Teresa Paolucci

Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study

Objective: To evaluate the efficacy of a perceptive rehabilitative approach, based on a new device, with regard to pain and disability in patients with chronic nonspecific low back pain. Design: Single blind, randomized, controlled trial. Setting: An outpatient academic hospital. Patients: Seventy-five patients with chronic low back pain. Interventions: Patients were randomized into three groups. Twenty-five subjects received 10 sessions in one month, based on specific perceptive exercises that were performed on a suitably developed device. Twenty-five patients entered a Back School programme. Twenty-five patients comprised a control group that received the same medical and pharmacological assistance as the other groups. Main outcome measures: Pain was assessed using the Visual Analogue Scale and McGill Pain Questionnaire. Disability was evaluated using the Oswestry Disability Index and Waddell Disability Index. All measurements were recorded before treatment, at the end of the study, and at 12 and 24 weeks. Results: General pain relief was recorded in all the groups, which was elicited more quickly in the perceptive treatment group; significant differences in pain scores were observed at the end of treatment (P < 0.001 for visual analogue scale and P = 0.001 for Questionnaire) versus the other groups. Disability scores in the perceptive group did not differ significantly from those in the other group, whereas these scores significantly differed between Back School and control groups at the follow-ups (P < 0.01 for both scales). Conclusion: Perceptive rehabilitation has immediate positive effects on pain. Back School reduces disabilities at follow-up.

Management of chronic pain in osteoporosis: challenges and solutions

Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP.

Effects of a Multidisciplinary Educational Rehabilitative Intervention in Breast Cancer Survivors: The Role of Body Image on Quality of Life Outcomes

In breast cancer survivors, own body image may change due to physical and psychological reasons, worsening womens living. The aim of the study was to investigate whether body image may affect the functional and quality of life outcomes after a multidisciplinary and educational rehabilitative intervention in sixty women with primary nonmetastatic breast cancer who have undergone conservative surgery. To assess the quality of life was administered The European Organization for Research and Treatment of Cancer Study Group on Quality of Life core questionnaire, while to investigate the psychological features and self-image were administered the following scales: the Body Image Scale, the Hamilton Rating Scale for Depression, and the State-Trait Anxiety Inventory. To assess the recovery of the function of the shoulder were administered: the Disabilities of the Arm, Shoulder, and Hand Questionnaire and the Constant-Murley Score. Data were collected at the baseline, at the end of the intervention, and at 3-month follow-up. We found a general improvement in the outcomes related to quality of life, and physical and psychological features after treatment (P < 0.001). During follow-up period, a higher further improvement in women without alterations in body image in respect of those with an altered self-perception of their own body was found (P = 0.01). In conclusion, the body image may influence the efficacy of a rehabilitative intervention, especially in the short term of follow-up.

A New Neurocognitive Interpretation of Shoulder Position Sense during Reaching: Unexpected Competence in the Measurement of Extracorporeal Space

Background. The position sense of the shoulder joint is important during reaching. Objective. To examine the existence of additional competence of the shoulder with regard to the ability to measure extracorporeal space, through a novel approach, using the shoulder proprioceptive rehabilitation tool (SPRT), during reaching. Design. Observational case-control study. Methods. We examined 50 subjects: 25 healthy and 25 with impingement syndrome with a mean age [years] of 64.52 +/− 6.98 and 68.36 +/− 6.54, respectively. Two parameters were evaluated using the SPRT: the integration of visual information and the proprioceptive afferents of the shoulder (Test 1) and the discriminative proprioceptive capacity of the shoulder, with the subject blindfolded (Test 2). These tasks assessed the spatial error (in centimeters) by the shoulder joint in reaching movements on the sagittal plane. Results. The shoulder had proprioceptive features that allowed it to memorize a reaching position and reproduce it (error of 1.22 cm to 1.55 cm in healthy subjects). This ability was lower in the impingement group, with a statistically significant difference compared to the healthy group (p < 0.05 by Mann–Whitney test). Conclusions. The shoulder has specific expertise in the measurement of the extracorporeal space during reaching movements that gradually decreases in impingement syndrome.

Effects of perceptive rehabilitation on balance control in patients with Parkinson's disease

BACKGROUND Subjects affected by Parkinsons disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance. OBJECTIVE To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living. METHODS In this pilot study, we have treated 9 patients with Parkinsons disease undergone rehabilitation aiming to restoring their correct body midline perception, according a schema treatment - no treatment - treatment. RESULTS During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale. CONCLUSIONS These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinsons disease for reducing both their static and dynamic balance impairments.

Improved interoceptive awareness in chronic low back pain: a comparison of Back school versus Feldenkrais method

Abstract Purpose: To determine the efficacy of the Feldenkrais method for relieving pain in patients with chronic low back pain (CLBP) and the improvement of interoceptive awareness. Method: This study was designed as a single-blind randomized controlled trial. Fifty-three patients with a diagnosis of CLBP for at least 3 months were randomly allocated to the Feldenkrais (mean age 61.21 ± 11.53 years) or Back School group (mean age 60.70 ± 11.72 years). Pain was assessed using the visual analog scale (VAS) and McGill Pain Questionnaire (MPQ), disability was evaluated with the Waddel Disability Index, quality of life was measured with the Short Form-36 Health Survey (SF-36), and mind–body interactions were studied using the Multidimensional Assessment of Interoceptive Awareness Questionnaire (MAIA). Data were collected at baseline, at the end of treatment, and at the 3-month follow-up. Results: The two groups were matched at baseline for all the computed parameters. At the end of treatment (Tend), there were no significant differences between groups regarding chronic pain reduction (p = 0.290); VAS and MAIA-N sub scores correlated at Tend (R = 0.296, p = 0.037). By the Friedman analysis, both groups experienced significant changes in pain (p < 0.001) and disability (p < 0.001) along the investigated period. Conclusions: The Feldenkrais method has comparable efficacy as Back School in CLBP. Implications for rehabilitation The Feldenkrais method is a mind–body therapy that is based on awareness through movement lessons, which are verbally guided explorations of movement that are conducted by a physiotherapist who is experienced and trained in this method. It aims to increase self-awareness, expand a person’s repertoire of movements, and to promote increased functioning in contexts in which the entire body cooperates in the execution of movements. Interoceptive awareness, which improves with rehabilitation, has a complex function in the perception of chronic pain and should be investigated further in future research. The efficacy of the Feldenkrais method is comparable with that of BS for nonspecific chronic low back pain. The physician can recommend a body–mind rehabilitation approach, such as the Feldenkrais method, or an educational and rehabilitation program, such as BS, to the patient, based on his individual needs. The 2 rehabilitation approaches are equally as effective in improving interoceptive awareness.

MMPI-2 profiles and illness perception in fibromyalgia syndrome: The role of therapeutic exercise as adapted physical activity

BACKGROUND Control of pain management is an important up-stream process in fibromyalgia (FM) mechanisms. OBJECTIVE To investigate whether adapted physical activity (APA) could change the illness perception in relation to the FM personality profile. METHODS Thirty-seven women with FM allocated randomly: 19 treatment group (TG) and 18 control group (CG). Interventions: exercises program included ten sessions, two times for week for one hour each and observation for CG. Scales: Illness Perception Questionnaire-revisited (IPQ-r) for the mental representation of the disease, Minnesota Multiphasic Personality Inventory profiles (MMPI-2) for personality tool and Fibromyalgia Impact Questionnaire (FIQ) for function, impact and symptoms. Outcome assessments were performed before rehabilitation treatment (T0) than at the end (T1), and a follow-up 12 weeks after treatment (T2). RESULTS APA was efficacy to improve FIQ values in TG at T1 and T2 test days (P = 0.014). Changes in IPQ-R values in T2 were not significant. All patients presented a baseline T-score≥65 in at least one of the basic and content MMPI-2 scales (Hy, D, Hs and Hea and Anx). CONCLUSION APA was efficacy in FM, but further research to differentiate between illness experience rather than focus ona strict personality profile are necessary.

Neurocognitive Rehabilitation in Parkinson’s Disease with Motor Imagery: A Rehabilitative Experience in a Case Report

A 50-year-old female with Parkinsons disease underwent a neurocognitive rehabilitation program consisting of one-hour-lasting sessions attended twice a week for three months. The balance and the risk of falls were determined using the Tinetti Balance and Gait Evaluation Scale. The pain was determined using the Visual Analog Scale and the course of the disease was examined using the Unified Parkinsons Disease Rating Scale (UPDRS). Endpoints were before the treatment, at the end of the treatment, and at a 12-week follow-up. The aim of this study is to evaluate the efficacy of neurocognitive rehabilitation in PD with motor imagery. Primary outcome is the improvement in balance and the falls risk reduction; secondary outcome is lower limb pain reduction.

Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study

The purpose of this pilot study was to determine the efficacy of an extremely low-frequency magnetic field (ELF-MF) in decreasing chronic pain in fibromyalgia (FM) patients. Thirty-seven females were recruited and randomized into two groups: one group was first exposed to systemic ELF-MF therapy (100 microtesla, 1 to 80 Hz) and then to sham therapy, and the other group received the opposite sequence of intervention. Pain, FM-related symptoms, and the ability to perform daily tasks were measured using the Visual Analog Scale, Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Scale (FAS), and Health Assessment Questionnaire (HAQ) at baseline, end of first treatment cycle, beginning of second treatment cycle (after 1 mo washout), end of second treatment cycle, and end of 1 mo follow-up. ELF-MF treatment significantly reduced pain, which increased on cessation of therapy but remained significantly lower than baseline levels. Short-term benefits were also observed in FIQ, FAS, and HAQ scores, with less significant effects seen in the medium term. ELF-MF therapy can be recommended as part of a multimodal approach for mitigating pain in FM subjects and improving the efficacy of drug therapy or physiotherapy.

A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial

Introduction/Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS) and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18–60 years old) with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group), physical exercises group (PE-group), and control group (CG). The Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Fibromyalgia Assessment Scale (FAS) were administered at baseline (T0), at the end of the treatment (T1) (after 10 rehabilitation sessions over a 5-week period), and at the 12-week follow-up (T2). Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.