Marco Monticone

Recent studies advocated the use of active cycling coupled with functional electrical stimulation to induce neuroplasticity and enhance functional improvements in stroke adult patients. The aim of this work was to evaluate whether the benefits induced by such a treatment are superior to standard physiotherapy. A single-blinded randomized controlled trial has been performed on post-acute elderly stroke patients. Patients underwent FES-augmented cycling training combined with voluntary pedaling or standard physiotherapy. The intervention consisted of fifteen 30-minutes sessions carried out within 3 weeks. Patients were evaluated before and after training, through functional scales, gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy group. Sixteen patients completed the training. After treatment, a general improvement of all clinical scales was obtained for both groups. Only the mechanical efficiency highlighted a group effect in favor of the experimental group. Although a group effect was not found for any other cycling or gait parameters, the experimental group showed a higher percentage of change with respect to the control group (e.g. the gait velocity was improved of 35.4% and 25.4% respectively, and its variation over time was higher than minimal clinical difference for the experimental group only). This trend suggests that differences in terms of motor recovery between the two groups may be achieved increasing the training dose. In conclusion, this study, although preliminary, showed that FES-augmented active cycling training seems to be effective in improving cycling and walking ability in post-acute elderly stroke patients. A higher sample size is required to confirm results.

To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve P < 0.001). After training, the primary outcome showed a clinically significant between-group change (12 % points), which was preserved at follow-up. At follow-up, the radiological deformities showed a significant, although not clinically meaningful, between-group difference of 4° in favour of the experimental group. The experimental programme was superior to general physiotherapy in reducing disability of adults with idiopathic scoliosis. Motor and cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1 year.

Growing attention is being given to cognitive-behavioural measures to improve interventions for spinal disorders. The Pain Vigilance and Awareness Questionnaire (PVAQ) has never been validated in Italian subjects with chronic low back pain (LBP). The purpose of this study is translating, culturally adapting and validating the Italian version of PVAQ (PVAQ-I). A cross-sectional evaluation of the psychometric properties of the PVAQ-I on patients with chronic LBP was conducted. The questionnaire was culturally adapted in accordance with international standards. The psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intra-class correlation coefficient, ICC); construct validity by comparing the PVAQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Hospital Anxiety and Depression Score (HADS), the Chronic Pain Acceptance Questionnaire (CPAQ), a Numerical Rating Scale of pain intensity (NRS) and the Oswestry Disability Questionnaire (ODI); and sensitivity to change by calculating the smallest detectable change. The PVAQ-I was administered to 131 subjects with chronic LBP (77 females, mean age of 48 ± 16 years, median symptoms duration of 12 months). Factor analysis confirmed a two-factor (passive awareness and active vigilance), 13-item solution, which led to an acceptable data-model fit. Internal consistency (α = 0.91) and test–retest reliability (ICC = 0.92) were good. As a priori hypothesized, construct validity showed moderate correlations between the PVAQ-I and PCS (r = 0.60), TSK (r = 0.44) and HADS-Anxiety (r = 0.53) and low correlations with HADS-Depression (r = 0.28), NRS (r = 0.28), ODI (r = 0.23) and CPAQ (r = −0.12). The smallest detectable change was 9. The PVAQ was successfully translated into Italian and proved to have satisfactory psychometric properties. Its use is recommended for clinical and research purposes.

Background: There are still doubts concerning the clinical impact of multidisciplinary cognitive behavioural rehabilitation programmes conducted in group‐based settings and about their long‐term effects on subjects with chronic low back pain (CLBP). This randomized, parallel‐group superiority‐controlled trial aimed at evaluating the effect of such a programme on disability, kinesiophobia, catastrophizing, pain and quality of life in CLBP.Methods: One hundred and fifty patients were randomly assigned to a 5‐week group‐based multidisciplinary programme of task‐oriented exercises integrated with cognitive behavioural therapy mainly aimed at managing kinesiophobia (experimental group, 75 subjects) or group‐based traditional exercises (control group, 75 subjects). Before treatment, 5 weeks later (post‐treatment), 12 and 24 months after the end of treatment, the Oswestry Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain Numerical Rating Scale and the Short Form Health Survey were assessed. A linear mixed model for repeated measures was used for each outcome measure.Results: Significant group (p < 0.001), time (p < 0.001) and time‐by‐group interaction (p < 0.001) effects were found on disability, with a between‐group difference (95% confidence interval) after training in favour of the experimental group of −10 (−12; −8). Also kinesiophobia, catastrophizing, pain, and quality of life improved to a significantly greater extent in the experimental group. The improvements of the experimental group were maintained at follow‐ups.Conclusion: This light group‐based multidisciplinary cognitive behavioural rehabilitation programme was superior to traditional exercises in reducing disability, kinesiophobia, catastrophizing, and enhancing the quality of life of subjects with CLBP. The effects lasted for at least 2 years after the end of the intervention.

Purpose: This study was undertaken to evaluate the effects of an inpatient 2‐month multidisciplinary rehabilitative program of task‐oriented exercises, cognitive–behavioral training, and occupational therapy on motor impairment, activities of daily living, and quality of life (QoL) in subjects with long‐duration Parkinson's disease (PD).Methods: Subjects were randomly selected for an experimental (multidisciplinary rehabilitative care) and a control group (general physiotherapy) and were assessed before treatment, after 8 weeks (post‐treatment), and 12 months after the end of treatment. Medications were not adjusted during training. Outcome measures were the Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III (primary outcome), the Berg Balance Scale, the Functional Independence Measure, and the 39‐Parkinson's Disease Questionnaire. A linear mixed model for repeated measures was used for each outcome.Results: Seventy subjects with PD (46 females; mean age, 74 ± 7 years; mean disease duration,15 ± 3 years, modified Hoehn & Yahr stage, 2.5‐4) were randomized, 64 completed the study (experimental = 32; control = 32). A significant effect of time, group, and time by group interaction were noted for all outcomes. The primary outcome showed a between‐group difference in favor of the experimental group of 25 points after training, which was maintained at follow‐up. After training, the Berg Balance Scale score of the experimental group was greater than 43.5, a value previously identified as a cutoff between fallers and nonfallers for subjects with PD.Conclusion: Our findings suggest that multidisciplinary rehabilitative care is useful in changing the course of motor impairment, balance, activities of daily living, and QoL. The effects lasted for at least 1 y after the intervention. © 2015 International Parkinson and Movement Disorder Society

The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) has been translated into various languages and tested in patients with scoliosis. However, the translations and their psychometric properties have never been systematically reviewed. This study aimed to evaluate the psychometric properties and to provide the current level of evidence of all the available translations of the SRS-22 using the “COnsensus-based Standards for the selection of health status Measurement INstruments” (COSMIN). A systematic review was performed. The PubMed, Medline, EMbase, and CINAHL databases were searched for articles concerning the translations of the SRS-22 and/or evaluating any of their measurement properties. Two reviewers independently assessed the methodological quality and the psychometric estimates of the selected studies by using the 4-point rating scale COSMIN checklist and a validated quality assessment criteria, respectively. The level of evidence of each psychometric property per language was determined combining COSMIN outcomes and psychometric results. The search strategy led to 24 articles evaluating the SRS-22 in 17 different languages. The methodological quality of the properties was mostly poor to fair, and there was a lack of information regarding them. The overall assessment was positive in 42.5 % of cases. The level of evidence resulted in a limited positive evidence in 11 languages. The Chinese (traditional), Dutch, Italian, Norwegian, and Spanish translations are advisable; the Greek, Japanese, Korean, Persian, Thai, and Turkish translations showed encouraging results but should be used with caution; the Brazilian, Chinese (simplified), Polish, and Swedish translations showed contradictory or scarce results, and no suggestions can be formulated; the French Canadian and German translations did not provide methodologically sound information. Further attention should be given to cross-cultural and structural validity, hypothesis testing, and responsiveness.

To evaluate the responsiveness and minimal important changes (MICs) for the Italian Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) as well as which questionnaire was the most responsive in subjects with chronic neck pain (NP). At the beginning and end of an 8-week rehabilitation programme, 200 patients completed the NDI and NPDS. After the programme, the global perceived effect (GPE) was also evaluated and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves; correlations between change scores of NPDS and NDI, and GPE). ROC curves were also used to compute the best cutoff levels between improved and stable subjects (MICs). The ES was 0.66 and 0.73, and the SRM was 1.09–1.26 for the NDI and NPDS, respectively. The ROC analyses revealed AUCs of 0.96 and 0.91 for the NDI and NPDS, respectively; the MICs were 7-percentage points for the NDI (sensitivity: 98 %; specificity: 81 %) and 10 for NPDS (93; 83 %), showing equivalent responsiveness properties. Baseline NPDS scores did not affect MIC estimate for the NPDS, while, for the NDI, higher MICs were found for patients with worst disability levels. Correlations between change scores of the NDI and NPDS and GPE were, respectively, high (0.71) and moderate (0.59). The Italian NDI and NPDS were equally sensitive in detecting clinical changes in subjects with chronic NP undergoing rehabilitation. We recommend taking the MICs into account when assessing patient improvement or planning studies in this clinical context.

Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward-backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach's α) and test-retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (Pearson's correlation). The questionnaire was administered to 308 patients with chronic low back pain. Factor analysis confirmed a four-factor solution (namely, Precontemplation, Contemplation, Action, and Maintenance), achieving an acceptable data-model fit. Internal consistency (α=0.91-93) and test-retest reliability (intraclass coefficient correlation=0.74-0.81) were satisfactory. Construct validity showed moderate correlations between Precontemplation and PCS (r=0.318), TSK (r=0.385), RMDQ (r=0.320) and NRS (r=0.335); low correlations were found between the other PSOCQ subscales and PCS (r=-0.062; 0.039), TSK (r=-0.164; 0.024), RMDQ (r=-0.073; 0.004) and NRS (r=-0.170; 0.020). Low correlations were found between the PSOCQ-I subscales and anxiety (r=-0.132; 0.150) and depression (r=-0.113; 0.186). The PSOCQ was translated successfully into Italian, and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purpose