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Abstract Background The etiology of neck pain is multifactorial and includes personal and work-related factors such as age, sex, wrong postures, and repeated strains. Studies based on bio-psychosocial model also link chronic neck pain to psychological factors. Over time, the use of multidisciplinary interventions for chronic neck pain has grown in order to improve disability, pain, and adaptive cognitions and behaviors towards patients’ problems. The objective is to evaluate the effectiveness of an individual-based multidisciplinary rehabilitation program that integrates cognitive-behavioral therapy focused on kinesiophobia with specific exercises in the treatment of patients with chronic neck pain, employed in different working activities. Methods A randomized, parallel-group superiority-controlled trial will be conducted with 1-year follow-up. One hundred seventy patients engaged in several working activities (blue collar and white collar workers) will be randomly allocated to either the experimental (receiving a multidisciplinary rehabilitation program combining multimodal exercises with psychologist-lead cognitive-behavioral therapy sessions) or the control group (receiving general care physiotherapy). Both groups will follow individual-based programs once a week for 10 weeks. The main outcome measures will be the Neck Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, the Short-Form Health Survey, and the Work Ability Index. Participants will be evaluated before, after training, and after 12 months. Discussion Findings may provide empirical evidence on the effectiveness of an individual-based multidisciplinary rehabilitation program on inducing clinically significant and long-term improvements in the disability, pain, psychological factors, and quality of life of workers with chronic neck pain and that these would be maintained in the long term. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities’ recommendations. Trial registration ClinicalTrials.gov NCT04768790 . Registered on 24 February 2021

Introduction: The overall contribution of physical exercise on the management of disabling consequences of leukemia and lymphoma in children is missing. The aim of this scoping review (ScoR) was to systematically collect, map and present the current research evidence concerning studies reporting data on physical exercise among children with leukemia and lymphoma., Evidence Acquisition: This ScoR was performed by adopting recommendations of the 2020 version of the "Joanna Briggs Institute Methodological Guidance", along with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. PubMed, Scopus, and the Central (Cochrane) were searched up to December 2023. Original studies were included, and results were presented numerically and thematically., Evidence Synthesis: One hundred twelve articles were identified through the search; 14 studies met the inclusion criteria. Publications have increased over the years. Most of the studies were conducted in Western countries. 11 articles (79%) owned to primary research (seven RCTs, and four observational studies), and 3 studies (21%) were systematic reviews. The overall sample size was of 293 individuals. 1 study included a mixed population of leukemias and lymphomas, while the others included only children with leukemia. The features of physical exercise were well described, including details on duration of treatment, frequency of exercises sessions, and duration of sittings., Conclusions: The studies indicated physical exercise as a contributor to the improvement of motor abilities and quality of life. More studies including outcome measures that assess disability are recommended. More evidence on the impact of physical exercise in children with lymphoma is needed.

Background: There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options., Aim: To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire., Design: Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment., Setting: Outpatient facilities., Population: People with LBP., Methods: The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC2.1); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations)., Results: The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7±14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (α=0.70-85) and test-retest assessment was excellent (ICC2.1=0.91-94). Construct validity was good, as ≥75% of hypotheses were confirmed., Conclusions: The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes., Clinical Rehabilitation Impact: This study adds original new data to the existing knowledge in the field of Commitment within the bio-psychosocial paradigm for disabled people. It is expected to contribute to the evaluative, clinical and rehabilitative approach of individuals with low back pain.

Background/Objectives : Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods : This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise.

Background: Evaluating the psychometric and clinical performances of the RM-18, the shorter version of the Roland Morris Disability Questionnaire (RMQ), in Italian people with non-specific low back pain (NSLBP) as a time-saving and clinically useful method of assessing disability., Methods: This cross-sectional study included 74 people (52 females and 22 males, 53.03 ± 15.25 years old) with NSLBP. The RM-18, the RMQ, the Oswestry Disability Index (ODI), and a pain intensity numerical rating scale (NRS) were administered. Psychometric testing included reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intraclass Correlation Coefficient, ICC2.1), and concurrent validity by comparing the RM-18 with the RMQ and the ODI (Pearson's r correlation). Two separate regression analyses were performed to investigate the different impact of RM-18 and RMQ on NRS., Results: Cronbach's α of RM-18 was 0.92 and ICC (2,1) = 0.96. Strong correlations were found with the RMQ and the ODI (r = 0.98; r = 0.78, respectively). The regression models showed that the RM-18 and the RMQ similarly impacted the NRS ( p < 0.001)., Conclusion: The RM-18 showed satisfactory psychometric testing and similarly impacted the NRS when compared to the RMQ. It can be recommended for clinical and research purposes in Italian people with NSLBP.

Chronic pain poses a widespread and distressing challenge; it can be resistant to conventional therapies, often having significant side effects. Non-invasive brain stimulation (NIBS) techniques offer promising avenues for the safe and swift modulation of brain excitability. NIBS approaches for chronic pain management targeting the primary motor area have yielded variable outcomes. Recently, the cerebellum has emerged as a pivotal hub in human pain processing; however, the clinical application of cerebellar NIBS in chronic pain treatment remains limited. This review delineates the cerebellum's role in pain modulation, recent advancements in NIBS for cerebellar activity modulation, and novel biomarkers for assessing cerebellar function in humans. Despite notable progress in NIBS techniques and cerebellar activity assessment, studies targeting cerebellar NIBS for chronic pain treatment are limited in number. Nevertheless, positive outcomes in pain alleviation have been reported with cerebellar anodal transcranial direct current stimulation. Our review underscores the potential for further integration between cerebellar NIBS and non-invasive assessments of cerebellar function to advance chronic pain treatment strategies.

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Federico Arippa reports financial support was partially provided by Sardegna Ricerche, I FAIR Program, and by the 10.13039/501100009873Regione Autonoma della Sardegna. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background and Aim: There is evidence to suggest that assessing back-specific altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specific body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP., Methods: The FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PI-NRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson's correlations); reliability by internal consistency (Cronbach's alpha) and test-retest repeatability (intraclass correlation coefficient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP., Results: Rasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confirmed; correlations: RMDQ (r = 0.35), PI-NRS (r = 0.25), PCS (r = 0.41) and TSK (r = 0.38). Internal consistency was acceptable (alpha = 0.82) and test-retest repeatability was excellent (ICC (2,1) = 0.88, 95% CI: 0.83, 0.92). The MDC 95 corresponded to 6.7 scale points., Conclusion: The FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community., (© 2024. The Author(s).)

The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.

Study Design: Nonrandomized controlled cohort., Objective: To compare early results between bipolar fusionless construct (BFC) and single posterior fusion (SPF) surgery in neuromuscular scoliosis (NMS)., Background: Surgical treatments for NMS have traditionally been characterized by high complication rates. A mini-invasive BFC was developed to reduce these risks while maintaining adequate curve reduction. There is, however, a current lack of studies comparing clinical and radiologic perioperative outcomes between both techniques., Methods: All patients surgically treated for NMS with to-pelvis construct between 2011 and 2021 at 2 centers were included and divided into 2 groups according to the surgical technique (BFC or SPF). Gender, age, main deformity region, etiology, preoperative and postoperative main curve magnitude and pelvic obliquity, surgery time, estimated blood loss and transfusion rates, length of hospital stay, the magnitude of main curve and pelvic obliquity correction, and early complications were compared. Quantitative data were compared through ANOVA or Mann-Whitney test. Analysis of qualitative outcomes was performed through Fisher exact test and logistic regressions. Kruskal-Wallis test was used to compare complications between groups., Results: Eighty-nine NMS patients were included: 48 in the SPF group and 41 in the BFC group. Surgery time (203 vs. 241 min), rate (32 vs. 52%) and severity of complications, unplanned returns to the operating room (15 vs. 39%), estimated blood loss (179 vs. 364 cc), and transfusion rates (27 vs. 73%) were lower in the BFC group ( P <0.05). There were no significant differences in age, maturity stage, preoperative curve magnitude, preoperative pelvic obliquity and postoperative curve, and pelvic obliquity correction between groups., Conclusions: BFC may be a safer and less invasive option for NMS surgical treatment, resulting in similar curve corrections while significantly decreasing the number and severity of complications as well as intraoperative blood loss when compared with SPF., Level of Evidence: Level -lll., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Upper limb lymphedema (ULLy) is an external (and/or internal) manifestation of lymphatic system insufficiency and deranged lymph transport for more than 3 months and frequently affects people as a consequence of breast cancer (BC). ULLy is often underestimated despite diminished motor skills, mood, and cognitive-behavioral complaints negatively condition the health-related quality of life (HRQoL) of persons. BC can also metastasize to the jawbone, further impacting on the HRQoL. In time, the implementation of robot-assisted rehabilitation (RR) for neurological diseases has grown to improve HRQoL and pain. This study aims to evaluate the effectiveness of a RR program in the treatment of individuals who develop an ULLy; as a further analysis, the study will assess the effectiveness of the same program in people with jawbone metastases from BC who will also develop ULLy. A randomized, parallel-group superiority-controlled trial will be conducted. 44 participants will be randomly allocated to either the experimental (receiving a RR program) or the control group (regular rehabilitation). Both groups will follow individual-based programs three times a week for 10 weeks. The main outcome measure will be the Lymphedema Quality of Life Questionnaire. Secondary outcomes will be a pain intensity numerical rating scale and the Cranio-Facial Pain Disability Inventory. Evaluations are before and after training and 6 months later. Findings may provide evidence on the effectiveness of a RR program on inducing improvements in the HRQoL and pain of individuals with ULLy due to BC. People with ULLy and jawbone metastases from BC are expected for similar or higher improvements as per the same comparisons above. This trial might contribute towards defining guidelines for good clinical rehabilitation routines and might be used as a basis for health authorities' endorsements.Trial registration OSF REGISTRIES, osf-registrations-jz7ax-v1 . Registered on 26 June 2023., (© 2023. The Author(s).)

Introduction: Little data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS)., Hypothesis: ERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications., Materials and Methods: This was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation., Results: The mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5). The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group., Conclusion: Implementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain., Level of Evidence: III; retrospective comparative study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: The Prosthesis Evaluation Questionnaire-Mobility Section (PEQ-MS) and the Prosthetic Mobility Questionnaire (PMQ 2.0) are two validated self-report questionnaires assessing mobility in people with lower-limb amputation., Objective: The aim of this study was to assess and compare the psychometric properties of PEQ-MS and PMQ 2.0 in a sample of 100 Italian lower-limb prosthesis users., Methods: We conducted a secondary Rasch analysis of data from a prospective single-group observational study, comparing the PEQ-MS and PMQ 2.0 head to head and then cocalibrating them onto a common interval-scaled metric, through common-person equating, to compare their operational range., Results: The PMQ 2.0 showed good measurement qualities. The PEQ-MS had acceptable psychometric properties, despite some weakness in item selection. Cocalibration of the two questionnaires indicated that they assess the same underlying construct (prosthetic mobility), but PMQ 2.0 items have a wider range of difficulty (by one logit). Finally, we created a nomogram allowing to "cross-walk" between scores of the two questionnaires., Conclusions: Comparison of the two questionnaires showed that the PMQ 2.0 has a better measurement performance and larger operational range than the PEQ-MS, making it more suitable for assessing lower-limb prosthesis users with a large range of locomotor abilities, in particular those with higher mobility levels., (Copyright © 2022 International Society for Prosthetics and Orthotics.)

Background: The contribution of sport in non-specific low back pain (NS-LBP) remains unknown, due to a large heterogeneity in the methods applied in research. The aims of this scoping review (ScR) were to systematically map and summarize findings concerning studies reporting data on NS-LBP among athletes., Methods: This ScR was developed referring to the 2020 version of the "Joanna Briggs Institute Methodological Guidance" and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. Five medical databases (Pubmed, Cochrane, Central, Embase, Pedro and Scopus) were searched up to November 2021. No limitations in terms of study design and language were applied. Results were presented numerically and thematically., Results: A total of 4061 records were identified through the initial search; 114 articles met the inclusion criteria. Publications have increased over the years, since 1990. Most of the studies were conducted in the USA (17.5%), even if most research was conducted in Europe (53.5%). Analytic observational (42%) and cross-sectional studies (37%) were the most used designs, followed by case reports (12%) and systematic reviews (9%). Boating (7%), football, soccer, volleyball, running and gymnastics (4.4% each) were the most investigated, although the majority of the studies considered sports in general (36.8%). The overall sample size median was 181, mean age 22 ± 10.2; 68% of athletes were professional and 32% amateur. Most of the studies (38%) did not detail the frequency of training. Sport was reported as a risk factor for developing NS-LBP in 67.5% of cases, especially in those studies which assessed activities implying high or repeated loading on the spine., Conclusions: This is the first ScR to provide a comprehensive overview on this topic. The increased number of publications on the association between sport practice and NS-LBP demonstrates a growing interest over the years on this topic. Some sport activities seem to be more involved than others in LBP development; however, research methods are extremely varied, thus more standardized observational research may focus on specific disciplines to properly contribute to research and clinical practice., (© 2022. The Author(s).)

Purpose: There is no consensus on the type of surgical treatment of congenital pseudarthrosis of the clavicle due to its rarity. The purpose of this study is to provide evidence in favor of a surgical technique and to explore factors correlated with bone consolidation., Methods: Systematic review of the literature and an analysis of the data for each subject, including all available subjects from the published series and clinical cases since 1990. Fisher's exact tests or T-tests were used to evaluate the effect of independent variables (age at surgery and type of treatment) on bone healing., Results: The literature search provides 305 articles; 30 were selected, reporting 191 patients and 194 clavicles. One hundred and fifty-one clavicles were operated on at a mean age of nine years and four months (from 8 months to 21 years). Thirteen clavicles (8, 6%) had not consolidated at the last follow-up. Concerning the type of fixation, the rate of healing was similar for plates and pins (p = 0.27). The rate of consolidation was higher with autograft than with allograft, xenograft, or no graft (p = 0.00001), and was 100% for vascularized graft. The mean age at surgery was higher for patients who healed at the last follow-up (118 vs. 61 months, p = 0.001)., Conclusion: In the event of surgical indication for congenital pseudarthrosis of the clavicle, it is recommended to perform autograft and stable fixation (level 4) after seven years old (level 4)., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

The aim of this study was to establish the reproducibility of tongue strength measurements in healthy women and men during maximum anterior isometric pressure (MAIP) and regular effort saliva swallows (RESS). In this cross-sectional study, 30 healthy young adults were required to push with the tip of the tongue on a piezo-resistive sensor glued to the hard palate, immediately above the central incisor line. Tongue pressures exerted on the sensor during MAIP and spontaneous RESS were recorded. Participants underwent a retest procedure within the same session to verify the reproducibility of measurements, as determined by intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Complete data were obtained from 30 subjects (15 women, 15 men; mean age 31.4 ± 7.8 years; mean weight 61.3 ± 9.4 kg). Compared to women, men showed a trend for generating larger MAIP (p = 0.06; d = 0.71) and RESS (p = 0.07; d = 0.69). After normalizing to body weight, height, and body mass index (BMI), such trends disappeared. At retest, MAIP and RESS proved stable and highly reliable (all ICCs ≥ 0.93) in men and women but associated to moderate variability as for SEM and MDC, with MAIP estimates associated to smaller SEM and MDC (SEM ranging 7.4-14.2%; MDC 18.6-20.9%) than RESS (SEM ranging 20.4-38.5%; MDC 52.5-55.6%). Piezo-resistive pressure sensors allow clinicians and researchers to perform reproducible measurements of tongue muscle performance. However, if therapeutic interventions are administered, measurement variability in tongue performance should be considered when appraising their clinical efficacy, especially for those populations who display impaired performance and may not be capable to generate high and stable forces. No gender-based differences emerged in the motor tasks tested., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The aim of this study was to translate, culturally adapt and validate an Italian version of the Athlete Fear Avoidance Questionnaire (AFAQ-I). We conducted a cross-sectional evaluation of the psychometric properties of the AFAQ-I in university athletes with musculoskeletal injuries, culturally adapting it in accordance with international standards. Psychometric evaluation included the assessment of structural validity (exploratory factor analysis), internal consistency (Cronbach's alpha and inter-item correlation), test-retest reliability [intraclass correlation coefficient, (ICC) (2,1)], measurement error and minimum detectable change (MDC). To examine construct validity, we compared (Spearman ρ) the AFAQ-I with a numerical pain rating scale (NPRS), the Pain Catastrophizing Scale (PCS) and the Fear Avoidance Beliefs Questionnaire (FABQ) subscales [FABQ-Physical Activity (FABQ-PA) and FABQ-Work (FABQ-W)]. The AFAQ-I was administered to 133 university athletes with musculoskeletal injuries (95 males and 38 females; mean age 25 years, SD 5; mean average pain duration 5.6 months, SD 8.7). Factor analysis revealed an acceptable 1-factor 10-item solution (explained common variance at minimum rank factor analysis: 0.74) although a couple of items (#6 and 9) presented low factor loadings, suggesting the presence of a small secondary dimension. Cronbach's alpha was 0.78 and the average inter-item correlation was 0.27. ICC (2,1) was 0.95 and the MDC was 4.4 points. As hypothesized a priori, the AFAQ-I moderately correlated with NPRS (ρ = 0.42), PCS (ρ = 0.59), FABQ-PA (ρ = 0.40) and FABQ-W (ρ = 0.34). In conclusion, the AFAQ-I is a valid Italian translation of AFAQ that demonstrates acceptable psychometric properties. However, we recommend further analysis of the construct definition of the AFAQ and additional examination of its structural validity., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known., Methods: Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit., Results: Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French., Conclusion: In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged., (© 2022. The Author(s), under exclusive licence to Scoliosis Research Society.)

Background: Osteoarthritis (OA) has traditionally been considered a disease of older adults (⩾65 years old), but it may appear in younger adults. However, the risk factors for OA in younger adults need to be further evaluated., Objectives: To develop a prediction model for identifying risk factors of OA in subjects aged 20-50 years and compare the performance of different machine learning models., Methods: We included data from 52,512 participants of the National Health and Nutrition Examination Survey; of those, we analyzed only subjects aged 20-50 years ( n  = 19,133), with or without OA. The supervised machine learning model 'Deep PredictMed' based on logistic regression, deep neural network (DNN), and support vector machine was used for identifying demographic and personal characteristics that are associated with OA. Finally, we compared the performance of the different models., Results: Being a female ( p  < 0.001), older age ( p  < 0.001), a smoker ( p  < 0.001), higher body mass index ( p  < 0.001), high blood pressure ( p  < 0.001), race/ethnicity (lowest risk among Mexican Americans, p  = 0.01), and physical and mental limitations ( p  < 0.001) were associated with having OA. Best predictive performance yielded a 75% area under the receiver operating characteristic curve., Conclusion: Sex (female), age (older), smoking (yes), body mass index (higher), blood pressure (high), race/ethnicity, and physical and mental limitations are risk factors for having OA in adults aged 20-50 years. The best predictive performance was achieved using DNN algorithms., Competing Interests: Competing interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2022.)

The Pain Catastrophizing Scale (PCS) is a widely studied tool to assess pain catastrophizing for chronic low back pain (LBP). Short forms of the PCS exist, but their measurement precision at individual level is unclear. This study aimed to analyze the Rasch psychometric characteristics of the PCS and three of its short forms (two 4-item and one 6-item) in a sample of 180 Italian-speaking patients with chronic LBP, and compare their measurement precision at the individual level. We performed a Rasch analysis on each version of the PCS and calculated test information functions (TIFs) to examine conditional measurement precision. Rasch analysis showed appropriate rating category functioning, unidimensionality, and acceptable fit to the Rasch model for all PCS versions. This represented a prerequisite for performing further advanced psychometric analyses. According to TIFs, the PCS full scale showed-at any score level-higher measurement precision in estimating individual pain catastrophizing than its short forms (which had unacceptably high standard errors of measurement). Our results show acceptable conditional precision of the PCS full scale in estimating pain catastrophizing. However, further studies are needed to confirm its diagnostic accuracy at individual level. On the other hand, the study warns against use of the three PCS short forms for clinical decision-making at the individual level., (© 2022. The Author(s).)

Purpose: To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term., Methods: By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure., Results: Significant group ( p  < 0.001), time ( p  < 0.001), and time-by-group interaction ( p  < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively., Conclusion: The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.

Purpose: There is growing interest in measures that assess upper-limb lymphedema after breast cancer. Since no validated Italian version of the Lymphedema Quality of Life Questionnaire for upper limbs (LYMQOL-UL) exists, we aimed to culturally adapt and validate an Italian version (LYMQOL-UL-IT) in order to allow its use in Italian patients., Materials and Methods: The LYMQOL-UL-IT was developed by means of forward-backward translation, review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC (2.1) ), measurement error by calculating the minimum detectable change (MDC 95 ), construct validity by confirmatory factor analysis, and evaluation of a priori hypotheses about the correlations between the four LYMQOL-UL domains, single items of the LYMQOL-UL, and measures of health-related quality of life and pain intensity (Spearman's rank correlation coefficient)., Results: The consensus-based version of LYMQOL-UL-IT was administered to 139 patients with upper-limb stable secondary iatrogenic lymphedema after breast cancer. The adapted questionnaire was well accepted as it was completed in less than 10 min, without missing answers or comprehension problems. Internal consistency was acceptable (α = 0.92-0.95). Test-retest reliability was good-to-excellent (ICC (2.1)  = 0.73-0.96). The MDC 95 for the four domains of the questionnaire was as follows: 0.64 scale points for Function, 0.40 for Appearance, 0.53 for Symptoms, and 0.81 for Mood. Factor analysis confirmed a 4-dimensional structure as originally conceived and the a priori hypotheses were met., Conclusion: The LYMQOL-UL-IT is reliable, sensitive to change and valid in patients with upper-limb stable secondary iatrogenic lymphedema after breast cancer. It can be used for clinical and research purposes.Implications for rehabilitationLymphedema is a frequently unnoticed clinical condition that not only impacts physical functioning but often restricts the health-related quality of life in breast cancer survivors.The Italian version of the Lymphedema Quality of Life Questionnaire for upper limbs (LYMQOL-UL-IT) is reliable, sensitive to change and valid in patients with upper-limb lymphedema after breast cancer.The LYMQOL-UL-IT tool can be recommended for clinical and research purposes.

Background: There is still a lack of information concerning Minimal Important Change (MIC) of the Quebec Back Pain Disability Scale (QBPDS), that limits its use for clinical and research purposes., Aim: Evaluating responsiveness and MIC of the QBPDS in Italians with chronic low back pain (LBP)., Design: This is a methodological research based on an observational study., Setting: Outpatient rehabilitation hospital., Population: Two hundred and one patients with chronic LBP., Methods: At the beginning and end of a multidisciplinary rehabilitation program, patients completed the QBPDS. At the end of treatment, they completed a 7-level global perceived effect (GPE) scale, which was split to obtain a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution-based (effect size [ES]; standardized response mean [SRM]; minimum detectable change [MDC95]) and anchor-based methods (receiver operating characteristics [ROC] curves). ROC curves were also used to compute the MIC (based on QBPDS change score, both absolute and expressed as percentage). Correlations between the change score of the QBPDS and GPE were calculated., Results: The ES was 0.29, the SRM was 0.43, and the MDC95 was 12 points. ROC analysis of the absolute change scores showed a MIC value of 6 points, with an area under the curve (AUC), sensitivity, and specificity of 0.83 (95% CI: 0.77-0.90), 77.7% and 80.8%, respectively. ROC analysis based on the percent change score from baseline revealed a MIC of 18% with an AUC, sensitivity and specificity of 0.85 (95% CI: 0.79-0.91), 80.6% and 80.8%, respectively. Correlation between change score of the QBPDS and GPE was ρ=-0.67., Conclusions: The QBPDS score change (expressed in both absolute value and percentage from baseline) was sensitive in detecting clinical changes in Italian subjects with chronic LBP undergoing multidisciplinary rehabilitation. In clinical practice, where absolute change is lower than MDC we recommend to rely on the MIC taking into account the percentage change from baseline condition., Clinical Rehabilitation Impact: The present study investigated the responsiveness and MIC of the QBPDS in a group of patients with chronic LBP. Our findings showed that the QBPDS score may classify with good to excellent discriminatory accuracy subjects who consider themselves as improved. Where examining change, we recommend considering both MICs we provided (expressing score change both in absolute value and as a percentage from baseline), and disregard values lower than MDC95, not being discernible from measurement error.

Accurate assessment of biomechanical risk associated with pushing/pulling tasks represents a challenging issue, especially in the health system where personnel are often required to maneuver beds and carts. Most studies in this field have been carried out in the laboratory, while few data have been collected under actual working conditions. This study aims to characterize the forces exerted during non-powered hospital bed maneuvering. Twenty participants were required to move a bed (equipped with a customized handlebar to measure exerted forces) along an actual hospital path including straight, turn and maneuver phases. The results show that higher forces are associated with the initial phase (peak and mean values 222 and 68 N) while the straight, turn and maneuvering phases required similar (lower) efforts. The combined effect of left, right and transversal forces suggests that the trunk of the operator might experience axial rotation, thus calling for further investigations of this aspect.

Introduction: Non-specific low back pain (NS-LBP) is one of the most common musculoskeletal conditions related to medical expenses and disability. Evidence suggests that changes in motion patterns could induce trunk instability and impaired postural control. Therefore, this systematic review investigated the effects of exercise on balance in patients with NS-LBP., Evidence Acquisition: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement and the main databases were searched for RCTs. Studies were independently screened through a standardized form and their internal validity assessed by using the Cochrane risk of bias (RoB) tool. Pooled effects were calculated at post-treatment and quality of evidence was assessed through the GRADE framework., Evidence Synthesis: Twelve articles were included in the review, eight in the meta-analysis. None of the studies were judged at low RoB. There is very low-quality evidence that exercise is effective in reducing Centre of Pressure (CoP) displacement (-16.99 [-27.29, -6.68]; P=0.001) and in improving single-leg stance test performance (-28.7 [-48.84, -8.67]; P=0.005) and dynamic balance (-4.74 [-8.02, -1.46]; P=0.005). Conversely, no significant results were observed in "ellipse area" and in "limits of stability" indexes. Other results were summarized in a qualitative synthesis., Conclusions: Exercise could be effective in improving both static and dynamic balance in patients with NS-LBP over a short-term period. However, quality of evidence was estimated as very low, hence further double-blinded, high-quality RCTs are needed to address clinical practice and research.

Background: The etiology of neck pain is multifactorial and includes personal and work-related factors such as age, sex, wrong postures, and repeated strains. Studies based on bio-psychosocial model also link chronic neck pain to psychological factors. Over time, the use of multidisciplinary interventions for chronic neck pain has grown in order to improve disability, pain, and adaptive cognitions and behaviors towards patients' problems. The objective is to evaluate the effectiveness of an individual-based multidisciplinary rehabilitation program that integrates cognitive-behavioral therapy focused on kinesiophobia with specific exercises in the treatment of patients with chronic neck pain, employed in different working activities., Methods: A randomized, parallel-group superiority-controlled trial will be conducted with 1-year follow-up. One hundred seventy patients engaged in several working activities (blue collar and white collar workers) will be randomly allocated to either the experimental (receiving a multidisciplinary rehabilitation program combining multimodal exercises with psychologist-lead cognitive-behavioral therapy sessions) or the control group (receiving general care physiotherapy). Both groups will follow individual-based programs once a week for 10 weeks. The main outcome measures will be the Neck Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, the Short-Form Health Survey, and the Work Ability Index. Participants will be evaluated before, after training, and after 12 months., Discussion: Findings may provide empirical evidence on the effectiveness of an individual-based multidisciplinary rehabilitation program on inducing clinically significant and long-term improvements in the disability, pain, psychological factors, and quality of life of workers with chronic neck pain and that these would be maintained in the long term. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities' recommendations., Trial Registration: ClinicalTrials.gov NCT04768790 . Registered on 24 February 2021., (© 2022. The Author(s).)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Unilaterality of motor symptoms is a distinctive feature of Parkinson's Disease (PD) and represents an important co-factor involved in motor deficits and limitations of functional abilities including postural instability and asymmetrical gait. In recent times, an increasing number of studies focused on the characterization of such alterations, which have been associated with increased metabolic cost and risk of falls and may severely compromise their quality of life. Although a large number of studies investigated the gait alterations in people with PD (pwPD), few focused on kinematic parameters and even less investigated interlimb asymmetry under a kinematic point of view. This retrospective study aimed to characterize such aspects in a cohort of 61 pwPD (aged 68.9 ± 9.3 years) and 47 unaffected individuals age- and sex-matched (66.0 ± 8.3 years), by means of computerized 3D gait analysis performed using an optical motion-capture system. The angular trends at hip, knee and ankle joints of pwPD during the gait cycle were extracted and compared with those of unaffected individuals on a point-by-point basis. Interlimb asymmetry was assessed using angle-angle diagrams (cyclograms); in particular, we analyzed area, orientation, trend symmetry and range offset. The results showed that pwPD are characterized by a modified gait pattern particularly at the terminal stance/early swing phase of the gait cycle. Significant alterations of interlimb coordination were detected at the ankle joint (cyclogram orientation and trend symmetry) and at the hip joint (range offset). Such findings might be useful in clinical routine to characterize asymmetry during gait and thus support physicians in the early diagnosis and in the evaluation of the disease progression.

Background: The Pain Catastrophizing Scale (PCS), a widely used tool to assess catastrophizing related to spinal disorders, shows valid psychometric properties in general but the minimal important change (MIC) is still not determined., Aim: The aim of this study was to assess responsiveness and MIC of the PCS in individuals with chronic low back pain (LBP) undergoing multidisciplinary rehabilitation., Design: Prospective observational study., Setting: The setting was outpatient rehabilitation hospital., Population: Two hundred and five patients with chronic LBP., Methods: Before and after an 8-week multidisciplinary rehabilitation program, 205 patients completed the Italian version of the PCS (PCS-I). We calculated the PCS-I responsiveness by distribution-based methods (effect size [ES], standardized response mean [SRM], and minimum detectable change [MDC]) and anchor-based methods [receiver operating characteristic (ROC) curves]. After the program, participants completed a 7-point global perceived effect scale (GPE), based on which they were classified as "improved" vs. "stable." ROC curves computed the best cut-off level (taken as the MIC) between the two groups. ROC analysis was also performed on subgroups according to patients' baseline PCS scores., Results: ES, SRM and MDC were 0.71, 0.67 and 7.73, respectively. ROC analysis yielded an MIC of 8 points (95% confidence interval [CI]: 6-10; area under the curve [AUC]: 0.88). ROC analysis of the PCS subgroups confirmed an MIC of 8 points (95%CI: 6-10) for no/low catastrophizers (score <30, N.=159; AUC: 0.90) and indicated an MIC of 11 points (95%CI: 8-14) for catastrophizers (score >30, N.=33; AUC: 0.84)., Conclusions: The PCS-I showed good ability to detect patient-perceived clinical changes in chronic LBP postrehabilitation. The MIC values we determined provide a benchmark for assessing individual improvement in this clinical context., Clinical Rehabilitation Impact: The present study calculated - in a sample of people with chronic LBP - the responsiveness and MIC of the PCS. These values increase confidence in interpreting score changes, enhancing their meaningfulness for both research and clinical contexts.

Background: Multidisciplinary rehabilitation induces disability improvement, pain reduction and favors return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials., Aim: The aim of this study is to test the effect of a multidisciplinary rehabilitative program incorporating cognitive-behavioral interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent., Design: Randomised parallel-group superiority-controlled trial., Setting: Outpatient rehabilitation hospital., Population: One hundred and fifty patients with subacute LBP., Methods: Patients were assigned randomly to a 10-week individual-based multimodal program of task-oriented exercises integrated with cognitive-behavioral therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure., Results: Significant group (P<0.001), time (P=0.002), and time-by-group interaction (P<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favor of the experimental group. A significant interaction effect (P<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up., Conclusions: The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year., Clinical Rehabilitation Impact: Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral and motor lasting changes.