Online teaching in physiotherapy education during COVID-19 pandemic in Italy: a retrospective case-control study on students\u2019 satisfaction and performance

Background: During COVID-19 pandemic, physiotherapy lecturers faced the challenge of rapidly shifting from face-to-face to online education. This retrospective case-control study aims to compare students' satisfaction and performances shown in an online course to a control group of students who underwent the same course delivered face-to-face in the previous five years. Methods: Between March and April 2020, a class (n = 46) of entry-level physiotherapy students (University of Verona - Italy), trained by an experienced physiotherapist, had 24-hours online lessons. Students exposed to the same course in the previous five academic years (n = 112), delivered with face-to-face conventional lessons, served as a historical control. The course was organized in 3 sequential phases: (1) PowerPoint presentations were uploaded to the University online platform, (2) asynchronous video recorded lectures were provided on the same platform, and (3) between online lectures, the lecturer and students could communicate through an email chat to promote understanding, dispel any doubts and collect requests for supplementary material (e.g., scientific articles, videos, webinars, podcasts). Outcomes were: (1) satisfaction as routinely measured by University with a national instrument and populated in a database; (2) performance as measured with an oral examination. Results: We compared satisfaction with the course, expressed on a 5-point Likert scale, resulting in no differences between online and face-to-face teaching (Kruskal-Wallis 2 = 0.24, df = 1, p = 0.62). We weighted up students' results by comparing their mean performances with the mean performances of the same course delivered face-to-face in the previous five years, founding a statistical significance in favour of online teaching (Wilcoxon rank sum test W = 1665, p < 0.001). Conclusions: Online teaching in entry-level Physiotherapy seems to be a feasible option to face COVID-19 pandemic, as satisfies students as well as face-to-face courses and leading to a similar performance. Entry-level Bachelors in Physiotherapy may consider moving to eLearning to facilitate access to higher education. Universities will have to train lecturers to help them develop appropriate pedagogical skills, and supply suitable support in terms of economic, organizational, and technological issues, aimed at guaranteeing a high level of education to their students. Trial registration: Retrospectively registered

The Use of Botulinum Toxin A as an Adjunctive Therapy in the Management of Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis

Several studies have investigated the effect of botulinum toxin A (BoNT-A) for managing chronic musculoskeletal pain, bringing contrasting results to the forefront. Thus far, however, there has been no synthesis of evidence on the effect of BoNT-A as an adjunctive treatment within a multimodal approach. Hence, Medline via PubMed, EMBASE, and the Cochrane Library-CENTRAL were searched until November 2020 for randomised controlled trials (RCTs) that investigated the use of BoNT-A as an adjunctive therapy for chronic musculoskeletal pain. The risk of bias (RoB) and the overall quality of the studies were assessed through RoB 2.0 and the GRADE approach, respectively. Meta-analysis was conducted to analyse the pooled results of the six included RCTs. Four were at a low RoB, while two were at a high RoB. The meta-analysis showed that BoNT-A as an adjunctive therapy did not significantly decrease pain compared to the sole use of traditional treatment (SDM −0.89; 95% CI −1.91; 0.12; p = 0.08). Caution should be used when interpreting such results, since the studies displayed very high heterogeneity (I = 94%, p < 0.001). The overall certainty of the evidence was very low. The data retrieved from this systematic review do not support the use of BoNT-A as an adjunctive therapy in treating chronic musculoskeletal pain

Disfunzioni della Percezione Corporea nelle Patologie Muscoloscheletriche e Reumatiche

This thesis presents a group of studies published, submitted or in preparation, and other research study projects approved by Ethics Committees. Its general aim is to explore how patients with MDRDs may show dysfunctions in body perception. It is composed of two main parts. PART I presents a general overview of body perception mechanisms and perceptual dysfunctions in MDRDs. More particularly, Chapter I offers a systematic review of the literature dedicated to the questions and knowledge gaps highlighted in the introduction. PART II approaches the relationship between BPDs and neuropathic pain through an overview of the neurophysiological mechanisms described in the literature dedicated to the role of neuropathic pain in \u201cphantom perceptions\u201d. A special focus has been placed on dysfunctions of the so-called small-fibers. Finally, Chapters II-V will address the hypotheses guiding the subsequent studies and research projects, which explore phenomena of bodily illusions in two categories of MDRDs: fibromyalgic patients and subjects with chronic low back pain affected by failed back surgery. A series of studies has been conducted during the three-year period of PhD training (2017-2019), while other research projects were proposed for future development. Research lines promoted has been planned and conducted from different perspectives, adopting a variety of methodologies in order to cover the complexity of body perception phenomena in chronic painful MDRDs

Ecological Gait as a Fall Indicator in Older Adults: A Systematic Review

Falls represent a major threat for elders, affecting their life quality and expectancy. Clinical tests and questionnaires showed low diagnostic value with respect to fall risk. Modern sensor technology allows in-home gait assessments, with the possibility to register older adults' ecological mobility and, potentially, to improve accuracy in determining fall risk. Hence, we studied the correlation between standardized assessments and ecological gait measures, comparing their ability to identify fall risk and predict prospective falls

Manual therapy: Exploiting the role of human touch

The physiotherapy approach to musculoskeletal pain is currently pointing more towards a hands-off management of patients by education and exercise therapy. However, hands-on techniques still represent a core element of musculoskeletal physiotherapy practice appreciated by patients and widely taught in educational program and clinical professional development training

Stroke and Etiopathogenesis: What Is Known?

Background: A substantial portion of stroke risk remains unexplained, and a contribution from genetic factors is supported by recent findings. In most cases, genetic risk factors contribute to stroke risk as part of a multifactorial predisposition. A major challenge in identifying the genetic determinants of stroke is fully understanding the complexity of the phenotype. Aims: Our narrative review is needed to improve our understanding of the biological pathways underlying the disease and, through this understanding, to accelerate the identification of new drug targets. Methods: We report, the research in the literature until February 2022 in this narrative review. The keywords are stroke, causes, etiopathogenesis, genetic, epigenetic, ischemic stroke. Results: While better risk prediction also remains a long-term goal, its implementation is still complex given the small effect-size of genetic risk variants. Some authors encourage the use of stroke genetic panels for stroke risk assessment and further stroke research. In addition, new biomarkers for the genetic causes of stroke and new targets for gene therapy are on the horizon. Conclusion: We summarize the latest evidence and perspectives of ischemic stroke genetics that may be of interest to the physician and useful for day-to-day clinical work in terms of both prevention and treatment of ischemic stroke

Explicit and implicit experience of own’s body in painful musculoskeletal disorders and rheumatic diseases: A scoping review protocol of available quantitative and qualitative evidence

Introduction: Our body experience is organized at twofold levels: perceptual and cognitive-emotional. These higher-order processes are clearly different from the primary sensory processing of somatic stimuli (somatosensation). However, most of the available studies have mainly investigated the mechanisms of somatosensation. Moreover, disturbances of our body experience have been documented in some pathological conditions of interest for rehabilitative interventions, but their clinical role and relevance is yet to be clarified. Because in this field we have limited knowledge on perceptual and cognitive body experience, there emerges a need to better clarify this matter. The aim of the present scoping review is to systematically map this topic and to examine the magnitude and the nature of the available evidences. Materials and Methods: The scoping review will be performed following the six-stage methodology suggested by Arksey and O’Malley. Ten electronic databases will be investigated since their inception. The search strategy will be peer reviewed by PRESS 2015 Evidence-Based Checklist as a quality assurance step. All records retrieved will be screened by two independent reviewers. The Population, Concept, and Context method will be adopted for eligibility criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used for results reporting. Two reviewers with different background will perform the search process independently. One author will extract data, checked by a second reviewer checking the matching with the research questions and goals. Any disagreements will be solved by a third reviewer. Ethics and Dissemination: Ethical approval is not required for scoping reviews. Dissemination will include submission to peer-reviewed journal and presentations in conferences in the area of rehabilitation

Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review

Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution

Neuropathic pain and symptoms of potential small-fiber neuropathy in fibromyalgic patients: a national on-line survey

OBJECTIVE: recent studies have highlighted that about 50% of fibromyalgic patients has a neuropathy of small- and/or large-fibers which could partially explain the puzzling symptoms of fibromyalgia (FM). Our aim was to investigate the estimated prevalence of self-reported neuropathic pain and small-fiber neuropathic symptoms (SFNS) indicative for the presence of small-fiber pathology in FM patients.METHODS: a nationwide sample of patients was recruited to participate in an on-line survey. Two groups of patients were considered in post-hoc analysis: those positive (FM+) to the Fibromyalgia Research Criteria (FRC) and those complaining typical symptoms of fibromyalgia without fulfilling the FRC (FM-).RESULTS: we collected data from 854 patients (749 FM+ and 105 FM-). Patients that scored 6550/100 at the Neuropathic Pain Symptoms Inventory (NPSI), indicating severe neuropathic pain, were 57.3% (62.4% in FM+ and 21.0% in FM-). Around 46% of patients presented three or more SFNS that could be suggestive of small fiber pathology, the most frequent being dry eyes/mouth, allodynia, and dyshidrosis. The NPSI score showed significant moderate/strong associations with disability (Spearman's rho=0.61), pain (rho=0.66), stiffness level (rho=0.46), number of painful sites (rho=0.40), and SFNS (rho=0.44). Despite the high prevalence of neuropathic pain and other symptoms attributable to potential small and/or large fibers pathology, neurophysiologic investigations were performed in 43.6% of cases and skin punch biopsy only in 1.9% of patients enrolled, as well as the assumption of anti-neuropathic pain drugs (13.2%).CONCLUSIONS: our findings underscore the high estimated prevalence of neuropathic pain and SFNS in FM patients