Combination of Rehabilitative Therapy with Ultramicronized Palmitylethanolamide for Chronic Low Back Pain: An Observational Study

Chronic low ba,:k pain (LBP) caused by intervertebral disc herniation was reported in the 2010 Global Burden of Disease study to be the main reason for;zears lived wittL disability. It causes significant personal, social, and economic burdens. Many of those who suffer from LBP find convent:ional medica.l treatments to be unsatisfactory for treating their pain, so they are increasingl'g resorting tcr complementary and alternalive medicine (CAM) therapies. Given that thr: population ir; aging, there is an urgent need to characterize the combinations of complementary therapie:; that yield the best outcomes and treatments, even for prolonged periods. The multiple action of PEA in connbination with CAVI therapies may represent the multitarget approachr needed trc tackle the as-yet unsolved problem of chronic pain resistant to conventional therapie

APPROCCIO CLINICO E RIABILITATIVO AL PAZIENTE PROTESIZZATO D'ARTO INFERIORE

Nella chirurgia sostitutiva protesica, ripercorrendo le tappe riabilitative e analizzandone le modalità e le tecniche, si evince che è possibile permettere al paziente il riapprendimento della corretta deambulazione con la riorganizzazione di tutte le fasi e della gestualità corrente per il reinserimento efficace nel contesto sociale di appartenenza. Oltre che dal punto di vista puramente motorio, il soggetto deve essere seguito anche sotto l’aspetto della psicomotricità e nel rispetto di importanti esigenze psicologiche. Viene sorretto, incoraggiato, ma soprattutto responsabilizzato sul fatto che per la ripresa completa si rende indispensabile la sua partecipazione attiva e la costanza dell’impegno. I riflessi pratici di una guarigione efficace e completa sono quindi estremamente proficui per il soggetto, il quale avverte in sé la capacità di ottemperare all’impegno del proprio recupero; seppur con stati d’ansia che insidiano il suo equilibrio, egli tenderà a proiettarsi nel suo futuro che quindi non apparirà denso di incognite. Non vi sarà commiserazione né emarginazione, ma voglia di vivere in una società che, anche se disumanizza i rapporti fra le differenti fasce di età, offre interessi e spazi per quanti sappiano organizzare la propria esistenza senza frustrazioni, remore e tentennamenti. La riabilitazione del protesizzato è un processo complesso perché non riguarda solamente il recupero della funzionalità della singola articolazione ma è rivolto a un riaddestramento globale del soggetto a una nuova modalità di vita relazionale. Il programma riabilitativo, quindi, deve essere personalizzato sul singolo e deve proporsi obiettivi differenti in base alle condizioni generali (anche cognitive). È necessario rendere possibile il raggiungimento di un livello di autosufficienza e autonomia motoria tale da permettere il ritorno alle normali attività di vita quotidiana

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

Background Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium. Aim Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the efectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients. Methods We divided the study into two parts. In the frst part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise. Results Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a signifcant improvement in blood levels of magnesium (2.11±0.15 vs. 1.94±0.11; p<0.05), on the NRS scale (5.7±0.81 vs. 6.6±1.18; p<0.05), the Tinetti scale (17.3±1.15 vs. 15.2±2.98; p<0.05) and the SarQoL questionnaire (47.3±5.21 vs. 44.9±5.54; p<0.05). Conclusions More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifable risk factors for osteoporosis

Can the combination of rehabilitation and vitamin D supplementation improve fibromyalgia symptoms at all ages?

Several studies have indicated a correlation between vitamin D deficiency and widespread chronic pain syndromes, such as fibromyalgia. During this study, the effect of supplementation with vitamin D in association with physical exercise in patients with fibromyalgia was evaluated, in terms of improvement of pain, functional capacity and quality of life, also evaluating the presence of any differences in age. A single-center, observational, comparative study was conducted in 80 fibromyalgia patients. They are randomized into 2 groups: Group A, consisting of patients ≤50 years; and group B, consisting of patients >50 years. Both received weekly supplementation with 50,000 IU cholecalciferol for 3 months in association with a rehabilitation protocol. Patients were assessed at enrollment (T0), 3 months (T1), and 6 months (T2) from the initial assessment with blood vitamin D dosage and administration of rating scales (NRS, FIQ, and SF-12). From the comparison between the two groups, we have seen that in young people, supplementation with high-dose vitamin D improves short-term musculoskeletal pain and long-term functional capacity. Conversely, musculoskeletal pain and long-term quality of life improve in the elderly. Supplementing with high doses of vitamin D in fibromyalgia patients improves the quality of life and pain in the elderly and also the functional capacity in the young

Combined Point of Care Tools Are Able to Improve Treatment Adherence and Health-Related Quality of Life in Patients with Severe Hemophilia: An Observational Prospective Study

Introduction: Ultrasound (US) assessment of joints is an evolving point of care tool for the detection of early joint arthropathy (Napolitano M, Kessler CM. Hemophilia A and B. Consultative Hemostasis and Thrombosis, Kitchens, 4th edition); population pharmacokinetic (pop-PK) studies are adopted as a useful instrument to set the prophylaxis regimen for patients with hemophilia, they may improve adherence (Nagao A.et al. Thromb Res. 2019 Jan; 173:79-84) and reduce the annual bleeding rate (ABR). Adherence to continuous intravenous administrations of factor VIII or Factor IX products is challenging, thus patients may experience breakthrough bleedings while on prophylaxis. Repeated US examinations of joint status have recently been advocated to attempt to remedy sub-optimal medication adherence (Di Minno A et al., Blood Rev. 2019 Jan;33:106-116). Aim of the current prospective analysis was to evaluate the impact of combined US assessment and pop-PK study on adherence to treatment and health related quality of life in patients with severe hemophilia A(HA) and B (HB) under regular prophylaxis. Material and methods: This prospective observational study was performed at a single tertiary center from January 2017 to June 2019. Research was conducted following the Helsinki Declaration. All patients included in the study provided a written informed consent for study participation. Patients with severe HA and HB routinely underwent, as part of regular 12-months follow-up visits, the following: US joints evaluation of elbows, knees and ankles using the HEAD-US protocol, treatment adherence evaluation by VERITAS-Pro questionnaire, health –related quality of life assessment by the standardized EQ-5D,EQ-VAS and pop-PK study (WAPPS-Hemo, McMaster University) as needed (i.e.in case of changes in life style, planned treatment switch); each patient visualised US and his estimated PK profile during medial encounters. Compliance to the prescribed treatment was also determined by analysis of patient diaries with infusion logs. Statistical analysis was performed using the SPSS software version 25.0 (SPSS Chicago, IL). Statistical tests were 2-sided, with a significance threshold of 0.05. Results: Twenty consecutive males with severe haemophilia were included in the current analysis, 13 with severe HA, 2 with HA with previous inhibitors and 5 HB, with a median age of 30 (range 14- 56) years and a median ABR of 5 (range:0-12). Nine patients were under primary prophylaxis, 8 under secondary prophylaxis and 3 under tertiary prophylaxis, they all self-infused at home. Four patients had one target joint and 3 patients had multiple target joints. For each enrolled subject, HEAD-US score, VERITAS-pro, EQ5D and EQ-VAS score were assessed at enrolment (T0) and at 12 (T12) and 24 (T24) months follow-up visits, respectively. Pop-PK was assessed in 11 patients: in 7 (5 HA,2 HB) it was assessed twice, before and after treatment switch to extended half-life (EHL) products, in 4 it was assessed once to modify prophylaxis treatment schedules for a more active life-style (N=2) or weight changes (N=2). Median ABR was 4 at T12 and 3.8 at T24. Reported breakthrough bleeds at T12 were 14, mainly trauma-related (N= 8) or affecting target joints (N=4), they were not reported at T24 in patients with PK-driven modified schedules (N=4) and in 4 patients under EHL treatments. Mean HEAD-US score at T0 resulted 8 (range:0-16), at T24 it was 6 (range:0-16). Mean Veritas-Pro score values were 42.7 at TO, 40.1 at T12 and 38.7 at T24. At T0, EQ-5D mean utility score was 0.82 (range: 0.68-1), at T24, the mean was 0.87 (range:0.72-1). In detail, at 24 months follow-up, there was a statistically significant (p<0.05) improvement in adherence to treatment with particular reference to the dimensions of communication and skipped doses. A tendency toward improved HEAD-US score, higher adherence and better quality of life scores, was observed in particular in patients switched to EHL products at T24, at a mean of 10 months after switching (range: 6-22 months). Conclusion: Several combined measures of haemophilia treatment monitoring, allowing visual assessment of joints status and PK profile estimates by patients have here shown to improve treatment adherence and quality of life in patients with HA and HB, this may be not only related to new available treatments but also to an increased awareness and education of patients

Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

Abstract: Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA‐ScR (Preferred Reporting Items for Systematic Reviews and Meta‐ Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low‐Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), lowintensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole‐body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease‐modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients