Lombalgia e lavoro: Il contributo della riabilitazione : Stato dell'arte

In the treatment of chronic low back pain the efficacy and specificity of rehabilitation has been scientifically demonstrated, as testified by the actual International Clinical Guidelines. The usable techniques include Back School and functional rehabilitation: the first one relate patients with low functional impairments, and usually no working disability, while the second one should be used when there is a disability in the activity of daily living and in the profession. Even if originally developed as an inpatient treatment, in these years some randomised controlled trials have shown the efficacy also of outpatient techniques for functional rehabilitation, as the DBC proposal

Un nuovo metodo di riabilitazione funzionale (DBC) in pazienti con disabilità lavorativa da patologia del rachide lombare

Rehabilitation is reducing disability through an improvement of function, i.e. rehabilitation need always to be "functional". Nevertheless, like it happened in other fields where rehabilitation has not yet reached its maturity, in spinal pathologies it has usually been considered equal to conservative treatment, i.e. not surgical relief of pain. But relieving pain does not always mean to recover function: in fact, it has been proven that there are no long term good results treating symptomatically chronic low back pain (CLBP). In the Eighties in USA a new kind of treatment has been introduced for inpatient rehabilitation of CLBP, based on a full-time four-weeks training of physical abilities, together with a cognitive and educational approach to pain. This treatment, named "functional rehabilitation", proved its efficacy also in randomised controlled trials (RCT). In the Nineties in Finland the outpatient version of this treatment for CLBP has been developed by "Documentation Based Care" (DBC), whose efficacy have also been documented in RCT: the efficiency of this last kind of treatment should be higher. DBC treatment is spreading around the world, and it recently reached Italy in Don Gnocchi

[A new method of functional rehabilitation of patients with occupational disability caused by lumbar spine pathology].

Rehabilitation is reducing disability through an improvement of function, i.e. rehabilitation need always to be "functional". Nevertheless, like it happened in other fields where rehabilitation has not yet reached its maturity, in spinal pathologies it has usually been considered equal to conservative treatment, i.e. not surgical relief of pain. But relieving pain does not always mean to recover function: in fact, it has been proven that there are no long term good results treating symptomatically chronic low back pain (CLBP). In the Eighties in USA a new kind of treatment has been introduced for inpatient rehabilitation of CLBP, based on a full-time four-weeks training of physical abilities, together with a cognitive and educational approach to pain. This treatment, named "functional rehabilitation", proved its efficacy also in randomised controlled trials (RCT). In the Nineties in Finland the outpatient version of this treatment for CLBP has been developed by "Documentation Based Care" (DBC), whose efficacy have also been documented in RCT: the efficiency of this last kind of treatment should be higher. DBC treatment is spreading around the world, and it recently reached Italy in Don Gnocchi

Osteoporosis treatment and fracture incidence: the ICARO longitudinal study.

Abstract None of the available osteoporosis therapies completely abolish the risk of fracture. Among 862 patients on treatment with antiresorptive agents (alendronate, risedronate, and raloxifene) for >1 year a fragility fracture was observed in 9.5%/year. This incidence is considerably higher than that observed in randomized clinical trials. INTRODUCTION: Available osteoporosis therapies reduced in randomized controlled trials (RCTs) the risk of fracture by 30-50%. The proportion of patients suffering from new fractures while on active treatment ("inadequate clinical treatment response" or ICR) can be derived from the data of the RCTs, where confounding factors are usually controlled by the exclusion criteria. In the retrospective part of the ICARO study we observed a 8.9% annual incidence of ICR. Here we report the results of the longitudinal part of the study. METHODS: The study includes 862 women with severe postmenopausal osteoporosis. Ninety-two of these patients (10.7%) were defined as having ICR (9.5%/year) during therapy with antiresorptive drugs (alendronate, risedronate, and raloxifene) for at least 1 year. RESULTS: The ICR patients were comparable to patients who did not sustain clinical fractures with regard to body mass index, follow-up duration, number of prevalent vertebral fractures, type of osteoporosis treatment, proportion of patients taking calcium and vitamin D supplements, and compliance with treatment. Those with ICR were significantly older (p=0.032) and more frequently had multiple vertebral deformities (p=0.013). CONCLUSIONS: The incidence of ICR during treatment with antiresorptive agents among patients with severe postmenopausal osteoporosis in a routine setting is considerably higher than that observed in randomized clinical trial