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13.05.2016 | Claude Müller, Monika Schäfer & Geri Thomann (Winterthur, Zürich)

Purpose: Several outcome measures are available to assess the severity of fatigue in people with multiple sclerosis (MS). The aim of this study was to adapt the Italian version of the Fatigue Impact Scale (FIS-40) and its modified versions: a 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5), and an 8-item version for daily use (DFIS-8) and investigate their measurement properties through classical theory-test (CTT) and Rasch analysis (RA)., Methods: 229 Italian-speaking adults with MS were included. Questionnaires were cross-culturally translated and subjected to CTT (i.e. internal consistency through Cronbach's alpha and unidimensionality through confirmatory factor analysis [CFA]) and RA. (i.e. internal construct validity, reliability, and targeting)., Results: Internal consistency was high for all scales (>0.850). Final CFAs reported issues in the unidimensionality for all scales except for FIS-40. Baseline RA revealed a misfit for all scales. After adjusting for local dependency, FIS-40, MFIS-21, and MFIS-5 fitted the Rasch model (RM). MFIS-21 and D-FIS-8 required a structural modification, i.e. item deletions to satisfy the RM., Conclusion: The FIS-40, MFIS-21, MFIS-5, and DFIS-8 achieved the fit to the RM after statistical and structural modifications. The fit to the RM allowed for providing ordinal-to-interval measurement conversion tables for all the questionnaires.

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), I 2 = 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.

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Background: 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., Objectives: 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., Design: cross-sectional study., Method: 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-)., Results: 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 (0.20<τ-b<0.33)., Conclusions: 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., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: 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). Design : A cross-sectional online survey was conducted in 2019, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Setting : Italy. Participants : One thousand two hundred and eighteen Italian OMPTs., Methods: 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., Results: 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 ( n  = 845; 69.4%; 95% CI 66.7-71.9) has indicated running not to be a relevant risk factor for the onset of LBP ( n  = 806; 66.2%; 95% CI 63.4-68.8). Moreover, most of the participants ( n  = 679; 55.7%; 95% CI 52.9-58.5) adopted a combination of manual therapy techniques and therapeutic exercise for the management of runners with LBP., Conclusions: 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.

Background: During COVID-19 pandemic, physiotherapy lecturers faced the challenge of rapidly shifting from face-to-face to online education. This retrospective case-control study aims to compare students' satisfaction and performances shown in an online course to a control group of students who underwent the same course delivered face-to-face in the previous five years., Methods: Between March and April 2020, a class (n = 46) of entry-level physiotherapy students (University of Verona - Italy), trained by an experienced physiotherapist, had 24-hours online lessons. Students exposed to the same course in the previous five academic years (n = 112), delivered with face-to-face conventional lessons, served as a historical control. The course was organized in 3 sequential phases: (1) PowerPoint presentations were uploaded to the University online platform, (2) asynchronous video recorded lectures were provided on the same platform, and (3) between online lectures, the lecturer and students could communicate through an email chat to promote understanding, dispel any doubts and collect requests for supplementary material (e.g., scientific articles, videos, webinars, podcasts). Outcomes were: (1) satisfaction as routinely measured by University with a national instrument and populated in a database; (2) performance as measured with an oral examination., Results: We compared satisfaction with the course, expressed on a 5-point Likert scale, resulting in no differences between online and face-to-face teaching (Kruskal-Wallis 2  = 0.24, df = 1, p = 0.62). We weighted up students' results by comparing their mean performances with the mean performances of the same course delivered face-to-face in the previous five years, founding a statistical significance in favour of online teaching (Wilcoxon rank sum test W = 1665, p < 0.001)., Conclusions: Online teaching in entry-level Physiotherapy seems to be a feasible option to face COVID-19 pandemic, as satisfies students as well as face-to-face courses and leading to a similar performance. Entry-level Bachelors in Physiotherapy may consider moving to eLearning to facilitate access to higher education. Universities will have to train lecturers to help them develop appropriate pedagogical skills, and supply suitable support in terms of economic, organizational, and technological issues, aimed at guaranteeing a high level of education to their students., Trial Registration: Retrospectively registered., (© 2021. The Author(s).)

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., (Copyright © 2021 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gizzi, Yavuz, Hillerkuss, Geri, Gneiting, Domeier, Schmitt and Röhrle.)

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., (Copyright © 2020 Rossettini, Geri, Palese, Marzaro, Mirandola, Colloca, Fiorio, Turolla, Manoni and Testa.)

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  < 0.05) and a higher velocity (vs 40.03 vs 34.35 mm/s; p  < 0.05) of execution of STS. Between-group comparisons highlighted a greater postural sway in the raising phase (21.63 vs 13.58; p  < 0.001) and a doubled sway during the stabilization phase (12.38 vs 4.98; p  < 0.001)., 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., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

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 < 0.001). No evidence of reflex responses to muscle tap was observed. Multi-electrode surface EMGs allowed for the first time to unequivocally and quantitatively describe the non-reflex nature of the response evoked by a muscle tap.