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Background and purpose: Shoulder pain is one of the most common musculoskeletal problems of the world's population. In particular, in water polo athletes, the frequency of injuries or pain to this joint is very high. The incidence of psychosocial factors in musculoskeletal pain is well recognized, even if they seem to be more present in chronic pain, rather than in acute pain. Case description The patient was a semi-professional water polo player with acute shoulder pain which occurred during a game. At first, the pain was very mild, but it progressively got worse after the visit to the casualty department where, even in the absence of any confirmed structural lesions, the patient is ordered to refrain from any active movements. The patient became worried, so his anxiety levels increased which worsened his symptoms. The physiotherapist opted for a “hands-off/hands-on approach”. Outcomes Significative improvements were observed in all the considered outcome measures the patient obtained complete recovery in a very short period of time and then he was able to return to his sport. Discussions Psychosocial factors such as anxiety, fear and catastrophizing can modulate pain responses in a subject without structural problems. Thus, counseling and education in pain science can be an effective therapeutic method, especially with conditions of acute, as well as chronic, pain. Level of evidence 4.

Purpose The Nottingham Clavicle Score (NCS) is a patient-reported outcome measure developed to evaluate treatment results of clavicle, acromioclavicular and sternoclavicular joint pathologies. Valid, reliable and user-friendly translations of outcome measure instruments are needed to allow comparisons of international results. The aim of this cross-sectional study was to translate and adapt the NCS into German and evaluate the psychometric properties of the German version. Methods The translation and cross-cultural adaptation of the NCS were completed using a ‘translation–back translation” method and the final version was administered to 105 German-speaking patients. The psychometric properties of this version (NCS-G) were evaluated in terms of feasibility, reliability, validity and sensitivity to change. Results No major differences occurred between the NCS translations into German and back into English, and no content- or linguistic-related difficulties were reported. The Cronbach’s alpha for the NCS-G was 0.885, showing optimal internal consistency. The Intraclass Correlation Coefficient for test–retest reliability was 0.907 (95% CI 0.844–0.945), with a standard error of measurement of 5.59 points and a minimal detectable change of 15.50 points. The NCS-G showed moderate to strong correlation with all other investigated scales (Spearman correlation coefficient: qDASH: ρ = – 0.751; OSS: ρ = 0.728; Imatani Score: ρ = 0.646; CMS: ρ = 0.621; VAS: ρ = – 0.709). Good sensitivity to change was confirmed by an effect size of 1.17 (95% CI 0.89–1.47) and a standardized response mean of 1.23 (95% CI 0.98–1.45). Conclusions This study demonstrated that NCS-G is reliable, valid, reproducible and well accepted by patients, showing analogous psychometric properties to the original English version. Level of evidence Level III.

To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services within primary health care in Tuscany, Italy.The Department of Health Professions of the Central Tuscany local health authority designed the model during 2020-2021. We describe the four phases of the organizational case study implementation of the model, namely: (i) analysis of the political and organizational framework, as well as determination of changing health-care needs; (ii) model co-design and training of multiprofessional health-care workers (local general practitioners, physiatrists and geriatricians); (iii) delivery and surveillance of rehabilitation services; and (iv) evaluation.During the initial roll-out of the project in April-December 2021, general practitioners referred 165 patients with a mean age of 83.7 years (standard deviation: 11.1) to the Family and Community Physiotherapist. Interventions were mainly activated for patients with comorbidities (64/165; 38.8%), followed by those with long-term immobilization issues (36/165; 21.8%). The most commonly provided intervention was counselling, contributing to the achievement of objectives for 127 patients (77.0%). A full rehabilitation path was proposed for only 10 patients (6.1%). No additional costs were incurred by the health authority during the implementation of the model.Our model facilitated the provision of rehabilitative care in the community, preventing the exacerbation of chronic conditions and meeting the population health needs in non-hospital environments. The model overcame the typical lack of integration within health-care services with flexibility, promoting care proximity solutions to cope with health challenges such as an ageing population and the coronavirus disease.Expliquer en quoi consiste le modèle de Kinésithérapeute de famille et de communauté, qui vise à intégrer les services de réadaptation dans les soins primaires en Toscane (Italie).Le Département des professions de la santé, sous l'égide des autorités sanitaires locales de Toscane centrale, a conçu ce modèle en 2020–2021. Dans le présent document, nous détaillons les quatre phases de l'étude de cas sur l'organisation et la mise en œuvre du modèle, à savoir: (i) l'analyse du cadre politique et organisationnel, ainsi que la définition des besoins changeants en matière de santé; (ii) la conception conjointe du modèle et la formation de professionnels de la santé multidisciplinaires (spécialistes de la réadaptation, gériatres et généralistes locaux); (iii) la prestation et le suivi des services de réadaptation; et enfin, (iv) l'évaluation.Pendant le déploiement initial du projet, entre avril et décembre 2021, les médecins généralistes ont transféré 165 patients dont l'âge moyen s'élevait à 83,7 ans (écart type: 11,1) au kinésithérapeute de famille et de communauté. La plupart des interventions ont été activées pour les patients souffrant de comorbidités (64/165; 38,8%), puis pour ceux présentant des problèmes liés à une immobilisation de longue durée (36/165; 21,8%). Les interventions les plus fréquentes étaient des consultations, qui ont aidé 127 patients (77,0%) à atteindre leurs objectifs. Seuls 10 patients (6,1%) se sont vu proposer un parcours de réadaptation complet. Les autorités sanitaires n'ont engagé aucune dépense supplémentaire durant la mise en œuvre du modèle.Notre modèle a facilité l'accès aux soins de réadaptation au sein de la communauté, et permis d'éviter l'aggravation d'affections chroniques tout en répondant aux besoins de la population en matière de santé, ailleurs qu'en milieu hospitalier. Il a également surmonté l'absence d'intégration aux services de santé grâce à sa flexibilité, en privilégiant les soins de proximité face à des défis tels que le vieillissement de la population et la maladie à coronavirus.Describir el modelo de Fisioterapeuta de familia y comunidad, que tiene como objetivo incorporar los servicios de rehabilitación dentro de la atención primaria de salud en la Toscana, Italia.El Departamento de Profesiones Sanitarias de la autoridad sanitaria local de la Toscana central diseñó el modelo durante 2020 y 2021. Se describen las cuatro fases del estudio de caso organizativo sobre la implementación del modelo, a saber: (i) el análisis del marco político y organizativo, así como la determinación de las necesidades cambiantes de atención sanitaria; (ii) el codiseño del modelo y la formación del personal sanitario multiprofesional (médicos generales locales, médicos rehabilitadores y geriatras); (iii) la prestación y la vigilancia de los servicios de rehabilitación; y (iv) la evaluación.Durante el despliegue inicial del proyecto entre abril y diciembre de 2021, los médicos generales remitieron al fisioterapeuta de familia y comunitario a 165 pacientes con una edad media de 83,7 años (desviación estándar: 11,1). Las intervenciones se aplicaron principalmente a los pacientes con comorbilidades (64/165; 38,8 %), seguidos por aquellos con problemas de inmovilización a largo plazo (36/165; 21,8 %). La intervención que más se proporcionó fue el asesoramiento, que contribuyó al logro de los objetivos para 127 pacientes (77,0 %). Se propuso una vía de rehabilitación completa solo para 10 pacientes (6,1 %). La autoridad sanitaria no incurrió en ningún coste adicional durante la implementación del modelo.Este modelo facilitó la prestación de cuidados de rehabilitación en la comunidad, lo que permitió prevenir el empeoramiento de enfermedades crónicas y satisfacer las necesidades sanitarias de la población en entornos no hospitalarios. El modelo superó la falta de integración que suele haber en los servicios sanitarios con flexibilidad, promoviendo soluciones de proximidad asistencial para abordar dificultades en materia de salud como el envejecimiento de la población y la enfermedad del coronavirus.وصف نموذج أخصائي العلاج الطبيعي للأسرة والمجتمع، والذي يهدف إلى دمج خدمات إعادة التأهيل في الرعاية الصحية الأولية في توسكاني بإيطاليا.قام قسم المهن الصحية التابع للهيئة الصحية المحلية في توسكاني المركزية بتصميم النموذج خلال الفترة 2020-2021. نحن نقوم بوصف المراحل الأربع لتنفيذ دراسة الحالة التنظيمية للنموذج، وهي: (1) تحليل إطار العمل السياسي والتنظيمي، وكذلك تحديد احتياجات الرعاية الصحية المتغيرة؛ و(2) تصميم نموذج مشترك وتدريب العاملين في مجال الرعاية الصحية ذوي المهن المتعددة (المحللين من الممارسين العموميين، وأخصائيي العلاج الطبيعي، وأطباء الشيخوخة)؛ و(3) تقديم خدمات إعادة التأهيل ومراقبتها؛ و(4) التقييم.خلال الانطلاق الأولي للمشروع في الفترة أبريل/نيسان إلى ديسمبر/كانون أول 2021، قام الممارسون العموميون بإحالة 165 مريضًا بمتوسط عمر 83.7 عامًا (الانحراف المعياري: 11.1) إلى أخصائي العلاج الطبيعي للأسرة والمجتمع. تم تنشيط التدخلات بشكل رئيسي للمرضى المصابين بأمراض مصاحبة (64/165؛(38.8 % ، يليها المرضى الذين يعانون من مشاكل عدم الحركة على المدى الطويل (36/165؛(21.8 % . كان التدخل الأكثر شيوعًا هو تقديم المشورة، مما ساهم في تحقيق الأهداف لعدد 127 مريضًا(77.0 % ) . تم اقتراح مسار كامل لإعادة التأهيل لعدد 10 مرضى فقط(6.1 %) . لم يتم تحميل أية تكاليف إضافية على الهيئة الصحية أثناء تنفيذ النموذج.أدى النموذج الخاص بنا لتوفير رعاية إعادة التأهيل في المجتمع، حيث منع تفاقم الحالات المزمنة، وقام بتلبية الاحتياجات الصحية للسكان في البيئات خارج المستشفى. تغلب النموذج على النقص المعتاد لتكامل خدمات الرعاية الصحية مع المرونة، وتعزيز حلول القرب من الرعاية، لمواكبة التحديات الصحية مثل السكان الذين يعانون من الشيخوخة، ومرض فيروس كورونا.描述家庭和社区理疗师模型，该模型旨在将理疗服务纳入意大利托斯卡纳的初级医疗护理之中。.托斯卡纳中央地方卫生局卫生专业部门在 2020-2021 年设计一个模型。我们描述了该模型的组织案例研究实施的四个阶段，即: (I) 分析政治和组织框架，并确定不断变化的医疗护理需要；(ii) 共同设计和培训跨专业医疗护理工作者（当地全科医生、理疗医生和老年医生）的模式；(iii) 提供和监察理疗服务；(iv) 评估。.在 2021 年 4 月至 12 月该项目最初推出期间，全科医生将 165 名平均年龄为 83.7 岁（标准差：11.1）的患者转诊给家庭和社区理疗师。干预措施主要针对有并发症的患者（64/165；38.8%），其次是有长期固定问题的患者（36/165；21.8%）。最常见的干预措施是咨询，帮助 127 名患者 (77.0%) 实现目标。只对 10 名患者 (6.1%) 提出了完整的理疗路径。在实施该模型的过程中，卫生当局没有产生任何额外费用。.该模型促进了社区康复服务的开展，预防了慢性病的加重，满足了非医院环境下人群的健康需求。该模式灵活地克服了医疗护理服务内部缺乏整合的典型问题，促进了就近护理解决方案，以应对人口老龄化和冠状病毒病等健康挑战。.Описать модель семейного и общинного физиотерапевта, целью которой является включение реабилитационных услуг в первичную медико-санитарную помощь в Тоскане, Италия.В 2020–2021 гг. Департамент медицинских профессий местного органа здравоохранения Центральной Тосканы разработал такую модель. Авторы описывают четыре этапа организационной реализации тематического исследования данной модели, а именно: (i) анализ политической и организационной структуры, а также определение меняющихся медико-санитарных потребностей; (ii) модель совместной разработки и обучения многопрофильных медицинских работников (местных врачей общей практики, физиотерапевтов и гериатров); (iii) предоставление и надзор за реабилитационными услугами; (iv) оценка.Во время первоначального осуществления проекта в апреле-декабре 2021 года врачи общей практики направили 165 пациентов со средним возрастом 83,7 года (стандартное отклонение: 11,1) к семейному и общинному физиотерапевту. Меры были в основном осуществлены для пациентов с сопутствующими заболеваниями (64/165; 38,8%), за которыми следовали пациенты с проблемами длительной иммобилизации (36/165; 21,8%). Наиболее частой мерой было консультирование, которое способствовало достижению целей у 127 пациентов (77,0%). Полный путь реабилитации был предложен только 10 пациентам (6,1%). Во время внедрения модели орган здравоохранения не понес никаких дополнительных затрат.Данная модель помогла оказать реабилитационную помощь в местных общинах, предотвратить обострения хронических состояний и удовлетворить потребности населения в охране здоровья в амбулаторных условиях. Эта модель позволила гибко преодолеть типичное отсутствие интеграции в рамках медицинских услуг, содействуя решению вопросов, связанных с обеспечением доступности медицинской помощи, и разрешать такие сложные проблемы в области здравоохранения, как старение населения и коронавирусная болезнь.

The six-minute walking test (6MWT) is a simple and widely used measure of functional capacity. The aim of this systematic review is to summarize findings on reliability of 6MWT in subjects who have had a stroke. Two independent investigators conducted an extensive search in multidisciplinary electronic databases from inception to August 2019, and selected complete original studies on the reliability of the 6MWT used to assess individuals with stroke. Two reviewers independently extracted data and evaluated methodological quality. Outcome for meta-analysis was reliability, measured by intraclass correlation coefficient (ICC). In addition, standard error of measurement (SEM) and minimal detectable change (MDC) were recorded. Of the 241 potentially relevant articles screened, 6 met inclusion criteria and 5 of them were included in meta-analysis. Combined correlation coefficient of .98 (confidence interval .98–.99) was found for test-retest reliability. Only one study investigated inter-rater and intra-rater reliability. SEM and MDC values were rarely reported. The 6MWT has high test-retest reliability, when used to assess individuals with stroke. Other types of reliability and SEM and MDC need further investigations in populations with a stroke.

Some individuals with hemiplegia show a postural disorder called pusher behavior. Various underlying theoretical mechanisms have been proposed, thus leading to various treatment approaches.The aim of this scoping review is to identify and analyze the available evidence on the treatment approaches for pusher behavior.Two independent reviewers conducted a literature search for original studies reporting on treatments for pusher behavior. Studies were searched in PubMed, Scopus, Web of Science, CINAHL and PEDro from their inception to December 2020. Treatment approaches were grouped in homogeneous areas based on the supposed underlying mechanism. To assess the reporting of the interventions, the Template for Intervention Description and Replication (TIDieR) was used.Thirty-one papers describing 45 interventions were included in the review. Most of the studies were case reports (i.e. including 1 person) (n = 16), followed by randomized controlled trials (n = 5), single subject design trials (n = 5), non-randomized controlled trials (n = 3), and case series (i.e. including more than 1 person) (n = 2). Treatment approaches were grouped into five categories: visual feedback, somatosensory cues, visual-somatosensory integration, brain stimulation, and other nonspecific treatments. The median number of TIDIeR items reported was 7 (range 4 to 10).Pusher behavior is still little-known. Five main categories of treatment approaches based on the alleged etiological underlying mechanisms have been identified. Most of studies are case reports; controlled trials should be further conducted. Intervention reporting should be improved to allow treatment replication in larger trials.

Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on “Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin” (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.

To compare the description of interventions defined as "usual care" in control groups with those provided in experimental groups in physiotherapy randomized clinical trials for multiple sclerosis.Two independent reviewers conducted a literature search and study selection from five databases from their inception to February 2021. Randomized clinical trials aimed to physiotherapy multiple sclerosis treatment and providing "usual care" in the control group were included. Intervention reporting was assessed using the TIDieR checklist. Word and reference counts for each group were extracted. The methodological quality was assessed by the PEDro scale.Twenty-four articles were included. The TIDieR total scores, word, and reference count were statistically higher in the experimental group, when compared to the control group (p 0.001). The TIDieR total score is not correlated with PEDro score, word, publication year, or reference counts.Control treatments identified as "usual care" are underdescribed when compared to experimental treatments, affecting the validity, generalizability, and interpretability of results.

Dock tuning is a crucial stage in the rig service life and in the sailing management. Such operation is necessary for safety and structural stability reasons. The applied pretension has the purpose to increase the stiffness of the whole rig, reducing large displacements caused by aerodynamic and inertial loads. Furthermore, since the rig is aimed at supporting sails, its deformation significantly affects aerodynamic performances, so that dock tuning has also a relevant impact on the propulsion, especially in racing. However, the complexity of the problem and the peculiarities of each different system are the causes of the lack of specific dock tuning procedures in rules and guidelines of Classification societies. The present work, developed in collaboration with the Italian shipyard Perini Navi S.p.A., consists in the validation of a dock tuning numerical procedure adopting a Finite Element Method (FEM) applied to a 67 m long mast. A detailed comparison with real-scale experimental results has been carried out, highlighting the importance of a reliable modelling to accurately predict the non-linear behaviour of the structure. Technical guidelines for dock tuning simulation of large rigs are also provided for the first time in open literature, to the best of the authors’ knowledge.

BACKGROUND: Rotator cuff calcific tendinopathy (RCCT) is a very frequent and debilitating disease often treated with Ultrasound-guided percutaneous irrigation (UGPI) followed by physiotherapy. OBJECTIVE: A multicenter observational clinical study was designed to assess the effects of physiotherapy after UGPI on the functional recovery of the shoulders of patients suffering from RCCT. METHOD: One hundred sixty-six patients (mean age 50.7± 7.6 years), 121 women, with painful RCCT were treated with UGPI and assessed at the day of UGPI (T0), and at one (T1), 3 (T2) and 6 (T3) months after treatment by the Constant- Murley Score (CMS), Oxford Shoulder Scale (OSS) and Numerical Rating Scale (NRS). Patients were divided into 2 groups, Physiotherapy (PT+) and not Physiotherapy (PT-) according to the performance of the rehabilitation program based on personal decision. RESULTS: A significant improvement at T1 in all outcomes in both groups and between T1 and T3 for NRS during movement and OSS was found, but not for NRS at rest and CMS. There was no difference between groups for all outcome measures. In 27,1% of patients symptoms recurred in an average of 13 ± 8 weeks. CONCLUSIONS: Results suggest that post-UGPI not-standardized physiotherapy might not provide additional clinical benefits in short and medium term. Further studies could assess the effectiveness of physiotherapy performed after three months in patients with recurrence of pain.

Background Lack of effective peer-review process of predatory journals, resulting in more ambiguity in reporting, language and incomplete descriptions of processes might have an impact on the reliability of PEDro scale. The aim of this investigation was to compare the reliability of the PEDro scale when evaluating the methodological quality of RCTs published in predatory (PJs) and non-predatory (NPJs) journals, to more confidently select interventions appropriate for application to practice. Methods A selected sample of RCTs was independently rated by two raters randomly selected among 11 physical therapists. Reliability of each item of the PEDro scale and the total PEDro score were assessed by Cohen’s kappa statistic and percent of agreement and by Intraclass Correlation Coefficients (ICC) and the Standard Error of Measurement (SEM), respectively. The Chi-square test was used to compare the rate of agreement between PJs and NPJs. Results A total number of 298 RCTs were assessed (119 published in NPJs). Cronbach’s alphas were .704 and .845 for trials published in PJs and NPJs, respectively. Kappa values for individual scale items ranged from .14 to .73 for PJs and from .09 to .70 for NPJs. The ICC was .537 (95% CI .425—.634) and .729 (95% CI .632-.803), and SEM was 1.055 and 0.957 for PJs and NPJs, respectively. Inter-rater reliability in discriminating between studies of moderate to high and low quality was higher for NPJs (k = .57) than for PJs (k = .28). Conclusions Interrater reliability of PEDro score of RCTs published in PJs is lower than that of trials published in NPJs, likely also due to ambiguous language and incomplete reporting. This might make the detection of risk of bias more difficult when selecting interventions appropriate for application to practice or producing secondary literature.

Background To review and meta-analyse the evidence about the prevalence of barriers to evidence-based practice (EBP) reported in physiotherapy. Methods Two independent investigators conducted an extensive electronic search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020 and included the retrieved articles if they investigated barriers to EBP among physiotherapy professionals. Subsequently, they extracted data and assessed the methodological quality using a scale described in a similar previous study. The outcome for meta-analysis was frequency of each reported barrier. Sub-analyses were performed grouping studies based on countries where surveys were performed, classified as either developed or developing countries. Results Twenty-nine articles were included in the systematic reviews and meta-analysis. Risk of bias assessment of included studies showed a median score: 4 points (interquartile range: 3–4). The findings of meta-analysis revealed that lack of time was the most frequently reported barrier (53.0% [95% confidence interval, 95%CI, 44.0–62.0]), followed by language (36.0% [95%CI 16.0–62.0]), lack of access (34.0% [95%CI 23.0.27]) and lack of statistical skills (31.0% [95%CI 20.0–44.0]). Lack of skills and lack of generalizability were declared as barriers by 27.0% [95%CI 18.0–38.0] and 23.0% [95%CI 15.0–33.0] of responders, respectively. Lack of support and lack of interest are less frequent, with 16.0% [95%CI 11.0–24.0] and 9.0% [95%CI 6.0–15.0] of responses, respectively. Barriers reported in investigations performed in developed countries were less frequent when compared to those performed in developing countries. Conclusion Organizational issues and methodological skills seem key issues to allow the implementation of EBP, suggesting the need to adopt or enhance organizational and training strategies to facilitate the implementation of the EBP. Quantitative synthesis showed high heterogeneity for all analyses, and therefore, pooled data should be interpreted with caution.

To study the characteristics of older patients with hip fracture admitted to rehabilitation units in Italy with a specific focus on geriatric syndromes and the rehabilitation process. Of 615 patients included almost half of the patients lived alone before the hip fracture. Most of the falls happened at home. Clinicians identified geriatric syndromes including delirium, dementia, and depression in a significant number of patients. We found a relatively low involvement of the multiprofessional team in the rehabilitation process. This two-year multicenter point prevalence study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the management of geriatric syndromes in this frail population To date in Italy we do not have sufficient information on the rehabilitation process of older patients with hip fractures especially in the context of dementia. The main aims of the study were to gather information on the characteristics of older patients with hip fracture admitted to rehabilitation units with a specific focus on geriatric syndromes and the rehabilitation process. A national multi-center “point prevalence study” was conducted in Italy over two index days in 2017 and 2018. All patients aged 70 years and older hospitalized on the index day in Rehabilitation Units after a hip fracture were eligible. A total of 615 patients were included. Most of the hospitals involved were from northern Italy, to a lesser extent from central and from southern Italy. The mean age was 83.08 ± 7.9 years. Almost half of the patients lived alone before the hip fracture. Most of the falls happened at home and while walking. The prevalence of delirium, dementia and malnutrition was 9.1%, 36.6%, and 19.3%, respectively. Antidepressants were prescribed in 27% of the population. The multidisciplinary team was activated as follows: occupational therapist in 18.9% of the cases, psychologists in 14.5%, social workers in 15.3%, and speech therapists in 6.5%. The study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the correct management of geriatric syndromes in this frail population. Future multicenter longitudinal studies are required to further study this population.

The Oxford Shoulder Instability Score (OSIS) is self-reported outcome measurement developed to evaluate shoulder instability taking into account also adaptive strategies. Valid, reliable, reproducible, and user-friendly translations of outcome measure instruments are needed to allow comparisons of international study results. The Italian translation and cultural adaptation of the OSIS were completed using a “translation–back translation” method and the final version was administered to a sample of 25 consecutive Italian-speaking patients. The psychometric properties of this adaptation were evaluated in terms of feasibility, reliability, construct validity, and responsiveness. No major differences occurred between the OSIS translations into Italian and back into English, and no content- or linguistic-related difficulties were reported. The Cronbach’s alpha for the total OSIS was 0.897. Intraclass correlation coefficient value for inter-rater reliability was 0.805, while for intra-rater reliability was 0.586. Spearman rank correlation coefficient between the OSIS and the Rowe score was 0.548 (p = 0.005) and between OSIS-I and SF-12 was 0.488 (p = 0.013). The Italian version of the OSIS is a reliable, valid, and reproducible outcome measure for clinical evaluation of patients affected by shoulder instability, which remains simple and user-friendly as the original version. Prospective cohort study, Level II. The availability of a validated translation of the OSIS will help surgeon to share their data on shoulder instability diagnostic and treatment in a more reproducible and comparable fashion.

To compare the quality of randomized controlled trials (RCTs) published in predatory and nonpredatory journals in the field of physical therapy.From a list of 18 journals included either on Beall's list (n=9) or in the Directory of Open Access Journals (DOAJ) (n=9), 2 independent assessors extracted all the RCTs published between 2014 and 2017. When journals published more than 40 RCTs, a sample of 40 trials was randomly extracted, preserving the proportions among years. Indexing in PubMed, country of journal publication, and dates of submission or acceptance were also recorded for each journal.The PEDro (Physiotherapy Evidence Database) scale and duration of the peer review.Four hundred ten RCTs were included. The mean PEDro score of articles published in non-Beall, DOAJ journals was higher than those published in Beall journals (mean score ± SD, 5.8±1.7 vs 4.5±1.5; P.001), with the differences increasing when the indexing in PubMed was also considered (6.5±1.5 vs 4.4±1.5; P.001). The peer review duration was significantly longer in non-Beall than in Beall journals (mean duration [d] ± SD, 145.2±92.9 vs 45.4±38.8; P.001) and in journals indexed in PubMed than in nonindexed journals (136.6±100.7 vs 60.4±55.7; P.001). Indexing in PubMed was the strongest independent variable associated with the PEDro score (adjusted RPotentially predatory journals publish lower-quality trials and have a shorter peer review process than non-Beall journals included in the DOAJ database.

Background and aim: In the acute phase of neuropathic pain due to nerve root disorders, the neurodynamic approach proposes the mobilization of the contralateral limb to decrease the pain and increase the range of motion in the affected limb. The aim of this study was to evaluate the effect of the contralateral knee mobilization on the ipsilateral knee extension range of motion in Slump position in healthy adult subjects. Methods: Thirty-eight healthy subjects underwent a placebo, control and experimental manoeuvres that included a passive contralateral knee mobilization into extension. The knee, hip and cervical angles and distance between glabella and femoral condyle achieved in Slump test position were measured with an optoelectronic motion analysis system before and after each manoeuvre. Results: Experimental manoeuvre produced a statistically significant increase of the knee extension ROM when compared to the control (p=.017) and placebo (p=.007) manoeuvres. A significant increase of the hip angle and distance between glabella and femoral condyle was detected after the experimental manoeuvres (p

Background In a clinical science-based profession such as physiotherapy, research is mandatory to update knowledge and to provide cost-effective, high quality treatments. This study aimed to provide point prevalence of Italian physiotherapists who are academics, holding a PhD degree, or being authors of scientific papers. The scientific journal productivity of physiotherapists was also thoroughly analyzed. Methods A descriptive cross-sectional study was carried out on all Italian physiotherapists. Academics, postdoctoral research fellows, and PhD graduates were identified by searching the Italian Ministry of Education, University and Research (MIUR), Italian Society of Physiotherapy, and university websites. Then, authors of articles indexed in Scopus were searched. The following data were extracted: type of affiliation, authorship order, H-index, number of publications and citations, name of journals, year of publication, and journal’s Impact Factor. Results The prevalence of academics, physiotherapists holding a PhD, or being author was 0.01%, 0.05%, and 0.56%, respectively. We identified 1083 papers co-authored by Italian physiotherapists, and their number has progressively increased over the years (p

BACKGROUND The Trunk Impairment Scale (TIS) is a widely-used tool aimed to evaluate trunk motor impairment for stroke patients. A validation trial of a translated form of the TIS was never conducted within an Italian population. AIM To describe translation, cultural adaptation, and validation (internal consistency, reliability, and validity) of the Italian version of the TIS (TIS-I). DESIGN Evaluation of the psychometric properties of a translated, culturally adapted questionnaire. SETTING Inpatient rehabilitation ward. POPULATION Sub-acute stroke patients. METHODS The TIS-I was developed involving forward-backward translation to establish correspondence with the original English latest version. Psychometric testing included internal consistency (Cronbach's alpha) and intra-rater and inter-rater reliability (ICC and Kappa), the standard error of measurement (SEM) and the minimal detectable change (MDC). Concurrent validity was estimated by comparing the TIS-I to the Trunk Control Test, balance subscore of the Fugl-Meyer (FM-BAL) and the mobility section of the Lindmark motor assessment chart (LIND-MOB), and construct validity by comparing the TIS-I to Barthel Index (BI) (Spearman rank correlation coefficient). RESULTS The scale was administered to 41 subjects, showing internal consistency ranged from 0.79 to 0.88. ICC values ranged from 0.725 to 0.933 for inter-rater reliability, with the SEM ranging from 0.52 to 1.11, and from 0.770 to 0.911 for intra-rater reliability, with SEM ranging from 0.52 to 1.64. MDC ranged from 1.44 to 4.55. Kappa values ranged from moderate to almost perfect. Spearman rank correlation coefficient between the TIS-I and the BI, LIND-MOB and FM-BAL was 0.63, 0.79 and 0.74 (P

The aims of this study were to translate and investigate the interrater, test-retest reliability and internal consistency of the functional behavior profile (FBP) in an Italian population with multiple sclerosis. The Italian version of the FBP (FBP-I) was developed and the reliability of the final questionnaire was measured. A sample of 22 persons with clinically diagnosed multiple sclerosis was independently assessed by two raters. Interrater and test-retest reliability of the subscores and of the total score of the FBP-I were good to excellent. The internal consistency of the FBP-I was high. The FBP-I showed good psychometric properties and it can be used to assess functional status in Italian-speaking patients with multiple sclerosis.

Weight saving is crucial in naval architecture to reduce costs and improve performances. In sailing ships design, rig's scantling is important also for ship stability, as rig's weight generates heeling actions on the vessel, due to heeled navigation. Therefore, rig's weight saving remarkably reduces ship's heeling, allowing to increase the wind exposed area, consequently improving the sailing performances. However, because of the complexity of the structure and uncertainties in loading conditions, the structural scantling of a rig implies the adoption of high safety factors. Furthermore, the increasing trend to use composite materials represents an additional source of complexity due to their anisotropic non-homogeneous nature and uncertainties on material properties, and generally implies even larger safety factors, besides implying high construction costs. The present work shows a comparison between an existing 76 m carbon mast and an aluminium alloy one. Suitable FEM models of both rigs were built up and used to assess the structural system strength according to applicable class rules. The cross-section stiffness of the aluminium mast was optimized in order to make masts’ performances comparable. The optimized aluminium mast, of comparable weight of the carbon one, results to be more cost-effective for such range of sailing vessels.

Background Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown. Objective To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia. Methods Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale. Results MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit. Conclusions Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment.

The aim of this study is to describe the reported quality of randomized controlled trials (RCTs) in pediatric physical therapy (PPT) and changes with time. All RCTs sourced from PEDro database and scored using the PEDro scale were included. RCTs were classified as high- or low quality both with the original cut-off of 6 and a modified cut-off of 5. The relationship between PEDro scores and year of publication was also investigated. One thousand three hundred sixty-seven articles were analyzed. According to the PEDro scale original and modified cut-off, 29% and 56% of the articles were classified as high-quality studies, respectively. The number of RCTs and the average PEDro score increased between 1962 and 2012. However, since some items of the scale could be more frequently satisfied, a further improvement of the quality of RCTs in PPT is recommended.

Objective: The aim of this study was to quantify and assess the levels of evidence of research and review articles published in professional Physical and Rehabilitation Medicine journals with international circulations. Design: Quantitative analysis of articles published in Physical and Rehabilitation Medicine journals. Methods: Selected articles from 7 Physical and Rehabilitation Medicine journals, published over a period of 6 years, were classified according to their level of evidence. Differ ences in the mean number of each type of article among journals and among years were analysed. Results: A total of 5,451 articles were included in this study, of which 636 (11.7%) were randomized controlled trials. Articles published with the highest frequency were those classified as Level III (n = 2,424, 44.5%), whereas “systematic reviews” were the least frequent (n = 164, 3.0%). Heterogeneity was found only in terms of distribution over journals. Conclusion: The distribution of different types of article in Physical and Rehabilitation Medicine journals is similar to that in other disciplines. No increase in articles with a high level of evidence was found in the selected journals over the period of study.

Diabetes mellitus (DM) is recognized as an important risk factor for stroke and might theoretically influence post-stroke level of disability, increasing the extension of the cerebral injured area. However, results of the few researches aimed at studying this influence are contradictory; moreover, the effect of DM on motor recovery has not been extensively studied. The aim of this study was to investigate the effect of DM on both functional and motor recovery.A total of 395 acute patients with first stroke were selected in a rehabilitation department and divided into two groups on the basis of the presence or absence of DM (DM+ and DM-, respectively). Outcome measures were the Barthel Index, the Fugl-Meyer Assessment Scale, and the mobility part of the motor assessment chart according to Lindmark and Hamrin. Participants were assessed at admission to department (T1, 13.9+/-7.9 days from stroke onset), at discharge (T2, 40.1+/-13.4), and at follow-up (T3, 84.2+/-14.3). A 2 x 3 analysis of variance with repeated measures was performed to verify the effect of group and of phase of assessment on motor and functional measures and their interaction.DM+ and DM- groups included 93 and 302 patients, respectively. Both groups showed a significant and progressive improvement in all outcome measures (P.001), but no interaction was found between group and phase of assessment, which means that motor and functional recovery was similar in the two groups.Results suggest that diabetes has no influence on motor and functional outcome within the acute and post-acute phase after stroke. Further research should investigate motor recovery in a longer-term period and with larger samples.

Background and Purpose. Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. Method. A case–control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at follow-up, 30–40 days after discharge (T3). Results. GHS was present in 52 patients (48.6%) and correlated significantly to shoulder pain at T1, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R2 = 0.766; p < 0.001). Conclusions. GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia. Copyright © 2006 John Wiley & Sons, Ltd.

Aim:The purpose of this study was to investigate the intra- and inter-rater reliability of the 36-item version of the Token Test.Methods:Twenty-four people following stroke with mild disorder of language comprehension were assessed by two speech therapists at a distance of 2 days apart.Results:The test showed excellent and good inter-rater reliability, while some parts had lower coefficients.Conclusion:This version of the Token Test can be used to assess mild disorder of oral language comprehension. However, further clearer instructions for administration and scoring may improve the test reliability.

Background and objective: haptic cues from fingertip light touch (LT) with a stationary surface reduce postural sway even at non-mechanically supportive force levels. Aim of this study was to determine the effects of LT on postural sway in older compared with younger persons. Subjects: twenty young (age 20–29, mean 23.9 + 2.5) and 20 older participants (age 65–83, mean 74.3 + 6.4). Methods: subjects stood in the semi-tandem position on a firm surface, and their postural sway was quantified using a force platform. Experimental trials, randomised across subjects, included two sight conditions (vision and no vision) and three contact conditions (no touch, NT; light touch, LT; and force touch, FT). The measured parameters were the length and the area of centre of pressure sway (COP-L and COP-A) and the mean velocity of COP displacements in the anterior–posterior (COP-AP) and medial–lateral (COP-ML) direction. Results: for all variables, the analysis showed significant differences between contact conditions, sight conditions and age. Contact–age interaction was significant between NT and LT conditions, with older participants showing greater decrease in postural sway than younger participants, but not between FT and LT conditions. Conclusions: results indicate that the effectiveness of LT in reducing postural sway may be greater in older than in younger persons, perhaps because in older persons haptic cues from upper extremity might counterbalance sub-clinical sensory loss in the lower extremities. This finding supports the hypothesis that older people may sometimes use a walking aid as an informative device and suggests that during balance training external aids should not be used.

Depression is very common following stroke. Correlation between post-stroke depression (PSD) and functional outcome has been shown, but differential impact both on functional and motor recovery has not been deeply investigated. This study evaluates the influence of PSD on motor and functional outcome.One hundred and seventeen acute stroke patients were selected in an intensive rehabilitation department, and divided into two groups according to the presence of PSD (PSD+ and PSD-). Screening measures were DSM-IV criteria, the Geriatric Depression Scale and the Cornell Scale. Outcomes were evaluated on the basis of the Barthel Index (BI) and the Fugl-Meyer Assessment Scale (FMA). Measurements were performed at admission to the department T1), discharge (T2) and follow up (T3) in a whole period of 3 months from stroke.Both groups showed a significant improvement in all outcome measures. Improvement differences were not significant on FMA scores in either group at each assessment; the PSD group had a significant higher improvement on BI score at follow-up. According to the logistic model, from T1 to T2 and from T1 to T3, only motor recovery shows a significant relation with functional recovery; from T2 to T3 PSD is the only significant factor related to functional recovery.PSD is not an influencing factor for motor recovery. Results show a negative impact of PSD on the functional recovery process after discharge and not during hospitalisation. Discharge appears to be critical step for management of PSD.

In universities around the world, physical therapist experts with a scientific background are appointed as professors of physical therapy. In the Italian academia, however, only 2 physical therapists have been appointed as professors in the academic sector known as “Sciences of nursing, rehabilitation and neuropsychiatric techniques” (MED/48).1 A total of 85 university programs of physical therapy are being taught in Italy, and thousands of credits are entrusted to physical therapists—yet most of these therapists are not officially part of the Italian academic world. In 2010, there was an expectation that this situation would change when the Italian Ministry of Education, University and Research (MIUR) introduced a new process for the appointment of Italian university professors.2 The first step of this new process (started in 2012) is national qualification for each scientific sector, with qualification awarded by specific commissions on the basis of the applicant's educational and research productivity. Only researchers who are qualified by one of these commissions are subsequently permitted to participate in the second step for becoming an Italian university professor: a competitive examination issued locally by each university. Italian physical therapists had great hope for this new process, because a growing number of physical therapists in Italy are involved in scientific activities and publish in indexed journals.3 In 2010, …

BACKGROUND Despite some practitioner perception of an inferior outcome in patients with total hip arthroplasty (THA) following hip fracture (HF) vs. osteoarthritis (OA), few studies have analyzed this issue. PURPOSE This cohort study compares characteristics and short-term outcomes in patients with THA following HF and OA during the rehabilitative postsurgical period. METHODS Records of all consecutive patients admitted in a rehabilitation department of a city hospital for THA, following HF or OA, were reviewed. Outcome measures were the Barthel Index, passive range of motion (PROM) for hip flexion and abduction, and length of hospitalization in the rehabilitation department. Participants were assessed at admission to department and at discharge. RESULTS Five hundred seven patients were included (353 in the OA group). The HF group had a longer length of rehabilitation hospital stay and more comorbidity, whereas the OA group had higher functional performances at admission. Both groups improved in all clinical outcome measures with less improvement in PROM abduction scores in the OA group. CONCLUSIONS Patients undergoing traumatic and elective surgery have distinctive clinical characteristics. Results support the idea that OA patient can have a reduced PROM when compared with HF patients.

Objective This case report describes a specific, literature-based physiotherapy treatment and the outcome for a stroke patient with pusher behaviour. Pusher behaviour is characterized by pushing strongly towards the hemiplegic side in all positions and resisting any attempt at passive correction of posture to bring the weight towards or over the midline of the body. Methods The patient was a 71-year-old man with clear pusher behaviour due to a stroke. Therapy for the pushing behaviour was performed over a 3-week period. Motor function, mobility, disability, tone anomalies and pusher behaviour were assessed before and after the study period. Immediate effects of a single training session were assessed by clinical observation. Results and conclusion Immediate effects on the pusher behaviour were observed when using visual and auditory feedback, but not when somatosensory input was used. These results were not maintained to the end of the treatment period. Treatment makes the patient able to use compensatory strategies for functional activities. The long-term effects should be investigated in more depth in the future.

which compared a programme of supervised balance exercise using Nintendo Wii Fit® with no intervention and reporting no sig-nificant differences. Besides author-selected exercises that tar -geted balance, they used a programme for general physical activity, as well as the previous repeated-measures design study performed by Plow et al.

Background and Purpose. The aim of this study was to quantify and assess the types of research and review articles published in physiotherapy professional journals with international circulations. Method. Selected articles from nine physiotherapy journals in a period of five years were classified according to their study design. Results. A total number of 1627 articles were included in this study of which 205 (12.60%) were randomized controlled trial (RCT). Articles published with the highest frequency were ‘observational/descriptive studies’ (n = 305, 18.75%), whereas ‘meta-analyses’ were the rarest ones (n = 21, 1.29%). Many articles were validation studies (n = 216, 13.28%) and articles classified as ‘others’ (n = 217, 13.34%). High heterogeneity was found in terms of distribution over years and journals with an improvement of the number of RCTs among years. Conclusion. The distribution of different types of article in physiotherapy journals is similar to other disciplines. The improvement of RCTs represents an important move in the right direction for evidence-based physiotherapy research. Copyright © 2009 John Wiley & Sons, Ltd.

The aim of this study is to assess the reported quality of randomized controlled trials (RCTs) on the effectiveness of neglect rehabilitation using a standardized scale. A search of seven electronic databases was carried out. Selected articles were scored using the PEDro scale and classified as high or low quality study both with the original cut off of 6 and a modified cut off of 5. A linear regression analysis between year of publication and quality rate was used to test whether the quality of the studies improved with time. A total of 18 RCTs were selected. Six articles (33.3%) and 10 articles (55.56%) were classified as having high quality when the original cut off or the modified cut off of the PEDro scale were used, respectively. Analysis shows no time-related changes in PEDro scores. The results show that reported quality is moderate for RCTs in neglect rehabilitation.