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Background Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear. Objectives To determine the prevalence of LBP in a wide sample of Italian runners. Design A cross-sectional online survey. Setting A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019. Participants 2539 Italian runners. Methods A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self-reported and included 38 questions. Main outcome measures Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer’s V. Only correlation values higher >0.60 were deemed of interest. Results 2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer’s V Conclusion The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle.

Objective This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies. Methods A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool. Results Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical (“My neck has gone wrong”); psychological (“I am worried about my recovery”); and social (“Pain limits my life”). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively). Conclusion An individual’s experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual’s experiences to offer a truly patient-centered care pathway. Impact This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.

To investigate the beliefs, knowledge, attitudes, behavior, and the clinical management procedures of the Italian physical therapists specialized in orthopedic manipulative physical therapy (OMPT) toward running and its correlation with low back pain (LBP).Survey Monkey software was used to administer the survey. The questionnaire was self-reported and included 26 questions. Descriptive statistics were used and related to the effective respondents for each question.One thousand two hundred and eighteen questionnaires (60.9%) were included in the analysis. A considerable cohort of OMPTs working in private practice clinical settings (Widespread knowledge of clinical and theoretical management of LBP in runners-patients has emerged among Italian OMPTs. The OMPTs' academic background agrees with the recent literature and therefore highlights the paucity of studies related to LBP as running-related injuries.

The coronavirus disease 2019 (COVID-19) pandemic has induced worldwide governments to adopt severe rules limiting individual freedom and imposing social distancing (eg, closing school, mandatory quarantine, restricting entertainments)1 in order to prevent the collapse of national health care systems. In addition to the goal of reducing the COVID-19 pandemic, this paradigm shift brings a different allocation of resources within diagnosis-related groups toward high-intensity levels of care (eg, intensive care units) needed for patients suffering of severe COVID-19. Although these measures are necessary in this pandemic, they constitute a barrier for health care professionals who are usually in close contact with patients needing low-intensity care, such as musculoskeletal (MSK) physical therapists.

Objective Objective The purpose of this review, focused on people with nonspecific neck pain (NSNP), was to assess the effectiveness of specific exercises that recruit the deep cervical muscles compared with other types of exercises or interventions and minimal or no treatment. Methods This systematic review with meta-analysis screened 5 databases (MEDLINE, Embase, CINAHL, Physiotherapy Evidence Database, and The Cochrane Library). Randomized controlled trials investigating the effectiveness of this type of exercise on the intensity of pain were included. Data for each included trial were extracted by 2 independent reviewers. The Cochrane Risk of Bias 2.0 tool was adopted to assess the internal validity of the included trials. The overall quality of evidence was layered with the Grading of Recommendations, Assessment, Development and Evaluations system. Results The review identified a total of 2397 records. Sixteen articles were included in the qualitative synthesis, and 9 studies were included in the meta-analysis. The pooled results found moderate- to very low-quality evidence that deep cervical muscle exercise protocols are not superior to other types of active exercises in reducing the intensity of pain in people with NSNP. Studies not included in the meta-analysis suggest that specific exercises induce better effects that are superior to those of nontreatment with clinically relevant results. Conclusion Clinicians can share this information with their patients through shared decision-making to determine a more tailored approach to adopt. Future studies with high methodological quality are necessary to reach firm conclusions. Impact There has been no consensus on exercise type and dosage for the management of NSNP. This study shows that exercises are a useful tool and that the effect of an exercise program that recruits deep cervical muscles seems to be comparable with the effect of other types of active exercises on pain intensity reduction. Lay summary If you have neck pain, exercises designed by a physical therapist can be a useful treatment tool. An exercise program that targets specific deep cervical muscles may be just as good as other types of active exercises to reduce the intensity of pain intensity; you and your therapist can work together to develop a program.

BACKGROUND: Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a lack of normative data about how hypersensitive a TrP is. Therefore, the objective was to quantify the PPT for myofascial TrP in the upper trapezius muscle and its modification after manual or instrumental physical therapy interventions.METHODS: A systematic review and meta-analysis were conducted among three databases (MEDLINE, Cochrane Library, and PEDro). Two independent reviewers conducted the electronic search and assessed the methodological quality of the included studies.RESULTS: Eleven studies with a high-risk bias indicated that the PPT at TrP sites was 105.11 kPa lower (95% CI: -148.93; -61.28) at active TrP sites (Chi-squared = 1.07, df = 1 (p = 0.30), I2 = 7%) compared to the PPT of the upper trapezius muscles of healthy subjects. In addition, the PPT of TrP was also lower than the reference values coming from the pain-free population. Moreover, the PPT increased after both manual and instrumental treatment by 28.36 kPa (95% CI: 10.75; 45.96) and 75.49 kPa (95% CI: 18.02; 132.95), respectively.CONCLUSIONS: The results of the present study show that TrP has a decreased PPT when compared to healthy muscles and that physical therapy may increase the PPT. However, the clinical relevance of this decreased PPT needs to be further elucidated. Further, the high risk of bias in all the retrieved studies undermines the validity of the results.

Recent studies suggest that transitory blood flow restriction (BFR) may improve the outcomes of training from anatomical (hypertrophy) and neural control perspectives. Whilst the chronic consequences of BFR on local metabolism and tissue adaptation have been extensively investigated, its acute effects on motor control are not yet fully understood. In this study, we compared the neuromechanical effects of continuous BFR against non-restricted circulation (atmospheric pressure—AP), during isometric elbow flexions. BFR was achieved applying external pressure either between systolic and diastolic (lower pressure—LP) or 1.3 times the systolic pressure (higher pressure—HP). Three levels of torque (15, 30, and 50% of the maximal voluntary contraction—MVC) were combined with the three levels of pressure for a total of 9 (randomized) test cases. Each condition was repeated 3 times. The protocol was administered to 12 healthy young adults. Neuromechanical measurements (torque and high-density electromyography—HDEMG) and reported discomfort were used to investigate the response of the central nervous system to BFR. The investigated variables were: root mean square (RMS), and area under the curve in the frequency domain—for the torque, and average RMS, median frequency and average muscle fibres conduction velocity—for the EMG. The discomfort caused by BFR was exacerbated by the level of torque and accumulated over time. The torque RMS value did not change across conditions and repetitions. Its spectral content, however, revealed a decrease in power at the tremor band (alpha-band, 5–15 Hz) which was enhanced by the level of pressure and the repetition number. The EMG amplitude showed no differences whilst the median frequency and the conduction velocity decreased over time and across trials, but only for the highest levels of torque and pressure. Taken together, our results show strong yet transitory effects of BFR that are compatible with a motor neuron pool inhibition caused by increased activity of type III and IV afferences, and a decreased activity of spindle afferents. We speculate that a compensation of the central drive may be necessary to maintain the mechanical output unchanged, despite disturbances in the afferent volley to the motor neuron pool.

Recent studies found that fibromyalgia may underly neuropathic conditions affecting the peripheral nervous system. Moreover, clinical observations and preliminary reports suggest the existence of body perceptions distortions (BPD) like "phantom" feelings of swollen hands and feet, similar to those complained by patients with other neuropathic conditions or subjected to experimental procedures affecting the peripheral nervous system.To investigate the prevalence of self-reported BPD in Italian people with fibromyalgia through an online survey administered with the help of the associations of patients distributed nationwide.cross-sectional study.A nationwide sample of 854 patients out of 1173 subjects enrolled was analyzed after the exclusion of comorbidities and incomplete answers. We additionally performed a post-hoc analysis comparing data of patients who entirely fulfilled the Fibromyalgia Research Criteria (FRC) (2011) for epidemiological studies with respect to those only partially responding to the FRC (FM-).Nearly 90% of subjects reported neuropathic pain, symptoms potentially indicative for small-fiber pathology, and at least 1 BPD, while 2 or more BPD was reported in 64.1% of cases. Phantom feelings of "heaviness", "constriction", and "swelling" were the most frequently self-reported perceptual distortions. BPD were significant correlated with symptoms potentially indicative for small-fiber pathology, neuropathic pain, disability, painful sites, and severity of fibromyalgia (0.20τ-b0.33).Our preliminary findings highlighted that the phenomenon of self-reported BPD in patients with fibromyalgia correlated with neuropathic symptoms. If these results will be confirmed in future studies BPD may be potentially considered as part of the clinical picture of fibromyalgia.

Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

Background The sit-to-stand (STS) test is usually included in the clinical assessment of balance and its instrumented analysis may support clinicians in objectively assessing the risk of falling. The aim of the present study was to assess if kinetic parameters of STS collected using a force platform, with particular focus on the raising and stabilization phase, could discriminate between young and older adults. Methods Twenty-four adults (age ranging from 18 to 65 years old) and 28 elderly adults (older than 65 years old) performed STS on a force platform. Data on ground reaction forces, sway, displacement and velocity of the center of pressure were gathered during the raising and the stabilization phases. Results elderly subjects showed significant greater global sway (146.97 vs 119.85; p p p p Conclusions The analysis of STS performed on a force platform provides further information about the age-specific pattern of STS execution. The stabilization phase of STS seems to be the more challenging for functional independent older adults and should be considered during balance assessment. Further studies are needed to confirm findings and improve generalizability of this study.

It is well established that muscle percussion may lead to the excitation of muscle fibres. It is still debated, however, whether the excitation arises directly at the percussion site or reflexively, at the end plates. Here we sampled surface electromyograms (EMGs) from multiple locations along human vastus medialis fibres to address this issue. In five healthy subjects, contractions were elicited by percussing the distal fibre endings at different intensities (5–50 N), and the patellar tendon. EMGs were detected with two 32-electrode arrays, positioned longitudinally and transversally to the percussed fibres, to detect the origin and the propagation of action potentials and their spatial distribution across vastus medialis. During muscle percussion, compound action potentials were first observed at the electrode closest to the tapping site with latency smaller than 5 ms, and spatial extension confined to the percussed strip. Conversely, during tendon tap (and voluntary contractions), action potentials were first detected by electrodes closest to end plates and at a greater latency (mean ± s.d., 28.2 ± 1.7 ms, p

Objective The aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features. Design A cross-sectional online survey. Setting National. Main outcome measures A 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions). Participants 1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey. Results 791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient's strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient's anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a "medium" education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%). Conclusion OMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs.

Myofascial trigger points (TP) constitute a conundrum in research and clinical practice as their etiopathogenesis is debated. Several studies investigating one or few muscles have shown that both active and latent TP causes an increased muscle activity, however the influence of TP on modular motor control during a reaching task is still unclear. Electromyographic signals, recorded from the muscles of the shoulder girdle and upper arm during a reaching task, were decomposed with Non-Negative Matrix Factorization algorithm. The extracted matrices of motor modules and activation signals were used to label the muscles condition as dominant or non-dominant. The presence of latent and active TP was detected in each muscle with manual examination. Despite a similar muscle activity was observed, we found that muscles with active TP had increased weighting coefficients when labeled in the dominant condition. No influences were found when muscles were in the non-dominant condition. These findings suggest that TP altered the motor control without co-contraction patterns. As a preliminary evidence, the present results suggest that the increased weighting coefficients in presence of TPs are associated with an alteration of the modular motor control without affecting the dimensionality of motor modules for each individual and reciprocal inhibition.

Introduction The physiotherapy approach to musculoskeletal pain is currently pointing more towards a hands-off management of patients by education and exercise therapy. However, hands-on techniques still represent a core element of musculoskeletal physiotherapy practice appreciated by patients and widely taught in educational program and clinical professional development training. Purpose This professional issue explain why hands-on techniques may be considered a specific form of touch and outlines the importance of having a deep and wider understanding of their action mechanisms. Three aspects of the human touch, namely analgesic, affective and somatoperceptual are considered in light of the current literature. Implications The view of hands-on techniques as a specific form of human touch implies a change of perspective. Primarily, manual therapy techniques are based on the physical properties of the delivered stimulus (requiring knowledge of anatomy, biomechanics and neurophysiology) as well as on the emotional properties that emerge from the sympathetic contact established with the patient. Secondarily, the manual therapists should develop relationship and communicative skills allowing this kind of touch to emerge. Thirdly, accordingly with this new perspective, the study of the multifaceted mechanisms of action of hands-on techniques requires a multidisciplinary team of researchers including specialists apparently far from the clinical field. Finally, the recognition of the therapeutic value of touch as one of the most qualifying professional acts of physiotherapists is needed and guarantees patients of its best evidence-based delivering.

Objective Recent studies have highlighted that about 50% of fibromyalgic patients has a neuropathy of small- and/or large-fibers which could partially explain the puzzling symptoms of fibromyalgia (FM). Our aim was to investigate the estimated prevalence of self-reported neuropathic pain and small-fiber neuropathic symptoms (SFNS) indicative for the presence of small-fiber pathology in FM patients. Methods A nationwide sample of patients was recruited to participate in an on-line survey. Two groups of patients were considered in post-hoc analysis: those positive (FM+) to the Fibromyalgia Research Criteria (FRC) and those complaining typical symptoms of fibromyalgia without fulfilling the FRC (FM−). Results We collected data from 854 patients (749 FM+ and 105 FM−). Patients that scored = 50/100 at the Neuropathic Pain Symptoms Inventory (NPSI), indicating severe neuropathic pain, were 57.3% (62.4% in FM+ and 21.0% in FM−). Around 46% of patients presented three or more SFNS that could be suggestive of small fiber pathology, the most frequent being dry eyes/mouth, allodynia, and dyshidrosis. The NPSI score showed significant moderate/strong associations with disability (Spearman's rho = 0.61), pain (rho = 0.66), stiffness level (rho = 0.46), number of painful sites (rho = 0.40), and SFNS (rho = 0.44). Despite the high prevalence of neuropathic pain and other symptoms attributable to potential small and/or large fibers pathology, neurophysiologic investigations were performed in 43.6% of cases and skin punch biopsy only in 1.9% of patients enrolled, as well as the assumption of anti-neuropathic pain drugs (13.2%). Conclusions Our findings underscore the high estimated prevalence of neuropathic pain and SFNS in FM patients.

Background:Fibromyalgia (FM) is the second most frequent disorder in rheumatic patients. Other than widespread pain, fatigue, sleep disturbance and cognitive impairments, patients complain also symptoms of suspected neuropathic origin, like burning pain, thermal sensitive skin, hyperalgesia, pins and needles sensations. Recent studies highlighted the presence of small- fibers pathology (SFP) and/or large-nerve fibers involvement in about 50% of FM patients, which could be the cause of neuropathic pain.Objectives:The aim of the study was to investigate the prevalence of neuropathic pain and symptoms indicative for the presence of SFP in Italian FM patients, studying the association with clinical variables.Methods:An on-line survey was designed according to the Checklist for Reporting Results of Internet E-Surveys guidelines (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The on-line Survey Monkey® platform was adopted to collect data. We calculated a-priori minimum number of 800 responders.We administered the survey by involving 7 FM patients’ associations distributed nationwide between July and September 2019. We explored demographic and clinical variables including pain and stiffness intensity, symptoms duration, and counting of painful sites. Neuropathic Pain Symptoms Inventory (NPSI) and Fibromyalgia Impact Questionnaire (FIQ) were administered. To study the presence of symptoms indicative of potential SFP we asked for the presence of 8 signs and symptoms reported in literature as characteristics of SFPs. Two groups of FM patients were considered: those positive (FM+) to the Fibromyalgia Research Criteria (FRC) (Wolfe et al., 2011), and those complaining typical FM symptoms but not fulfilling the FRC (FM-).Results:The survey was correctly completed by 76% of participants (892/1173). A total sample of 854 patients (749 in FM+ and 105 in FM-) was analyzed after the exclusion of subjects with major comorbidities. The mean NPSI score was significantly higher in FM+ (56.3/100) respect to FM- (34.2/100). NPSI score was ≥50/100 in 62.4% of FM+ patients and in 21.0% of FM-. More than 3 symptoms indicative for SFP were found in 51% of FM+ patients and in 15.2% of FM-. Dry eyes/mouth, allodynia and changed pattern of sweating on body were the 3 most frequently reported symptoms. We found statistically significant strong associations (prho=0.53) and pain (rho=0.63), and a moderate correlation with stiffness levels (rho=0.45) and counting of painful sites (rho=0.33). Symptoms indicative for SFP were significantly correlated (prhoConclusion:This findings highlight the importance of neuropathic pain symptoms identification, since we found a high prevalence and a strong correlation with clinical variables in our cohort of FM patients. The assessment of the neuropathic dimension of pain through self-administered questionnaire should be part of the routine clinical practice.References:[1]Wolfe, F., et al., 2011. Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. The Journal of Rheumatology 38, 1113–1122.Disclosure of Interests: :Antonello Viceconti: None declared, Tommaso Geri: None declared, Simone De Luca: None declared, Filippo Maselli: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Marco Testa: None declared, Giacomo Rossettini: None declared

Contextual Factors (CFs) have been documented to influence nursing interventions and patients' outcomes triggering placebo/nocebo effects. However, given that no studies to date have explored the beliefs and the use of CFs among nursing students, a cross-sectional study was undertaken. Two Italian nursing programmes were involved and a self-administered survey tool was used. A total of 510 students participated. The majority (266; 52.2%) defined CFs as an intervention without a specific effect on the condition being treated, but with a possible nonspecific effect. They reported a substantial level of confidence in CFs and in using them more than twice/week in addition to nursing interventions to optimise clinical outcomes. Physiological and psychological therapeutic effects were mostly reported by participants in treating insomnia (n = 351; 68.8%) and chronic pain (n = 310; 60.8%). The use of CF was considered ethically acceptable when it exerted beneficial psychological effects (n = 188; 36.8%). Participants communicated to patients that a CF is a treatment that can help and will not hurt (n = 128; 25.1%). Students are aware of the value of CFs. Increasing their emphasis in nursing programmes can promote nursing students’ consideration with regards to their use, their underlying mechanisms, their potential effects, as well as their ethical and comunicative implications.

Background A variety of interventions has been proposed for symptomatology relief in primary headaches. Among these, manual trigger points (TrPs) treatment gains popularity, but its effects have not been investigated yet. Objective The aim was to establish the effectiveness of manual TrP compared to minimal active or no active interventions in terms of frequency, intensity, and duration of attacks in adult people with primary headaches. Methods We searched MEDLINE, COCHRANE, Web Of Science, and PEDro databases up to November 2017 for randomized controlled trials (RCTs). Two independent reviewers appraised the risk-of-bias (RoB) and the grading of recommendations, assessment, development, and evaluation (GRADE) to evaluate the overall quality of evidence. Results Seven RCTs that compared manual treatment vs minimal active intervention were included: 5 focused on tension-type headache (TTH) and 2 on Migraine (MH); 3 out of 7 RCTs had high RoB. Combined TTH and MH results show statistically significant reduction for all outcomes after treatment compared to controls, but the level of evidence was very low. Subgroup analysis showed a statistically significant reduction in attack frequency (no. of attacks per month) after treatment in TTH (MD -3.50; 95% CI from -4.91 to -2.09; 4 RCTs) and in MH (MD -1.92; 95% CI from -3.03 to -0.80; 2 RCTs). Pain intensity (0-100 scale) was reduced in TTH (MD -12.83; 95% CI from -19.49 to -6.17; 4 RCTs) and in MH (MD -13.60; 95% CI from -19.54 to -7.66; 2RCTs). Duration of attacks (hours) was reduced in TTH (MD -0.51; 95% CI from -0.97 to -0.04; 2 RCTs) and in MH (MD -10.68; 95% CI from -14.41 to -6.95; 1 RCT). Conclusion Manual TrPs treatment of head and neck muscles may reduce frequency, intensity, and duration of attacks in TTH and MH, but the quality of evidence according to GRADE approach was very low for the presence of few studies, high RoB, and imprecision of results.

Background Context effects are well known and were described as integral part of the clinical setting (1). The conscious use of contextual factors (CF) has been recently proposed as an effective modality capable to influence the physiotherapy outcome by facilitation of placebo responses. (2) To date, the knowledge about CF adoption in clinical practice of physical therapists is absent. Objectives The aim of this study was to investigate frequency of use, beliefs and attitudes about contextual factors among Italian physical therapists specialized in manual therapy (OMTs) Methods An invitation to participate in an online survey was sent to 906 OMTs through the database of the Master in Musculoskeletal Rehabilitation (MRDM) of University of Genova by SurveyMonkey Software®. These likely correspond to more than 85% of the whole OMTs population in Italy. A 17 items questionnaire and two clinical scenarios assessed behaviour, beliefs and attitudes of OMTs about CF adoption in clinical practice and data were analysed by descriptive statistic. Results 906 OMTs were invited to participate in the survey and 558 responded (62%). The majority of OMTs uses CF in their practice frequently (52%). They believe that an actual effect of CF can occur in acute pain (57%), chronic pain (78%) and rheumatologic disorders (56%). OMTs consider the use of CF ethically acceptable when it exerts beneficial psychological effects and their effectiveness was shown during clinical experience (31%). They disagree on the adoption of CF when they are based on deception, undermine the trust between OMT and patients, create legal problems or produce side effects (17%). 38% of respondents do not communicate the use of CF to their patients and they adopt CF as addition to other physical therapy interventions with the aim of optimizing clinical responses (20%). Expectation and psychological mechanisms are believed to be the main aspects behind placebo and nocebo effects induced by CF (7%). Conclusions The use of CF is quite common among Italian OMTs and they mostly had positive attitudes towards their use and effectiveness. References Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001 Mar 10;357(9258):757–62. Testa M, Rossettini G. Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther. 2016;24:65–74. Disclosure of Interest None declared

Background Placebo and nocebo represent psycho-neuro-immuno-endocrinological responses commonly encountered in nursing care (1,2). A new paradigm proposed the contextual factors (CF) as mediators and moderators of these responses (3). To date, the knowledge about the awareness of CF and their use in nursing is scant. Objectives The goal of this study was to examine frequency of use, beliefs and attitudes of Italian specialised nurses regarding the contextual factors. Methods In December 2016, through SurveyMonkey Software®, an online survey was conducted by sending a questionnaire to the members of four Italian Nursing Association, grouping nurses specialized in Neuroscience, Medical, Geriatric and Diabetic care. Behaviours, beliefs and attitudes of nurses about the implementation of CF in clinical practice were assessed by a 17 items questionnaire and resulting data were analysed by descriptive statistic. Results Of the 1411 members of the involved Nursing Associations invited to participate to the survey 425 responded (30.1%). An high number of respondent nurses adopts CF often in their practice (42%). They believe that CF can positively influence acute pain (47.5%), chronic pain (61%) and rheumatologic disorders (42%). 34% of responders consider the use of CF, if it can determine beneficial psychological effects, as ethically accep table. 15.5% responders oppose to the adoption of CF when based on deception or if they undermines trust between nurses and patients. A relevant number of nurses (24%) do not communicate the use of CF to their patients and 19% implement CF as addition to other nursing interventions to optimize clinical responses. Nurses explain the power of CF through patient9s expectation and psychological mechanism (11%). Conclusions The Italian specialised nurses use CF quite frequently and believe that their use has the capacity of positively influencing the clinical outcome. Larger surveys are needed to understand the proportion of use of CF by nurses in common clinical practice in Italy. References Miller LR, Miller FG. Understanding placebo effects: Implications for nursing practice. Nurs Outlook. 2015 Sep-Oct;63(5):601–6. Hauser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012 Jun;109(26):459–65. Palese A, Rossettini G, Testa M. Placebo and nocebo responses in nursing practice: a discussion paper on the role of contextual factors. In revision at Nurs Inq. Disclosure of Interest None declared

Aim: To assess whether patients with persistent neck pain display evidence of altered masticatory muscle behavior during a jaw-clenching task, despite the absence of orofacial pain or temporomandibular disorders. Methods: Ten subjects with persistent, nonspecific neck pain and 10 age- and sex-matched healthy controls participated. Maximal voluntary contractions (MVCs) of unilateral jaw clenching followed by 5-second submaximal contractions at 10%, 30%, 50%, and 70% MVC were recorded by two flexible force transducers positioned between the first molar teeth. Task performance was quantified by mean distance and offset error from the reference target force as error indices, and standard deviation of force was used as an index of force steadiness. Electromyographic (EMG) activity was recorded bilaterally from the masseter muscle with 13 X 5 grids of electrodes and from the anterior temporalis with bipolar electrodes. Normalized EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution, and the average normalized RMS was determined for the bipolar acquisition. Between-group differences were analyzed with the Kruskal Wallis analysis of variance. Results: Task performance was similar in patients and controls. However, patients displayed greater masseter EMG activity bilaterally at higher force levels (P < .05). Conclusion: This study has provided novel evidence of altered motor control of the jaw in people with neck pain despite the absence of orofacial pain or temporomandibular disorders.

Background The muscle impairment in Temporomandibular disorders (TMDs)1, frequently observed in patients with different rheumatic diseases, contribute to diminished recruitment and force tuning ability. The quantitative assessment of the motor function is capital in the diagnosis and rehabilitation of TMDs. In this study, we propose an intuitive visual feedback of the bite force that promote the coordination and control of jaw muscles. Objectives Validity and reliability evaluation of a visual feedback system for masticatory muscle assessment Methods The force signals, measured by two customized force transducers positioned between the first molars teeth, became the spatial coordinates of a cursor which moved on a PC monitor according to the subject9s bite force on the right (axis x) and left sensors (axis y). The subject9s force during a maximal monolateral left (Lx, Ly), monolateral right (Rx, Ry) and bilateral (BILx, BILy) clenching outlined the boundaries of the Working Area (WA) (Figure 1). During a trial, the task required was to match the position of the 23 targets randomly displayed within the WA, each target being displayed for 5 s and alternated with 5 s of rest. Each subject performed two sessions of three trials in two consecutive days. Matching errors were measured by Mean Distance (MD), calculated as the mean cursor-target distance, and Offset Error (OE), calculated as the distance between the mean cursor position and the target. For the reliability analysis of MD and OE, we considered the Intraclass Correlation Coefficient (ICC), the Standard Error of Measurement (SEM), and the Limits of Agreement (LOA). The validity of both indices was investigated with a linear regression analysis. A 2-way repeated measures ANOVA with SESSION (2 levels) and TRIAL (3 levels) as factors was done to control for any learning effect. Results The 13 subjects included showed a wide range of WAs, geometrically representing functional aspects like maximal force, and left/right independence in force generation. MD showed a more acceptable reliability (ICC =0.78, 95%CI 0.43-0.93;SEM =26%;LOA = -29%, 23%) instead of OE (ICC=0.66, 95%CI 0.20–0.88; SEM=37%; LOA = -31%, 42%). The correlation between MD and OE was high (r=0.96, p Conclusions This visual feedback system provided a valid and reliable representation of the mandibular motor function to be extended in the evaluation of patients suffering from rheumatic diseases. The use of error indices (MD, OE) may characterize the individual performance during force control tasks of jaw elevator muscles in health and disease. This technique may also provide specific rehabilitation programs for TMDs because the subject9s improvement during the second session was most likely attributable to a learning effect. References Manfredini D, Guarda-Nardini L, Winocur E, et al., Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:453. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2332