Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: a single-blind randomized controlled clinical trial.

BACKGROUND: Traditional rehabilitation improves pain and function in patients with shoulder impingement syndrome. Neurocognitive rehabilitation has shown to be highly effective after surgical reconstruction of the anterior cruciate ligament. However, its effects in patients with shoulder impingement syndrome have not yet been established. AIM: The aim of the study was to compare the effects of neurocognitive therapeutic exercise, based on proprioception and neuromuscular control, on pain and function in comparison to traditional therapeutic exercise in patients with shoulder impingement syndrome. DESIGN: Single-blind randomized, non-inferiority clinical trial. SETTING: Outpatient clinic of Geriatrics and Physiatrics, University Hospital. POPULATION: Forty-eight patients with shoulder impingement syndrome (Neer stage I) and pain lasting for at least three months. METHODS: Participants were randomly allocated (1:1) to either neurocognitive therapeutic exercise or traditional therapeutic exercise. Both treatments were provided one-hour session, three times a week for five weeks. The primary outcome measure was the short form of the Disability of the Arm, Shoulder and Hand Questionnaire (Quick-DASH questionnaire) for the assessment of physical ability and symptoms of the upper extremity. SECONDARY OUTCOME MEASURES: Constant-Murley shoulder outcome score for the determination of range of motion, pain and strength; American Shoulder and Elbow Surgeons Society standardized shoulder assessment form for the evaluation of physical ability in daily-living tasks; a visual analogue scale for pain assessment at rest and during movements; Likert score for the estimation of participant satisfaction. ENDPOINTS: before treatment, end of treatment, 12 and 24 weeks after the completion of each intervention for all outcome measures, except for the Likert score that was evaluated only at the end of treatment. FOLLOW-UP: 24 weeks. RESULTS: At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcomes measures relative to baseline values, except for the visual analogue scale at rest that was unaffected by traditional therapeutic exercise. For all outcome measures, changes over time were greater in the neurocognitive therapeutic exercise group relative to the traditional therapeutic exercise group. The level of satisfaction with treatment was higher for participants in the neurocognitive therapeutic exercise group. CONCLUSION: Neurocognitive rehabilitation is effective in reducing pain and improving function in patients with shoulder impingement syndrome, with benefits maintained for at least 24 weeks. CLINICAL REHABILITATION IMPACT: skills and function of the shoulder can greatly benefit from neurocognitive rehabilitation.

Role of spiritual beliefs on disability and health-related quality of life in acute inpatient rehabilitation unit.

BACKGROUND: The influence of spirituality and religious beliefs on health-related quality of life and disability in the rehabilitation field is discussed in literature. AIM: To describe the role of spiritual belief on functional recovery and health-related quality of life in acute inpatient rehabilitation ward. DESIGN: Observational cross sectional study. SETTING: Inpatients clinic of Physical Medicine and Rehabilitation Department, University Hospital. POPULATION: One hundred and four patients admitted to an inpatient acute rehabilitation ward, after a neurological or orthopedic disease. METHODS: Anamnestic and demographic data were reported on a standardized form. The Royal Free Interview for Spiritual and Religious Beliefs (RFI) and Cumulative Illness Rating Scale (CIRS) were performed on admission (T0). SF-36 item Short Form Health Survey Questionnaire (SF36) and the Barthel index (BI) were performed on admission (T0) and on discharge (T1). RESULTS: Statistical analysis was performed on 102 patients with spiritual belief divided in strong (55 cases) and weak (47 cases) spiritual belief. Change from baseline (T1-T0) of SF36 domains between groups showed a significant higher improvement in Physical Role and Physical Composite Score in the weak belief group than in the strong belief group. The latter presented an improvement (without statistical significance) in almost every emotional score. We found no significant difference in change from baseline of Barthel index between the groups. CONCLUSION: Strength of spiritual belief seems to influence some aspects of quality of life of acute inpatient in the rehabilitation setting. It seems that patients with less spiritual belief showed more improvement in physical role, after acute rehabilitation.

Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial.

BACKGROUND: Deep heating therapy (DHT) has shown to improve pain and function in patients with knee osteoarthritis (OA) in the short term. Benefits of superficial heating therapy (SHT) are controversial. Long-term effects of both heating modalities have not yet been investigated. AIM: To compare the effects of DHT and SHT in patients with symptomatic knee OA, and to determine the long-term effects of heat therapy. DESIGN: Double-blind randomized clinical trial. SETTING: Outpatient clinic of Geriatrics and Physiatrics, University Hospital. POPULATION: Fifty-four patients with radiologically established diagnosis of moderate knee OA (Kellgren-Lawrence grade II or III) and pain lasting for at least three weeks. METHODS: DHT: local microwave diathermy (three 30-min sessions a week for four weeks); SHT: application of hot packs (three 30-min sessions a week for four weeks). PRIMARY OUTCOME MEASURE: Western Ontario and McMaster Universities (WOMAC) index for the assessment of joint pain, stiffness and physical function limitations. SECONDARY OUTCOME MEASURES: British Medical Research Council (BMRC) rating scale for the evaluation of muscle strength, and a visual analogue scale (VAS) for pain assessment. Follow up: 24 weeks for all outcome measures; 12 months for the primary outcome. RESULTS: Intention-to-treat analyses showed a treatment effect in favor of DHT for all outcome measures. No clinically relevant changes were observed in the SHT group. Benefits of DHT were maintained over 12 months of follow-up. CONCLUSIONS: DHT via localized microwave diathermy improves pain, muscle strength and physical function in patients affected by knee OA, with benefits maintained over the long term. No clinically relevant improvements were observed in patients who underwent SHT. CLINICAL REHABILITATION IMPACT: DHT via microwave diathermy delivered three times a week for four weeks significantly improves pain and function in patients affected by moderate knee OA, with benefits retained for at least 12 months. No clinically relevant changes are observed in knee OA patients treated with SHT.

[The role of occupational therapy in rehabilitating injured at work]. / Il ruolo della terapia occupazionale nella riabilitazione dell'infortunato sul lavoro.

The evolution of social and health setting in its demographic, productive and welfare elements make work as a finalized activity oriented to different tasks, from individual indepencence to social integration. In this context, the word "re-habilitation" has a double value; on one hand consideration of lifetime acquired abilities; on the other hand recovery of residual activities, consistent with the disablement. In Italy, for years, rehabilitation activities were performed by physiotherapists, who had inadequate occupational knowledge and preferred technical skills of non-finalized function recovery. The acknowledgment of Occupational Therapist took place in the end of the '90s, so that the few organizations sensitive to Occupational Therapy, as "Fondazione Maugeri" and "Fondazione Don Gnocchi", found "prepared ad hoc" personnel only abroad, above all in Spain and Switzerland. Nowadays we have specific first degree courses, but what really obstacles the development of this field is the economic crisis which afflicts healthcare services and avoids the growth of new sectors.

Postural control in patients with total hip replacement.

AIM: The aim of this study was to investigate the balance of the standing position and the motor responses by means of dynamic posturography (DP) in patients affected by hip osteoarthritis and treated by total hip replacement (THR). METHODS: Data obtained from THR patients were compared with those of control adult groups ofage-matched subjects with normal hearing and no history of audio-vestibular symptoms. The statistical tests used were paired and unpaired Student's t-test. Significance was set for P<0.05. The study was carried out at the Department of Otorhinolaryngology and Department of Physiatrics and Rehabilitation of the A. Gemelli University Hospital of Rome (Italy). Twenty-three consecutive patients, without cochleo-vestibular or neurological pathologies (screened by accurate case-history), affected by hip osteoarthritis and treated by THR were enrolled. The main outcome measure were Sensory Organization Test (SOT), Motor control test (MCT) and Adaptation test (AT) obtained by means of Equi-Test Dynamic Posturography System by NeuroCom (Int. Inc., Clackamas, OR, USA). RESULTS: When analysing the SOT and MCT, no statistically significant differences were observed between patients and controls. In the AT, the sway energy score decreased in the course of the test in an up and down perturbation both in healthy and in THR patients. CONCLUSIONS: These data confirm a normal postural control and symmetrical responses in THR patients and confirm the absence of a detectable relationship between balance problems and fall risk. These results could be justified by an irrelevant role of intracapsular proprioceptors in maintaining balance. Moreover DP could be useful in osteo-articular diseases for understanding balance, evaluating surgical outcome and monitoring the rehabilitation program.

Application of ''Protocollo di Minima per l'ictus'' (PMIC- Minimal Protocol for Stroke) for inpatient rehabilitation setting.

AIM: The aim of this study was to describe the baseline characteristics of a sample of stroke patients admitted to rehabilitation settings with the use of a standardised stroke assessment named ''Protocollo di Minima per l'ictus cerebrale'' (PMIC), to verify the usefulness of the application of PMIC and to compare the data of the authors with the international literature. METHODS: An observational cross sectional study was conducted on a sample of 102 first-time stroke patients (mean age: 71.9 [+/-11.6], 54 men), in three inpatient rehabilitation centres. MEASUREMENT: PMIC. RESULTS: Most patients were enrolled within 14 days of stroke onset. PMIC assessment took on average 20 minutes and provided the following information: 35% had architectural barriers in their homes; 82% of the cases had 1 or more family assistants; the educational level was low for 53%; 72% were retired; most cases were ischemic stroke without any side predominance being shown; 44% had partial anterior circulation infarcts (PACI) ischemic stroke; 18.6% presented dysphagia; 73% had sphincteral incontinence; there was no hypertone in more than 50% of the cases; 87% required assistance; the median Motricity Index Side Score (Miss) value was 44.1; 38% was affected by mood tone alteration. CONCLUSION: PMIC appeared to be a useful tool for a standardized evaluation of stroke patients. These results provide data with a high correspondence in international reports.