State of art of mobility medicine: some more abstracts and evidence that the success of Pdm3 is based on extra-session relationships.

Scientific conferences increasingly suffer from the need for short presentations in which speakers like to dwell on the details of their work. A mitigating factor is to encourage discussion and planning of collaborations by organizing small meetings in a hotel large enough to host all attendees. This extends discussions' opportunities during morning breakfasts, lunches, dinners and long evenings together. Even if the vast majority of participants will not stay for the entire duration of the Conference, the possibilities for specialists to interact with specialists who are even very distant in terms of knowledge increase enormously. In any case, the results in terms of new job opportunities for young participants outweigh the costs for the organizers. Thirty years of Padova Muscle Days offer many examples, but the authors of this report on the state of the art of Mobility Medicine testify that this also happened in the 2024 Five Days of Muscle and Mobility Medicine (2024Pdm3) hosted at the Hotel Petrarca, Thermae of Euganea Hills and Padua, Italy which is in fact a valid countermeasure to the inevitable tendencies towards hyperspecialization that the explosive increase in scientific progress brings with it.

Is There a New Road to Spinal Cord Injury Rehabilitation? A Case Report about the Effects of Driving a Go-Kart on Muscle Spasticity.

BACKGROUND: Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. METHODS: The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. RESULTS: It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. CONCLUSIONS: Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity.

Validity of ultrasound rectus femoris quantitative assessment: A comparative study between linear and curved array transducers.

Appendicular skeletal mass is commonly used to assess the loss in muscle mass and US represents a valid, and reliable method. However, the procedural protocols are still heterogeneous. The aim of this study was to compare the intertransducers validity of thickness, width, and CSA measurements of RF muscle. The AP, LL and CSA of RF muscle were evaluated with both linear and curve probes in ten healthy subjects and six sarcopenic patients. In the healthy group the mean AP diameters measured with the linear array were significantly higher than those measured with the curved array. AP and CSA were higher in the healthy group compared with the sarcopenic group with both transducers. There was a positive correlation between weight and LL diameter, and a negative correlation between age and muscle AP, measured with the linear probe. Both linear and curved probes represent valid methods in US evaluation of the CSA of the RF muscle. However, in the healthy subjects, the thickness and width of the of the same muscle, are affected by the type of probe.

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.

Effect of Intensive Rehabilitation Program in Thermal Water on a Group of People with Parkinson's Disease: A Retrospective Longitudinal Study.

The main objective of this study is to test the effect of thermal aquatic exercise on motor symptoms and quality of life in people with Parkinson's Disease (PD). Fourteen participants with diagnosis of idiopathic PD completed the whole rehabilitation session and evaluation protocol (Hoehn and Yahr in OFF state: 2-3; Mini Mental State Examination >24; stable pharmacological treatment in the 3 months prior participating in the study). Cognitive and motor status, functional abilities and quality of life were assessed at baseline and after an intensive rehabilitation program in thermal water (12 sessions of 45 min in a 1.4 m depth pool at 32-36 ∘C). The Mini Balance Evaluation System Test (Mini-BESTest) and the PD Quality of Life Questionnaire (PDQ-39) were considered as main outcomes. Secondary assessment measures evaluated motor symptoms and quality of life and psychological well-being. Participants kept good cognitive and functional status after treatment. Balance of all the participants significantly improved (Mini-BESTest: p<0.01). The PDQ-39 significantly improved after rehabilitation (p=0.038), with significance being driven by dimensions strongly related to motor status. Thermal aquatic exercise may represent a promising rehabilitation tool to prevent the impact of motor symptoms on daily-life activities of people with PD. PDQ-39 improvement foreshows good effects of the intervention on quality of life and psychological well-being.

Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review.

Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P-patient: athletes, I-Intervention: conservative treatment with therapeutic exercise or injection therapies, C-Comparison: not needed, O-Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.

Could the Improvement of Supraspinatus Muscle Activity Speed up Shoulder Pain Rehabilitation Outcomes in Wheelchair Basketball Players?

Shoulder pain (SP) is a common clinical complaint among wheelchair basketball (WB) players, since their shoulders are exposed to intense overload and overhead movements. The supraspinatus tendon is the most exposed to WB-related injuries and it is primarily responsible for SP in WB athletes. In these cases, SP rehabilitation remains the main treatment, but there is still a lack of specific protocols which should be customized to WB players' peculiarities and to the supraspinatus muscle activity monitor, and the improvement of rehabilitation outcomes is slow. Thus, the aim of this study was to verify if the improvement of supraspinatus muscle activity, monitored in real time with surface electromyography (sEMG) during the execution of therapeutic exercises, could speed up SP rehabilitation outcomes in WB players. Thirty-three athletes were enrolled. They were divided into two groups. Both groups underwent the same shoulder rehabilitation program, but only the Exercise Plus sEMG Biofeedback Group executed therapeutic exercises while the activity of the supraspinatus muscles was monitored using sEMG. Participants were evaluated at enrollment (T0), at the end of 4 weeks of the rehabilitation program (T1), and 8 weeks after T1 (T2), using the following outcome measures: supraspinatus muscle activity as root mean square (RMS), Wheelchair User's Shoulder Pain Index (WUSPI), shoulder abduction, and external rotation range of motion (ROM). The Exercise Plus sEMG Biofeedback Group improved more and faster for all the outcomes compared to the Exercise Group. The monitoring and improvement of supraspinatus muscle activity seems to be an effective way to speed up SP rehabilitation outcomes in WB players, since it makes the performance of therapeutic exercise more precise and finalized, obtaining better and faster results in terms of recovery of shoulder function.

Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial.

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis. AIM: By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF. DESIGN: Open label randomized controlled clinical trial. SETTING: Outpatient clinic. POPULATION: Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle. METHODS: Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI). RESULTS: Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG. CONCLUSIONS: Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology. CLINICAL REHABILITATION IMPACT: ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.

Influence of pain-related psychological factors on therapeutic outcomes in patients with chronic low back pain after oxygen-ozone treatment: a case-series.

The aim of the study was to identify the variables related to therapeutic success of intramuscular oxygen-ozone (O2O3) in patients with chronic low back pain (LBP). Twenty-one patients underwent an eight-session intramuscular-paravertebral O2O3 treatment with a weekly frequency. Numeric Rating Score for pain (NRSp), anxiety (NRSa), mood (NRSm), Oswestry Disability Index (ODI) and Physical and Mental Component Summary scores (PCS and MCS) of Short Form 12 (SF-12) were assessed baseline, after the treatment and at six-months follow-up. The ODI and NRSp scores showed significant improvement at the end of the treatment: the improvement in pain was maintained also at 6 months' follow-up. A significant correlation between baseline NRSa and the variation of the NRSp and ODI was observed. There was a correlation between NRSm at baseline and the variation of the ODI. A moderate correlation between MCS-12 at baseline and the variation of the NRSp score was found. Surprisingly, patients with a more compromised psychological well-being due to LBP had better results after oxygen-ozone therapy. Therefore, NRSa, NRSm and MCS-12 scores could be useful predictors of good therapeutic outcome.

Post COVID-19 persistent fatigue: a proposal for rehabilitative interventions in the spa setting.

With this letter to Editor, we aim at offering our viewpoint on the potential use of the spa resources to contribute to the treatment of persistent COVID-19 sequelae. In particular, our argumentations focus on the comprehensive management of fatigue persisting after the resolution of the acute infection. This sequela seems to be the most frequent disabling outcome, leading to a delay in social reintegration and return to working life.We suggest that spa facilities including multidisciplinary interventions and trained staffs could be an appropriate setting for providing rehabilitative protocols to treat chronic fatigue in post COVID-19 subjects. Spa treatments may improve the physical symptoms of chronic fatigue and modulate the immune imbalance, reducing persisting inflammation. Moreover, in the spa setting, specific respiratory rehabilitation and neuropsychological interventions could be provided. The rehabilitative protocol could also properly address comorbidities.In conclusion, respecting the hygiene and preventive measures, the spa setting could represent the appropriate environment to take care of post-COVID chronic fatigue, offering adequate and multidisciplinary rehabilitation protocols. Further, prospective trials on this topic are needed to fully evaluate the positive impact of a comprehensive rehabilitative treatment in the spa environment for subjects with post-COVID-19 fatigue.

Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach.

Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.

Neuropathic Pain and Rehabilitation: A Systematic Review of International Guidelines.

BACKGROUND: Neuropathic pain is an injury or disease of the central and/or peripheral somatosensory nervous system, and it has a significant impact on quality of life, especially since it is often refractory to treatment. Rehabilitative intervention is considered in various guidelines on neuropathic pain treatment, although not in an organic nor detailed way. The aim of this systematic review was to analyze the most indicated therapeutic strategies, providing rehabilitative recommendations in the management of neuropathic pain. METHODS: A systematic review was performed according to PRISMA guidelines. The scientific search, carried out until July 2020, considered guidelines in English language of the last thirteen years. RESULTS: Six guidelines were analyzed, from which emerges that a multidisciplinary approach, comprehensive of pharmacologic and nonpharmacologic interventions, should drive neuropathic pain management. A relevant role in non-pharmacological intervention is played by rehabilitation, through an adequate tailored rehabilitation program and physical therapies. CONCLUSION: This analysis highlights the importance of rehabilitation but also the lack of evidence on various rehabilitative practices. Arises hence the need for further studies in this field to better define a rehabilitative treatment strategy.

17-Italian Foot Function Index with numerical rating scale: development, reliability, and validity of a modified version of the original Foot Function Index.

BACKGROUND: Clinical research quantifies symptoms and signs of pain. OBJECTIVE: To develop a brief outcome measure to assess foot and ankle conditions, the psychometric properties of a modified version of the original Foot Function Index (FFI) were examined. METHODS: Eighty-six subjects with musculoskeletal foot and ankle disorders were enrolled. The internal consistency and test-retest reliability were evaluated by using Cronbach's α and intraclass correlation coefficient (ICC). Criterion validity was tested by Pearson's correlation coefficient between 17 items of the Italian FFI (17-IFFI) and the Lower Extremity Functional Scale (LEFS). The responsiveness was calculated using the receiver operating characteristic curve (ROC). RESULTS: Cronbach's Alpha was 0.95 (95% CI: 0.92, 0.99). The intra-interviewer and inter-interviewer ICC values were, respectively, 0.92 (95% CI: 0.88-10 0.96) and 0.90 (95% CI: 0.89-0.94). Correlations between the 17-IFFI scores and the LEFS scores were -0.564 and -0.456 at the initial and at the end of the treatment, respectively. The ROC analysis revealed an area under the curve of 0.732 (95% CI: 0.61-0.82) for the 17-IFFI and 0.633 (95% CI: 0.52-0.71) for the LEFS score. CONCLUSIONS: The 17-IFFI is a reliable and valid scale and we recommend its application to evaluate the effectiveness of a treatment in patients with musculoskeletal foot and ankle disorders.

Groin pain and iliopsoas bursitis: always a cause-effect relationship?

BACKGROUND AND OBJECTIVE: Iliopsoas bursitis (IB) is characterized by inflammation and enlargement of the iliopsoas bursa. Although this condition is often associated with degenerative or inflammatory arthritis, infections, trauma, overuse and impingement syndromes, osteonecrosis and hip replacement, the pathogenesis of IB remains uncertain. We present a case report of IB associated with moderate hip osteoarthritis (HOA). METHODS: We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments. An ultrasonography examination of the left hip revealed fluid-induced distension of the iliopsoas bursa, which was treated with aspiration followed by a corticosteroid-anesthetic injection. RESULTS: At the 30-day follow-up, despite an initial improvement in the patient's symptoms, both the pain and functional limitation returned, though not in association with bursa distension. The patient therefore underwent a total hip arthroplasty, which fully relieved the symptoms. CONCLUSION: We hypothesize that iliopsoas bursitis may, when associated with other pathological conditions, not be the only source of pain. It should, nevertheless, be considered for differential diagnosis purposes.