Principles and Practice of Geriatric Medicine, 2005
Page 1. 57 Cardiac Rehabilitation in Older People Niccol`o Marchionni, Francesco Fattirolli,Lucio... more Page 1. 57 Cardiac Rehabilitation in Older People Niccol`o Marchionni, Francesco Fattirolli,Lucio A. Rinaldi and Giulio Masotti ... P r inciples and P r actice of G er iatr ic Medicine , 4th E dition. E dited by M .S. J ohn Pathy, Alan J. Sinclair and J ohn E . Morley. ...
Background and Purpose. The aim of this study was to quantify and assess the types of research an... more Background and Purpose. The aim of this study was to quantify and assess the types of research and review articles published in physiotherapy professional journals with international circulations. Method. Selected articles from nine physiotherapy journals in a period of fi ve years were classifi ed according to their study design. Results. A total number of 1627 articles were included in this study of which 205 (12.60%) were randomized controlled trial (RCT). Articles published with the highest frequency were 'observational/descriptive studies' (n = 305, 18.75%), whereas 'meta-analyses' were the rarest ones (n = 21, 1.29%). Many articles were validation studies (n = 216, 13.28%) and articles classifi ed as 'others ' (n = 217, 13.34%). High heterogeneity was found in terms of distribution over years and journals with an improvement of the number of RCTs among years. Conclusion. The distribution of different types of article in physiotherapy journals is similar to other disciplines. The improvement of RCTs represents an important move in the right direction for evidence-based physiotherapy research.
Background and Purpose. Glenohumeral subluxation (GHS) is a frequent complication in patients wit... more Background and Purpose. Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. Method. A case-control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at followup, 30-40 days after discharge (T3). Results. GHS was present in 52 patients (48.6%) and correlated signifi cantly to shoulder pain at T1, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R 2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R 2 = 0.766; p < 0.001). Conclusions. GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.
Background and Purpose. Considerable disagreement exists among researchers with regard to the pre... more Background and Purpose. Considerable disagreement exists among researchers with regard to the prevalence, pathophysiology, and treatment of "pusher behavior" (PB), partly because of different testing procedures. This study was primarily aimed at establishing cutoff scores for and the construct validity of the Scale for Contraversive Pushing (SCP). The prevalence of PB in people with right-and left-brain lesions also was investigated.
We would like to thank Drs Baccini, Paci, and Rinaldi (Neurorehabil Neural Repair 2006; 20: 468-4... more We would like to thank Drs Baccini, Paci, and Rinaldi (Neurorehabil Neural Repair 2006; 20: 468-472) for their thorough analysis of reliability and validity of our Clinical Scale for Contraversive Pushing (SCP). 1 This scale may help diagnose and quantify the behavior ...
Pushing toward the hemiplegic side can interfere with mobility training after stroke. This study ... more Pushing toward the hemiplegic side can interfere with mobility training after stroke. This study estimated the internal consistency, interrater reliability, and validity of the Scale for Contraversive Pushing (SCP). Twenty-six patients with recent stroke were diagnosed with pusher behavior (PB). Two testers, randomly selected from 3 other examiners, independently assessed each patient using the SCP on the same day within 3 days of admission for rehabilitation. Cohen kappa coefficient was used to determine the agreement between the clinical and SCP diagnosis. The interrater reliability of the scale was estimated by calculation of the intraclass correlation coefficient. Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha coefficient and Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s coefficients were used to estimate the internal consistency of the scale and correlations between the subscores and the total score. The agreement between SCP and clinical diagnosis was very low when the original cutoff criterion for SCP diagnosis was used but was almost perfect with a modified criterion. The interrater reliability was good to excellent with regard both to each sub-score and to the total score. The internal consistency was very high, along with correlations between subscores and total score of the scale. The results provide support for use of the SCP based on its reliability and validity using a modified cutoff criterion to make a diagnosis of PB.
Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter c... more Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter changes (ARWMC), is largely due to hypertension and it is, in turn, responsible for geriatric syndromes, including decline in cognitive, functional and motor/gait abilities. This review analyzes the link between hypertension and ARWMC, as well as the complex relationships between ARWMC and cognitive impairment, executive dysfunction, and movement/gait abnormalities. The available evidence supports the hypothesis that these functional consequences of ARWMC are responsible for substantial disability in the elderly. Thus, adequate treatment of hypertension may represent a feasible way to reduce the burden of disability in late life.
The Journal of Rehabilitation Research and Development, 2005
This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patien... more This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies. Abbreviations: FES = functional electrical stimulation, GHJ = glenohumeral joint, GHS = glenohumeral subluxation, SP = shoulder pain. This material is the result of work supported with resources and the use of facilities at the University of Florence. * References are listed in "References" section of main body text. † Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations. Note: Numbers in parentheses indicate range. NA = not available (mean, range, or both), AP = anteroposterior view. * Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations.
Journal of Neurology, Neurosurgery & Psychiatry, 2011
Objective. Physiotherapy is usually provided only in the first few months after stroke, while its... more Objective. Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods. We searched published studies where participants were randomized to an active physiotherapy intervention, compared to placebo or no intervention, at least 6 months after stroke. Outcome was change in mobility and activities of daily living (ADL) independence. Quality of trials was evaluated using the PEDro scale. Findings were summarized across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% confidence interval (CI) in random effects models. Results. Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14-0.45). Efficacy of the intervention was particularly evident when short-and long-distance walking (SDW, LDW) were considered as separate outcomes, with WMD of 0.05 m/sec (95% CI 0.008-0.088) and 20 m (95% CI 3.6-36.0), respectively. Also ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation. A variety of physiotherapy interventions improve functional outcomes even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients that had experienced stroke and should be valued in planning community rehabilitation services.
Background and Aim: Diabetes mellitus (DM) is recognized as an important risk factor for stroke a... more Background and Aim: Diabetes mellitus (DM) is recognized as an important risk factor for stroke and might theoretically influence post-stroke level of disability, increasing the extension of the cerebral injured area. However, results of the few researches aimed at studying this influence are contradictory; moreover, the effect of DM on motor recovery has not been extensively studied. The aim of this study was to investigate the effect of DM on both functional and motor recovery. Methods: A total of 395 acute patients with first stroke were selected in a rehabilitation department and divided into two groups on the basis of the presence or absence of DM (DM+ and DM−, respectively). Outcome measures were the Barthel Index, the Fugl-Meyer Assessment Scale, and the mobility part of the motor assessment chart according to Lindmark and Hamrin. Participants were assessed at admission to department (T1, 13.9±7.9 days from stroke onset), at discharge (T2, 40.1±13.4), and at follow-up (T3, 84.2±14.3). A 2×3 analysis of variance with repeated measures was performed to verify the effect of group and of phase of assessment on motor and functional measures and their interaction. Results: DM+ and DM− groups included 93 and 302 patients, respectively. Both groups showed a significant and progressive improvement in all outcome measures (Pb.001), but no interaction was found between group and phase of assessment, which means that motor and functional recovery was similar in the two groups. Conclusion: Results suggest that diabetes has no influence on motor and functional outcome within the acute and post-acute phase after stroke. Further research should investigate motor recovery in a longer-term period and with larger samples.
Objective: To describe the change with time of the reported methodological quality of randomized ... more Objective: To describe the change with time of the reported methodological quality of randomized controlled trials of physiotherapy interventions.
supine, knee extended and the angle between pelvis and trunk of 1508. The subjects were studied 1... more supine, knee extended and the angle between pelvis and trunk of 1508. The subjects were studied 1 day before and 1 day after the knee surgery in both lower limbs. Every subject has performed both exercises twice, for a total number of eight exercises. There was 1 min of pause between two successive exercises and the sequence of execution among the eight exercises has been randomised. It has been used the pocket EMG (BTS) and bipolar electrodes to record the surface electromyography. The electrodes were positioned on the rectus femoris, vastus medialis and vastus lateralis of the quadriceps. It was recorded the eventual pain during the execution of exercises using a visual analogic scale (VAS) after every exercise. Nonparametric tests were used for the statistical analysis using the SPSS software.
Results show that some differences exist in postural sway between bindfolded sighted individuals ... more Results show that some differences exist in postural sway between bindfolded sighted individuals and blind persons, especially when blindness is congenital, likely because these individuals had to develop since birth non-visual strategies for postural control. Fingertip contact is effective in reducing postural sway in the blind as well as in the sighted. Age is the main factor influencing postural stability, but it does not limit the ability to use haptic information to reduce postural sway. This finding supports the hypothesis that older people may use a cane as an informative device rather than a mechanical aid.
limbs and of the lifted lower limb are impossible, turned out to be very difficult for both the g... more limbs and of the lifted lower limb are impossible, turned out to be very difficult for both the groups, with less difference as regards cinematic parameters and platform values. In short, the practising of physical activities provides a best balance in one-leg stance. In particular, in sportsmen there's a better management of the relationship between foot and ground, essential condition to prevent ankle sprains.
Principles and Practice of Geriatric Medicine, 2005
Page 1. 57 Cardiac Rehabilitation in Older People Niccol`o Marchionni, Francesco Fattirolli,Lucio... more Page 1. 57 Cardiac Rehabilitation in Older People Niccol`o Marchionni, Francesco Fattirolli,Lucio A. Rinaldi and Giulio Masotti ... P r inciples and P r actice of G er iatr ic Medicine , 4th E dition. E dited by M .S. J ohn Pathy, Alan J. Sinclair and J ohn E . Morley. ...
Background and Purpose. The aim of this study was to quantify and assess the types of research an... more Background and Purpose. The aim of this study was to quantify and assess the types of research and review articles published in physiotherapy professional journals with international circulations. Method. Selected articles from nine physiotherapy journals in a period of fi ve years were classifi ed according to their study design. Results. A total number of 1627 articles were included in this study of which 205 (12.60%) were randomized controlled trial (RCT). Articles published with the highest frequency were 'observational/descriptive studies' (n = 305, 18.75%), whereas 'meta-analyses' were the rarest ones (n = 21, 1.29%). Many articles were validation studies (n = 216, 13.28%) and articles classifi ed as 'others ' (n = 217, 13.34%). High heterogeneity was found in terms of distribution over years and journals with an improvement of the number of RCTs among years. Conclusion. The distribution of different types of article in physiotherapy journals is similar to other disciplines. The improvement of RCTs represents an important move in the right direction for evidence-based physiotherapy research.
Background and Purpose. Glenohumeral subluxation (GHS) is a frequent complication in patients wit... more Background and Purpose. Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. Method. A case-control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at followup, 30-40 days after discharge (T3). Results. GHS was present in 52 patients (48.6%) and correlated signifi cantly to shoulder pain at T1, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R 2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R 2 = 0.766; p < 0.001). Conclusions. GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.
Background and Purpose. Considerable disagreement exists among researchers with regard to the pre... more Background and Purpose. Considerable disagreement exists among researchers with regard to the prevalence, pathophysiology, and treatment of "pusher behavior" (PB), partly because of different testing procedures. This study was primarily aimed at establishing cutoff scores for and the construct validity of the Scale for Contraversive Pushing (SCP). The prevalence of PB in people with right-and left-brain lesions also was investigated.
We would like to thank Drs Baccini, Paci, and Rinaldi (Neurorehabil Neural Repair 2006; 20: 468-4... more We would like to thank Drs Baccini, Paci, and Rinaldi (Neurorehabil Neural Repair 2006; 20: 468-472) for their thorough analysis of reliability and validity of our Clinical Scale for Contraversive Pushing (SCP). 1 This scale may help diagnose and quantify the behavior ...
Pushing toward the hemiplegic side can interfere with mobility training after stroke. This study ... more Pushing toward the hemiplegic side can interfere with mobility training after stroke. This study estimated the internal consistency, interrater reliability, and validity of the Scale for Contraversive Pushing (SCP). Twenty-six patients with recent stroke were diagnosed with pusher behavior (PB). Two testers, randomly selected from 3 other examiners, independently assessed each patient using the SCP on the same day within 3 days of admission for rehabilitation. Cohen kappa coefficient was used to determine the agreement between the clinical and SCP diagnosis. The interrater reliability of the scale was estimated by calculation of the intraclass correlation coefficient. Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha coefficient and Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s coefficients were used to estimate the internal consistency of the scale and correlations between the subscores and the total score. The agreement between SCP and clinical diagnosis was very low when the original cutoff criterion for SCP diagnosis was used but was almost perfect with a modified criterion. The interrater reliability was good to excellent with regard both to each sub-score and to the total score. The internal consistency was very high, along with correlations between subscores and total score of the scale. The results provide support for use of the SCP based on its reliability and validity using a modified cutoff criterion to make a diagnosis of PB.
Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter c... more Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter changes (ARWMC), is largely due to hypertension and it is, in turn, responsible for geriatric syndromes, including decline in cognitive, functional and motor/gait abilities. This review analyzes the link between hypertension and ARWMC, as well as the complex relationships between ARWMC and cognitive impairment, executive dysfunction, and movement/gait abnormalities. The available evidence supports the hypothesis that these functional consequences of ARWMC are responsible for substantial disability in the elderly. Thus, adequate treatment of hypertension may represent a feasible way to reduce the burden of disability in late life.
The Journal of Rehabilitation Research and Development, 2005
This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patien... more This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies. Abbreviations: FES = functional electrical stimulation, GHJ = glenohumeral joint, GHS = glenohumeral subluxation, SP = shoulder pain. This material is the result of work supported with resources and the use of facilities at the University of Florence. * References are listed in "References" section of main body text. † Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations. Note: Numbers in parentheses indicate range. NA = not available (mean, range, or both), AP = anteroposterior view. * Paci M, Nannetti L, Baccini M, Pasquini J, Rinaldi LA, Taiti PG. Shoulder subluxation after a stroke: relationships with pain and motor recovery. Physiother Res Int. Unpublished observations.
Journal of Neurology, Neurosurgery & Psychiatry, 2011
Objective. Physiotherapy is usually provided only in the first few months after stroke, while its... more Objective. Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods. We searched published studies where participants were randomized to an active physiotherapy intervention, compared to placebo or no intervention, at least 6 months after stroke. Outcome was change in mobility and activities of daily living (ADL) independence. Quality of trials was evaluated using the PEDro scale. Findings were summarized across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% confidence interval (CI) in random effects models. Results. Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14-0.45). Efficacy of the intervention was particularly evident when short-and long-distance walking (SDW, LDW) were considered as separate outcomes, with WMD of 0.05 m/sec (95% CI 0.008-0.088) and 20 m (95% CI 3.6-36.0), respectively. Also ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation. A variety of physiotherapy interventions improve functional outcomes even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients that had experienced stroke and should be valued in planning community rehabilitation services.
Background and Aim: Diabetes mellitus (DM) is recognized as an important risk factor for stroke a... more Background and Aim: Diabetes mellitus (DM) is recognized as an important risk factor for stroke and might theoretically influence post-stroke level of disability, increasing the extension of the cerebral injured area. However, results of the few researches aimed at studying this influence are contradictory; moreover, the effect of DM on motor recovery has not been extensively studied. The aim of this study was to investigate the effect of DM on both functional and motor recovery. Methods: A total of 395 acute patients with first stroke were selected in a rehabilitation department and divided into two groups on the basis of the presence or absence of DM (DM+ and DM−, respectively). Outcome measures were the Barthel Index, the Fugl-Meyer Assessment Scale, and the mobility part of the motor assessment chart according to Lindmark and Hamrin. Participants were assessed at admission to department (T1, 13.9±7.9 days from stroke onset), at discharge (T2, 40.1±13.4), and at follow-up (T3, 84.2±14.3). A 2×3 analysis of variance with repeated measures was performed to verify the effect of group and of phase of assessment on motor and functional measures and their interaction. Results: DM+ and DM− groups included 93 and 302 patients, respectively. Both groups showed a significant and progressive improvement in all outcome measures (Pb.001), but no interaction was found between group and phase of assessment, which means that motor and functional recovery was similar in the two groups. Conclusion: Results suggest that diabetes has no influence on motor and functional outcome within the acute and post-acute phase after stroke. Further research should investigate motor recovery in a longer-term period and with larger samples.
Objective: To describe the change with time of the reported methodological quality of randomized ... more Objective: To describe the change with time of the reported methodological quality of randomized controlled trials of physiotherapy interventions.
supine, knee extended and the angle between pelvis and trunk of 1508. The subjects were studied 1... more supine, knee extended and the angle between pelvis and trunk of 1508. The subjects were studied 1 day before and 1 day after the knee surgery in both lower limbs. Every subject has performed both exercises twice, for a total number of eight exercises. There was 1 min of pause between two successive exercises and the sequence of execution among the eight exercises has been randomised. It has been used the pocket EMG (BTS) and bipolar electrodes to record the surface electromyography. The electrodes were positioned on the rectus femoris, vastus medialis and vastus lateralis of the quadriceps. It was recorded the eventual pain during the execution of exercises using a visual analogic scale (VAS) after every exercise. Nonparametric tests were used for the statistical analysis using the SPSS software.
Results show that some differences exist in postural sway between bindfolded sighted individuals ... more Results show that some differences exist in postural sway between bindfolded sighted individuals and blind persons, especially when blindness is congenital, likely because these individuals had to develop since birth non-visual strategies for postural control. Fingertip contact is effective in reducing postural sway in the blind as well as in the sighted. Age is the main factor influencing postural stability, but it does not limit the ability to use haptic information to reduce postural sway. This finding supports the hypothesis that older people may use a cane as an informative device rather than a mechanical aid.
limbs and of the lifted lower limb are impossible, turned out to be very difficult for both the g... more limbs and of the lifted lower limb are impossible, turned out to be very difficult for both the groups, with less difference as regards cinematic parameters and platform values. In short, the practising of physical activities provides a best balance in one-leg stance. In particular, in sportsmen there's a better management of the relationship between foot and ground, essential condition to prevent ankle sprains.
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