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Objectives: To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training., Methods: All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors., Result: A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91)., Conclusion: This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. Face validity was high. Patients answered all questions and the "does not apply" option was never selected. Internal reliability (Cronbach's α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA. Internal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure. The Italian CARE measure can be used to assess patient's perceived therapist's empathy in patients undergoing physical therapy after THA and TKA. Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty. Design: Randomised controlled trial. Setting: Humanitas Clinical and Research Center, Milan, Italy Participants: Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty. Interventions: All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity. Outcome measures: A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go – TUG) (primary outcome), maximum walking speed (10-Meter Walk Test – 10MWT), pain (Numeric Pain Rating Scale – NPRS) and fear of movement (Tampa Scale of Kinesiophobia – TSK) the day before and at four days after surgery. Results: No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference −5.8 s, 95% confidence interval from −11.3 to −0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences. Conclusions: Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: The discovery of the Mirror Neuron System has promoted the development of Action Observation Therapy (AOT) to improve motor and functional abilities in patients with Parkinson's disease (PD). This innovative approach involves observing video-clips showing motor contents, which may vary across the studies influencing AOT efficacy. To date, no studies have systematically summarized the effects of AOT in patients with PD on motor and functional outcomes, underlining the characteristics of visual stimuli in relation to their efficacy. Objectives: To describe the potential benefits of AOT in patients with PD and discuss the characteristics of visual stimuli used in clinical studies in relation to their efficacy. Methods: A systematic literature search was carried out using MEDLINE via PubMed, EMBASE, Scopus, and PEDro, from inception until March 2020. Randomized controlled trials that investigated the effects of AOT on motor and functional recovery in patients with PD were included. Two independent reviewers appraised the records for inclusion, assessed the methodological quality, and extracted the following data: number and characteristics of participants, features and posology of the treatments, outcome measures at each follow-up, and main results. Findings were aggregated into a quantitative synthesis (mean difference and 95% confidence interval) for each time point. Results: Overall, 7 studies (189 participants) with a mean PEDro score of 6.1 (range: 4–8) points were selected. Included studies revealed AOT as effective in improving walking ability and typical motor signs (i.e., freezing of gait and bradykinesia) in patients with PD. Moreover, when this approach incorporated ecological auditory stimuli, changes to functional abilities and quality of life were also induced, which persisted up to 3 months after treatment. However, included studies adopted AOT stimuli with heterogeneous posology (from a single session to 8 weeks) and characteristics of motor contents might be responsible for different motor and functional recovery (person-related and viewing perspectives, transitive or intransitive actions, healthy subjects or patients, and association or not with imitation). Conclusions: AOT leads to improvements in motor and functional abilities in patients with PD and the characteristics of visual stimuli may play a role in determining AOT effects, deserving further investigations. [ABSTRACT FROM AUTHOR]

Background: Few data address modalities for speeding up functional independence in subjects included in a fast-track approach after total hip arthroplasty (THA). The study aim was to assess short-term effects of mobilization and walking the day of THA (WDS) on independence, pain, function and quality of life. Methods: Seventy-one patients were allocated in a study (SG: n = 36) or control (CG: n = 35) groups according to time of surgery and recovery from anesthesia. Patients who recovered lower limbs sensitivity (disappearance of sensation deficits) and motility (MRC scale ≥3 at knee, ankle and great toe extension) by 7.00 p.m. made up the SG, whereas patients who underwent surgery later and recovered from anesthesia after 7.00 p.m. made up the CG. SG underwent WDS, whereas CG performed mobilization and walking the day after surgery starting the same physiotherapy program 1 day later. Patients were evaluated for independence (Functional Independence Measure - FIM), pain (Numeric Rating Scale - NRS), hip function (Harris Hip Score - HHS) and quality of life (EuroQoL-5Dimension - EQ. 5D and EQ. 5D-VAS)the day before surgery, at 3 and 7 days in a hospital setting. Analysis of Covariance with age (SG: mean 60.9, SD 9.0; CG: mean 65.5, SD 8.9) and BMI (SG: mean 27.4, SD 2.8; CG: mean 26.7, SD 2.4) as covariates was used to assess between-group differences over time. Results: Between-groups differences were observed for FIM total and motor scores (p = 0.002, mean difference: 2.1, CI95: 0.64, 3.7) and FIM self-care (p = 0.01, mean difference: 1.7, CI95: 0.41, 3) in favor of SG at 3 days. Between-group differences were found for FIM self-care (p = 0.021, mean difference: 1.2, CI95: 0.18, 2.1) in favor of SG at 7 days. FIM total and motor scores (p < 0.001), FIM self-care (p = 0.027) and transfer-locomotion (p < 0.001) and HHS (p = 0.032) decreased after surgery followed by improvements in postoperative days (p ≤ 0.001). No differences were found for NRS, EQ. 5D and EQ. 5D-VAS. Conclusions: WDS produces additional benefits in patients' independence in the first week after THA. Absence of pain aggravation or adverse effects on hip function and quality of life may allow clinicians to recommend WDS to promote discharge with functional independence. [ABSTRACT FROM AUTHOR]

Background. The Six-Minute Walk Test (6MWT) often is used to measure exercise capacity in people with cardiopulmonary diseases but has some disadvantages. The 6MWT administered on a treadmill (Tr6MWT) requires less physical space and allows for easier monitoring of vital parameters than the traditional 6MWT. Objective. The objectives of this study were: (1) to analyze the validity of the Tr6MWT in people who underwent cardiac surgery; (2) to compare the reliability, responsiveness, and people's tolerance of the Tr6MWT with those of the 6MWT; and (3) to evaluate the agreement between the 2 tests. Design. This study was designed to assess reliability and validity.Methods. Twenty-six participants who were inpatients were assessed before a 2-week rehabilitation program. Twenty of them also were assessed after rehabilitation. All participants performed 3 Tr6MWT trials and 3 6MWT trials that were randomly assigned on 2 consecutive days. Results. The Pearson r correlation coefficient between the Tr6MWT and the 6MWT was .72, indicating satisfactory concurrent validity. The Tr6MWT was as well tolerated as the 6MWT. The Tr6MWT produced reproducible results after 2 practice tests, whereas the 6MWT did so after only 1 practice test. Both tests showed high test-retest reliability (intraclass correlation coefficient of .94; standard errors of measurement of 23 m for the Tr6MWT and 18.5 m for the 6MWT). The Tr6MWT showed better responsiveness than the 6MWT (effect sizes of 0.9 for the Tr6MWT and 0.6 for the 6MWT). The distance covered during the Tr6MWT was significantly shorter (X62 m, SD91) before rehabilitation but not after rehabilitation. Limitations. A crossover randomized procedure could have improved the reliability of the Tr6MWT in people who performed the 6MWT first. Conclusions. The Tr6MWT appears to be an instrument with adequate concurrent validity and to be tolerable, reliable, and responsive for the evaluation of exercise capacity in people after cardiac surgery even though it is not interchangeable with the 6MWT. [ABSTRACT FROM AUTHOR]

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AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONMovement restrictions and assistive devices have traditionally been recommended to prevent hip dislocation after total hip arthroplasty (THA). Considering the advancements in THA surgery, a review of treatment recommendations is worthwhile. The aim of this study was to investigate whether unrestricted protocol (without movement restrictions and assistive devices) should be recommended for THA patients.A multiprofessional panel used the GRADE-Adolopment to develop the present recommendations, following the GIN-McMaster-Guideline-Development-Tool. We selected guideline topic and target audience, formulated clinical questions and prioritised outcomes. For the first question, a source guideline was identified and adoloped, whereas the second question required a de-novo recommendation. Therefore, the GRADE-Evidence-Profile and the Evidence-to-Decision framework were completed. Finally, the panel discussed and formulated the final recommendations.Hip dislocation was defined as critical outcome. No between-groups differences in the early dislocation rates were found: without movement restrictions, 1623 patients, RR 0.44 (CI95 0.16–1.20); without assistive devices, 4426 patients, RR 0.75 (CI95 0.52–1.08). Finally, considering small desirable health effects and trivial undesirable health effects of the intervention, we integrated two “conditional-recommendations” in favour of an unrestricted protocol.Through GRADE-adolopment approach new recommendations to provide an evidence-based guidance after THA have been formulated.For patients undergoing total hip arthroplasty (THA), unless otherwise indicated by the surgeon, the removal of movement restrictions and assistive devices early after THA does not affect hip dislocation rate, regardless of surgical approach.On the other hand, unrestricted protocols may enhance a more rapid recovery process, shorter length of stay and less caregiver assistance.A more liberal lifestyle early after THA surgery (e.g., no mandatory sleeping posture) is associated with higher patient’s satisfaction.The non-routine adoption of movement restriction and assistive devices allows a costs reduction for both patients and the healthcare system after THA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Teaching how to improve activities and participation of elderly subjects: the carelessness of the Italian Academia shown by the national qualification for physiotherapists".