Spinal Orthosis in Adolescent Idiopathic Scoliosis: An Overview of the Braces Provided by the National Health Service in Italy.

Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the most common form of scoliosis in the pediatric population. The etiology is multifactorial, including genetic and environmental factors. The incidence is roughly equal between males and females, while there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we carried out a review of the scientific literature about the indication and success rates of the braces provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment is present in the scientific literature, demonstrating a high degree of variability. The overall success rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.

Quantum Medicine: A Role of Extremely Low-Frequency Magnetic Fields in the Management of Chronic Pain.

Extremely low-frequency electromagnetic field (ELF-MF) therapy is a promising treatment for chronic pain, given its ability to interact with body homeostasis using water-mediated transmission mechanisms typical of quantum medicine. The present study aims to assess the effects of ELF-MF therapy on chronic pain in 49 patients suffering from various musculoskeletal disorders. The therapy was applied through a Quec Phisis setup generating the electromagnetic field as the ion cyclotronic resonance. Patients underwent eight therapy sessions of 45 min each performed every other day. The bioimpedance assessment was based on the comparison of the height-adjusted body resistance (R/h) and reactance (Xc/h) measured during the first and last sessions of eight-session treatment. Pain perception was quantified using the standard visual-analog scale. We found significant increases in both R/h and Xc/h parameters of body bioimpedance after electromagnetic therapy corresponding with reductions in pain perception. We conclude that the ELF-MF therapy can restore the body's state of health and thus seems a valid therapeutic approach for the treatment of musculoskeletal-derived pain.

Capacitive and Resistive Electric Transfer Therapy: A Comparison of Operating Methods in Non-specific Chronic Low Back Pain.

Capacitive and resistive electric transfer (TECAR) modes of therapy use radiant energy to generate endogenous heat and are used for musculoskeletal disorders for their analgesic, decontracting, and elasticizing properties. While the capacitive mode is supposed to interact with soft tissues, the resistive mode interacts more with hard tissues. This study aims to investigate whether the successive order of the two modes during their application could make a difference concerning the outcome. The study included 40 patients affected by chronic non-specific low back pain. Patients were assessed using algometry, before and immediately after the therapeutic intervention, and thermal imaging, before, immediately after, and then 30 and 60 min after the intervention. Each patient had two TECAR interventions on different days of a total of 20 min each, with a resistive followed by capacitive mode and conversely, capacitive followed by resistive mode. The capacitive mode alternated with the resistive mode by 10 min during either intervention. Results showed that the effects consisting of temporary increases in the superficial temperature of the lower back and pressure pain threshold were alike for both interventions. We conclude that TECAR therapy reduces low back pain regardless of the operative mode adopted, with only an insignificant advantage when starting the sequence from the resistive application.

Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study.

The oculomotor system plays an important role in the development of migraines. This is an observational study that aims to investigate the rehabilitative efficacy of muscle energy therapy (MET) in reducing migraine symptoms. MET was based on post-isometric relaxation and reciprocal inhibition, targeting the extraocular muscles. Patients diagnosed with chronic migraines and positive results in the Smooth Pursuit Eye Movement Test were enrolled in the study. The effects of treatment were assessed using the following questionnaires: Migraine Disability Assessment (MIDAS), Neck Disability Index (NDI), Pittsburg Sleep Quality Index (PSQI), Dizziness Handicap Inventory (DHI), and the neck range of motion (ROM). Additionally, rheological parameters of neck muscles were assessed. We reported beneficial effects of MET on the amelioration of the frequency of headaches, neck pain and dizziness-related disabilities and disordered sleep. However, benefits concerning the neck motion and rheological properties of oculomotor structures were unconvincing. In conclusion, the study showed advantageous effects of manual oculomotor therapy consisting of reductions in migraine-related painful symptomatology. The results diminish the role of ocular muscle mechanical properties in the genesis of migraine, shifting attention to the modulatory role of the neuromuscular ocular component, likely involving trigeminal innervation, which can be subject to migraine manual therapy.

Manual Pressure Release and Low-Grade Electrical Peripheral Receptor Stimulation in Nonspecific Low Back Pain: A Randomized Controlled Trial.

Chronic nonspecific low back pain is a frequent clinical condition affecting the general population and influencing disability level and quality of life. We performed a single-blinded, randomized, and controlled study to compare the effectiveness of manual pressure release (MPR) and electrical neuromodulation (ENM) treatments in the management of chronic low back pain. There were 20 patients with chronic low back pain randomly assigned to 6 treatment sessions with either technique. Both groups were treated for 2 days a week for 3 weeks. Myofascial trigger points (MTrPs) were identified and skin conductance, pressure-pain threshold, postural changes, and the Oswestry Disability Index were assessed before and after each treatment session, along with the protocol-end data compared against the baseline data in each group. We found an outstanding and about equal deactivation of MTrPs from pre- to post-treatment in both groups, reducing disability in patients with chronic low back pain. The study highlights the ENM as a reliable tool for the evaluation of MTrPs, given a high agreement with the MPR. The effect on the neuromuscular condition of treating the "key trigger points" found in this study advances the knowledge of medical rehabilitation.

Integrated Thermal Rehabilitation: A New Therapeutic Approach for Disabilities.

A mutual link between somatic and visceral neural pathways is known in medicine. This study addresses therapeutic effectiveness of an integrated rehabilitative approach of thermal aquatic environment, combined with neuromuscular manual stimulation, on activation of afferent sensory visceral and somatic efferent neuronal motor pathways in different pathologies of neuromuscular motor and respiratory systems. The study included 63 patients subjected to a protocol consisting of hydroponic treatment, hydrokinesitherapy associated with ozonized vascular pathway, and mud therapy associated with cardiorespiratory treatment performed in aquatic environment and aided by neuromuscular manual therapy. The therapeutic protocol consisted of rehabilitation sessions 5 days a week for 2 months. The outcome measures were spirometry tests and the following evaluation instruments: Tinetti Gait and Balance assessment scale, Functional Independence Measurement, visual analogue scale, and the EQ-5D-5 L instrument. The tests were applied before and after the protocol completion. The findings demonstrate a general increase in patients' everyday living autonomy and quality of life, with a particular improvement in respiratory function tests. We conclude that the integrated thermal approach holds promise in therapeutic rehabilitation of disabilities.

Rehabilitation of Neuromotor Disabilities in Aquatic Microgravity Environment.

The aquatic environment has a high potential in rehabilitation treatment of acute lesions and in chronic diseases. The Safe Bearing Back method is proposed to stimulate the reorganization of deteriorated sensory neuromotor skills. The aim of the present study was to verify the effectiveness and the long-term maintenance of the benefits of a specific thermal rehabilitation training in neuromotor and neurological disabilities. Seventy four patients were evaluated using the Functional Independence Measure (FIM), Tinetti Gait-Balance Scale (TIN), and Visual Analog Scale (VAS) for pain. In addition, a general health index was developed, conceived as a linear combination, with unit weights, of the normalized FIM, TIN, and VAS indicators. Measurements were made at T1 (baseline before treatment), T2 (after a five-month treatment, which was the end of treatment), and T3 (6 months after the end of treatment). Self-sufficiency, walking ability, and subjective pain perception were improved after the treatment. The improvement tapered off during the six-month-long follow-up, but the patients' condition remained well compared with the baseline level before the implementation of the treatment program. We conclude that hydrokinesitherapy with the Safe Bearing Back method demonstrates is clearly effective in the immediate and medium-term rehabilitation of neuromotor diseases.

Integrated Rehabilitation Approach with Manual and Mechanic-Acoustic Vibration Therapies for Urinary Incontinence.

This study aims to verify whether an integrated rehabilitation protocol comprising neuromuscular manual therapy and focused mechanical-acoustic vibrations can significantly reduce pelvic floor dysfunctions in women affected by stress, urge, or mixed urinary incontinence. Sixty-two women were treated with a combination of neuromuscular manual therapy and mechanical-acoustic vibrations at the level of superficial pelvic floor muscle groups. The results were analyzed before the beginning and after the end of the study protocol with the myometric measuring device MyotonPRO, the Pelvic Floor Disability Index (PFDI-20), and the Pelvic Floor Impact Questionnaire (PFIQ-7). Two patients withdrew from the study after the first visit. The 60 remaining patients showed significant improvements of myometric parameters, with the percentage variations ranging from +8.5% to +20.7% for the muscle logarithmic decrement, from -11.2 to -13.9% for muscle frequency, and from -4.8% to -12.3% for muscle stiffness. There has been a reduction of 56% in the perceived disability induced by urinary incontinence, measured with the PFDI-20, and 43% reduction in the impact of the problem on daily living, measured with the PFIQ-7. We conclude that a combination of neuromuscular manual therapy and mechanical-acoustic vibrations effectively reduces pelvic symptoms in patients affected by urinary incontinence, with minimal invasiveness.

Bioprogressive Paradigm in Physiotherapeutic and Antiaging Strategies: A Review.

This review updates the knowledge on the use of bioprogressive philosophy in current rehabilitation paradigms, focusing on age-related ailments and antiaging strategies. It is a holistic approach that combines aspects of biology and function into the realm of rehabilitation therapy. The bioprogressive philosophy, with assistance of modern technological developments, such as microgravity-producing devices and techniques, enables personalized and targeted therapeutic approach that seems the most effective in rehabilitation and prevention of neuro-myo-sensory disorders that compromise the homeostatic body harmony, particularly in old age. The review defines the aging, discusses the most common physical dysfunctions, linked to posture, balance, or gait, and gives cues to modern antiaging rehabilitative approaches. The emphasis is put on the proprio-neuromuscular facilitation, a combination of stretch technique that steps into the bioprogressive approach, as currently the best method in the world of physical rehabilitation.

Effects of Manual Somatic Stimulation on the Autonomic Nervous System and Posture.

Low back pain frequently involves a multifactorial etiology and requires medical attention. The aim of the study was to assess the associations among pain, posture, and autonomic nervous system function in patients with low back pain, using neuromuscular manual therapy versus a generic peripheral manual stimulation (back massage therapy). Twenty young patients with low back pain were enrolled into the study. The patients were randomly divided into two groups: treated with neuromuscular manual therapy performed after a specific structural evaluation and treated with back massage therapy. Both groups performed eight sessions of 30 min each, once a week for two months. There were three main time points of the assessment: during the first, the fourth, and the last eighth session. In each of these three sessions, data were collected before onset of session (baseline), 5 min from onset, at end of session, and 5 min after the end. All patients were subjected to stabilometric evaluation and were assessed on a visual analogue scale to quantify postural and pain changes. Tabletop capnography and pulse oximetry were used to monitor autonomic changes. The findings were that the improvement in posture and pain reduction were appreciably better in patients subjected to neuromuscular manual therapy than in those subjected to back massage therapy, with a comparable autonomic response in both groups. In conclusion, the study demonstrates that posture modification was significantly more advantageous in patient treated with neuromuscular manual therapy.

Preoperative Rehabilitation in Lung Cancer Patients: Yoga Approach.

Lung cancer is one of the leading causes of cancer death worldwide. Surgical removal remains the best option for most tumors of this type. Reduction of cigarette consumption in patients with lung cancer candidates for the surgery could limit the impact of tobacco on postsurgical outcomes. Breathing exercises appear to help combat cigarette cravings. Yoga exercise benefits have been studied in lung cancer survivors, rather than in the preoperative setting. In this study, we have recruited 32 active smokers affected by lung cancer and being candidates for pulmonary surgery. The patients were randomly assigned to two groups: one treated by standard breathing and the other treated by yoga breathing (YB). The groups were evaluated at times T0 (baseline) and T1 (after 7 days of treatment) to compare the effects of the two breathing treatments on pulmonary performance in a presurgery setting. Pulmonary and cardiocirculatory functions have been tested using a self-calibrating computerized spirometer and a portable pulse oximetry device. The findings demonstrate appreciable short-term improvement in lung function assessed by spirometry. We conclude that yoga breathing can be a beneficial preoperative support for thoracic surgery.

Effect of combined treatment with focused mechano-acoustic vibration and pharmacological therapy on bone mineral density and muscle strength in post-menopausal women.

INTRODUCTION: Osteoporosis is a systemic disease of the skeleton characterized by a reduction in bone mass and alterations in microarchitecture accompanied by increase in fracture risk, with a relevant decline in quality of life and important social, economic, and health implications, representing one of the most common causes of disability and a major financial item of health cost in many Countries. The best therapy for osteoporosis is prevention, consisting in measures to avoid or slow the onset of the disease. Treatment includes measures aimed at osteoporotic individuals, with or without previous fractures and a high risk of a first or additional fracture. METHOD: We enrolled thirty post-menopausal osteoporotic women, allocated in the first group underwent a 6-month personalized drug therapy and focused mechanoacoustic vibration (2 sessions per week, each lasting 15 minutes); women allocated in the second group underwent only 6-month personalized drug therapy. Patients were evaluated performing dual-energy X-ray absorptiometry (DXA) and isokinetic machine evaluation, and administration of Tinetti scale and ECOS-16 questionnaire. RESULT: Show improvement of bone mineral density (BMD) and T-score at the lumbar spine and femoral neck, handgrip strength and isokinetic strength of the knee estensors, balance and gait, and quality of life. CONCLUSION: Hence, the combined treatment with focused mechano-acoustic vibration and pharmacological therapy has a beneficial effect on BMD and T-score as well as on the muscle strength and quality of life of osteoporotic subjects.

Integrated Thermal Rehabilitation Care: An Intervention Study.

BACKGROUND: The aim of this study was to evaluate the effects of integrated thermal rehabilitation care (ITRC) on postural balance and health-related quality of life in subjects with basic autonomy. MATERIALS AND METHODS: From June to December 2021, a total of 50 individuals with six points on the Katz Index of Independence in Activities of Daily Living (ADL) and a mean age of 66 (DS ± 12), comprising 27 (54%) males and 23 (46%) females, were selected. This study was carried out at the Thermal Medical Center of Castelnuovo della Daunia (Foggia, Italy), which operates within the National Health Service. The outcome measures were baropodometry (static exam, dynamic exam, and stabilometric exam), a biometric evaluation system, and the EuroQol 5-Dimension (EQ-5D-5L). RESULTS: Statistical analysis of the data showed how balance affected postural control and how ITRC was able to reduce the body's imbalance and improve quality of life. The vertical angles in frontal projection displayed an increment in the values (head/shoulder, p = 0.009; head/pelvis, p = 0.001; right hip/knee, p = 0.01; right hip/ankle, p = 0.008). In a dynamic analysis, the podalic weight percentage was shown to have a reduction in imbalance on both sides (left side, p = 0.01; right side, p = 0. 01). EQ-5D-5L showed a statistically significant improvement in quality of life and perception of quality of life. Indeed, the health status score improved in all items and in the total rate of the EQ index. In all subjects, walking motility (p = 0.005), self-care (p = 0.002), and habitual activity (p = 0.002) showed statistically significant increments in their values. Pain/discomfort (p = 0.001) and anxiety (p = 0.006) were also reduced. In addition, there was a statistically significant increment in the Visual Analogue Scale (VAS) score (p = 0.001) for life perception. CONCLUSIONS: The ITRC approach showed how small adjustments and postural rebalancing led to a significant improvement in quality of life. ITRC can be considered an effective treatment with good tolerability for a variety of musculoskeletal disorders.

Combined ultrasound guided peritendinous hyaluronic acid (500-730 Kda) injection with extracorporeal shock waves therapy vs. extracorporeal shock waves therapy-only in the treatment of shoulder pain due to rotator cuff tendinopathy. A randomized clinical trial.

BACKGROUND: Rotator cuff tendinopathy (RCTe) is the most common cause of pain and shoulder dysfunction. Numerous clinical studies have demonstrated the therapeutic capacity of exogenous peritendinous hyaluronic acid (HA), and the effectiveness of extracorporeal shockwaves therapy (ESWT) in reducing pain. The aim of this study was to evaluate the added effects of HA treatment plus ESWT (E-g) or ESWT alone (SC-g), focusing on reduction of self-reported pain and disability of patients with RCTe. METHODS: Monocentric, randomized open-label clinical trial. Patients' selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility (Lecce, Italy). Patients with a diagnosis of RCTe, were randomly allocated to the E-g or to the SC-g. Participants were assessed for self-perceived pain, and for disability, at baseline, after 30 and 60 days. RESULTS: Forty adults (mean age 50.8±6.3; 23 woman, 17 men) were enrolled in the study, twenty for each group. During the study, both groups improved their perceived level of disability of the arm (-25.01±2.79; P<0.001), and for pain (-3.13±0.50; P<0.001). A multiplicative effect was demonstrated in the time × treatment interaction for disability (beta±SE beta: 7.40±1.77; P<0.001), and pain (beta±SE beta: 0.95±0.32; P<0.001). Moreover, more patients in the E-g reached the MCID in the outcomes-score compared to SC-g. Lastly, number needed to treat were calculated, for disability: NNT=2 (95% CI: 1-3), and for pain-score: NNT=1 (95% CI: 1-2). CONCLUSIONS: This study provides preliminary evidence that, compared to ESWT alone, the combining ESWT and peritendinous HA-injections, revert disability and reduces shoulder pain faster in patients with RCTe.

Ankle-Brachial Index and Arterial Stiffness, Modulate the Exertional Capacity of High-Frequency Training Athletes.

Ankle-brachial index and arterial stiffness are associated with leg function in the elderly and in patients with peripheral arterial disease. Little is known about the meaning of these parameters in young and trained subjects and how they are related to physical performance. The main objective was to evaluate the mediating role of arterial stiffness and ankle-brachial index in physical performance. In a cross-sectional, case-control study, 240 male athletes were consecutively enrolled from the Laboratory of Cardiology and Sports Medicine, "G. d'Annunzio" University (Italy). All the subjects underwent the examination protocol for the annual medical evaluation for sport participation. Soccer (football) players compared to runners showed a lower level of ankle-brachial index, higher arterial stiffness, and lower systolic and diastolic blood pressure. In the treadmill stress test, soccer players compared to runners showed a greater maximal aerobic capacity. Differences in cardiovascular performance between soccer players and runners were mediated by better arterial stiffness and low level of ankle-brachial index; the estimated effect was 0.11 ± 0.05 and 0.24 ± 0.06, respectively. Vigorous strength training drops blood pressure and increases arterial stiffness. Taken together, our findings would seem to suggest that ABI and CAVI could be used as markers for athletes' performance.

Efficacy of Ultrasound-Guided Percutaneous Lavage and Biocompatible Electrical Neurostimulation, in Calcific Rotator Cuff Tendinopathy and Shoulder Pain, A Prospective Pilot Study.

Calcific tendinopathy of the shoulder (CTS) is the most common cause of shoulder pain. Conservative treatment is considered as the first therapeutic choice for CTS. The main objective of this study was to assess the effect of US-guided needling (UGN) compared to UGN plus Biocompatible Electrical Neurostimulation (BEN) in the treatment of the CTS. Pilot, prospective, non-interventional, monocentric, and observational study of patients treated for calcific rotator cuff tendinopathy and shoulder pain. Patients' selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility. Forty adult patients (aged 40−60 years) with a diagnosis of CTS in the acute and colliquative phase were recruited and enrolled into the study. Participants were assessed for self-perceived pain through the Numerical Rating Scale (NRS), and for functional limitation through the Shoulder Pain and Disability Index score (SPADI) at baseline (T0), after 15 days (T1), and after 40 days (T2). As a possible confounding factor between the two treatments' response, the dimension of the tendon calcification was also assessed by US-examination. Through the study, both groups improved their perceived functional performance of the arm (p-value < 0.001). AT T1, the SPADI score decreased by half in both groups, and the improvement remained stable at T2. A multiplicative effect (Time × Treatment) was demonstrated (p-value < 0.001). An improvement in the NRS score was measured at T1, and it remained stable at T2, a multiplicative effect was also reported (p-value < 0.001). The main results of this pilot study provide evidence that UGN plus BEN increases functional performance and reduces shoulder pain in individuals with CTS. Moreover, the tendon calcification dimension at the baseline and the percentage of drainage of the lesion were associated with a functional performance recovery and pain reduction detected after intervention.

An Observational Cross-Sectional Study of Gender and Disability as Determinants of Person-Centered Medicine in Botulinum Neurotoxin Treatment of Upper Motoneuron Syndrome.

The motor behaviour of patients with Upper Motor Neuron Syndrome (UMNS) is characterised by spasticity. The first-line treatment for this clinical condition is Botulinum neurotoxin A (BoNTA), but the number and key locations of muscles which need to be treated is not much discussed in the literature. Cross-sectional analysis of outpatient cohort with UMNS spasticity, who were potential candidates for BoNTA treatment, was performed. Between November 2020 and November 2021, all consecutive adult patients eligible for BoNTA treatment were enrolled. The inclusion criteria encompass UMNS spasticity (onset being ≥6 months), with disabling muscles hypertonia. Patients underwent a clinical evaluation, a comprehensive assessment with the Modified Ashworth Scale, with the Modified Rankin Scale, and a patients' perception-centred questionnaire. In total, 68 participants were enrolled in the study, among them 40 (58.8%) were male; mean age 57.9 ± 15.1. In women, BoNTA was more frequently required for adductor group muscles, independently from potential confounders (OR = 7.03, 95%CI: 1.90-25.97). According to the pattern of disability, patients with hemiparesis more frequently need to be treated in the upper limb, whereas the diplegia/double-hemiparesis group needed to be treated more frequently at the adductor and crux muscles compared to their counterparts. UMNS spasticity in women could require more attention to be paid to the treatment of adductor muscle spasticity, potentially because the dysfunction of those muscles could influence sphincteric management, required for perineal hygiene and/or sexual life.

Bio-Physics Approach to Urinary Incontinence Disabilities.

BACKGROUND: The terminology of urinary incontinence (UI) and pelvic floor dysfunctions is complex. It affects quality of life and daily activities in personal, social, and professional fields. Managing UI without pharmacologic therapies is effective with a low risk of adverse effects and a large benefit for increasing continence rates. The aim of this preliminary retrospective observational study is to evaluate the effectiveness of the association between manual therapy and focused mechano-acoustic vibrations in women with nonspecific UI. MATERIALS AND METHODS: A group of 15 incontinent women (mean age 59.5 ± 11.4), referred to the Physiotherapy Center, Rehabilitation and Re-education (Ce.Fi.R.R.), located at the University "Gabriele d'Annunzio" of Chieti-Pescara from January 2019 December 2021, were enrolled after medical examination. The women were evaluated at T0 (admission protocol), T1 (after 8 weeks), and T2 (after 12 weeks). All patients received the rehabilitation protocol twice a week for a total of 8 weeks (T1) and were reevaluated after 12 weeks (T2). Outcome measures were: the Pelvic Floor Disability Index, the Pelvic Floor Impact Questionnaire-7, and the MyotonPRO. RESULTS: The analysis of MyotonPRO data showed no significant improvements in all parameters. The PFDI-20 and PFIQ-7 questionnaire results showed a significant reduction in scores between T0 and T2.Results over time of the ANOVA values confirming the significant differences in the PFDI-20 and PFIQ-7 questionnaire results but not in the MyotonPRO variables. CONCLUSIONS: Despite limitations and no significant results, this study demonstrated that the integration of manual and focused mechano-acoustic vibrations therapy improved the symptoms of UI and reduced its psychosocial impact. Further experience could be required to establish the place of this integrated approach in achieving long-term improvements in UI.

Thyroid hormone signaling is associated with physical performance, muscle mass, and strength in a cohort of oldest-old: results from the Mugello study.

Thyroid hormones (THs) play a crucial role in the homeostasis of muscle function, such as myogenesis and energy metabolism, suggesting that the thyroid may be also involved in the entropic processes of muscle aging. The aim of the present study is to evaluate the effect of TH signaling on physical performance, muscle mass, and strength in a cohort of community-dwelling oldest-old subjects (> 90 years). The study population was selected in a rural area of central Italy (Mugello, Tuscany), and the design was cross-sectional. Four hundred seventy-five subjects (130 males and 345 females) were enrolled, representing about 65% of all the nonagenarians living in the Mugello area. After adjusting for multiple confounding factors (sex, age, diabetes, and levothyroxine administration), the lowest quartile of FT3/FT4 ratio distribution showed lower physical performance compared to the other quartiles (ß ± SE: - 0.49 ± 0.12; p < 0.001), whereas the highest quartile of FT3/FT4 ratio was associated with higher skeletal muscle index (ß ± SE: 1.11 ± 0.42; p = 0.009). In addition, the lowest quartile of FT4 showed a statistically significant higher handgrip strength (ß ± SE: 1.78 ± 0.68; p = 0.009) compared to all other quartiles. This study demonstrates that nonagenarians with higher FT3/FT4 ratios had better preserved muscle function, therefore successfully overcoming the imbalance of homeostatic and entropic processes involved in muscle aging. However, we could not establish a cause-effect relationship due to the cross-sectional design of the study.

Home Rehabilitation System in Chronic Stroke: An Observational Study in Central Italy.

INTRODUCTION: By 6 months following a stroke, approximately 65% of stroke survivors cannot incorporate into daily activities, resulting completely dependent. The aim of this study is to assess the overall outcome in psychological and physical well-being, increase in residual abilities, reintegration and social inclusion for people with chronic disabilities resulting from stroke, after home rehabilitation. MATERIALS AND METHODS: We assessed the functional outcome of a group of 600 patients with disability related to several pathological conditions and undergoing home rehabilitation therapy (twice a week for 40 sessions per year) as granted by the Public Health. We evaluated the outcome with Barthel and Functional Independence Measure (FIM) scales. Furthermore, in a group of 73 persons with chronic stroke we also carried out an overall evaluation, by using specific rating scales (FIM, Stroke Impact Scale, Motricity Index, Tinetti Balance Scale, 10-m Walking Test, 6-min Walking Test, 5 Repetitions Sit-to-Stand Test, and Hamilton Depression Scale) after 120 days (114 ± 6) from the end of the home rehabilitation program. RESULTS: The results highlighted a statistically significant improvement between T0 and T1 and a significant worsening between T1 and T2 (follow-up at 3 months). Hamilton Depression Scale is the only parameter that significantly improves both at the time T1 and T2. CONCLUSIONS: Territorial rehabilitation system should consider some fundamental aspects: centrality of the person and the individual health project; identification of specific and personalized rehabilitation plan and prognosis based on the results of a follow-up; ultra-specialization of interventions; multidisciplinary team; highlight of the emerging needs; and coordination of the different care pathways.