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Alessandro de Sire,1 Francesco Agostini,2 Andrea Bernetti,2 Massimiliano Mangone,2 Marco Ruggiero,2 Stefano Dinatale,2 Alessandro Chiappetta,2 Marco Paoloni,2 Antonio Ammendolia,1 Teresa Paolucci3 1Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy; 2Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy; 3Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University of Chieti-Pescara, Chieti, ItalyCorrespondence: Francesco Agostini, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy, Email francescoagostini.ff@gmail.comBackground: Frozen shoulder (FS) is a painful condition characterized by progressive loss of shoulder function with passive and active range of motion reduction. To date, there is still no consensus regarding its rehabilitative treatment for pain management.Purpose: The aim of this umbrella review of systematic reviews was to analyze the literature, investigating the effects of non-surgical and rehabilitative interventions in patients suffering from FS.Patients and Methods: A review of the scientific literature was carried out from 2010 until April 2020 using the following search databases: PubMed, Medline, PEDro, Scopus and Cochrane Library of Systematic Reviews. A combination of terms was used for the search: frozen shoulder OR adhesive capsulitis AND systematic review OR meta-analysis AND rehabilitation NOT surgery NOT surgical intervention. We included systematic reviews that specifically dealt with adults with FS, treated with non-surgical approaches. All the systematic reviews and meta-analyses included in the study that met the inclusion criteria were assessed using the Assessment of Multiple Systematic Reviews as a quality assessment tool.Results: Out of 49 studies, only 14 systematic reviews respected the eligibility criteria and were included in this study. Their results showed an important heterogeneity of the studies and all of them agree on the lack of high-quality scientific work to prove unequivocally which rehabilitative treatment is better than the other. Due to this lack of gold standard criteria, there may be also a heterogeneity in the diagnosis of the reviews analyzed.Conclusion: Non-surgical and rehabilitative interventions are undoubtedly effective in treating FS, but there is no evidence that one approach is more effective than the other regarding the methods reported. Future high-quality RCTs are needed to standardize the treatment modalities of each physiotherapy intervention to provide strong recommendations in favor.Keywords: adhesive capsulitis, frozen shoulder, pain control, pain management, rehabilitation, non-surgical interventions

Objective To determine whether asymptomatic flexible flat feet show specific postural assessment with respect to neutral feet in 6-year-old children.Methods In this cross-sectional observational study, 164 subjects were observed and divided into two groups: 57 with flexible flat feet and 107 with neutral feet. A non-quantitative inspection by podoscopy and baropodometry were performed to evaluate plantar support, and a clinical examination to assess postural setting.Results The prevalence of flexible flat feet was 34.8%. The differenceinthe mean centre of pressure (CoP) between the two groups was significant (p=0.028), regarding the antero-posterior direction of CoP only. There was no significant differencein the presence of postural growth disharmony between the neutral and flat-feet groups.Conclusion The flattening of the plantar archseems to be linked to a displacement of CoP Y, more posterior in flat feet than in neutral feet; on the other hand, postural harmony in 6-year-old children during growth is not influenced by flat feet.

Purpose Facet joint syndrome (FJS) is an arthritis-like condition of the spine that can be a significant source of low back pain (LBP). Ozone therapy (OT) could be an additional treatment method. We evaluated the therapeutic results of percutaneous injection of ozone to ablate acute LBP caused by FJS. Methods A 73-year-old Caucasian woman was treated by OT: one ozone injection (20 µg/mL) per week for 3 weeks under ultrasound guidance. After a break of 1 week, she performed exercises for aquatic rehabilitation (twice a week for 4 weeks). Results The outcome measure was pain relief for ≥6 months according to the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory (BPI) test. From baseline to 1 month after OT, a reduction in pain was documented and the result was maintained at 6-month follow-up. Conclusion OT followed by aquatic exercises could be efficacious against the LBP caused by FJS.

Teresa Paolucci,1 Letizia Pezzi,1 Roberta La Verde,2 Pasqualino Maietta Latessa,3 Rosa grazia Bellomo,4 Raoul Saggini1 1University G. d’Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy; 2S. Filippo Neri Hospital, Physical Medicine and Rehabilitation, “Sapienza” University, Rome, Italy; 3Department for Life Quality Studies, University of Bologna, Bologna, Italy; 4University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, ItalyCorrespondence: Teresa PaolucciG. D’Annunzio University of Chieti-Pescara, Rehabilitation Unit, Department of Medical and Oral Sciences and Biotechnologies (DSMOB), Via Dei Vestini 66100, Chieti Scalo, ItalyEmail teresapaolucci@hotmail.comBackground: Aging has been associated with the progressive depletion of lean mass, reductions in muscle strength and the coordination of the lower extremities, accompanied by decreased gait assurance and balance control. Also, less balance control favors falling which is the leading cause of injury among the elderly. The aim of this systematic review is to identify and evaluate existing evidence regarding the use of focused vibration (FV) to improve balance and reduce the risk of falling during the rehabilitation of elderly populations.Methods: The PICO question is what are the effects of focal/segmental/local vibration training on the assessment of balance and the risk of falls among the elderly population? A thorough literature review was conducted between May 1, 2009, and June 30, 2019, for studies in English, randomized clinical trials, including crossover and prospective design studies with assessing balance and the risk of falls in elderly populations (age > 60 years).Results: Eight articles (N = 8) satisfied the inclusion criteria and were considered, of which 6 are RTC, one cross-sectional study and one clinical study, for a total of 635 participants. A total of 6 different vibration devices were used, each of which was associated with different FV frequency and amplitude characteristics and different treatment protocols.Conclusion: In conclusion, FV can be effective in decreasing the risk of falls and improving the assessment of balance, but more evidence is necessary considering the limits of the studies; however, it does look an important promise during rehabilitative treatment.Keywords: rehabilitation, risk of falls, exercise, vibration, equilibrium

Massimo Mammucari,1 Teresa Paolucci,2 Domenico Russo,3 Enrica Maggiori,1 Raffaele Di Marzo,4 Alberto Migliore,5 Umberto Massafra,5 Gianpaolo Ronconi,6 Paola Emilia Ferrara,6 Fabio Gori,7 Barbara Bifarini,7 Stefano Brauneis,8 Renato Vellucci,9 Rocco Domenico Mediati,9 Bartolomeo Violo,10 Silvia Natoli,11 Carmen Pediliggieri,12 Cristiana Di Campli,12 Maria Chiara Collina12 1Primary Care Unit, ASL RM 1, Rome, Italy; 2Unit of Physical Medicine and Rehabilitation, G. D’ Annunzio University of Chieti-Pescara, Department of Oral Medical Science and Biotechnology (DSMOB), Chieti, Italy; 3“San Marco” Hospice and Palliative Care, Latina, Italy; 4Member of the Italian Society of Mesotherapy, Rome, Italy; 5Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy; 6Physical Medicine and Rehabilitation Unit, IRCCS, Catholic University of Sacred Heart, Rome, Italy; 7Section of Anaesthesia, Intensive Care, and Pain Medicine, University Hospital Santa Maria Della Misericordia, Perugia, Italy; 8Pain Centre “Enzo BorzomatI”, University Hospital of Rome “Policlinico Umberto I”, Rome, Italy; 9Anaesthesiology Department, University Hospital Careggi, Florence, Italy; 10Pain Therapy Unit, S. Spirito Nuovo Regina Margherita Hospital, Rome, Italy; 11Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy; 12Department of Vascular Surgery, Limb Salvage and Diabetic Foot, IDI-IRCCS, Rome, ItalyCorrespondence: Massimo MammucariPrimary Care Unit, Local Health, ASL RM 1, Rome, 00165, ItalyTel +39-06-61560695 Email massimo.mammucari@libero.itAbstract: Mesotherapy (local intradermal therapy, LIT) is a technique used to slowly spread drugs in tissues underlying the site of injection to prolong the pharmacological effect with respect to intramuscular injection. Recommendations for proper medical use of this technique have been made for pain medicine and rehabilitation, chronic venous disease, sport medicine, musculoskeletal disorders, several dermatological conditions, skin ageing, and immune-prophylaxis. Although mesotherapy is considered a valid technique, unresolved questions remain, which should be answered to standardize methodology and dosing regimen as well as to define the right indications in clinical practice. New randomized controlled trials are needed to test single products (dose, frequency of administration, efficacy and safety). Even infiltration of substances for dermo-cosmetic purposes must be guided by safety and efficacy tests before being proposed by mesotherapy. In this article, we put forth a preclinical and clinical research plan and a health technology assessment as a call to action by doctors, researchers and scientific societies to aid national health authorities in considering mesotherapy for prevention, treatment and rehabilitation paths.Keywords: mesotherapy, intradermal therapy, research plan