Calogero Foti

Background: Non-pharmacologic management of chronic low back pain (cLBP) should be considered the first-line treatment. However, consensus guidelines and internationally accepted recommendations on the therapeutic algorithm are missing. The present level I systematic review presents a qualitative analysis of advancements in physiotherapy over the past decades to discuss the role of physical and rehabilitation medicine in the management of cLBP. Methods: In August 2025, the following databases were accessed: PubMed, Web of Science and Embase. All randomised controlled trials evaluating the efficacy of physiotherapy programs in patients with cLBP were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The data extraction and risk-of-bias evaluation were performed independently by two authors. Results: Data from 150 randomised controlled trials (RCTs) (12,773 patients) were collected. The mean symptom duration was 61.2 ± 51.0 months, and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years, and the mean body mass index (BMI) was 25.8 ± 2.9 kg/m2. Conclusions: Managing cLBP is challenging. While individual investigations highlight the efficacy of a specific intervention, most cLBP management strategies share common elements. Combining key elements from various approaches may prove crucial. Although this result is not decisive for treatment, it paves the way for further research that considers a more holistic and multidisciplinary approach.

Corticosteroid injections (CSIs) are widely used in Physical and Rehabilitation Medicine, but their safety profile is strongly influenced by the formulation-specific chemical structure and physicochemical properties of each molecule, as well as by injection technique and dosing strategy. Particulate corticosteroids such as triamcinolone acetonide and methylprednisolone acetate exhibit low aqueous solubility, microcrystal formation, and prolonged intra-articular residence, which translate into sustained anti-inflammatory effects but also higher risks of chondrotoxicity, calcifications, tendinopathy, cutaneous and muscular atrophy, osteonecrosis, nerve injury, infection, and post-injection flare, especially with repeated or high-dose use. In contrast, more soluble preparations like betamethasone and dexamethasone sodium phosphate provide rapid onset and shorter duration of action, with reduced local depot-related complications but a greater propensity for transient systemic effects such as glycemic spikes. Across adverse events, less soluble, longer-acting formulations and inaccurate extra-articular delivery consistently emerge as key drivers of local tissue damage. Ultrasound guidance significantly improves injection accuracy, optimizes drug deposition of both particulate and non-particulate agents, and may enhance clinical outcomes while limiting complications, thereby representing a relevant component of CSI practice. In conclusion, this narrative review proposes a formulation-oriented framework for corticosteroid selection, integrating pharmaceutical formulation, physicochemical properties, imaging guidance, and individualized rehabilitation strategies to optimize molecule selection, minimize adverse effects, and advance a precision rehabilitation paradigm.

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different analyses and studies suggest that TR-related deaths may have increased over the last 20 years. This trend may justify a greater focus on timely diagnosis and management of TR. For a long time, this problem has been underestimated or treated with only pharmacological therapy (diuretics). The use of the isolated surgical option remains infrequent, especially in patients at high surgical risk, for whom a significant number of patients with TR are still not treated, and a disability remains that is difficult to manage and rehabilitate. To date, there are emerging as an alternative to surgery in high-risk patients with severe TR multiple transcatheter devices that aim to reduce TR through different functional mechanisms. There are numerous minimally invasive treatments for TR, and many devices used for the treatment of this disabling pathology. In fact, there are various treatments with a transcatheter approach using ever-new devices. The use of heterotopic implantation of bioprosthetic valves in the superior and inferior vena cava represents an additional therapeutic armamentarium that, through caval reflux, can constitute an additional resource, too. Starting from a single clinical experience and describing a clinical case report, a narrative review has been undertaken by reviewing the various studies that have investigated this type of approach and their impact on the general, cardiac, and functional sides, to then discuss the cost–benefit ratio in light of knowledge on this specific topic.

Background: Patients with spinal cord injury (SCI) typically have longer lengths of stay (LOS) compared to other rehabilitation patients and show variable therapeutic responses. Identifying reliable predictors of functional outcomes is essential. This study aimed to find prognostic factors to detect patients with high/low functional response, prolonged LOS, and those discharged home. Methods: We retrospectively reviewed charts of SCI patients admitted to our center since 1997, recording neurological status (International Standards for Neurological Classification of SCI), Spinal Cord Independence Measure (SCIM), and Walking Index for SCI (WISCI). Rehabilitation results were measured by treatment effectiveness, reflecting the proportion of potential improvement achieved. Patients with SCIM and WISCI effectiveness above the mean plus one standard deviation (SD) were considered outliers, as were those with LOS exceeding the mean plus one SD. Forward stepwise logistic regression identified variables linked to high effectiveness, LOS, and discharge destination. Results: A total of 1059 patients were included (739 males, mean age 50.8 ± 18; 587 with non-traumatic etiology). There were 132 LOS outliers, 163 high SCIM responders, and 144 high WISCI responders; 913 were discharged home. Regression analysis found that year of admission, older age, and complications at admission and during rehabilitation were independently associated with reduced likelihood of high SCIM response; complications at admission and during rehabilitation were associated with reduced likelihood of high WISCI response; year of admission, older age, longer lesion-to-admission time, and complications during rehabilitation predicted prolonged LOS; and more recent year of admission, traumatic etiology, and lower discharge SCIM were associated with nursing home placement. Conclusions: Our data provide a basis for further research into the problem of SCI prognosis. Subgroups of subjects with poor or excellent rehabilitation prognosis could be recognized at the beginning of treatment based on clinical factors.

Patients with severe neurological sequelae often experience profound motor deconditioning that, combined with impaired mucociliary clearance, reduced lung volume, and the presence of tracheostomy, predisposes them to pulmonary infections and serious respiratory complications. A 24-year-old male with spastic quadriplegia secondary to childhood cerebral hemorrhage from an arteriovenous malformation, tracheostomy with a cuffed cannula under mechanical ventilation, and hydrocephalus treated with a ventriculoperitoneal shunt, presented to the emergency department with fever unresponsive to paracetamol and ceftriaxone. Laboratory tests showed markedly elevated inflammatory indices (C-reactive protein 249.3 mg/dl), and chest computed tomography revealed extensive consolidation of the left lower lobe with an air bronchogram and endobronchial obstruction, consistent with aspiration pneumonia. Fibrobronchoscopy confirmed the presence of endobronchial material, and culture grew Acinetobacter baumannii. Given the patient’s clinical and functional status, the physiatrists prescribed an Individual Rehabilitation Project (motor and respiratory re-educational programs, including passive mobilization of major joints, cautious trunk stabilization, and lung volume recruitment maneuvers) to support the effects of positive-pressure ventilation. The case underscores the dual challenge of neurological impairment and pulmonary vulnerability, where immobilization further exacerbates respiratory compromise and infection risk, fostering sarcopenia and poor quality of life. In patients with spastic quadriplegia of cerebrovascular origin on long-term mechanical ventilation, a synergistic approach combining NIV optimization and individualized motor-respiratory rehabilitation may represent an effective strategy to control recurrent infections and maintain clinical stability. In this area, there is currently insufficient evidence, and urgent future research is needed.

Cissus quadrangularis (CQ) is a Vitaceae-derived medicinal plant rich in flavonoids, phytosterols, triterpenoids, vitamins, and bone-relevant minerals, conferring combined antioxidant, anti-inflammatory, phytoestrogenic, and osteoanabolic properties that modulate key pathways involved in bone remodeling. This narrative review aims to synthesize preclinical and clinical evidence on CQ as a potential adjunct in osteoporosis management. Preclinical studies demonstrate that CQ enhances osteoblast differentiation, collagen and matrix deposition, and mineralization, while inhibiting osteoclastogenesis and inflammatory osteoclastogenic cytokines, leading to improved bone microarchitecture, bone mineral density, and callus formation in fracture and estrogen-deficiency models. CQ phytobioactives have also been successfully integrated into advanced biomaterials, exosome-like vesicles, and self‑emulsifying drug delivery systems, improving bioavailability, osseointegration, and regenerative performance in critical-sized defects and implant models. Clinical data, although limited and heterogeneous, consistently indicate that CQ accelerates fracture healing, reduces bone pain, and increases functional recovery in maxillofacial and mandibular fractures, with favorable effects on serum calcium, alkaline phosphatase, and osteopontin expression and without major safety concerns based on available short-term data. In postmenopausal osteopenia, randomized trials show that 24‑week oral CQ stabilizes bone turnover markers and delays bone loss, albeit without short‑term gains in bone mineral density. CQ thus emerges as a multi-target, generally well-tolerated candidate for integrative osteoporosis care, particularly for early bone loss (i.e., osteopenia), fracture healing, and osteoprotection during antiresorptive drug holidays (i.e., temporary suspension of bisphosphonate therapy, particularly in the context of dental procedures). However, the absence of standardized formulations, small sample sizes, short follow-ups, and lack of head‑to‑head comparisons with standard anti‑osteoporotic therapies currently available underscore the need for long-term, multicenter randomized controlled studies using bioavailable, well-characterized CQ preparations.

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field.

Background Patients with spinal cord injury (SCI) typically have longer lengths of stay (LOS) compared to other rehabilitation patients and show variable therapeutic responses. Identifying reliable predictors of functional outcomes is essential. This study aimed to find prognostic factors to detect patients with high/low functional response, prolonged LOS, and those discharged home. Methods We retrospectively reviewed charts of SCI patients admitted to our center since 1997, recording neurological status (International Standards for Neurological Classifica-tion of SCI), Spinal Cord Independence Measure (SCIM), and Walking Index for SCI (WIS-CI). Rehabilitation results were measured by treatment effectiveness, reflecting the propor-tion of potential improvement achieved. Patients with SCIM and WISCI effectiveness above the mean plus one standard deviation (SD) were considered outliers, as were those with LOS exceeding mean plus one SD. Forward stepwise multiple regression identified variables linked to high effectiveness, LOS, and discharge destination. Results A total of 1059 patients were included (739 males, mean age 50.8±18; 587 with non-traumatic etiology). There were 132 LOS outliers, 163 high SCIM responders, and 144 high WISCI responders; 913 were discharged home. Regression analysis found age, lesion level, and complications at admission and during rehabilitation predicted SCIM outliers; AIS grade, age, and rehabilitation complications predicted WISCI outliers; rehabilitation complications, discharge SCIM, bladder management independence, and lesion etiology were linked to longer LOS; discharge SCIM, fecal incontinence, and gender influenced home discharge. Conclusions Our data provide a basis for further research into the problem of SCI progno-sis. Subgroups of subjects with poor or excellent rehabilitation prognosis could be recog-nized at the beginning of treatment based on clinical factors.