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Background: Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge. Aim: To evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care. Design: Randomized Controlled Trial (NCT03592420, clinicalTrials.gov). Setting: Outpatients in two Italian centers. Population: 403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke. Methods: After the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3). Results: 690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (& PLUSMN; 3.5) and 1.77 (& PLUSMN; 3.2) mean falls per subject, respectively. Subjects with & GE; 1 fall and & GE;2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations. Conclusions: The intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.

Le alterazioni biomeccaniche a carico del piede diabetico sono note da anni [1] ma non si è ancora trovato consenso relativamente ad un modello biomeccanico affidabile circa il carico esercitato sui vari segmenti del piede durante la deambulazione [2]. Lo scopo di questo studio è quello di valutare in modo integrato la cinematica articolare e le pressioni plantari durante la deambulazione per quantificare le modificazioni biomeccaniche e funzionali del piede diabetico. Sono stati valutati 140 soggetti con una metodologia integrata cinematica-pressioni plantari durante il cammino. La presente analisi è stata condotta su un campione di 30 piedi, equamente distribuito tra tre sottogruppi: diabetici di tipo I (T1), diabetici di tipo II (T2) e controlli (C). Come variabile cinematica è stata selezionata l'escursione articolare (RoM,) sul piano frontale dell'articolazione tibiotarsica, mentre si è scelto l'integrale pressione-tempo (PTI) come variabile dinamica relativa al carico dell'intero piede e delle 5 regioni di interesse. Rispetto ai controlli, T1 ha mostrato un significativo spostamento del carico dal mesopiede e dall'avampiede alle dita (T1: 19.2 ± 7.4, 104.3 ± 38.3, 47.0 ± 29.3; C: 24.1 ± 10.1, 118.9 ± 26.3, 34.1 ± 20.8) associato a una riduzione non statisticamente significativa del RoM. Rispetto a C, T2 ha mostrato cambiamenti significativi nel carico nell'avampiede e dita (T2: 150.4 ± 63.3, 28.4 ± 15.6) e una significativa riduzione del RoM. Inoltre, T2 si è differenziato significativamente da T1 per il carico inferiore al retropiede e alle dita e il carico superiore all'avampiede. I risultati evidenziano i cambiamenti biomeccanici che il tipo di diabete da solo, senza neuropatia o complicazioni di deformità, può comportare nel piede durante il cammino. [1] Van Netten JJ, et al, Diab Metab Res Rev 2016, 32(Suppl. 1): 84-98. [2] Bus SA, Diab Metab Res Rev 2012 28(Suppl 1): 54-59., Diabetic foot biomechanics alterations are well known [1] even though a consensus on the best biomechanical model of pressures developed in different foot segments during gait was not found yet [2]. The aim of this study was to quantify and identify biomechanical and functional alterations of diabetic foot with an integrated approach joints kinematic and plantar pressures during gait. 140 subject were included in the study and evaluated with an integrated pressure-kinematic model during normal gait.This analysis reported a sample of 30 feet equally distributed in three groups:tipe I diabetes (T1), tipe II diabetes (T2) and controls (C). Upper ankle Range of Motion (ROM) on the frontal plane was selected as kinematic variable to be studied while pressure-time integral (PTI) as dynamic variable of the entire foot and of the 5 selected foot regions. Comapred to controls, T1 showed a significant load shift from midfoot and forefoot to toes (T1: 19.2 ± 7.4, 104.3 ± 38.3, 47.0 ± 29.3; C: 24.1 ± 10.1, 118.9 ± 26.3, 34.1 ± 20.8)associated to a non significant ROM reduction. Compared to C, T2 showed significant load changes at forefoot and toes (T2: 150.4 ± 63.3, 28.4 ± 15.6) and a significant ROM reduction. Also, T2 showed a significant lower load at rearfoot and toes and higher load at forefoot compared to T1. These results enlight biomachanical alterations that diabetes by it self, without influence of neuropathy or morphological alterations, can produce in foot during gait. [1] Van Netten JJ, et al, Diab Metab Res Rev 2016, 32(Suppl. 1): 84-98. [2] Bus SA, Diab Metab Res Rev 2012 28(Suppl 1): 54-59.

The shoulder complex provides greater freedom of motion than any other joint in the body at the expense of reduced stability. Shoulder joint movements include flexion-extension, abduction-addcuction, circumduction and rotation. They result from a complex interplay between static and dynamic stabilizers that require equilibrium and synchronicity. Shoulder instability is a comon problem in active populations, especially young athletes. It can occur in overhead throwing athletes (chronic overuse injuries) but more commonly occurs in contact athletes (acute thraumatic dislocations). The contact sports most commonly associated with shoulder instability include rugby, football, wrestling and hockey. This chapter analyses the clinical functional anatomy and biomechanics of shoulder structures with some insight regarding their patologic changes associated with shoulder instability in the athlete.