Showing papers in "European Journal of Physical and Rehabilitation Medicine in 2005"

Italian guidelines on rehabilitation treatment of adolescents with scoliosis OR other spinal deformities

Abstract: A mandated by the Italian Ministry of Health, the Italian Society of Physical Medicine and Rehabilitation (Societa Italiana Medicina Fisica e Riabilitazione, SIMFER) appointed a Commission composed of SIMFER members to draw up guidelines for the rehabilitation treatment of adolescents with spinal deformities. Other medical organizations contributing to the redaction of the final guidelines version were the Italian Society of Orthopedics and Traumatology (Societa Italiana di Ortopedia e Traumatologia, SIOT), the Italian Society of Trau-matology and Pediatric Orthopedics (Societa Italiana di Traumatologia e Ortopedia Pediatrica, SITOP), the Italian Study Group on Scoliosis and Spinal Diseases (Gruppo Italiano di studio della Scoliosi e delle patologie vertebrali, GIS), the Study Group on Scoliosis and Spinal Diseases (Gruppo di Studio della Scoliosi e delle patologie vertebrali, GSS), which collaborated through society members nominated by the organizations’

Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study.

Abstract: Aim. Despite the lateral epicondylitis or tennis elbow is a common cause of pain in orthopaedic and sports medicine, the results of the different modalities of conservative treatment are still contradictory. The pourpose of this study was to evaluate the efficacy of radial shock wave therapy (RSWT) in the treatment of tennis elbow. Methods. In a prospective randomized controlled singleblind study, of 75 eligible patients, 62 with tennis elbow were randomly assigned to study group and control group. There were 31 patients in the study group and 31 patients in the control group. Both groups had received a treatment a week for 4 weeks; the study group had received 2 000 impulses of RSWT and the control group 20 impulses of RSWT. All patients were evaluated 3 times: before treatment, at the end of treatment and to 6 months follow-up. The evaluation consisted of assessments of pain, pain-free grip strength test, and functional impairment. Results. Statistical analysis of visual analogue scale (VAS), disabilities of the arm, shoulder, and hand (DASH) questionnaire and pain-free grip strength test scores has shown, both after treatment and to the follow-up at 6 months, significant difference comparing study group versus control group (P <0.001). Statistical analysis within the groups, showed always statistically significant values for the study group. Also the control group showed statistically significant differences for some analyzed parameters. Nevertheless such differences resulted to be more statistics that not clinics as it showed the percentage of satisfied patients in the study group

Shoulder-hand syndrome after stroke. A complex regional pain syndrome.

Abstract: Complex regional pain syndrome (CRPS) types I and II are neuropathic pain disorders that develop as an exaggerated response to a traumatic lesion or nerve damage, that generally affects the extremities, or as the consequence of a distant process such as a stroke, spinal lesion or myocardial infarction. It rarely appears without an apparent cause. CRPS of upper limbs after stroke is frequently today called shoulder-hand syndrome (SHS). The onset and severity of SHS appears to be related with the aetiology of the stroke, the severity and recovery of motor deficit, spasticity and sensory disturbances. Another important aetiological factor is glenohumeral subluxation. The physiopathology of the disease is still not known. In CRPS, there is an exaggerated inflammatory response and some chemical mediators have been identified and are present in the inflammatory soup around the primary afferent fibres that, through different processes, can induce hyper-excitability of the afferent fibres (peripheral sensitization). It is hypothesized that a localized neurogenic inflammation is at the basis of oedema, vasodilation and hyperhidrosis that are present in the initial phases of CRPS. The repeated discharge of the C fibres causes an increased medullary excitability (central sensitization). Another important factor is the reorganisation of the central nervous system, and in particular this appears to affect the primary somatosensory cortex. The central role of the sympathetic nerve is presently in doubt. However, it is thought that a sub-group of CRPS patients exists in whom a predominant factor is the hyper-activity of the sympathetic nervous system, and that it responds positively to sympathetic block. Diagnosis is clinical and there are no specific tests, nor pathognomic symptoms to identify this disease with certainty. Diagnosis of CRPS after stroke appears more complex than in other pathological situations: the paretic upper arm frequently appears painful, oedematose, with altered heat and tactile sensations and slightly dystrophic skin within a non-use syndrome. Some investigations can aid differential diagnosis with other diseases. Treatment may be non-pharmacological, pharmacological, with psychotherapy, regional anaesthesia, neuromodulation and sympathectomy. In any case there is little evidence that supports the efficacy of the interventions normally used to treat or prevent CRPS-SHS. The key to effective treatment undoubtedly lies in a an expert multidisciplinary team that is co-ordinated and motivated and that treats the disorder with individualised therapy.

Therapeutic exercise for knee osteoarthritis: considering factors that may influence outcome.

Abstract: While exercise has been shown to be beneficial for reducing pain and improving physical function in individuals with knee osteoarthritis (OA), there are still individuals who do not always respond well to this treatment approach. There are a number of factors that have been shown to influence either the degree of disability and/or the progression of disease in individuals with knee OA. These factors include quadriceps inhibition or activation failure, obesity, passive knee laxity, knee alignment, fear of physical activity and self efficacy. It may be possible that varying levels of these factors might also interfere with an individual's ability to participate in an exercise or physical activity program or minimize the benefits that can be achieved by such programs. This paper examines the influence of these factors on physical function and their potential for altering the outcome of exercise therapy programs for individuals with knee OA. Implications and suggestions for potential adjunctive interventions to address these factors in future research and clinical practice are also discussed.

Critical comparison of nine different self-administered questionnaires for the evaluation of disability caused by low back pain.

Abstract: Aim The aim of this study was to critically compare 9 self-administered questionnaires designed to evaluate disability caused by back pain. Methods The questionnaires were analyzed considering and comparing their psychometric characteristics (reliability, validity, responsiveness, minimal clinically relevant difference), together with other practical and technical aspects (number of items, number and kind of domains, scaling of items, scoring, time to complete, validated translations, etc.). Data were obtained from scientific literature. Results Only 3 out of 9 analyzed instruments (i.e., the Oswestry Low Back Pain Disability Questionnaire, the Quebec Back Pain Disability Scale, and the Roland-Morris Low Back Pain Disability Questionnaire) appear fully validated from a psychometric standpoint. Conclusions On the basis of psychometric evaluations as well as feasibility considerations, the authors suggest using either the Roland-Morris or Oswestry questionnaire as the best assessment of the level of disability caused by back pain.

Cardiac rehabilitation after myocardial infarction: a review to understand barriers to participation and potential solutions.

Abstract: As survival after myocardial infarction (MI) improves, secondary prevention is becoming increasingly important. Cardiac rehabilitation (CR) is one modality for delivery of secondary prevention, whose ultimate goal is to help patients receive appropriate preventive therapies that will help them optimize health and reduce the risk of future cardiac diseases. However, participation rates in CR are less than optimal: in the United States, only 29.5% of MI survivors participated, in Japan 21% of those with acute MI, and in Australia 29% of those eligible were referred, and only 1/3 of those referred acutally attended CR; moreover, there does not appear to be a trend towards increasing participation over time. After reviewing the components of CR and the benefits of participation, this paper will focus on the barriers to participation in CR: from a theoretical framework to consider barriers at patient, provider, health system, and societal levels. We then explore the possible solutions to overcome them and finally propose recommendation for future research.

The needs of young people with disabilities in transition from paediatric to adult services.

Abstract: Transition to adulthood requires consolidation of identity, achievement of independence establishment of adult relationships and finding vocation. Those with disabilities and health problems experience difficulty in this through lack of social opportunity. There are 340,000 affected UK individuals of 16-29 years. Most, having survived childhood disability, may experience later deterioration in functional level. Most will require long term monitoring. Health needs include treatment for the complications and progression of their condition, appropriate treatment for everyday, and unrelated diseases, and health maintenance knowledge. Leaving a cohesive paediatric service and entering the uncoordinated adult health services has been described as hurtling into a void''. Therefore, number of health service models have been proposed, including the person-focussed model, a disease-focussed model, a hospital-based model, a team-based outside the health service, a named person, a voluntary organisation and a primary care model. For those with complex disabilities an interdisciplinary team comprising a consultant in Rehabilitation Medicine, (who will facilitate referral to other medical consultants) occupational therapy, speech therapy, psychology and social work input with support from physiotherapy and nursing addresses all these needs. Young Adult Teams can both teach skills, and facilitate health and other service usage. This whole area of work is under-researched. The outcomes for disabling childhood conditions must be investigated, and planning for adulthood must influence the pattern of care in childhood. The most urgent need is to set up effective services for young adults, which will help to ensure that their 50 years of adulthood have quality of life.

SIMFER Rehabilitation treatment guidelines in postmenopausal and senile osteoporosis.

Abstract: A widely used and well established, physical therapy and rehabilitation for postmenopausal and senile osteoporosis still lacks evidence-based scientific support for the rationale of specific areas of therapy. These guidelines derive from an extensive literature review of the subject. Wherever specific studies were lacking, expert opinion was enlisted to fill these gaps. The guidelines do not include the role of physical exercise in the premenopausal period.

Measuring long-term outcome in people with lower limb amputation: cross-validation of the Italian versions of the Prosthetic Profile of the Amputee and Prosthesis Evaluation Questionnaire.

Abstract: Aim Recently 2 questionnaires have been developed for people with lower limb amputation to determine, in follow-up studies, the level of function and extent of prosthetic use, to measure major life domains connected with prosthesis function, and to study the factors potentially related to prosthetic use the Prosthetic Profile of the Amputee (PPA) and the Prosthesis Evaluation Questionnaire (PEQ). The purpose of the present study was: a) to produce Italian versions of both PPA (PPA-it) and PEQ (PEQ-it), using a validated procedure of cross-cultural translation; b) to analyse and discuss the internal consistency and construct validity of the main sections of the 2 questionnaires, in an Italian population. Methods The PPA questionnaire consists of 44 questions arranged in 6 sections. The PEQ is composed of 82 questions subdivided into 9 scales related to 4 sectors. In order to produce the Italian versions of the PPA and PEQ the forward/backward translation method was used. The final versions of the questionnaires were mailed to 110 patients and 95 of them returned the questionarries. Results The Cronbach's alpha of Locomotor Capabilities Index (LCI/5), part of the PPA, was 0.97, and those of the 9 PEQ-it scales ranged from 0.64 (appearance) to 0.95 (mobility, MO). The LCI/5 and MO correlated highly with each other (rs=0.81) and with the variables related to prosthesis use. There was a significant correlation among the PEQ-it domains concerning MO, prosthesis function, psycho-social aspects and well-being. Conclusion Unfortunately, the acceptability and feasibility of both questionnaires (rather low completion rate, visual analogue scale format of PEQ, demanding scoring procedures) were sub-optimal, and their structure (item selection, response format, scaling properties, etc.) would need some refinement and simplification in order to facilitate a broader clinical use. On the other hand, findings for the LCI/5 (PPA) and MO (PEQ) are encouraging (particularly regarding the first scale) and confirm their sound practical and psychometric features.

Exercise rehabilitation in cardiac transplantation patients: a comprehensive review.

Abstract: Cardiac transplant recipients are often severely deconditioned, the result of their presurgical disease state, and as a consequence are prime candidates for exercise-based rehabilitation. The training regimen, however, needs to take into account the patient's atypical central and peripheral responses to exercise. This review deals with these changes, describes typical exercise testing and training protocols, with some reference to the Toronto practice, and summarizes training-induced benefits as well as long-term residual effects. The evidence for sympathetic reinnervation is reviewed, with the conclusion that while it may occur over time, it is inconsistent, and partial in nature.

The role of exercise training for patients with heart failure.

Abstract: Heart failure (HF) is characterized by dyspnea and fatigue leading to exercise intolerance. HF patients have been advised to avoid exercise because of concerns about detrimental cardiac effects. However, in many studies on the effects of exercise training HF patients have demonstrated beneficial outcomes. Furthermore, exercise training has been found to be safe. Recent studies have demonstrated that exercise training might reduce morbidity and mortality. Although these data are promising, confirmation is required from a large clinical trial powered to examine the effects of exercise training on mortality and morbidity. The "Heart Failure - A Controlled Trial Investigating Outcomes of Exercise TraiNing" (HF-ACTION) trial, a large randomized controlled clinical trial, will answer that question. Standardized guidelines for exercise training HF patients have not been established. Exercise training should be individualized according to the results of the exercise test. Ideally, the exercise program should be initiated in the setting of a supervised program followed by a home-based program. Each patient should have a tailored activity program based on a prescription for the frequency of each session, the intensity, duration of each session, and modalities to be used. Exercise training should involve aerobic exercise. Resistance exercise and interval training might be an acceptable method for HF patients; however, more studies are required for these types of exercise programs.

Psychosocial factors and assessment in cardiac rehabilitation.

Abstract: Understanding the unique impact of psychosocial factors on the development and progression of coronary heart disease (CHD) has significant implications for cardiac rehabilitation (CR). Recent guidelines for CR strongly recommend the assessment of psychosocial factors and provision of behavioral interventions for CR participants. In this review, we focus on the most prominent psychosocial issues in CR literature, namely depression, anxiety, social support, and cardiac-prone personality. First, we summarize the current empirical findings with regard to each of the psychosocial issues in CR. In addition, we provide recommendations for some of the most common or useful instruments for assessing these psychosocial factors in CR settings. The results show that anxiety and depression are, in general, prevalent among CR participants, and that CR appears to be effective in reducing these distressful symptoms as well as coronary-prone behaviors. There is some evidence suggesting that higher anxiety and depression as well as a lack of social support may prevent cardiac patients from attending CR or predict non-adherence and premature dropout in CR participants. The generalizability of these findings, however, may be compromised by several methodological issues, including relatively small samples, low representation of women in studies, and lack of rigorous statistical controls. Future research is needed to investigate the specific role of each psychosocial factor in the context of rehabilitation.

The effects of traumatic brain injury on patients and their families. A follow-up study.

Abstract: AIM With this study we wanted to verify whether the same uneasiness elements as those described by numerous previous studies also existed in an Italian sample of traumatic brain-injured (TBI) patients. METHODS A follow-up investigation was conducted on a sample of 16 subjects who had suffered severe TBI 5 to 10 years earlier. Based on series of neuropsychological tests, the patients' levels of remaining autonomous function were assessed. For each patient, a family reference person was identified with a semistructured interview to define how they dealt with the consequences of the trauma within the familial nucleus, what motivated their choices, the social outcome of the familial nucleus, the behavioral outcome, and the social- and work-related outcomes of the patient. The caregiver's current emotions were also analyzed. RESULTS The study results confirmed that the family felt isolated from the social groups it used to belong to, and that few patients had fully achieved reinsertion into their social and/or work environments. Only 50% of subjects had returned to their job, most of them finding work at a lower level. The closest relatives reported experiencing a state of hardship. Many (70%) care-givers expressed by a steady feeling of worry but had devised effective compensatory strategies over the course of the study period to deal with depression. Such compensation appeared to be the result of the care-givers' awareness of the need to cope with situations where the patients very often depended on them. The hardship level the patient's familial nucleus experienced was not correlated with the patient's social- and work-related outcome, and elements of difficulty were evident among the relatives of patients who had returned to a productive life and those who were close to the family. The presence of severe cognitive and/or behavioral disability was a major factor in generating concern and worry about the future. In cases where the patient was severely disabled, the happiness level perceived by the patient's relatives, as expressed on a 5-point Likert scale, was 2.1, whilst in cases where disability was absent the level was 3.5. CONCLUSIONS Our observations confirm evidence from previous studies that even many years after a severe trauma incident, a state of disability and/or hardship involving the entire familial nucleus persists.

Handgrip impairment in Charcot-Marie-Tooth disease.

Abstract: Aim Charcot-Marie-Tooth disease (CMT) is a genetic neuropathy causing muscle weakening in the feet, legs and hands, with consequent impairment of ambulation and handgrip. For fast clinical evaluation and rehabilitation management of handgrip deficits, a functional classification in 4 stages or levels of clinical severity, based on the loss of handgrip types from the finest to the roughest, has been recently proposed. The aim of this study is to evaluate the prevalence of each level of handgrip impairment in a wide population of patients affected with demyelinating and axonal CMT. Methods Two-hundred and forty-eight non-operated hands were examined to evaluate if and how the pinch between the pulp of the thumb and the pulp of the second or third finger was made, starting from the palm-up position with the fingers abducted or, in case of impossibility to do so, if a lateral pinch or only a grasp was possible. Following to this observation, each hand was fitted in 1 of the 4 stages described in the above-mentioned classification and then the frequency of each stage was determined. Results As a whole, 75.4% hands were at stage 1; 9.7 were at stage 2; 10.9% at stage 3; 4% at stage 4. Conclusions The results of this survey reveal that, in the majority of the CMT cases, handgrip is affected mildly so that only simple recommendations to prevent further muscle and joint damage are required; however, in more than 1 out 5 cases, the handrip impairment is quite severe and requires a detailed rehabilitative program with daily exercises, and, in a small number of cases, is so severe that independence in the daily living activities is lost or very reduced.

Depression and psychosocial factors in Turkish women with fibromyalgia syndrome.

Abstract: AIM The aim of this study was to evaluate the demographic qualifications, frequency of depression, degree of pain, and the correlations between these factors in Turkish women with fibromyalgia syndrome (FS). METHODS Fifty-three women with FS and 54 healthy women were included in the study. The visual analogue scale (VAS) was applied to evaluate the degree of pain and Beck depression inventory (BDI) for depression. RESULTS Mean age of the FS and the healthy women groups was 42.6+/-9.6 (21-63) and 39.4+/-13.2 (24-60) years respectively; which were statistically similar (P>0.05). Of the patients, 69.8% were married, and the mean years of education was 8.7+/-4.8 years. Marriage among relatives was found in 18.4% of the patients. The mean VAS score of the patients was 7.2+/-1.7 cm with the mean duration of pain 5+/-4.6 years. Mean BDI scores of FS patients and the healthy group were 15.7+/-8.7 and 10.2+/-5.5 respectively; the difference between the 2 groups was statistically significant (P<0.05). According to the BDI scores, 90% of FS patients were classified as depressed; among them, 50% had minor, 38% moderate, and 2% severe depression. FS patients who were married to a relative had higher scores of BDI (r=0.414, P=0.013). There was negative correlation between BDI score and patients' total year of education (r=-0.295, P=0.037); and the husband's education level (r=-0.367, P=0.030). According to BDI, the c2 test revealed significant depression in patients with sleep-disorders (P=0.009). CONCLUSIONS We found a significant degree of depression in Turkish female FS patients. This situation is found to be correlated with the education level of both patient and husband; marital status, and sleep-disorder; it is suggested that these factors should be taken into consideration in the diagnosis, treatment and follow-up of FS patients.

Experts' beliefs on physiotherapy for patients with ankylosing spondylitis and assessment of their knowledge on published evidence in the field. Results of a questionnaire among international ASAS members.

Abstract: AIM The aim of this study was to assess both the opinion of an international group of experts about the place and importance of physiotherapy in the management of ankylosing spondylitis (AS) as well as the awareness of the responders about scientific evidence on efficacy and cost-effectiveness of physiotherapy in AS. METHODS An e-mail questionnaire ''Experts' Beliefs on Physiotherapy for Patients with Ankylosing Spondylitis'' has been sent to all 71 international ASsessment of Ankylosing Spondylitis (ASAS) members. Completion of the twenty-eight-item questionnaire was done through the ASAS website (www.ASAS-group.org). RESULTS The number of responders was 53 (response rate 73%). Altogether 94% of the responders regard themselves as experts in the field of clinical care for AS patients. There is almost unanimous (86-92%) consensus on the efficacy of physiotherapy (widely defined, i.e. as physical therapy-including exercises, application of physical modalities and spa-therapy) for patients with axial and peripheral joint manifestations of AS. Physiotherapy is considered to be indicated for both early AS (less than 2 years after diagnosis) (88%) and AS of longer duration (2 to 10 years) (94%), implying that this non-pharmaceutical intervention should be made available for or should be prescribed to AS patients. Also daily exercises at home are considered indicated for both early (less than 2 years after diagnosis) AS (90%) and AS of longer duration of disease (90%). High-level evidence (Cochrane reviews or publications of one or more randomized controlled clinical trials) favoring efficacy of physiotherapy was considered available by 33% of the participants, whereas 43% replied ''no'' and 24% did not know. Finally, excluding the costs of the intervention, 39% of the participants reported that Spa-therapy might reduce health care costs as usage of NSAIDs, physician visits and ability to work or sick leave, whereas 26% said ''no'' and 35% did not know. CONCLUSIONS The international ASAS experts hold a favorable opinion on the efficacy of physiotherapy in AS, including group exercises and spa therapy, almost irrespective of disease duration and type of articular involvement (axial/peripheral). Awareness of published evidence on physiotherapy in AS is unsatisfactory.

Strength training for patients with chronic heart failure.

Abstract: Chronic (congestive) heart failure (CHF) is a disabling disease where patients suffer from dyspnoea and exercise intolerance. Peripheral skeletal muscle disorders play a major role in the pathogenesis of these symptoms and also in the progression of the disease. Besides cardiovascular endurance training, strength training should be an important component of cardiac rehabilitation programs in CHF because of its ability to efficiently improve muscle function and muscle mass. Safety of this type of training, while long-time questioned, has been established. Training recommendations for strength training should be based on current research. The positive training effects induced by strength training improve the patients' functional capacity and exercise tolerance and thereby also their quality of life and its widespread use should be promoted.

Effects of short term cast wearing on respiratory and cardiac responses to submaximal and maximal exercise in adolescents with idiopathic scoliosis.

Abstract: Aim Bracing is widely used to treat adolescent scoliosis. However, bracing may also affect respiratory and cardiovascular function. In this thirteen-weeks longitudinal study we evaluated the effect of brace wearing on maximal and submaximal cardiorespiratory capacity in adolescents with moderate idiopathic scoliosis. Methods Eight boys and 8 girls (12-18 years) with scoliosis of the thoracic spine (Cobb angle range 32 degrees - 42 degrees in boys and 32 degrees - 60 degrees in girls) were enrolled. Respiratory basal function (forced vital capacity, FVC, and forced expired volume in 1 s, FEV(1)) and cardiorespiratory adjustments to submaximal and maximal cycle ergometer exercise (heart rate, HR, pulmonary ventilation, VE, and oxygen consumption, VO(2)) were measured a week before fitting a brace, after 1 and 12 weeks of brace wearing, and a week after brace removal. Results With respect to pretreatment values: a) after 1 week of brace wearing FVC and FEV(1) were significantly reduced in both genders; b) after 12 weeks of bracing the amount of oxygen consumed per heart beat was reduced during maximal and submaximal exercises in females only; c) ventilatory efficiency was unchanged in both genders in each condition; d) oxygen uptake during maximal exercise was decreased (by about 10-20%) in females only; e) after brace removal all variables tended to regress to pretreatment values. Conclusions Although data are preliminary and need to be confirmed on larger samples of patients, the brace appears to limit maximal exercise performance especially in girls, where it affects the cardiopulmonary efficiency. Thus, moderate physical exercise during brace wearing is advised to counteract respiratory, cardiovascular and muscle inefficiency due to ribcage movement limitations.

A randomized controlled trial on the efficacy of physical exercise in patients braced for instability of the lumbar spine.

Abstract: Aim Spinal instability is often disregarded as a cause of chronic low back pain and until now there has been no agreement as to its definition and on its nosologic importance or as to a conservative therapeutic protocol. The authors aim to verify whether possible symptomatological characteristics are reflected in radiological findings and, although there is no univocal opinion on the utilization of orthoses of containment for unstable segments, they also aim to verify their efficacy on pain control and neuromotor performance when employed in isolation or in association with the most reliable rehabilitation techniques. Methods Forty-eight patients between the ages of 30 and 50 were entered in the study, selected with special exclusion criteria and appropriately randomized to a group following kinesitherapy (KT) and orthoses (O) (O+KT group) and to a control group (orthoses [O] group); the symptomatological and instrumental characteristics were studied at time intervals 0 (t0), 3 months (t3), 6 months (t6), and 12 months (12t). Results The samples examined present homogeneous characteristics. Lumbar instability pain is related to the presence of shift and not to hypermobility, when the latter is guided by efficient neuromotor feedback. In the O+KT group, treatment achieves the two-fold results of reducing shift and increasing mobility in the absence of pain. Both groups tend to increase the utilization of a brace over time. Furthermore, in the O+KT group, a marked reduction in the use of medicine is noticed. Conclusions Following treatment both groups report a decrease in pain even though the results of neuromotor performance prove to be better in the group following KT.

Effectiveness of functional magnetic versus electrical stimulation in women with urinary incontinence.

Abstract: Aim Urinary incontinence is one of the most common medical complaints in women. We here propose to evaluate and compare the effects of 2 conservative treatment modalities, functional electrical stimulation (FES) and functional magnetic stimulation (FMS). Methods We studied 22 female patients with urinary incontinence and divided them into 2 treatment groups (14 patients in the FES and 8 in the FMS group). The mean age of the patients in the FES group was 51.14+/-11.9 and in the FMS group 42.25+/-6.9 years. Functional electrical stimulation was applied continuously at 10 Hz and 30-50 Hz in urge and stress urinary incontinence respectively. In mixed urinary incontinence stimulation was applied at 10 Hz for 15 min and at 50 Hz for 15 min. The treatment sessions were for 20 min, 3 times a week for 6-8 weeks (12 with mixed, 2 with stress incontinence). FMS was applied by a magnetic chair, twice weekly for 6 weeks (6 with mixed, 1 with stress urinary and 1 with urge urinary incontinence). The efficacy of the treatment was judged from patient impressions, records in urinary diaries, results of 1 h pad test, perineometry value and digital palpation score. Results The perineometry value, digital palpation score increased significantly during stimulation compared with prestimulation levels in both groups (P 0.05). Conclusions Both FES and FMS treatments were effective. FMS does not involve intravaginal stimulation and it is twice a week. Although FMS is not often used it is more cost effective than FES. In order to have exact knowledge of this issue; more research than has been done in a greater number of subjects is required.

A review to develop an effective exercise training for heart failure patients.

Abstract: The patient with heart failure relies on varied physiological adaptations to exercise training. Although, the cardiovascular adaptations may be limited, the patient with heart failure relies on changes in the pulmonary system as well as peripheral muscular adaptations. Therefore, the intent of this review is to outline effective exercise program design and to discuss the effects of exercise training on the patient with heart failure, including cardiovascular, pulmonary, and peripheral musculature adaptations. As a result of exercise training, patients with heart failure can improve their exercise capacity and quality of life, despite no or reduced improvement in central hemodynamics. Respiratory muscle endurance improves with exercise training which contributes to patients' increased exercise capacity, decreased breathlessness, and decreased perception of breathlessness. In addition, peripheral muscle adaptations result in an enhanced ability for oxygen extraction and utilization, a delayed onset of anaerobic metabolism during physical activity, and less fatigue as a result of physical activity and activities of daily living. Many of the physiological sequela associated with reduce functional ability in heart failure patients are correctable with exercise training. The practical implications (and maybe the most important to the patient) of these positive adaptations include less frequent rest periods, lesser overall fatigue, greater confidence to embark on physical tasks, maintenance of independence, and enhanced quality of life.

Are some cases of spina bifida combined with cerebral palsy? A study of 28 cases.

Abstract: Aim This study is a description of a group of children with spina bifida who present with neurological impairments resembling cerebral palsy. Spina bifida is a complex congenital spinal anomaly causing paraparesis. Some children with spina bifida have neurological impairments, which fit into the definition of cerebral palsy. Extensive spasticity discordant with the level of the spina bifida lesion, upper extremity dysfunction and cognitive impairment are suggestive of concomitant cerebral palsy in these cases. The probable etiology for this problem may be neglected hydrocephalus, meningitis or other brain lesions common in spina bifida. Methods In this study we have reviewed our cohort of 365 patients and found 28 cases with the above-mentioned findings. Main evaluation parameters used were the Ashworth scale for spasticity, Green and Banks modified classification for hand function, cognitive function, mental status, ambulation and lesion level. Results Twenty-eight out of 365 children with spina bifida had neurological impairments resembling cerebral palsy. Their mean age was 59.9+/-41.3 (range, 16.8-31.2) months. Seventy percent of the patients were nonambulatory and therapeutic ambulation only was present in 30% of patients. Seventy percent of the children had spasticity of Ashworth grade 2 or higher. Upper extremity dysfunction, and cognitive impairment were also observed in 80% of the patients involved in this study. The spinal lesion was 60% thoracal and 20% upper lumbar, and none of the cases had signs of spinal tethering. Conclusions We believe that this group of children with spina bifida may be regarded as having concomitant cerebral palsy. This fact implies that the management of this group of patients having mixed findings must be changed accordingly.

Cerebral blood flow velocity during postural changes on tilt table in stroke patients.

Abstract: Aim The aim of the study is to investigate the correlation between orthostatic hypotension (OH), mean flow velocity (MFV) as measured by transcranial Doppler (TCD) in middle cerebral artery (MCA) bilaterally during tilt table test (TTT) and functional and neurological parameters in acute ischemic stroke patients, undergoing rehabilitation. Methods Thirteen patients after first ischemic stroke in the MCA territory and 13 healthy volunteers were examined. TTT was performed with elevating the subject from supine to 80 masculine standing position and back to supine within 10 min. Peripheral blood pressure was measured and monitoring of MFV in MCA of damaged and healthy hemisphere by TCD was performed during the TTT. Patients underwent the test few days after admission to rehabilitation department and were classified into 2 subgroups: those with decrease of systolic blood pressure of at least 20 mm/Hg during the test and those without the OH. Results Among patients without OH, MFV indexes were almost the same in damaged and healthy MCA and did not changed during the test. Patients with OH symptoms showed significant differences between blood flow velocities in 2 hemispheres in favor of nondamaged size. No association was found between the OH and the severity of functional and neurological status after stroke. Conclusions These findings suggest that the appearance of OH after ischemic stroke may be associated with decreased blood flow velocity in damaged MCA at the beginning of rehabilitation treatment, but not with functional and neurological status of the patient.

Nosocomial infections in the rehabilitation department.

Abstract: AIM The patients of a Rehabilitation Department are at high risk of nosocomial infections because they generally have a long term hospitalisation and more and more frequently immune-compromised subjects, like old patients or with chronic illness, are admitted to rehabilitation programs. However, to evaluate the real infectious risk of a Rehabilitation Unit, it is important to consider also that a high number of patients are transferred from other hospitals after a specific therapy of the acute phase of their medical or surgical pathology and so many nosocomial microrganisms previously acquired may spread to a Rehabilitation Unit. METHODS From January to December 2003 we have performed a screening of the bacteruria among the patients at admittance to the Rehabilitation Unit of S. Orsola Fatebenefratelli Hospital of Brescia (Italy). RESULTS A significant bacteruria (>100000 cfu/mL) in 28.9% of 114 patients coming from home and in 41.9% of 179 patients transferred from other hospitals without antibacterial treatment has been documented. CONCLUSIONS These findings confirm the presence of an high number of patients colonized or infected by nosocomial bacteria previously acquired in hospital and underline the need, in addition to specific skill, of wide infectious knowledge among the medical staff of a Rehabilitation Unit. A specific approach to the infectious problem in the Rehabilitation Department in order to reduce the risk of nosocomial infections may be suggested.

ZooMS: a non invasive analysis of global and metameric movement of the lumbar spine.

Abstract: Aim. The assessment of spine mobility is an important parameter to define its functionality. In the last decades a lot of research has been carried out mainly through radiographic investigations; non invasive methods demonstrated not to be sufficiently accurate, not to allow free movement, not to provide metameric assessment and suitable for everyday clinical practice. The aim of this study is the development of a new experimental non invasive protocol, called Zoom on mobility of the spine (ZooMS) to assess the mobility of lumbar spine, from the 11 th thoracic to the sacrum bone and the pelvis, with the possibility of identifying the metameric contribution of each rotation around all the axes correlated to the global movement. Methods. We developed a dedicated non invasive methodology based on optoelectronic techniques for 3D target recording to be applied to the functional evaluation of the mobility of the lumbar spine in young healthy males. Ten subjects participated in the method validation, performing free rotations (flexion/extension, lateral bending and axial rotation) from standing to the maximum excursion and back. Results. The comparison of the range of motion (RoM) with those presented in literature was satisfactory, although some differences were shown (above

Europa Medicophysica is indexed by Medline: opening new perspectives for European, Mediterranean and Italian physical and rehabilitation medicine.

Abstract: E Medicophysica is a historical, forty oneyears-old, glorious scientific journal, that followed almost the entire history of European and Italian physical and rehabilitation medicine (PRM), and that in the last years overcame the boundaries of Europe to include in its interest all the Mediterranean area. PRM for years has been considered the cinderella of clinical sciences, because its attention focused historically more on persons than on illnesses, while its methods of treatment are centered more on relationships than on biological or chemical patterns: now this is considered a requirement for all medical activities. The long standing absence of measurement instruments in PRM, even with some resistance in the physicians devoted to this human science to consider it also a science per se, is almost cancelled today by a strong evolution of both classification and evaluation tools ranging from outcomes to quality of life and satisfaction of treatments: today this is not only research, it is everyday clinical practice. The PRM doctor, that used to be the unimportant end of a chain driven by other specialists, is now the centre of a strong and large team, an interdisciplinary network devoted to the care of single persons: in intensive care, hospitals, research centres, universities, and community. All this was particularly true in Europe and even more in the Latin world, where humanistic approaches to medicine are more traditional than scientific ones, not only in PRM. Europa Medicophysica followed this pathway, but everything changed in the last years.

Physical therapy and rehabilitation programs in the management of hip osteoarthritis.

Abstract: Nonpharmacological treatment programmes are as important as drug treatment in hip osteoarthritis (OA). Drugs (analgesic and nonsteroidal anti-inflammatory drugs) should not be used as sole treatments in hip OA. Patient education and weight reduction are the primary therapeutic approaches. Different types of exercises are beneficial for patients with hip OA. Occupational therapy plays a central role in the management of hip OA patients with functional limitations. More and better-designed trials are needed to evaluate the efficacy of nonpharmacological treatment programmes used in hip OA.

Prognostic value of motor evoked potentials in stroke motor outcome.

Abstract: Functional study technologies of the central nervous system (CNS) are fast developing, yielding further objective data for evidence based neurological rehabilitation. Transcranial magnetic stimulation is a safe and non invasive technique of functional investigation of several aspects of the CNS. During the past few years many studies have focused on motor evoked potentials (MEPs) in the investigation of central nervous system and particularly of central motor pathways. Among the various issues of rehabilitative concern in this context, the prognostic value of MEPs of motor outcome after stroke is the most interesting one. The aim of this review, conducted on Medline database, is to find out the current agreement in the literature about this topic and to outline clinical criteria of use of the test. Many of the retrieved papers suggest an added value of MEPs on motor prognosis after first ischemic sylvian stroke, highlighting higher specificity in clinical cases with paralysis or severe paresis in the acute stage. A clinical use of MEPs in specific stroke subgroups might help to plan a more individual rehabilitative project through realistic motor recovery goals and selected techniques of treatment; a more reliable motor prognosis may also be useful for rehabilitation effectiveness research and for a more aimed use of resources.

Short history of Europa Medicophysica: 41 years of contributions to the scientific roots of the Specialty of Physical and Rehabilitation Medicine.

Abstract: E Medicophysica is born in 1964, and his history follows, and sometimes contributes to drive that of the Specialty of Physical and Rehabilitation Medicine (PRM) in Europe and Italy. The second name was “The European Journal of Physical Medicine and Rehabilitation” (Figure 1), being since the beginnig the Official Journal of the European Federation of Physical Medicine and Rehabilitation, as well as that of the Società Italiana di Medicina Fisica e Riabilitativa (Italian Society of Physical and Rehabilitation Medicine, SIMFER) (Figure 2). In the European Editorial Board there were 28 members from 17 countries, while in the Italian one there were 13 members; the journal was organised in 2 parts: first, the international one, with papers in English or French, then the Italian one (Figure 3). In the first Editorial, published in our 3 official languages, the 3 founders Dario Fiandesio (that also served as the first Chief-Editor), Giorgio Nino Valobra and Rene Waghemacker stated: “For many years the need has been felt among exponents of Physical Medicine and Rehabilitation for a European journal in which to express their views and discuss common problems”.1 In fact, looking at Index Medicus/Medline and at the general rehabilitation journal, in those years in Europe existed only “Rehabilitation” (England: 1948-1977) and “Die Rehabilitation” (Germany: 1962), while of those still publishing worldwide only “Archives of physical medicine and rehabilitation” (USA: 1953), and the “Journal of rehabilitation” (USA: 1945) were already founded. The mission of our journal was: “For those already spe-