Validity of the wall goniometer as a screening tool to detect postural abnormalities in Parkinson's disease

none24INTRODUCTION: Software-based measurements of postural abnormalities in Parkinson's disease (PD) are the gold standard but may be time-consuming and not always feasible in clinical practice. Wall goniometer (WG) is an easier, quicker, and inexpensive instrument for screening patients with postural abnormalities, but no studies have investigated its validity so far. The aim of this study was to investigate the validity of the WG to measure postural abnormalities. METHODS: A total of 283 consecutive PD outpatients with ≥5° forward trunk, lateral trunk or forward neck bending (FTB, LTB, FNB, respectively) were recruited from seven centers for movement disorders. Postural abnormalities were measured in lateral and posterior view using a freeware program (gold standard) and the WG. Both angles were expressed in degrees (°). Sensitivity and specificity for the diagnosis of camptocormia, Pisa syndrome, and anterocollis were assessed. RESULTS: WG showed good to excellent agreement (intraclass correlation coefficient from 0.80 to 0.98) compared to the gold standard. Bland-Altman plots showed a mean difference between the methods from -7.4° to 0.4° with limits of agreements from -17.7° to 9.5°. Sensitivity was 100% for the diagnosis of Pisa syndrome, 95.74% for anterocollis, 76.67% for upper camptocormia, and 63.64% for lower camptocormia. Specificity was 59.57% for Pisa syndrome, 71.43% for anterocollis, 89.80% for upper camptocormia, and 100% for lower camptocormia. Overall, the WG underestimated measurements, especially in lower camptocormia with an average of -8.7° (90% of cases). CONCLUSION: WG is a valid tool for screening Pisa syndrome and anterocollis, but approximately 10° more should be added for camptocormia.openTinazzi M.; Gandolfi M.; Artusi C.A.; Lanzafame R.; Zanolin E.; Ceravolo R.; Capecci M.; Andrenelli E.; Ceravolo M.G.; Bonanni L.; Onofrj M.; Telese R.; Bertolotti C.; Polverino P.; Manganotti P.; Mazzucchi S.; Giannoni S.; Vacca L.; Stocchi F.; Casali M.; Zibetti M.; Lopiano L.; Fasano A.; Geroin C.Tinazzi, M.; Gandolfi, M.; Artusi, C. A.; Lanzafame, R.; Zanolin, E.; Ceravolo, R.; Capecci, M.; Andrenelli, E.; Ceravolo, M. G.; Bonanni, L.; Onofrj, M.; Telese, R.; Bertolotti, C.; Polverino, P.; Manganotti, P.; Mazzucchi, S.; Giannoni, S.; Vacca, L.; Stocchi, F.; Casali, M.; Zibetti, M.; Lopiano, L.; Fasano, A.; Geroin, C

Does the Degree of Trunk Bending Predict Patient Disability, Motor Impairment, Falls, and Back Pain in Parkinson's Disease?

Background: Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a “typical” parkinsonian stooped posture to progressively greater degrees of spine deviation. Objective: To analyze the association between degree of postural abnormalities and disability and to determine cut-off values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain. Methods: The study population was 283 PD patients with ≥5° of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale [MDS-UPDRS] part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cut-off was identified using receiver operating characteristic (ROC) curves. Results: We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment in LTB (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.03–1.22). ROC curves showed that patients with LTB of 10.5° (SBM, AUC 0.626) may have moderate/severe motor impairment. Conclusions: The severity of trunk misalignment does not fully explain limitation in ADLs, motor impairment, falls, and back pain. Multiple factors possibly related to an aggressive PD phenotype may account for disability in PD patients with FTB, LTB, and FNB

Systematic rapid "living" review on rehabilitation needs due to COVID-19: Update to March 31st, 2020

INTRODUCTION: The outbreak of COVID-19 epidemics has challenged the provision of health care worldwide, highlighting the main flaws of some national health systems with respect to their capacity to cope with the needs of frail subjects. People experiencing disability due to COVID-19 express specific rehabilitation needs that deserve a systematic evidence-based approach. The aim of this article is to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to COVID-19. The first rapid "living"review will present the results of a systematic search performed up to March 31st, 2020. EVIDENCE ACQUISITION: A systematic search in PubMed, Pedro, and Google Scholar was performed using the search terms: "COVID-19,""Coronavirus,""severe acute respiratory syndrome coronavirus 2,""rehabilitation,""physical therapy modalities,""exercise,""occupational therapy,"and "late complications."Papers published up to March 31st, 2020, in English, were included. EVIDENCE SYNTHESIS: Out of the 2758 articles retrieved, nine were included in the present review. Four of them are "calls for action", three provide recommendations about rehabilitation interventions in the acute phase, two address the needs of people quarantined at home or with restricted mobility due to the lockdown, and one provides a Core Outcome Set to be used in clinical trials to test the efficacy of health strategies in managing COVID-19 patients. CONCLUSIONS: All selected papers were based on previous literature and not on the current COVID-19 pandemic. Main messages included: 1) early rehabilitation should be granted to inpatients with COVID-19; 2) people with restricted mobility due to quarantine or lockdown should receive exercise programs to reduce the risk of frailty, sarcopenia, cognitive decline and depression; 3) telerehabilitation may represent the first option for people at home. Further updates are warranted in order to characterize the emerging disability in COVID-19 survivors and the adverse effects on the health of chronically disabled people

Systematic rapid living review on rehabilitation needs due to COVID-19: Update as of April 30th, 2020

INTRODUCTION: This paper adds to the series of systematic rapid living reviews, started in April 2020, to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to COVID-19 pandemic. The aim of this paper is to present the results of a systematic scientific literature search performed on papers published from April 1st to April 30th, 2020. EVIDENCE ACQUISITION: A systematic search was performed on PubMed, Embase, Scopus, CINAHL, PEDro, Web of Science and the main international guideline databases for articles published (including Epub), in English, from April 1st to April 30th, 2020. Papers were included if they reported on one of the following: 1) prevalence and features of the emerging disability after COVID-19; 2) rehabilitation strategies applied for COVID-19 patients, regardless of setting or stage; 3) information about rehabilitation services after COVID-19; 4) impact on diseases of rehabilitative interest; 5) complications of rehabilitative interest. EVIDENCE SYNTHESIS: Out of 445 articles retrieved for the time frame, 50 were finally included for qualitative analysis. They consist of seven guidelines, one scoping review, one randomized controlled trial, four descriptive studies (qualitative), one case series, one case report, and 35 expert opinions. CONCLUSIONS: This systematic rapid living review showed an increasing evidence on rehabilitation needs due to COVID-19 outbreak during April 2020. The main novelties include: 1) the first appearance of epidemiological data on the likely high incidence of neurological complications/ disabling sequelae in patients hospitalized for COVID-19; 2) rapid guidelines on the management of chronically disabled patients in the COVID-19 era; 3) advices to provide COVID-19 patients with early respiratory rehabilitation in the acute phase, and with telemonitoring and telerehabilitation in the post-acute phase. Although the overall quality of studies has increased, prospective cohort studies on disability course in COVID-19 pandemic and experimental studies on the effects of rehabilitation are still warranted

Rehabilitation and covid-19: a rapid living systematic review 2020 by cochrane rehabilitation field. Update as of september 30th, 2020

introduction: the coVid-19 outbreak response requires identifying and understanding the long-term consequences of this new pathology and how to manage these. This living systematic review presents the most current and seminal information coming from the scientific literature. it is the monthly update of the second edition of the rapid living systematic review 2020 conducted by cochrane rehabilitation rEh-coVEr action steering committee. the aim of this review was to update the monthly coVid-19 and rehabilitation literature research up to september 30, 2020. EVidEncE acQuisition: Methodology described in the second edition of the rapid living systematic review 2020 conducted by cochrane rehabilitation rEh-coVEr action was applied. the most important medical databases were searched, and papers related to coVid-19 and rehabilitation were retrieved and summarized descriptively. EVidEncE synthEsis: the database search retrieved 2526 publications. duplicates were removed, and 1150 unique records were screened for inclusion. after screening titles, abstracts and full-texts, 37 papers were included in the present review. according to ocEbM 2011 levels of evidence table, most studies (78.4%) fall within the level of evidence 4 category, while the remainder (22.6%) are categorized as level of evidence 3. Most studies described patients in acute (51.4%) or subacute (35.0%) phase, while no studies described the chronic consequences of coVid-19. Just one study dealt with rehabilitation interventions regarding coVid-19, and two discussed reorganization of rehabilitative services. conclusions: the most recently published coVid-19 research focuses more on describing the clinical presentations and the natural history of the pathology, rather than rehabilitation interventions or service delivery. Studies with high levels of evidence regarding the efficacy of interventions, long-term monitoring, or new organization models remain lacking

Pain processing in functional and idiopathic dystonia: An exploratory study

Background: Pain is often experienced by patients with functional dystonia and idiopathic cervical dystonia and is likely to be determined by different neural mechanisms. Objective: In this exploratory study, we tested the sensory-discriminative and cognitive-emotional component of pain in patients with functional and idiopathic dystonia. Methods: Ten patients with idiopathic cervical dystonia, 12 patients with functional dystonia, and 16 age- and sex-matched healthy controls underwent psychophysical testing of tactile and pain thresholds and pain tolerance. We delivered electrical pulses of increasing intensity to the index finger of each hand and the halluces of each foot. Pain threshold and pain tolerance were respectively defined as the (1) intensity at which sensation changed from unpainful to faintly painful and (2) intensity at which painful sensation was intolerable. Results: No differences were found between the three groups for tactile and pain thresholds assessed in hands and feet. Pain tolerance was significantly increased in all body regions only in functional dystonia. Patients with continuous functional dystonia had higher pain tolerance compared to subjects with paroxysmal functional dystonia and idiopathic cervical dystonia. There was no correlation between pain tolerance and pain scores, depression, anxiety, disease duration, and motor disability in both groups. Conclusions: Patients with functional dystonia have a dissociation between the sensory-discriminative and cognitive-emotional components of pain, as revealed by normal pain thresholds and increased pain tolerance. Abnormal connectivity between the motor and limbic systems might account for abnormal pain processing in functional dystonia. © 2018 International Parkinson and Movement Disorder Society

Monitoring of Sangiovese Red Wine Chemical and Sensory Parameters along One-Year Aging in Different Tank Materials and Glass Bottle

The aim of this research was to study how different tank materials affected the chemical composition and the sensory profile of a red wine during aging. For this purpose, a single varietal Sangiovese wine was aged at the same time by using different tank materials including stainless steel, epoxy-coated concrete, uncoated concrete, earthenware raw amphorae, and new and used oak barrels. Phenolic and volatile compounds, elemental content, tartaric stability, and sensory discriminant attributes of Sangiovese wine from the 2018 harvest were measured after 6 and 12 months of aging in tanks and 6 months in glass bottle (after the aging of 6 months carried out in each relevant container). The results showed that the different tanks significantly differentiated the wines on the base of all the chemical and sensory parameters considered. In particular, wines aged in earthenware raw amphorae and uncoated concrete registered a high content of polymeric pigments as the wine aged in the new oak barrel, resulting in materials that better promote the wine color stabilization. The same wines also showed the highest pH and tartaric stability, mostly likely related to the observed release of inorganic compounds from the tank material. Moreover, bottle aging enhanced the chemical and sensory differences between all the wines: they were characterized by a higher content of varietal volatiles such as norisoprenoids and terpenes, probably due to the reductive conditions in the bottle. The bottle also affected the perceived quality of the wines aged in concrete (uncoated and epoxy-coated) associated to the floral flavor, floral odor, sweetness attributes, and, to a lesser extent, acidity, while the ones aged in stainless steel and amphorae is associated to the berry jam odor