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Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature., Methods: This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain., Results: In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm 2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm 2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) ( p < 0.001). All sites with digital pressure pain also had ESWT pain., Conclusions: These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy.

Background: Shortening and rotational deformity of the lower limb (SRD) is a major complication of hip fracture surgery. It causes not only hip joint dysfunction but also functional impairments due to abnormal gait parameters, decreased gait velocity, and poor balance. Despite a number of previous studies, the effect of SRD on the postsurgical recovery of these patients is still not clear., Objective: To compare the functional abilities and balance before and after rehabilitation for people with and without SRD after hip fracture surgery and to assess whether SRD affects rehabilitation., Design: Prospective observational study., Setting: Inpatients of a rehabilitation unit., Participants: A total of 102 people with hip fracture (62 without SRD and 40 with SRD at the time of admission to the unit)., Main Outcome Measures: Berg Balance Scale (BBS) and Functional Independence Measure (FIM) motor score, administered before and after rehabilitation., Interventions: Motor rehabilitation., Results: Before rehabilitation, patients with SRD had lower motor-FIM (p = .002) and BBS (p = .001) scores than those without SRD. After rehabilitation, both groups showed similar improvements in motor-FIM, BBS, range of motion, muscle strength, and pain scores (p < .001, for all), but patients with SRD still had lower motor-FIM and BBS scores (p = .014 and .003, respectively) and lower effectiveness in motor-FIM and BBS (p = .039 and p = .034, respectively) than those without SRD., Conclusions: SRD is associated with lower levels of balance and functional abilities before and after rehabilitation and it adversely affects rehabilitation for patients with hip fractures., (© 2022 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM ( p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH ( p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Purpose: This prospective observational cohort study aimed to verify whether single Berg Balance Scale (BBS) items were important determinants of improvement in functional abilities in patients with peripheral neuropathy (PN)., Methods: Data were collected in 75 older patients with PN performing a standard motor rehabilitation program. Backward stepwise multiple regression analyses were performed to identify determinants of outcome measures. Gain in total and motor Functional Independence Measure (FIM) and gain in motor-FIM areas were the outcome measures., Results: Among BBS items, at the end of rehabilitation, the score was higher in "sitting unsupported" (3.94 ± 0.22) and lower in "standing on one foot" (1.18 ± 1.06). The gain was higher in "standing to sitting" (1.02 ± 0.67) and "standing unsupported" (1.00 ± 1.00), and lower in "sitting unsupported" (0.22 ± 0.60) and "standing on one foot" (0.65 ± 0.77). "Standing unsupported" was the only determinant of gain in motor-FIM (beta - 0.36, p = 0.002) and gain in self-care (beta - 0.37, p = 0.002). The R 2 value of the models was 0.13 and 0.14, respectively. No independent variable was a determinant of gain in total-FIM., Conclusions: The study shows that "unsupported standing" is an important determinant of results of ADL rehabilitation in PN patients and indicates that ability to stand without support for a fairly long time is an essential requirement to achieve with rehabilitation higher gain levels in functional abilities in PN patients., (© 2021. Belgian Neurological Society.)

Background and Aims: Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation., Methods: Data were collected in 80 PN patients, aged over 65 years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status., Results: At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p < 0.001) and efficiency in total-FIM (beta - 0.38, p = 0.001). Conversely, age was a predictor of the final total-FIM score (beta - 0.31, p = 0.002) and effectiveness in total-FIM (beta - 0.49, p < 0.001). The R 2 values of the models were, respectively, 0.39, 0.15, and 0.24., Discussion: In PN patients, functional impairment at admission and age are important predictors of functional abilities at the end of rehabilitation., Conclusions: These findings suggest the need for more intensive rehabilitation in older, more disabled PN patients because they risk achieving lower functional levels with standard rehabilitation programs., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: To date little is known about factors affecting walking rehabilitation in Parkinson's disease (PD) patients., Objective: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation., Methods: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson's Disease Rating Scale, Hoehn and Yahr scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes., Results: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p < 0.001), corresponding to an increase of +17.16%. At the end of rehabilitation, the 6MWD was significantly longer in PD patients with stages 1-3 of the Hoehn and Yahr scale. Berg Balance Scale (β= 0.47, p < 0.001) and right Grip and Pinch at admission (β= 0.36, p = 0.001) were the only determinants of final 6MWD. The R2 value of the model was 0.47 (R2 adjusted 0.45). No variable was a determinant of gain in 6MWD., Conclusions: The study indicates that balance and generalized muscle strength are important determinants of walking rehabilitation in PD patients, in whom it is essential to maintain high levels of balance and muscle strength for a time as long as possible. These findings suggest planning more intensive rehabilitation treatments in PD patients with low levels of balance and muscle strength.

Purpose: Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation., Methods: Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance., Results: The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p < 0.001). The daily gain in BBS score was 0.39 ± 0.31 and the percent improvement was 32.28 ± 23.04%. Standing with one foot in front and standing on one foot were the BBS items with the lowest score at discharge and the lowest daily gain and percent improvement. The Cognitive-Functional Independence Measure (cognitive-FIM), hip muscles strength, and Katz index at discharge had moderate-to-strong relationships with final score, daily gain and percentage of improvement in BBS. Cognitive-FIM was a predictor of final BBS score (beta 0.49, p < 0.001), daily gain in BBS (beta 0.34, p < 0.001) and percent improvement in BBS (beta 0.44, p < 0.001). Conversely, hip muscles strength was a predictor of final BBS score (beta 0.32, p = 0.001), and Cumulative Illness Rating Scale severity, a predictor of daily gain in BBS (beta -0.29, p = 0.001). The R 2 value of the models were, respectively, 0.39, 0.23, and 0.19., Conclusions: Cognitive function, comorbidities and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of these specific factors can be useful for physicians to identify patients needing specific rehabilitation programs for balance.

Background: Effectiveness of phone surveillance and other communication technologies in the management of neck pain patients have been evaluated previously only at the suspension of the service., Aim: To verify whether a phone surveillance program can improve pain, disability, and adherence to home exercises in neck pain patients, and whether the improvement achieved continues to be maintained also after suspension of the support., Design: This is a randomized controlled study., Setting: Outpatients of Rehabilitation Unit., Population: 84 out of 100 outpatients consecutively randomized (by blocks of four) to Phone group (N.=42, performing a 6-month home-based phone surveillance program) or to Control group (N.=42, with the only recommendation to continue exercising at home without phone surveillance) were considered. The home-based phone surveillance program consisted of 12 scheduled phone calls, each performed every fortnight by a nurse-tutor with expertise in rehabilitation for the first six months of the study. At the end of phone surveillance period, Phone patients were encouraged to continue home exercises for a further 6 months period., Methods: Pain severity (assessed with Pain VAS), disability (Neck Disability Index), and adherence to exercises performed at home (classified as: ≥5 sessions/week, 2-4 sessions/week, occasional or no sessions) were outcome measures. Pain severity and disability were assessed at entry, at 6 and 12 months, while adherence to exercises was self-reported and recorded at 6 and 12 months. Differences between groups were analyzed with χ2 test, Student's t-test or ANOVA., Results: At 6 months, Pain VAS (P=0.013) and Neck Disability Index scores (P=0.012) were lower in Phone patients than Controls. At 12 months, Neck Disability Index scores (P=0.026) continued to be lower in Phone patients than Controls. At 6 months, 97.6% of Phone patients and 80.9% of Controls performed rehabilitation at home with a range of 2 to 7 sessions/week; while at 12 months, the respective percentages of Phone and Control patients were 92.9% and 73.8%. Adherence to home exercises was higher in Phone patients than in Controls at 6 (P=0.013) and 12 months (P=0.019)., Conclusions: In patients with chronic neck pain, the positive effects of phone surveillance on the neck disability and adherence to home exercises still persist 6 months after the suspension of the support., Clinical Rehabilitation Impact: This knowledge can be useful for physicians to plan home rehabilitation of neck pain patients.

Background and Aim: The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation., Methods: This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures., Results: At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = - 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = - 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = - 0.22, p = 0.016)., Discussion: Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency., Conclusions: These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

Background: To date, there are no published data on the use of devices in the management of rotator cuff tear (RCT)., Aim: The aim of this study was to evaluate the effect of supervised arm cycloergometer training on pain during activities and shoulder functionality in patients with symptomatic full-thickness RCT., Design: This is a prospective randomized controlled pilot study., Setting: Outpatients of our Rehabilitation Unit., Population: In this pilot study, 40 elderly outpatients (>70 years) with RCT were randomized to two groups: cycloergometer (CYC) vs. control patients., Methods: All patients underwent a common outpatient rehabilitation exercise program consisting of ten 30-min sessions (5 sessions/week). At discharge, CYC patients received 15-min training with an arm cycloergometer and were invited to use the cycloergometer at home 20 min/twice a day. Control patients were invited to continue the standard exercises. During the 6-month study period CYC patients, but not control patients, received educational reinforcement monthly from the nurse of the telemedicine service. Outcomes assessed, between admission (T0) and 6-month follow-up (T6), were: pre to postpain during activities, active and passive ROMsum, ROM-painsum, revised Constant Total Score, and Health Assessment Questionnaire (HAQ)., Results: At T6, CYC patients showed a significant improvement in all outcome measures with respect to T0 (all: P<0.001). CYC patients showed also significant improvement in passive forward elevation, abduction, and external rotation of shoulder, as well as in active ROMsum and ROM-painsum in all single shoulder movements, and significant improvement in the HAQ items: dressing/grooming, eating, hygiene, reach, and common daily activities. At T6 the CYC group had lower pain during activities (P<0.01) and higher revised constant total score (P<0.01), ROM-painsum (P<0.05) and active ROMsum (P<0.05) than control patients. Home cycloergometer use was inversely associated to pain during activities (P<0.01) and revised Constant Total Score (P<0.01) at T6., Conclusions: A short program of shoulder passive exercises and cuff strengthening exercises followed by regular use of the cycloergometer for 6 months at home can reduce pain and improve shoulder functionality in RCT patients., Clinical Rehabilitation Impact: Our findings indicate that the cycloergometer may be useful in patients with RCT when regularly used at home and suggest use of this mechanical device in rehabilitation programs for these patients.

Background and Aims: Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue., Methods: We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome., Results: Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, β = 0.46 and -0.25) and effectiveness (respectively, β = 0.47 and -0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, β = 0.21 and -0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03-64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52-10.63) were risk indicators for nursing home., Conclusions: Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.

Context: Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair., Objective: To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients., Design: Prospective and observational study., Setting: Outpatient service for rehabilitation., Patients: Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR)., Interventions: Motor rehabilitation after surgical treatment of rotator cuff repair., Measures: Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery., Results: Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6 mo postsurgery., Conclusions: This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6 mo postsurgery.

Objective: To investigate if a structured physician-directed, nurse-managed, home-based telemedicine (HBT) program, consisting of scheduled/unscheduled phone surveillance, can reduce pain in patients with chronic neck pain., Design: This is a prospective randomized controlled study conducted on outpatients. Following outpatient rehabilitation, patients (n = 100) were consecutively randomized to a 6-month HBT program (HBT group) or no HBT but only the recommendation to continue exercising at home (control group). At baseline and after 6 months, pain severity (visual analog scale) and disability (Neck Disability Index) were evaluated., Results: At 6 months, neck pain and disability declined in both groups (P < 0.001 for both groups, both parameters), but the decline was significantly more marked in the HBT group (P = 0.001, both parameters). At 6 months, 87.2% of HBT patients and 65.9% of control subjects were performing home exercises (in the range of 2-7 exercise sessions/wk). Pain and disability scores were correlated to participation in the HBT program, patients' perception of HBT, and adherence to home exercises., Conclusions: Home-based telemedicine may be a useful additional tool to help physicians in the management of chronic neck pain.

Background: Few studies have investigated the relationships between aphasia and activities of daily living (ADLs) in stroke patients., Aim: This study was aimed firstly to determine which task within the ADLs has poorer functional recovery in stroke patients with aphasia after rehabilitation, second to identify which specific task is related to aphasia., Design: This is a prospective and observational study., Setting: Inpatients of our Rehabilitation Unit., Population: The study was carried out in 219 patients with primary diagnosis of stroke with (104) and without aphasia (115)., Methods: All patients underwent usual rehabilitation. Aachen Aphasia Test and Functional Independence Measure scale were used to assess severity of aphasia and ADLs, respectively. Gain in ADLs was the main outcome measure., Results: At the end of rehabilitation patients with aphasia had lower gain in bathing, dressing upper body, dressing lower body, toileting, stair climbing, and higher gain in social interaction, problem solving, and memory with respect to patients without aphasia. However, when data were adjusted for side of hemiplegia, Fugl-Meyer score and trunk control test, patients with aphasia showed lower gain in dressing upper body (P=0.027), dressing lower body (P=0.009), lower toileting (P=0.027), and higher gain in social interaction (P<0.001). In the multivariate regression analysis, aphasia was an important determinant of gain in bathing (β=0.26), dressing upper body (β=0.24), dressing lower body (β=0.22), lower toileting (β=0.22), and social interaction (β=-0.29)., Conclusions: The current study points out that, after usual rehabilitation, the patients with aphasia show a poor gain in personal care activities and higher gain in social interaction., Clinical Rehabilitation Impact: Knowledge of these findings: 1) can guide the rehabilitation team in selecting specific and appropriate therapies aimed to give patient with aphasia the highest possible functional independence in ADLs; 2) is useful to family members and social rehabilitation services for domiciliary management of patients with aphasia.

Progressive multifocal leukoencephalopathy is a demyelinating disease of the central nervous system, characterized by aggressive deterioration of white matter pathways throughout the subcortical brain parenchyma. This disease leads the patient to a total dependence in all activities of daily (ADLs) living in few months. The literature on rehabilitation of progressive multifocal leukoencephalopathy is scanty and, at present, it is unknown whether rehabilitation may modify the course of disability in this disease. This paper describes the functional course of a patients with progressive multifocal leukoencephalopathy who incurred in a severe functional impairment of ADLs after an unintentional fall and prolonged bed rest. The multidisciplinary in-hospital rehabilitation program and integrated homecare approach allowed the patient to improve her functional capacities and go on with living at home.

Background and Aims: To address the relationships among motor patterns evaluated according to the limb synergies and functional outcomes in stroke patients and clarify which motor pattern was the most important predictor of functional outcomes., Methods: The study was conducted on 208 patients with primary diagnosis of stroke admitted for in-hospital rehabilitation. At entry, the Fugl-Meyer Scale was administered to assess motor function according to limb synergies. Pearson's correlation was used to assess the relationship between variables, and backward stepwise regression analysis was used to identify the outcome determinants. Final functional independence measure (FIM) scores and length of in-hospital stay were the outcome measures., Results: At the end of rehabilitation, motor-FIM scores of patients with extensor and flexor synergies, mixing synergies, and no dependence from the synergies were higher than those of no movements and flexor synergy. Multivariate regression analysis showed that extensor synergy of upper limb was an independent predictor of final motor-FIM, personal care and mobility, extensor synergy of lower limb of locomotion, while mixing synergies of upper limb was an independent predictor of length of in-hospital stay., Conclusions: In stroke rehabilitation, the patients' motor patterns according to the synergies strongly relate with functional outcomes and are important outcome predictors.

Background: Very few studies have investigated activities of daily living (ADLs) post hip-surgery as a possible determinant of functional outcome after hip fracture., Aim: This prospective, observational study aimed to correlate hip-fracture patients' ADLs on admission to in-hospital rehabilitation with their functional outcome post-rehabilitation., Methods: Of 216 consecutive hip-fracture patients admitted to our Rehabilitation Unit, 204 patients were eligible for the final analyses. All patients underwent the usual rehabilitation. At admission, basic ADLs were assessed by the Functional Independence Measure (FIM) scale. Discharge scores, efficiency and effectiveness in motor-FIM, and discharge destination were outcome measures. Backward stepwise regressions were performed to identify determinants of outcome measures. Age, sex, education, number of relatives, orthopedic treatment, onset to admission interval, Mini Mental State Examination (MMSE), Cumulative Illness Rating Scale, Neuropsychiatric Inventory, ROM, Muscle Strength, and FIM scores at admission were independent variables., Results: There was functional gain in all ADLs post-rehabilitation, walking being the FIM-item with the highest efficiency and effectiveness (respectively, 0.14±0.0 and 64.2±21). Multivariate analyses showed that MMSE was a determinant of final score, efficiency, and effectiveness in motor-FIM. Bladder control was a determinant of final score and effectiveness in motor-FIM, while eating and bathing were determinants of final motor-FIM score. Bowel management was the only determinant of discharge destination., Conclusion: Basic ADLs, in particular eating, bathing, bladder and bowel management, are important determinants of outcome in hip fracture., Clinical Rehabilitation Impact: The results of this study suggest that, in designing studies on outcome prediction in hip fracture, researchers should include tests assessing performance of basic ADLs as independent variables, as this could allow to identify new prognostic indicators that may be helpful for physicians in managing hip fracture patients post-rehabilitation.

Background: The correlation between single neuropsychiatric symptoms and functional outcome in hip fracture patients is little investigated in the literature, and it is not yet established which neuropsychiatric symptoms are the most important determinants of functional outcome., Aim: To determine which neuropsychiatric symptoms are the most important determinants of functional outcome., Methods: This prospective study was carried out in 204 consecutive patients with primary diagnosis of hip fracture admitted to our Rehabilitation Unit for a course of rehabilitation. Neuropsychiatric symptoms were assessed at admission with the Neuropsychiatric Inventory (NPI). Outcome measures of rehabilitation were: final score, efficiency and effectiveness in motor-Functional Independence Measure (motor-FIM), and discharge destination. Pearson's correlation coefficients were used to assess the relationship between NPI variables and the outcome measures, while backward stepwise regression was used to identify determinants of the outcome measures., Results: Pearson's correlation showed that night-time behavior disturbances were related to all outcome measures, while agitation, depression, elation, apathy, disinhibition and irritability were significantly related to motor-FIM outcomes. At multivariate regression analysis agitation was the only determinant of final motor-FIM score, while irritability was the only determinant of efficiency and effectiveness in motor-FIM score. No neuropsychiatric symptom was a determinant of discharge destination., Conclusions: This study highlights that in hip fracture patients there are relationships between specific neuropsychiatric symptoms and functional outcome. Among the neuropsychiatric symptoms, irritability and agitation are the most important. They are associated to poor functional outcome and are the only determinants of motor-FIM outcome measures., Implications for Rehabilitation: Relationships between specific neuropsychiatric symptoms and functional outcome have not been clearly described in hip fracture patients. Irritability and agitation have been shown to have the strongest relationship with poor functional outcomes. Appropriate identification, assessment and treatment of neuropsychiatric symptoms may be useful to physicians for the management of hip fracture patients.

Objective: The aim of this study was to determine the association between functional recovery and neuropsychiatric symptoms in hip fracture patients undergoing in-hospital rehabilitation. Very few studies have extensively evaluated neuropsychiatric symptoms in hip fracture patients, and the relationship between these symptoms and rehabilitation outcome is not yet clearly defined., Design: This study was conducted on 200 patients with hip fracture who underwent a rehabilitation program. The Neuropsychiatric Inventory was used to identify neuropsychiatric symptoms. Efficiency and effectiveness in terms of the motor-Functional Independence Measure and length of stay were considered as outcome measures., Results: At admission, 74% of the patients had neuropsychiatric symptoms. At the end of rehabilitation, the patients with neuropsychiatric symptoms had a lower motor-Functional Independence Measure effectiveness (P = 0.015) and efficiency (P = 0.002) and a longer length of stay (P = 0.008) than those without neuropsychiatric symptoms. However, after adjustment for the Mini-Mental State Examination, the patients with neuropsychiatric symptoms differed from those without symptoms only in terms of longer length of stay (P = 0.006) and lower motor-Functional Independence Measure efficiency (P = 0.008)., Conclusions: Neuropsychiatric symptoms make the rehabilitation process slower and less efficient in hip fracture patients. Understanding the relationship between neuropsychiatric symptoms and outcome may be useful to physicians for the management of hip fracture patients.

Background: Duration of rehabilitation is an important rehabilitation clinical outcome both from a clinical and administrative point of view. Very few studies have looked at predictors oftreatment duration in out-patient rehabilitation setting especially in patients with orthopedic-traumatologic conditions., Aim: We undertook a prospective study to assess treatment duration and identify variables predicting this outcome measure (primary outcome) and efficiency in range of motion and activities of daily living (secondary outcome)., Design: Prospective and observational study., Setting: Out-patient Service for Rehabilitation., Population: Two hundred and ten patients admitted to Out-patient Service for Rehabilitation of orthopedic disorders were enrolled: 94 patients had limb fracture (35 wrist fracture, 28 ankle fracture, 27 shoulder fracture), and 120 and undergone elective orthopedic surgery (27 cruciate reconstruction, 93 rotator cuff repair)., Methods: Univariate Regression analysis was applied to analyze relationships among variables and length of rehabilitation while backward stepwise regression analysis was used to predict treatment duration. The independent variables were age, gender, work, type of physical therapy, comorbidity, pain, onset to admission interval, initial disability, initial range of motion percentage (ROM), and diagnosis group., Results: Mean treatment duration was 29.7±15 days. Treatment duration following rotator cuff repair was significantly longer than that of cruciate reconstruction (P=0.005), wrist fracture (P<0.001), and ankle fracture (P=0.002). Treatment duration was related to working status, admission disability, onset to admission interval, diagnosis group, admission pain, and admission range of motion. In multivariate regression analysis, admission range of motion and onset to admission interval were the only independent predictors of treatment duration and efficiency in range of motion, while admission range of motion and admission Health Assessment Questionnaire were predictors of efficiency in Health Assessment Questionnaire score., Conclusion: The study highlights that rehabilitative treatment duration has strong relationship with admission range of motion and onset admission interval. CLINICAL REHABILITATION IMPACT. These findings should be useful for physicians for planning therapeutic measures in patients with orthopedic-traumatologic conditions and for managing the usual activities of an Out-patient Rehabilitative Service.

Background: Very few studies have investigated the influence of single activities of daily living (ADL) at admission as possible predictors of functional outcome after rehabilitation., Aim: The aim of the current study was to investigate admission functional status and performance of basic ADLs as assessed by Functional Independence Measure (FIM) scale as possible predictors of motor and functional outcome after stroke during inpatient rehabilitation., Design: This is a prospective and observational study., Setting: Inpatients of our Department of Physical Medicine and Rehabilitation., Population: Two hundred sixty consecutive patients with primary diagnosis of stroke were enrolled and 241 patients were used in the final analyses., Methods: Two backward stepwise regression analyses were applied to predict outcome. The first backward stepwise regression had age, gender, stroke type, stroke-lesion size, aphasia, neglect, onset to admission interval, Cumulative Illness Rating Scale, National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Scale, Trunk Control Test, and FIM (total, motor and cognitive scores) as independent variables. The second analyses included the above variables plus FIM items as an independent variable. The dependent variables were the discharge scores and effectiveness in total and motor-FIM, and discharge destination., Results: The first multivariate analysis showed that admission Fugl-Meyer, neglect, total, motor and cognitive FIM scores were the most important predictors of FIM outcomes, while admission NIHSS score was the only predictor of discharge destination. Conversely, when admission single FIM items were included in the statistical model, admission Fugl-Meyer, neglect, grooming, dressing upper body, and social interaction scores were the most important predictors of FIM outcomes, while admission memory and bowel control scores were the only predictors of discharge destination., Conclusion: Our study indicates that performances of basic ADLs are important stroke outcome predictors and among which social interaction, grooming, upper body dressing, and bowel control are the most important., Clinical Rehabilitation Impact: The results of this study suggests that, when designing other studies on stroke outcome predictions, researchers should also include tests which assess performances of basic ADLs as independent variables, because this may allow identification of new prognostic indicators that can be helpful for the physician for managing stroke patients at the end of the rehabilitation period.

Aim: The aim of this prospective study was to evaluate the effect of corticosteroids intra-articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes., Methods: A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra-articular injection of 40 mg triamcinolone acetonide and 20 patients had a repeat injection at a 21-day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non-steroidal anti-inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission., Results: At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3-month interval post-therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity., Conclusions: Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra-articular injections of corticosteroids., (© 2013 Japan Geriatrics Society.)

Unlabelled: Up to date studies have assessed costs and outcomes of rehabilitation in outpatients. Aim of the current prospective study was to evaluate the rehabilitative and economical effectiveness of an outpatient rehabilitative practice., Methods: The study was performed in 349 patients admitted for rehabilitation due to sequelae of orthopaedic surgery (repair of rotator cuff tear, anterior cruciate ligament reconstruction), limbs fracture (should, wrist, foot), whiplash neck pain, and chronic spinal pain (low back pain and neck pain). All patients were submitted to rehabilitation. Before and after rehabilitation, range of motion of joint or pain were assessed. Economical effectiveness and rehabilitative effectiveness in range of motion and pain were considered as outcome measures., Results: Rehabilitative effectiveness was 71.9%+/-30%. Length of rehabilitation (beta=0.29) and initial joint status (beta=0.36) had the strongest relationship with rehabilitative effectiveness. Rehabilitative effectiveness was higher in patients with sequelae of anterior cruciate ligament reconstruction. Economical effectiveness was 48.0%+01 and was related to length of rehabilitation (beta=0.11) only. Economical effectiveness was higher in low back pain carried out in group (136%+/-0.0)., Conclusions: The study gives evidence that in outpatient rehabilitation the rehabilitative effectiveness is higher than economical one. In addition, the study shows that rehabilitative treatments carried out in group only have higher economical effectiveness. These data must be considered useful in planning the ambulatory rehabilitation.

This study reports the case of a 47-year old female with low back pain radiating to groin and anterior regions of the left thigh and leg. At symptoms onset, electromyography showed left L3-L4 radiculopathy, and nuclear magnetic resonance revealed disc protrusion at the same level with impingement of the spinal nerve root. The clinical symptoms were ascribed to lumbar disco-radicular conflict. The patient underwent steroidal anti-inflammatory treatment with epidural steroid injections, chiropractic spinal manipulations and rehabilitation program, with no relief. Thirteen months after the onset of pain, a computed tomography of sacroiliac joints showed osteolytic lesion in the iliac bone of left joint, and a bone scintigraphy highlighted foci of intense uptake at left iliac bone and left proximal extremity of the femur. The bone biopsy and pathological examinations showed findings consistent with large B-cell non-Hodgkin lymphoma. This case report highlights the fact that in making differential diagnosis of low back pain radiating to the leg we have to consider the rare possibility that pain can be due to non-Hodgkin lymphoma that involves simultaneously the iliac bone and proximal extremity of the femur.

Aim: To describe the unusual course of a patient with cerebellar ataxia who underwent rehabilitation., Method: At admission, the patient underwent motor rehabilitation and assessment by Tinetti Assessment, Klockgether Score, National Institute of Health Stroke Scale, Trunk Control Test, Fugl-Meyer Scale, Barthel Index, and Mini Mental State Examination., Results: The patient showed very rapid and severe decline of motor and functional tests during the first month of hospitalization and complete dependence in <2 months, despite rehabilitation. He died 10 months after onset, with a neuro-pathological diagnosis of sporadic Creutzfeldt-Jakob disease (CJD)., Conclusion: Our case report suggests that sporadic CJD must be hypothesized when ataxia worsens rapidly and severely despite rehabilitation.

The study evaluates the possible relations between cognitive impairment, persisting anosognosia for hemiplegia and peripersonal neglect. Thirty eight chronic right hemisphere stroke patients were divided in three age- and education-matched groups: A (n = 13) patients with left hemiparesis, peripersonal neglect, and anosognosia for hemiplegia; B (n = 12) patients with left hemiparesis and peripersonal neglect, and C (n = 13) patients with left hemiparesis only. We used MMSE and WAIS Verbal IQ and verbal subtests to assess cognitive impairment in patients, in order to avoid a bias due to visuospatial deficit, which is common in patients with neglect. VIQ, Information, Digit Span and Vocabulary WAIS subtests as well as MMSE were found to be significantly lower in group A versus group B. No difference was found in any test between groups B and C, indicating a general worse cognition in patients compared to those without anosognosia for hemiplegia. Patients with anosognosia for hemiplegia also showed larger brain lesions and, more frequently, frontal, parietal, temporal and basal ganglia involvement, particularly if they had low verbal IQ, indicating a relationship between cognitive impairment, persisting anosognosia for hemiplegia and large right hemisphere lesions.

Objective: The aim of this study was to evaluate the effect of intraarticular injections of corticosteroids (triamcinolone) in patients with symptomatic rotator cuff tears (RCT)., Design: Randomized controlled study., Setting: Rehabilitation unit., Patients: Sixty patients with full-thickness RCT were enrolled in the study. Patients were randomly divided into three equal groups of 20 patients. The first group received single intraarticular injection of 40 mg triamcinolone, the second group received two injections of 40 mg triamcinolone at 21-day interval, and the third group received no treatment (control group). All patients underwent rehabilitation sessions. Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant-Murley score., Measures: Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant-Murley score., Results: Pain at night score of both groups who received triamcinolone was lower than that of Control Group at 1 month (P < 0.05 and P < 0.01 in first and second groups, respectively) and at 3 months (P < 0.05 and P < 0.01 in the first and second groups, respectively). Similarly, activity pain score of groups treated with triamcinolone was lower than that of the control group at 1 month (P < 0.001 in both groups) and at 3 months (P < 0.001 in both groups). There was no statistically significant difference in pain at night between the first and second groups at 1 and at 3 months. There was no statistically significant difference among groups at 3 and 6 months in Constant-Murley scores., Conclusions: Our study indicates that intraarticular injection of triamcinolone improves pain relief for 3 months in RCT and its action is not prolonged or potentiated by two injections of the drug done at 21-day intervals., (Wiley Periodicals, Inc.)

Available studies did not clarify whether a language examination may predict functional and motor outcome in patients with aphasia undergoing rehabilitation. This was the aim of the current study. Language examination considered in this study was the Aachen Aphasia Test (AAT). One hundred fifty-six patients with a primary diagnosis of acute cerebrovascular accident of left hemisphere were included: 105 with and 51 without aphasia. Backward stepwise regression analysis was used to predict final scores in total-, motor-, and cognitive-Functional Independence Measure (FIM). The independent variables were age, gender, stroke type, stroke lesion size, onset to admission interval, National Institute of Health Stroke Scale, Fugl-Meyer Scale, Trunk Control Test, initial motor-FIM, and AAT (spontaneous speech, token test, repetition, written language, confrontation naming, comprehension). In the multivariate regression analysis, comprehension was the only function of the language to be predictor of the final total-FIM (β = +0.35) and final cognitive-FIM (β = +0.61). Comprehension was a predictor of total-FIM (β = +0.27) and cognitive-FIM (β = +0.54) as well, when additional backward stepwise regression analysis (which did not include comprehension and expression scores in the final total- and cognitive-FIM) was performed. When multivariate regression analysis took into consideration only language functions as independent variables, spontaneous speech (β = +0.41) only was the predictor of motor-FIM. The study highlights that AAT is the predictor of functional outcome in the patient with aphasia. Among the functions of language, comprehension seems to be the most important predictive factor of total- and cognitive-FIM, while spontaneous speech seems to be a predictor of motor-FIM.

Objective: Very few studies have investigated the predictive value of functional outcome, social outcome and discharge destination in patients with cerebrovascular accident (CVA) with aphasia. The aim of this study was to verify whether aphasia is predictor for outcome in patients with stroke with aphasia., Methods: The study was carried out in 262 patients with primary diagnosis of CVA and aphasia, included over a 6-year period (2001-2007): 131 with and 131 without aphasia. Statistically significant variables at the univariate regression analysis were submitted to the multivariate analysis. Backward stepwise regression analysis was applied to predict final motor-Functional Independence Measure (FIM), effectiveness in motor-FIM, final cognitive-FIM score and effectiveness in cognitive-FIM and discharge destination. Independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, motor function, trunk control test, initial motor-FIM and committed caregiver identified on admission to rehabilitation., Results: Patients with aphasia had lower motor-FIM and cognitive-FIM scores both at admission and at discharge, if compared with those without aphasia. Effectiveness in motor-FIM and cognitive-FIM scores was also poorer in patients with aphasia. Seventy-seven per cent of patients with aphasia and 91.6% of patients without aphasia returned at home. In the multivariate regression analysis, aphasia was predictor of final motor-FIM (β = 0.15), final cognitive FIM (β = 0.72), effectiveness in motor-FIM (β = 0.17) and discharge destination (β = 0.20)., Conclusions: Aphasia is a predicting factor of outcome and it is the most important predictor of social outcome in patients with stroke with aphasia.