is a patient-centered approach. Outcomes of PRM interventions and programs, showed reduction of impairments in body functions, activity limitations, and impacting on participation restrictions, and also reduction in costs as well as decrease in mortality for certain groups of patients.

In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the definitions and concepts relevant for PRM. Physical and Rehabilitation Medicine is the primary medical specialty responsible for the prevention, medical diagnosis, treatment and rehabilitation management of persons of all ages with disabling health conditions and their co-morbidities, specifically addressing their impairments and activity limitations in order to facilitate their physical and cognitive functioning (including behavior), participation (including quality of life) and modifying personal and environmental factors. To arrive to this PRM definition we need to consider a conceptual description of it. Several fundamental aspects must be observed namely functioning, disability and rehabilitation. These definitions include and are presented in this chapter: - Functioning: all that human bodies do and the actions that people perform. In the International Classification of Functioning, Disability and Health (ICF), functioning is operationalized in terms of functioning domains, and these domains are partitioned into the dimensions of Body Functions and Structures, Activities and Participation ; - Disability: the problem a person has performing the actions that he or she needs and wants to do, because of how an underlying health condition - a disease, injury or even ageing - affects his or her performance in his or her actual environment ; - Rehabilitation: a set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environments. The ICF definition of disability clearly distinguishes between problems that result entirely from the underlying health condition (capacity) from problems arising from the interaction between capacity and the environment and personal factors (performance). This paper approaches all these concepts that are essential to the understanding of the PRM strategy to evaluate disability and implement interventions that may lead to the improvement of functioning and health.

Objective: To investigate the long-term behavioral and neurophysiological effects of combined time-locked repetitive Transcranial Magnetic Stimulation (rTMS) and physical therapy (PT) intervention in chronic stroke patients with mild motor disabilities. Methods: 30 patients were enrolled in a double-blind, randomized, single-center clinical trial. Patients received 10 daily sessions of 1Hz rTMS over the intact motor cortex. In different groups, stimulation was either real (rTMSR) or sham (rTMSS) and was administered either immediately before or after PT. Outcome measures included dexterity, force, interhemispheric inhibition and corticospinal excitability and were assessed for three months after the end of treatment. Results: Treatment induced cumulative rebalance of excitability in the two hemispheres and a reduction of interhemispheric inhibition in the rTMSR-groups. Use-dependent improvements were detected in all groups. Improvements in trained abilities were small and transitory in rTMSS patients. Greater behavioral and neurophysiological outcomes were found after rTMSR, with the group receiving rTMSR before PT (rTMSR-PT) showing robust and stable improvements and the other group (PT-rTMSR) showing a slight improvements decline over time. Conclusion: Our findings indicate that priming PT with inhibitory rTMS is optimal to boost use-dependent plasticity and rebalance motor excitability and suggest that time-locked rTMS is a valid and promising approach for chronic stroke patients with mild motor impairment. Classification of evidence: This interventional study provides Class I evidence that time-locked repetitive Transcranial Magnetic Stimulation (rTMS) before or after physical therapy improves measures of dexterity and force in the affected limb in patients with chronic deficits more than 6 months post stroke.