Rehabilitación física con telemedicina durante la pandemia COVID-19 / Physical rehabilitation with telemedicine during the COVID-19 pandemic

CONTEXTO CLÍNICO: La enfermedad por el Coronavirus 2019 (COVID­19, por su sigla en inglés Coronavirus Disease 2019) es una enfermedad respiratoria de humanos producida por un nuevo coronavirus identificado con la sigla SARS-CoV-2.1 El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaro la COVID-19 como una pandemia, y en Argentina se registraron hasta el momento 6.034 casos y 305 fallecidos (6,7 fallecidos/millón de habitantes). En Argentina, el 31 de marzo comenzó el aislamiento social, preventivo y obligatorio, con aislamiento estricto hasta el 13 de abril, aislamiento administrado desde el 13 al 26 de abril y con segmentación geográfica desde el 26 de abril hasta la actualidad. Durante todo este período se han restringido las consultas y procedimientos médicos no urgentes con el objetivo de evitar el contagio de la población y del personal sanitario, así como también de aumentar la capacidad de respuesta del sistema de salud ante la pandemia. Uno de los efectos adversos del aislamiento y de la restricción de procedimientos electivos es la potencial discontinuación de tratamientos crónicos, dentro de los cuales se encuentra la rehabilitación física. Esto ha generado un impulso a la tele-asistencia para la atención y seguimiento de los pacientes, particularmente de aquellos con patologías crónicas. Se postula el uso de tele-asistencia kinesiológica de patologías durante la pandemia COVID-19 como alternativa durante las restricciones vigentes y para disminuir el riesgo de exposición de los pacientes y el personal de salud. TECNOLOGÍA: La telemedicina, que se incluye dentro de un concepto más amplio denominado telesalud, se define como "la prestación de servicios de atención de salud, por todos los profesionales de salud que utilizan tecnologías de la información y comunicación para el intercambio de información válida para el diagnóstico, tratamiento y prevención de las enfermedades y lesiones, la investigación y la evaluación, y para la educación continua de proveedores de atención de salud, para la promoción de la salud de los individuos y sus comunidades." A su vez, la teleconsulta se define como la comunicación a distancia entre dos o más integrantes del equipo de salud (a menudo entre médicos de atención primaria y especialistas), o entre un proveedor de salud y el paciente, utilizando las tecnologías de la información y comunicación. La teleconsulta sincrónica hace referencia a la forma de comunicación que sucede en tiempo real, habitualmente con transmisión de audio y video de manera simultánea (ej. videoconferencia). OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de rehabilitación física con telemedicina para distintas patologías. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron, seis RS, dos ECAs con evaluaciones económicas, cinco recomendaciones y cuatro políticas de cobertura. CONCLUSIONES: Evidencia de baja calidad sugiere que la rehabilitación física con telemedicina no sería menos efectiva que la rehabilitación presencial o los cuidados usuales sin rehabilitación. Existe gran variabilidad en las técnicas de tele-rehabilitación empleadas, incluyendo al teléfono, la videoconferencia, realidad virtual y programas de internet. Las sociedades científicas sobre rehabilitación física de Estados Unidos, Canadá, Australia y Reino Unido recomiendan el uso de tele-rehabilitación durante el aislamiento por COVID-19. La Superintendencia de Servicios de Salud de Argentina recomienda que, durante el "aislamiento social, preventivo y obligatorio" por la pandemia COVID-19, los financiadores de la seguridad social y privados deberán implementar y fomentar el uso de teleasistencia y/o teleconsulta, a fin de garantizar las prestaciones de demanda esencial. Los financiadores públicos y privados de Estados Unidos cubren la tele-rehabilitación, mientras que el sistema de salud público de Australia no lo hace.(AU)

AANEM survey of training in electrodiagnostic medicine in U.S. residency programs.

BACKGROUND: Little literature exists describing resident training in peripheral electrodiagnosis (EDX). METHODS: U.S. residency programs in neurology and physical medicine and rehabilitation (PM&R) were surveyed by the AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) on specific features of EDX training. RESULTS: Ninety-seven programs responded to the survey. Training duration was 4-8 weeks in most neurology programs; training averaged 22 weeks in PM&R programs. EDX experience was required in all PM&R and in 90% of neurology programs. Results varied greatly for the residency years of training, pulling of residents for other responsibilities, participation in continuity clinics, number of teaching physicians, number of needle examinations performed, organization of nerve conduction training, written/oral examinations, muscle/nerve biopsy reviews, and training materials. CONCLUSIONS: This survey demonstrated large variability in training of neurology and PM&R residents in peripheral EDX.

French clinical guidelines for peripheral motor nerve blocks in a PRM setting.

INTRODUCTION: Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. METHOD: Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society. RESULTS: No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine - up to 2mg/kg - "check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician"; for ropivacaine - up to 1.5mg/kg, with a maximum of 100mg - the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician. CONCLUSION: These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.

Rehabilitation for Cancer Survivors: How We Can Reduce the Healthcare Service Inequality in Low- and Middle-Income Countries.

Cancer diagnosis often substantially affects patient's physical, psychological, and emotional status. Most patients with cancer experience declining of energy, activity levels, social-cultural participation, and relationships. In addition, cancer progression and adverse effects of aggressive cancer treatment often cause debilitating pain, fatigue, weakness, joint stiffness, depression, emotional instability, limited mobility, poor nutritional status, skin breakdown, bowel dysfunction, swallowing difficulty, and lymphedema leading into functional impairment and disability that can be addressed through rehabilitation care. Comprehensive care models by involving cancer rehabilitation have resulted in significant improvement of patient's quality of life. Although cancer rehabilitation has been implemented in many high-income countries, it is either not yet or suboptimally delivered in most low- and middle-income countries. In this review, we discussed gaps regarding cancer rehabilitation services and identified opportunities to improve quality of cancer care in developing countries. Future collaborations among international organizations and stakeholders of health care delivery systems are required to initiate and improve high-quality cancer rehabilitation in the developing countries.

Baropodometry on patients after total knee arthroplasty.

PURPOSE: It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct. METHODS: We designed a prospective observation longitudinal study to assess postural stability following TKA. Between December 2014 and May 2015, sixty consecutive patients were recruited through local orthopedic physician offices and hospitals. The patients scheduled to undergo TKA were recruited and were monitored before surgery (T0) and at 1 (T1), 3 (T2) and 6 months (T3) after knee surgery. The correction of varus/valgus deviation at X-ray and the Knee Society Score were performed to verify the functional recovery. We used static and dynamic baropodometric analysis to evaluate postural assessment. RESULTS: After surgery, there was a significant improvement in physiological alignment of knee axes (p < 0.0001) and of Knee and Function Scores (excellent, mean values 80.5 and 80.7, respectively, p < 0.0001). The static analysis showed that the center of gravity and the pressure on the foot of the operated limb were corrected toward the physiological center (p < 0.0001) and the body weight displaced to the forefeet and to the hindfeet reduced bilaterally (p < 0.0001). The type of footprint did not change. The dynamic analysis confirmed the significant normalization of the pressure on the foot of the operated limb at all follow-ups (p < 0.0001). The percentage of load was reduced on the operated limb (p = 0.0096) and speed of step, cadence and semi-step length increased (p < 0.0001). CONCLUSION: These data show the progressive recovery of stability after TKA from the immediate postoperative to the subsequent months. The clinical and functional improvement correlated with a load redistribution between the two limbs. The baropodometry could be an excellent noninvasive method for monitoring effects of rehabilitation treatment.

Evaluating Disability Insurance Assistance as a Specific Intervention by Physiatrists at a Cancer Center.

Because of their expertise, physiatrists provide disability insurance assistance for cancer survivors. In this brief report, we perform a descriptive retrospective analysis of all new (354) outpatient physiatry consultations from January 1, 2009, to December 31, 2013, at a National Cancer Institute Comprehensive Cancer Center. Disability and/or work accommodations were brought up at some point with the physiatrist during the duration of their care for 131 (37%) of 354 patients. More than 90% of the discussions took place during the first visit. Of those patients who had a documented disability/employment discussion, 58 (44.3%) of 131 patients were originally referred for disability assistance specifically, and 58 (44.3%) of 131 also had disability insurance paperwork completed by the physiatrist. Outcomes of initial physiatry disability insurance assistance were 45 (77.6%) of 58 approved/renewed, 5 (8.6%) of 58 denied, and 8 (13.8%) of 58 unknown/died during the disability application process. The median form size was 33 (SD, 25.95) items. This study is the first of its kind and provides an initial look at work-related discussions and support with disability insurance paperwork as a specific intervention provided by physiatrists at a cancer center. The results are compelling and demonstrate that physiatrists frequently provide these interventions. These interventions take considerable time and effort but are generally successful.

Descripción de la población de personas con cáncer de mama referida al Programa de Rehabilitación en Cáncer y Cuidados Paliativos del Servicio de Fisiatría del Hospital Dr. Rafael Ángel Calderón Guardia, 01 de junio del 2012 al 31 de mayo del 2013. / Description of people with breast cancer referred to the Rehabilitation Program in Cancer and Palliative Care of the Rehabilitation Service in the Hospital Dr. Rafael Ángel Calderón Guardia, from june 1rst, 2012 to may 31, 2013

ResumenObjetivos:Realizar la caracterización de la población referida al Programa de Rehabilitación en Cáncer y Cuidados Paliativos del Servicio de Fisiatría del Hospital Dr. Rafael Ángel Calderón Guarida, en el período comprendido entre 01 de junio del 2012 al 31 de mayo del 2013.Optimizar las actividades del personal de los servicios, en el abordaje de los problemas o situaciones de salud que puedan presentar los pacientes; con lo que se logra mejorar la utilización del tiempo, de los recursos y mejorar la calidad de la atención.Métodos:Diseño del estudio: Observacional Retrospectivo-Descriptivo. Se estudió una población conformada por las pacientes con cáncer de mama referidas al Programa de Rehabilitación en Cáncer y Cuidados Paliativos del Servicio de Fisiatría del Hospital Dr. Rafael Ángel Calderón Guardia, en el período comprendido entre el 01 de junio del 2012 al 31 de mayo del 2013 (12 meses). Las variables estudiadas fueron: Edad, sexo, estado civil, diagnóstico, tratamiento, diagnóstico fisiátrico. Se preparó una base de datos electrónica (Excel). La técnica de muestreo y unidad de análisis fueron: Frecuencia; incidencia, prevención, porcentaje.Resultados:Predominancia del cáncer de mama en el sexo femenino, el rango de edad al diagnóstico fue de 40 a 89 años cumplidos. La incidencia en menores de 50 años corresponde aproximadamente con el 30% de las pacientes. En prácticamente todas las pacientes el diagnóstico fisiátrico incluía la prevención de complicaciones. Y más comúnmente asociaban dolor, limitación de los arcos de movimiento y linfedema del miembro superior.El Programa de Rehabilitación en Cáncer y Cuidados Paliativos del Servicio de Fisiatría del Hospital Dr. Rafael Ángel Calderón Guardia existente ofrece los servicios básicos fundamentales, para las pacientes con diagnóstico reciente, en tratamiento o con secuelas de cáncer de mama, y en condición terminal. Para mejorar la atención integral de los pacientes con cáncer de mama, debe incluir la valoración y educación prequirúrgica, intervenciones que ya se están gestionando en conjunto con los servicios referidores.Conclusiones:Se debe mejorar el Programa de Rehabilitación en Cáncer y Cuidados Paliativos del Servicio de Fisiatría del Hospital Dr. Rafael Ángel Calderón Guardia existente para la atención integral de los pacientes con cáncer de mama y la rehabilitación de los pacientes con cáncer de mama tiene un rol fundamental para favorecer su atención integral y por ende su calidad de vida.

AbstractObjetives:Caracterization of women referred to the Rehabilitation Program in Cancer and Palliative Care of the Rehabilitation Service of the Hospital Dr. Rafael Ángel Calderón Guarida, between june 1rst, 2012 and May 31, 2013. Optimice services, problem assesment or health situations, to improve atention´s quality.Methods:Study design: Observtive Retrospective - Descriptive. Variables: age, gender, marital state, diagnosis, treatment, physiatrist diagnosis.Results:Most women with breast cancer are diagnosed at 40-89 years-old.Incidence in less than 50 years-old is approximately 30%. Almost all women included complication prevention, and associated pain, movility impair and lymphedema.the Rehabilitation Program in Cancer and Palliative Care of the Rehabilitation Service of the Hospital Dr. Rafael Ángel Calderón Guardia offers basic services for women with breast cancer. To improve integral attention is necessary to include education and pre-operatory assesment.Conclusions:The Rehabilitation Program in Cancer and Palliative Care of the Rehabilitation Service of the Hospital Dr. Rafael Ángel Calderón Guarida has to improve and the rehabilitation has a basic rol to complete integral attention and life quality in patients with breast cancer.

Palliative Care and Physiatry in the Oncology Care Spectrum: An Opportunity for Distinct and Collaborative Approaches.

As cancer evolves from a terminal illness to a chronic medical condition, so too does the view of clinical services. Palliative care and physical medicine and rehabilitation (PM&R) will increase in acceptance because they provide a valuable resource. The overarching theme is improving cancer-related symptoms or treatment-related side effects, improving patient health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision making. Managing symptom burden may improve therapy participation/performance. PM&R and palliative care departments are well-equipped to develop patient-centered care protocols, and could play an important role in developing a universal measure of performance status.

Chaotic analysis of heart rate dynamics after an exercise with flexible pole / Análise caótica da dinâmica da frequência cardíaca após exercício com barra flexível

INTRODUCTION: Exercises with a flexible pole have been applied in clinical practice for upper limb rehabilitation. Nevertheless, its acute effects on cardiac autonomic regulation are unclear. OBJECTIVE: To evaluate the acute effects of exercise with flexible pole on complex behavior of heart rate variability (HRV). METHOD: We investigated 32 healthy female volunteers aged between 18 and 25 years who performed a session of exercise with a flexible pole. HRV was analyzed 10 minutes before and 10 minutes immediately after the exercise. RESULTS: Exercises with a flexible pole did not significantly change time and frequency domain indices of HRV. Non-linear analysis of HRV through the Higuchi Fractal Dimension was not significantly changed during recovery from exercise compared to the control reading at rest. CONCLUSION: Exercises with the flexible pole were unable to acutely change chaotic behavior of heart rate dynamics. This is advantageous for assessments of levels of rehabilitative treatment required in such patients; and their susceptibility to dynamical diseases.

INTRODUÇÃO: Exercícios com uma barra flexível têm sido usados na prática clínica para a reabilitação do membro superior. No entanto, os seus efeitos agudos sobre a regulação autonômica cardíaca não estão bem esclarecidas. OBJETIVO: Avaliar os efeitos agudos do exercício com barra flexível sobre o comportamento complexo da variabilidade da frequência cardíaca (VFC). MÉTODO: Foram investigadas 32 voluntárias saudáveis com idades entre 18 e 25 anos que realizaram uma sessão de exercício com barra flexível. A VFC foi analisada 10 minutos antes e 10 minutos imediatamente depois do exercício. RESULTADOS: Os exercícios com a barra flexível não alteraram significativamente os domínios de tempo e frequência de VFC. Análise não-linear da VFC através da Dimensão Fractal Higuchi mostra que a mesma não foi significativamente alterada durante a recuperação do exercício em relação ao controle pré-exercício. CONCLUSÃO: O exercício com a barra flexível não alterou profundamente o comportamento caótico da dinâmica da frequência cardíaca. Isto é vantajoso para a avaliação de níveis de tratamento de reabilitação necessário em tais pacientes; e sua suscetibilidade a doenças dinâmicas.

Hernia discal lumbar, una visión terapéutica / Une vision thérapeutique / Lumbar disc herniation, a therapeutic vision

INTRODUCCIÓN: la radiculopatía por hernia de disco lumbar es la mayor causa de morbilidad que enfrentan los cirujanos espinales. Existen múltiples estrategias de tratamiento para esta afección, sin consenso actual entre secuestrectomía y discectomía, y sobre la necesidad de fusionar el segmento. OBJETIVO: mostrar nuestros resultados a los 4 años de seguimiento, en el tratamiento quirúrgico de la hernia discal lumbar mediante discectomía foraminal. MÉTODO: estudio descriptivo prospectivo en pacientes diagnosticados con hernias discales lumbares y tratados quirúrgicamente mediante discectomía foraminal simple y evaluados 4 años después RESULTADOS: muestra constituida por 67 pacientes, la mayoría (62,69 %) del sexo masculino; edad media cercana a los 40 años en ambos sexos. Se confirmó el diagnóstico en el 85,3 % de los casos mediante IRM. Predominó la localización L5-S1 y L4-L5, con 16 % de más de un segmento. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría a los 4 años de operados. CONCLUSIONES: el tratamiento quirúrgico de las hernias de disco mediante discectomía foraminal simple, según nuestra experiencia, produce buenos resultados; a los 4 años de efectuada la operación se constató disminución del dolor y mejoría de la función.

INTRODUCTION: Radiculopathy by lumbar disc herniation is a major cause of morbidity faced by spinal surgeons. There are many treatment strategies for this condition, and no current consensus among sequestrectomy and discectomy, and the need to merge the segment. OBJECTIVE: Show our results at 4 years of follow-up in the surgical treatment of lumbar disc herniation by foraminal discectomy. METHOD: A prospective study was conducted in patients diagnosed with lumbar disc herniation and foraminal surgically treated by simple discectomy and assessed four years later. RESULTS: The sample consisted of 67 patients, the majority (62.69%) was male; average age of nearly 40 years in both sexes. The diagnosis was confirmed in 85.3% of cases by MRI. L5-S1 and L4-L5 locations predominated, with 16% of more than one segment. Oswestry index and the Visual Analog Scale for pain showed significant improvement after four years of surgery. CONCLUSIONS: The surgical treatment of herniated discs by simple foraminal discectomy, in our experience, has good results; at four years of operation pain decrease and improvement in function was found

INTRODUCTION: La radiculopathie par hernie discale lombaire est la cause de morbidité la plus souvent traitée par les chirurgiens spécialisés en moelle épinière. Il y a plusieurs stratégies de traitement pour cette affection, mais aujourd'hui il n'y a pas de consensus ni entre la séquestrectomie et la discectomie ni sur la nécessité de fusionner le segment. OBJECTIF: Le but de ce travail est de montrer, après 4 ans de suivi, nos résultats à propos du traitement chirurgical d'une hernie discale lombaire par décompression foraminale. MÉTHODE: Une étude descriptive et prospective de patients diagnostiqués de hernie discale lombaire, traités chirurgicalement par décompression foraminale simple et évalués quatre ans après, a été réalisée. RÉSULTATS: Dans un échantillon de 67 patients, dont la plupart étaient du sexe masculin (62,69 %) et avaient un moyen d'âge de 40 ans environ chez tous les deux sexes, on a confirmé le diagnostic par IRM dans 85,3 % des cas. Les hernies ont été souvent localisées aux niveaux L5-S1 et L4-L5, dont 16 % correspondait à plus d'un segment. Quatre ans après l'opération, l'indice d'Oswestry et l'échelle visuelle analogique de douleur ont montré une amélioration significative. CONCLUSIONS: D'après notre expérience, le traitement chirurgical des hernies discales lombaires par décompression foraminale simple a montré de très bons résultats. Quatre ans après l'opération, on a constaté une diminution de la douleur et une amélioration de la fonction.

Instruments for assessment of impairments and activity limitations in patients with hand conditions: A European Delphi study.

OBJECTIVE: To reach multidisciplinary European consensus on the assessment tools for impairments and activity limitations in patients with hand conditions. DESIGN: Electronic Delphi method. SUBJECTS: Thirty experts from European societies for hand therapy, hand surgery, and physical and rehabilitation medicine. METHODS: In 3 rounds, participants were asked which of 13 preselected categories of the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions should be assessed. In addition, they were asked to choose which of 55 preselected instruments they preferred for each category by confirming or rejecting instrument-specific statements. RESULTS: All 13 preselected ICF categories were considered relevant. Consensus was based on ≥ 75% agreement. After 3 rounds, 9 instruments were selected: Shape Texture Identification Test, Semmes Weinstein Monofilament Test, Visual Analogue Scale for pain, goniometer, Jamar Dynamometer, Pinch Gauge Device, Cold Intolerance Symptom Severity questionnaire, Canadian Occupational Performance Measure, and Disabilities of the Arm, Shoulder and Hand Questionnaire. It remained undecided whether to use the Nine-Hole Pegboard Test or the Purdue Pegboard Test. CONCLUSION: In this European Delphi study, multidisciplinary consensus was reached on 9 assessment tools for impairments and activity limitations in patients with hand conditions addressing 13 categories of the Brief ICF Core Set for Hand Conditions.

Nineteen reasons why physiatrists should do musculoskeletal ultrasound: EURO-MUSCULUS/USPRM recommendations.

This article is an eventual consensus of experts from the European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) pertaining to the use of musculoskeletal ultrasound in physical and rehabilitation medicine. Nineteen important reasons (as regards general advantages, specific conditions in physical and rehabilitation medicine, as well as comparisons with other imaging tools) have been highlighted to consolidate the scenario of how/why the probe of ultrasound needs to become the stethoscope, the extended hand, and the pen of physiatrists.

Current research funding methods dumb down health care and rehabilitation for disabled people and aging population: a call for a change.

Health care systems in Western societies are faced with two major challenges: aging populations and the growing burden of chronic conditions. This translates into more persons with disabilities and the need for more Physical and Rehabilitation Medicine (PRM) services. We raise the point of how these emerging needs are faced by the actual research funding. We briefly present the results of an analysis we made about research funding by the Italian National Health Service as an interesting case study, since it relates to Italy (the financer) and the United States, where National Institutes of Health (NIH) reviewers were identified according to their classification of research topics. The topics of potentially greatest interest for aging Western societies, like chronicity, disability and rehabilitation, were among those least often funded and considered in the traditional method of financing research projects. These results could be based on those PRM peculiarities that make the specialty different from all other classical biomedical specialties, namely the bio-psycho-social approach and its specific research methodologies. Moreover, PRM researchers are spread among the different topics as usually classified, and it is probable that PRM projects are judged by non-PRM reviewers. There are at least two possible ways in which research can be better placed to meet the emerging needs of Western societies (chronicity, disability and consequently also rehabilitation). One is to create specific keywords on these topics so as to improve the match between researchers and reviewers; the second is to allocate specific funds to research in these areas. In fact, the not coherence between emerging needs and research priorities have already been periodically addressed in the past with specific "political" and/or "social" initiatives, when researchers were forced to respond to new emergencies: some historical examples include cancer or HIV and viral diseases or the recent Ebola outbreak.

Regenerative principles enrich cardiac rehabilitation practice.

Cardiovascular morbidity imposes a high degree of disability and mortality, with limited therapeutic options available in end-stage disease. Integral to standard of care, cardiac rehabilitation aims on improving quality-of-life and prolonging survival. The recent advent of regenerative technologies paves the way for a transformative era in rehabilitation medicine whereby, beyond controlling risk factors and disease progression, the prospect of curative solutions is increasingly tangible. To date, the spectrum of clinical experience in cardiac regenerative medicine relies on stem cell-based therapies delivered to the diseased myocardium either acutely/subacutely, after a coronary event, or in the setting of chronic heart failure. Application of autologous/allogeneic stem cell platforms has established safety and feasibility, with encouraging signals of efficacy. Newer protocols aim to purify cell populations in an attempt to eliminate nonregenerative and enrich for regenerative cell types before use. Most advanced technologies have been developed to isolate resident cell populations directly from the heart or, alternatively, condition cells from noncardiac sources to attain a disease-targeted lineage-specified phenotype for optimized outcome. Because a multiplicity of cell-based technologies has undergone phase I/II evaluation, pivotal trials are currently underway in larger patient populations. Translation of regenerative principles into clinical practice will increasingly involve rehabilitation providers across the continuum of patient care. Regenerative rehabilitation is thus an emerging multidisciplinary field, full of opportunities and ready to be explored.

Gene therapy for inherited muscle diseases: where genetics meets rehabilitation medicine.

The development of clinical vectors to correct genetic mutations that cause inherited myopathies and related disorders of skeletal muscle is advancing at an impressive rate. Adeno-associated virus vectors are attractive for clinical use because (1) adeno-associated viruses do not cause human disease and (2) these vectors are able to persist for years. New vectors are now becoming available as gene therapy delivery tools, and recent preclinical experiments have demonstrated the feasibility, safety, and efficacy of gene therapy with adeno-associated virus for long-term correction of muscle pathology and weakness in myotubularin-deficient canine and murine disease models. In this review, recent advances in the application of gene therapies to treat inherited muscle disorders are presented, including Duchenne muscular dystrophy and x-linked myotubular myopathy. Potential areas for therapeutic synergies between rehabilitation medicine and genetics are also discussed.

Disease-in-a-dish: the contribution of patient-specific induced pluripotent stem cell technology to regenerative rehabilitation.

Advances in regenerative medicine technologies will lead to dramatic changes in how patients in rehabilitation medicine clinics are treated in the upcoming decades. The multidisciplinary field of regenerative medicine is developing new tools for disease modeling and drug discovery based on induced pluripotent stem cells. This approach capitalizes on the idea of personalized medicine by using the patient's own cells to discover new drugs, increasing the likelihood of a favorable outcome. The search for compounds that can correct disease defects in the culture dish is a conceptual departure from how drug screens were done in the past. This system proposes a closed loop from sample collection from the diseased patient, to in vitro disease model, to drug discovery and Food and Drug Administration approval, to delivering that drug back to the same patient. Here, recent progress in patient-specific induced pluripotent stem cell derivation, directed differentiation toward diseased cell types, and how those cells can be used for high-throughput drug screens are reviewed. Given that restoration of normal function is a driving force in rehabilitation medicine, the authors believe that this drug discovery platform focusing on phenotypic rescue will become a key contributor to therapeutic compounds in regenerative rehabilitation.

Actual evidence in the medical approach to adolescents with idiopathic scoliosis.

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the Scoliosis Research Society (SRS) criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agreement among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is their main goal. A systematic review shows that there are no studies on manual treatment. The SOSORT Guidelines offer the actual standard of conservative care.

Bracing for scoliosis in 2014: state of the art.

Bracing is currently the primary method for treating moderate idiopathic scoliosis (IS) during the developmental phase of growth. Following a lengthy debate, during which researchers and authors questioned the role of bracing in the treatment of IS due to inconsistent evidence, the Bracing in Adolescent Idiopathic Scoliosis Trial study have provided a high level of evidence to the value of bracing and may have convinced most of those who were skeptic. However, although some guidelines have been published, there remains no standard for constructing scoliosis orthoses and no standard treatment protocol. The Scoliosis Research Society criteria were established to provide a framework by which to research bracing and adolescent idiopathic scoliosis, and the Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria were published to guarantee a minimum level of expertise for MDs and CPOs involved in the brace treatment. However, very few contemporary papers follow both sets of criteria, and the extensive variety of braces makes it difficult to determine if one is superior to another. The aim of this paper is to provide an overview of state-of-the-art brace treatment, highlighting commonly used braces and their history, biomechanical concept, and results, as reported in published literature. Specific focus is placed on European (i.e., Chêneau and derivatives, Dynamic Derotating, Lyon, PASB, Sforzesco, TLI, TriaC) and North American (i.e. Boston, Charleston, Milwaukee, Providence, Rosenberger, SpineCor, Wilmington) designs. Details about different building techniques are also reported, along with recently developed tools that are designed to monitor compliance.