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2. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review

Author

Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Andrenelli E., Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Andrenelli E.

Abstract

BACKGROUND: Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.

Published
2022

3. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author

Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bizzarrini E., Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bizzarrini E.

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function.OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity.METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale.RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved.CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022

4. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Author

Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022

5. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

Author

Morone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, and Iosa M

Subjects
stroke, neurorehabilitation, robot-assisted walking training, wearable robot, activities of daily living, motor learning, plasticity., Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429
Abstract

Giovanni Morone,1,2 Stefano Paolucci,1,2 Andrea Cherubini,3 Domenico De Angelis,1 Vincenzo Venturiero,1 Paola Coiro,1 Marco Iosa1,2 1Private Inpatient Unit, 2Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy; 3Department of Robotics, LIRMM UM-CNRS, Montpellier, France Abstract: In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented. Keywords: exoskeleton, neurorehabilitation, robot-assisted walking training, wearable robot, activities of daily living, motor learning, plasticity

Published
2017

7. Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Author

Straudi S., Baluardo L., Arienti C., Bozzolan M., Lazzarini S. G., Agostini M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Perrero L., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Cinnera AM, Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli C., Gandolfi M., Russo EF, Boetto V., Straudi, S., Baluardo, L., Arienti, C., Bozzolan, M., Lazzarini, S. G., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Perrero, L., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Cinnera, Am, Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, C., Gandolfi, M., Russo, Ef, and Boetto, V.

Subjects
Stroke, robot-assisted arm therapy, exoskeleton device, exoskeleton devices, end-effector device, arm rehabilitation, end-effector devices
Abstract

BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Published
2022

8. Chronic Pain Due to Pelvis Fracture and Perceptive Rehabilitation

Author

Morone, G, Paolucci, T, Fusco, A, Iosa, M, Saraceni, Vm, Spadini, E, and Paolucci, S

Subjects
Automotive Engineering
Abstract

Recently, somatosensory rehabilitation is knowing a growing interest in chronic pain condition. In fact, new evidences have associated an impaired lumbopelvic control with a decreased tactile acuity, generating and sustaining chronic low back pain mechanisms. Consequently, an adequate tactile rehabilitation, entailing a discrimination training with a stimulation tasks, seems to be effective on pain, reducing lumbopelvic impairments. Also the use of perceptual surfaces can be effective on back pain, favouring a tactile and proprioceptive sensory stimulation on the trunk and improving the postural control through a body midline realignment. The aim of this manuscript was to describe the preliminary evidences on two cases of chronic pain due to pelvis fracture treated with the perceptive surfaces. Furthermore, we have tried to clarify the mechanisms involved in chronic back pain and the effect of a somatosensory rehabilitation. Finally, it was analyzed the role of craniocaudal body midline with the gravitational vertical axis in the setting of correct alignment for improving postural control in these conditions.

Published
2022
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11. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

Author

Bressi F., Cricenti L., Campagnola B., Bravi M., Miccinilli S., Santacaterina F., Sterzi S., Straudi S., Agostini M., Paci M., Casanova E., Marino D., La Rosa G., Giansanti D., Perrero L., Battistini A., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Gallotti M., Germanotta M., Aprile I., Bressi, F., Cricenti, L., Campagnola, B., Bravi, M., Miccinilli, S., Santacaterina, F., Sterzi, S., Straudi, S., Agostini, M., Paci, M., Casanova, E., Marino, D., La Rosa, G., Giansanti, D., Perrero, L., Battistini, A., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Gallotti, M., Germanotta, M., and Aprile, I.

Subjects
Stroke, robotic, cognitive outcome, rehabilitation, robotic rehabilitation, systematic review, upper limb
Abstract

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.

Published
2022

12. Robot-Assisted Upper Limb Training for Patients with Multiple Sclerosis: An Evidence-Based Review of Clinical Applications and Effectiveness

Author

Straudi S., Tramontano M., Russo E. F., Perrero L., Agostini M., Gandolfi M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Arienti C., Baluardo L., Cinnera A. M., Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli P., Boetto V., Straudi, S., Tramontano, M., Russo, E. F., Perrero, L., Agostini, M., Gandolfi, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Arienti, C., Baluardo, L., Cinnera, A. M., Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, P., and Boetto, V.

Subjects
robotics, Fluid Flow and Transfer Processes, Exoskeleton, Multiple sclerosis, Rehabilitation, Robotic devices, Technology, QH301-705.5, Process Chemistry and Technology, Physics, QC1-999, General Engineering, Multiple sclerosis, robotics, rehabilitation, exoskeleton, Engineering (General). Civil engineering (General), Computer Science Applications, NO, Chemistry, General Materials Science, Multiple sclerosi, TA1-2040, Biology (General), Instrumentation, QD1-999
Abstract

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusions.

Published
2022

13. What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations

Author

Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., Bonaiuti D., Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., and Bonaiuti D.

Abstract

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robot

Published
2021

14. robotic-assisted gait rehabilitation following stroke: A systematic review of current guidelines and practical clinical recommendations

Author

Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Introduction: Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. EVidEncE acQuisition: We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and october 31, 2020. We explored electronic databases (n.=4), guideline repositories and professional rehabilitation networks (n.=12). two independent reviewers used the appraisal of Guidelines for research and Evaluation (aGrEE) ii instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. conclusions: our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. however, robot assisted gait training (raGt) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

Published
2021

15. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Author

Morandi, A, Zambon, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Marengoni, A, Bellelli, G, Rispoli, V, Malara, A, Spadea, F, Di Cello, S, Ceravolo, F, Fabiano, F, Chiaradia, G, Gabriele, A, Lenino, P, Andrea, T, Settembrini, V, Capomolla, D, Citrino, A, Scriva, A, Bruno, I, Secchi, R, De Martino, E, Muccinelli, R, Lupi, G, Paonessa, P, Fabbri, A, Passuti, M, Castellari, S, Po, A, Gaggioli, G, Varesi, M, Moneti, P, Capurso, S, Latini, V, Ghidotti, S, Riccardelli, F, Macchi, M, Rigo, R, Claudio, P, Angelo, B, Flavio, C, Benedetta, B, Boffelli, S, Cassinadri, A, Franzoni, S, Spazzini, E, Andretto, D, Tonini, G, Andreani, L, Coralli, M, Balotta, A, Cancelliere, R, Ballardini, G, Simoncelli, M, Mancini, A, Strazzacapa, M, Fabio, S, De Filippi, F, Giudice, C, Dentizzi, C, Azzini, M, Cazzadori, M, Mastroeni, V, Bertassello, P, Claudia Benati, H, Nesta, E, Tobaldini, C, Guerini, F, Elena, T, Mombelloni, P, Fontanini, F, Gabriella, L, Pizzorni, C, Oliverio, M, Del Grosso, L, Giavedoni, C, Bidoli, G, Mazzei, B, Corsonello, A, Fusco, S, Vena, S, De Vuono, T, Maiuri, G, Luca, F, Andrea, A, Giovanni, S, Rossella, N, Castegnaro, E, De Rosa, S, Sechi, R, Benvenuti, E, Del Lungo, I, Giardini, S, Giulietti, C, Mauro, D, Eleonora, B, Martina, P, Irene, F, Riccardo, B, Federica, S, Ilaria, D, Bertoletti, E, D'Amico, F, Caronzolo, F, Grippa, A, Lombardo, G, Pipicella, T, Antonino, S, Francesco, C, Valeria, P, Daniela, L, Domenico, C, Giorgio, B, March, A, Nitti, M, Felici, A, Pavan, S, Piazzani, F, Lunelli, A, Dimori, S, Margotta, A, Soglia, T, Postacchini, D, Brunelli, R, Santini, S, Francavilla, M, Macchiati, I, Sorvillo, F, Giuli, C, Mecocci, P, Longo, A, Perticone, F, Addesi, D, Rosa, P, Bencardino, G, Falbo, T, Grillo, N, Marco, F, Mirella, F, Fanto, F, Isaia, G, Pezzilli, S, Bergamo, D, Furno, E, Rrodhe, S, Lucarini, S, Dijk, B, Dall'Acqua, F, Cappelletto, F, Calvani, D, Becheri, D, Giuseppe, M, Costanza, M, Vito, A, Francesca, B, Magherini, L, Novella, M, Franca, B, Lucia Gambardella, P, Valente, C, Ilaria, B, Alice, F, Porrino, P, Ceci, G, Giuliana, B, Michela, T, Eleonora, C, Ettore, E, Camellini, C, Servello, A, Grassi, A, Rozzini, R, Tironi, S, Grassi, M, Troisi, E, Carlo, C, Simona Gabriella, D, Flaminia, F, Federica, R, Beatrice, P, Sofia, T, Gabutto, A, Quazzo, L, Rosatello, A, Suraci, D, Tagliabue, B, Perrone, C, Ferrara, L, Castagna, A, Tremolada, M, Giuseppe, C, Stefano, B, Davide, O, Piano, S, Serviddio, G, Lo Buglio, A, Gurrera, T, Merlo, V, Rovai, C, Cotroneo, A, Carlucci, R, Abbaldo, A, Monzani, F, Qasem, A, Bini, G, Tafuto, S, Galli, G, Bruni, A, Mancuso, G, Calipari, D, Giuseppe Massimiliano, D, Bernardini, B, Corsini, C, Michele, C, Sara, D, Cagnin, A, Fragiacomo, F, Pompanin, S, Piero, A, Marco, C, Zurlo, A, Guerra, G, Pala, M, Menozzi, L, Gatti, C, Magon, S, Roberto, M, Alfredo, D, Fabio, F, Ruana, T, Elisa, M, Christian, M, Marco, P, Massimo, G, Di Francesco, V, Faccioli, S, Pellizzari, L, Giorgia, F, Barbagallo, G, Lunardelli, M, Martini, E, Ferrari, E, Macchiarulo, M, Corneli, M, Bacci, M, Battaglia, G, Anastasio, L, Lo Storto, M, Seresin, C, Simonato, M, Loreggian, M, Cestonaro, F, Durando, M, Latella, R, Mazzoleni, M, Russo, G, Ponte, M, Valchera, A, Salustri, G, Petritola, D, Costa, A, Sinforiani, E, Cotta, M, Pizio, R, Cester, A, Formilan, M, Pietro, B, Carbone, P, Cazzaniga, I, Appollonio, I, Cereda, D, Stabile, A, Xhani, R, Acampora, R, Tremolizzo, L, Federico, P, Antonio, C, Valerio, P, Cesare, B, Zhirajr, M, Giovanni, V, Maria, A, Mariaelena, S, Bottacchi, E, Bucciantini, E, Di Giovanni, M, Franchi, F, Lucchetti, L, Mariani, C, Grande, G, Rapazzini, P, Marco, M, Romanelli, G, Franco, N, Alessio, M, Nicola, L, Laura, P, Nazario, P, Chiara, G, Soccorso, P, Andrea, S, Luca, B, Francesca, S, Roberto, A, Anna, C, Fugazza, L, Guerrini, C, De Paduanis, G, Iallonardo, L, Palumbo, P, Zuliani, G, Ortolani, B, Capatti, E, Soavi, C, Bianchi, L, Francesconi, D, Miselli, A, Gloria, B, Tommaso, R, Chiara, P, Agata, M, Marco, D, Luca, M, Gianluca, G, Suardi, T, Zaccarini, C, Manuela, R, Mirra, G, Muti, E, Bottura, R, Gianpaolo, M, Secreto, P, Bisio, E, Cecchettani, M, Naldi, T, Pallavicino, A, Pugliese, M, Iozzo, R, Grassi, G, Bombelli, M, Dell'Oro, R, Quarti Trevano, F, Giussani, G, Paternò, G, Contro, E, Mannironi, A, Giorli, E, Oberti, S, Fierro, B, Piccoli, T, Giacalone, F, Mandas, A, Serchisu, L, Costaggiu, D, Pinna, E, Orru, F, Mannai, M, Cordioli, Z, Pelizzari, L, Turcato, E, Arduini, P, Cacace, C, Chiloiro, R, Cimino, R, Ruberto, C, Giovanni, R, Pietro, G, Laura, G, Alberto, C, Carmen, R, Santo, P, Andriolli, A, Burattin, G, Rossi, L, Andreolli Antonino, C, Tezza, F, Maddalena, P, Laura, S, Crippa, P, Aloisio, P, Di Monda, T, Malighetti, A, Galbassini, G, Salutis, D, Ivaldi, C, Russo, A, Bennati, E, Pino, E, Zavarise, G, Pesci, A, Suigo, G, Faverio, P, Andrea, G, Sabrina, P, Zanasi, M, Moniello, G, Rostagno, C, Cartei, A, Polidori, G, Ungar, A, Melis, M, Martellini, E, Enrico, M, Monica, T, Antonella, G, Giovanna, L, Migliorini, M, Caramelli, F, Battiston, B, Berardino, M, Cavallo, S, Alessandro, M, Anna, S, Lombardi, B, D'Ippolito, P, Furini, A, Villani, D, Clara, R, Guarneri, M, Paolucci, S, Bassi, A, Coiro, P, De Angelis, D, Morone, G, Venturiero, V, Palleschi, L, Raganato, P, Di Niro, G, Rosa, C, Loredana, B, Imoscopi, A, Tibaldi, V, Bottignole G, G, Calvi, E, Clementi, C, Zanocchi, M, Agosta, L, Nortarelli, A, Provenzano, G, Mari, D, Romano, F, Rosini, F, Mansi, M, Rossi, S, Geriatria, A, Inzaghi, L, Bonini, G, Rossi, P, Potena, A, Lichii, M, Candiani, T, Grimaldi, W, Bertani, E, Alessandra, P, Calogero, P, Pinto, D, Bernardi, R, Nicolino, F, Galetti, C, Gianstefani, A, Giulia, C, Lorenzo, M, Odetti, P, Monacelli, F, Prefumo, M, Fiammetta, M, Canepa, M, Minaglia, C, Paolisso, G, Rizzo, M, Prestano, R, Dalise, A, Barra, D, Bosco, L, Asprinio, V, Dallape, L, Perina, E, Incalzi, R, Bartoli, I, Pluderi, A, Maina, A, Pecoraro, E, Sciarra, M, Prudente, A, Paola, M, Francesca, M, Manuel, V, Luisella, C, Maria, P, Tina, S, Benini, L, Levato, F, Mhiuta, V, Alius, F, Davidoaia, D, Giardini, V, Garancini, M, Bellamoli, C, Terranova, L, Bozzini, C, Tosoni, P, Provoli, E, Cascone, L, Dioli, A, Ferrarin, G, Bucci, A, Bua, G, Fenu, S, Bianchi, G, Casella, S, Romano, V, Maurizio, P, Mascherona, I, Belotti, G, Cavaliere, S, Cuni, E, Merciuc, N, Oberti, R, Veneziani, S, Capoferri, E, De Bernardi, E, Colombo, K, Bravi, M, Nicoletta, N, D'Arcangelo, P, Montenegro, N, Montanari, R, Lamanna, P, Gasperini, B, Isabella, M, Stefania, D, Gaia, A, Filippo, C, Palama, C, Di Emidio, C, Scarpini, E, Arighi, A, Fumagalli, G, Basilico, P, De Amicis Margherita, M, Marta, M, Diletta, M, Granata, A, Ranalli, C, Cammilli, A, Cavallini, M, Tricca, M, Natella, D, Gabbani, L, Tesi, F, Martella, L, Imbrici, R, Guerrini, G, Scotuzzi, A, Sozzi, F, Valenti, L, Chiarello, A, Monia, M, Pilotto, A, Prete, C, Senesi, B, Meta, A, Pendenza, E, Pasqualetti, G, Polini, A, Tognini, S, Ballino, E, Dell'Aquila, G, Gasparrini, P, Marotti, E, Migale, M, Scrimieri, A, Falsetti, L, Salvi, A, Toigo, G, Ceschia, G, Rosso, A, Tongiorgi, C, Scarpa, C, De Dominicis, L, Pucci, E, Renzi, S, Cartechini, E, Tomassini, P, Del Gobbo, M, Ugenti, F, Romeo, P, Nardelli, A, Lauretani, F, Visioli, S, Montanari, I, Ermini, F, Giordano, A, Pigato, G, Simeone, E, Barbujani, M, Giampieri, M, Amoruso, R, Piccinini, M, Ferrari, C, Gambetti, C, Sfrappini, M, Semeraro, L, Striuli, R, Pelliccioni, G, Marinelli, D, Fabi, K, Rossi, T, Pesallaccia, M, Sabbatini, D, Gobbi, B, Cerqua, R, Tagliani, G, Schlauser, E, Caser, L, Caramello, E, Sandigliano, F, Rosso, G, Ferrari, A, Bendini, C, Luisa, D, Casella, M, Prampolini, R, Scevola, M, Vitale, E, Roberto, B, Carlo, F, Sergio, F, Alberto, S, Daniela, Z, Giulia, B, Serena, G, Michele, B, Maugeri, D, Sorace, R, Anzaldi, M, De Gesu, R, Morrone, G, Davolio, F, Fabbo, A, Palmieri, M, Zoli, M, Forti, P, Pirazzoli, L, Fabbri, E, Terenzi, L, Bergolari, F, Wenter, C, Ruffini, I, Insam, M, Abraham, E, Kirchlechner, C, Cucinotta, D, Antonino, L, Basile, G, Grazia, A, Parise, P, Boccali, A, Amici, S, Gambacorta, M, Lasagni, A, Lovati, R, Giovinazzo, F, Kimak, E, Zappa, P, Medici, F, Lo Castro, M, Mauro, F, De Luca, A, Sancesario, G, Martorana, A, Scaricamazza, B, Toniolo, S, Di Lorenzo, F, Liguori, C, Lasco, A, Vita, N, Giomi, M, Forte, F, Padovani, A, Rozzini, L, Ceraso, A, Salvatore, C, Cottino, M, Vitali, S, Marelli, E, Tripi, G, Miceli, S, Urso, G, Grioni, G, Vezzadini, G, Misaggi, G, Forlani, C, Avanzi, S, Serena, S, Claudia, C, Marilena, V, Alberto, L, Diego, G, Alessandro, G, Iemolo, F, Sanzaro, E, D'Asta, G, Proietto, M, Carnemolla, A, Razza, G, Spadaro, D, Bertolotti, M, Mussi, C, Neviani, F, Roberto, C, Valentina, G, Linda, M, Francesca, V, Tarozzi, A, Balestri, F, Mannarino, G, Bigolari, M, Natale, A, Grassi, S, Bottaro, C, Stefanelli, S, Bovone, U, Tortorolo, U, Quadri, R, Leone, G, Ponzetto, M, Frasson, P, Annoni, G, Confalonieri, R, Corsi, M, Moretti, D, Teruzzi, F, Umidi, S, Mazzola, P, Perego, S, Persico, I, Olivieri, G, Bonfanti, A, Hajnalka, S, Galeazzi, M, Massariello, F, Anzuini, A, Caffarra, P, Barocco, F, Spallazzi, M, Paolo, C, Simonetta, M, Chioatto, P, Bortolamei, S, Soattin, L, Ruotolo, G, Beneamino, B, Giuseppe, B, Bertazzoli, M, Rota, E, Adobati, A, Scarpa, A, Granziera, S, Zuccher, P, Fabbro, A, Zara, D, Lo Nigro, A, Franchetti, L, Toniolo, M, Marcuzzo, C, Rollone, M, Guerriero, F, Sgarlata, C, Masse, A, Zatti, G, Piatti, M, Graci, J, Benati, G, Boschi, F, Biondi, M, Fiumi, N, Erika, T, Locatelli, S, Mauri, S, Beretta, M, Margheritis, L, Desideri, G, Liberatore, E, Carucci, A, Bonino, P, Caput, M, Antonietti, M, Polistena, G, De la Pierre, F, Mari, M, Massignani, P, Tombesi, F, Selvaggio, F, Verbo, B, Bodoni, P, Marchionni, N, Sabatini, T, Mussio, E, Magni, E, Bianchetti, A, Crucitti, A, Titoldini, G, Cossu, B, Fascendini, S, Licini, C, Tomasoni, A, Calderazzo, M, Daniela, T, Valentina, L, Melotti, R, Lilli, A, Buda, S, Adversi, M, Noro, G, Turco, R, Ubezio, M, Mantovani, A, Viola, M, Serrati, C, Pretta, S, Infante, M, Gentile, S, D'Ambrosio, V, Mazzanti, P, Brambilla, C, Sportelli, S, Platto, C, Faraci, B, Quattrocchi, D, Pernigotti, L, Pisu, C, Sicuro, F, Zagnoni, P, Ghiglia, S, Mosca, M, Corazzin, I, Deola, M, Biagini, C, Bencini, F, Cantini, C, Tonon, E, Pierinelli, S, Onofrj, M, Thomas, A, Filomena, B, Bonanni, L, Gabriella, C, Comi, G, Magnani, G, Santangelo, R, Mazzeo, S, Francesca, C, Giordano, C, Roberto, S, Barbieri, C, Giroldi, L, Bandini, F, Masina, M, Malservisi, S, Cicognani, A, Ricca, L, Piccininni, M, Tassinari, T, Brogi, D, Sugo, A, Alessandra, F, Sonia, M, Valerio, V, Andrea, U, Enrico, C, Vera, R, Assunta, S, Gianmaria, Z, Mauro, P, Barone, A, Razzano, M, Giuseppe, I, Angela, B, Francesco, S, Valeria, D, Federico, G, Lucia, P, Antonella, V, Elisabetta, D, Cristina, R, Nadia, C, Maria, S, Luciano, A, Chiara, C, Bini, P, Pignata, M, Enrico, B, Maria, V, Giovanni, C, Giorgio, C, Piera, R, Alberto, Z, Ceccon, A, Magrin, L, Marin, S, Barbara, S, Matteo, M, Caterina, P, Carla, R, Federica, G, Clara, T, Melania, C, Giampaolo, B, Stefano, G, Valeria, G, Lucia, M, Giovambattista, D, Ester, L, Cecilia, C, Maurizio, T, Nadia, B, Grillo, A, Arenare, F, Tonino, M, David, K, Giorgio, V, Ubaldo, B, Vincenzo, S, Stefano, M, Marino, F, Busonera Flavio, M, Paolo, A, Monica, M, Francesco, B, Roberto, F, Paolo, B, Durantemangoni, E, Testoni, M, Fabio, D, Loredana, S, Valeria, S, Fabiano, M, Annabella, D, Salvatore, D, Greco, A, Grazia, D, Daniele, S, Gianluca, R, Renzo, G, Sergio, M, Morena, B, Vitali, M, Marina, P, Paolo, D, Cristina, S, Orlandini, F, La Regina, M, Desiree, A, Mario, B, Paola, P, Padulo, F, Cristina, M, Dario, R, Giancarla, M, Guido, R, Elena, M, Marileda, N, Igor, B, Nicole, B, Elena, R, Paolillo, C, Riccardi, A, Claudia, B, Barbara, R, Silvia, V, Oliver, B, Mauro, C, Eleonora, M, Giuseppe, P, Rosaria, T, Maria, C, Davide, D, Stefania, C, Massimo, P, Luca, S, Martina, D, Paola, V, Lia, S, Sandro, C, Valentina, D, Erminia, B, Paola, C, Romina, R, Minisola, S, Luciano, C, Pasquale, A, Ilaria, L, Guglielmo, S, Marco, E, Sara, R, Paola, A, Claudio, A, Francesco, R, Alessandro, C, Simona, M, Lara, F, Paola, R, Simonetta, C, Antonella, C, Generoso, U, Fernando, G, Giuliano, C, Emanuela, S, Mariolina, S, Alessandro, D, Giulia, L, Famularo, S, Sandini, M, Pinotti, E, Gianotti, L, Antonella, B, Giulia, P, Sante, G, Rossi, A, Rubele, S, Sant, S, Marco, V, Danila, C, Fabio, R, Bandirali, M, Nicoletta, C, Laura, B, Paolo, T, Luciano, T, Leonello, A, Margherita, S, Pierluigi, D, Laura, R, Fabiana, T, Giovanna, C, Antonino, A, Felice, C, Danilo, F, Giovanna, D, Francesco, L, Salini, S, Giorgetta, C, Giovanni, G, Gerardo, B, Silvio, R, Letizia, S, Davide, B, Rosaria, R, Maria, D, Raffaele, P, Palmieri, V, Palasciano, G, Belfiore, A, Portincasa, P, Carlo, S, Alessia, D, Valiani, V, Carolina, B, Tiziana, C, Paola, T, Ugo, P, Giacomo, P, Castellano, M, Anna, G, Elisa, C, Federica, C, Antonietta, C, Luigi, M, Fabio, L, Salvatore, B, Gelosa, G, Viviana, A, Piras, V, Andrea, C, Alessandra, B, Coen, D, Magliola, R, Milanesio, D, Muzzulini, C, Paolo, F, Marinella, T, Sofia, C, Marta, B, Siano, P, Capo, G, Napoletano, R, Cecilia, P, Mancini, C, Del Buono, C, De Bartolomeo, G, Addolorata, M, Carmen, C, Moschettini, G, Franco, M, Daniela, R, D'Amico, G, Mirella, P, Endrizzi, C, Trotta, L, Ciarambino, T, Orazio, Z, Emanuela, T, Marta, S, Thomas, F, Giacomo, T, Ignazio, D, Andrea, B, Giuseppe, O, Emanuela, F, Serena, A, Elena, D, Serena, B, Erika, N, Elena, S, Manuela, P, Francesca, A, Angelo, T, Morandi A., Zambon A., Di Santo S. G., Mazzone A., Cherubini A., Mossello E., Bo M., Marengoni A., Bellelli G., Rispoli V., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Chiaradia G., Gabriele A., Lenino P., Andrea T., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Passuti M. T., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Rigo R., Claudio P., Angelo B., Flavio C., Benedetta B., Boffelli S., Cassinadri A., Franzoni S., Spazzini E., Andretto D., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Ballardini G., Simoncelli M., Mancini A., Strazzacapa M., Fabio S., De Filippi F., Giudice C., Dentizzi C., Azzini M., Cazzadori M., Mastroeni V., Bertassello P., Claudia Benati H. S., Nesta E., Tobaldini C., Guerini F., Elena T., Mombelloni P., Fontanini F., Gabriella L., Pizzorni C., Oliverio M., Del Grosso L. L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Luca F. F., Andrea A., Giovanni S., Rossella N., Castegnaro E., De Rosa S., Sechi R. B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., Mauro D. B., Eleonora B., Martina P., Irene F., Riccardo B., Federica S., Ilaria D. L., Bertoletti E., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Antonino S., Francesco C., Valeria P. G., Daniela L., Domenico C., Giorgio B., March A., Nitti M. T., Felici A., Pavan S., Piazzani F., Lunelli A., Dimori S., Margotta A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Mecocci P., Longo A., Perticone F., Addesi D., Rosa P. C., Bencardino G., Falbo T., Grillo N., Marco F., Mirella F., Fanto F., Isaia G., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dijk B., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Giuseppe M., Costanza M., Vito A., Francesca B., Magherini L., Novella M., Franca B., Lucia Gambardella P. M., Valente C., Ilaria B., Alice F., Porrino P., Ceci G., Giuliana B., Michela T., Eleonora C., Ettore E., Camellini C., Servello A., Grassi A., Rozzini R., Tironi S., Grassi M. G., Troisi E., Carlo C., Simona Gabriella D. S., Flaminia F., Federica R., Beatrice P., Sofia T., Gabutto A., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M. L., Giuseppe C., Stefano B., Davide O., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Cotroneo A. M., Carlucci R., Abbaldo A., Monzani F., Qasem A. A., Bini G., Tafuto S., Galli G., Bruni A. C., Mancuso G., Calipari D., Giuseppe Massimiliano D. L., Bernardini B., Corsini C., Michele C., Sara D. F., Cagnin A., Fragiacomo F., Pompanin S., Piero A., Marco C., Zurlo A., Guerra G., Pala M., Menozzi L., Gatti C. D., Magon S., Roberto M., Alfredo D. G., Fabio F., Ruana T., Elisa M., Christian M., Marco P., Massimo G., Di Francesco V., Faccioli S., Pellizzari L., Giorgia F., Barbagallo G., Lunardelli M. L., Martini E., Ferrari E., Macchiarulo M., Corneli M., Bacci M., Battaglia G., Anastasio L., Lo Storto M. S., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Latella R., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Petritola D., Costa A., Sinforiani E., Cotta M. R., Pizio R. N., Cester A., Formilan M., Pietro B., Carbone P., Cazzaniga I., Appollonio I., Cereda D., Stabile A., Xhani R., Acampora R., Tremolizzo L., Federico P., Antonio C., Valerio P., Cesare B., Zhirajr M., Giovanni V., Maria A., Mariaelena S., Bottacchi E., Bucciantini E., Di Giovanni M., Franchi F., Lucchetti L., Mariani C., Grande G., Rapazzini P., Marco M., Romanelli G., Franco N., Alessio M., Nicola L., Laura P., Nazario P., Chiara G., Soccorso P., Andrea S., Luca B., Francesca S., Roberto A., Anna C., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Zuliani G., Ortolani B., Capatti E., Soavi C., Bianchi L., Francesconi D., Miselli A., Gloria B., Tommaso R., Chiara P., Agata M. M., Marco D. A., Luca M., Gianluca G., Suardi T., Zaccarini C., Manuela R., Mirra G., Muti E., Bottura R., Gianpaolo M., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R. C., Grassi G., Bombelli M., Dell'Oro R., Quarti Trevano F., Giussani G. C., Paternò G., Contro E., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Santo P. D., Andriolli A., Burattin G., Rossi L., Andreolli Antonino C. G., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Salutis D., Ivaldi C., Russo A. M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M. R., Martellini E., Enrico M., Monica T., Antonella G., Giovanna L., Migliorini M., Caramelli F., Battiston B., Berardino M., Cavallo S., Alessandro M., Anna S., Lombardi B., D'Ippolito P., Furini A., Villani D., Clara R., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Rosa C. A., Loredana B., Imoscopi A., Tibaldi V., Bottignole G G., Calvi E., Clementi C., Zanocchi M., Agosta L., Nortarelli A., Provenzano G., Mari D., Romano F. Y., Rosini F., Mansi M., Rossi S., Geriatria A. R., Inzaghi L., Bonini G., Rossi P., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Alessandra P., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Giulia C., Lorenzo M., Odetti P., Monacelli F., Prefumo M., Fiammetta M., Canepa M., Minaglia C., Paolisso G., Rizzo M. R., Prestano R., Dalise A. M., Barra D., Bosco L. D., Asprinio V., Dallape L., Perina E., Incalzi R. A., Bartoli I. R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P. L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M. C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A. M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A. C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P. M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P. F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Barbujani M., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D. M., Casella M., Prampolini R., Scevola M., Vitale E., Roberto B., Carlo F., Sergio F., Alberto S., Daniela Z., Giulia B., Serena G., Michele B., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Fabbo A., Palmieri M., Zoli M., Forti P., Pirazzoli L., Fabbri E., Terenzi L., Bergolari F., Wenter C., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Antonino L., Basile G., Grazia A. M., Parise P., Boccali A., Amici S., Gambacorta M., Lasagni A., Lovati R., Giovinazzo F., Kimak E., Zappa P., Medici F., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Padovani A., Rozzini L., Ceraso A., Salvatore C., Cottino M., Vitali S., Marelli E., Tripi G., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Avanzi S., Serena S., Claudia C., Marilena V., Alberto L., Diego G., Alessandro G., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Mussi C., Neviani F., Roberto C., Valentina G., Linda M., Francesca V., Tarozzi A., Balestri F., Mannarino G., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Annoni G., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Mazzola P., Perego S., Persico I., Olivieri G., Bonfanti A., Hajnalka S., Galeazzi M., Massariello F., Anzuini A., Caffarra P., Barocco F., Spallazzi M., Paolo C. G., Simonetta M., Chioatto P., Bortolamei S., Soattin L., Ruotolo G., Beneamino B., Giuseppe B., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Fabbro A. D., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Boschi F., Biondi M., Fiumi N., Erika T., Locatelli S. M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A. C., Bonino P., Caput M., Antonietti M. P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Marchionni N., Sabatini T., Mussio E., Magni E., Bianchetti A., Crucitti A., Titoldini G., Cossu B., Fascendini S., Licini C., Tomasoni A., Calderazzo M., Daniela T., Valentina L., Melotti R. M., Lilli A., Buda S., Adversi M., Noro G., Turco R., Ubezio M. C., Mantovani A. R., Viola M. C., Serrati C., Pretta S., Infante M., Gentile S., D'Ambrosio V., Mazzanti P., Brambilla C., Sportelli S., Platto C., Faraci B., Quattrocchi D., Pernigotti L. M., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Biagini C. A., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Filomena B., Bonanni L., Gabriella C., Comi G., Magnani G., Santangelo R., Mazzeo S., Francesca C., Giordano C., Roberto S. A., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Piccininni M., Tassinari T., Brogi D., Sugo A., Alessandra F., Sonia M., Valerio V., Andrea U. C., Enrico C., Vera R. F., Assunta S., Gianmaria Z., Mauro P., Barone A., Razzano M., Giuseppe I., Angela B., Francesco S., Valeria D. A., Federico G., Lucia P., Antonella V., Elisabetta D. C., Cristina R., Nadia C., Maria S., Luciano A., Chiara C., Bini P., Pignata M., Enrico B., Maria V., Giovanni C., Giorgio C., Piera R., Alberto Z., Ceccon A., Magrin L., Marin S., Barbara S., Matteo M., Caterina P. M., Carla R., Federica G., Clara T., Melania C., Giampaolo B., Stefano G., Valeria G., Lucia M., Giovambattista D., Ester L., Cecilia C. A., Maurizio T., Nadia B., Grillo A., Arenare F., Tonino M., David K., Giorgio V. P., Ubaldo B., Vincenzo S., Stefano M., Marino F., Busonera Flavio M. T., Paolo A., Monica M., Francesco B., Roberto F., Paolo B., DuranteMangoni E., Testoni M., Fabio D. S., Loredana S., Valeria S., Fabiano M., Annabella D. G., Salvatore D. C., Greco A., Grazia D. O., Daniele S., Gianluca R., Renzo G., Sergio M., Morena B., Vitali M., Marina P., Paolo D. C., Cristina S., Orlandini F., La Regina M., Desiree A., Mario B., Paola P., Padulo F., Cristina M., Dario R., Giancarla M., Guido R., Elena M., Marileda N., Igor B., Nicole B., Elena R., Paolillo C., Riccardi A., Claudia B., Barbara R., Silvia V., Oliver B., Mauro C., Eleonora M., Giuseppe P., Rosaria T., Maria C., Davide D. A., Stefania C., Massimo P., Luca S., Martina D. F., Paola V., Lia S., Sandro C., Valentina D. S., Erminia B., Paola C., Romina R., Minisola S., Luciano C., Pasquale A., Ilaria L., Guglielmo S., Marco E., Sara R., Paola A., Claudio A., Francesco R., Alessandro C., Simona M., Lara F., Paola R., Simonetta C., Antonella C., Generoso U., Fernando G., Giuliano C., Emanuela S., Mariolina S., Alessandro D., Giulia L., Famularo S., Sandini M., Pinotti E., Gianotti L., Antonella B., Giulia P., Sante G., Rossi A., Rubele S., Sant S., Marco V., Danila C., Fabio R., Bandirali M. P., Nicoletta C., Laura B., Paolo T., Luciano T., Leonello A., Margherita S., Stefania D. N., Pierluigi D. S., Laura R., Fabiana T., Giovanna C., Antonino A., Felice C., Danilo F., Giovanna D. B., Francesco L., Salini S., Angela B. M., Giorgetta C., Giovanni G., Gerardo B., Silvio R., Letizia S., Davide B., Rosaria R. M., Maria D. A., Raffaele P., Palmieri V. O., Palasciano G., Belfiore A., Portincasa P., Carlo S., Alessia D., Valiani V., Carolina B., Tiziana C., Paola T., Ugo P., Giacomo P., Castellano M., Anna G., Elisa C., Federica C., Antonietta C. M., Luigi M., Fabio L., Salvatore B., Gelosa G., Viviana A. T., Piras V., Andrea C., Alessandra B., Coen D., Magliola R., Milanesio D., Muzzulini C. L., Paolo F., Marinella T., Sofia C. M., Marta B., Siano P., Capo G., Napoletano R., Cecilia P., Mancini C., Del Buono C., De Bartolomeo G., Addolorata M., Carmen C., Giovanni V. A., Moschettini G., Franco M., Daniela R., D'Amico G., Mirella P., Endrizzi C., Trotta L., Ciarambino T., Orazio Z., Emanuela T., Marta S., Thomas F., Giacomo T., Ignazio D. F., Andrea B., Giuseppe O., Emanuela F., Serena A., Elena D. I., Serena B., Erika N., Roberto S., Elena S., Manuela P., Francesca A., Angelo T., Morandi, A, Zambon, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Marengoni, A, Bellelli, G, Rispoli, V, Malara, A, Spadea, F, Di Cello, S, Ceravolo, F, Fabiano, F, Chiaradia, G, Gabriele, A, Lenino, P, Andrea, T, Settembrini, V, Capomolla, D, Citrino, A, Scriva, A, Bruno, I, Secchi, R, De Martino, E, Muccinelli, R, Lupi, G, Paonessa, P, Fabbri, A, Passuti, M, Castellari, S, Po, A, Gaggioli, G, Varesi, M, Moneti, P, Capurso, S, Latini, V, Ghidotti, S, Riccardelli, F, Macchi, M, Rigo, R, Claudio, P, Angelo, B, Flavio, C, Benedetta, B, Boffelli, S, Cassinadri, A, Franzoni, S, Spazzini, E, Andretto, D, Tonini, G, Andreani, L, Coralli, M, Balotta, A, Cancelliere, R, Ballardini, G, Simoncelli, M, Mancini, A, Strazzacapa, M, Fabio, S, De Filippi, F, Giudice, C, Dentizzi, C, Azzini, M, Cazzadori, M, Mastroeni, V, Bertassello, P, Claudia Benati, H, Nesta, E, Tobaldini, C, Guerini, F, Elena, T, Mombelloni, P, Fontanini, F, Gabriella, L, Pizzorni, C, Oliverio, M, Del Grosso, L, Giavedoni, C, Bidoli, G, Mazzei, B, Corsonello, A, Fusco, S, Vena, S, De Vuono, T, Maiuri, G, Luca, F, Andrea, A, Giovanni, S, Rossella, N, Castegnaro, E, De Rosa, S, Sechi, R, Benvenuti, E, Del Lungo, I, Giardini, S, Giulietti, C, Mauro, D, Eleonora, B, Martina, P, Irene, F, Riccardo, B, Federica, S, Ilaria, D, Bertoletti, E, D'Amico, F, Caronzolo, F, Grippa, A, Lombardo, G, Pipicella, T, Antonino, S, Francesco, C, Valeria, P, Daniela, L, Domenico, C, Giorgio, B, March, A, Nitti, M, Felici, A, Pavan, S, Piazzani, F, Lunelli, A, Dimori, S, Margotta, A, Soglia, T, Postacchini, D, Brunelli, R, Santini, S, Francavilla, M, Macchiati, I, Sorvillo, F, Giuli, C, Mecocci, P, Longo, A, Perticone, F, Addesi, D, Rosa, P, Bencardino, G, Falbo, T, Grillo, N, Marco, F, Mirella, F, Fanto, F, Isaia, G, Pezzilli, S, Bergamo, D, Furno, E, Rrodhe, S, Lucarini, S, Dijk, B, Dall'Acqua, F, Cappelletto, F, Calvani, D, Becheri, D, Giuseppe, M, Costanza, M, Vito, A, Francesca, B, Magherini, L, Novella, M, Franca, B, Lucia Gambardella, P, Valente, C, Ilaria, B, Alice, F, Porrino, P, Ceci, G, Giuliana, B, Michela, T, Eleonora, C, Ettore, E, Camellini, C, Servello, A, Grassi, A, Rozzini, R, Tironi, S, Grassi, M, Troisi, E, Carlo, C, Simona Gabriella, D, Flaminia, F, Federica, R, Beatrice, P, Sofia, T, Gabutto, A, Quazzo, L, Rosatello, A, Suraci, D, Tagliabue, B, Perrone, C, Ferrara, L, Castagna, A, Tremolada, M, Giuseppe, C, Stefano, B, Davide, O, Piano, S, Serviddio, G, Lo Buglio, A, Gurrera, T, Merlo, V, Rovai, C, Cotroneo, A, Carlucci, R, Abbaldo, A, Monzani, F, Qasem, A, Bini, G, Tafuto, S, Galli, G, Bruni, A, Mancuso, G, Calipari, D, Giuseppe Massimiliano, D, Bernardini, B, Corsini, C, Michele, C, Sara, D, Cagnin, A, Fragiacomo, F, Pompanin, S, Piero, A, Marco, C, Zurlo, A, Guerra, G, Pala, M, Menozzi, L, Gatti, C, Magon, S, Roberto, M, Alfredo, D, Fabio, F, Ruana, T, Elisa, M, Christian, M, Marco, P, Massimo, G, Di Francesco, V, Faccioli, S, Pellizzari, L, Giorgia, F, Barbagallo, G, Lunardelli, M, Martini, E, Ferrari, E, Macchiarulo, M, Corneli, M, Bacci, M, Battaglia, G, Anastasio, L, Lo Storto, M, Seresin, C, Simonato, M, Loreggian, M, Cestonaro, F, Durando, M, Latella, R, Mazzoleni, M, Russo, G, Ponte, M, Valchera, A, Salustri, G, Petritola, D, Costa, A, Sinforiani, E, Cotta, M, Pizio, R, Cester, A, Formilan, M, Pietro, B, Carbone, P, Cazzaniga, I, Appollonio, I, Cereda, D, Stabile, A, Xhani, R, Acampora, R, Tremolizzo, L, Federico, P, Antonio, C, Valerio, P, Cesare, B, Zhirajr, M, Giovanni, V, Maria, A, Mariaelena, S, Bottacchi, E, Bucciantini, E, Di Giovanni, M, Franchi, F, Lucchetti, L, Mariani, C, Grande, G, Rapazzini, P, Marco, M, Romanelli, G, Franco, N, Alessio, M, Nicola, L, Laura, P, Nazario, P, Chiara, G, Soccorso, P, Andrea, S, Luca, B, Francesca, S, Roberto, A, Anna, C, Fugazza, L, Guerrini, C, De Paduanis, G, Iallonardo, L, Palumbo, P, Zuliani, G, Ortolani, B, Capatti, E, Soavi, C, Bianchi, L, Francesconi, D, Miselli, A, Gloria, B, Tommaso, R, Chiara, P, Agata, M, Marco, D, Luca, M, Gianluca, G, Suardi, T, Zaccarini, C, Manuela, R, Mirra, G, Muti, E, Bottura, R, Gianpaolo, M, Secreto, P, Bisio, E, Cecchettani, M, Naldi, T, Pallavicino, A, Pugliese, M, Iozzo, R, Grassi, G, Bombelli, M, Dell'Oro, R, Quarti Trevano, F, Giussani, G, Paternò, G, Contro, E, Mannironi, A, Giorli, E, Oberti, S, Fierro, B, Piccoli, T, Giacalone, F, Mandas, A, Serchisu, L, Costaggiu, D, Pinna, E, Orru, F, Mannai, M, Cordioli, Z, Pelizzari, L, Turcato, E, Arduini, P, Cacace, C, Chiloiro, R, Cimino, R, Ruberto, C, Giovanni, R, Pietro, G, Laura, G, Alberto, C, Carmen, R, Santo, P, Andriolli, A, Burattin, G, Rossi, L, Andreolli Antonino, C, Tezza, F, Maddalena, P, Laura, S, Crippa, P, Aloisio, P, Di Monda, T, Malighetti, A, Galbassini, G, Salutis, D, Ivaldi, C, Russo, A, Bennati, E, Pino, E, Zavarise, G, Pesci, A, Suigo, G, Faverio, P, Andrea, G, Sabrina, P, Zanasi, M, Moniello, G, Rostagno, C, Cartei, A, Polidori, G, Ungar, A, Melis, M, Martellini, E, Enrico, M, Monica, T, Antonella, G, Giovanna, L, Migliorini, M, Caramelli, F, Battiston, B, Berardino, M, Cavallo, S, Alessandro, M, Anna, S, Lombardi, B, D'Ippolito, P, Furini, A, Villani, D, Clara, R, Guarneri, M, Paolucci, S, Bassi, A, Coiro, P, De Angelis, D, Morone, G, Venturiero, V, Palleschi, L, Raganato, P, Di Niro, G, Rosa, C, Loredana, B, Imoscopi, A, Tibaldi, V, Bottignole G, G, Calvi, E, Clementi, C, Zanocchi, M, Agosta, L, Nortarelli, A, Provenzano, G, Mari, D, Romano, F, Rosini, F, Mansi, M, Rossi, S, Geriatria, A, Inzaghi, L, Bonini, G, Rossi, P, Potena, A, Lichii, M, Candiani, T, Grimaldi, W, Bertani, E, Alessandra, P, Calogero, P, Pinto, D, Bernardi, R, Nicolino, F, Galetti, C, Gianstefani, A, Giulia, C, Lorenzo, M, Odetti, P, Monacelli, F, Prefumo, M, Fiammetta, M, Canepa, M, Minaglia, C, Paolisso, G, Rizzo, M, Prestano, R, Dalise, A, Barra, D, Bosco, L, Asprinio, V, Dallape, L, Perina, E, Incalzi, R, Bartoli, I, Pluderi, A, Maina, A, Pecoraro, E, Sciarra, M, Prudente, A, Paola, M, Francesca, M, Manuel, V, Luisella, C, Maria, P, Tina, S, Benini, L, Levato, F, Mhiuta, V, Alius, F, Davidoaia, D, Giardini, V, Garancini, M, Bellamoli, C, Terranova, L, Bozzini, C, Tosoni, P, Provoli, E, Cascone, L, Dioli, A, Ferrarin, G, Bucci, A, Bua, G, Fenu, S, Bianchi, G, Casella, S, Romano, V, Maurizio, P, Mascherona, I, Belotti, G, Cavaliere, S, Cuni, E, Merciuc, N, Oberti, R, Veneziani, S, Capoferri, E, De Bernardi, E, Colombo, K, Bravi, M, Nicoletta, N, D'Arcangelo, P, Montenegro, N, Montanari, R, Lamanna, P, Gasperini, B, Isabella, M, Stefania, D, Gaia, A, Filippo, C, Palama, C, Di Emidio, C, Scarpini, E, Arighi, A, Fumagalli, G, Basilico, P, De Amicis Margherita, M, Marta, M, Diletta, M, Granata, A, Ranalli, C, Cammilli, A, Cavallini, M, Tricca, M, Natella, D, Gabbani, L, Tesi, F, Martella, L, Imbrici, R, Guerrini, G, Scotuzzi, A, Sozzi, F, Valenti, L, Chiarello, A, Monia, M, Pilotto, A, Prete, C, Senesi, B, Meta, A, Pendenza, E, Pasqualetti, G, Polini, A, Tognini, S, Ballino, E, Dell'Aquila, G, Gasparrini, P, Marotti, E, Migale, M, Scrimieri, A, Falsetti, L, Salvi, A, Toigo, G, Ceschia, G, Rosso, A, Tongiorgi, C, Scarpa, C, De Dominicis, L, Pucci, E, Renzi, S, Cartechini, E, Tomassini, P, Del Gobbo, M, Ugenti, F, Romeo, P, Nardelli, A, Lauretani, F, Visioli, S, Montanari, I, Ermini, F, Giordano, A, Pigato, G, Simeone, E, Barbujani, M, Giampieri, M, Amoruso, R, Piccinini, M, Ferrari, C, Gambetti, C, Sfrappini, M, Semeraro, L, Striuli, R, Pelliccioni, G, Marinelli, D, Fabi, K, Rossi, T, Pesallaccia, M, Sabbatini, D, Gobbi, B, Cerqua, R, Tagliani, G, Schlauser, E, Caser, L, Caramello, E, Sandigliano, F, Rosso, G, Ferrari, A, Bendini, C, Luisa, D, Casella, M, Prampolini, R, Scevola, M, Vitale, E, Roberto, B, Carlo, F, Sergio, F, Alberto, S, Daniela, Z, Giulia, B, Serena, G, Michele, B, Maugeri, D, Sorace, R, Anzaldi, M, De Gesu, R, Morrone, G, Davolio, F, Fabbo, A, Palmieri, M, Zoli, M, Forti, P, Pirazzoli, L, Fabbri, E, Terenzi, L, Bergolari, F, Wenter, C, Ruffini, I, Insam, M, Abraham, E, Kirchlechner, C, Cucinotta, D, Antonino, L, Basile, G, Grazia, A, Parise, P, Boccali, A, Amici, S, Gambacorta, M, Lasagni, A, Lovati, R, Giovinazzo, F, Kimak, E, Zappa, P, Medici, F, Lo Castro, M, Mauro, F, De Luca, A, Sancesario, G, Martorana, A, Scaricamazza, B, Toniolo, S, Di Lorenzo, F, Liguori, C, Lasco, A, Vita, N, Giomi, M, Forte, F, Padovani, A, Rozzini, L, Ceraso, A, Salvatore, C, Cottino, M, Vitali, S, Marelli, E, Tripi, G, Miceli, S, Urso, G, Grioni, G, Vezzadini, G, Misaggi, G, Forlani, C, Avanzi, S, Serena, S, Claudia, C, Marilena, V, Alberto, L, Diego, G, Alessandro, G, Iemolo, F, Sanzaro, E, D'Asta, G, Proietto, M, Carnemolla, A, Razza, G, Spadaro, D, Bertolotti, M, Mussi, C, Neviani, F, Roberto, C, Valentina, G, Linda, M, Francesca, V, Tarozzi, A, Balestri, F, Mannarino, G, Bigolari, M, Natale, A, Grassi, S, Bottaro, C, Stefanelli, S, Bovone, U, Tortorolo, U, Quadri, R, Leone, G, Ponzetto, M, Frasson, P, Annoni, G, Confalonieri, R, Corsi, M, Moretti, D, Teruzzi, F, Umidi, S, Mazzola, P, Perego, S, Persico, I, Olivieri, G, Bonfanti, A, Hajnalka, S, Galeazzi, M, Massariello, F, Anzuini, A, Caffarra, P, Barocco, F, Spallazzi, M, Paolo, C, Simonetta, M, Chioatto, P, Bortolamei, S, Soattin, L, Ruotolo, G, Beneamino, B, Giuseppe, B, Bertazzoli, M, Rota, E, Adobati, A, Scarpa, A, Granziera, S, Zuccher, P, Fabbro, A, Zara, D, Lo Nigro, A, Franchetti, L, Toniolo, M, Marcuzzo, C, Rollone, M, Guerriero, F, Sgarlata, C, Masse, A, Zatti, G, Piatti, M, Graci, J, Benati, G, Boschi, F, Biondi, M, Fiumi, N, Erika, T, Locatelli, S, Mauri, S, Beretta, M, Margheritis, L, Desideri, G, Liberatore, E, Carucci, A, Bonino, P, Caput, M, Antonietti, M, Polistena, G, De la Pierre, F, Mari, M, Massignani, P, Tombesi, F, Selvaggio, F, Verbo, B, Bodoni, P, Marchionni, N, Sabatini, T, Mussio, E, Magni, E, Bianchetti, A, Crucitti, A, Titoldini, G, Cossu, B, Fascendini, S, Licini, C, Tomasoni, A, Calderazzo, M, Daniela, T, Valentina, L, Melotti, R, Lilli, A, Buda, S, Adversi, M, Noro, G, Turco, R, Ubezio, M, Mantovani, A, Viola, M, Serrati, C, Pretta, S, Infante, M, Gentile, S, D'Ambrosio, V, Mazzanti, P, Brambilla, C, Sportelli, S, Platto, C, Faraci, B, Quattrocchi, D, Pernigotti, L, Pisu, C, Sicuro, F, Zagnoni, P, Ghiglia, S, Mosca, M, Corazzin, I, Deola, M, Biagini, C, Bencini, F, Cantini, C, Tonon, E, Pierinelli, S, Onofrj, M, Thomas, A, Filomena, B, Bonanni, L, Gabriella, C, Comi, G, Magnani, G, Santangelo, R, Mazzeo, S, Francesca, C, Giordano, C, Roberto, S, Barbieri, C, Giroldi, L, Bandini, F, Masina, M, Malservisi, S, Cicognani, A, Ricca, L, Piccininni, M, Tassinari, T, Brogi, D, Sugo, A, Alessandra, F, Sonia, M, Valerio, V, Andrea, U, Enrico, C, Vera, R, Assunta, S, Gianmaria, Z, Mauro, P, Barone, A, Razzano, M, Giuseppe, I, Angela, B, Francesco, S, Valeria, D, Federico, G, Lucia, P, Antonella, V, Elisabetta, D, Cristina, R, Nadia, C, Maria, S, Luciano, A, Chiara, C, Bini, P, Pignata, M, Enrico, B, Maria, V, Giovanni, C, Giorgio, C, Piera, R, Alberto, Z, Ceccon, A, Magrin, L, Marin, S, Barbara, S, Matteo, M, Caterina, P, Carla, R, Federica, G, Clara, T, Melania, C, Giampaolo, B, Stefano, G, Valeria, G, Lucia, M, Giovambattista, D, Ester, L, Cecilia, C, Maurizio, T, Nadia, B, Grillo, A, Arenare, F, Tonino, M, David, K, Giorgio, V, Ubaldo, B, Vincenzo, S, Stefano, M, Marino, F, Busonera Flavio, M, Paolo, A, Monica, M, Francesco, B, Roberto, F, Paolo, B, Durantemangoni, E, Testoni, M, Fabio, D, Loredana, S, Valeria, S, Fabiano, M, Annabella, D, Salvatore, D, Greco, A, Grazia, D, Daniele, S, Gianluca, R, Renzo, G, Sergio, M, Morena, B, Vitali, M, Marina, P, Paolo, D, Cristina, S, Orlandini, F, La Regina, M, Desiree, A, Mario, B, Paola, P, Padulo, F, Cristina, M, Dario, R, Giancarla, M, Guido, R, Elena, M, Marileda, N, Igor, B, Nicole, B, Elena, R, Paolillo, C, Riccardi, A, Claudia, B, Barbara, R, Silvia, V, Oliver, B, Mauro, C, Eleonora, M, Giuseppe, P, Rosaria, T, Maria, C, Davide, D, Stefania, C, Massimo, P, Luca, S, Martina, D, Paola, V, Lia, S, Sandro, C, Valentina, D, Erminia, B, Paola, C, Romina, R, Minisola, S, Luciano, C, Pasquale, A, Ilaria, L, Guglielmo, S, Marco, E, Sara, R, Paola, A, Claudio, A, Francesco, R, Alessandro, C, Simona, M, Lara, F, Paola, R, Simonetta, C, Antonella, C, Generoso, U, Fernando, G, Giuliano, C, Emanuela, S, Mariolina, S, Alessandro, D, Giulia, L, Famularo, S, Sandini, M, Pinotti, E, Gianotti, L, Antonella, B, Giulia, P, Sante, G, Rossi, A, Rubele, S, Sant, S, Marco, V, Danila, C, Fabio, R, Bandirali, M, Nicoletta, C, Laura, B, Paolo, T, Luciano, T, Leonello, A, Margherita, S, Pierluigi, D, Laura, R, Fabiana, T, Giovanna, C, Antonino, A, Felice, C, Danilo, F, Giovanna, D, Francesco, L, Salini, S, Giorgetta, C, Giovanni, G, Gerardo, B, Silvio, R, Letizia, S, Davide, B, Rosaria, R, Maria, D, Raffaele, P, Palmieri, V, Palasciano, G, Belfiore, A, Portincasa, P, Carlo, S, Alessia, D, Valiani, V, Carolina, B, Tiziana, C, Paola, T, Ugo, P, Giacomo, P, Castellano, M, Anna, G, Elisa, C, Federica, C, Antonietta, C, Luigi, M, Fabio, L, Salvatore, B, Gelosa, G, Viviana, A, Piras, V, Andrea, C, Alessandra, B, Coen, D, Magliola, R, Milanesio, D, Muzzulini, C, Paolo, F, Marinella, T, Sofia, C, Marta, B, Siano, P, Capo, G, Napoletano, R, Cecilia, P, Mancini, C, Del Buono, C, De Bartolomeo, G, Addolorata, M, Carmen, C, Moschettini, G, Franco, M, Daniela, R, D'Amico, G, Mirella, P, Endrizzi, C, Trotta, L, Ciarambino, T, Orazio, Z, Emanuela, T, Marta, S, Thomas, F, Giacomo, T, Ignazio, D, Andrea, B, Giuseppe, O, Emanuela, F, Serena, A, Elena, D, Serena, B, Erika, N, Elena, S, Manuela, P, Francesca, A, Angelo, T, Morandi A., Zambon A., Di Santo S. G., Mazzone A., Cherubini A., Mossello E., Bo M., Marengoni A., Bellelli G., Rispoli V., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Chiaradia G., Gabriele A., Lenino P., Andrea T., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Passuti M. T., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Rigo R., Claudio P., Angelo B., Flavio C., Benedetta B., Boffelli S., Cassinadri A., Franzoni S., Spazzini E., Andretto D., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Ballardini G., Simoncelli M., Mancini A., Strazzacapa M., Fabio S., De Filippi F., Giudice C., Dentizzi C., Azzini M., Cazzadori M., Mastroeni V., Bertassello P., Claudia Benati H. S., Nesta E., Tobaldini C., Guerini F., Elena T., Mombelloni P., Fontanini F., Gabriella L., Pizzorni C., Oliverio M., Del Grosso L. L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Luca F. F., Andrea A., Giovanni S., Rossella N., Castegnaro E., De Rosa S., Sechi R. B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., Mauro D. B., Eleonora B., Martina P., Irene F., Riccardo B., Federica S., Ilaria D. L., Bertoletti E., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Antonino S., Francesco C., Valeria P. G., Daniela L., Domenico C., Giorgio B., March A., Nitti M. T., Felici A., Pavan S., Piazzani F., Lunelli A., Dimori S., Margotta A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Mecocci P., Longo A., Perticone F., Addesi D., Rosa P. C., Bencardino G., Falbo T., Grillo N., Marco F., Mirella F., Fanto F., Isaia G., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dijk B., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Giuseppe M., Costanza M., Vito A., Francesca B., Magherini L., Novella M., Franca B., Lucia Gambardella P. M., Valente C., Ilaria B., Alice F., Porrino P., Ceci G., Giuliana B., Michela T., Eleonora C., Ettore E., Camellini C., Servello A., Grassi A., Rozzini R., Tironi S., Grassi M. G., Troisi E., Carlo C., Simona Gabriella D. S., Flaminia F., Federica R., Beatrice P., Sofia T., Gabutto A., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M. L., Giuseppe C., Stefano B., Davide O., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Cotroneo A. M., Carlucci R., Abbaldo A., Monzani F., Qasem A. A., Bini G., Tafuto S., Galli G., Bruni A. C., Mancuso G., Calipari D., Giuseppe Massimiliano D. L., Bernardini B., Corsini C., Michele C., Sara D. F., Cagnin A., Fragiacomo F., Pompanin S., Piero A., Marco C., Zurlo A., Guerra G., Pala M., Menozzi L., Gatti C. D., Magon S., Roberto M., Alfredo D. G., Fabio F., Ruana T., Elisa M., Christian M., Marco P., Massimo G., Di Francesco V., Faccioli S., Pellizzari L., Giorgia F., Barbagallo G., Lunardelli M. L., Martini E., Ferrari E., Macchiarulo M., Corneli M., Bacci M., Battaglia G., Anastasio L., Lo Storto M. S., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Latella R., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Petritola D., Costa A., Sinforiani E., Cotta M. R., Pizio R. N., Cester A., Formilan M., Pietro B., Carbone P., Cazzaniga I., Appollonio I., Cereda D., Stabile A., Xhani R., Acampora R., Tremolizzo L., Federico P., Antonio C., Valerio P., Cesare B., Zhirajr M., Giovanni V., Maria A., Mariaelena S., Bottacchi E., Bucciantini E., Di Giovanni M., Franchi F., Lucchetti L., Mariani C., Grande G., Rapazzini P., Marco M., Romanelli G., Franco N., Alessio M., Nicola L., Laura P., Nazario P., Chiara G., Soccorso P., Andrea S., Luca B., Francesca S., Roberto A., Anna C., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Zuliani G., Ortolani B., Capatti E., Soavi C., Bianchi L., Francesconi D., Miselli A., Gloria B., Tommaso R., Chiara P., Agata M. M., Marco D. A., Luca M., Gianluca G., Suardi T., Zaccarini C., Manuela R., Mirra G., Muti E., Bottura R., Gianpaolo M., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R. C., Grassi G., Bombelli M., Dell'Oro R., Quarti Trevano F., Giussani G. C., Paternò G., Contro E., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Santo P. D., Andriolli A., Burattin G., Rossi L., Andreolli Antonino C. G., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Salutis D., Ivaldi C., Russo A. M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M. R., Martellini E., Enrico M., Monica T., Antonella G., Giovanna L., Migliorini M., Caramelli F., Battiston B., Berardino M., Cavallo S., Alessandro M., Anna S., Lombardi B., D'Ippolito P., Furini A., Villani D., Clara R., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Rosa C. A., Loredana B., Imoscopi A., Tibaldi V., Bottignole G G., Calvi E., Clementi C., Zanocchi M., Agosta L., Nortarelli A., Provenzano G., Mari D., Romano F. Y., Rosini F., Mansi M., Rossi S., Geriatria A. R., Inzaghi L., Bonini G., Rossi P., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Alessandra P., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Giulia C., Lorenzo M., Odetti P., Monacelli F., Prefumo M., Fiammetta M., Canepa M., Minaglia C., Paolisso G., Rizzo M. R., Prestano R., Dalise A. M., Barra D., Bosco L. D., Asprinio V., Dallape L., Perina E., Incalzi R. A., Bartoli I. R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P. L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M. C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A. M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A. C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P. M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P. F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Barbujani M., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D. M., Casella M., Prampolini R., Scevola M., Vitale E., Roberto B., Carlo F., Sergio F., Alberto S., Daniela Z., Giulia B., Serena G., Michele B., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Fabbo A., Palmieri M., Zoli M., Forti P., Pirazzoli L., Fabbri E., Terenzi L., Bergolari F., Wenter C., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Antonino L., Basile G., Grazia A. M., Parise P., Boccali A., Amici S., Gambacorta M., Lasagni A., Lovati R., Giovinazzo F., Kimak E., Zappa P., Medici F., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Padovani A., Rozzini L., Ceraso A., Salvatore C., Cottino M., Vitali S., Marelli E., Tripi G., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Avanzi S., Serena S., Claudia C., Marilena V., Alberto L., Diego G., Alessandro G., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Mussi C., Neviani F., Roberto C., Valentina G., Linda M., Francesca V., Tarozzi A., Balestri F., Mannarino G., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Annoni G., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Mazzola P., Perego S., Persico I., Olivieri G., Bonfanti A., Hajnalka S., Galeazzi M., Massariello F., Anzuini A., Caffarra P., Barocco F., Spallazzi M., Paolo C. G., Simonetta M., Chioatto P., Bortolamei S., Soattin L., Ruotolo G., Beneamino B., Giuseppe B., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Fabbro A. D., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Boschi F., Biondi M., Fiumi N., Erika T., Locatelli S. M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A. C., Bonino P., Caput M., Antonietti M. P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Marchionni N., Sabatini T., Mussio E., Magni E., Bianchetti A., Crucitti A., Titoldini G., Cossu B., Fascendini S., Licini C., Tomasoni A., Calderazzo M., Daniela T., Valentina L., Melotti R. M., Lilli A., Buda S., Adversi M., Noro G., Turco R., Ubezio M. C., Mantovani A. R., Viola M. C., Serrati C., Pretta S., Infante M., Gentile S., D'Ambrosio V., Mazzanti P., Brambilla C., Sportelli S., Platto C., Faraci B., Quattrocchi D., Pernigotti L. M., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Biagini C. A., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Filomena B., Bonanni L., Gabriella C., Comi G., Magnani G., Santangelo R., Mazzeo S., Francesca C., Giordano C., Roberto S. A., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Piccininni M., Tassinari T., Brogi D., Sugo A., Alessandra F., Sonia M., Valerio V., Andrea U. C., Enrico C., Vera R. F., Assunta S., Gianmaria Z., Mauro P., Barone A., Razzano M., Giuseppe I., Angela B., Francesco S., Valeria D. A., Federico G., Lucia P., Antonella V., Elisabetta D. C., Cristina R., Nadia C., Maria S., Luciano A., Chiara C., Bini P., Pignata M., Enrico B., Maria V., Giovanni C., Giorgio C., Piera R., Alberto Z., Ceccon A., Magrin L., Marin S., Barbara S., Matteo M., Caterina P. M., Carla R., Federica G., Clara T., Melania C., Giampaolo B., Stefano G., Valeria G., Lucia M., Giovambattista D., Ester L., Cecilia C. A., Maurizio T., Nadia B., Grillo A., Arenare F., Tonino M., David K., Giorgio V. P., Ubaldo B., Vincenzo S., Stefano M., Marino F., Busonera Flavio M. T., Paolo A., Monica M., Francesco B., Roberto F., Paolo B., DuranteMangoni E., Testoni M., Fabio D. S., Loredana S., Valeria S., Fabiano M., Annabella D. G., Salvatore D. C., Greco A., Grazia D. O., Daniele S., Gianluca R., Renzo G., Sergio M., Morena B., Vitali M., Marina P., Paolo D. C., Cristina S., Orlandini F., La Regina M., Desiree A., Mario B., Paola P., Padulo F., Cristina M., Dario R., Giancarla M., Guido R., Elena M., Marileda N., Igor B., Nicole B., Elena R., Paolillo C., Riccardi A., Claudia B., Barbara R., Silvia V., Oliver B., Mauro C., Eleonora M., Giuseppe P., Rosaria T., Maria C., Davide D. A., Stefania C., Massimo P., Luca S., Martina D. F., Paola V., Lia S., Sandro C., Valentina D. S., Erminia B., Paola C., Romina R., Minisola S., Luciano C., Pasquale A., Ilaria L., Guglielmo S., Marco E., Sara R., Paola A., Claudio A., Francesco R., Alessandro C., Simona M., Lara F., Paola R., Simonetta C., Antonella C., Generoso U., Fernando G., Giuliano C., Emanuela S., Mariolina S., Alessandro D., Giulia L., Famularo S., Sandini M., Pinotti E., Gianotti L., Antonella B., Giulia P., Sante G., Rossi A., Rubele S., Sant S., Marco V., Danila C., Fabio R., Bandirali M. P., Nicoletta C., Laura B., Paolo T., Luciano T., Leonello A., Margherita S., Stefania D. N., Pierluigi D. S., Laura R., Fabiana T., Giovanna C., Antonino A., Felice C., Danilo F., Giovanna D. B., Francesco L., Salini S., Angela B. M., Giorgetta C., Giovanni G., Gerardo B., Silvio R., Letizia S., Davide B., Rosaria R. M., Maria D. A., Raffaele P., Palmieri V. O., Palasciano G., Belfiore A., Portincasa P., Carlo S., Alessia D., Valiani V., Carolina B., Tiziana C., Paola T., Ugo P., Giacomo P., Castellano M., Anna G., Elisa C., Federica C., Antonietta C. M., Luigi M., Fabio L., Salvatore B., Gelosa G., Viviana A. T., Piras V., Andrea C., Alessandra B., Coen D., Magliola R., Milanesio D., Muzzulini C. L., Paolo F., Marinella T., Sofia C. M., Marta B., Siano P., Capo G., Napoletano R., Cecilia P., Mancini C., Del Buono C., De Bartolomeo G., Addolorata M., Carmen C., Giovanni V. A., Moschettini G., Franco M., Daniela R., D'Amico G., Mirella P., Endrizzi C., Trotta L., Ciarambino T., Orazio Z., Emanuela T., Marta S., Thomas F., Giacomo T., Ignazio D. F., Andrea B., Giuseppe O., Emanuela F., Serena A., Elena D. I., Serena B., Erika N., Roberto S., Elena S., Manuela P., Francesca A., and Angelo T.

Abstract

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.

Published
2020

17. Robot-assisted arm therapy in neurological health conditions: Rationale and methodology for the evidence synthesis in the CICERONE Italian Consensus Conference

Author

Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., Santacaterina, F., Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., and Santacaterina, F.

Subjects
Upper extremity, Consensus, Robot, medicine.medical_treatment, Population, Psychological intervention, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Consensu, Robotic surgical procedure, Consensus development conference, Neurological rehabilitation, Rehabilitation, Robotic surgical procedures, Arm, Humans, Italy, Disabled Persons, Robotics, NO, Nursing, medicine, education, Upper limb, education.field_of_study, Rehabilitation, Robotics, Upper extremity, Neurological rehabilitation, Consensus conference, business.industry, Consensus conference, Neurological health conditions, Data extraction, Electromechanical devices, Disabled Person, Working group, business, Evidence synthesis, Human
Abstract

BACKGROUND: Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions. AIM: The aim of this paper was to explain the methodology used by the working group dedicated to synthesizing evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference. DESIGN: The methodological approach of the working group. SETTING: All rehabilitation settings. POPULATION: Patients with disability following a neurological health condition. METHODS: Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions. RESULTS: WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed. CONCLUSIONS: This paper summarized the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions. CLINICAL REHABILITATION IMPACT: WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.

Published
2021

18. What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials

Author

Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., Taglione, E., Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., and Taglione, E.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Walk Test, Cochrane Library, law.invention, Multiple sclerosis, Disability Evaluation, Physical medicine and rehabilitation, Gait training, Randomized controlled trial, law, Multiple Sclerosi, Neurologic, Medicine, Humans, Gait Disorders, Gait, Gait Disorders, Neurologic, Randomized Controlled Trials as Topic, Rehabilitation, Robotics, Combined Modality Therapy, Multiple Sclerosis, Exoskeleton Device, business.industry, Evidence-based medicine, Robotic, Berg Balance Scale, business, human activities, Human
Abstract

Introduction In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described. Evidence acquisition As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies. Evidence synthesis The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed. Conclusions In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.

Published
2021

21. Urgent Measures for the Containment of the Coronavirus (Covid-19) Epidemic in the Neurorehabilitation/Rehabilitation Departments in the Phase of Maximum Expansion of the Epidemic

Author

Bartolo, M., Intiso, D., Lentino, C., Sandrini, G., Paolucci, S., Zampolini, M., Alfonsi, E., Antonucci, G., Baricich, A., Casu, G., Ciancarelli, I., Cisari, C., De Tanti, A., Estraneo, A., Ferraro, F., Gandolfi, M., Invernizzi, M., Iolascon, G., Martinuzzi, A., Morelli, D., Morone, G., Munari, D., Nordio, S., Picelli, A., Scarponi, F., Pingue, V., Solaro, C., Trompetto, C., Bartolo, M., Intiso, D., Lentino, C., Sandrini, G., Paolucci, S., Zampolini, M., Alfonsi, E., Antonucci, G., Baricich, A., Casu, G., Ciancarelli, I., Cisari, C., De Tanti, A., Estraneo, A., Ferraro, F., Gandolfi, M., Invernizzi, M., Iolascon, G., Martinuzzi, A., Morelli, D., Morone, G., Munari, D., Nordio, S., Picelli, A., Scarponi, F., Pingue, V., Solaro, C., and Trompetto, C.

Subjects
Settore M-PSI/02 - PSICOBIOLOGIA E PSICOLOGIA FISIOLOGICA, medicine.medical_treatment, Phase (combat), lcsh:RC346-429, epidemic, rehabilitation, 03 medical and health sciences, 0302 clinical medicine, Documentation, Intensive care, Health care, Pandemic, medicine, 030212 general & internal medicine, COVID-19, rehabilitation, neurorehabilitation, epidemic, infection, health care, organization, lcsh:Neurology. Diseases of the nervous system, Neurorehabilitation, neurorehabilitation, Rehabilitation, business.industry, COVID-19, health care, infection, organization, medicine.disease, Neurology, Perspective, Neurology (clinical), Medical emergency, business, Choking, 030217 neurology & neurosurgery
Abstract

COVID-19 has rapidly become a pandemic emergency, distressing health systems in each affected country. COVID-19 determines the need for healthcare in a large number of people in an extremely short time and, like a tsunami wave, overruns emergency, infectious diseases, and pneumology departments as well as intensive care units, choking healthcare services. Rehabilitation services are also affected by this epidemic which forces radical changes both in the organization and in the operating methods. In the absence of reference literature on this issue, this report aims to provide a background documentation to support physicians and healthcare personnel involved in neurorehabilitation and rehabilitation care.

Published
2020
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22. Effectiveness of a sensor-based technology in upper limb motor recovery in post-acute stroke neurorehabilitation: A randomized controlled trial

Author

Tramontano, M., Morone, G., Angela Palomba, Angelis, S., Mercuro, A., Caltagirone, C., Grasso, M. G., Tramontano, M., Morone, G., Palomba, A., De Angelis, S., Mercuro, A., Caltagirone, C., and Grasso, M. G.

Subjects
Stroke, Upper Extremity, Stroke rehabilitation, Upper limb sensory-motor training, Treatment Outcome, Sensor-based motor rehabilitation, Humans, Subacute stroke, Recovery of Function
Abstract

Sensor-based technological therapy devices could be a possible neurorehabilitation strategy for motor rehabilitation in patients with stroke during the post-acute hospitalization, especially for treating upper extremities function limitations. The audio-visual feedback devices are characterized by interactive therapy games that allow training the movement of shoulders, elbows, and wrist, measuring the strength and the active range of motion of upper limb, registering data in an electronic database to quantitatively monitoring measures and therapy progress. This study aimed to investigate the effects of sensor-based motor rehabilitation in add-on to the conventional neurorehabilitation for improving the upper limb functions in patients with subacute stroke. Thirty-seven patients were enrolled in the study and randomly assigned to the experimental group and the control group. The training consisting of twelve sessions of upper limb training compared with twelve sessions of upper limb sensory-motor training, without robotic support. Both rehabilitation programs were performed for 40 minutes three times a week, for 4 weeks, in addition to conventional therapy. All patients were evaluated at the baseline (T0) and after 4 weeks of training (T1). The within-subject analysis showed a statistically significant improvement in both groups in all clinical scales. The analysis of effectiveness revealed that, compared with baseline (T0), the improvement percentage in the Modified Barthel Index was greater in the experimental group than the control group. The use of a sensor-based training with audio-video-feedback could be a useful complementary strategy for improving upper limb motor functions in patients with stroke during post-acute neurorehabilitation.&nbsp

Published
2020

23. Watch your step! Who can recover stair climbing independence after stroke?

Author

Morone, G, Matamala-Gomez, M, Sanchez-Vives, M, Paolucci, S, Iosa, M, Morone G., Matamala-Gomez Marta., Sanchez-Vives M. V., Paolucci S., Iosa M., Morone, G, Matamala-Gomez, M, Sanchez-Vives, M, Paolucci, S, Iosa, M, Morone G., Matamala-Gomez Marta., Sanchez-Vives M. V., Paolucci S., and Iosa M.

Abstract

BACKGROUND: After discharge, most patients who have suffered a stroke remain with some limitations in their stair climbing ability. This is a critical factor in order to be independent in real-life mobility. Although there are several studies on prognostic factors for gait recovery, few of them have focused on the recovery of stair climbing. AIM: The aim of this study was to identify prognostic risk factors for the recovery of stair climbing ability in a large sample of subjects with subacute stroke. DESIGN: Observational study. SETTING: Neurorehabilitation Inpatient Unit. POPULATION: Subjects within the first month after stroke that had been admitted to an inpatient rehabilitation unit and discharged after an intensive inpatient rehabilitation. METHODS: Demographical and clinical data were collected. Barthel Index (BI), Trunk Control Test and Motricity Index (MI) scores were recorded at admission and at discharge. Patients received two daily 40-minute sessions of motor rehabilitation, six days per week, during approximately two months. Forward Binary Logistic regressions were used to identify the role of risk factors, using as dependent variables the recovery of stair climbing ability and walking ability at discharge. As independent variables we used age, gender, onset-to-admission interval, side of hemiparesis, trunk control, Motricity Index (MI), presence of obesity, presence of neglect, presence of depression, classification of cerebral infarction (total anterior circulation, partial anterior circulation, posterior circulation or lacunar infarcts), degree of independence in activities of daily living, and cognitive state, all assessed at admission. RESULTS: A total of 257 subjects were enrolled. BI-Score, MI-Score and presence of unilateral spatial neglect at admission were able to explain 83% of variance for the recovery of stair climbing ability. Subjects with a BI >40 at admission were about 17 times more likely to be able to climb stairs again than other

Published
2018

24. The efficacy of vestibular rehabilitation in patients with neurological disorders: a systematic review

Author

Tramontano, Marco, Russo, Valentina, Spitoni, G. F., Ciancarelli, I., Paolucci, S., Manzari, L., and Morone, G.

Subjects
Balance, Multiple Sclerosis, Cerebral stroke, Vestibular Rehabilitation, Physiotherapy techniques, Brain injuries, Parkinson disease, Stroke, Balance postural, Brain injuries, Cerebral stroke, Multiple sclerosis, TBI, VOR adaptation, Oculo-motor reflex, Parkinson, Sensory-motor Learning
Abstract

Objective: The aim of this systematic review is to critically assess the effectiveness of vestibular rehabilitation (VR) administered either alone or in combination with other neurorehabilitation strategies in patients with neurologic disorders. Data Sources: An electronic search was conducted by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. Study Selection: All clinical studies carried out on adult patients with a diagnosis of neurologic disorders who performed VR provided alone or in combination with other therapies were included. Data Extraction: Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa Scale. Data Synthesis: The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Twelve studies were included in the review. All the included studies, with 1 exception, report that improvements provided by customized VR in subject affected by a central nervous system diseases are greater than traditional rehabilitation programs alone. Conclusions: Because of the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VR cannot be made. Results show that VR programs are safe and could easily be implemented with standard neurorehabilitation protocols in patients affected by neurologic disorders. Hence, more high-quality randomized controlled trials of VR in patients with neurologic disorders are needed.

Published
2020

25. From movement to thought and back: a review on the role of cognitive factors influencing technological neurorehabilitation

Author

De Bartolo, D, Spitoni, Gf, Iosa, M, Morone, G, Ciancarelli, I, Paolucci, S, and Antonucci, G

Subjects
motor rehabilitation, cognition: technologies, motor disorders, cognitive rehabilitation, new technologies, rehabilitation
Abstract

In recent years, cognitive theories have increasingly influenced the approach to motor rehabilitation. The connection between different aspects of cognitive and motor function is increasingly documented, underlining the importance of developing rehabilitation projects that take cognitive aspects into account. The aim of this non-systematic review is to highlight the relationship between cognition and motion and, in the light of new rehabilitation technologies, to better define how aspects of cognition can affect motor rehabilitation.

Published
2020

26. The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a study protocol for a randomized controlled trial to test early and long-term efficacy and to identify determinants of response

Author

Mattia, D., Pichiorri, F., Colamarino, E., Masciullo, M., Morone, G., Toppi, J., Pisotta, I., Tamburella, F., Lorusso, M., Paolucci, S., Puopolo, M., and Cincotti, F.

Subjects
Male, 030506 rehabilitation, Longitudinal study, Motor learning, medicine.medical_treatment, Brain plasticity, EEG-based brain-computer interface, Hand functional motor recovery, Motor imagery, Neurorehabilitation, Stroke, lcsh:RC346-429, law.invention, Study Protocol, 0302 clinical medicine, Randomized controlled trial, law, Medicine, Longitudinal Studies, Randomized Controlled Trials as Topic, Rehabilitation, Stroke Rehabilitation, Electroencephalography, General Medicine, Middle Aged, Brain-Computer Interfaces, Imagination, Female, 0305 other medical science, Adult, medicine.medical_specialty, Modified Ashworth scale, Motor Activity, Upper Extremity, 03 medical and health sciences, Physical medicine and rehabilitation, Humans, lcsh:Neurology. Diseases of the nervous system, business.industry, Recovery of Function, medicine.disease, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background Stroke is a leading cause of long-term disability. Cost-effective post-stroke rehabilitation programs for upper limb are critically needed. Brain-Computer Interfaces (BCIs) which enable the modulation of Electroencephalography (EEG) sensorimotor rhythms are promising tools to promote post-stroke recovery of upper limb motor function. The “Promotoer” study intends to boost the application of the EEG-based BCIs in clinical practice providing evidence for a short/long-term efficacy in enhancing post-stroke hand functional motor recovery and quantifiable indices of the participants response to a BCI-based intervention. To these aims, a longitudinal study will be performed in which subacute stroke participants will undergo a hand motor imagery (MI) training assisted by the Promotoer system, an EEG-based BCI system fully compliant with rehabilitation requirements. Methods This longitudinal 2-arm randomized controlled superiority trial will include 48 first ever, unilateral, subacute stroke participants, randomly assigned to 2 intervention groups: the BCI-assisted hand MI training and a hand MI training not supported by BCI. Both interventions are delivered (3 weekly session; 6 weeks) as add-on regimen to standard intensive rehabilitation. A multidimensional assessment will be performed at: randomization/pre-intervention, 48 h post-intervention, and at 1, 3 and 6 month/s after end of intervention. Primary outcome measure is the Fugl-Meyer Assessment (FMA, upper extremity) at 48 h post-intervention. Secondary outcome measures include: the upper extremity FMA at follow-up, the Modified Ashworth Scale, the Numeric Rating Scale for pain, the Action Research Arm Test, the National Institute of Health Stroke Scale, the Manual Muscle Test, all collected at the different timepoints as well as neurophysiological and neuroimaging measures. Discussion We expect the BCI-based rewarding of hand MI practice to promote long-lasting retention of the early induced improvement in hand motor outcome and also, this clinical improvement to be sustained by a long-lasting neuroplasticity changes harnessed by the BCI-based intervention. Furthermore, the longitudinal multidimensional assessment will address the selection of those stroke participants who best benefit of a BCI-assisted therapy, consistently advancing the transfer of BCIs to a best clinical practice. Trial registration Name of registry: BCI-assisted MI Intervention in Subacute Stroke (Promotoer). Trial registration number: NCT04353297; registration date on the ClinicalTrial.gov platform: April, 15/2020.

Published
2020

27. Adipokines and Neurorehabilitation in Obese Stroke Patients

Author

Ciancarelli I, Morone G, Iosa M, Paolucci S, Pignolo L, Tonin P, Antonio Cerasa, and Ciancarelli MGT

Subjects
Neurorehabilitation, Obesity, stroke patients, hormones, hormone substitutes, and hormone antagonists
Abstract

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

Published
2020
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28. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials

Author

Hayden, J.A., Wilson, Maria, Stewart, S., Cartwright, J.L., Smith, A.O., Riley, R.D., Tulder, M. van, Bendix, T., Cecchi, F., Costa, L.O.P., Dufour, N., Ferreira, M.L., Foster, N.E., Gudavalli, M.R., Hartvigsen, J., Helmhout, P., Kool, J., Koumantakis, G.A., Kovacs, F.M., Kuukkanen, T., Long, A., Macedo, L.G., Machado, L.A.C., Maher, C.G., Mehling, W., Morone, G., Peterson, T., Rasmussen-Barr, E., Ryan, C.G., Sjögren, T., Smeets, R., Staal, J.B., Unsgaard-Tøndel, M., Wajswelner, H., Yeung, E.W., Hayden, J.A., Wilson, Maria, Stewart, S., Cartwright, J.L., Smith, A.O., Riley, R.D., Tulder, M. van, Bendix, T., Cecchi, F., Costa, L.O.P., Dufour, N., Ferreira, M.L., Foster, N.E., Gudavalli, M.R., Hartvigsen, J., Helmhout, P., Kool, J., Koumantakis, G.A., Kovacs, F.M., Kuukkanen, T., Long, A., Macedo, L.G., Machado, L.A.C., Maher, C.G., Mehling, W., Morone, G., Peterson, T., Rasmussen-Barr, E., Ryan, C.G., Sjögren, T., Smeets, R., Staal, J.B., Unsgaard-Tøndel, M., Wajswelner, H., and Yeung, E.W.

Abstract

Item does not contain fulltext, BACKGROUND: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise. METHODS: In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers. RESULTS: We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers-these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics. CONCLUSIONS: This study provides potentially useful information to help treat patients and design future studies of exercise inte

Published
2020

29. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Author

Morandi, A., Zambon, A., Di Santo, S. G., Mazzone, A., Cherubini, A., Mossello, E., Bo, M., Marengoni, A., Bellelli, G., Rispoli, V., Malara, A., Spadea, F., Di Cello, S., Ceravolo, F., Fabiano, F., Chiaradia, G., Gabriele, A., Lenino, P., Andrea, T., Settembrini, V., Capomolla, D., Citrino, A., Scriva, A., Bruno, I., Secchi, R., De Martino, E., Muccinelli, R., Lupi, G., Paonessa, P., Fabbri, A., Passuti, M. T., Castellari, S., Po, A., Gaggioli, G., Varesi, M., Moneti, P., Capurso, S., Latini, V., Ghidotti, S., Riccardelli, F., Macchi, M., Rigo, R., Claudio, P., Angelo, B., Flavio, C., Benedetta, B., Boffelli, S., Cassinadri, A., Franzoni, S., Spazzini, E., Andretto, D., Tonini, G., Andreani, L., Coralli, M., Balotta, A., Cancelliere, R., Ballardini, G., Simoncelli, M., Mancini, A., Strazzacapa, M., Fabio, S., De Filippi, F., Giudice, C., Dentizzi, C., Azzini, M., Cazzadori, M., Mastroeni, V., Bertassello, P., Claudia Benati, H. S., Nesta, E., Tobaldini, C., Guerini, F., Elena, T., Mombelloni, P., Fontanini, F., Gabriella, L., Pizzorni, C., Oliverio, M., Del Grosso, L. L., Giavedoni, C., Bidoli, G., Mazzei, B., Corsonello, A., Fusco, S., Vena, S., De Vuono, T., Maiuri, G., Luca, F. F., Andrea, A., Giovanni, S., Rossella, N., Castegnaro, E., De Rosa, S., Sechi, R. B., Benvenuti, E., Del Lungo, I., Giardini, S., Giulietti, C., Mauro, D. B., Eleonora, B., Martina, P., Irene, F., Riccardo, B., Federica, S., Ilaria, D. L., Bertoletti, E., D'Amico, F., Caronzolo, F., Grippa, A., Lombardo, G., Pipicella, T., Antonino, S., Francesco, C., Valeria, P. G., Daniela, L., Domenico, C., Giorgio, B., March, A., Nitti, M. T., Felici, A., Pavan, S., Piazzani, F., Lunelli, A., Dimori, S., Margotta, A., Soglia, T., Postacchini, D., Brunelli, R., Santini, S., Francavilla, M., Macchiati, I., Sorvillo, F., Giuli, C., Mecocci, P., Longo, A., Perticone, F., Addesi, D., Rosa, P. C., Bencardino, G., Falbo, T., Grillo, N., Marco, F., Mirella, F., Fanto, F., Isaia, G., Pezzilli, S., Bergamo, D., Furno, E., Rrodhe, S., Lucarini, S., Dijk, B., Dall'Acqua, F., Cappelletto, F., Calvani, D., Becheri, D., Giuseppe, M., Costanza, M., Vito, A., Francesca, B., Magherini, L., Novella, M., Franca, B., Lucia Gambardella, P. M., Valente, C., Ilaria, B., Alice, F., Porrino, P., Ceci, G., Giuliana, B., Michela, T., Eleonora, C., Ettore, E., Camellini, C., Servello, A., Grassi, A., Rozzini, R., Tironi, S., Grassi, M. G., Troisi, E., Carlo, C., Simona Gabriella, D. S., Flaminia, F., Federica, R., Beatrice, P., Sofia, T., Gabutto, A., Quazzo, L., Rosatello, A., Suraci, D., Tagliabue, B., Perrone, C., Ferrara, L., Castagna, A., Tremolada, M. L., Giuseppe, C., Stefano, B., Davide, O., Piano, S., Serviddio, G., Lo Buglio, A., Gurrera, T., Merlo, V., Rovai, C., Cotroneo, A. M., Carlucci, R., Abbaldo, A., Monzani, F., Qasem, A. A., Bini, G., Tafuto, S., Galli, G., Bruni, A. C., Mancuso, G., Calipari, D., Giuseppe Massimiliano, D. L., Bernardini, B., Corsini, C., Michele, C., Sara, D. F., Cagnin, A., Fragiacomo, F., Pompanin, S., Piero, A., Marco, C., Zurlo, A., Guerra, G., Pala, M., Menozzi, L., Gatti, C. D., Magon, S., Roberto, M., Alfredo, D. G., Fabio, F., Ruana, T., Elisa, M., Christian, M., Marco, P., Massimo, G., Di Francesco, V., Faccioli, S., Pellizzari, L., Giorgia, F., Barbagallo, G., Lunardelli, M. L., Martini, E., Ferrari, E., Macchiarulo, M., Corneli, M., Bacci, M., Battaglia, G., Anastasio, L., Lo Storto, M. S., Seresin, C., Simonato, M., Loreggian, M., Cestonaro, F., Durando, M., Latella, R., Mazzoleni, M., Russo, G., Ponte, M., Valchera, A., Salustri, G., Petritola, D., Costa, A., Sinforiani, E., Cotta, M. R., Pizio, R. N., Cester, A., Formilan, M., Pietro, B., Carbone, P., Cazzaniga, I., Appollonio, I., Cereda, D., Stabile, A., Xhani, R., Acampora, R., Tremolizzo, L., Federico, P., Antonio, C., Valerio, P., Cesare, B., Zhirajr, M., Giovanni, V., Maria, A., Mariaelena, S., Bottacchi, E., Bucciantini, E., Di Giovanni, M., Franchi, F., Lucchetti, L., Mariani, C., Grande, G., Rapazzini, P., Marco, M., Romanelli, G., Franco, N., Alessio, M., Nicola, L., Laura, P., Nazario, P., Chiara, G., Soccorso, P., Andrea, S., Luca, B., Francesca, S., Roberto, A., Anna, C., Fugazza, L., Guerrini, C., De Paduanis, G., Iallonardo, L., Palumbo, P., Zuliani, G., Ortolani, B., Capatti, E., Soavi, C., Bianchi, L., Francesconi, D., Miselli, A., Gloria, B., Tommaso, R., Chiara, P., Agata, M. M., Marco, D. A., Luca, M., Gianluca, G., Suardi, T., Zaccarini, C., Manuela, R., Mirra, G., Muti, E., Bottura, R., Gianpaolo, M., Secreto, P., Bisio, E., Cecchettani, M., Naldi, T., Pallavicino, A., Pugliese, M., Iozzo, R. C., Grassi, G., Michele, B., Raffaella, D. O., Fosca, Q. T., Giorgio, G. C., Giovanni, P., Ernesto, C., Mannironi, A., Giorli, E., Oberti, S., Fierro, B., Piccoli, T., Giacalone, F., Mandas, A., Serchisu, L., Costaggiu, D., Pinna, E., Orru, F., Mannai, M., Cordioli, Z., Pelizzari, L., Turcato, E., Arduini, P., Cacace, C., Chiloiro, R., Cimino, R., Ruberto, C., Giovanni, R., Pietro, G., Laura, G., Alberto, C., Carmen, R., Santo, P. D., Andriolli, A., Burattin, G., Rossi, L., Andreolli Antonino, C. G., Tezza, F., Maddalena, P., Laura, S., Crippa, P., Aloisio, P., Di Monda, T., Malighetti, A., Galbassini, G., Salutis, D., Ivaldi, C., Russo, A. M., Bennati, E., Pino, E., Zavarise, G., Pesci, A., Suigo, G., Faverio, P., Andrea, G., Sabrina, P., Zanasi, M., Moniello, G., Rostagno, C., Cartei, A., Polidori, G., Ungar, A., Melis, M. R., Martellini, E., Enrico, M., Monica, T., Antonella, G., Giovanna, L., Migliorini, M., Caramelli, F., Battiston, B., Berardino, M., Cavallo, S., Alessandro, M., Anna, S., Lombardi, B., D'Ippolito, P., Furini, A., Villani, D., Clara, R., Guarneri, M., Paolucci, S., Bassi, A., Coiro, P., De Angelis, D., Morone, G., Venturiero, V., Palleschi, L., Raganato, P., Di Niro, G., Rosa, C. A., Loredana, B., Imoscopi, A., Tibaldi, V., Bottignole G, G., Calvi, E., Clementi, C., Zanocchi, M., Agosta, L., Nortarelli, A., Provenzano, G., Mari, D., Romano, F. Y., Rosini, F., Mansi, M., Rossi, S., Geriatria, A. R., Inzaghi, L., Bonini, G., Rossi, P., Potena, A., Lichii, M., Candiani, T., Grimaldi, W., Bertani, E., Alessandra, P., Calogero, P., Pinto, D., Bernardi, R., Nicolino, F., Galetti, C., Gianstefani, A., Giulia, C., Lorenzo, M., Odetti, P., Monacelli, F., Prefumo, M., Fiammetta, M., Canepa, M., Minaglia, C., Paolisso, G., Rizzo, M. R., Prestano, R., Dalise, A. M., Barra, D., Bosco, L. D., Asprinio, V., Dallape, L., Perina, E., Incalzi, R. A., Bartoli, I. R., Pluderi, A., Maina, A., Pecoraro, E., Sciarra, M., Prudente, A., Paola, M., Francesca, M., Manuel, V., Luisella, C., Maria, P. L., Tina, S., Benini, L., Levato, F., Mhiuta, V., Alius, F., Davidoaia, D., Giardini, V., Garancini, M., Bellamoli, C., Terranova, L., Bozzini, C., Tosoni, P., Provoli, E., Cascone, L., Dioli, A., Ferrarin, G., Bucci, A., Bua, G., Fenu, S., Bianchi, G., Casella, S., Romano, V., Maurizio, P., Mascherona, I., Belotti, G., Cavaliere, S., Cuni, E., Merciuc, N., Oberti, R., Veneziani, S., Capoferri, E., De Bernardi, E., Colombo, K., Bravi, M., Nicoletta, N., D'Arcangelo, P., Montenegro, N., Montanari, R., Lamanna, P., Gasperini, B., Isabella, M., Stefania, D., Gaia, A., Filippo, C., Palama, C., Di Emidio, C., Scarpini, E., Arighi, A., Fumagalli, G., Basilico, P., De Amicis Margherita, M., Marta, M., Diletta, M., Granata, A., Ranalli, C., Cammilli, A., Cavallini, M. C., Tricca, M., Natella, D., Gabbani, L., Tesi, F., Martella, L., Imbrici, R., Guerrini, G., Scotuzzi, A. M., Sozzi, F., Valenti, L., Chiarello, A., Monia, M., Pilotto, A., Prete, C., Senesi, B., Meta, A. C., Pendenza, E., Pasqualetti, G., Polini, A., Tognini, S., Ballino, E., Dell'Aquila, G., Gasparrini, P. M., Marotti, E., Migale, M., Scrimieri, A., Falsetti, L., Salvi, A., Toigo, G., Ceschia, G., Rosso, A., Tongiorgi, C., Scarpa, C., De Dominicis, L., Pucci, E., Renzi, S., Cartechini, E., Tomassini, P. F., Del Gobbo, M., Ugenti, F., Romeo, P., Nardelli, A., Lauretani, F., Visioli, S., Montanari, I., Ermini, F., Giordano, A., Pigato, G., Simeone, E., Barbujani, M., Giampieri, M., Amoruso, R., Piccinini, M., Ferrari, C., Gambetti, C., Sfrappini, M., Semeraro, L., Striuli, R., Pelliccioni, G., Marinelli, D., Fabi, K., Rossi, T., Pesallaccia, M., Sabbatini, D., Gobbi, B., Cerqua, R., Tagliani, G., Schlauser, E., Caser, L., Caramello, E., Sandigliano, F., Rosso, G., Ferrari, A., Bendini, C., Luisa, D. M., Casella, M., Prampolini, R., Scevola, M., Vitale, E., Roberto, B., Carlo, F., Sergio, F., Alberto, S., Daniela, Z., Giulia, B., Serena, G., Maugeri, D., Sorace, R., Anzaldi, M., De Gesu, R., Morrone, G., Davolio, F., Fabbo, A., Palmieri, M., Zoli, M., Forti, P., Pirazzoli, L., Fabbri, E., Terenzi, L., Bergolari, F., Wenter, C., Ruffini, I., Insam, M., Abraham, E., Kirchlechner, C., Cucinotta, D., Antonino, L., Basile, G., Grazia, A. M., Parise, P., Boccali, A., Amici, S., Gambacorta, M., Lasagni, A., Lovati, R., Giovinazzo, F., Kimak, E., Zappa, P., Medici, F., Lo Castro, M., Mauro, F., De Luca, A., Sancesario, G., Martorana, A., Scaricamazza, B., Toniolo, S., Di Lorenzo, F., Liguori, C., Lasco, A., Vita, N., Giomi, M., Forte, F., Padovani, A., Rozzini, L., Ceraso, A., Salvatore, C., Cottino, M., Vitali, S., Marelli, E., Tripi, G., Miceli, S., Urso, G., Grioni, G., Vezzadini, G., Misaggi, G., Forlani, C., Avanzi, S., Serena, S., Claudia, C., Marilena, V., Alberto, L., Diego, G., Alessandro, G., Iemolo, F., Sanzaro, E., D'Asta, G., Proietto, M., Carnemolla, A., Razza, G., Spadaro, D., Bertolotti, M., Mussi, C., Neviani, F., Roberto, C., Valentina, G., Linda, M., Francesca, V., Tarozzi, A., Balestri, F., Mannarino, G., Bigolari, M., Natale, A., Grassi, S., Bottaro, C., Stefanelli, S., Bovone, U., Tortorolo, U., Quadri, R., Leone, G., Ponzetto, M., Frasson, P., Annoni, G., Bruni, A., Confalonieri, R., Corsi, M., Moretti, D., Teruzzi, F., Umidi, S., Mazzola, P., Perego, S., Persico, I., Olivieri, G., Bonfanti, A., Hajnalka, S., Galeazzi, M., Massariello, F., Anzuini, A., Caffarra, P., Barocco, F., Spallazzi, M., Paolo, C. G., Simonetta, M., Chioatto, P., Bortolamei, S., Soattin, L., Ruotolo, G., Beneamino, B., Giuseppe, B., Bertazzoli, M., Rota, E., Adobati, A., Scarpa, A., Granziera, S., Zuccher, P., Fabbro, A. D., Zara, D., Lo Nigro, A., Franchetti, L., Toniolo, M., Marcuzzo, C., Rollone, M., Guerriero, F., Sgarlata, C., Masse, A., Zatti, G., Piatti, M., Graci, J., Benati, G., Boschi, F., Biondi, M., Fiumi, N., Erika, T., Locatelli, S. M., Mauri, S., Beretta, M., Margheritis, L., Desideri, G., Liberatore, E., Carucci, A. C., Bonino, P., Caput, M., Antonietti, M. P., Polistena, G., De la Pierre, F., Mari, M., Massignani, P., Tombesi, F., Selvaggio, F., Verbo, B., Bodoni, P., Marchionni, N., Sabatini, T., Mussio, E., Magni, Eugenio, Bianchetti, A., Crucitti, Antonio, Titoldini, G., Cossu, B., Fascendini, S., Licini, C., Tomasoni, A., Calderazzo, M., Daniela, T., Valentina, L., Melotti, R. M., Lilli, A., Buda, S., Adversi, M., Noro, G., Turco, R., Ubezio, M. C., Mantovani, A. R., Viola, M. C., Serrati, C., Pretta, S., Infante, M., Gentile, S., D'Ambrosio, V., Mazzanti, P., Brambilla, C., Sportelli, S., Platto, C., Faraci, B., Quattrocchi, D., Pernigotti, L. M., Pisu, C., Sicuro, F., Zagnoni, P., Ghiglia, S., Mosca, M., Corazzin, I., Deola, M., Biagini, C. A., Bencini, F., Cantini, C., Tonon, E., Pierinelli, S., Onofrj, M., Thomas, A., Filomena, B., Bonanni, L., Gabriella, C., Comi, G., Magnani, G., Santangelo, R., Mazzeo, S., Francesca, C., Giordano, C., Roberto, S. A., Barbieri, C., Giroldi, L., Bandini, F., Masina, M., Malservisi, S., Cicognani, A., Ricca, L., Piccininni, M., Tassinari, T., Brogi, D., Sugo, A., Alessandra, F., Sonia, M., Valerio, V., Andrea, U. C., Enrico, C., Vera, R. F., Assunta, S., Gianmaria, Z., Mauro, P., Barone, A., Razzano, M., Giuseppe, I., Angela, B., Francesco, S., Valeria, D. A., Federico, G., Lucia, P., Antonella, V., Elisabetta, D. C., Cristina, R., Nadia, C., Maria, S., Luciano, A., Chiara, C., Bini, P., Pignata, M., Enrico, B., Maria, V., Giovanni, C., Giorgio, C., Piera, R., Alberto, Z., Ceccon, A., Magrin, L., Marin, S., Barbara, S., Matteo, M., Caterina, P. M., Carla, R., Federica, G., Clara, T., Melania, C., Giampaolo, B., Stefano, G., Valeria, G., Lucia, M., Giovambattista, D., Ester, L., Cecilia, C. A., Maurizio, T., Nadia, B., Grillo, A., Arenare, F., Tonino, M., David, K., Giorgio, V. P., Ubaldo, B., Vincenzo, S., Stefano, M., Marino, F., Busonera Flavio, M. T., Paolo, A., Monica, M., Francesco, B., Roberto, F., Paolo, B., Durantemangoni, E., Testoni, M., Fabio, D. S., Loredana, S., Valeria, S., Fabiano, M., Annabella, D. G., Salvatore, D. C., Greco, A., Grazia, D. O., Daniele, S., Gianluca, R., Renzo, G., Sergio, M., Morena, B., Vitali, M., Marina, P., Paolo, D. C., Cristina, S., Orlandini, F., La Regina, M., Desiree, A., Mario, B., Paola, P., Padulo, F., Cristina, M., Dario, R., Giancarla, M., Guido, R., Elena, M., Marileda, N., Igor, B., Nicole, B., Elena, R., Paolillo, C., Riccardi, A., Claudia, B., Barbara, R., Silvia, V., Oliver, B., Mauro, C., Eleonora, M., Giuseppe, P., Rosaria, T., Maria, C., Davide, D. A., Stefania, C., Massimo, P., Luca, S., Martina, D. F., Paola, V., Lia, S., Sandro, C., Valentina, D. S., Erminia, B., Paola, C., Romina, R., Minisola, S., Luciano, C., Pasquale, A., Ilaria, L., Guglielmo, S., Marco, E., Sara, R., Paola, A., Claudio, A., Francesco, R., Alessandro, C., Simona, M., Lara, F., Paola, R., Simonetta, C., Antonella, C., Generoso, U., Fernando, G., Giuliano, C., Emanuela, S., Mariolina, S., Alessandro, D., Giulia, L., Famularo, S., Sandini, M., Pinotti, E., Gianotti, L., Antonella, B., Giulia, P., Sante, G., Rossi, A., Rubele, S., Sant, S., Marco, V., Danila, C., Fabio, R., Bandirali, M. P., Nicoletta, C., Laura, B., Paolo, T., Luciano, T., Leonello, A., Margherita, S., Stefania, D. N., Pierluigi, D. S., Laura, R., Fabiana, T., Giovanna, C., Antonino, A., Felice, C., Danilo, F., Giovanna, D. B., Francesco, L., Salini, S., Angela, B. M., Giorgetta, C., Giovanni, G., Gerardo, B., Silvio, R., Letizia, S., Davide, B., Rosaria, R. M., Maria, D. A., Raffaele, P., Palmieri, V. O., Palasciano, G., Belfiore, A., Portincasa, P., Carlo, S., Alessia, D., Valiani, V., Carolina, B., Tiziana, C., Paola, T., Ugo, P., Giacomo, P., Castellano, M., Anna, G., Elisa, C., Federica, C., Antonietta, C. M., Luigi, M., Fabio, L., Salvatore, B., Gelosa, G., Viviana, A. T., Piras, V., Andrea, C., Alessandra, B., Coen, D., Magliola, R., Milanesio, D., Muzzulini, C. L., Paolo, F., Marinella, T., Sofia, C. M., Marta, B., Siano, P., Capo, G., Napoletano, R., Cecilia, P., Mancini, C., Del Buono, C., De Bartolomeo, G., Addolorata, M., Carmen, C., Giovanni, V. A., Moschettini, G., Franco, M., Daniela, R., D'Amico, G., Mirella, P., Endrizzi, C., Trotta, L., Ciarambino, T., Orazio, Z., Emanuela, T., Marta, S., Thomas, F., Giacomo, T., Ignazio, D. F., Andrea, B., Giuseppe, O., Emanuela, F., Serena, A., Elena, D. I., Serena, B., Erika, N., Roberto, S., Elena, S., Manuela, P., Francesca, A., Angelo, T., Magni E. (ORCID:0000-0002-2235-2280), Crucitti A. (ORCID:0000-0003-3496-4185), Morandi, A., Zambon, A., Di Santo, S. G., Mazzone, A., Cherubini, A., Mossello, E., Bo, M., Marengoni, A., Bellelli, G., Rispoli, V., Malara, A., Spadea, F., Di Cello, S., Ceravolo, F., Fabiano, F., Chiaradia, G., Gabriele, A., Lenino, P., Andrea, T., Settembrini, V., Capomolla, D., Citrino, A., Scriva, A., Bruno, I., Secchi, R., De Martino, E., Muccinelli, R., Lupi, G., Paonessa, P., Fabbri, A., Passuti, M. T., Castellari, S., Po, A., Gaggioli, G., Varesi, M., Moneti, P., Capurso, S., Latini, V., Ghidotti, S., Riccardelli, F., Macchi, M., Rigo, R., Claudio, P., Angelo, B., Flavio, C., Benedetta, B., Boffelli, S., Cassinadri, A., Franzoni, S., Spazzini, E., Andretto, D., Tonini, G., Andreani, L., Coralli, M., Balotta, A., Cancelliere, R., Ballardini, G., Simoncelli, M., Mancini, A., Strazzacapa, M., Fabio, S., De Filippi, F., Giudice, C., Dentizzi, C., Azzini, M., Cazzadori, M., Mastroeni, V., Bertassello, P., Claudia Benati, H. S., Nesta, E., Tobaldini, C., Guerini, F., Elena, T., Mombelloni, P., Fontanini, F., Gabriella, L., Pizzorni, C., Oliverio, M., Del Grosso, L. L., Giavedoni, C., Bidoli, G., Mazzei, B., Corsonello, A., Fusco, S., Vena, S., De Vuono, T., Maiuri, G., Luca, F. F., Andrea, A., Giovanni, S., Rossella, N., Castegnaro, E., De Rosa, S., Sechi, R. B., Benvenuti, E., Del Lungo, I., Giardini, S., Giulietti, C., Mauro, D. B., Eleonora, B., Martina, P., Irene, F., Riccardo, B., Federica, S., Ilaria, D. L., Bertoletti, E., D'Amico, F., Caronzolo, F., Grippa, A., Lombardo, G., Pipicella, T., Antonino, S., Francesco, C., Valeria, P. G., Daniela, L., Domenico, C., Giorgio, B., March, A., Nitti, M. T., Felici, A., Pavan, S., Piazzani, F., Lunelli, A., Dimori, S., Margotta, A., Soglia, T., Postacchini, D., Brunelli, R., Santini, S., Francavilla, M., Macchiati, I., Sorvillo, F., Giuli, C., Mecocci, P., Longo, A., Perticone, F., Addesi, D., Rosa, P. C., Bencardino, G., Falbo, T., Grillo, N., Marco, F., Mirella, F., Fanto, F., Isaia, G., Pezzilli, S., Bergamo, D., Furno, E., Rrodhe, S., Lucarini, S., Dijk, B., Dall'Acqua, F., Cappelletto, F., Calvani, D., Becheri, D., Giuseppe, M., Costanza, M., Vito, A., Francesca, B., Magherini, L., Novella, M., Franca, B., Lucia Gambardella, P. M., Valente, C., Ilaria, B., Alice, F., Porrino, P., Ceci, G., Giuliana, B., Michela, T., Eleonora, C., Ettore, E., Camellini, C., Servello, A., Grassi, A., Rozzini, R., Tironi, S., Grassi, M. G., Troisi, E., Carlo, C., Simona Gabriella, D. S., Flaminia, F., Federica, R., Beatrice, P., Sofia, T., Gabutto, A., Quazzo, L., Rosatello, A., Suraci, D., Tagliabue, B., Perrone, C., Ferrara, L., Castagna, A., Tremolada, M. L., Giuseppe, C., Stefano, B., Davide, O., Piano, S., Serviddio, G., Lo Buglio, A., Gurrera, T., Merlo, V., Rovai, C., Cotroneo, A. M., Carlucci, R., Abbaldo, A., Monzani, F., Qasem, A. A., Bini, G., Tafuto, S., Galli, G., Bruni, A. C., Mancuso, G., Calipari, D., Giuseppe Massimiliano, D. L., Bernardini, B., Corsini, C., Michele, C., Sara, D. F., Cagnin, A., Fragiacomo, F., Pompanin, S., Piero, A., Marco, C., Zurlo, A., Guerra, G., Pala, M., Menozzi, L., Gatti, C. D., Magon, S., Roberto, M., Alfredo, D. G., Fabio, F., Ruana, T., Elisa, M., Christian, M., Marco, P., Massimo, G., Di Francesco, V., Faccioli, S., Pellizzari, L., Giorgia, F., Barbagallo, G., Lunardelli, M. L., Martini, E., Ferrari, E., Macchiarulo, M., Corneli, M., Bacci, M., Battaglia, G., Anastasio, L., Lo Storto, M. S., Seresin, C., Simonato, M., Loreggian, M., Cestonaro, F., Durando, M., Latella, R., Mazzoleni, M., Russo, G., Ponte, M., Valchera, A., Salustri, G., Petritola, D., Costa, A., Sinforiani, E., Cotta, M. R., Pizio, R. N., Cester, A., Formilan, M., Pietro, B., Carbone, P., Cazzaniga, I., Appollonio, I., Cereda, D., Stabile, A., Xhani, R., Acampora, R., Tremolizzo, L., Federico, P., Antonio, C., Valerio, P., Cesare, B., Zhirajr, M., Giovanni, V., Maria, A., Mariaelena, S., Bottacchi, E., Bucciantini, E., Di Giovanni, M., Franchi, F., Lucchetti, L., Mariani, C., Grande, G., Rapazzini, P., Marco, M., Romanelli, G., Franco, N., Alessio, M., Nicola, L., Laura, P., Nazario, P., Chiara, G., Soccorso, P., Andrea, S., Luca, B., Francesca, S., Roberto, A., Anna, C., Fugazza, L., Guerrini, C., De Paduanis, G., Iallonardo, L., Palumbo, P., Zuliani, G., Ortolani, B., Capatti, E., Soavi, C., Bianchi, L., Francesconi, D., Miselli, A., Gloria, B., Tommaso, R., Chiara, P., Agata, M. M., Marco, D. A., Luca, M., Gianluca, G., Suardi, T., Zaccarini, C., Manuela, R., Mirra, G., Muti, E., Bottura, R., Gianpaolo, M., Secreto, P., Bisio, E., Cecchettani, M., Naldi, T., Pallavicino, A., Pugliese, M., Iozzo, R. C., Grassi, G., Michele, B., Raffaella, D. O., Fosca, Q. T., Giorgio, G. C., Giovanni, P., Ernesto, C., Mannironi, A., Giorli, E., Oberti, S., Fierro, B., Piccoli, T., Giacalone, F., Mandas, A., Serchisu, L., Costaggiu, D., Pinna, E., Orru, F., Mannai, M., Cordioli, Z., Pelizzari, L., Turcato, E., Arduini, P., Cacace, C., Chiloiro, R., Cimino, R., Ruberto, C., Giovanni, R., Pietro, G., Laura, G., Alberto, C., Carmen, R., Santo, P. D., Andriolli, A., Burattin, G., Rossi, L., Andreolli Antonino, C. G., Tezza, F., Maddalena, P., Laura, S., Crippa, P., Aloisio, P., Di Monda, T., Malighetti, A., Galbassini, G., Salutis, D., Ivaldi, C., Russo, A. M., Bennati, E., Pino, E., Zavarise, G., Pesci, A., Suigo, G., Faverio, P., Andrea, G., Sabrina, P., Zanasi, M., Moniello, G., Rostagno, C., Cartei, A., Polidori, G., Ungar, A., Melis, M. R., Martellini, E., Enrico, M., Monica, T., Antonella, G., Giovanna, L., Migliorini, M., Caramelli, F., Battiston, B., Berardino, M., Cavallo, S., Alessandro, M., Anna, S., Lombardi, B., D'Ippolito, P., Furini, A., Villani, D., Clara, R., Guarneri, M., Paolucci, S., Bassi, A., Coiro, P., De Angelis, D., Morone, G., Venturiero, V., Palleschi, L., Raganato, P., Di Niro, G., Rosa, C. A., Loredana, B., Imoscopi, A., Tibaldi, V., Bottignole G, G., Calvi, E., Clementi, C., Zanocchi, M., Agosta, L., Nortarelli, A., Provenzano, G., Mari, D., Romano, F. Y., Rosini, F., Mansi, M., Rossi, S., Geriatria, A. R., Inzaghi, L., Bonini, G., Rossi, P., Potena, A., Lichii, M., Candiani, T., Grimaldi, W., Bertani, E., Alessandra, P., Calogero, P., Pinto, D., Bernardi, R., Nicolino, F., Galetti, C., Gianstefani, A., Giulia, C., Lorenzo, M., Odetti, P., Monacelli, F., Prefumo, M., Fiammetta, M., Canepa, M., Minaglia, C., Paolisso, G., Rizzo, M. R., Prestano, R., Dalise, A. M., Barra, D., Bosco, L. D., Asprinio, V., Dallape, L., Perina, E., Incalzi, R. A., Bartoli, I. R., Pluderi, A., Maina, A., Pecoraro, E., Sciarra, M., Prudente, A., Paola, M., Francesca, M., Manuel, V., Luisella, C., Maria, P. L., Tina, S., Benini, L., Levato, F., Mhiuta, V., Alius, F., Davidoaia, D., Giardini, V., Garancini, M., Bellamoli, C., Terranova, L., Bozzini, C., Tosoni, P., Provoli, E., Cascone, L., Dioli, A., Ferrarin, G., Bucci, A., Bua, G., Fenu, S., Bianchi, G., Casella, S., Romano, V., Maurizio, P., Mascherona, I., Belotti, G., Cavaliere, S., Cuni, E., Merciuc, N., Oberti, R., Veneziani, S., Capoferri, E., De Bernardi, E., Colombo, K., Bravi, M., Nicoletta, N., D'Arcangelo, P., Montenegro, N., Montanari, R., Lamanna, P., Gasperini, B., Isabella, M., Stefania, D., Gaia, A., Filippo, C., Palama, C., Di Emidio, C., Scarpini, E., Arighi, A., Fumagalli, G., Basilico, P., De Amicis Margherita, M., Marta, M., Diletta, M., Granata, A., Ranalli, C., Cammilli, A., Cavallini, M. C., Tricca, M., Natella, D., Gabbani, L., Tesi, F., Martella, L., Imbrici, R., Guerrini, G., Scotuzzi, A. M., Sozzi, F., Valenti, L., Chiarello, A., Monia, M., Pilotto, A., Prete, C., Senesi, B., Meta, A. C., Pendenza, E., Pasqualetti, G., Polini, A., Tognini, S., Ballino, E., Dell'Aquila, G., Gasparrini, P. M., Marotti, E., Migale, M., Scrimieri, A., Falsetti, L., Salvi, A., Toigo, G., Ceschia, G., Rosso, A., Tongiorgi, C., Scarpa, C., De Dominicis, L., Pucci, E., Renzi, S., Cartechini, E., Tomassini, P. F., Del Gobbo, M., Ugenti, F., Romeo, P., Nardelli, A., Lauretani, F., Visioli, S., Montanari, I., Ermini, F., Giordano, A., Pigato, G., Simeone, E., Barbujani, M., Giampieri, M., Amoruso, R., Piccinini, M., Ferrari, C., Gambetti, C., Sfrappini, M., Semeraro, L., Striuli, R., Pelliccioni, G., Marinelli, D., Fabi, K., Rossi, T., Pesallaccia, M., Sabbatini, D., Gobbi, B., Cerqua, R., Tagliani, G., Schlauser, E., Caser, L., Caramello, E., Sandigliano, F., Rosso, G., Ferrari, A., Bendini, C., Luisa, D. M., Casella, M., Prampolini, R., Scevola, M., Vitale, E., Roberto, B., Carlo, F., Sergio, F., Alberto, S., Daniela, Z., Giulia, B., Serena, G., Maugeri, D., Sorace, R., Anzaldi, M., De Gesu, R., Morrone, G., Davolio, F., Fabbo, A., Palmieri, M., Zoli, M., Forti, P., Pirazzoli, L., Fabbri, E., Terenzi, L., Bergolari, F., Wenter, C., Ruffini, I., Insam, M., Abraham, E., Kirchlechner, C., Cucinotta, D., Antonino, L., Basile, G., Grazia, A. M., Parise, P., Boccali, A., Amici, S., Gambacorta, M., Lasagni, A., Lovati, R., Giovinazzo, F., Kimak, E., Zappa, P., Medici, F., Lo Castro, M., Mauro, F., De Luca, A., Sancesario, G., Martorana, A., Scaricamazza, B., Toniolo, S., Di Lorenzo, F., Liguori, C., Lasco, A., Vita, N., Giomi, M., Forte, F., Padovani, A., Rozzini, L., Ceraso, A., Salvatore, C., Cottino, M., Vitali, S., Marelli, E., Tripi, G., Miceli, S., Urso, G., Grioni, G., Vezzadini, G., Misaggi, G., Forlani, C., Avanzi, S., Serena, S., Claudia, C., Marilena, V., Alberto, L., Diego, G., Alessandro, G., Iemolo, F., Sanzaro, E., D'Asta, G., Proietto, M., Carnemolla, A., Razza, G., Spadaro, D., Bertolotti, M., Mussi, C., Neviani, F., Roberto, C., Valentina, G., Linda, M., Francesca, V., Tarozzi, A., Balestri, F., Mannarino, G., Bigolari, M., Natale, A., Grassi, S., Bottaro, C., Stefanelli, S., Bovone, U., Tortorolo, U., Quadri, R., Leone, G., Ponzetto, M., Frasson, P., Annoni, G., Bruni, A., Confalonieri, R., Corsi, M., Moretti, D., Teruzzi, F., Umidi, S., Mazzola, P., Perego, S., Persico, I., Olivieri, G., Bonfanti, A., Hajnalka, S., Galeazzi, M., Massariello, F., Anzuini, A., Caffarra, P., Barocco, F., Spallazzi, M., Paolo, C. G., Simonetta, M., Chioatto, P., Bortolamei, S., Soattin, L., Ruotolo, G., Beneamino, B., Giuseppe, B., Bertazzoli, M., Rota, E., Adobati, A., Scarpa, A., Granziera, S., Zuccher, P., Fabbro, A. D., Zara, D., Lo Nigro, A., Franchetti, L., Toniolo, M., Marcuzzo, C., Rollone, M., Guerriero, F., Sgarlata, C., Masse, A., Zatti, G., Piatti, M., Graci, J., Benati, G., Boschi, F., Biondi, M., Fiumi, N., Erika, T., Locatelli, S. M., Mauri, S., Beretta, M., Margheritis, L., Desideri, G., Liberatore, E., Carucci, A. C., Bonino, P., Caput, M., Antonietti, M. P., Polistena, G., De la Pierre, F., Mari, M., Massignani, P., Tombesi, F., Selvaggio, F., Verbo, B., Bodoni, P., Marchionni, N., Sabatini, T., Mussio, E., Magni, Eugenio, Bianchetti, A., Crucitti, Antonio, Titoldini, G., Cossu, B., Fascendini, S., Licini, C., Tomasoni, A., Calderazzo, M., Daniela, T., Valentina, L., Melotti, R. M., Lilli, A., Buda, S., Adversi, M., Noro, G., Turco, R., Ubezio, M. C., Mantovani, A. R., Viola, M. C., Serrati, C., Pretta, S., Infante, M., Gentile, S., D'Ambrosio, V., Mazzanti, P., Brambilla, C., Sportelli, S., Platto, C., Faraci, B., Quattrocchi, D., Pernigotti, L. M., Pisu, C., Sicuro, F., Zagnoni, P., Ghiglia, S., Mosca, M., Corazzin, I., Deola, M., Biagini, C. A., Bencini, F., Cantini, C., Tonon, E., Pierinelli, S., Onofrj, M., Thomas, A., Filomena, B., Bonanni, L., Gabriella, C., Comi, G., Magnani, G., Santangelo, R., Mazzeo, S., Francesca, C., Giordano, C., Roberto, S. A., Barbieri, C., Giroldi, L., Bandini, F., Masina, M., Malservisi, S., Cicognani, A., Ricca, L., Piccininni, M., Tassinari, T., Brogi, D., Sugo, A., Alessandra, F., Sonia, M., Valerio, V., Andrea, U. C., Enrico, C., Vera, R. F., Assunta, S., Gianmaria, Z., Mauro, P., Barone, A., Razzano, M., Giuseppe, I., Angela, B., Francesco, S., Valeria, D. A., Federico, G., Lucia, P., Antonella, V., Elisabetta, D. C., Cristina, R., Nadia, C., Maria, S., Luciano, A., Chiara, C., Bini, P., Pignata, M., Enrico, B., Maria, V., Giovanni, C., Giorgio, C., Piera, R., Alberto, Z., Ceccon, A., Magrin, L., Marin, S., Barbara, S., Matteo, M., Caterina, P. M., Carla, R., Federica, G., Clara, T., Melania, C., Giampaolo, B., Stefano, G., Valeria, G., Lucia, M., Giovambattista, D., Ester, L., Cecilia, C. A., Maurizio, T., Nadia, B., Grillo, A., Arenare, F., Tonino, M., David, K., Giorgio, V. P., Ubaldo, B., Vincenzo, S., Stefano, M., Marino, F., Busonera Flavio, M. T., Paolo, A., Monica, M., Francesco, B., Roberto, F., Paolo, B., Durantemangoni, E., Testoni, M., Fabio, D. S., Loredana, S., Valeria, S., Fabiano, M., Annabella, D. G., Salvatore, D. C., Greco, A., Grazia, D. O., Daniele, S., Gianluca, R., Renzo, G., Sergio, M., Morena, B., Vitali, M., Marina, P., Paolo, D. C., Cristina, S., Orlandini, F., La Regina, M., Desiree, A., Mario, B., Paola, P., Padulo, F., Cristina, M., Dario, R., Giancarla, M., Guido, R., Elena, M., Marileda, N., Igor, B., Nicole, B., Elena, R., Paolillo, C., Riccardi, A., Claudia, B., Barbara, R., Silvia, V., Oliver, B., Mauro, C., Eleonora, M., Giuseppe, P., Rosaria, T., Maria, C., Davide, D. A., Stefania, C., Massimo, P., Luca, S., Martina, D. F., Paola, V., Lia, S., Sandro, C., Valentina, D. S., Erminia, B., Paola, C., Romina, R., Minisola, S., Luciano, C., Pasquale, A., Ilaria, L., Guglielmo, S., Marco, E., Sara, R., Paola, A., Claudio, A., Francesco, R., Alessandro, C., Simona, M., Lara, F., Paola, R., Simonetta, C., Antonella, C., Generoso, U., Fernando, G., Giuliano, C., Emanuela, S., Mariolina, S., Alessandro, D., Giulia, L., Famularo, S., Sandini, M., Pinotti, E., Gianotti, L., Antonella, B., Giulia, P., Sante, G., Rossi, A., Rubele, S., Sant, S., Marco, V., Danila, C., Fabio, R., Bandirali, M. P., Nicoletta, C., Laura, B., Paolo, T., Luciano, T., Leonello, A., Margherita, S., Stefania, D. N., Pierluigi, D. S., Laura, R., Fabiana, T., Giovanna, C., Antonino, A., Felice, C., Danilo, F., Giovanna, D. B., Francesco, L., Salini, S., Angela, B. M., Giorgetta, C., Giovanni, G., Gerardo, B., Silvio, R., Letizia, S., Davide, B., Rosaria, R. M., Maria, D. A., Raffaele, P., Palmieri, V. O., Palasciano, G., Belfiore, A., Portincasa, P., Carlo, S., Alessia, D., Valiani, V., Carolina, B., Tiziana, C., Paola, T., Ugo, P., Giacomo, P., Castellano, M., Anna, G., Elisa, C., Federica, C., Antonietta, C. M., Luigi, M., Fabio, L., Salvatore, B., Gelosa, G., Viviana, A. T., Piras, V., Andrea, C., Alessandra, B., Coen, D., Magliola, R., Milanesio, D., Muzzulini, C. L., Paolo, F., Marinella, T., Sofia, C. M., Marta, B., Siano, P., Capo, G., Napoletano, R., Cecilia, P., Mancini, C., Del Buono, C., De Bartolomeo, G., Addolorata, M., Carmen, C., Giovanni, V. A., Moschettini, G., Franco, M., Daniela, R., D'Amico, G., Mirella, P., Endrizzi, C., Trotta, L., Ciarambino, T., Orazio, Z., Emanuela, T., Marta, S., Thomas, F., Giacomo, T., Ignazio, D. F., Andrea, B., Giuseppe, O., Emanuela, F., Serena, A., Elena, D. I., Serena, B., Erika, N., Roberto, S., Elena, S., Manuela, P., Francesca, A., Angelo, T., Magni E. (ORCID:0000-0002-2235-2280), and Crucitti A. (ORCID:0000-0003-3496-4185)

Abstract

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.

Published
2020

30. Effects on balance skills and patient compliance of biofeedback training with inertial measurement units and exergaming in subacute stroke: A pilot randomized controlled trial

Author

Lupo, A, Cinnera, Am, Pucello, A, Iosa, M, Coiro, P, Personeni, S, Gimigliano, F, Iolascon, G, Paolucci, S, Morone, G, Lupo, A., Cinnera, A. M., Pucello, A., Iosa, M., Coiro, P., Personeni, S., Gimigliano, Francesca, Iolascon, Giovanni, Paolucci, Stefano, and Morone, G.

Subjects
Adult, Male, Rehabilitation, Stroke Rehabilitation, Participation, Biofeedback, Psychology, Pilot Projects, Biofeedback, Middle Aged, Virtual reality, Brain Ischemia, Exercise Therapy, Stroke, Treatment Outcome, Motor Skills, biofeedback, participation, postural balance, rehabilitation, stroke, virtual reality, Postural balance, Humans, Patient Compliance, Female, Aged
Abstract

Stroke patients have reduced balance and postural control that limits their activities of daily living and participation in social life. Recently, many exergaming systems based on video-biofeedback have been developed for balance training in neurological conditions, however their efficacy remains to be proven. The aim of this study was to investigate the effects on balance skills and patient compliance of biofeedback training based on inertial measurement units and exergaming in subacute stroke. The enrolled subjects were randomized into two groups: subjects allocated to the experimental group performed 10 sessions of biofeedback balance training using inertial sensors, whereas subjects allocated to the control group performed 10 sessions of conventional balance training. All subjects were assessed at T0 (pre-treatment), T1 (posttreatment) and T2 (1-month follow-up). The Berg Balance Scale, Rivermead Mobility Index and modified Barthel Index were used to assess balance, mobility and global disability, respectively. To assess the severity of the stroke and its effects on the patient we used the National Institutes of Health Stroke Scale and the Canadian Neurological Scale. Finally, a static force platform evaluating stabilometric paparameters was used to assess balance skills. Fifteen subjects with subacute stroke (4F; age 57.80 ± 13.7) completed the experimental protocol. The analysis showed a significant improvement in balance skills and in the overall clinical outcomes in the experimental group compared with the control group; the experimental group also showed better compliance with the training. The biofeedback system of the device used in this study probably enhances neuroplasticity mechanisms of postural and balance skills in subacute stroke patients. Stroke patients have reduced balance and postural control that limits their activities of daily living and participation in social life. Recently, many exergaming systems based on video-biofeedback have been developed for balance training in neurological conditions, however their efficacy remains to be proven. The aim of this study was to investigate the effects on balance skills and patient compliance of biofeedback training based on inertial measurement units and exergaming in subacute stroke. The enrolled subjects were randomized into two groups: subjects allocated to the experimental group performed 10 sessions of biofeedback balance training using inertial sensors, whereas subjects allocated to the control group performed 10 sessions of conventional balance training. All subjects were assessed at T0 (pre-treatment), T1 (posttreatment) and T2 (1-month follow-up). The Berg Balance Scale, Rivermead Mobility Index and modified Barthel Index were used to assess balance, mobility and global disability, respectively. To assess the severity of the stroke and its effects on the patient we used the National Institutes of Health Stroke Scale and the Canadian Neurological Scale. Finally, a static force platform evaluating stabilometric parameters was used to assess balance skills. Fifteen subjects with subacute stroke (4F; age 57.80 ± 13.7) completed the experimental protocol. The analysis showed a significant improvement in balance skills and in the overall clinical outcomes in the experimental group compared with the control group; the experimental group also showed better compliance with the training. The biofeedback system of the device used in this study probably enhances neuroplasticity mechanisms of postural and balance skills in subacute stroke patients.

Published
2018

32. Exercise treatment effect modifiers in persistent low back pain: An individual participant data meta-analysis of 27 randomized controlled trials

Author

Hayden, Ja, Wilson, Mn, Stewart, S, Cartwright, J, Smith, Ao, Riley, Rd, Vantulder, Mw, and the Chronic Low Back Pain (LBP) IPD Meta-Analysis Group: Bendix, T, Cecchi, F, Costa, Lop, Dufour, N, Ferreira, Ml, Foster, Ne, Gudavalli, Mr, Hartvigsen, J, Helmhout, P, Kool, J, Koumantakis, G, Kovacs, F, Kuukkanen, T, Long, A, Macedo, L, Machado, La, Maher, Cg, Mehling, W, Morone, G, Petersen, T, Rasmussen-Barr, E, Ryan, Cg, Sjögren, T, Smeets, R, Staal, Jb, Unsgaard-Tøndel, M, Wajswelner, H, and Yeung, Ew.

Published
2019

36. Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: A qualitative study

Author

Giovannetti, A. M., Borreani, C., Bianchi, E., Giordano, A., Cilia, S., Cipollari, S., Rossi, I., Cavallaro, C., Clerici, V. T., Rossetti, E., Stefanelli, M. C., Totis, A., Pappalardo, A., Occhipinti, G., Confalonieri, P., Veronese, S., Grasso, M. G., Patti, F., Zaratin, P., Battaglia, M. A., Solari, A., Amadeo, R., Ponzio, M., Lugaresi, A., Martino, G., Palmisano, L., Pagano, E., Radice, D., Farinotti, M., Ferrari, G., Rosato, R., Oliver, D. J., Pucci, E., Tesio, L., Pietrolongo, E., Giuntoli, M., Fittipaldo, A., Cugno, C., Causarano, R., Morino, P., Campanella, A., Mantegazza, R., Tucci, L., Ippoliti, F., Morone, G., Fusco, A., Cascio, V., Cimino, V., Zagari, F., Lopes de Carvalho, M. L., Motta, R., Onofrj, M., Da Col, D., and Casale, G.

Subjects
Male, Genetics and Molecular Biology (all), Palliative care, Medical Doctors, Psychologists, Team Role Inventories, Health Care Providers, medicine.medical_treatment, Nurses, Social Sciences, lcsh:Medicine, Referring Physician, Severity of Illness Index, Biochemistry, law.invention, 0302 clinical medicine, Sociology, Randomized controlled trial, Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), law, Medicine and Health Sciences, Medical Personnel, 030212 general & internal medicine, Human Families, lcsh:Science, Aged, 80 and over, Multidisciplinary, Rehabilitation, Palliative Care, Neurodegenerative Diseases, Qualitative Studies, Middle Aged, Home Care Services, Professions, Neurology, Research Design, Female, Psychology, Research Article, Adult, Multiple Sclerosis, Drug Research and Development, Patients, Immunology, Research and Analysis Methods, Autoimmune Diseases, 03 medical and health sciences, Nursing, Physicians, Intervention (counseling), medicine, Humans, Clinical Trials, Aged, Pharmacology, lcsh:R, Biology and Life Sciences, Demyelinating Disorders, Focus group, Randomized Controlled Trials, Health Care, People and Places, Population Groupings, Clinical Immunology, lcsh:Q, Clinical Medicine, 030217 neurology & neurosurgery, Qualitative research
Abstract

Background We performed a qualitative study to investigate the experiences of participants in a multicentre randomized controlled trial on a home-based palliative approach (HPA) for adults with severe multiple sclerosis (MS) and their caregivers. Our aim was to explore the strengths and challenges of the intervention, and circumstances that may have influenced its efficacy. Methods Participants to the qualitative study were the patients, their caregivers, patient referring physicians, and the teams who delivered the HPA intervention. We performed semi-structured one-on-one interviews with 12 patients and 15 informal caregivers chosen using a maximum variation strategy, two focus group meetings with patient referring physicians (4 participants each), and one with the HPA teams (9 participants). Results From data analysis (framework method) 38 sub-categories emerged, which were grouped into 10 categories and 3 themes: 'expectations,' 'met and unmet needs', and 'barriers’. Intervention benefits were improved control of symptoms and reduced sense of isolation of the patient-caregiver dyads. Limitations were: factors related to experimental design (difficulty of dyads in identifying examiner and team roles, additional burden for caregivers); team issues (insufficient team building /supervision, competing priorities); limitations of the intervention itself (insufficient length, lack of rehabilitation input); and external factors (resource limitations, under-responsive services/professionals). The referring physician focus groups provided little experiential data. Conclusions The HPA reduced patient symptoms and sense of isolation in patients and caregivers. The indirect role of the HPA teams, and insufficient length of the intervention were key limitations. The experimental design imposed additional burdens on the dyads. Key barriers were the paucity of available services, the demanding administrative procedures, and lack of networking facilities. These findings suggest that two major requirements are necessary for home palliative care to be effective in this patient population: HPA teams well-connected with MS rehabilitation services, and care delivered over the long-term, with variable intensity. Trial registration Current Controlled Trials ISRCTN73082124 (Registered 19/06/2014).

Published
2018

37. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis

Author

Solari, A., Giordano, A., Patti, F., Grasso, M. G., Confalonieri, P., Palmisano, L., Ponzio, M., Borreani, C., Rosato, R., Veronese, S., Zaratin, P., Battaglia, M. A., Amadeo, R., Lugaresi, A., Martino, G., Pagano, E., Radice, D., Farinotti, M., Ferrari, G., Oliver, D. J., Pucci, E., Tesio, L., Pietrolongo, E., Giuntoli, M., Fittipaldo, A., Cugno, C., Causarano, R., Morino, P., Campanella, A., Mantegazza, R., Tucci, L., Ippoliti, F., Morone, G., Fusco, A., Cascio, V., Cimino, V., Zagari, F., Lopes de Carvalho, M. L., Motta, R., Onofrj, M., Da Col, D., and Casale, G.

Subjects
Male, medicine.medical_specialty, caregivers, symptom burden, Palliative care, Aftercare, Severity of Illness Index, law.invention, Multiple sclerosis, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Randomized controlled trial, law, Activities of Daily Living, medicine, Humans, 030212 general & internal medicine, palliative care, quality of life, randomized controlled trial, Aged, business.industry, Symptom burden, Middle Aged, medicine.disease, Home based, Home Care Services, Treatment Outcome, Neurology, Italy, Multivariate Analysis, Physical therapy, Disease Progression, Female, Neurology (clinical), Homebound Persons, business, Original Research Papers, 030217 neurology & neurosurgery
Abstract

Background: Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce. Objective: To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers. Methods: Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3 months, and 6 months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients). Results: Of 78 dyads randomized, 76 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, and statistical significance was borderline in per-protocol analysis ( p = 0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes. Conclusion: HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.

Published
2018

43. Studio RCT sull’efficacia del training assistito da robot associato a riabilitazione convenzionale per il recupero funzionale dell’arto superiore negli esiti di ictus: protocollo clinico

Author

Mazzoleni, S., Bonaiuti, D., Aprile, I., Bartolo, M., Battini, E., Calabrò, R. S., Colombo, R., Del Felice, A., Filoni, S., Focacci, A., Franceschini, M., Gandolfi, M. L., Maggioni, G., Morone, G., Pignolo, L., Posteraro, F., Spagnuolo, C., Straudi, S., Taveggia, G., and Waldner, A.

Published
2017

46. Low quality of life and psychological wellbeing contrast with moderate perceived burden in carers of people with severe multiple sclerosis

Author

Giordano, A, Cimino, V, Campanella, A, Morone, G, Fusco, A, Farinotti, Palmisano, L, Confalonieri, P, Lugaresi, A, Grasso, Mg, Ponzio, M, Veronese, S, Patti, Francesco, Solari, A, on behalf of the, Pensami, Project, Giordano, Andrea, Cimino, Vincenzo, Campanella, Angela, Morone, Giovanni, Fusco, Augusto, Farinotti, Mariangela, Palmisano, Lucia, Confalonieri, Paolo, Lugaresi, Alessandra, Grasso, Maria Grazia, Ponzio, Michela, Veronese, Simone, Patti, Francesco, Solari, Alessandra, and PeNSAMI project

Subjects
Male, Palliative care, health care facilities, manpower, and services, Hospital Anxiety and Depression Scale, Severity of Illness Index, Outcome measure, 0302 clinical medicine, Primary progressive multiple sclerosis, Cost of Illness, Surveys and Questionnaires, Medicine, 030212 general & internal medicine, Depression (differential diagnoses), health care economics and organizations, Aged, 80 and over, Secondary progressive multiple sclerosis, Illness burden, Middle Aged, humanities, Caregivers, Neurology, Spouse, behavior and behavior mechanisms, Anxiety, Secondary progressive multiple sclerosi, Female, medicine.symptom, Clinical psychology, Adult, Employment, Quality of life, Multiple Sclerosis, 03 medical and health sciences, Young Adult, Quality of life (healthcare), Humans, Socioeconomic status, Aged, Psychiatric Status Rating Scales, business.industry, social sciences, Caregiver, Mood, Cross-Sectional Studies, Primary progressive multiple sclerosi, Socioeconomic Factors, Multivariate Analysis, Linear Models, Perception, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background: Few studies have investigated wellbeing and burden in carers of peoplewith severe multiple sclerosis (PwSMS). Objectives: To assess the impact of providing care to PwSMS, and explore variables associated with perceived carer burden. Methods: Cross-sectional assessment of health-related quality of life (HRQOL), mood symptoms (Hospital Anxiety and Depression Scale, HADS), and perceived carer burden (22-item Zarit Burden Interview, ZBI) in 78 PwSMS carers. Multivariate linear regression explored carer and PwSMS factors associated with ZBI score. Results: Carers (61%women, mean age 60.2 years, 53% spouse/partner) had significantly lower HRQOL (all SF-36 scales) than the norm, especially for Role Limitation Emotional/Physical, and Emotional Wellbeing. Sixty-eight percent had pathologic (≥8) Anxiety, and 44% had pathologic Depression scores on HADS. Nonetheless, perceived carer burdenwas only moderate (mean ZBI score 35.6, SD 14.3). High carer anxiety (p < 0.0001), low household income (p= 0.009), and living with the PwSMS (p= 0.02) were independent predictors of perceived burden. Conclusions: Caring for PwSMS has a detrimental effect on HRQOL and psychological wellbeing. High carer anxiety, loweconomic status, and living in predict higher burden. It is crucial to recognize PwSMS carers as full partners in the provision of care, and to respond to their own needs.

Published
2016

48. Home-based palliative approach for people with severe multiple sclerosis and their carers: Study protocol for a randomized controlled trial

Author

Solari, Alessandra, Giordano, Andrea, Grasso, Maria Grazia, Confalonieri, Paolo, Patti, Francesco, Lugaresi, Alessandra, Palmisano, Lucia, Amadeo, Roberta, Martino, Giovanni, Ponzio, Michela, Casale, Giuseppe, Borreani, Claudia, Causarano, Renzo, Veronese, Simone, Zaratin, Paola, Battaglia, MARIO ALBERTO, Radice, D., Oliver, D. J., Pucci, E., Tesio, L., Cugno, C., Morino, P., Lopes de Carvalho, M. L., Giuntoli, M., Motta, R., Stefanelli, M. C., Bianchi, E., Giovannetti, A., Torri Clerici, V., Rossetti, E., Totis, A., Campanella, A., Martini, F., Fittipaldo, A., Ferrari, G., Mantegazza, R., Rossi, I., Troisi, E., Pompa, A., Tucci, L., Ippoliti, F., Morone, G., Fusco, A., Da Col, D., Lissoni, B., Pietrolongo, E., Onofrj, M., Cilia, S., Leone, C., Cascio, V., Cimino, V., Occhipinti, G., Pappalardo, A., Cavallaro, C., Zagari, F., and Alessandra Solari, Andrea Giordano, Maria Grazia Grasso, Paolo Confalonieri, Francesco Patti, Alessandra Lugaresi, Lucia Palmisano, Roberta Amadeo, Giovanni Martino, Michela Ponzio, Giuseppe Casale, Claudia Borreani, Renzo Causarano, Simone Veronese, Paola Zaratin, Mario Alberto Battaglia, PeNSAMI project

Subjects
Complex intervention, Multiple sclerosis, Palliative care, Qualitative research, Randomized controlled trial, Home Care Service, Pediatrics, medicine.medical_specialty, Medicine (miscellaneous), law.invention, Quality of life (healthcare), law, Intervention (counseling), Multiple Sclerosi, medicine, Single-Blind Method, Pharmacology (medical), Clinical Protocol, business.industry, Caregiver, Focus group, Clinical trial, Mood, Family medicine, business, Human
Abstract

Preliminary evidence suggests that palliative care may be useful for people with severe multiple sclerosis (MS). The aim of this study is to determine the effectiveness of a home-based palliative approach (HPA) for people with severe MS and their carers. This is a single-blind randomized controlled trial with a nested qualitative study. Seventy-five severe MS-carer dyads are being randomized (at three centers, one in each area of Italy) to HPA or usual care (UC) in a 2:1 ratio. Each center has a specially trained team consisting of four professionals (physician, nurse, psychologist, social worker). The team makes a comprehensive assessment of the needs of the dyads. HPA content is then agreed on, discussed with the patient’s caring physician, and delivered over six months. The intervention is not intended to replace existing services. At later visits, the team checks the HPA delivery and reviews/modifies it as necessary. HPA and UC dyads are assessed at home by a blind examiner at baseline, and three and six months later; they also receive monthly telephone interviews. Dyads assigned to UC receive the examiner’s visits and telephone interviews, but not the team visits. Primary outcome measures are changes in symptoms (Palliative care Outcome Scale-Symptoms-MS, POS-S-MS), and quality of life (the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), not assessed in patients with severe cognitive compromise) at three and six months. Other outcomes are changes in patient functional status and mood; changes in carer quality of life, mood and caregiving burden; costs; incorporation with standard care; unplanned hospital admissions; referrals to hospice; and deaths. The experience of participants will be evaluated qualitatively by individual semi-structured interviews (HPA patients and carers) and focus group meetings (HPA patients’ caring physicians). The results of our study will show whether the HPA is feasible and beneficial to people with severe MS and their carers living in the three Italian geographic areas. The nested qualitative study will add to the understanding of the strengths and limitations of the intervention. The trial was registered with Current Controlled Trials (identifier: ISRCTN73082124 ) on 19 June 2014.

Published
2015

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