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Background and Objectives: Digital ulcers (DUs) are the most common complication in patients with Systemic Sclerosis (SSc). They cause pain with hand dysfunction and negatively impact activities of daily and working life. Our study aims to evaluate the efficacy of a combined treatment of manual therapy and ultrasound therapy in SSc patients with ischemic DU (IDU) compared to manual therapy alone. Materials and Methods: We conducted a before-and-after study (non-randomized study). We enrolled a consecutive series of IDU patients undergoing rehabilitation treatment and divided them into two groups: a treatment group consisting of patients undergoing a combination of manual therapy and US water immersion and a standard care group consisting of patients subjected to manual therapy alone. At the time of the first visit (T0) and at the end of the 4-week rehabilitation period (T1), we evaluated functional capacity, pain intensity, ulcer evolution, and quality of life. Results: In the treatment group, we observed a statistically significant improvement in the functional capacity of the hand (DHI: 28.15 ± 11.0 vs. 19.05 ± 8.83; p < 0.05), pain (NRS: 5.55 ± 1.2 vs. 2.9 ± 1.09; p < 0.05), and PSST score (24.4 ± 4.0 vs. 16.2 ± 2.36; p < 0.05). In the standard care group, we observed a statistically significant improvement only for the functional capacity of the hand (DHI: 28.85 ± 9.72 vs. 22.7 ± 7.68; p < 0.05). Finally, from the comparison between the treatment group and the standard care group, we observed statistically significant improvements in pain (2.9 ± 1.09 vs. 4.5 ± 1.07; p < 0.05) and in the PSST scale (16.2 ± 2.36 vs. 20.4 ± 4.02; p < 0.05). Furthermore, at the end of treatment in the treatment group, 15 ulcers (62.5%) were completely healed, while in the standard care group, only 3 ulcers were completely healed (14.3%). Conclusions: Combined treatment with manual therapy and ultrasound therapy appears to be useful in the management of IDU in patients with scleroderma.

Background: A BMI > 25 is the most decisive, albeit modifiable, risk factor for knee osteoarthritis (KOA). This study aimed at assessing the efficacy of intra-articular injections of hybrid hyaluronic acid (HA) complexes (Sinovial® H-L) for the treatment of KOA in overweight patients in terms of disease severity, cardiocirculatory capacity, and quality of life. Materials: In this single-site, open-label, prospective trial, 37 patients with symptomatic knee OA were assessed at baseline and 3 months after ultrasound-guided intra-articular injection of hybrid HA complexes (Sinovial® H-L). Results: Primary variables displaying a statistically significant improvement after treatment were pain (VAS), disease severity (WOMAC), and cardiopulmonary capacity (6 min walk test). Among secondary variables, quality of life (SF-12) improved significantly, as did analgesic intake for pain control. No statistically significant difference was observed in body fat and muscle mass percentage measured by bioelectrical impedance analysis. Conclusions: Intra-articular hybrid HA injections are significantly effective in improving OA-related disease severity, cardiopulmonary function, and analgesic intake. This supports the role of hybrid HA viscosupplementation as a nonpharmacological treatment to relieve pain, reduce disability, improve quality of life, and limit the risk of polypharmacy in overweight patients with knee OA.

Upper gastrointestinal (GI) side effects are a main reason for discontinuing bisphosphonate treatment, an important therapeuticoption for osteoporosis patients. Consequently, the development of novel formulations with improved tolerability is warranted. Inthis multicenter prospective, observational, postauthorization safety study conducted in Italy and Spain, postmenopausal women(PMW) with osteoporosis (naïve to bisphosphonates) were treated weekly with a buffered soluble alendronate 70 mg effervescent(ALN-EFF) tablet (Binosto®) and followed for 12  3 months. Information was collected on adverse events (AEs), medication errors,persistence, and compliance using the Morisky-Green questionnaire. Patients (N = 1028) aged 67  9 years (mean  SD) receivedALN-EFF weekly. The cumulative incidence of upper GI AEs (oesophageal toxicity, gastritis, gastric ulcers, and duodenitis) relatedto ALN-EFF (primary endpoint) was 9.6% (95% condence interval [CI] 7.9–11.6%), the vast majority being of mild intensity. The mostfrequently occurring upper GI AEs related to ALN-EFF were dyspepsia (2.7%), gastroesophageal reux disease (2.4%), and nausea(2.2%). None of the relevant upper GI AEs listed in the primary endpoint and no serious AEs were reported. At least one medicationerror occurred in 29.9% (95% CI 27.1–32.8%) of patients. However, the majority of medication errors were associated with adminis-tration instructions applicable to any oral bisphosphonate and only seven medication errors were associated with the ALN-EFF for-mulation. ALN-EFF was discontinued in 209 of 1028 (20.3%) patients. The most frequent reasons for discontinuation were AEsrelated to ALN-EFF (46.9%) and patients’ decision (42.6%). Compliance with ALN-EFF was high, reected by a mean Morisky-Greenscore of 92.8  18.6. PMW with osteoporosis treated with ALN-EFF in a real-world setting experienced few upper GI AEs. In addition,they had a low discontinuation and high compliance compared with other formulations, suggesting that ALN-EFF may increasepatient satisfaction and therefore long-term adherence and efcacy

Objective: Purpose: To investigate whether treatment with citicoline, in association with vitamin B6, ginger, melissa and ViNitrox, could improve Dizziness Handicap Inventory (DHI) scores in patients affected by dizziness and vertigo. Materials and methods: Fifty-five consecutive subjects (ranging from 49 to 71 years of age) who complained of dizziness and vertigo of unknown origins were treated with citicoline (500 mg) along with ginger (200 mg), vitamin B6 (2.1 mg), melissa (300 mg) and ViNitrox (150 mg) twice per day for a two-month period. Patients underwent pure tone audiometry (PTA) and a neurotological visit including spontaneous nystagmus testing, bedside examination and the Romberg Test. To evaluate the perceived severity of dizziness and vertigo, its impact on life and the efficacy of treatment, patients were assessed using the DHI before and after treatment. Results: The majority of patients did not report any family history of hearing impairment (94.54%), and 67.27% did not report any kind of hearing loss at the moment of the first examination; mean PTA0.5-4 kHz resulted in 32.5 dB HL and 31.9 dB HL for the left and right ear, respectively. DHI mean value before treatment was 55.85 ± 11.69, while it decreased to 19.85 ± 10.56 after completing therapy (p=0.0001); no significant association between the variables examined and post-treatment DHI values was found (p>0.05). Conclusion: Our results suggest that the use of citicoline should be taken into consideration when managing patients suffering from balance disorders.

Fahr's syndrome is a rare neurological diseas characterized by the presence of idiopathic deposition of calcium in aeras of the brain that control movements.

Background. Many observational studies and some clinical trials suggested a role of vitamin D counteracting bone and muscle loss in aging. Serum levels of 25-hydroxyvitamin D (25OHD) seem to be associated to muscle strength and physical performance. The aim of our study was to compare physical performance and muscle strength in subjects with different serum levels of vitamin D. Materials and methods. We compared 40 patients with vitamin D deficiency (25 OHD 30 ng/ml). The muscle strength and muscle performance were, respectively, assessed with the Jamar handheld dynamometer and the Short Physical Performance Battery (SPPB). Results. Results are showed in table. Parameters Vitamin D deficiency subjects (n=40) Normal subjects (n=37) p-value Age (years) 66.9 ± 7.27 67.54 ± 8.29 NS Body Mass Index (BMI) (kg/m2) 25.37 ± 3.59 25.72 ± 3.25 NS HGS (kg) 12.81 ± 5.10 15.70 ± 6.89 0.038 Gait speed 1m/s: 15/40 (37.5%) 1 m/s: 17/37 (45.9%) NS SPPB score 8: 23/40 (57.5%) 8: 20/37 (73%) NS Conclusions. Subjects with hypovitaminosis resulted to have a significant reduction in muscle strength but not in physical performance.

A deficiency in calcium intake, is considered an important risk factor for the development of osteoporosis. Since the human body cannot produce calcium, individuals are recommended to maintain an adequate daily intake. The aim of the “Calcium Intake in the Mediterranean Region” Study is to evaluate the mean calcium intake in men and women between 40 and 80 residing in various areas of the Mediterranean basin. Enrolled subjects have been asked to fill out a self-administered questionnaire to evaluate the mean daily calcium intake from food, principle risk factors for osteoporosis were registered. A dual- energy X-ray absorptiometry (DEXA) has also been carried out to evaluate bone mineral density (BMD). During the recruitment period between March 2011 and February 2014, were enrolled 982 subjects. 90% are female, the average age is 60.4±10.0 years.The mean daily calcium intake is 1005 ± 449.9mg. Over the 63% of the sample assume a lower calcium intake compared to the recommended dietary allowance (RDA), there are statistically significant gender differences (p < 0.0001) because men have a greater calcium assumption. There is also a significant decreasing trend of assumption with age (p < 0.0001). Calcium Intake is lower in osteopenic and osteoporotic subjects compared to subjects with normal BMD (p=0.0048). Factors significantly associated with a low calcium intake are: sex, age, body mass index, previous fracture, family fracture history. Our study remarks the importance of calcium for the bone health and at the same time, confirms that Mediterranean women over 60 years of age need more calcium daily intake.

This ongoing multicentre study was carried out to investigate the adherence to intermittent parathyroid hormone treatment and the effect on QoL in a typical Italian population eligible for drug reimbursement (i.e. a new vertebral or hip fracture following at least one year of anti-resorptive therapy or three severe vertebral fractures or two severe and one femur fracture). 204 female patients (mean age: 72.6±8.3) were enrolled between March 2008 and April 2009. These patients were treated with PTH (PTH 1–34 or PTH 1–84) according to Italian legislation. Here, we report the results obtained at month 6.

The main aim of this paper is to compare two diffrent rehabilitation tecniques for treatment of the shoulder joint following injury of the rotator cuff. The seriousness of the pathology means patients generally have to endure a considerable period during wich use of the joint in question is impossible

Background: The various mechanisms involved in peripheral nerve regeneration, induced by exercise and electrical nerve stimulation, are still unclear. Objective: The aim of this review was to summarize the influence of physical exercise and/or electrical stimulation on peripheral nerve repair and regeneration and the variation of impact of intervention depending on timing, as well as kind and dosage of the intervention. A literature survey was conducted on PubMed, Scopus, and Web of Science, between February 2021 to July 2021, with an update in September 2022. Methodology: The literature search identified 101,386 articles with the keywords: “peripheral nerve” OR “neuropathy” AND “sprouting” OR “neuroapraxia” OR “axonotmesis” OR “neurotmesis” OR “muscle denervation” OR “denervated muscle” AND “rehabilitation” OR “physical activity” OR “physical exercise” OR “activity” OR “electrical stimulation”. A total of 60 publications were included. Eligible studies were focused on evaluating the process of nerve repair (biopsy, electromyographic parameters or biomarker outcomes) after electrical stimulation or physical exercise interventions on humans or animals with peripheral sensory or motor nerve injury. Synthesis: This study shows that the literature, especially regarding preclinical research, is mainly in agreement that an early physical program with active exercise and/or electrical stimulation promotes axonal regenerative responses and prevents maladaptive response. This was evaluated by means of changes in electrophysiological recordings of CMAPs for latency amplitude, and the sciatic functional index (SFI). Furthermore, this type of activity can cause an increase in weight and in muscle fiber diameter. Nevertheless, some detrimental effects of exercising and electrical stimulation too early after nerve repair were recorded. Conclusion: In most preclinical studies, peripheral neuropathy function was associated with improvements after physical exercise and electrical stimulation. For humans, too little research has been conducted on this topic to reach a complete conclusion. This research supports the need for future studies to test the validity of a possible rehabilitation treatment in humans in cases of peripheral neuropathy to help nerve sprouting.

This study aimed to evaluate the prevalence of vertebral fractures in elderly women with a recent hip fracture. The burden of vertebral fractures expressed by the Spinal Deformity Index (SDI) is more strictly associated with the trochanteric than the cervical localization of hip fracture and may influence short-term functional outcomes. INTRODUCTION: This study aimed to determine the prevalence and severity of vertebral fractures in elderly women with recent hip fracture and to assess whether the burden of vertebral fractures may be differently associated with trochanteric hip fractures with respect to cervical hip fractures. METHODS: We studied 689 Italian women aged 60 years or over with a recent low trauma hip fracture and for whom an adequate X-ray evaluation of spine was available. All radiographs were examined centrally for the presence of any vertebral deformities and radiological morphometry was performed. The SDI, which integrates both the number and the severity of fractures, was also calculated. RESULTS: Prevalent vertebral fractures were present in 55.7 % of subjects and 95 women (13.7 %) had at least one severe fracture. The women with trochanteric hip fracture showed higher SDI and higher prevalence of diabetes with respect to those with cervical hip fracture, p = 0.017 and p = 0.001, respectively. SDI, surgical menopause, family history of fragility fracture, and type2 diabetes mellitus were independently associated with the risk of trochanteric hip fracture. Moreover, a higher SDI was associated with a higher percentage of post-surgery complications (p = 0.05) and slower recovery (p

Vaccine hesitancy (VH) is known to play a relevant role in thwarting the efforts toward reaching satisfactory influenza vaccination coverage, and has caused similar difficulties during the COVID-19 pandemic. This study aims to describe the phenomenon and produce insights on the reasons behind VH. A survey was administered between December 2020 and February 2021 to adults living in the cities of Bologna and Palermo. Of the 443 subjects enrolled, 47.3% were likely to get the influenza vaccination, while 75.6% were willing to receive the COVID-19 vaccination. The most frequent determinants that motivated the willingness to get the COVID-19 vaccine were trust in the safety of vaccines and belief that the vaccine is an effective tool. As for people’s unwillingness to be vaccinated, being exposed to information that produced doubts about the vaccine and lack of trust in a newly developed vaccine were the most frequently involved determinants. Statistically significant positive associations were found between the willingness to be vaccinated and postgraduate education and the propensity towards influenza vaccination. A negative association with being over 40 years old and of female gender was also found. These results might have an impact in better understanding individual reasons behind VH, identifying which categories are more exposed to it and which strategies should be implemented.

Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low-Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients.

Giovanni Iolascon,1 Alessandro de Sire,1– 3 Dario Calafiore,1,4 Maria Grazia Benedetti,5 Carlo Cisari,2,6 Giulia Letizia Mauro,7 Silvia Migliaccio,8 Ranuccio Nuti,9 Giuseppina Resmini,10 Stefano Gonnelli,9 Antimo Moretti1 1Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy; 2Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy; 3Rehabilitation Unit, “Mons L. Novarese” Hospital, Vercelli, Moncrivello, Italy; 4Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantova, Italy; 5Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy; 6Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy; 7Department of Surgical and Oncology Sciences, University of Palermo, Palermo, Italy; 8Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome, Foro Italico, Rome, Italy; 9Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; 10Section of Orthopaedics and Traumatology, Treviglio-Caravaggio Hospital, Treviglio, Bergamo, ItalyCorrespondence: Alessandro de SirePhysical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Viale Piazza D’Armi 1, Novara 28100, ItalyTel +3903213734800Email alessandro.desire@gmail.comObjective: To assess physical performance, number of falls, previous fragility fractures, and ongoing pharmacological therapy in a cohort of post-menopausal women, according to their risk of falling.Methods: In this multicenter cross-sectional study, we recruited in a 3-year period (May 2016 to April 2019), women aged > 60 years referred to seven Osteoporosis and Bone Metabolism Outpatient Services of the Italian Group for the Study of Metabolic Bone Diseases. The study population was divided into three groups according to the risk of falling, assessed through the Elderly Fall Screening Test (EFST): low risk (EFST score=0– 1); moderate risk (EFST=2– 3); high risk (EFST=4– 5). Outcome measures were: 4-meter gait speed (4MGS); unipedal stance time (UST); number of falls in the previous year; previous fragility fractures; ongoing pharmacological therapy.Results: We analyzed 753 women (mean aged 70.1± 9.2 years): 378 (50.2%) at low risk of falling, 247 (32.8%) at moderate risk, and 128 (17.0%) at high risk. 4MGS and UST resulted as pathological in the 93.9% and 99.2%, respectively, of women at high risk. There were significant differences among groups for both outcomes (p< 0.001). There was also a significant difference among groups (p< 0.001) in terms of previous falls and fragility fractures. Lastly, there were significant differences (p< 0.05) among groups in using antihypertensive drugs, antiplatelet agents, anticoagulants, antidepressants, anti-osteoporotic drugs, and vitamin D, and/or calcium supplementation.Conclusion: Physical performance, prevalence of falls and fragility fractures, and an assessment of pharmacological therapy should be investigated in post-menopausal women because of their significant correlation with risk of falling.Keywords: accidental falls, osteoporosis, walking speed, fractures, bone, rehabilitation

Highlights • Hormonal receptors positive breast tumor and prostate cancer are managed with endocrine therapies. • Endocrine therapies designed for breast and prostate cancer are often associated to serious adverse skeletal related events, such fractures. • Denosumab is a monoclonal anti-body binding RANKL which acts as inhibitor of osteoclasts activity, thus increasing bone mass. • Denosumab was showed to strongly prevent hormonal therapies-related skeletal issues. • Denosumab administration results safe in bone mass increase and reduction of fractures risk., Hormonal therapies for receptor positive-breast and prostate cancer patients have shown clinical efficacy but also several side effects including osteoporosis, loss of bone mass and increased fracture risk. Denosumab represents an anti RANKL (receptor activator of nuclear factor-kB ligand) monoclonal anti-body acting as inhibitor of osteoclasts formation, function, and survival, then increasing bone mass. Herein, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the role of Denosumab in saving bone health in prostate and breast cancer patients receiving respectively androgen deprivation therapy and adjuvant endocrine therapy. Moreover, selected patients have to be treated with Denosumab at the dose of 60 mg every six month or placebo. Outcomes studied included the bone mass density (BMD) increase at 24 and 36 months, BMD loss, reduction of fractures risk (in particular vertebral) at 24 and 36 months and safety (overall, serious adverse events – SAEs and discontinuation rate). Our results showed a reduction of the BMD loss up to 36 months both at the lumbar and femoral level and a BMD increase both at 24 and 36 months. It was also found a reduction in the number of new vertebral and femoral fractures at 24 and 36 months. Finally, our pooled analysis showed that Denosumab did not affect both the SAEs and therapy discontinuation risk. In conclusion, Denosumab administration can be considered effective and safe in the prevention and management of the above mentioned adverse events related to hormonal therapies designed for breast and prostate tumors.

Background: The presence of the vitamin D receptor (VDR) has been recently demonstrated in human muscle supporting the theory of a role of vitamin D in the proliferation and differentiation of muscle cells. So far only few studies investigated the association between vitamin D and muscle performance in postmenopausal women. Aim: To define the functional impact of vitamin D deficiency. Design: Multicenter retrospective study. Setting: Five Italian outpatient services of Physical and Rehabilitation Medicine (PRM). Population: Postmenopausal women. Methods: We divided the population in two groups based on the threshold of 30 ng/mL as cut-off to define sufficient and insufficient serum levels of 25-hydroxyvitamin D3 [25(OH)D3]. Outcome measures were: appendicular lean mass (ALM); ALM-to-BMI ratio (ALMBMI); total fat mass (FM); visceral adipose tissue (VAT); Hand Grip Strength (HGS); Knee Isometric Extension Strength (KES); Short Physical Performance Battery (SPPB); 4-meter gait speed (4MGS). Results: We analyzed the data records of 401 postmenopausal women (mean age 66.93±8.47 years): 203 with hypovitaminosis D (mean age 66.81±8.11 years) and 198 with normal levels of 25(OH)D3 (mean age 67.04±8.84 years). The analysis showed a significant difference between the two groups in terms of: ALMBMI(0.002), FM (P

Osteoporosis is characterizated by low bone mass and microarchitectural modifications of bone tissue with a consequent increase in fragility fracture.

Purpose. Osteoarthritis (OA) is the most common joint disorder in the elderly, causing significant pain which negatively affects mobility and quality ol liie. The aim of the study was to assess the effectiveness of ultrasound Ímage-guided intra-articular injections of Hyalubrix@ combined with exercise therapy in the treatment of hip osteoarthritis. Methods. This was a single site, prospèctive, open-fabel, Investigator-initiated study. Forty patients rilere enrolled and received three ultrasound image.guided injections of Hyalubrix@, 45 days apart, combined with three sessions a week of physícal therapy (proprioceptive rehabilitation of the lower limbs; gait training; balance training) up to a total of 30 sessions (10 weeks), starting from one week after the first injection. Results. The primary obiective was to achieve a lasting reduction in OA symptoms related to pain during activity. During the course of the study the pain perceived by the patient during activity dropped from a mean value of 6.94 cm to a mean value of 1.46 cm and showed a statistically significant decrease from visit 1 compared to baseline (p < 0.05) which was confirmed at all the subsequent time points. Significant improvements were also observed in the evaluation of the secondary objectives: hip disability; OA-related pain at rest; daily functioning and NSAIDs intake. Conclusions. Results from this study including 40 patients for a total of 65 treated hips demonstrate a significant improvement in OA-related pain, hip disability, and patient's daily functioning as well as a reduction in NSAIDS intake. Patients suffering from hip OA sèem to benefil from the treatment wiih Hyalubrix@ injections plus exercise therapy.

The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study (MUSIC-OS) is a prospective, observational study of women with osteoporosis in Europe and Canada. At baseline, patients with gastrointestinal symptoms reported lower adherence to osteoporosis treatment, treatment satisfaction, and health-related quality of life, than those without gastrointestinal symptoms. INTRODUCTION: The aim of the study was to examine gastrointestinal (GI) symptoms and the association between GI symptoms and treatment adherence, treatment satisfaction, and health-related quality of life (HRQoL) among osteoporotic women in Europe and Canada. METHODS: Baseline results are reported here for a prospective study which enrolled postmenopausal, osteoporotic women who were initiating (new users) or continuing (experienced users) osteoporosis treatment at study entry (baseline). A patient survey was administered at baseline and included the occurrence of GI symptoms during 6-month pre-enrolment, treatment adherence (adherence evaluation of osteoporosis (ADEOS), score 0-22), treatment satisfaction (Osteoporosis Treatment Satisfaction Questionnaire for Medications (OPSAT-Q), score 0-100) and HRQoL (EuroQol-5 dimension (EQ-5D) utility, score 0-1; OPAQ-SV, score 0-100). The association between GI symptoms and ADEOS (experienced users), OPSAT-Q (experienced users), and HRQoL (new and experienced users) was assessed by general linear models adjusted for patient characteristics. RESULTS: A total of 2959 patients (2275 experienced and 684 new users) were included. Overall, 68.1 % of patients experienced GI symptoms in the past 6 months. Compared with patients without GI symptoms, patients with GI symptoms had lower mean baseline scores on most measures. The mean adjusted differences were ADEOS, -0.43; OPSAT-Q, -5.68; EQ-5D, -0.04 (new users) and -0.06 (experienced users), all P < 0.01. GI symptoms were also associated with lower OPAQ-SV domain scores: physical function, -4.17 (experienced users); emotional status, -4.28 (new users) and -5.68 (experienced users); back pain, -5.82 (new users) and -11.33 (experienced users), all P < 0.01. CONCLUSIONS: Patients with GI symptoms have lower treatment adherence and treatment satisfaction and worse HRQoL than patients without GI symptoms.

Background and Objective Since oxidative stress plays a pathogenetic role in chronic neck pain (CNP), we investigated whether a combination of α-lipoic acid (ALA) and superoxide dismutase (SOD) might improve pain control and the efficacy of physiotherapy (“multimodal therapy”) in patients with CNP. Setting This study was conducted in the Rehabilitation Unit of the Department of Surgical and Oncological Sciences at the University Policlinic in Palermo, Italy. Design and Patients This was a prospective, randomized, open study in outpatients. Intervention Patients randomly received either physiotherapy alone (group 2; n = 45) or a combination of ALA 600 mg and SOD 140 IU daily in addition to physiotherapy (group 1; n = 51), for 60 days. Pain was assessed by a visual analogue scale (VAS) and a modified Neck Pain Questionnaire (mNPQ). Treatment compliance and safety were also evaluated. Results Both groups experienced a significant reduction in the VAS and mNPQ scores after 1 month; however, while no further improvement was observed in group 2 at 60 days, group 1 showed a further VAS reduction (p

Analysis of the results of the study shows that prevention and treatment of osteoporosis risk factors are crucial in reducing the incidence to prescribed treatment and because of the most frequent cause of discontinuation of drug treatment (81,6%) is represented by a separate decision of the patient, it requires an extensive campaign oublic awareness on the problem of osteoporosis and its debilitating complications.

AS is a chronic and progressive pathology that notably cripples the patient's psyco-physical status, with a remarkable compromising of the relational life. Practising regularly the therapeutic exercise along with the anti-TNF alpha, allowed a quick pain reduction, a long maintenance of the rachis functional elasticity and a correct posture, giving a better social and professional life quality.

Osteoarthritis does not mean a degenerative articular process only but a pathologic expression of wear, inflammation and immunological imbalance of the joints. Our study has the aim to demonstrate the effectiveness of eco-guidate infiltrations with high molecular weight associated with administration of oral chondroprotective supplements (glucosamine solfate, chondroitin sulphate, hydrolyzed collagen type II, hyaluronic acid and L carnitine fumarate) in comparison with the only treatment with ecoguided infiltrations with hyaluronic acid in patients suffering from primary osteoarthiritis of the hip.

An early rehabilitation program, in combination with proper medication, can prevent the worsen of the hand algo-dystrophy towards a permanent framework characterized by muscle-tendon stiffness, contractures and ankylosis of the distal small joints. We can assert, consequently, that synergy between functional rehabilitation, treatment with disodium clodronate, PEMF and Laser Nd-Yag is a main point for therapeutic efficacy

After the preliminary outcomes obtained, we can assert that a post-operative rehabilitation program supplemented by an educational booklet, such as visual and mnemonic support, improves results of surgery of the spine, quality of life and maintains over time the well-being.

Analysis of our data shows that the functional rehabilitation associated with the CO2 laser causes a greater reduction in pain, better recovery of joint ROM and increase in muscle strength compared to treatment associated with injections of corticosteriods

This study was performed to obtain clinical evidence, not only about immediate analgesic effect, but also regarding the delay in arthroplasty. Results show that 3 infiltrations every 30 days are well tolerated and they get a high degree of satisfaction for effectiveness for at least 6 months.

An analysis of the data shows that the PTH 1-34 in association with specific rehabilitation treatment is effective in reducing early pain borne by the dorsal-lumbar spine, to avoid the risk of new fractures, improve balance and gait to correct a good quality of life. Even taking into account the small number of patients, we emphasize the absence of new osteoporotic fractures in women who have also physical therapy and therapeutic exercise.

In patients with hemispheric stroke, abnormal motor performances are described also in the ipsilateral limbs. They may be due to a cortical reorganization in the unaffected hemisphere; moreover, also peripheral mechanisms may play a role. To explore this hypothesis, we studied motor performances in 15 patients with hemispheric stroke and in 14 patients with total knee arthroplasty, which have a reduced motility in the prosthesized leg. Using the unaffected leg, they performed five superimposed circular trajectories in a prefixed pathway on a computerized footboard, while looking at a marker on the computer screen. The average trace error was significantly different between the groups of patients and healthy subjects [F ((2,25)) = 7.9; p = 0.003]; on the contrary, the test time execution did not vary significantly. In conclusion, both groups of patients showed abnormal motor performances of the unaffected leg; this result suggests a likely contribution of peripheral mechanisms.

An electronic baropodometer was used to study a case of lower limb dysmetria caused by an accident with delayed functional recovery of gait. A static baropodometric test of the patient without shoes and without orthesis revealed plantar imprints with loads within the norm; a static test with shoes but without orthesis showed that the operated right foot carried 42% of the body weight and the pressure peak M was on the second left metatarsal head, while the pressure centres of the individual plantar ("articular") imprints were not equidistant from the ground projection of the body's centre of gravity. In a static baropodometric test with shoes and with external orthesis, the loads were uniformly distributed on the plantar imprints and the articular pressure centres were equidistant from the ground projection of the body's centre of gravity. In the dynamic baropodometric test, the use of orthesis almost completely eliminated the limp characterising the patient's gait and improved all the parameters measured. This study confirms the value of EBP in the diagnostic evaluation and follow-up of patients with dysmetria of the lower limbs.

Introduction: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population.Methods: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions.Results: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year.Conclusions: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies. © 2010 Tarantino et al.; licensee BioMed Central Ltd.