Gianluca Bertoni

Objectives: To map how sleep has been assessed in osteoarthritis (OA) and/or inflammatory arthritis (IA), and to synthesize the evidence on the prevalence, characteristics and relationships between sleep disturbances and these conditions. Methods: We conducted a scoping review following the JBI guidelines and reported it following the PRISMA extension guidelines for scoping reviews (PRISMA-ScR). Medline (PubMed), EMBASE, CINAHL, Cochrane Central, PsycINFO, grey literature sources and ClinicalTrials.gov were searched. Using the RU-SATED framework, we categorized and narratively synthesized sleep dimensions and assessment methods and tracked the clinical impact of sleep disturbances in OA and IA. Results Two hundred and eighty-three: records (265 published studies; 18 registered trials) were included. They comprised 171 studies on IA, 77 on OA and 17 on mixed populations, which were considered separately where appropriate. Sleep assessment methods varied across studies, favouring subjective over objective measurements. Studies primarily focused on sleep satisfaction, duration, efficiency and sleepiness, overlooking regularity and timing. Global sleep disturbances were observed in ∼40–90% of OA and IA participants, with prevalence estimates varying substantially according to definitions, assessment methods and study populations. A consistent pattern of discrepancies between subjective and objective sleep metrics was identified. Conclusion: Sleep disturbance is a prevalent and clinically significant feature of both OA and IA, yet it remains under-represented in research and routine care. This review highlights substantial heterogeneity in sleep assessment and consistent discrepancies between subjective and objective measures. These findings support the need for standardized, multimethod approaches and for integrating sleep evaluation into rheumatology research and clinical guidelines.

The online version contains supplementary material available at 10.1186/s12877-026-07121-6.

Importance: Ethical and bioethical issues are central to the identity and practice of physical therapy. A comprehensive overview of how these issues are addressed in the literature is essential for advancing education, clinical practice, and professional reflection. Objective: The objective was to systematically map ethical and bioethical issues in the physical therapy literature, describe the methodologies employed, and identify key gaps to inform education, practice, and policy. Data Sources: Medline (via PubMed), Embase, Cochrane Central, CINAHL, PsycINFO, PEDro, grey literature sources, and academic library resources were searched from inception to October 2024. The review protocol was prospectively published on medRxiv. Study Selection: Studies addressing ethical or bioethical issues in physical therapy were included, encompassing both normative and descriptive (empirical) approaches. After screening titles, abstracts, and full texts, 108 studies met the inclusion criteria. Data Extraction and Synthesis: Data were extracted using a modified Joanna Briggs Institute standardized form. A narrative synthesis was conducted to map ethical themes and characterize methodological approaches across studies. Main Outcomes and Measures: Identification and mapping of ethical and bioethical themes and characterization of research methodologies applied. Results: A total of 15,464 records were identified; 3223 duplicates were removed. Of 12,241 titles and abstracts screened, 385 full texts were assessed, and 108 studies were included. Major themes included ethical reasoning (n = 33), ethical reasoning and education (n = 19), ethical theories (n = 12), care relationships (n = 15), justice and equity (n = 8), perception of ethical issues (n = 13), and codes of ethics (n = 8). Key challenges involved physical touch, informed consent, professional boundaries, and moral distress. Structural barriers, cultural contexts, and disparities in ethics education were recurring concerns. Ethical reasoning was often situational and intuitive, whereas formal codes were frequently perceived as disconnected from clinical practice. Conclusions and Relevance: Ethical complexities in physical therapy arise from its embodied, relational, and context-sensitive nature. The literature reveals variability in how ethics is taught and applied across settings and highlights underexplored areas, including oncology, end-of-life care, digital health and artificial intelligence, and equity, diversity, and inclusion. Findings emphasize the need to strengthen ethics education, reinforce the application of existing codes of ethics, and provide organizational support for ethical deliberation. This synthesis provides a foundation for future research and can inform curricular development, clinical practice, and policy initiatives in physical therapy ethics.

Introduction: Cancer rehabilitation is increasingly recognized as a core component of cancer care, yet little is known about how people with cancer perceive its ethical dimensions. This study explored how patients experience autonomy, safety, equity, and relational care within physiotherapy-led cancer rehabilitation.Methods: We conducted a qualitative interview study using reflexive thematic analysis (RTA). Twenty adults with a previous cancer diagnosis who had received physiotherapy related to cancer rehabilitation within the past three years were purposively sampled to maximize variation in age, gender, diagnosis, stage, care setting, and geographical area. Interviews were conducted online, audio-recorded, transcribed verbatim, anonymized, and analyzed inductively from a constructionist, experiential perspective.Results: Five themes captured ethically salient aspects of rehabilitation experiences: (1) struggles for meaningful participation, where involvement in decisions was sometimes limited despite rhetoric of autonomy; (2) balancing safety and control, where professional caution was experienced as both protective and at times over-restrictive; (3) unequal access as systemic injustice, with geography, logistics, and poor information affecting access to services; (4) empathy and emotional presence, which fostered trust, dignity, and motivation; and (5) limits of standardized care, where rigid protocols and time pressure risked depersonalization unless offset by flexibility. Participants did not view rehabilitation as a merely technical intervention, but as an ethically charged practice shaped by everyday interactions, organizational contexts, and opportunities for agency.Conclusions: People with cancer experience rehabilitation as an ethical as well as clinical practice. Flexible, dialogic, and equitable models of care may better support dignity, participation, and shared decision-making.

Background: Osteoarthritis (OA) and inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondylarthritis (axSpA), are leading causes of disability worldwide, significantly impacting health and quality of life. Sleep issues are highly prevalent in these populations, exacerbating pain, fatigue, and disease activity. However, there is a dearth of evidence regarding how sleep disorders should be assessed. Objective: The main objectives are to identify, describe, and synthesise which types of sleep dimensions are evaluated, what measurement tools are employed to measure them in individuals with OA and IA, and provide an overview of the impact of sleep issues in OA and IA. Methods: This systematic scoping review will follow the Joanna Briggs Institute methodological framework and be reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for Systematic Scoping Reviews. The search strategy will involve PubMed, Embase, Cochrane Central, PsycINFO, and CINAHL, along with grey literature sources. Articles will be selected based on predefined eligibility criteria, and data will be synthesised narratively. Anticipated outcomes: This systematic scoping review will synthesise the current literature on studies that collect and report sleep assessment as a primary or secondary outcome in people with OA and IA. It will clarify which sleep dimensions are assessed and how they are measured, provide an updated overview to inform clinical practice regarding sleep assessment and impact in OA and IA, and identify key research gaps. Dissemination: The findings will be disseminated through research publications, including peer‐reviewed articles and conference abstract(s)/presentation(s).

Introduction: Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists. Participants: Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected. Data Collection: Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics. Data Analysis: Sessions were recorded, transcribed, and analyzed using Braun and Clarke’s ‘Reflexive Thematic Analysis’. Results: Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis – ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations – navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation – balancing ­treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment – ethical considerations in discontinuing treatment. Discussion: These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context. Conclusions: The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.

Introduction: Health professionals that act as lecturers in higher education necessitate the acquisition of pedagogical skills along with clinical ones. Consequently, pedagogical training courses have been introduced as part of professional development or within university curricula. While several studies explored the experiences of attending courses on pedagogical methodology, there is a notable gap in the literature within the rehabilitation field. Hence, this qualitative study explored the experience of Italian postgraduate health professionals in rehabilitation about the experience of attending pedagogical methodology courses in their postgraduate education. Materials and methods: A qualitative focus group study was carried out. Specifically, the authors purposefully recruited participants with different professional backgrounds (physiotherapy, speech therapy, and others) with or without lecturing experience. Recent graduates and students of the Master of Science in ’Rehabilitative Sciences of the Health Professions’ at the University of Verona (Verona, Italy) were recruited. The focus groups were analysed following a ’Reflexive Thematic Analysis’ by Braun & Clarke within a social constructionist framework. Results: Three focus groups were conducted with seventeen Italian participants (age: 33 ± 9; 71% women, n = 12; 29% men, n = 5). The analysis identified three main themes: 1) “A Brave New Pedagogical World,” reflecting participants’ exposure to innovative teaching approaches; 2) “Becoming a Cutting-Edge Lecturer,” highlighting skills acquired for delivering inspiring lectures; and 3) “Something Beyond Pedagogy,” where participants reported skills applicable to other professional contexts, including clinical practice. Conclusion: The results of this study showed that pedagogical courses provide a positive learning experience for rehabilitation health professionals, helping them develop relevant pedagogical skills. Although our findings suggest the potential benefits of these courses in preparing healthcare professionals for teaching roles, further studies are needed to evaluate their direct impact on educational practices and patient outcomes.

Background and aims: Ethical considerations play a crucial role in physiotherapy, influencing patient care, professional conduct, and clinical decision-making. Despite its significance, there is a limited comprehensive understanding of how ethical principles are applied in physiotherapy practice. The evolving nature of the field, alongside advancements in treatment approaches, presents new ethical challenges that require systematic investigation. This scoping review aims to map the existing literature on ethical issues within physiotherapy, identify research methodologies, and highlight knowledge gaps. Method: This review will follow the methodological framework proposed by the Joanna Briggs Institute (JBI) for scoping reviews and will be reported following the PRISMA for Scoping Reviews guidelines. A comprehensive search will be conducted on PubMed, Medline, Embase, CINAHL, PsychInfo, Cochrane Central, and Pedro. The gray literature will be consulted. Studies involving physiotherapists and those addressing ethical issues in physiotherapy practice will be included. Data extraction will be based on a standardized form, and a narrative synthesis will categorize the ethical issues and principles. Discussion: The review will provide a broad overview of ethical issues and principles in physiotherapy. It will inform future research priorities, guide ethical training for practitioners, and support the development of policies and guidelines to improve ethical shared decision-making in physiotherapy practice.