Abstract
Background
Temporomandibular disorders (TMD) are the main cause of chronic facial pain, and intra‐articular (IA) injections of hyaluronic acid (HA) are commonly performed.
Objectives
This ...umbrella review of systematic reviews aimed at analysing the effectiveness of HA injections on pain and functional outcomes in patients affected by TMD.
Methods
PubMed, Cochrane Library and PEDro were systematically searched from inception until 17 January 2023 to identify systematic reviews evaluating the effects on pain and functional outcomes of HA IA injections. PROSPERO registration number: CRD42022382586.
Results
Out of 316 papers suitable for title/abstract screening, 18 articles were included in the umbrella review. Thirteen studies included only randomized controlled clinical trials (RCTs). The included systematic reviews reported no statistically significant differences between HA and corticosteroids, whereas platelet derivates seem to have good results in pain relief. The literature did not show severe adverse events, except for mild pain in the site of injection. Concerning the quality assessment of the 18 systematic reviews, 2 (11.11%) had a high quality, 3 (16.67%) a moderate quality, 7 (38.89%) a low quality and 6 (33.33%) a critically low quality.
Conclusions
Taken together, findings of this umbrella review showed intriguing effects of IA HA injections in terms of reduction of pain intensity and improvement of functioning in patients affected by TMD. Furthermore, there is no agreement on the effectiveness of a combination of arthrocentesis or arthroscopy with IA HA injections. Although the literature showed these positive results after IA HA injections, the overlapping of primary studies in the systematic reviews included might have affect our results, such as the very low quality of the papers. Thus, further RCTs are needed to confirm the efficacy of IA injections of HA on pain relief in patients with TMD.
Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion–relaxation phenomenon (FRP) evaluation is a valid clinical tool for low ...back pain (LBP) assessment. Yoga, a holistic mind–body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight‐session yoga asanas program, with the first session conducted in‐clinic and the rest delivered with tele‐approach. Outcome measures included pain intensity, flexion–relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow‐up (visual analog scale VAS: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele‐yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long‐term effects of yoga for managing LBP.
The COVID‐19 pandemic has had a strong impact on healthcare workers (HCWs), affecting their physical and mental health. In Italy, HCWs have been among the first exposed to unprecedented pressure, ...dealing with large numbers of infections during the first pandemic wave. However, the severe psychological consequences on HCWs find little evidence in the literature, especially in terms of comparison to the status quo ante pandemic. The aim of this study was to provide an assessment of the mental health burden in a cohort of Italian HCWs during the COVID‐19 pandemic, comparing their condition with that before the emergency, to direct the promotion of mental well‐being among HCWs worldwide. In this retrospective study, we included physicians, physical therapists, and nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and Rehabilitation Unit from a Southern Italy University Hospital. All study participants underwent a battery of psychological tests, aimed at verifying their state of mental health during the COVID‐19 emergency and before it. Depressive, anxiety, and burnout symptoms were assessed using the following questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire‐9 (PHQ‐9), and General Anxiety Disorder‐7. Depressive, anxiety, and burnout clinical relevance symptoms were present in HCWs during the COVID‐19 pandemic more than those before the emergency. Fifty percent of the HCWs obtained a score clinically significant during the emergency. Moreover, a depersonalization factor showed a statistically significant increase in average scores (p < 0.0001). The PHQ‐9 scale showed that 47.1% of the operators reported depressive state presence. The number of operators scoring above the cut‐off for the anxiety scale tripled during the emergency (p < 0.0001). The female gender conferred greater risks for depression. Taken together, the findings of this study showed that our sample of Italian HCWs showed a greater risk for depression, anxiety, and stress during the COVID‐19 pandemic. These data might be a starting point to plan mental health monitoring and prevention programs for HCWs, thus ensuring patients receive the best possible care performances even during healthcare crises such as the current pandemic.
Highlights
Depressive, anxiety, and burnout were present in Italian healthcare workers during COVID‐19 pandemic.
A depersonalization factor showed to be significant increased.
The 47.1% of the operators reported a depressive state.
The female gender conferred greater risks for depression.
Hip fractures are the most common osteoporotic fractures related to disability in older adults, requiring surgery and a subsequent rehabilitation treatment. Sarcopenia is currently considered as a ...predictive of worse outcome in hip fracture patients and myostatin has been recently proposed a potential biomarker of this condition. Twenty hip fracture patients after total hip replacement (mean aged 75.9 ± 2.4 years) were randomly divided into two groups of ten subjects (groups A and B). Both groups performed a rehabilitation program (5 sessions of 40 min/week for 2 weeks, followed by home-based exercise protocol). Group A received also 2-month amino acid supplementation. Serum myostatin levels significantly decreased after 2 months in both group A (
p
= 0.01) and group B (
p
= 0.03) in sarcopenic patients only in group A (
p
= 0.04). These results suggest that myostatin might be considered a promising biomarker of sarcopenia in hip fracture older adults’ patients undergoing rehabilitation and amino acid supplementation.
Background
It has been suggested that overweight and obese individuals have an increased risk to develop vitamin D deficiency, commonly associated with poor muscle performance. The relationship among ...fat mass, vitamin D status, and skeletal muscle is still debated.
Aims
To evaluate the effects of the combination of hypovitaminosis D and overweight on muscle mass and strength, and physical performance in post-menopausal women.
Methods
In this cross-sectional study, we recruited post-menopausal women referring to a physiatric outpatient service for the management of osteoporosis over a 36-month period. We compared four groups: (1) normal weight with hypovitaminosis D; (2) overweight with normal serum 25(OH)D
3
; (3) overweight with hypovitaminosis D; and (4) normal weight with normal serum 25(OH)D
3
(control group). Outcome measures were: appendicular lean mass-to-BMI ratio; hand grip strength; and short physical performance battery.
Results
We analysed 368 women (mean aged 67.2 ± 7.8 years): 95 normal weight with hypovitaminosis D, 90 overweight with normal levels of 25(OH)D
3
, 96 overweight with hypovitaminosis D, and 87 normal weight with normal levels of 25(OH)D
3
. Overweight women with hypovitaminosis D had a significant risk of reduced muscle mass (OR 5.70;
p
< 0.001), strength (OR 12.05;
p
< 0.001), and performance (OR 5.84;
p
< 0.001) compared to controls. Normal weight women with hypovitaminosis D had only a greater risk of an impairment of muscle strength (OR 7.30;
p
< 0.001) and performance (OR 3.16;
p
< 0.001).
Discussion
According to our findings, both hypovitaminosis D and overweight should be investigated in post-menopausal women because of their negative effects on skeletal muscle mass and function.
Conclusions
This study demonstrated that hypovitaminosis D is associated to impaired muscle function and its combination with overweight might lead also to muscle wasting in a cohort of post-menopausal women.
Technological advances and digital solutions have been proposed to overcome barriers to sustainable rehabilitation programs in patients with musculoskeletal disorders. However, to date, standardized ...telemonitoring systems able to precisely assess physical performance and functioning are still lacking.
To validate a new mobile telemonitoring system, named System for Tracking and Evaluating Performance (Step-App
), to evaluate physical performance in patients undergone knee and hip total arthroplasty.
Prospective cohort study.
A consecutive series of older adults with knee and hip total arthroplasty participated in a comprehensive rehabilitation program. The Step-App
, a mobile telemonitoring system, was used to remotely monitor the effects of rehabilitation, and the outcomes were assessed before (T0) and after the rehabilitation treatment (T1). The primary outcomes were the 6-Minute Walk Test (6MWT), the 10-Meter Walk Test (10MWT), and the 30-Second Sit-To-Stand Test (30SST).
Out of 42 patients assessed, 25 older patients were included in the present study. The correlation analysis between the Step-App
measurements and the traditional in-person assessments demonstrated a strong positive correlation for the 6MWT (T0: r
=0.9981, P<0.0001; T1: r
=0.9981, P<0.0001), 10MWT (T0: r
=0.9423, P<0.0001; T1: r
=0.8634, P<0.0001), and 30SST (T0: r
=1, P<0.0001; T1: r
=1, P<0.0001). The agreement analysis, using Bland-Altman plots, showed a good agreement between the Step-App
measurements and the in-person assessments.
Therefore, we might conclude that Step-App
could be considered as a validated mobile telemonitoring system for remote assessment that might have a role in telemonitoring personalized rehabilitation programs for knee and hip replacement patients.
Our findings might guide clinicians in remote monitoring of physical performance in patients with musculoskeletal conditions, providing new insight into tailored telerehabilitation programs.
The outbreak of COVID-19 epidemics has challenged the provision of health care worldwide, highlighting the main flaws of some national health systems with respect to their capacity to cope with the ...needs of frail subjects. People experiencing disability due to COVID-19 express specific rehabilitation needs that deserve a systematic evidence-based approach. The aim of this article is to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to COVID-19. The first rapid "living" review will present the results of a systematic search performed up to March 31st, 2020.
A systematic search in PubMed, Pedro, and Google Scholar was performed using the search terms: "COVID-19," "Coronavirus," "severe acute respiratory syndrome coronavirus 2," "rehabilitation," "physical therapy modalities," "exercise," "occupational therapy," and "late complications." Papers published up to March 31st, 2020, in English, were included.
Out of the 2758 articles retrieved, nine were included in the present review. Four of them are "calls for action", three provide recommendations about rehabilitation interventions in the acute phase, two address the needs of people quarantined at home or with restricted mobility due to the lockdown, and one provides a Core Outcome Set to be used in clinical trials to test the efficacy of health strategies in managing COVID-19 patients.
All selected papers were based on previous literature and not on the current COVID-19 pandemic. Main messages included: 1) early rehabilitation should be granted to inpatients with COVID-19; 2) people with restricted mobility due to quarantine or lockdown should receive exercise programs to reduce the risk of frailty, sarcopenia, cognitive decline and depression; 3) telerehabilitation may represent the first option for people at home. Further updates are warranted in order to characterize the emerging disability in COVID-19 survivors and the adverse effects on the health of chronically disabled people.
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