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V O L U M E 5 2 - S U P P L . 1 N o . 2 - A P R I L 2 0 1 6
EUROPEAN JOURNAL OF
PHYSICAL AND REHABILITATION
MEDICINE
MEDITERRANEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
formerly
EUROPA MEDICOPHYSI CA
Chief Editor: Stefano NEGRINI
PUBBLIC AZIONE PERIODIC A BIMES TRALE - POS TE I TALIANE S .P .A. - SPED . IN A.P .D .L. 353/2003 (CONV . IN L. 27/02/2004 N° 46) AR T. 1, COMMA 1, DCB/CN - ISSN 1 973-9087
TAXE PERÇUE
Official Journal of
Italian Society of Physical and Rehabilitation Medicine (SIMFER)
European Society of Physical Medicine and Rehabilitation (ESPRM)
European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS - PRM)
Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM)
Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with
International Society of Physical and Rehabilitation Medicine (ISPRM)
20
thEuropean Congress of
PHYSICAL and REHABILITATION MEDICINE
Estoril - Lisbon
23-28 April 2016
Board of Directors
This journal is PEER REVIEWED and is indexed by: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor: 1,903
Published by Edizioni Minerva Medica - Corso Bramante 83-85 - 10126 Torino (Italy) - Tel. +39 011 678282 - Fax +39 011 674502 - Web Site: www.minervamedica.it Editorial office: ejprm@minervamedica.it - Subscriptions: subscriptions.dept@minervamedica.it - Advertising: journals3.dept@minervamedica.it
Chief Editor address: S. Negrini - University of Brescia - Viale Europa 11 - 25123 Brescia, Italy - IRCCS Don Gnocchi Milan, Via Capecelatro 66, 20141 Milan, Italy. E-mail: stefano.negrini@med.unibs.it - snegrini@dongnocchi.it - stefano.negrini@isico.it
Annual subscriptions:
Italy - Individual: Online € 110,00, Print € 115,00, Print+Online € 120,00; Institutional: Print € 150,00, Online (Small € 325,00, Medium € 373,00, Large € 390,00, Print+Online (Small € 341,00, Medium € 388,00, Large € 404,00).
European Union - Individual: Online € 185,00, Print € 190,00, Print+Online € 200,00; Institutional: Print € 265,00, Online (Small € 325,00, Medium € 373,00, Large € 390,00, Print+Online (Small € 351,00, Medium € 399,00, Large € 414,00).
Outside European Union - Individual: Online € 205,00, Print € 215,00, Print+Online € 225,00; Institutional: Print € 290,00, Online (Small € 341,00, Medium € 393,00, Large € 409,00), Print+Online (Small € 362,00, Medium € 414,00, Large € 430,00).
Subscribers: Payment to be made in Italy: a) by check; b) by bank transfer to: Edizioni Minerva Medica, INTESA SANPAOLO Branch no. 18 Torino. IBAN: IT45 K030 6909 2191 0000 0002 917 c) through postal account no. 00279109 in the name of Edizioni Minerva Medica, Corso Bramante 83-85, 10126 Torino; d) by credit card Diners Club International, Master Card, VISA, American Express. Foreign countries: a) by check; b) by bank transfer to: Edizioni Minerva Medica, INTESA SANPAOLO Branch no. 18 Torino. IBAN: IT45 K030 6909 2191 0000 0002 917; BIC: BCITITMM c) by credit card Diners Club International, Master Card, VISA, American Express.
Members: for payment please contact the Society.
Notification of changes to mailing addresses, e-mail addresses or any other subscription information must be received in good time. Notification can be made by sending
Senior Editor
P. DI BENEDETTO (Udine, Italy) Managing EditorA. OLIARO (Turin, Italy)
Scientific Secretaries
I. APRILE (Rome, Italy) – N. BAROTSIS (Naxos, Greece) - F. GIMIGLIANO (Naples, Italy) S. MOSLAVAC (Varazdinske Topice, Croazia) – P. SALE (Rome, Italy) - A. PICELLI (Verona, Italy)
A. SANTAMATO (Foggia, Italy)
Editorial Board
Chief-Editor
S. NEGRINI (Brescia-Milan, Italy)
Deputy Editors
M. G. CERAVOLO (Ancona, Italy) G. STUCKI (Nottwill, Switzerland)
M. ZAMPOLINI (Trevi, Italy)
Honorary Consulting Editor
F. FRANCHIGNONI (Veruno, Italy)
Associate Editors
M. DI MONACO (Turin, Italy) - M. FRANCESCHINI (Rome, Italy)
L. OZCAKAR (Ankara, Turkey) - S. PAOLUCCI (Rome, Italy) - N. SMANIA (Verona, Italy)
M. G. BENEDETTI (Bologna, Italy) F.C. BOYER (Reims, France) H. BURGER (Ljubljana, Slovenia) A. CANTAGALLO (Padua, Italy) S. CARDA (Lausanne, Switzerland) R. CASALE (Montescano, Italy) E. DALLA TOFFOLA (Pavia, Italy) A. DELARQUE (Marseille, France) G. FERRIERO (Veruno, Italy) P. FIORE (Foggia, Italy) C. FOTI (Rome, Italy)
R. FRISCHKNECHT (Lausanne, Switzerland)
R. GIMIGLIANO (Naples, Italy) S. GRAZIO (Zagreb, Croatia)
C. GUTENBRUNNER (Hannover, Germania) W. JANSSEN (Rotterdam, the Netherlands) J. KARPPINEN (Oulu, Finland) C. KIEKENS (Lovanio, Belgium) A. KUKUCVEDECI (Ankara, Turkey) M.-M. LEFEVRE-COLAU (Paris, France) T. LEJEUNE (Brussels, Belgium) J. LEXELL (Lund, Sweden) S. MASIERO (Padua, Italy) F. MOLTENI (Costa Masnaga, Italy)
A. ORAL (Istanbul, Turkey) L. PADUA (Rome, Italy) M. PAOLONI (Rome, Italy)
T. PATERNOSTRO-SLUGA (Vienna, Austria) S. STERZI (Rome, Italy)
O. SVENSSON ( Sweden) T. VLAK (Split, Croatia) S. PINTO (Lisbon, Portugal) V. SANTILLI (Rome, Italy) J.K. STANGHELLE (Oslo, Norway) P. TAKAC (Košice, Slovak Republic) L. TESIO (Milan, Italy)
F. ZAINA (Milan, Italy)
A. GIUSTINI (Coordinator) N. CHRISTODOULOU (UEMS-PRM Section) A. DELARQUE (ESPRM)
MEDITERRANEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE formerly EUROPA MEDICOPHYSICA
Official Journal of
Italian Society of Physical and Rehabilitation Medicine (SIMFER) European Society of Physical and Rehabilitation Medicine (ESPRM)
European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM) Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM)
Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with
International Society of Physical and Rehabilitation Medicine (ISPRM)
Founded as Europa Medicophysica by ITALIAN SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE (SIMFER) and TOMASO OLIARO in 1965
Chief-Editors - D. FIANDESIO (1964-1986) - S. BOCCARDI (1987-1991) - F. FRANCHIGNONI (1992-1995) - P. DI BENEDETTO (1995-2004) - S. NEGRINI (2004-2007)
PHYSICAL AND REHABILITATION
MEDICINE
Board of Directors
This journal is PEER REVIEWED and is indexed by: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor: 1,903
Published by Edizioni Minerva Medica - Corso Bramante 83-85 - 10126 Torino (Italy) - Tel. +39 011 678282 - Fax +39 011 674502 - Web Site: www.minervamedica.it Editorial office: ejprm@minervamedica.it - Subscriptions: subscriptions.dept@minervamedica.it - Advertising: journals3.dept@minervamedica.it
Chief Editor address: S. Negrini - University of Brescia - Viale Europa 11 - 25123 Brescia, Italy - IRCCS Don Gnocchi Milan, Via Capecelatro 66, 20141 Milan, Italy. E-mail: stefano.negrini@med.unibs.it - snegrini@dongnocchi.it - stefano.negrini@isico.it
Annual subscriptions:
Italy - Individual: Online € 110,00, Print € 115,00, Print+Online € 120,00; Institutional: Print € 150,00, Online (Small € 325,00, Medium € 373,00, Large € 390,00, Print+Online (Small € 341,00, Medium € 388,00, Large € 404,00).
European Union - Individual: Online € 185,00, Print € 190,00, Print+Online € 200,00; Institutional: Print € 265,00, Online (Small € 325,00, Medium € 373,00, Large € 390,00, Print+Online (Small € 351,00, Medium € 399,00, Large € 414,00).
Outside European Union - Individual: Online € 205,00, Print € 215,00, Print+Online € 225,00; Institutional: Print € 290,00, Online (Small € 341,00, Medium € 393,00, Large € 409,00), Print+Online (Small € 362,00, Medium € 414,00, Large € 430,00).
Subscribers: Payment to be made in Italy: a) by check; b) by bank transfer to: Edizioni Minerva Medica, INTESA SANPAOLO Branch no. 18 Torino. IBAN: IT45 K030 6909 2191 0000 0002 917 c) through postal account no. 00279109 in the name of Edizioni Minerva Medica, Corso Bramante 83-85, 10126 Torino; d) by credit card Diners Club International, Master Card, VISA, American Express. Foreign countries: a) by check; b) by bank transfer to: Edizioni Minerva Medica, INTESA SANPAOLO Branch no. 18 Torino. IBAN: IT45 K030 6909 2191 0000 0002 917; BIC: BCITITMM c) by credit card Diners Club International, Master Card, VISA, American Express.
Members: for payment please contact the Society.
Notification of changes to mailing addresses, e-mail addresses or any other subscription information must be received in good time. Notification can be made by sending the new and old information by mail, fax or e-mail or directly through the website www.minervamedica.it at the section “Your subscriptions
- Contact subscriptions department”. Complaints regarding missing issues must be made within six months of the issue’s publication date. Prices for back issues and years are available upon request.
© Copyright 2016 by Edizioni Minerva Medica - Torino. All right reserved. No part of this publication may be reproduced, stored or transmitted in any form or any means, without the prior permission of the copyright owner. Bimonthly publication. Authorized by Turin Court no. 1705 of April 28, 1965. Secretariat of the Italian Society of
Physical Medicine and Rehabilitation - c/o Fondazione Pro Juventute - Via Maresciallo Caviglia 30 - 00194 Roma
Senior Editor
P. DI BENEDETTO (Udine, Italy) Managing EditorA. OLIARO (Turin, Italy)
Scientific Secretaries
I. APRILE (Rome, Italy) – N. BAROTSIS (Naxos, Greece) - F. GIMIGLIANO (Naples, Italy) S. MOSLAVAC (Varazdinske Topice, Croazia) – P. SALE (Rome, Italy) - A. PICELLI (Verona, Italy)
A. SANTAMATO (Foggia, Italy)
Editorial Board
Chief-Editor
S. NEGRINI (Brescia-Milan, Italy)
Deputy Editors
M. G. CERAVOLO (Ancona, Italy) G. STUCKI (Nottwill, Switzerland)
M. ZAMPOLINI (Trevi, Italy)
Honorary Consulting Editor
F. FRANCHIGNONI (Veruno, Italy)
Associate Editors
M. DI MONACO (Turin, Italy) - M. FRANCESCHINI (Rome, Italy)
L. OZCAKAR (Ankara, Turkey) - S. PAOLUCCI (Rome, Italy) - N. SMANIA (Verona, Italy)
M. G. BENEDETTI (Bologna, Italy) F.C. BOYER (Reims, France) H. BURGER (Ljubljana, Slovenia) A. CANTAGALLO (Padua, Italy) S. CARDA (Lausanne, Switzerland) R. CASALE (Montescano, Italy) E. DALLA TOFFOLA (Pavia, Italy) A. DELARQUE (Marseille, France) G. FERRIERO (Veruno, Italy) P. FIORE (Foggia, Italy) C. FOTI (Rome, Italy)
R. FRISCHKNECHT (Lausanne, Switzerland)
R. GIMIGLIANO (Naples, Italy) S. GRAZIO (Zagreb, Croatia)
C. GUTENBRUNNER (Hannover, Germania) W. JANSSEN (Rotterdam, the Netherlands) J. KARPPINEN (Oulu, Finland) C. KIEKENS (Lovanio, Belgium) A. KUKUCVEDECI (Ankara, Turkey) M.-M. LEFEVRE-COLAU (Paris, France) T. LEJEUNE (Brussels, Belgium) J. LEXELL (Lund, Sweden) S. MASIERO (Padua, Italy) F. MOLTENI (Costa Masnaga, Italy)
A. ORAL (Istanbul, Turkey) L. PADUA (Rome, Italy) M. PAOLONI (Rome, Italy)
T. PATERNOSTRO-SLUGA (Vienna, Austria) S. STERZI (Rome, Italy)
O. SVENSSON ( Sweden) T. VLAK (Split, Croatia) S. PINTO (Lisbon, Portugal) V. SANTILLI (Rome, Italy) J.K. STANGHELLE (Oslo, Norway) P. TAKAC (Košice, Slovak Republic) L. TESIO (Milan, Italy)
F. ZAINA (Milan, Italy)
A. GIUSTINI (Coordinator) N. CHRISTODOULOU (UEMS-PRM Section) A. DELARQUE (ESPRM)
MEDITERRANEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE formerly EUROPA MEDICOPHYSICA
Official Journal of
Italian Society of Physical and Rehabilitation Medicine (SIMFER) European Society of Physical and Rehabilitation Medicine (ESPRM)
European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM) Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM)
Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with
International Society of Physical and Rehabilitation Medicine (ISPRM)
Founded as Europa Medicophysica by ITALIAN SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE (SIMFER) and TOMASO OLIARO in 1965
Chief-Editors - D. FIANDESIO (1964-1986) - S. BOCCARDI (1987-1991) - F. FRANCHIGNONI (1992-1995) - P. DI BENEDETTO (1995-2004) - S. NEGRINI (2004-2007)
PHYSICAL AND REHABILITATION
MEDICINE
G. AKYUZ (MFPRM)
This Journal complies with the Code of Self-Discipline of Medical/Scientific Publishers associated with FARMAMEDIA and may accept advertising
This Journal is associated with
The European Journal of Physical and Rehabilitation Medicine publishes papers of clinical interest in physical and rehabilitation medicine. Manuscripts may be submitted in the form of editorials, original articles, systematic review articles, case reports, special articles and letters to the Editor.
Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (http://www.icmje.org/).
Articles not conforming to international standards will not be considered for acceptance.
Submission of manuscripts
Papers should be submitted directly to the online Editorial Office at the Edizioni Minerva Medica website: www.minervamedicaonlinesubmission.it
Duplicate or multiple publication
Submission of the manuscript means that the paper is original and has not yet been totally or partially published, is not currently under evaluation elsewhere, and, if accepted, will not be published elsewhere either wholly or in part. Splitting the data concerning one study in more than one publication could be acceptable if authors justify the choice with good reasons both in the cover let-ter and in the manuscript. Authors should state the new scientific contribution of their manuscript as compared to any previously published article derived from the same study. Relevant previously published articles should be includ-ed in the cover letter of the currently submittinclud-ed article.
Permissions to reproduce previously published material
Material (such as illustrations) taken from other publications must be accom-panied by the publisher’s permission.
Copyright
The Authors agree to transfer the ownership of copyright to European Journal of Physical and Rehabilitation Medicine in the event the manuscript is pub-lished.
Ethics committee approval
All articles dealing with original human or animal data must include a state-ment on ethics approval at the beginning of the methods section, clearly indicating that the study has been approved by the ethics committee. This paragraph must contain the following information: the identification details of the ethics committee; the name of the chairperson of the ethics committee; the protocol number that was attributed by the ethics committee and the date of approval by the ethics committee.
The journal adheres to the principles set forth in the Helsinki Declaration (http://www.wma.net/en/30publications/10policies/b3/index.html) and states that all reported research concerning human beings should be conducted in accordance with such principles. The journal also adheres to the International Guiding Principles for Biomedical Research Involving Animals (http://www. cioms.ch/publications/guidelines/1985_texts_of_guidelines.html) recom-mended by the WHO and requires that all research on animals be conducted in accordance with these principles.
Patient consent
Authors should include at the beginning of the methods section of their manu-script a statement clearly indicating that patients have given their informed consent for participation in the research study.
Every precaution must be taken to protect the privacy of patients. Authors should obtain permission from the patients for the publication of photographs or other material that might identify them. If necessary the Editors may request a copy of such permission.
Conflicts of interest
Authors must disclose possible conflicts of interest including financial agree-ments or consultant relationships with organizations involved in the research. All conflicts of interest must be declared both in the authors’ statement form and in the manuscript file. If there is no conflict of interest, this should also be explicitly stated as none declared. All sources of funding should be acknowl-edged in the manuscript.
Authorship
All persons and organizations that have participated to the study must be listed among the Authors or in the acknowledgements. The manuscript should be approved by all co-authors, if any, as well as — tacitly or explicitly — by the responsible authorities of the institution where the work was carried out. Authors must meet the criteria for authorship established by the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (http://www.icmje.org/).
The authors implicitly agree to their paper being peer-reviewed. All manu-scripts will be reviewed by Editorial Board members who reserve the right to reject the manuscript without entering the review process in the case that the topic, the format or ethical aspects are inappropriate. Once accepted, all manuscripts are subjected to copy editing. If modifications to the manuscript are requested, the corresponding author should send to the online Editorial Office the revised manuscript under two separate files, one file containing the revised clean version and another containing both a letter with point-by-point responses to the reviewers’ comments and the revised version with corrections highlighted.
Correction of proofs should be limited to typographical errors. Substantial changes in content (changes of title and authorship, new results and corrected values, changes in figures and tables) are subject to editorial review. Changes that do not conform to the journal’s style are not accepted. Corrected proofs must be sent back within 3 working days to the online Editorial Office of the European Journal of Physical and Rehabilitation Medicine. In case of delay, the editorial staff of the journal may correct the proofs on the basis of the original manuscript.
Publication fees are €500.00 per article (€300.00 if the first author is a member of the Italian Society of Physical and Rehabilitation Medicine – SIMFER). Editorial Board members are entitled to have one article published free per year provided they are the first author of the article. Colour figures, linguistic revision, and excessive alterations to proofs will be charged to the authors. For further information about publication terms please contact the Editorial Office of the European Journal of Physical and Rehabilitation Medicine, Edizioni Minerva Medica, Corso Bramante 83-85, 10126 Torino, Italy – Phone +39-011-678282 – Fax +39-011-674502 –
E-mail: ejprm@minervamedica.it.
ARTICLE TYPES
Instructions for the most frequent types of articles submitted to the journal.
Editorials. Commissioned by the Editor in Chief, editorials deal with a subject
of topical interest about which the author expresses his/her personal opinion. No more than 1000 words (3 typed, double-spaced pages) and up to 15 refer-ences will be accepted.
Original articles. These should be original contributions to the subject.
The text should be 3000-5500 words (8 to 16 typed, double-spaced pages) not including references, tables, figures. No more than 50 references will be accepted. The article must be subdivided into the following sections: introduction, materials and methods, results, discussion, conclusions. Please add to the materials and methods a complete description of the treat-ments applied using the standard table adapted from the TIDIER checklist (http: //www.equator-network.org/reporting-guidelines/tidier/).The Journal supports the efforts to increase quality of writing in scientific papers. We require authors to:
— choose, according to the design of their paper, one of the following guide-lines;
— conform the structure of their paper to the checklist requirements; — specify in the covering letter which checklist was chosen. Guidelines (for more information, see www.equator-network.org): — randomized controlled trials (CONSORT - www.consort-statement.org); — non-randomized controlled trials (TREND - www.cdc.gov/trendstatement); — observational studies (STROBE - www.strobe-statement.org);
— quality improvement in health care (SQUIRE - www.squire-statement.org).
Systematic reviews and meta-analyses. Systematic reviews and
meta-analy-ses are welcome. The text should be 6000-12000 words (17 to 34 typed, dou-ble-spaced pages) not including references, tables, figures. No more than 100 references will be accepted. The article must be subdivided into the following sections: introduction, evidence acquisition, evidence synthesis, conclusions. In this case, we require authors to:
— choose, according to the design of their paper, one of the following guide-lines;
— conform the structure of their paper to the checklist requirements; — specify in the covering letter which checklist was chosen. Guidelines (for more information, see www.equator-network.org): — systematic reviews (PRISMA - www.prisma-statement.org);
— meta-analyses of observational studies (MOOSE - www.equatornetwork. org) index.aspx?0=1052).
The European Journal of Physical and Rehabilitation Medicine publishes papers of clinical interest in physical and rehabilitation medicine. Manuscripts may be submitted in the form of editorials, original articles, systematic review articles, case reports, special articles and letters to the Editor.
Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (http://www.icmje.org/).
Articles not conforming to international standards will not be considered for acceptance.
Submission of manuscripts
Papers should be submitted directly to the online Editorial Office at the Edizioni Minerva Medica website: www.minervamedicaonlinesubmission.it
Duplicate or multiple publication
Submission of the manuscript means that the paper is original and has not yet been totally or partially published, is not currently under evaluation elsewhere, and, if accepted, will not be published elsewhere either wholly or in part. Splitting the data concerning one study in more than one publication could be acceptable if authors justify the choice with good reasons both in the cover let-ter and in the manuscript. Authors should state the new scientific contribution of their manuscript as compared to any previously published article derived from the same study. Relevant previously published articles should be includ-ed in the cover letter of the currently submittinclud-ed article.
Permissions to reproduce previously published material
Material (such as illustrations) taken from other publications must be accom-panied by the publisher’s permission.
Copyright
The Authors agree to transfer the ownership of copyright to European Journal of Physical and Rehabilitation Medicine in the event the manuscript is pub-lished.
Ethics committee approval
All articles dealing with original human or animal data must include a state-ment on ethics approval at the beginning of the methods section, clearly indicating that the study has been approved by the ethics committee. This paragraph must contain the following information: the identification details of the ethics committee; the name of the chairperson of the ethics committee; the protocol number that was attributed by the ethics committee and the date of approval by the ethics committee.
The journal adheres to the principles set forth in the Helsinki Declaration (http://www.wma.net/en/30publications/10policies/b3/index.html) and states that all reported research concerning human beings should be conducted in accordance with such principles. The journal also adheres to the International Guiding Principles for Biomedical Research Involving Animals (http://www. cioms.ch/publications/guidelines/1985_texts_of_guidelines.html) recom-mended by the WHO and requires that all research on animals be conducted in accordance with these principles.
Patient consent
Authors should include at the beginning of the methods section of their manu-script a statement clearly indicating that patients have given their informed consent for participation in the research study.
Every precaution must be taken to protect the privacy of patients. Authors should obtain permission from the patients for the publication of photographs or other material that might identify them. If necessary the Editors may request a copy of such permission.
Conflicts of interest
Authors must disclose possible conflicts of interest including financial agree-ments or consultant relationships with organizations involved in the research. All conflicts of interest must be declared both in the authors’ statement form and in the manuscript file. If there is no conflict of interest, this should also be explicitly stated as none declared. All sources of funding should be acknowl-edged in the manuscript.
Authorship
All persons and organizations that have participated to the study must be listed among the Authors or in the acknowledgements. The manuscript should be approved by all co-authors, if any, as well as — tacitly or explicitly — by the responsible authorities of the institution where the work was carried out. Authors must meet the criteria for authorship established by the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (http://www.icmje.org/).
Authors’ statement
Papers must be accompanied by the authors’ statement (http://www.minerva-medica.it/en/journals/europa-medicophysica/index.php) relative to copyright, originality, authorship, ethics and conflicts of interest, signed by all authors.
Disclaimer
The Publisher, Editors, and Editorial Board cannot be held responsible for the opinions and contents of publications contained in this journal.1
The authors implicitly agree to their paper being peer-reviewed. All manu-scripts will be reviewed by Editorial Board members who reserve the right to reject the manuscript without entering the review process in the case that the topic, the format or ethical aspects are inappropriate. Once accepted, all manuscripts are subjected to copy editing. If modifications to the manuscript are requested, the corresponding author should send to the online Editorial Office the revised manuscript under two separate files, one file containing the revised clean version and another containing both a letter with point-by-point responses to the reviewers’ comments and the revised version with corrections highlighted.
Correction of proofs should be limited to typographical errors. Substantial changes in content (changes of title and authorship, new results and corrected values, changes in figures and tables) are subject to editorial review. Changes that do not conform to the journal’s style are not accepted. Corrected proofs must be sent back within 3 working days to the online Editorial Office of the European Journal of Physical and Rehabilitation Medicine. In case of delay, the editorial staff of the journal may correct the proofs on the basis of the original manuscript.
Publication fees are €500.00 per article (€300.00 if the first author is a member of the Italian Society of Physical and Rehabilitation Medicine – SIMFER). Editorial Board members are entitled to have one article published free per year provided they are the first author of the article. Colour figures, linguistic revision, and excessive alterations to proofs will be charged to the authors. For further information about publication terms please contact the Editorial Office of the European Journal of Physical and Rehabilitation Medicine, Edizioni Minerva Medica, Corso Bramante 83-85, 10126 Torino, Italy – Phone +39-011-678282 – Fax +39-011-674502 –
E-mail: ejprm@minervamedica.it.
ARTICLE TYPES
Instructions for the most frequent types of articles submitted to the journal.
Editorials. Commissioned by the Editor in Chief, editorials deal with a subject
of topical interest about which the author expresses his/her personal opinion. No more than 1000 words (3 typed, double-spaced pages) and up to 15 refer-ences will be accepted.
Original articles. These should be original contributions to the subject.
The text should be 3000-5500 words (8 to 16 typed, double-spaced pages) not including references, tables, figures. No more than 50 references will be accepted. The article must be subdivided into the following sections: introduction, materials and methods, results, discussion, conclusions. Please add to the materials and methods a complete description of the treat-ments applied using the standard table adapted from the TIDIER checklist (http: //www.equator-network.org/reporting-guidelines/tidier/).The Journal supports the efforts to increase quality of writing in scientific papers. We require authors to:
— choose, according to the design of their paper, one of the following guide-lines;
— conform the structure of their paper to the checklist requirements; — specify in the covering letter which checklist was chosen. Guidelines (for more information, see www.equator-network.org): — randomized controlled trials (CONSORT - www.consort-statement.org); — non-randomized controlled trials (TREND - www.cdc.gov/trendstatement); — observational studies (STROBE - www.strobe-statement.org);
— quality improvement in health care (SQUIRE - www.squire-statement.org).
Systematic reviews and meta-analyses. Systematic reviews and
meta-analy-ses are welcome. The text should be 6000-12000 words (17 to 34 typed, dou-ble-spaced pages) not including references, tables, figures. No more than 100 references will be accepted. The article must be subdivided into the following sections: introduction, evidence acquisition, evidence synthesis, conclusions. In this case, we require authors to:
— choose, according to the design of their paper, one of the following guide-lines;
— conform the structure of their paper to the checklist requirements; — specify in the covering letter which checklist was chosen. Guidelines (for more information, see www.equator-network.org): — systematic reviews (PRISMA - www.prisma-statement.org);
— meta-analyses of observational studies (MOOSE - www.equatornetwork. org) index.aspx?0=1052).
Case reports. These give a description of particularly interesting cases.
The text should be 1500-2000 words (4 to 5 typed, double-spaced pages) not including references, tables, figures. No more than 10 references will be accepted. The article must be subdivided into the following sections: introduc-tion, case report or clinical series, discussion, conclusions.
In this case, we require authors to conform the structure of their paper to the requirements of the following guidelines:
ences will be accepted.
Historical notes. Papers on specific millestones, techniques and pioneers in
the history of physical medicine rehabilitation are welcome. Contributions should fully cover the historical topic proposed through revision of original documents, proper citation of original works or secondary sources, referenc-ing the istitution where the sources were found out.Permission for historical images publication is required. No more than 2000-2500 words /5-6 typed, double-spaced pages) and up to 15 references will be accepted.
Letters to the Editor. These may refer to articles already published in the
journal or to a subject of topical interest that the authors wish to present to readers in a concise form. The text should be 500-1000 words (1 to 3 typed, double-spaced pages) not including references, tables, figures. No more than 5 references will be accepted.
Guidelines. These are documents drawn up by special committees or
authori-tative sources.
The number of figures and tables should be appropriate for the type and length of the paper.
PREPARATION OF MANUSCRIPTS
Text file
Manuscripts must be drafted according to the template for each type of paper (editorial, original article, systematic review and meta-analysis, case report, special article, letter to the Editor).
The formats accepted are Word and RFT. The text file must contain title, authors’ details, notes, abstract, key words, text, references and titles of tables and figures. Tables and figures should be submitted as separate files.
Title and authors’ details
• Short title, with no abbreviations. • First name and surname of the authors.
• Affiliation (section, department and institution) of each author. Notes
• Dates of any congress where the paper has already been presented. • Mention of any funding or research contracts or conflict of interest. • Acknowledgements.
• Name, address, e-mail of the corresponding author. Abstract and key words
For original articles, the abstract should be structured as follows: Background (what is already known and what is not), Aim (what was studied), Design (type of study: systematic review, meta-analysis, RCT, observational, longi-tudinal, controlled, blinded, other), setting (location/facility: inpatient, outpa-tient, community, other), Population (who was evaluated), Methods (what was done), Results (what was found), Conclusions (what this paper adds to the lit-erature), Clinical Rehabilitation Impact (how the study results could improve everyday practice in rehabilitation clinics). The abstract must not exceed 350 words. For systematic reviews and meta-analyses, the abstract should be struc-tured as follows: introduction, evidence acquisition, evidence synthesis, con-clusions. The abstract must not exceed 350 words. For case reports and single-case study the abstract should be structured as follows: Background (what is already known and what is not), Case report (short description), Clinical Rehabilitation Impact (what is new to the actual clinical Rehabilitation knowl-edge). The abstract must not exceed 150 words.
No abstracts are required for editorials or letters to the Editor.
Key words should refer to the terms from Medical Subject Headings (MeSH) of MEDLINE/PubMed.
Text
Identify methodologies, equipment (give name and address of manufacturer in brackets) and procedures in sufficient detail to allow other researchers to reproduce results. Specify well-known methods including statistical proce-dures; mention and provide a brief description of published methods which are not yet well known; describe new or modified methods at length; justify their use and evaluate their limits. For each drug generic name, dosage and administration routes should be given. Brand names for drugs should be given in brackets. Units of measurement, symbols and abbreviations must conform
entries in the text should be quoted using superscripted Arabic numer-als. References must be set out in the standard format approved by the International Committee of Medical Journal Editors (www.icmje.org). Journals
Each entry must specify the author’s surname and initials (list all authors when there are six or fewer; when there are seven or more, list only the first six and then “et al.”), the article’s original title, the name of the Journal (according to the abbreviations used by MEDLINE/PubMed), the year of publication, the volume number and the number of the first and last pages. When citing refer-ences, please follow the rules for international standard punctuation carefully. Examples:
- Standard article.
Sutherland DE, Simmons RL, Howard RJ. Intracapsular technique of trans-plant nephrectomy. Surg Gynecol Obstet 1978;146:951-2.
- Organization as author
International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Ann Int Med 1988;108:258-65. - Issue with supplement
Payne DK, Sullivan MD, Massie MJ. Women’s psychological reactions to breast cancer. Semin Oncol 1996;23(1 Suppl 2):89-97.
Books and monographs
For occasional publications, the names of authors, title, edition, place, pub-lisher and year of publication must be given.
Examples:
- Books by one or more authors
Rossi G. Manual of Otorhinolaryngology. Turin: Edizioni Minerva Medica; 1987.
- Chapter from book
De Meester TR. Gastroesophageal reflux disease. In: Moody FG, Carey LC, Scott Jones R, Ketly KA, Nahrwold DL, Skinner DB, editors. Surgical treat-ment of digestive diseases. Chicago: Year Book Medical Publishers; 1986. p. 132-58.
- Congress proceedings
Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiol-ogy. Proceedings of the 10th International Congress of EMG and Clinical Neurophysiology; 1995 Oct 15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996. Electronic material
- Standard journal article on the Internet
Kaul S, Diamond GA. Good enough: a primer on the analysis and interpreta-tion of noninferiority trials. Ann Intern Med [Internet]. 2006 Jul 4 [cited 2007 Jan 4];145(1):62-9. Available from:
http://www.annals.org/cgi/reprint/145/1/62.pdf - Standard citation to a book on CD-ROM or DVD
Kacmarek RM. Advanced respiratory care [CD-ROM]. Version 3.0. Philadelphia: Lippincott Williams & Wilkins; ©2000. 1 CD-ROM: sound, color, 4 3/4 in.
- Standard citation to a homepage
AMA: helping doctors help patients [Internet]. Chicago: American Medical Association; ©1995-2007 [cited 2007 Feb 22]. Available from: http://www. ama-assn.org/.
Footnotes and endnotes of Word must not be used in the preparation of refer-ences.
References first cited in a table or figure legend should be numbered so that they will be in sequence with references cited in the text taking into consid-eration the point where the table or figure is first mentioned. Therefore, those references should not be listed at the end of the reference section but consecu-tively as they are cited.
Titles of tables and figures
Titles of tables and figures should be included both in the text file and in the file of tables and figures.
File of tables
Each table should be submitted as a separate file. Formats accepted are Word and RTF. Each table must be typed correctly and prepared graphically in keep-ing with the page layout of the journal, numbered in Roman numerals and accompanied by the relevant title. Notes should be inserted at the foot of the table and not in the title. Tables should be referenced in the text sequentially. File of figures
Vol. 52 - Suppl. 1 to No. 2Vol. 52 - No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE VV
145
ORIGINAL ARTICLES
Extracorporeal shockwaves versus ultrasound-guid-ed percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial
Del Castillo-González F., Ramos-Álvarez J. J., Rodríguez-Fabián G., González-Pérez J., Jiménez-Herranz E., Varela E.
152
Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute reha-bilitation settings
Huang S-W., Lin L-F., Chou L-C., Wu M-J., Liao C-D., Liou T-H.
159
Effects of an eccentric training personalized by a low rate of perceived exertion on the maximal capacities in chronic heart failure: a randomized controlled trial
Casillas J. M., Besson D., Hannequin A., Gremeaux V., Morisset C., Tordi N., Laurent Y., Laroche D.
169
Effects of a muscular training program on chronic obstructive pulmonary disease patients with moder-ate or severe exacerbation antecedents
López-García A., Souto-Camba S., Blanco-Aparicio M., González-Doniz L., Saleta J. L., Verea-Hernando H.
176
Assessment of selective motor control in clinical Gillette’s test using electromyography
Manikowska F., Chen B. P. J., Jóźwiak M., Lebiedowska M. K.
Vol. 52
April 2016
No. 2
186
Electromyographical characteristics and muscle uti-lization in hemiplegic patients during sit-to-stand activity: an observational study
Lu R-R., Li F, Zhu B
195
Clinical scales for measuring stroke rehabilitation pro-mote functional recovery by supporting teamwork
Bartolo M., Zucchella C., Tortola P., Spicciato F., Sandrini G., Pierelli F.
203
Analyzing the modified Rankin Scale using concepts of the International Classification of Functioning, Disability and Health
Berzina G., Sveen U., Paanalahti M., Sunnerhagen K. S.
214
The positive role of caregivers in terminal cancer patients’ abilities: usefulness of the ICF framework
Giardini A., Ferrari P., Negri E. M., Majani G., Magnani C., Preti P.
223
Effects of home-based exercise training on VO2 in
breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): a randomized controlled trial
Cornette T., Vincent F., Mandigout S., Antonini M-T-, Leobon S., Labrunie A., Venat L., Lavau-Denes S., Tubiana-Mathieu N.
MEDITERRANEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
formerly EUROPA MEDICOPHYSICA
CONTENTS
PHYSICAL AND REHABILITATION
MEDICINE
Vol. 52
April 2016
Suppl. 1 to No. 2
CONTENTS
SPEAKERS PRESENTATIONS ...
1
ORAL PRESENTATIONS ...
127
POSTER PRESENTATIONS ...
427
20
thEuropean Congress of
PHYSICAL and REHABILITATION MEDICINE
SUPPORT FOR STUDENTS WITH DISABILITIES IN PORTUGUESE HIGHER EDUCATION: THE GTAEDES WORKGROUP
Aguardenteiro Pires Lilia1, Martins Gracinda2
1 University of Lisbon, Faculdade de Letras, Núcleo de Apoio ao Aluno, Alameda da Universidade, Lisbon,
Portugal
2 University of Aveiro
Officially formed in June 2004, the workgroup of disability services of Portuguese Higher Education Insti-tutions (GTAEDES) «Grupo de Trabalho para o Apoio a Estudantes com Deficiências no Ensino Superior» (GTAEDES), is composed by public Higher Education Institutions (HEI) that offer services to support students with disabilities. The objective is to provide a quality service to these students and to promote and facilitate the exchange of experiences, the development of initiatives and the rationalization of resources. With this communication, we aim to present some data about the way that the HEI have been organizing themselves over the past 10 years in order to answer these students’ needs. We found that, over the last years, the number of students with disabilities in Portuguese Higher Education has increased and that the HEI are responding to this challenge by increasing the number of Disability Support Services as well as developing specific internal legislation, in particular the public HEI.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 3
PHYSICAL THERAPY MODALITIES AND REHABILITATION TECHNIQUES IN THE MANAGE-MENT OF NEUROPATHIC PAIN
Akyuz Gulseren
Dept of PM&R and Division of Pain Medicine Marmara University School of Medicine Istanbul, Turkey
Neuropathic pain (NP) has a complex, severe and persistent character with varying intensity and duration changes and it is usually unresponsive to treatment. NP can accompany to many diseases and can also be related with an injury. NP syndromes according to anatomical involvement can be divided into three groups: Peripheral nervous system, central nervous system and mixed). Pharmacological and non-pharmacological treatment options have been used extensively. First-line medication choice in NP includes tricyclic antidepres-sants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), anticonvulantidepres-sants, opioids, cannabinoids and topical agents. Physical therapy modalities such as superficial and deep heat applications, traction, laser, transcutaneous electrical nerve stimulation (TENS), diadynamic and interferential electrical currents are more helpful when combined with therapeutic exercises. Psychotherapy, cognitive behavioral therapy (CBT) and re-laxation therapy are recommended in the management of NP. Non-invasive (repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)) and invasive neuromodulation tech-niques (deep brain stimulation (DBS), motor cortex stimulation (MCS), and spinal cord stimulation (SCS)) are also focused on the treatment of NP. These neurostimulation techniques promise hope for the future of NP treatment.
CANCER PAIN AND REHABILITATION Akyuz Gulseren
Dept of PM&R and Division of Pain Medicine Marmara University School of Medicine Istanbul, Turkey
Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells, which can result in death. Cancer is caused by both external factors (eg, chemicals, radiation, viruses) and internal fac-tors (eg, hormones, immune conditions, inherited mutations). Today, cancer is treated with surgery, radiation, chemotherapy, hormones, immunotherapy, and rehabilitation.
Cancer rehabilitation is a process to restore physical and/or mental, psychological abilities due to the disease or its complications, and side effects of therapies in order to function in a normal or near normal way. In cancer rehabilitation there are four stages: a) Preventive; b) Restorative; c) Supportive; and d) Palliative. The goals of cancer pain management and rehabilitation are to decrease pain, stabilize general health status, minimize dysfunction, and improve quality of life. Pain in cancer patients can be cancer-related 70%; treatment-related 15%; or non-related with cancer and treatment 15%. Management of cancer pain aims to develop helpful strategies to eliminate pain; to prevent disability; to help patients get back to daily living activities. Treatment protocol should be individualized depending on the needs of patient. Education increases patient compliance to cancer pain management.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 5
RESPIRATORY REHABILITATION IN PULMONARY CANCER Almeida Paula
Dept. Physical Medicine and Rehabilitation Hospital Pedro Hispano
Matosinhos, Portugal
Pulmonary Rehabilitation reduce symptoms, improve quality of life and increase physical and emotional par-ticipation in everyday activities in COPD. Benefits of Pulmonary Rehabilitation are high level evidence based. Benefits also apply to other pulmonary chronic diseases including cancer.
DO PHYSICAL THERAPIES HAVE A ROLE IN THE PAIN TREATMENT IN SCI? Antunes Filipe
MFR/Unidade de Dor Crónica do Hospital de Braga Hospital de Braga
Braga, Portugal
SCI is a major issue in PRM field. Pain after SCI is the most important handicap in these patients and a special challenge to overcome.
Physical therapies are an alternative and complementary approach in pain clinic and a valid option in a multi-modal therapy, besides its limited evidence results. Exercise in its different multi-modalities is the core issue of PRM action. Other possibilities are physical agents, mainly electrical stimulation.
We will discuss the role of PRM in helping people with pain after SCI, in order to understand actual and future possibilities.
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ULTRASOUND GUIDED INTERVENTIONAL PROCEDURES FOR BACK PAIN Barotsis Nikos
Physiatrist, Fellow EBPRM Private Practitioner
Naxos, Greece
Landmark-based techniques, fluoroscopy and computer tomography have predominantly been used to guide interventional procedures in lumbar pain management. Recently, there has been considerable interest in the use of ultrasound for procedures involving the lumbar spine.
It is well documented that imaging guided techniques are superior to blind ones, as it concerns accuracy and outcomes. Ultrasound guidance presents certain advantages in comparison with other techniques, including the avoidance of radiation exposure, increased mobility, lower equipment expenses; it allows real-time imaging and soft tissue, nerve, and blood vessel visualization. The ultrasound guided techniques present limitations as well, mainly related to the body habitus and the depth of the target tissue.
In order to start practicing US guided lumbar spine procedures it is important to become familiar with the lumbosacral sonographic views first.
The aim of this lecture is to present the most commonly used sonographic views and to familiarize the audi-ence with the following techniques, performed under ultrasound guidance:
1. medial branch blocks 2. facet joint injections 3. pararadicular injections 4. neuraxial procedures 5. muscle injections
MUSCLE STRENGHT AND FUNCTIONAL OUTCOMES Beckert Paulo
PM&R (CUF) ; Health and Performance Unit (FPF) CUF Alvalade; Fed. Portuguesa Futebol
Lisbon, Portugal
Reduction in skeletal muscle strength after injuries to the musculoskeletal system depend of several factors. Sports injuries should result in skeletal muscle hypotrophy and weakness, decrease of aerobic capacity and fatigability. These negative effects can be expanded with immobilization.
Programs of sports rehabilitation after injuries include several components including joint and soft tissue mobility, endurance, flexibility, balance, proprioception, strength, speed and power. These programs follow a logical sequence to restore these components and promote an optimal functional outcome and peak perfor-mance.
Restoration of strength is one of the most relevant and vital aspects of a rehabilitation program. Designing optimal resistance training programs in a rehabilitation process in order to maximize training adaptations is a challenge for all involved in rehabilitation of injured athletes.
The training variables must be manipulated in own way to elicit muscular and neural adaptation in order to maximize adaptations..
For maximal strength gains occur it is necessary an appropriate method of training. Periodization (planned manipulations of training variables, ie, load, set and repetitions) is one way to approach the design of strength training programs and to meet established goals and get an optimal functional outcome.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 9
RECOVERY AFTER BRAIN INJURY: A MATTER OF LESION, BRAIN AND ENVIRONMENT Boldrini Paolo
Dept. Rehabilitation Medicine ULSS9 Treviso
Treviso, Italy
Major gaps in knowledge on the recovery process after acquired brain injury concern different responses to similar injuries, and similar outcomes after different injuries. The pre-morbid individual factors and environ-mental factors that may play a role in determining such differences are described, and perspectives for future research are proposed. Among the individual factors which could influence the outcome, demographic (e.g. age, gender), social (e.g. education), and biological characteristics have been studied. Environmental factors have been less extensively investigated. The systematic collection of data, for example through population based registries, may be helpful in elucidating the relationships among these factors.
HOME-AND COMMUNITY-BASED REHABILITATION IN CHRONIC DISABLING CONDI-TIONS: CONCEPTUAL FRAMEWORK(S) AND PRACTICAL ISSUES
Boldrini Paolo
Dept. Rehabilitation Medicine ULSS9 Treviso
Treviso, Italy
Chronic disabling conditions (CDC) can be seen as a distinct health category, and represent a major health and social issue in most of the countries. Comorbidity/multimorbidity, individual and environmental factors often interact in these conditions, determining limitations of functioning and participations with different levels of severity and complexity. Several models of care have been proposed to address these issues; the ICF model is much helpful in elucidating the relationships among the different factors impacting on functioning in persons with CDC. Home and community care and rehabilitation may play a crucial role in the manage-ment of these conditions, and require theoretical frameworks which are quite different from those used in the hospital settings. Such aspects are illustrated and their practical implications are described, with specific reference to the capacity-performance distinction.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 11
STATE OF THE ART IN ASSESSMENT AND TREATMENT OF SUBJECTS WITH POST-POLIO SYNDROME
Borg Kristian
Div. of Rehabilitation Medicine, Dept. of Clinical Sciences Danderyd Hospital, Karolinska Institute
Stockholm, Sweden
Rehabilitation of patients with prior polio is mainly based on physiotherapy. Patients with full or almost full strength may perform physical training without restrictions. Patients with a critical degree of muscle weakness should be advised to perform endurance training and patients with a severe muscle weakness shall be treated by a physiotherapeutic approach in order to avoid muscle contractures. The finding of an inflammatory reac-tion in post-polio patients may open for new treatment strategies.
ETHICAL ISSUES IN REHABILITATION OF PERSONS AFTER AMPUTATION Burger Helena
Medical Director
University Rehabilitation Institute, Ljubljana, Slovenia
Amputation is surgery to remove all or part of an upper or lower limb and is already an ethical issue. Due to Australian and Dutch guidelines for rehabilitation of people after amputation, surgeon has to consult PRM team and patients before surgery. After surgery there are many other ethical issues, such as whether to fit a prosthesis or not, when to fit it (specially in patients with wounds), which prosthetic components to use, rec-ommendations for return to work, driving, prevention of secondary impairments and overuse problems. For modern prosthetic components that are collecting information about use of prosthesis it is also issues whose are these data. The evidence for some of them will be presented.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 13
COMPREHENSIVE REHABILITATION AFTER UPPER LIMB AMPUTATION Burger Helena
Medical Director
University Rehabilitation Institute, Ljubljana, Slovenia
The human hands are a very complex part of the body with many different motor and sensory functions. After amputation, all functions of the human hand are lost. Consequently person has problems with many activities and participation. To be successful the rehabilitation has to focus on all levels of human functioning, has to start immediately after injury and has to include all team members.
One possibility that we have is also fitting person with prostheses. In the last decade there has been a huge development in the field of upper limb prosthetic components. At the moment there is still lack of evidence which prosthetic components are the best for individual person.
PAIN AND SPASTICITY IN SCI. WHO COMES FIRST? Casale Roberto
Advanced Technology Rehabilitation & Pain Rehabilitation Unit Habilita, Care & Research Hospitals
Zingonia (BG), Italy
Pain and spasticity are frequently associated not only with spinal cord injuries (SCI) patients but also in many neurological conditions such as Multiple Sclerosis (MS) and spastic hemiplegia (SE). In all these conditions pain can have a negative impact on the rehabilitation outcome influencing different clinical aspects including the degree of spasticity. Moreover, the clinical picture can be even more complex by an inverse relationship between spasticity and pain since spasticity can be painful and therefore, being able to trigger a vicious circle spasticity-pain-spasticity.
Pain and spasticity can be both generated by the same lesion of the spinal cord. In this case, spasticity and pain are of neuropathic origin. In other cases, pain has different generators for instance in joints and muscles and therefore pain has a nociceptive origin while spasticity has a different and neuropathic origin. In SCI, some nociceptive pain conditions can be also pre-existing to the neurological lesions while others are a consequence of the neurological lesion and frequently related to the degree and extent of spasticity.
Moreover, regardless from nociceptive or neuropathic origin pain and spasticity can be felt in the same or in different anatomical parts. In SCI pain can be therefore felt in anatomical districts above the lesion, below the lesion or felt in the dermatomal distribution of the injured spinal cord segment.
In the clinical battlefield all these combinations, nociceptive and neuropathic, same or different anatomical districts, can be associated and made the rehabilitation approach even more complicated.
Thus, in SCI patients (as well as in MS and hemiplegia) with spasticity and pain, the pivotal issue to choose the proper rehabilitation and pharmacological approach is to disentangle the physiopathology of the painful condition.
Is the pain primarily of neuropathic origin (i.e. generated by the same neurological lesion) or is the painful condition of nociceptive origin and, in this case, is it secondary, following the primitive neurological lesion or disease, or is it a non-related pain condition. All these combinations deserve different approaches in pain and spasticity in SCI. Who comes first?
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 15
ACTION OBSERVATION AS A TOOL FOR UPPER LIMB RECOVERY Ceravolo Maria Gabriella
Dept. Experimental and Clinical Medicine Politecnica delle Marche University
Ancona, Italy
Background: Action observation (AO) can be defined as a dynamic state during which the observer can un-derstand what the other is doing by simulating the actions and outcomes that are likely to follow from the observed motor act. Its clinical impact on upper limb functional recovery in sub-acute stroke patients has been addressed in a few studies.
Methods: In order to explore the differential role of the AO in right versus left hemisphere-damaged stroke patients, a randomized controlled trial has been performed. The study included 67 patients with ischemic le-sions purely, who underwent intensive rehabilitation in an inpatient setting, with the addition of 15-minute daily sessions of either experimental (EG) or control treatment (CG), twice per day. EG group was asked to carefully watch footages showing 20 different daily routine tasks (actions) carried out with the upper limb, and then imitate the task, across 20 daily sessions, for 4 consecutive weeks. At the beginning (T0), and at the end of the treatment (T1), and at 6 months from treatment conclusion (T2), the Fugl-Meyer Test (FM) and Box and Block Test (BBT) scores were measured.
Results: While all subjects showed a significant improvement in arm function after either treatment, those with left hemiparesis exhibited a significantly greater improvement when treated with the AO protocol, than with standard treatment. Conversely, right hemiparetic subjects showed a similar upper limb function im-provement independent of group allocation.
Conclusion: Action observation can stimulate and enhance the beneficial effects of motor training on motor memory formation, especially in left hemiparetic patients following an acute ischemic stroke. Future trials on larger samples are warranted, exploiting this add-on therapy through the assistance of tele-rehabilitation.
INNOVATIVE TECHNIQUES AND REHABILITATION IN PARKINSON’S DISEASE Ceravolo Maria Gabriella
Dept. Experimental and Clinical Medicine Politecnica delle Marche University
Ancona, Italy
Innovative technologies for rehabilitation of people with Parkinson’s disease (PD) have dramatically increased these past 20 years. An overview of available tools and their current level of validation will be presented. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for gait training, even if greater information is needed on its specific indications in PD patients with or without freezing of gait, as well as in different disease phases. Action observation treatment is being widely used in the rehabilitation of motor impairments, with some admitted benefits for gait improve-ment; further data is needed to understand its supporting role in upper limb training. Non-invasive brain stimulation (rTMS and TDCS) are promising since research studies on very small samples have determined the different benefits of either frontal or parietal cortex stimulation on motor performances; however clinical evidence of their effectiveness is still lacking
Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and ‘‘real use’’ of those devices is still an issue since most of them are not easily available in current practice.
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RESEARCH METHODOLOGY AND ETHICS IN PRM Ceravolo Maria Gabriella
Dept. Experimental and Clinical Medicine Politecnica delle Marche University
Ancona, Italy
Research is a search for knowledge; it can be seen as an art of scientific investigation, or, better, as a movement from the known to the unknown, a voyage of discovery. The main aim of research is to find out the truth which is hidden and which has not been discovered as yet. Though being the result of a passionate search for truth, scientific research must be systematic in its method of defining and redefining problems, formulating hypothesis or suggested solutions; collecting, organizing and evaluating data; making deductions and reach-ing conclusions; and at last carefully testreach-ing the conclusions to determine whether they fit the formulatreach-ing hypothesis. Research studies vary, according to the objectives of scientific research:
1. exploratory studies are designed to gain familiarity with a phenomenon or to achieve new insights into it; 2. descriptive studies serve to portray accurately the characteristics of a particular individual, situation or
groups
3. analytical or diagnostic studies are used to determine the frequency with which something occurs or with which it is associated with something else;
4. hypothesis-testing, or intervention studies are designed to test a hypothesis of a causal relationship be-tween variables.
Whatever the research objective and the study design, the scientific method is referred to basic postulates like: 1. it relies on empirical evidence;
2. it utilizes relevant concepts;
3. it is committed to only objective considerations;
4. it presupposes ethical neutrality, i.e., it aims at nothing but making only adequate and correct statements about population objects;
5. it results into probabilistic predictions;
6. it aims at formulating most general axioms or what can be termed as scientific theories.
Accordingly, the scientific method is free from personal bias or prejudice and the researcher is guided by the rules of logical reasoning.
DIAGNOSIS OF OSTEOPOROSIS: BONE DENSITOMETRY IN TODAY’S CLINICAL PRACTICE (DIAGNOSIS)
Cetin Alp
Dept. Physical Medicine and Rehabilitation Hacettepe University Medical
Ankara, Turkey
Osteoporosis is the most common metabolic bone disorder characterized by low bone mass and microarchi-tectural deterioration, which subsequently increases bone fragility and susceptibility to fracture. The gold‐ standard method to assess BMD is dual X‐ray absorptiometry (DXA). It has acceptable accuracy errors and good precision and reproducibility. DXA allows accurate diagnosis of osteoporosis, estimation of fracture risk, and monitoring of patients undergoing treatment. The World Health Organization defined osteoporosis as a T-score of -2.5 or lower. Normal is defined as a T-score of -1.0 or greater and osteopenia is defined as a T-score of -1.0 to -2.5.
The International Society for Clinical Densitometry (ISCD) recommends DXA screening healthy women for osteoporosis at age 65 and men without risk factors for osteoporosis at age 70, and screening higher-risk men and women earlier. The ISCD recommends obtaining BMD measurements of the posteroanterior spine and proximal femur. The lateral spine and Ward’s triangle region of the hip should not be used for diagnosis, because these sites overestimate osteoporosis and results can be false-positive. Patients in whom the hip or the spine, or both, cannot be measured or interpreted, and those with primary hyperparathyroidism BMD may be measured in the forearm, using a 33% radius on the nondominant forearm.
Although DXA is gold standard for BMD measurement, mistakes in BMD testing are commonly seen related with patient positioning, interpreting DXA reports, and artefacts. Correct performance of BMD measure-ments using DXA requires rigorous attention to detail in positioning and analysis. When DXA studies are performed incorrectly, it can lead to major mistakes in diagnosis and therapy.
Physicians interested in osteoporosis management, even if not directly involved in the performance and in-terpretation of DXA, should be familiar with the correct DXA testing and inin-terpretation to minimize serious errors and allow proper use of bone densitometry.
Vol. 52 - Suppl. 1 to No. 2 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 19
COMPREHENSIVE REHABILITATION OF SPORTS INJURIES Christodoulou Nicolas
Limassol Centre of Physical and Rehabilitation Medicine European University Cyprus, School of Medicine. Limassol, Cyprus
The presentation analyses the basic principles of sports injuries rehabilitation, the stages of a tissue injury and the techniques used in rehabilitation of such problems. Since rehabilitation begins at the time of injury and continues even after the athlete’s return to competition, the focus is on what is done at the field-side at the time of injury, in the rehabilitation departments and during the athlete’s return to the field for training and competition. To design a rehabilitation plan which would maximize the restorative events, it is important to know the Pathophysiology of the tissue-injuries and the three stages of their healing process: the inflammatory stage, the fibroblastic-repair stage, and the maturation-remodelling stage. Knowledge of the several physical modalities used during the acute, sub-acute and functional phase of rehabilitation is important as well. Im-provement of neuromuscular control, correction of maladaptive behaviours, sport-specific and multi-plane activity, functional retraining, balance & proprioception re-education and athletic psychological approach are essential parts of the whole rehabilitation program. Examples for mobility exercises, strength exercises and stretching exercises are presented for several muscle groups and the relevant joints.
RESEARCH AND PROFESSIONAL ACTIVITIES PRM SECTION OF UEMS Christodoulou Nicolas
Limassol Centre of Physical and Rehabilitation Medicine European University Cyprus, School of Medicine. Limassol, Cyprus
The members of the European Union of Medical Specialists (UEMS) are the national medical associations of the European Union States. In parallel, UEMS is divided into Sections, one for each EU recognized primary medical specialty. The Section of Physical and Rehabilitation Medicine is one of these bodies. Delegates of PRM from each EU State and from associate and observer states participate to the activities of our Section. For functional reasons, the work in our Section is divided in three committees: The Board for Educational affairs, the Professional Practice Committee for the Field of PRM physicians’ competence and the Clinical Affairs Committee for the quality of clinical care.
Especially in the Professional Practice Committee (PPC), a lot of work has been done over the last years, con-cerning research for the professional competence of PRM physicians and a lot of papers have been published in referred journals. The White Book of PRM in Europe, which was published in 2006 in two referred PRM journals, was prepared in the PPC with the collaboration of the other European PRM Bodies. Ten years later, we work methodologically for its revision. A series of published research papers for the role and competence of PRM physicians have been collected in an e-book under the title “The Field of Competence of the Physical and Rehabilitation Medicine Physicians -Part One”.
Research continues in the PPC for the Competence of our physicians in other medical fields and the results will be first published in referred journals. Eventually, we plan to publish the part two of the e-Book “The Field of Competence of the Physical and Rehabilitation Medicine Physicians”, including all these papers which will be published from 2015 to 2018. The aim is to give helpful e-books to our colleagues for their daily practice and for defending and promoting the PRM specialty among medical professionals of other specialties and in the negotiations with the authorities of national health systems.
All the above work is going to be presented during this presentation, indicating that research in the field of specialty’s competence is as important and useful as the general medical research.
