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Teresa Paolucci,1 Letizia Pezzi,1 Roberta La Verde,2 Pasqualino Maietta Latessa,3 Rosa grazia Bellomo,4 Raoul Saggini1 1University G. d’Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy; 2S. Filippo Neri Hospital, Physical Medicine and Rehabilitation, “Sapienza” University, Rome, Italy; 3Department for Life Quality Studies, University of Bologna, Bologna, Italy; 4University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, ItalyCorrespondence: Teresa PaolucciG. D’Annunzio University of Chieti-Pescara, Rehabilitation Unit, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), Via Dei Vestini 66100, Chieti Scalo, ItalyEmail teresapaolucci@hotmail.comBackground: Aging has been associated with the progressive depletion of lean mass, reductions in muscle strength and the coordination of the lower extremities, accompanied by decreased gait assurance and balance control. Also, less balance control favors falling which is the leading cause of injury among the elderly. The aim of this systematic review is to identify and evaluate existing evidence regarding the use of focused vibration (FV) to improve balance and reduce the risk of falling during the rehabilitation of elderly populations.Methods: The PICO question is what are the effects of focal/segmental/local vibration training on the assessment of balance and the risk of falls among the elderly population? A thorough literature review was conducted between May 1, 2009, and June 30, 2019, for studies in English, randomized clinical trials, including crossover and prospective design studies with assessing balance and the risk of falls in elderly populations (age > 60 years).Results: Eight articles (N = 8) satisfied the inclusion criteria and were considered, of which 6 are RTC, one cross-sectional study and one clinical study, for a total of 635 participants. A total of 6 different vibration devices were used, each of which was associated with different FV frequency and amplitude characteristics and different treatment protocols.Conclusion: In conclusion, FV can be effective in decreasing the risk of falls and improving the assessment of balance, but more evidence is necessary considering the limits of the studies; however, it does look an important promise during rehabilitative treatment.Keywords: rehabilitation, risk of falls, exercise, vibration, equilibrium

Teresa Paolucci,1 Letizia Pezzi,1 Antonello Marco Centra,1 Niki Giannandrea,1 Rosa Grazia Bellomo,2 Raoul Saggini1 1Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D’Annunzio University of Chieti-Pescara, Chieti, Italy; 2Department of Biomolecular Sciences, University of Study of Urbino Carlo Bo, Urbino, ItalyCorrespondence: Teresa PaolucciG. D’Annunzio University of Chieti-Pescara, Chieti, ItalyEmail teresapaolucci@hotmail.comAbstract: Electromagnetic fields (EMFs) provide a non-invasive, safe, and easy method to treat pain with respect to musculoskeletal diseases. The purpose of this systematic review was to describe the use of electromagnetic therapy in the rehabilitation field by investigating the efficacy in acute and chronic pain in the musculoskeletal disorders. A database search was conducted using the following resources: PubMed, Cochrane, PEDro, SCOPUS, and WoS. The following MESH terms were used: [Electromagnetic field AND/OR Rehabilitation], [Electromagnetic field AND/OR Pain], [Pulsed Magnetic field AND/OR Rehabilitation] and [Pulsed Magnetic field AND/OR Pain], [Pulsed Electromagnetic field AND/OR Rehabilitation] and [Pulsed Electromagnetic field AND/OR Pain], per the guidelines of the PRISMA statement. Articles published between January 1, 2009 and December 31, 2018 were included as assessment of musculoskeletal pain conditions, randomized clinical trial including crossover and prospective design studies, full English text available, population age > 18 years; instead were excluded neurological randomized clinical trials, transcranial magnetic stimulation application, neuropathic pain, animal/in vitro studies, and articles without English abstract or English full text. Three independent investigators (AMC, NG, and LP) retrieved all the information. Twenty-one RTC (N=21) were considered for the inclusion and exclusion criteria. The results showed as pulsed magnetic fields at low intensity and frequency (from 1 Hz up to 100 Hz) are commonly used with efficacy in resolving musculoskeletal pain. EMFs therapy is a well tolerated, effective with no negative side effects, which can be integrated with rehabilitation for the treatment of chronic and acute pain in musculoskeletal diseases, but further studies are needed to examine the use of more standardized protocols.Keywords: pulsed electromagnetic fields, rehabilitation, physical medicine, magnetic therapy, pain

Rosa Grazia Bellomo,1,* Teresa Paolucci,2,* Niki Giannandrea,2 Letizia Pezzi,2 Raoul Saggini2 1University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, Italy; 2University G.d’Annunzio Chieti, Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), Chieti-Pescara, Italy*These authors contributed equally to this workCorrespondence: Teresa PaolucciUniversity G.d’Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Viale Abruzzo 322, Chieti-Pescara 66100 CH, ItalyEmail teresapaolucci@hotmail.comPurpose: Facet joint syndrome (FJS) is an arthritis-like condition of the spine that can be a significant source of low back pain (LBP). Ozone therapy (OT) could be an additional treatment method. We evaluated the therapeutic results of percutaneous injection of ozone to ablate acute LBP caused by FJS.Methods: A 73-year-old Caucasian woman was treated by OT: one ozone injection (20 μg/mL) per week for 3 weeks under ultrasound guidance. After a break of 1 week, she performed exercises for aquatic rehabilitation (twice a week for 4 weeks).Results: The outcome measure was pain relief for ≥ 6 months according to the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory (BPI) test. From baseline to 1 month after OT, a reduction in pain was documented and the result was maintained at 6-month follow-up.Conclusion: OT followed by aquatic exercises could be efficacious against the LBP caused by FJS.Keywords: ozone, low back pain, Oswestry Disability Index, spine, injection

T Paolucci,1 RG Bellomo,2 MA Centra,1 N Giannandrea,1 L Pezzi,1 R Saggini11University G.d’Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy; 2University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, ItalyBackground: Mesotherapy can be included as an ancillary treatment in the management of localized pain in rehabilitation, but there are no definitive treatment protocols for this approach.Objectives: The purpose of this review was to examine new indications for more standard protocols of mesotherapy in rehabilitation.Materials and methods: This systematic review was performed using the following resources: PubMed, Cochrane, PEDro, Scopus, and Google Scholar. The following algorithm was developed, based on the PICO acronym, to evaluate the effects of mesotherapy, with pain as the primary outcome (MESH terms): [mesotherapy AND pain], [mesotherapy AND musculoskeletal], [mesotherapy AND musculoskeletal disorder], [intradermal therapy AND pain], and [intradermal therapy AND musculoskeletal disorder].Results: Seven articles (N=7) satisfied the inclusion criteria and were considered in the review: two of them treated osteoarthritis of the knee (3 sessions) and pes anserine (9 sessions) emphasizing a good efficacy of mesotherapy. Five studies analyzed spine diseases (specifically, two was about chronic and nonspecific neck pain, two about acute low back pain and one about chronic spinal pain): the results of mesotherapy treatment are encouraging both for the resolution of acute and chronic musculoskeletal vertebral pain from one to five sessions.Conclusion: Mesotherapy showed a good effect to reduce acute and chronic musculoskeletal pain and, also, it is a well-tolerated treatment. Nonetheless future randomized controlled trials should be desirable for more uniform treatment protocols.Keywords: mesotherapy, intradermal injection, rehabilitation, pain, musculoskeletal