Roberto Meroni

Comparison of Active Stretching Technique and Static Stretching Technique on Hamstring Flexibility

Objectives:To compare a passive and an active stretching technique to determine which one would produce and maintain the greatest gain in hamstring flexibility. To determine whether a passive or an active stretching technique results in a greater increase in hamstring flexibility and to compare whether the gains are maintained. Design:Randomized controlled trial. Setting:Institutional. Participants:Sixty-five volunteer healthy subjects completed the enrollment questionnaire, 33 completed the required 75% of the treatment after 6 weeks, and 22 were assessed 4 weeks after the training interruption. Intervention:A 6-week stretching program with subjects divided into 2 groups with group 1 performing active stretching exercises and group 2 performing passive stretching exercises. Main Outcome Measures:Range of motion (ROM) was measured after 3 and 6 weeks of training and again 4 weeks after the cessation of training and compared with the initial measurement. Results:After 3 weeks of training, the mean gain in group 1 (active stretching) on performing the active knee extension range of motion (AKER) test was 5.7°, whereas the mean gain in group 2 (passive stretching) was 3° (P = .015). After 6 weeks of training, the mean gain in group 1 was 8.7°, whereas the mean gain in group 2 was 5.3° (P = .006). Twenty-two subjects were reassessed 4 weeks after the cessation of the training with the maintained gain of ROM in group 1 being 6.3°, whereas the maintained gain in group 2 was 0.1° (P = .003). Conclusions:Active stretching produced the greater gain in the AKER test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group. Active stretching was more time efficient compared with the static stretching and needed a lower compliance to produce effects on flexibility.

Women performing repetitive work: Is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population?

ObjectivesShoulder disorders in the occupational environment have been widely studied, but the quality of research and methodology applied vary. Little has been done to ascertain whether shoulder pain in female repetitive workers is due to any verifiable pathology, or to compare findings with the general population. Therefore, we decided to evaluate the prevalence of self-reported shoulder pain in a group of female supermarket cashiers and in the general female population using a standardized questionnaire. Shoulder pain prevalence was then compared to imaging findings in order to assess specific and non-specific pain prevalence.Material and Methods196 cashiers and 302 controls filled in a standardized shoulder questionnaire and underwent an imaging examination of a shoulder.ResultsThe prevalence of shoulder pain was significantly higher in the group of cashiers (46.4%) than in the general population (25.5%) (OR = 1.821; 95% CI: 1.426–2.325). Specific pain prevalence was higher among the controls (19.5%) than among the cashiers (13.2%).ConclusionsThe more frequent reports of shoulder pain in the supermarket cashiers are not correlated with a higher prevalence of imaging abnormalities. The causes of these more frequent complaints should be probably sought in the psycho-social and occupational environment.

RASCH ANALYSIS OF THE NECK BOURNEMOUTH QUESTIONNAIRE TO MEASURE DISABILITY RELATED TO CHRONIC NECK PAIN

OBJECTIVE To determine the psychometric properties of the Neck Bournemouth Questionnaire in patients with chronic neck pain, using Rasch analysis. METHODS A sample of 161 subjects with chronic neck pain was assessed with the Neck Bournemouth Questionnaire. Before performing Rasch analysis, we examined the structure of the scale with factor analysis. The goodness-of-fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items, differential item functioning, person separation index, and mean persons location were assessed. RESULTS Both exploratory and confirmatory factor analyses supported the presence of 2 factors. Only Factor 1 needed a modification (item 7 removal) in order to achieve the fit to the Rasch model (χ2 = 10.65, df 8, p = 0.22). The person separation index was 0.80 and the mean location of persons 0.48 (standard deviation (SD) 1.02). Factor 2 (items 4 and 5) fitted the model without modifications (χ2 = 3.86, df 4, p = 0.42). Its person separation index and mean persons location were, respectively, 0.77 and -0.71 (SD 1.57). CONCLUSION The Neck Bournemouth Questionnaire with the purposed modification may provide useful clinical profiles and change scores of subjects with chronic neck pain for research purposes.

Rasch analysis of the Italian version of fear avoidance beliefs questionnaire (FABQ-I)

Abstract Purpose: To perform a Rasch analysis (RA) of the Fear Avoidance Beliefs questionnaire (FABQ-I) in a sample of chronic non-specific low back pain (CLBP) patients. The RA is expected to provide information about the internal construct validity and all the single items consistency of the FABQ-I and then contributing to the knowledge about the questionnaire’s clinimetric properties. Methods: One hundred and fifty subjects with CLBP were enrolled into the study. The FABQ-I have been studied by means of RA. The sample size needed to obtain stable person, item and rating-scale calibrations for use with the Rasch model was based on the level of error expected in the measure. Results: RA did not support the total scale as an unidimensional measure of Fear Avodiance Beliefs. Also the analysis of the Physical Activity (PA) and Word (WO) subscales as well as the attempts of manipulation failed in achieving an acceptable fit to the Rasch model. Conclusion: FABQ-I may be considered to reflect a multiple psychological constructs describing scale. The raw score of the FABQ-I and changes in scores must be interpreted with caution because as a general measure of fear avoid beliefs was not supported. Implication for Rehabilitation Fear avoidance beliefs questionnaire (FABQ-I) as a whole, as well as the PA and WO subscales does not fit Rasch model thus indicating a “Fear Avoidance” represent a multidimensional construct. Practitioners should be aware that FABQ-I need to be used with caution in clinical settings. The score of different items should not be summed in order to obtain an “overall score of Fear Avoidance Beliefs”. Every item of the FABQ-I potentially defines its own dimension. Changes in scores must be interpreted with caution because FABQ-I as a general measure of fear avoid beliefs was not supported, also the ability to distinguish between distinct levels of the underlying trait is poor. Caution: This study was conducted on a sample of Chronic Low Back Pain patients; thus, the results might not be generalized on patients with other pathologies/conditions.

Physical Therapy Versus a General Exercise Programme in Patients with Hoehn Yahr Stage II Parkinson’s Disease: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVE Several studies suggest that general exercise (GE) and physical therapy programmes (PT) improve the outcomes of Parkinsons disease (PD) patients; however, the available data do not allow a determination of which treatment is more effective. Our study aims to compare the effects of physiotherapy and general exercise in Parkinsons disease. METHODS Design and setting: Randomized controlled trial -general hospital outpatient clinic. The participants were patients with Hoehn Yahr stage II PD. Two randomized groups: one receiving PT and one receiving GE. The outcome measures were the FIM, Hamilton Rating Scale, TUG test, and UPDRS. RESULTS FIM median scores improved by 3 points in the PT group after treatment, and the improvements were maintained at follow-up. The GE FIM median scores were unchanged after treatment and were reduced by 1 point at follow-up (p < 0.05). The TUG test time was reduced in the PT group but increased in the GE group with a 3-second difference between groups at follow-up, suggesting improved functional mobility after specific physiotherapy (p < 0.05). The UPDRS median score change from baseline was significantly different between the two groups at the end of treatment (6.5 points) and at follow-up (11 points), with a benefit for the physiotherapy group. CONCLUSIONS Physiotherapy seems to be more effective than a generic exercise programme in patients with Hoehn Yahr stage II PD.

Reliability of the gross motor function classification system and the manual ability classification system in children with cerebral palsy in Tanzania

ABSTRACT Objectives: Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) are broadly studied in high-income countries, but data concerning their functioning are lacking in developing countries. Therefore, we analyzed their reliability and sensitivity to change in children with cerebral palsy in Tanzania. Methods: GMFCS and MACS are two ordinal grading systems used to assess motor functions while observing children’s performances. Forty-nine children were classified by two independent physiotherapy students at baseline, after one month and after one year. Reliability and sensitivity to change were analyzed using intraclass correlation coefficient (ICC), effect size (ES), standard response mean (SRM), standard error of measurement (SEM), and minimal detectable change (MDC). Results: Inter- (ICC = 0.97/0.95 for GMFCS/MACS) and intra-rater reliability (ICC = 0.98/0.96 GMFCS/MACS) were excellent. Sensitivity to change was small (ES = −0.14/0.11, SRM = −0.24;/0.24 GMFCS/MACS). SEM was 0.2 points, resulting in MDC = 0.5/0.7 for GMFCS/MACS, respectively. Conclusions: GMFCS and MACS demonstrated excellent reliability, but not sensitivity to change.

Ultrasonography of the shoulder: asymptomatic findings from working-age women in the general population

[Purpose] The aim of this study was to estimate the prevalence of abnormal shoulder ultrasonographic findings in a sample of asymptomatic women. [Subjects and Methods] A secondary analysis of a cross-sectional study was performed. We recruited 305 women (aged 18–56 years). All the subjects had a structured interview screening for self-reported symptoms and underwent a shoulder ultrasonographic examination, in which both shoulders were examined. The radiologist was blinded to the clinical history of the participants. All detectable shoulder abnormalities were collected. [Results] Of the subjects, 228 (74.75%) were asymptomatic at both shoulders, and 456 asymptomatic shoulders were analyzed. Lack of uniformity (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 28 shoulders (6.14%), 19 (4.17%) on the dominant side and 9 (1.97%) on the non-dominant side. Tendinosis (supraspinatus, infraspinatus, subscapularis, and biceps brachii long head) was found in 19 shoulders (5.32%), 12 (2.63%) on the dominant side and 7 (1.53%) on the non-dominant side. Calcification and other abnormal findings were reported. [Conclusion] The most common abnormalities were calcifications within the rotator-cuff tendons and humeral head geodes; other degenerative findings were less common.

Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases

[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: “border training” which involves exercising vision at the edge of the damaged visual field, and “blindsight training,” which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments after tDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia.

Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI)

Introduction  Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective  Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods  We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results  We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions  Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

THU0632-HPR The Neck Bournemouth Questionnaire, an Item Response Theory Study

Background Several questionnaires on neck pain are usually assumed to be unidimensional as their raw scores are considered interval measures. However, the assumption of unidimensionality requires the questionnaire data to satisfy certain criteria when tested with modern psychometric approaches, such as Item Response Theory. The Neck Bournemouth Questionnaire (NBQ) has already been cross-culturally adapted and validated in Italian on a population of subjects with chronic neck pain (Geri et al., 2014). We examined this scale by means of Rasch analysis an Item Response Theory model in order to provide a disease-specific questionnaire whose scores can be assumed as interval variables and, consequently, legitimately their change scores as meaningful. Objectives Validation of the Italian NBQ with Rasch analysis. Methods A sample of 161 subjects with chronic neck pain was assessed with the NBQ. The structure of the scale was preliminarily tested with both exploratory and confirmatory factor analyses. Rasch analysis was performed analysing the following features: the goodness of fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items and Differential Item Functioning (DIF) were examined to consider the NBQ an interval scale. Further, the Person Separation Index and the Mean Location of Persons were used, respectively, to assess the internal consistency and the targeting of the scale. Results Both the exploratory and confirmatory factor analyses revealed a two factors structure of the NBQ. Factor 1 (item 1, 2, 3, 6) fitted the model (χ2=10.65, df 8, p=0.22) after removal of item 7, which had low communalities on exploratory factor analysis and further showed disordered thresholds (Figure). Item 2 presented a marginal uniform Differential Item Functioning across educational level. The Person Separation Index was 0.80 and the Mean Location of Persons was 0.48 (SD=1.02). Factor 2 (Item 4 and 5) fitted the model (χ2=3.86, df 4, p=0.42). The Person Separation Index and the Mean Location of Persons of factor 2 were, respectively, 0.77 and -0.71 (SD=1.57). Conclusions The NBQ is a useful tool for the assessment of patients with chronic neck pain. The NBQ showed a two factors structure, each factor fitted the Rasch model and therefore works as a unidimensional measure. Using the interval scores of the NBQ may provide meaningful change scores to establish the effectiveness of treatments for chronic neck pain in clinical trials. References Geri T, Signori A, Gianola S, Rossettini G, Grenat G, Checchia G, et al. Cross-cultural adaptation and validation of the Neck Bournemouth Questionnaire in the Italian population. Quality of Life Research. 2014. Epub ahead of print 23 September 2014. Disclosure of Interest None declared