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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

Introduction. Intramuscular hemorrhages are the second most common type of bleeding in patients with haemophilia. In haemophilic patients, muscle bleeding causes pain and postural defects and requires a long healing time. Aim. The purpose of this study is to evaluate the effectiveness of kinesiotaping, in combination with functional rehabilitation and CO2 laser therapy, in the healing process of MH in patients with haemophilia. Methods. We recruited 39 haemophilia patients who presented with a muscle hematoma. The patients were divided into 2 groups: treatment group treated with kinesiotaping, functional re-education and CO2 laser therapy, and a control group treated with functional re-education and CO2 laser therapy. The evolution of the hematoma was studied ultrasonographically and some evaluation scales (NRS, FISH) were administered. Results. The treatment group, compared to the control group, showed significant improvements in terms of: hematoma diameter (2.36 ± 3.32 vs 6.47 ± 3.37; p < 0.05), hematoma thickness (0.08 ± 0.12 vs 0.28 ± 0.14; p = 0.08), pain (NRS: 2 ± 1.57 vs 3.53 ± 1.37; p < 0.05) and number of days of replacement therapy (n days: 1.3 ± 0.48 vs 3.2 ± 0.98; p < 0.05). These results were shown to be superior in patients on prophylaxis. Conclusions. Kinesiotaping, associated with therapeutic exercise and physical therapy, can be a valuable aid in reducing the healing times of muscle hematomas in haemophilic patients, especially if already under prophylaxis.

Background: Despite recent improvements in survival due to advances in treatment, the quality of life of patients with lymphoma may be compromised by the long-term complications of chemotherapy and steroid therapy. Among these, a potentially relevant problem is bone loss and the development of fragility fractures.Aim: To provide further evidence of clinical or subclinical skeletal complications in correlation with biological variables and markers of bone disease in patients with complete response to therapy.Method: A cross-sectional observational study was conducted on subjects diagnosed with lymphoma with subsequent antineoplastic treatment, disease status after therapy defined as complete response disease for at least a year now. We performed: blood chemistry tests, imaging techniques (DEXA) and screening tools for the assessment of functional status and quality of life (SARC-F and mini-OQLQ).Results: Approximately 50% of the patients had osteoporosis. We found hypovitaminosis D and high PTH levels in most of the patients. We also found a high prevalence of vertebral fractures in 65.5% of cases. In the majority of patients, we found hypovitaminosis D and high levels of PTH. Furthermore, a statistically significant association between high PTH levels and previous lymphoma treatment. Finally, the Mini Osteoporosis Quality of Life questionnaire demonstrated a loss of quality of life as a consequence of the change in bone status.Conclusions: Patient treatment design for personalized chemotherapy would be desirable to reduce late effects on bone. Also, early prevention programs need to be applied before starting treatment. The most benefited subpopulations could be not only elderly but also young patients.

Background: Local treatments such as ultraviolet-A (UVA) phototherapy, topical calcitriol, injection of autologous fat grafting, Platelet-Rich Plasma (PRP), hyaluronic acid (HA) and local ultrasound (US) treatment are considered alternative approaches for skin involvement in Systemic sclerosis (SSc). The aim of our study was to evaluate the efficacy of PRP injection and lipofilling or local ultrasound in the treatment of SSc-related digital ulcers (DUs). Methods: We enrolled 28 patients with SSc. At baseline time (T0), all patients were treated with Iloprost intravenous infusions. Then, twelve patients (group 1) received a first inoculation of PRP, after 15 days a second inoculation of PRP and after 15 days a third of lipofilling. Six patients continued only the Iloprost therapy (controls). Ten patients (group 2) underwent medical sessions with ultrasound treatment for 10 days. Clinical evaluation was assessed at baseline, after 3 and 12 months of treatment for all patients. Results: In our study have shown an improvement in cutaneous and microvascular level, in quality of life, in mobility of extremities of upper limbs and a reduction of administration of Iloprost after PRP-Lipofilling or US treatment. Conclusions: Our findings suggest that PRP coupled with lipofilling or ultrasound treatment in SSc patients, can be considered additional procedures in the management of DUs.

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.

OBJECTIVE: To provide informa- tion on the clinical presentation of sciatic neu- ropathy and its management in a real-world set- ting, and to analyze the effects of a multimodal approach based on the association of physical and pharmacological therapy. PATIENTS AND METHODS: A multicentric ob- servational prospective study was conducted in 44 Italian tertiary centers specialized in Physical Medicine and Rehabilitation, Orthopedics, Neu- rology, Neurosurgery, and Rheumatology. To de- velop a shared management of LPB with sciat- ica, a dedicated clinical record was proposed to collect data about diagnosis, treatment, and outcomes. Pain, disability, and quality of life were recorded trough validated questionnaires at baseline and after a two-month follow-up. RESULTS: 394 patients (age, mean ± SD 55.7 ± 14.1 years, 57.1% females) with chronic LBP and sciatica were enrolled in the study. The charac- teristics of the selected group showed a certain variability in the clinical presentation. At base- line, patients received several different thera- peutic options among physical, pharmacolog- ical and neurotrophic treatments. A subgroup of 312 patients was treated with a combination of neurotrophic agents containing alpha-lipoic acid (ALA). After a two-month follow-up, a gen- eral improvement in both perceived pain and functional disabilities was observed. A signi - cant improvement (p < 0.001) in the Pain Numer- ic Rating Scale (NRS), Roland e Morris Disability Questionnaire (RMDQ) and Brief Pain Inventory (BPI) Italian short version was observed. CONCLUSIONS: Sciatic neuropathy is a multi- faceted condition managed by means of a wide spectrum of therapeutic options. The results of this study suggest that a multimodal approach based on the association of ALA with physical and pharmacological therapies can be bene - cial in the treatment of LBP with sciatica.

OBJECTIVES:It is accepted that the optimal management of patients with fibromyalgia (FM) requires a combination of non-pharmacological and pharmacological interventions. Our study aimed to analyse the effects of a supplemented physical program on the quality of life of FM patients.METHODS:We enrolled 60 patients, all female (mean age 49±5.7 years), with primary FM (mean years of disease 33±12 months). Patients who agreed to participate in this study met the proposed 1990 American College of Rheumatology classification criteria and the 2010 American College of Rheumatology preliminary diagnostic criteria and were recruited at Policlinico P. Giaccone, University Hospital of Palermo, Italy. Thirty patients undertook a physical program consisting by group exercises, laser and TENS treatment (Combi-group). The remaining 30 FM patients (Exonly-group) practiced only group exercise (Control group). Ten patients with mechanical pain were considered as unrelated control group disease. Fatigue, sleep dysfunction and pain were reported and evaluated before and after the treatment for each patient. Particularly, the Fibromyalgia Impact Questionnaire (FIQ), SF36 Questionnaire (SF36) and Visual analogic scale for pain and fatigue (VAS pain and fatigue) were administered at baseline (T0) and at the end of the treatment (T1) (after 40 rehabilitation sessions over 20-week).RESULTS:The combined treatment significantly improved the perception of pain and fatigue and the overall quality of life. In detail, the Combi-group experienced a statistically significant improvement in FIQ but not in the SF36 after the treatment. CONCLUSIONS:According to our results, an intense physical rehabilitation program could be considered a promising essential step in the management of FM patients.

La Cervicoartrosi è un’artropatia di tipo evolutivo la cui base anatomica è rappresentata da un processo degenerativo con inizio nelle cartilagini articolari che vanno incontro a fenomeni di usura, proliferazioni marginali, eburneizzazione dei capi ossei. L’incidenza tende ad essere in costante aumento per l’allungamento della vita media, interessando maggiormente il sesso femminile con un rapporto di 3:1. L’artrosi cervicale clinicamente si manifesta con dolore in regione cervico- dorsale, contrattura dei muscoli paravertebrali, limitazione del ROM fino a possibili manifestazioni neurologiche. Si può inoltre giungere ad una insufficienza vasomotoria di tipo funzionale, dipendente dalla postura e dai movimenti del rachide. Ne conseguiranno nevralgie, vertigini, nausea e talvolta vomito. Scopo dello studio individuare seguendo i principi della EBM le terapie più valide per contrastare i sintomi tipici della malattia correlando sesso, età e principali comorbilità.

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.

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Scopo della review è quello di affermare che le vibrazioni rappresentano uncampo nuovo e da esplorare.Esse potrebbero essere una via alternativa nei soggetti anziani ed osteoporotici, essendo un esercizio dolce, sicuro, e facile da apprendere. Tuttatvia non sono stati ancora deliniati nè protocolli efficaci ed univoci nè il più valido range di ampiezza e frequenza vibratoria che può essere applicata in manoera sicura elicitando una significativa risposta di sintonizzazione. Riteniamo che è importante valutare attentamente i possibili effetti e le reazioni avverse all'esposizione a lungo termine alle vibrazioni su giovani e adulti sani prima di sottoporli a soggetti anziani e osteoporotici.

La struttura del complesso anatomico della spalla è caratterizzata da un'ampia escursione articolare. LA nostra esperienza si è basata su uno studio preliminare di 21 pazienti; tutti prsentavano una stadiaizone di patologia di grado lieve/ moderata. Dall'analisi dei dati si evince come il trattamento combinato farmacologico/ riabilitativo possa fornire risultati migliori rispetto al solo trattamento farmacologico.

L'artrosi rappresenta la causa più frequente di disabilità nell'anziano interessando ginocchio, mano e anca. L'approccio col paziente si basa sull'educazione ad un corretto stile di vita e sull'impostazione di un programma riabilitativo.

L'importanza dell'esercizio terapeutico nel trattamento integrato dell'osteoporosi vertebrale deriva dal fatto che produce sul tessuto osseo effetti metabolici positivi. Scopo del rpogramma chinesiterapico è di ottenere un buon tonotrofismo dei musocli deficitari e rilassare quelli che per compenso sono in uno stato di contrattura permanente e quindi dolorosa. Il compito del fisiatra deve indirizzarsi verso l'istruzione e l'adattamento della vita personale e di relazione del soggetto osteoporotico.

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

Gli autori descrivono il trattamento riabilitaivo nella ricostruzione del L.C.A. dalla II alla III settimana dopo l'intervento, allorquando inizia la concessione del carico. Sottolineano l'importanza del trattamento propriocettivo per far acquistare al paziente la sensazione di stabilità del ginocchio operato. Rilevano che, agli effetti di un reiserimento ottimale nell'attività agonistica, il riallineamento allo sforzo ed agli stress risulta di rilevante significato. Infine sottolineano il valore degli aspetti psicologici di riabilitazione che non trascurano anche la personalità e le motivazioni del paziente.

Gli autori considerano la ricostruzione del L.C.A. per formulare un razionale di riabilitazione post- chirurgica che, nel rispetto delle leggi della biologia per l'attecchimneto del neolegamento, acceleri il recupero funzionale del paziente.Sottolinenano l'importanza di iniziare il porgramma riabilitativo sin dal gioro dopo l'intervento per poi proseguire rispettando le fasi ed i tempi per una corretta esecuzione dell'esercizio terapeutico.Definiscono le sequele terapeutiche ed indicano le tecniche di più frequente impiego.

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.

Patients with vertebral fragility fractures often experience chronic pain, postural and balance disorders, and poor quality of life (QoL). Although several studies have investigated the role of rehabilitation in severe osteoporosis, the effectiveness of this intervention in patients with multiple vertebral fractures is poorly known. The aim of our longitudinal cohort study is to evaluate the effectiveness of rehabilitation, including postural training, resistance exercises, and visual stabilization exercises, for a 7-week period, on the pain, postural balance, and QoL of subjects with at least two vertebral fragility fractures receiving denosumab and vitamin D. We investigated, before (T0) and after (T1, at 7 weeks) rehabilitation, the following outcome measures on 28 patients: pain (Numerical Rating Scale (NRS)), self-perceived QoL (36-Item Short Form Survey (SF-36) and Mini-Osteoporosis Quality of Life Questionnaire (Mini-OQOL)), dizziness (Dizziness Handicap Inventory (DHI-I)), mobility (Timed-Up and Go (TUG) test), and instrumental posturographic assessment (FreeMed posturography system). At the end of the treatment, improvements of pain and QoL were recorded. Pain relief was highly obtained in patients with more than two vertebral fractures. Moreover, a significant functional improvement (TUG test) was found in those with two vertebral fractures, without any statistically significant change reported for other outcomes. Our findings suggest that combined intervention, including anti-osteoporotic drugs and postural rehabilitation, should be proposed to osteoporotic patients with multiple vertebral fractures.

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.

The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

Le ortesi sono dispositivi finalizzati al recupero di una funzione corporea in quanto migliorano la biomeccanica, la funzionalità e la performance. Distinguiamo Corsetti dinamici, semirigidi e rigidi. Importante sottolineare che l'uso dei corsetti deve essere limitato soltanto nella fase acuta.

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.

L'osteoporosi è un disordine scheletrico cronico-evolutivo, caratferizzato dalla perdita dell'equilibrio del metabolismo osseo con conseguente degenerazione quantitativa e qualitativa che compromette la resistenza dell'osso e predispone ad un aumentato rischio di fratture. Colpisce soprattutto il sesso femminile,conunaprevalenza del33%nelrange tra60eT0aacheaumentaconl'avanzaredell'età. Può rimanere clinicamente silente e successivamente manifestarsi con fratture (vertebrali 100.000 casi/anno, di polso 85.000 casi/anno e femorali 80.000 casi/anno). Le fratture da fragilità comportano gravi conse gseîze, sia a livello clinico individuale che sociale ed economico; rappresenrano pertanto una fonte di disabilità complessa, che in quanto tale necessita di una presa in carico globale. Lo studio RIFRA nasce da un'idea del GISMO per rispondere alla necessità primaria di quantificare il reale rischio fratturativo in Italia attraverso una specifica scheda e di valutare l'influenza delle comorbilità e delle terapie corelate al rischio di frattura. L'obiettivo secondario analizzare \a percentuale di pazienti sottoposti a trattamento farmacologico in relazione ai valori densitometrici e alle pregresse fratture, nonché valutare la prevalenza di fratture da fragilità nella popol azione in studio.