State of the art of current 3-D scoliosis classifications: a systematic review from a clinical perspective

Scoliosis is a complex three dimensional (3D) deformity: the current lack of a 3D classification could hide something fundamental for scoliosis prognosis and treatment. A clear picture of the actually existing 3D classifications lacks. The aim of this systematic review was to identify all the 3D classification systems proposed until now in the literature with the aim to identify similarities and differences mainly in a clinical perspective. After a MEDLINE Data Base review, done in November 2013 using the search terms "Scoliosis/classification" [Mesh] and "scoliosis/classification and Imaging, three dimensional" [Mesh], 8 papers were included with a total of 1164 scoliosis patients, 23 hyperkyphosis and 25 controls, aged between 8 and 20 years, with curves from 10\ub0 to 81\ub0 Cobb, and various curve patterns. Six studies looked at the whole 3D spine and found classificatory parameters according to planes, angles and rotations, including: Plane of Maximal Curvature (PMC), Best Fit Plane, Cobb angles in bodily plane and PMC, Axial rotation of the apical vertebra and of the PMC, and geometric 3D torsion. Two studies used the regional (spinal) Top View of the spine and found classificatory parameters according to its geometrical properties (area, direction and barycenter) including: Ratio of the frontal and the sagittal size, Phase, Directions (total, thoracic and lumbar), and Shift. It was possible to find similarities among 10 out of the 16 the sub-groups identified by different authors with different methods in different populations. In summation, the state of the art of 3D classification systems include 8 studies which showed some comparability, even though of low level. The most useful one in clinical everyday practice, is far from being defined. More than 20 years passed since the definition of the third dimension of the scoliosis deformity, now the time has come for clinicians and bioengineers to start some real clinical application, and develop means to make this approach an everyday tool

Cross-cultural adaptation, reliability and validity of the Fremantle Knee Awareness Questionnaire in Italian subjects with painful knee osteoarthritis

Background and aim: Growing attention is being given to utilising physical function measures to better understand and manage knee osteoarthritis (OA). The Fremantle Knee Awareness Questionnaire (FreKAQ), a self-reported measure of body-perception specific to the knee, has never been validated in Italian patients. The aims of this study were to culturally adapt and validate the Italian version of the FreKAQ (FreKAQ-I), to allow for its use with Italian-speaking patients with painful knee OA. Methods: The FreKAQ-I was developed by means of forward–backward translation, a final review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included: internal structural validity by Rasch analysis; construct validity by assessing hypotheses of FreKAQ correlations with the knee injury and osteoarthritis outcome score (KOOS), a pain intensity numerical rating scale (PI-NRS), the pain catastrophising scale (PCS), and the Hospital anxiety and depression score (HADS) (Pearson’s correlations); known-group validity by evaluating the ability of FreKAQ scores to discriminate between two groups of participants with different clinical profiles (Mann–Whitney U test); reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficient, ICC2.1); and measurement error by calculating the minimum detectable change (MDC). Results: It took one month to develop a consensus-based version of the FreKAQ-I. The questionnaire was administered to 102 subjects with painful knee OA and was well accepted. Internal structural validity confirmed the substantial unidimensionality of the FreKAQ-I: variance explained was 53.3%, the unexplained variance in the first contrast showed an eigenvalue of 1.8, and no local dependence was detected. Construct validity was good as all of the hypotheses were met; correlations: KOOS (rho = 0.38–0.51), PI-NRS (rho = 0.35–0.37), PCS (rho = 0.47) and HADS (Anxiety rho = 0.36; Depression rho = 0.43). Regarding known-groups validity, FreKAQ scores were significantly different between groups of participants demonstrating high and low levels of pain intensity, pain catastrophising, anxiety, depression and the four KOOS subscales (p ≤ 0.004). Internal consistency was acceptable (α = 0.74) and test–retest reliability was excellent (ICC = 0.92, CI 0.87–0.94). The MDC95 was 5.22 scale points. Conclusion: The FreKAQ-I is unidimensional, reliable and valid in Italian patients with painful knee OA. Its use is recommended for clinical and research purposes

Isokinetic strength of foot plantar and dorsal flexors in young male orienteers

Orienteers navigate point to point in unfamiliar and uneven grounds using map and compass to run their races. High levels of fitness and running speed are requested to cover successfully long distances and climbs. Strength in ankle and foot muscles is necessary to overcome natural obstacles in rough terrains (1). Eight male orienteers of junior Italian team (OR; age, 19\ub11.6yr), 8 cross country track and fields experienced runners (TF; 20\ub14.5yr), and 8 sedentary persons (control group CG; 23\ub12.7yr), all with right lower limb dominance volunteered. Ages, weights, heights, and body mass indices between groups did not differ (ANOVA, p>0.05). Each participant performed and an isokinetic dynamometer measured 4 repetitions of right and left foot dorsal and plantar flexions at the angular speeds of 60-120-180deg/sec respectively. Within side, group and angular speed, the ratios of peak torques between plantar and dorsal flexors were also computed. Descriptive statistics were calculated within subject, group, movement, angular speed, and side. For each movement, the effects of group and side, and group 7side interactions on peak torques at different speeds were compared by ANOVA (statistical significance 5%). Within group, dorsal and plantar flexors of right foot were generally stronger than those of contralateral limb, but differences were not significant. Side-related differences were similar in all groups (p>0.05). On average, OR performed larger peak torques in both sides and movements. Differences were significant in foot plantar flexors at 60-120-180deg/sec, and in foot dorsal flexors at 60 and 120deg/sec (p 640.04). In both limbs, the ratios between plantar and dorsal flexors were larger in OR at 120-180deg/sec, and in TF at 60deg/sec (p<0.01). Orienteers build their physical training mostly on overcoming natural obstacles and running on uneven grounds. This approach could stimulate a continuous proprioceptive activity, and favor the reinforcement of ankle and foot muscles. Data could be of interest for coaches to set efficient training plans preventing accidental injuries, and for physical therapists and physicians to quantify the effects of rehabilitation. Investigations should be extended to a larger group of participants and to other muscular districts

Miglioramento della resistenza e della performance muscolare mediante trattamento con onde d&#8217;urto defocalizzate

Scopo di questo studio \ue8 la valutazione degli effetti di un trattamento con onde d\u2019urto defocalizzate sull\u2019attivit\ue0 del muscolo scheletrico in termini di resistenza e di performance. Sono stati reclutati 60 soggetti sani, 30 maschi e 30 femmine. 40 pazienti sono stati sottoposti al protocollo di intervento, mentre 20 hanno partecipato al gruppo di controllo, senza ricevere il trattamento con onde d\u2019urto. Al termine di un ciclo di quattro sedute di onde d\u2019urto si \ue8 osservato un aumento dell\u2019Endurance Time e una diminuzione della Frequenza Cardiaca Massimale durante il test da sforzo a carico costante su cicloergometro. A 12 settimane dalla fine del trattamento i valori della Frequenza cardiaca Massimale non hanno subito variazioni statisticamente significative, mentre quelli dell\u2019Endurance Time hanno subito un ritorno ai valori basali. Per quanto riguarda la performance muscolare si \ue8 visto un miglioramento significativo alla valutazione T1, subito dopo la terapia con onde d\u2019urto, e alla valutazione T2, 12 settimane dopo l\u2019ultima seduta di onde d\u2019urto, rispetto alla valutazione iniziale a T0. Non \ue8 stata evidenziata una differenza statisticamente significativa tra i valori rilevati a T1e quelli a T2. I risultati di questo studio suggeriscono che il trattamento con onde d\u2019urto defocalizzate pu\uf2 portare a un miglioramento dell\u2019attivit\ue0 del muscolo scheletrico in termini di performance e di resistenza muscolare senza provocare alcun tipo di danno ai tessuti. Questi risultati aprono possibilit\ue0 di applicazione di questa metodica sia in ambito clinico (per esempio per il recupero funzionale dell\u2019amiotrofia ex non usu), sia in ambito sportivo

The risk assessment and prediction tool (Rapt) after hip and knee replacement: A systematic review

Purpose The Risk Assessment and Prediction Tool (RAPT) is an interesting instrument for predicting the discharge destination and length of stay (LOS) for patients after hip or knee arthroplasty. The aim of this review is to describe its predictive ability, current utilization, and future prospects through the analysis of scientific literature. Methods The databases of PubMed, Web of Sciences, Cochrane Library, and Pedro were searched for English studies on RAPT prediction capacity. Only original prospective or retrospective articles that analyze specifically the use of RAPTwere included, whereas those concerned with other preoperative prediction tools or those only considering other aspects of recovery after joint replacements were excluded. Results A total of 27 references were retrieved, and 8 studies were selected. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high-and low-risk patients. In the intermediate risk category, a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome. Conclusion Although contrarily to many of the other scores, the RAPT has been validated in multiple countries with relatively similar results between different institutions; however, its validity has yet to be tested and adapted in every nation context. Further studies confirming the predictive accuracy of RAPT at other institutions are needed as well as studies assessing the effect of using RAPT to identify patients for targeted interventions in terms of LOS, discharge disposition, clinical outcomes, and financial impact. Level of Evidence This is a level IV, systematic review of level III and IV study

Isokinetic evaluation of knee flexors and extensors in young male orienteers

Orienteering races usually develop in wooded lands with large differences in slopes. In addition to the climbs, long descents are frequently covered. Therefore, lower limb muscular strength is necessary to sustain these challenges on rough terrains (1). Eight male orienteers of junior Italian team (OR; age, 19\ub11.6yr), 8 cross country track and fields experienced runners (TF; 20\ub14.5yr), and 8 sedentary persons (control group CG; 23\ub12.7yr), all with right lower limb dominance volunteered. Between groups, no age-, weight-, height-, and BMI-related differences were found (ANOVA, p>0.05). Each participant performed and an isokinetic dynamometer measured 5 repetitions of right and left knee flexion and extension at the angular speeds of 60-120-180-240-300deg/sec respectively. The ratios of peak torques between knee flexors and extensors were also computed, at each angular speed. Descriptive statistics were calculated within subject, group, movement, angular speed, and side. For each movement, the effects of group and side, and group 7side interactions on peak torques at different speeds were compared by ANOVA (statistical significance 5%). On average within group, flexor and extensor muscles of the right knee were stronger than those of contralateral limb, but no significant differences were found. Side-related differences were similar in all groups (p>0.05). In both sides and movements at each angular speed, OR performed larger peak torques than TF and CG (p<0.001). For each angular velocity, the ratios between flexors and extensors were larger in OR (p<0.001). For orienteers, overcoming natural obstacles, and engaging eccentric work of knee muscles when running downhill could represent effective training tools. Data could be of interest for athletes, coaches, physical therapists, and physicians to set efficient training plans, to prevent trauma, and to define rehabilitation treatments. Further investigations should be extended to other muscular districts, and to other sports

Altered cardiovascular autonomic regulation in overweight children engaged in regular phycal activity

Overweight (OW) and obesity in children are important forerunners of cardiovascular risk, possibly through autonomic nervous system (ANS) dysregulation, while physical exercise exerts a beneficial influence. In this observational study we hypothesise that OW might influence ANS profile even in a population performing high volume of supervised exercise. We study 103 young soccer players, homogeneous in terms of gender (all male), cultural background, school, age (11.2\ub11 years) and exercise routine, since they all belong to the same soccer club, thus guaranteeing equality of supervised training and similar levels of competitiveness. ANS is evaluated by autoregressive spectral analysis of heart rate and systolic arterial pressure (SAP) variabilities. We estimate also the accumulated weekly Metabolic Equivalents and time spent in sedentary activities. We subdivide the entire population in two subgroups (normal weight and OW) based on the International Obesity Task Force criteria. In OW soccer players (10.7% of total group) we observe an altered profile of autonomic cardiovascular regulation, characterised by higher values of SAP (113\ub14 vs 100\ub11 mm Hg, 39.7\ub13 vs 66.2\ub110%), higher Low Frequency variability power of SAP (an index of vasomotor sympathetic regulation) (12\ub13 vs 4.5 mm Hg(2)) and smaller spontaneous baroreflex gain (an index of cardiac vagal regulation) (19\ub13 vs 33 \ub13 ms/mm Hg) (all (p<0.02)). Moreover Correlation analysis on the entire study population shows a significant link between anthropometric and autonomic indices. These data show that OW is associated to a clear autonomic impairment even in children subjected to an intense aerobic training