Effectiveness of a Virtual Reality rehabilitation in stroke patients with sensory-motor and proprioception upper limb deficit: A study protocol.

INTRODUCTION: Stroke is the second leading cause of death in Europe. In the case of stroke survival (almost 70%), only 25% of patients recover completely, while the remaining 75% will undergo a rehabilitation phase that varying from months to years. The primary outcomes of a stroke involve motor impairment in the upper limbs, resulting in a partial or complete inability to move the limb on the right or left side, depending on the affected hemisphere. Furthermore, the motor deficit distorts the proprioception of the body and the embodiment ability of the injured limb. This could be rehabilitated through the paradigm of body illusion that modulates the motor rehabilitation. The present protocol aims to investigate the effectiveness of a Virtual Reality system for sensorimotor and proprioception upper limb deficit compared to a traditional upper limb rehabilitation program. METHOD: This study has a randomized and controlled design with control and experimental groups, and 4 measurement times: pre-intervention, immediately after the intervention, and two follow-ups (at 6 and 12 months). The inclusion criteria are: (a) Being 18 to 85 years old, both males and females; (b) Suffering from ischemic or haemorrhagic stroke; (c) The stroke event must have occurred from two to eighteen months before recruitment; (d) Patients must have moderate to severe upper limb motor deficit, and the alteration of sensorimotor and proprioception abilities of the injury upper limb; (e) Patients must understand and sign the written consent for enrolment. The rehabilitation last four weeks with three sessions per week at Bellaria Hospital of Bologna (Italy). The VR protocol uses two types of technology: immersive and non-immersive, and the control group follow the traditional rehabilitation program.

Evaluation of the feasibility and acceptability of a home-based supervised exercise programme in individuals with spinal cord injuries: SCI-HOME-ACTIVE study protocol.

Physical activity is essential to a healthy lifestyle for adults with spinal cord injuries (SCI). Although exercise is recognised as an important tool for improving the well-being and independence of people with SCI, most individuals do not engage in physical exercise. Traditional exercise programmes often require participation in rehabilitation centres or specialised facilities, making them less accessible for individuals with chronic SCI. Many people with SCI live in rural communities and other geographically isolated areas where access to fitness facilities and outdoor recreational areas involves long commutes or expensive transportation, which is one of the most common barriers to exercise reported by people with physical disabilities. Consequently, exercise remains an underused intervention for improving health and function in people with SCI despite its proven effects in reducing pain, fatigue, fall risk and other secondary health conditions. This pilot study evaluates the feasibility and acceptability of a home-based supervised exercise programme for individuals with chronic SCI. The study will be an interventional and prospective pilot study. People with SCI will participate in a 3-month home-based exercise programme. Primary outcomes will include adherence to the exercise programme, while secondary outcomes will encompass quality of life, functional capacity, musculoskeletal health and clinical parameters. The programme will be structured into 1-hour sessions, held twice weekly for 3 months, conducted online and in small groups. The results of this study could be relevant for future indications of the best setting and strategy to ensure adherence to physical activity.

A novel multistep approach to standardize the reported risk factors for in-hospital falls: a proof-of-concept study.

Background: Uncertainty and inconsistency in terminology regarding the risk factors (RFs) for in-hospital falls are present in the literature. Objective: (1) To perform a literature review to identify the fall RFs among hospitalized adults; (2) to link the found RFs to the corresponding categories of international health classifications to reduce the heterogeneity of their definitions; (3) to perform a meta-analysis on the risk categories to identify the significant RFs; (4) to refine the final list of significant categories to avoid redundancies. Methods: Four databases were investigated. We included observational studies assessing patients who had experienced in-hospital falls. Two independent reviewers performed the inclusion and extrapolation process and evaluated the methodological quality of the included studies. RFs were grouped into categories according to three health classifications (ICF, ICD-10, and ATC). Meta-analyses were performed to obtain an overall pooled odds ratio for each RF. Finally, protective RFs or redundant RFs across different classifications were excluded. Results: Thirty-six articles were included in the meta-analysis. One thousand one hundred and eleven RFs were identified; 616 were linked to ICF classification, 450 to ICD-10, and 260 to ATC. The meta-analyses and subsequent refinement of the categories yielded 53 significant RFs. Overall, the initial number of RFs was reduced by about 21 times. Conclusion: We identified 53 significant RF categories for in-hospital falls. These results provide proof of concept of the feasibility and validity of the proposed methodology. The list of significant RFs can be used as a template to build more accurate measurement instruments to predict in-hospital falls.

Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy.

BACKGROUND: This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. METHODS: A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. RESULTS: A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. CONCLUSIONS: Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool.