Planning and designing impartial health systems through mobile healthcare.

Starting from the definition of an health system widespread on the territory, the paper investigates design strategies for the definition of a health campus that can allow more efficient services based on an integrated program of mobile healthcare units. The possibility of creating a minimum space requires a correct and detailed analysis of those medical interventions and assistance which would most contribute to the healthcare of citizens in West Bengal, reducing the NGOs and NHS overheads. The model, responding the social and cultural complexity of India, can be adaptable and its flexibility allows to be expanded and to be subjected to future modifications

Treatment of medial collateral ligament injuries of the knee with focused extracorporeal shockwave therapy: A case report

Medial collateral ligament (MCL) injuries are the most frequent ligamentous injuries of the knee. Focused extracorporeal shock wave therapy (f-ESWT) is progressively expanding its field of application to many musculoskeletal pathologies. Although there is evidence surrounding the efficacy of f-ESWT in tendinopathies, no studies have described the usefulness of ultrasound (US)-guided f-ESWT in the treatment of ligament injuries. Herein, we report a case of a MCL injury treated with f-ESWT. Moreover, our case shows the importance of using ultrasonography in determining the effect of treatment. A 60-year-old man with a focal area of lesion in the deep fibers underwent 4 weekly sessions of US-guided f-ESWT to the injured ligament area. His pain decreased to a visual analog scale (VAS) of 3 at the end of the treatment and was completely resolved at the 1-month follow-up visit, with these results being maintained at 4-month follow-up. The US examination showed an initial deposition of “newly formed tissue” at the site of previous injury of the proximal MCL insertion, and a reduction in MCL thickness together with an improvement in echostructure. Based on this result, we speculate that non-surgical ligament injuries could be a new indication for f-ESWT. However, further investigation on the effects of f-ESWT for ligament injuries is needed

Dextrose prolotherapy for chronic tendinopathy: A scoping review

Introduction: Tendinopathy is a frequent source of musculoskeletal pain and disability. Between treatment options, prolotherapy, an injection treatment that aims to promote tissue healing, could play a role in symptomatic and functional improvement. The purpose of the study is to analyze current evidence about the effect of dextrose injections on clinical outcomes in patients with chronic tendinopathy. Methods: A literature search on MEDLINE (PubMed) and PEDro databases was conducted. All randomized controlled trials (RCTs) published in the last 10 years, with available abstracts, in English language, analyzing the effect of prolotherapy in human subjects with a diagnosis of chronic tendinopathy were considered. Methodological quality was assessed by PEDRO scale quality assessment tool. Results: Sixteen papers were included. Most of the RCTs were of medium to high quality. Based on the analyzed data, prolotherapy could represent an easy to access, cheap, safe and effective conservative treatment in rotator cuff tendinopathy and in epiconodylosis and could improve pain control in the medium to long-term, with encouraging data on function restoring in the long term. However, solutions preparation, procedural aspects and comparators were highly heterogeneous. Conclusion: Current evidence suggests that prolotherapy can results in improving symptoms in patients with tendinopathy, with no observed adverse reactions. However, few RCTs have been conducted; the results are not consistent enough and have a wide heterogeneity in their protocols so comparing data was not always possible. Therefore, further studies require a repeatable standardized procedure to confirm these positive preliminary results

Clinical Impact of Balneotherapy and Therapeutic Exercise in Rheumatic Diseases: A Lexical Analysis and Scoping Review

Objective: To review the evidence regarding the clinical effect of spa therapy for rheumatic diseases, with particular attention given to association protocols between balneotherapy and rehabilitation interventions, and to support the literature research and studies' selection with lexical analysis. Methods: A lexical analysis was performed considering a list of words representing diseases and outcome measures linked to the theme studied in our review. Then, two independent researchers conducted a literature search on PubMed using the string employed for lexical analysis, including Randomized Controlled Trials regarding spa therapy's clinical effects on patients affected by rheumatic diseases published in the last 30 years. After the exclusion of works that did not meet the eligibility criteria, 14 studies were included in the final scoping review. Results: Spa therapy has shown a favourable effect on pain, function and quality of life in patients with Osteoarthritis, Fibromyalgia and Rheumatoid Arthritis. Different treatment modalities and types of water have demonstrated beneficial long-term clinical improvement. Furthermore, the association between thermal therapy and rehabilitation treatments has shown better clinical outcomes, probably due to the synergistic effect between the peculiar properties of the thermal waters and the therapeutic exercise program, if conducted in the same context. Conclusions: The combination of balneotherapy and rehabilitative interventions seems to be effective in ameliorating several outcomes in patients with rheumatic diseases. However, due to the wide variety of methodologies and interventions employed, these findings need to be further investigated. The lexical analysis should represent an auxiliary support for an extensive evaluation of scientific literature

The relationship between clinical tests, ultrasound findings and selected field-based wheelchair skills tests in a cohort of quadriplegic wheelchair rugby athletes: A pilot study

Manual wheelchair use may determine shoulder joint overload and rotator cuff injury. Chronic shoulder pathologies can also influence the propulsion ability of wheelchair athletes with spinal cord injury (SCI) during sport activities. However, the relationship between shoulder pathology and wheelchair performances has never been explored. Therefore, the study aimed to investigate the correlation between shoulder pathologic findings with clinical tests and ultrasonography evaluation and the results of wheelchair performance tests. Nineteen quadriplegic wheelchair rugby players were evaluated to investigate the association between clinical and ultrasound shoulder pathologic findings and their correlation with the performance of field-based selected wheelchair skills tests (WSTs). The outcome measures were the International Wheelchair Rugby Classification Score, dominant and non-dominant Physical Examination Shoulder Score, and dominant and non-dominant Ultrasound Shoulder Pathology Rating Scale (USPRS). The WST was measured at the beginning and at one-year follow-up. A statistically significant correlation was found between the time since SCI and dominant USPRS (p < 0.005). The non-dominant USPRS was strongly related to WST at the beginning (p < 0.005) and the end of the study (p < 0.05). Data suggest that the severity of the non-dominant shoulder pathology detected on the ultrasound is related to lower performance on the WST. Chronic manual wheelchair use could be responsible for dominant SCI shoulder joint and rotator cuff muscle damage, while non-dominant USPRS could be related to performance on the WST

Motor imagery and rehabilitation of a professional soccer player after anterior cruciate ligament injury: A case report

Anterior cruciate ligament (ACL) injury is one of the most common musculoskeletal injuries; it is the third most important injury in elite athletes after muscular strains and fractures. Generally, an early rehabilitation is needed in order to obtain an optimal restoration of both knee joint stability and sensory function. In the first part of the rehabilitation phase, when the athlete cannot get the job done in the field yet, it can be useful to perform the action observation (AO) and motor imagery (MI) training. This is a case report about a 24-year-old professional soccer player who re-ported an ACL injury and medial collateral ligament (MCL) during a league game. During the rehabilitation period, the player has remained in close contact with his teammates, staying on the field right away during workouts, without participating actively. The technique of "motor imagery" and action observation were applied to reinforce the effect of rehabilitation and reduce recovery times. The follow-up consisted in a muscle strength evaluation with an isokinetic test and a postural assessment using a video-raster-stereography system "Formetric". At the end of the rehabilitation program, the player returned to the activity in less time than normal recovery time as described in literature

Efficacy of Ultrasound-Guided Percutaneous Lavage and Biocompatible Electrical Neurostimulation, in Calcific Rotator Cuff Tendinopathy and Shoulder Pain, A Prospective Pilot Study

Calcific tendinopathy of the shoulder (CTS) is the most common cause of shoulder pain. Conservative treatment is considered as the first therapeutic choice for CTS. The main objective of this study was to assess the effect of US-guided needling (UGN) compared to UGN plus Biocompatible Electrical Neurostimulation (BEN) in the treatment of the CTS. Pilot, prospective, non-interventional, monocentric, and observational study of patients treated for calcific rotator cuff tendinopathy and shoulder pain. Patients’ selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility. Forty adult patients (aged 40–60 years) with a diagnosis of CTS in the acute and colliquative phase were recruited and enrolled into the study. Participants were assessed for self-perceived pain through the Numerical Rating Scale (NRS), and for functional limitation through the Shoulder Pain and Disability Index score (SPADI) at baseline (T0), after 15 days (T1), and after 40 days (T2). As a possible confounding factor between the two treatments’ response, the dimension of the tendon calcification was also assessed by US-examination. Through the study, both groups improved their perceived functional performance of the arm (p-value < 0.001). AT T1, the SPADI score decreased by half in both groups, and the improvement remained stable at T2. A multiplicative effect (Time × Treatment) was demonstrated (p-value < 0.001). An improvement in the NRS score was measured at T1, and it remained stable at T2, a multiplicative effect was also reported (p-value < 0.001). The main results of this pilot study provide evidence that UGN plus BEN increases functional performance and reduces shoulder pain in individuals with CTS. Moreover, the tendon calcification dimension at the baseline and the percentage of drainage of the lesion were associated with a functional performance recovery and pain reduction detected after intervention