Effects of soft tissue mobilisation on subacute adherent linear scars: a single-group intervention study.

OBJECTIVE: Scar adherence due to a pathological healing process can cause physical and psychological disturbance. Soft tissue mobilisation (STM) techniques are widely used to treat and prevent scar adherence, but little is known on their effects. We aimed to analyse the effect of STM in patients with subacute post-surgical scar adhesions affecting the extremities. METHOD: A single-group quasi-experimental study was conducted on consecutive patients undergoing post-surgery limb rehabilitation. Patients with a baseline Adhesion Severity (AS) index of <0.5 at the worst scar point, as measured by the Adheremeter, were eligible. All patients who completed a minimum of five manual treatment sessions were included. The primary outcome was the AS index and the secondary outcome was the Italian version of the Patient and Observer Scar Assessment Scales (POSAS-I). RESULTS: A cohort of 19 patients underwent an average of eight STM sessions over a period of one month. The AS index value increased from a median of 0.12 at baseline (interquartile range (IQR): 0.05-0.25) to 0.41 post-treatment (IQR: 0.26-0.63; median change: 0.24; IQR: 0.16-0.40; p<0.001). A large effect size was observed for both AS and Observer Scar Assessment Scale (OSAS-I) (Cohen r=0.6), with a large probability of superiority (PS) (87% and 86%, respectively). A moderate effect was observed for the Patient Scar Assessment Scale (PSAS-I) (Cohen=0.4; PS=71%). Pre-post treatment changes exceeded the minimal detectable changes for the AS and OSAS-I in 68% of subjects, and for PSAS-I in 21% of subjects. CONCLUSION: STM manual techniques may produce a large effect on the mobility of adherent subacute post-surgical scars.

Video-based Goniometer Applications for Measuring Knee Joint Angles during Walking in Neurological Patients: A Validity, Reliability and Usability Study.

Easy-to-use evaluation of Range Of Motion (ROM) during walking is necessary to make decisions during neurological rehabilitation programs and during follow-up visits in clinical and remote settings. This study discussed goniometer applications (DrGoniometer and Angles - Video Goniometer) that measure knee joint ROM during walking through smartphone cameras. The primary aim of the study is to test the inter-rater and intra-rater reliability of the collected measurements as well as their concurrent validity with an electro-goniometer. The secondary aim is to evaluate the usability of the two mobile applications. A total of 22 patients with Parkinson's disease (18 males, age 72 (8) years), 22 post-stroke patients (17 males, age 61 (13) years), and as many healthy volunteers (8 males, age 45 (5) years) underwent knee joint ROM evaluations during walking. Clinicians and inexperienced examiners used the two mobile applications to calculate the ROM, and then rated their perceived usability through the System Usability Scale (SUS). Intraclass correlation coefficients (ICC) and correlation coefficients (corr) were calculated. Both applications showed good reliability (ICC > 0.69) and validity (corr > 0.61), and acceptable usability (SUS > 68). Smartphone-based video goniometers could be used to assess the knee ROM during walking in neurological patients, because of their acceptable degree of reliability, validity and usability.

The client satisfaction with device: a Rasch validation of the Arabic version in patients with upper and lower limb amputation.

BACKGROUND: The Client Satisfaction with Devices (CSD) module of the Orthotics and Prosthetics Users' Survey is an extensively used questionnaire that measures patients' satisfaction with orthosis and prosthesis. However, the validated version for Arabic speakers (CSD-Ar) is only applicable for orthosis users. OBJECTIVES: The aim of this study was to evaluate the psychometric proprieties of the CSD-Ar for prosthetics users. METHODS: The study used a convenience sample of prosthesis users from Saudi Arabia and Turkey (N = 183), who completed the CSD-Ar. The collected data were analysed using Rasch analysis to evaluate item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF) using WINSTEPS version 4.6.1. RESULTS: Based on the analysis, the four-response Likert-scale was acceptable, as shown by the category functioning test, All eight items did achieve a fit to the Rasch Model [(infit) and (outfit) mean-square 0.75 to 1.3]. Person separation reliability was 0.76, and item separation reliability was 0.94. A principal component analysis (PCA) showed satisfactory unidimensionality and no local item dependency. The DIF analysis showed no notable dependency among items on participant characteristics in terms of age, gender, duration of use, country, and level of amputation. CONCLUSION: This study contributes to the confidence of using CSD-Ar to evaluate users' satisfaction with different prostheses, affirming the need for further refinement of the quality of the outcome measure.

State of art in intra-articular hip injections of different medications for osteoarthritis: a systematic review.

BACKGROUND: Intra-articular hip injections for osteoarthritis represent a useful instrument to reduce pain and disability in the common clinical practice. Several medications can be injected locally with different level of evidence-based efficacy. OBJECTIVE: The objective of this systematic review is to investigate the effectiveness of intra-articular injections of different medications or substances for the pain treatment and the management of disability in subjects affected by hip osteoarthritis. METHODS: Two reviewers selected independently randomised controlled trials published in the last 10 years, using PubMed and Scopus databases. The risk of bias was evaluated with Cochrane library assessment tool. RESULTS: 12 randomised controlled trials have been selected. We found 8 papers comparing hyaluronic acid with platelet rich plasma, with corticosteroids and with saline solution; 1 paper compares two types of hyaluronic acid with different molecular weights; 3 papers study the effects of corticosteroids alone or compared to ketorolac or saline solution. CONCLUSIONS: The studies reviewed were heterogeneous regarding sample size, level of osteoarthritis, evaluated with Kellegren-Lawrence score, medications used and follow up timings. However, we have observed that intra-articular injections of platelet-rich plasma seem to decrease pain at short term and disability at long term, in patients affected by hip osteoarthritis better than hyaluronic acid. The association of hyaluronic acid and corticosteroids could give better results compared to hyaluronic acid alone, while the use of intra-articular ketorolac and saline solution requires more studies.

Does cycling induced by functional electrical stimulation enhance motor recovery in the subacute phase after stroke? A systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of cycling with functional electrical stimulation on walking, muscle power and tone, balance and activities of daily living in subacute stroke survivors. DATA SOURCES: Ten electronic databases were searched from inception to February 2020. REVIEW METHODS: Inclusion criteria were: subacute stroke survivors (<6 months since stroke), an experimental group performing any type of cycling training with electrical stimulation, alone or in addition to usual care, and a control group performing usual care alone. Two reviewers assessed eligibility, extracted data and analyzed the risks of bias. Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% Confidence Intervals (CI) were estimated using fixed- or random-effects models to evaluate the training effect. RESULTS: Seven randomized controlled trials recruiting a total of 273 stroke survivors were included in the meta-analyses. There was a statistically significant, but not clinically relevant, effect of cycling with electrical stimulation compared to usual care on walking (six studies, SMD [95% CI] = 0.40 [0.13, 0.67]; P = 0.004), capability to maintain a sitting position (three studies, MD [95% CI] = 7.92 [1.01, 14.82]; P = 0.02) and work produced by the paretic leg during pedaling (2 studies, MD [95% CI] = 8.13 [1.03, 15.25]; P = 0.02). No significant between-group differences were found for muscular power, tone, standing balance, and activities of daily living. CONCLUSIONS: Cycling training with functional electrical stimulation cannot be recommended in terms of being better than usual care in subacute stroke survivors. Further investigations are required to confirm these results, to determine the optimal training parameters and to evaluate long-term effects.

Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome.

BACKGROUND: Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen's test and Tinel's sign. METHODS: In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman's (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery. RESULTS: Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p <  0.001) with NCS. The FDT was able to discriminate subjects with severe/extreme NCS findings, and two thresholds (0.29-0.36) were identified. Adding the FDT to the provocative tests improved the overall diagnostic accuracy (specificity: 0.97, CI95% 0.83-0.99; LR+: 14.49, CI95% 2.09-100.53). CONCLUSIONS: Sensorimotor impairments related to CTS can affect hand dexterity. The FDT discriminated patients with severe NCS involvement. Positive results on the clinical battery (Phalen, Tinel, and FDT) could help to confirm the CTS diagnosis, showing a very high specificity and LR+. On the contrary, the low sensitivity is not able to rule out CTS in individuals with negative results.

Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study.

BACKGROUND: Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors. METHODS: Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed. RESULTS: Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy. CONCLUSIONS: Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015, .

Relationship between work fatigue and manual dexterity in dental professionals: observational study.

BACKGROUND: Neuro-muscular fatigue (ANM) in the upper limbs can cause impaired coordination and dexterity. The main purpose of the study was to investigate whether ANM induced by a working day produced a reduction in digital dexterity in a population of dental health workers (OSD). Secondary objective was to investigate whether there were relationships between any reductions in dexterity and independent socio-demographic variables (gender, age and profession). METHODS: A cohort of OSD was assessed before and at the end of a working day of at least 7 hours using the Functional Dexterity Test (FDT). The effects of ANM (time), of the tested limb (dominance), and of their interaction on dexterity were investigated using two-way ANOVA. A multiple linear regression model was applied to explore the relationship between dexterity performance and independent variables. RESULTS: A total of 50 OSDs were included. The net time of the FDT at the end of the day was always higher than in the morning. The ANOVA showed a significant difference for time (p <0.001) and side (p <0.001), but an effect from the interaction between the two factors was not identified (p = 0.428). The worsening of manual dexterity appears to be weakly correlated with age on both sides, and with the profession in the dominant limb. CONCLUSION: The ANM appears to have negatively affected the dexterity of both hands in the sample examined. The results of this study may be useful for planning the OSD's work agenda more carefully.

Predicting Motor and Cognitive Improvement Through Machine Learning Algorithm in Human Subject that Underwent a Rehabilitation Treatment in the Early Stage of Stroke.

BACKGROUND: The objective of this study was to investigate, in subject with stroke, the exact role as prognostic factor of common inflammatory biomarkers and other markers in predicting motor and/or cognitive improvement after rehabilitation treatment from early stage of stroke. METHODS: In this longitudinal cohort study on stroke patients undergoing inpatient rehabilitation, data from 55 participants were analyzed. Functional and clinical data were collected after admission to the rehabilitation unit. Biochemical and hematological parameters were obtained from peripheral venous blood samples on all individuals who participated in the study within 24hours from the admission at the rehabilitative treatment. Data regarding the health status were collected at the end of rehabilitative treatment. First, a feature selection has been performed to estimate the mutual dependence between input and output variables. More specifically, the so called Mutual Information criterion has been exploited. In the second stage of the analysis, the Support Vector Machines (SVMs), a non-probabilistic binary machine learning algorithm widely used for classification and regression, has been used to predict the output of the rehabilitation process. Performances of the linear SVM regression algorithm have been evaluated considering a different number of input features (ranging from 4 to 14). The performance evaluation of the model proposed has been investigated in terms of correlation, Root Mean Square Error (RMSE) and Mean Absolute Deviation Percentage (MADP). RESULTS: Results on the test samples show a good correlation between all the predicted and measured outputs (i.e. T1 Barthel Index (BI), T1 Motor Functional Independence Measure (FIM), T1 Cognitive FIM and T1 Total FIM) ranging from 0.75 to 0.81. While the MADP is high (i.e., 83.96%) for T1 BI, the other predicted responses (i.e., T1 Motor FIM, T1 Cognitive FIM, T1 Total FIM) disclose a smaller MADP of 30%. Accordingly, the RMSE ranges from 4.28 for T1 Cognitive FIM to 22.6 for T1 BI. CONCLUSIONS: In conclusion, the authors developed a new predictive model using SVM regression starting from common inflammatory biomarkers and other ratio markers. The main efforts of our model have been accomplished in regard to the evidence that the type of stroke has not shown itself to be a critical input variable to predict the discharge data, furthermore, among the four selected indicators, Barthel at T1 is the less predictable (MADP > 80%), while it is possible to predict T1 Cognitive FIM with an MADP less than 18%.

Assessment of dexterity and diagnostic accuracy of the Functional Dexterity Test in patients with carpal tunnel syndrome. / Valutazione della destrezza e accuratezza diagnostic del Functional Dexterity Test in soggetti affetti da syndrome del tunnel carpale.

BACKGROUND: The diagnosis of carpal tunnel syndrome (STC) is centered on the symptoms. However, patients also show an impairment of sensorimotor functions, but the relationship between STC and manual dexterity has never been investigated. OBJECTIVES: To analyze the correlation between manual dexterity and severity of the STC. Another objective was the diagnostic accuracy of the clinical battery including provocative tests (Phalen, Tinel) and Functional Dexterity Test (FDT). METHODS: A sample of 80 subjects with suspected STC was subdivided into 4 groups based on EMG (severe/extreme-GrA, moderate-GrB, mild/minimal-GrC, negative-GrD) and evaluated in blind by Phalen, Tinel and FDT. The relationship between the FDT and the allocation of subjects was investigated by Spearman's rho, while the groups were compared with univariate ANOVA and Tukey's post hoc analysis. Diagnostic accuracy of the clinical battery was expressed by sensitivity, specificity, and likelihood ratios (LR). RESULTS: A moderate (r=0.48, p minor of 0.001) correlation was found between FDT and the 4 groups. ANOVA has returned a significant difference between GrA vs. all others and between GrB vs. GrD. The battery showed a sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of 70%, 94%, 11.98 and 0.31 respectively. CONCLUSIONS: The results of this study supported the hypothesis that STC patients also have a dexterity impairment. The FDT was able to discriminate between three levels of severity (negative, mild to moderate, severe to extreme), maintaining a good level of diagnostic accuracy in addition to provocative tests.

Rasch analysis of the Italian Lower Extremity Functional Scale: insights on dimensionality and suggestions for an improved 15-item version.

OBJECTIVE: To investigate dimensionality and the measurement properties of the Italian Lower Extremity Functional Scale using both classical test theory and Rasch analysis methods, and to provide insights for an improved version of the questionnaire. DESIGN: Rasch analysis of individual patient data. SETTING: Rehabilitation centre. PARTICIPANTS: A total of 135 patients with musculoskeletal diseases of the lower limb. RESULTS: Patients were assessed with the Lower Extremity Functional Scale before and after the rehabilitation. Rasch analysis showed some problems related to rating scale category functioning, items fit, and items redundancy. After an iterative process, which resulted in the reduction of rating scale categories from 5 to 4, and in the deletion of 5 items, the psychometric properties of the Italian Lower Extremity Functional Scale improved. The retained 15 items with a 4-level response format fitted the Rasch model (internal construct validity), and demonstrated unidimensionality and good reliability indices (person-separation reliability 0.92; Cronbach's alpha 0.94). Then, the analysis showed differential item functioning for six of the retained items. The sensitivity to change of the Italian 15-item Lower Extremity Functional Scale was nearly equal to the one of the original version (effect size: 0.93 and 0.98; standardized response mean: 1.20 and 1.28, respectively for the 15-item and 20-item versions). CONCLUSION: The Italian Lower Extremity Functional Scale had unsatisfactory measurement properties. However, removing five items and simplifying the scoring from 5 to 4 levels resulted in a more valid measure with good reliability and sensitivity to change.

A simple orthosis solves a problem in a patient with a dystonic finger after stroke.

These authors use a custom-fabricated orthotic device to improve hand motion and function for a client with hand dystonia after stroke. Clinical observation and reasoning resulted in an effective solution to control the dystonia that was acceptable to the client. - Kristin Valdes, OTD, OT, CHT, Practice Forum Editor.

Cross-cultural adaptation, reproducibility and validation of the Italian version of the Patient and Observer Scar Assessment Scale (POSAS).

The Patient and Observer Scar Assessment Scale (POSAS) is one of the most robust instruments to assess scar quality, but there is no Italian version, and no other competing instruments are available in Italian. The aim of this study was to translate and validate an Italian version of POSAS (POSAS-I). POSASv2.0 was culturally adapted in accordance with international standards. The psychometric assessment included acceptability/feasibility, internal consistency, reproducibility, construct validity and sensitivity to change. Cultural equivalence of POSAS-I with the English version was confirmed. The validation study included 102 subjects with surgical scars. Both subscales demonstrated acceptable internal consistency (Cronbach's α = 0·72-0·80). Reproducibility of the OSAS-I (ICCs = 0·93-0·94; SEM = 1·8 points; MDC95 = 5·1 points) was superior to that of PSAS-I (ICC = 0·65; SEM = 5·7 points; MDC95 = 15·7 points). OSAS-I showed moderate to good correlations with the Vancouver Scar Scale (VSS), Global Rating of Change Scale (GRCS) and PSAS-I. Sensitivity to change was large for PSAS-I (effect size = 1·08; standardised response mean = 0·96) and moderate to large for OSAS-I (ES = 0·69; SRM = 0·92). This study confirmed that POSAS-I can be used to assess patients with surgical scars in the Italian population. OSAS-I is useful for clinical and research purposes, while PSAS-I should be better used to capture patients' own opinions and symptoms in clinical settings.

[Case report: Iatrogenic shoulder pain syndrome following spinal accessory nerve injury during lateral cervical neck dissection for tongue cancer: the role of rehabilitation and ethical-deontological issues]. / Caso clinico di sindrome della spalla dolorosa post lesione iatrogena del nervo accessorio spinale in seguito a svuotamento latero-cervicale del collo per carcinoma della lingua: ruolo della riabilitazione e aspetti etico-deontologici.

The shoulder pain syndrome is the most frequent complication of lateral cervical neck dissection and may be caused by iatrogenic injury to the spinal accessory nerve, causing pain and functional limitation of the upper limb and of the cervical spine. Interdisciplinary collaboration and early rehabilitation can reduce the consequences of disability and the possible issues that can arise due to inadequate management of the problem.

[Short-term and medium-term efficacy of mesotherapy in patients with lower back pain due to spondyloarthrosis]. / Efficacia della mesoterapia a breve e medio termine in pazienti affetti da lombalgia muscolotensiva da spondilartrosi.

Mesotherapy is an intradermal treatment for patients with local pain. The literature describes the efficacy of mesotherapy in the treatment of musculoskeletal disorders measuring a reduction of analgesic drug intake and of healthcare spending. The aim of this study was to measure the effects of mesotherapy on pain and disability in patients with low back pain due to spondyloarthrosis.

[Conservative treatment of tendinopathies of upper limbs in occupational health: a literature review]. / Trattamenti conservative nelle tendinopatie agli arti superiori in ambito occupazioinale: revision narrative.

BACKGROUND: In the last few years, the incidence of upper limbs tendon injuries has seen a dramatic increase among workers. Conservative treatment is the first choice to relieve symptoms, allowing a safe return to work. However, the scientific evidence of its  efficacy is widely debated. OBJECTIVE AND METHODS: Research and literature review on the efficacy of conservative treatment of upper limbs tendon injuries in occupational settings. RESULTS: A total of 271 references were found on Medline and Embase up to May 2015. 116 papers were excluded, 155 articles were included and the full text read. CONCLUSIONS: After a timely diagnosis, a prompt start of the rehabilitation programme and a limitation of complete rest are useful to relieve pain, increase functionality and reduce work absenteeism in the long term. Conservative treatment combinations, such as manual therapy, specific exercises focused on increasing flexibility and muscle strength and specific-gesture training, achieves more significant results than a single isolated treatments. Currently, there is no strong scientific evidence to support prolotherapy and Platelet-Rich Plasma (PRP). However, current promising results will encourage further studies. Awareness among both employers and employees about prevention and risk factors should be enhanced.

Classical test theory and Rasch analysis validation of the Upper Limb Functional Index in subjects with upper limb musculoskeletal disorders.

OBJECTIVE: To perform a comprehensive analysis of the psychometric properties and dimensionality of the Upper Limb Functional Index (ULFI) using both classical test theory and Rasch analysis (RA). DESIGN: Prospective, single-group observational design. SETTING: Freestanding rehabilitation center. PARTICIPANTS: Convenience sample of Italian-speaking subjects with upper limb musculoskeletal disorders (N=174). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Italian version of the ULFI. Data were analyzed using parallel analysis, exploratory factor analysis, and RA for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices. RESULTS: Parallel analysis revealed 2 factors explaining 32.5% and 10.7% of the response variance. RA confirmed the failure of the unidimensionality assumption, and 6 items out of the 25 misfitted the Rasch model. When the analysis was rerun excluding the misfitting items, the scale showed acceptable fit values, loading meaningfully to a single factor. Item separation reliability and person separation reliability were .98 and .89, respectively. Cronbach alpha was .92. CONCLUSIONS: RA revealed weakness of the scale concerning dimensionality and internal construct validity. However, a set of 19 ULFI items defined through the statistical process demonstrated a unidimensional structure, good psychometric properties, and clinical meaningfulness. These findings represent a useful starting point for further analyses of the tool (based on modern psychometric approaches and confirmatory factor analysis) in larger samples, including different patient populations and nationalities.