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Stefania COSTI

Personale tecnico amministrativo
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede ex-Neuroscienze
Ricercatore t.d. art. 24 c. 3 lett. A
Dip. Medico, Chirurgico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico e di Medicina Rigenerativa - sede CdL Fisioterapia, Padiglione Spallanzani, Viale Umberto I n. 50, Reggio Emilia

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Pubblicazioni

2024 - Lesion mapping and functional characterization of hemiplegic children with different patterns of hand manipulation [Articolo su rivista]
Errante, A.; Bozzetti, F.; Piras, A.; Beccani, L.; Filippi, M.; Costi, S.; Ferrari, A.; Fogassi, L.
abstract

Brain damage in children with unilateral cerebral palsy (UCP) affects motor function, with varying severity, making it difficult the performance of daily actions. Recently, qualitative and semi-quantitative methods have been developed for lesion classification, but studies on mild to moderate hand impairment are lacking. The present study aimed to characterize lesion topography and preserved brain areas in UCP children with specific patterns of hand manipulation. A homogeneous sample of 16 UCP children, aged 9 to 14 years, was enrolled in the study. Motor assessment included the characterization of the specific pattern of hand manipulation, by means of unimanual and bimanual measures (Kinematic Hand Classification, KHC; Manual Ability Classification System, MACS; House Functional Classification System, HFCS; Melbourne Unilateral Upper Limb Assessment, MUUL; Assisting Hand Assessment, AHA). The MRI morphological study included multiple methods: (a) qualitative lesion classification, (b) semi-quantitative classification (sq-MRI), (c) voxel-based morphometry comparing UCP and typically developed children (VBM-DARTEL), and (d) quantitative brain tissue segmentation (q-BTS). In addition, functional MRI was used to assess spared functional activations and cluster lateralization in the ipsilesional and contralesional hemispheres of UCP children during the execution of simple movements and grasping actions with the more affected hand. Lesions most frequently involved the periventricular white matter, corpus callosum, posterior limb of the internal capsule, thalamus, basal ganglia and brainstem. VMB-DARTEL analysis allowed to detect mainly white matter lesions. Both sq-MRI classification and q-BTS identified lesions of thalamus, brainstem, and basal ganglia. In particular, UCP patients with synergic hand pattern showed larger involvement of subcortical structures, as compared to those with semi-functional hand. Furthermore, sparing of gray matter in basal ganglia and thalamus was positively correlated with MUUL and AHA scores. Concerning white matter, q-BTS revealed a larger damage of fronto-striatal connections in patients with synergic hand, as compared to those with semi-functional hand. The volume of these connections was correlated to unimanual function (MUUL score). The fMRI results showed that all patients, but one, including those with cortical lesions, had activation in ipsilesional areas, regardless of lesion timing. Children with synergic hand showed more lateralized activation in the ipsilesional hemisphere both during grasping and simple movements, while children with semi-functional hand exhibited more bilateral activation during grasping. The study demonstrates that lesion localization, rather than lesion type based on the timing of their occurrence, is more associated with the functional level of hand manipulation. Overall, the preservation of subcortical structures and white matter can predict a better functional outcome. Future studies integrating different techniques (structural and functional imaging, TMS) could provide further evidence on the relation between brain reorganization and specific pattern of manipulation in UCP children.

2024 - Models of Care in Providing Comprehensive Healthcare on Cancer Survivors: A Scoping Review with a TIDieR Checklist Analysis [Articolo su rivista]
Torreggiani, Martina; Maselli, Deborah; Costi, Stefania; Guberti, Monica
abstract

Background: The study's aim is to identify the models of care used to provide survivorship care plans (SCPs) to cancer survivors in healthcare services, describing what kind of professionals are involved, in which settings and timings, and their feasibility. Methods: The Joanna Briggs Institute methodology for scoping reviews is followed. Studies that considered the SCPs applying different models of care, in any healthcare setting on any adult cancer survivors who completed oncological treatments, have been included. Pubmed, Embase, Cochrane Library, Scopus, and Cinahal were searched from 2013 to 2023 with these keywords: "Survivorship Care Plan", "Oncology", and "Program". The study selection process was reported with the PRISMA-ScR. A total of 325 records were identified, 42 were screened, and, ultimately, 23 articles were included. Results: The models of care include: SCP standardization in hospitals; self-support oriented; consultation-based; primary or specialist direct referral; shared care; a multimodal approach. Multidisciplinary teams were involved in the SCP models of care. The settings were private clinics or cancer centers. One-hour SCP interventions were most frequently delivered through in-person visits, by telephone, or online. Conclusions: Implementing SCPs is feasible in healthcare contexts, but with challenges, like time and resource management. Patient-centered programs promoting coordinated care are promising models of care.

2024 - Physiotherapists' training in oncology rehabilitation from entry-level to advanced education: A qualitative study [Articolo su rivista]
Bertoni, G.; Conti, V.; Testa, M.; Coppola, I.; Costi, S.; Battista, S.
abstract

Background and Purpose: Physiotherapy is gaining a central role in oncology. However, the training and competencies needed by physiotherapists in oncology rehabilitation are still unclear. This study aims to articulate the training trajectory of physiotherapists in oncology rehabilitation from entry-level education to advanced education degrees.Methods: Qualitative focus group study following a 'Reflexive Thematic Analysis' for data analysis. Participants were Italian physiotherapists with expertise in Oncology Rehabilitation (either clinically or academically) and Physiotherapy Bachelor of Science (BSc) course leaders, selected through purposive sampling.Results: Two focus groups were conducted with 14 participants. Six themes were developed: 1. 'Entry-Level Education in Oncology Rehabilitation: Let's Have a Taste', as the BSc introduces oncology rehabilitation. 2. 'Basic Knowledge: Building up the Library' as students acquire basic knowledge on oncology rehabilitation during their BSc; 3. 'Learning by Experience: The Relevance of the Placement' to answer the question "Is this the right road for me?"; 4. 'Clinical Reasoning and Competencies in Oncology Rehabilitation Embedded in Uncertainty' because oncology physiotherapists need to deal with the uncertainty of their patients' status; 5. 'Advanced Education Degree Skills: from Appetiser to the Main Course', as advanced education degree courses allow for becoming an expert in the field; 6. 'A Call to Action for Physiotherapists: Prevention-Diagnosis-Survivorship & End of Life', to realise their critical role in all the phases of the oncology path.Conclusions: The BSc in Physiotherapy provides a foundation for future physiotherapists to understand oncology rehabilitation, but advanced education is necessary for expertise. The findings of this study have important implications for creating a shared physiotherapy curriculum in oncology rehabilitation.Implication for Physiotherapy Practice: This study has significant implications for improving physiotherapy curricula in oncology rehabilitation, positively impacting the skills and competencies of practitioners in this paramount field.

2023 - Activities Carried Out during the First COVID-19 Lockdown by Italian Citizens [Articolo su rivista]
Paltrinieri, Sara; Bressi, Barbara; Mazzini, Elisa; Fugazzaro, Stefania; Rondini, Ermanno; Giorgi Rossi, Paolo; Costi, Stefania
abstract

: The SARS-CoV-2 pandemic has altered how citizens engage in activities. This study describes the new activities citizens engaged in during the first lockdown, factors that helped them cope with the confinement, the supports they used the most, and which supports they would have liked to receive. This cross-sectional study consists of an online survey made of 49 questions that was completed by the citizens of the province of Reggio Emilia (Italy) from 4 May until 15 June 2020. The outcomes of this study were explored by focusing on four of the survey questions. Of the 1826 citizens who responded, 84.2% had started new leisure activities. Males, participants who lived in the plain or foothills, and those who experienced nervousness engaged less in new activities, while those whose employment status changed, whose lifestyle worsened, or whose use of alcohol increased engaged in more activities. The support of family and friends, leisure activities, continuing to work, and an optimistic attitude were perceived to be of help. Grocery delivery and hotlines providing any type of information and mental health support were used frequently; a lack of health and social care services and of support in reconciling work with childcare was perceived. Findings may help institutions and policy makers to better support citizens in any future circumstances requiring prolonged confinement.

2023 - Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study [Articolo su rivista]
Mezzarobba, Susanna; Cosentino, Carola; Putzolu, Martina; Panuccio, Francescaroberta; Fabbrini, Giovanni; Valente, Donatella; Costi, Stefania; Galeoto, Giovanni; Pelosin, Elisa
abstract

IntroductionFreezingof gait (FOG) in Parkinson's disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD.ObjectiveThe aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It).MethodsThe translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach's alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y).To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Falls Efficacy Scale-International (FES-I), the 6-min Walking Test (6MWT), the Mini Balance Evaluation System Test (Mini-BESTest) and the Short Physical Performance Battery (SPPB) were investigated.ResultsThe Italian N-FOGQ had high internal consistency (Cronbach's alpha = 0.859). Validity analysis showed significant correlations between NFOG-Q-IT total score and M-H&Y scores (r = 0.281 p < 0.001), MDS-UPDRS (r = 0.359 p < 0.001), FES-I (r = 0.230 p = 0.002), Mini BESTest (r = -0.256 p = 0.001) and 6MWT (r = -0.166 p = 0.026). No significant correlations were found with SPPB, MOCA and MMSE.ConclusionThe NFOG-It is a valuable and reliable tool for assessing FOG symptoms, duration and frequency in PD subjects. Results provide the validity of NFOG-Q-It by reproducing and enlarging previous psychometric data.

2023 - Integrated Short-term Palliative Rehabilitation to improve quality of life and equitable care access in incurable cancer (INSPIRE): a multinational European research project [Articolo su rivista]
Bayly, J.; Ahmedzai, H. H.; Blandini, M. G.; Bressi, B.; Caraceni, A. T.; Carvalho Vasconcelos, J.; Costi, S.; Fugazzaro, S.; Guberti, M.; Guldin, M. -B.; Hauken, M.; Higginson, I.; Laird, B. J. A.; Ling, J.; Normand, C.; Nottelmann, L.; Oldervoll, L.; Payne, C.; Prevost, A. T.; Stene, G. B.; Vanzulli, E.; Veber, E.; Economos, G.; Maddocks, M.
abstract

Background: Disability related to incurable cancer affects over a million Europeans each year and people with cancer rank loss of function among the most common unmet supportive care needs. Objectives: To test the clinical and cost-effectiveness of an integrated short-term palliative rehabilitation intervention, to optimise function and quality of life in people affected by incurable cancer. Design: This is a multinational, parallel group, randomised, controlled, assessor blind, superiority trial. Methods: The INSPIRE consortium brings together leaders in palliative care, oncology and rehabilitation from partner organisations across Europe, with complementary expertise in health service research, trials of complex interventions, mixed-method evaluations, statistics and economics. Partnership with leading European civil society organisations ensures citizen engagement and dissemination at the highest level. We will conduct a multinational randomised controlled trial across five European countries, recruiting participants to assess the effectiveness of palliative rehabilitation for people with incurable cancer on the primary outcome – quality of life – and secondary outcomes including disability, symptom burden and goal attainment. To support trial conduct and enhance analysis of trial data, we will also conduct: comparative analysis of current integration of rehabilitation across oncology and palliative care services; mixed-method evaluations of equity and inclusivity, processes and implementation for the intervention, at patient, health service and health system levels. Finally, we will conduct an evidence synthesis, incorporating INSPIRE findings, and a Delphi consensus to develop an international framework for palliative rehabilitation practice and policy, incorporating indicators, core interventions, outcomes and integration methods. Scientific contribution: If positive, the trial could produce a scalable and equitable intervention to improve function and quality of life in people with incurable cancer and reduce the burden of care for their families. It could also upskill the practitioners involved and motivate future research questions. The intervention could be adapted and integrated into different health systems using existing staff and services, with little or no additional cost.

2023 - Occupational therapy improves social participation of complex patients discharged from hospital: results of a powered randomized controlled trial [Articolo su rivista]
Costi, Stefania; Pellegrini, Martina; Braglia, Luca; Cavuto, Silvio; Fugazzaro, Stefania
abstract

Purpose: To verify the effectiveness of experimental occupational therapy plus intensive standard rehabilitation compared to intensive standard rehabilitation alone on the reintegration to social activities of complex patients three months after hospital discharge. Materials and methods: Patients with a score ≥ 9 on the Rehabilitation Complexity Scale at admission to an intensive rehabilitation ward were randomized to the control or experimental group. Both groups received intensive multidisciplinary rehabilitation aimed at recovering independence in the basic activities of daily life (ADL). The experimental group also received experimental occupational therapy services to address goals identified through the administration of the Canadian Occupational Performance Measure (COPM). Experimental occupational therapy began during the in-hospital phase and continued in the home-based setting. It consisted of teaching strategies, recommending aids, and providing personalized information regarding available community support. Results: Ninety-two individuals with a mean age of 65 years (female 44.6%) were enrolled. The experimental group significantly improved participation measured by the Reintegration to Normal Living Index (mean changes 8.61, 95% CI: 1-16.23, p = 0.027). The performance and satisfaction scores of the COPM, both during hospitalization and after discharge, and independence in ADL also improved. No differences in mood disturbances were found. Conclusion: Early post-discharge occupational therapy integrated with multidisciplinary rehabilitation improves the social participation of complex patients. Future research should investigate the concrete feasibility of implementing this complex intervention cost-effectively and in different contexts. Trial registration: ClinicalTrials.gov Identifier NCT03668938 (first posted date 13/09/2018).

2023 - Patient-reported outcome measure to implement routine assessment of cancer survivors' unmet needs: An overview of reviews and COSMIN analysis [Articolo su rivista]
Contri, Angela; Paltrinieri, Sara; Torreggiani, Martina; Chiara Bassi, Maria; Mazzini, Elisa; Guberti, Monica; Campanini, Isabella; Ghirotto, Luca; Fugazzaro, Stefania; Costi, Stefania
abstract

: As the number of cancer survivors (CSs) is increasing worldwide, providing services relevant to the specific, unmet needs of these individuals is crucial. There are currently various patient-reported outcome measures (PROMs) whose aim is to identify the unmet needs of CSs. Still, limited guidance supports healthcare providers in choosing the most valid and reliable PROMs for this purpose. We conducted this overview of systematic reviews (SRs) on the psychometric properties of PROMs addressing the unmet needs of adult CSs suffering from non-cutaneous cancers. We searched databases for SRs published between 2012 and January 2023. Two SRs were included, covering 14 PROMs tested on 19,151 CSs. These were assessed according to the COSMIN methodology for SRs of PROMs for the quality of their measurement properties and risk of bias, thus providing guidance in selecting PROMs that appropriately reflect the unmet needs of CSs.

2023 - Psycho-Educational and Rehabilitative Intervention to Manage Cancer Cachexia (PRICC) for Advanced Patients and Their Caregivers: Lessons Learned from a Single-Arm Feasibility Trial [Articolo su rivista]
Buonaccorso, Loredana; Fugazzaro, Stefania; Autelitano, Cristina; Bertocchi, Elisabetta; Allisen Accogli, Monia; Denti, Monica; Costi, Stefania; Martucci, Gianfranco; Braglia, Luca; Bassi, Maria Chiara; Silvia Tanzi, And
abstract

2023 - Therapeutic education and physical activity are feasible and safe in hematologic cancer patients referred to chemotherapy: results of a randomized controlled trial [Articolo su rivista]
Accogli, M. A.; Denti, M.; Costi, S.; Fugazzaro, S.
abstract

Purpose: Although over 60% of patients with hematologic cancer report distressing fatigue, they often do not receive recommendations on fatigue management strategies. The aim of this pilot study was to estimate the feasibility of therapeutic education and physical activity (TEPA) by measuring the patients’ adherence to this multidimensional intervention. The secondary aim was to estimate the impact of TEPA on clinical outcomes. Methods: Patients with hematologic cancer participated in this single-center, open-label, randomized controlled trial. The control group (CG) received two educational group sessions on fatigue and physical activity. The experimental group (EG) received the two educational sessions plus six weekly individual sessions aimed at implementing a personalized physical exercise program. Follow-ups were at 1, 3, and 7 months. Results: Forty-six patients referred to chemotherapy were included, corresponding to 54% of recruitment rate. Adherence reached 90% in the EG and 68% in the CG. Most patients (65% in EG and 64% in CG) attended a minimum of 80% of the planned sessions. Overall retention rate was 87% (85% in EG and 91% in CG). No adverse events were registered. No between-group differences were detected in fatigue (FACIT-F), psychological distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), or functional exercise capacity (TUG test and 6MWT). Adherence to an active lifestyle, measured by a semi-structured interview, increased from 56.5 to 84% in the EG at 7 months (p = 0.02), whereas it decreased slightly in the CG (from 47.8 to 42.9%). Conclusion: Multidimensional rehabilitation interventions are feasible and safe in this population, and larger trials should focus on the efficacy of such approaches on clinically relevant outcomes. Trial registration: ClinicalTrials.gov Identifier: NCT03403075.

2022 - Adaptation of the Core Set for Vocational Rehabilitation for Cancer Survivors: A Qualitative Consensus-Based Study [Articolo su rivista]
Paltrinieri, S.; Costi, S.; Pellegrini, M.; Diaz Crescitelli, M. E.; Vicentini, M.; Mancuso, P.; Giorgi Rossi, P.; Fugazzaro, S.; Mazzini, E.; Escorpizo, R.; Ghirotto, L.
abstract

Purpose: The Core Set for Vocational Rehabilitation (CS-VR) of the International Classification of Functioning, Disability and Health (ICF) describes the work functioning of individuals in need of VR. We aimed to adapt the CS-VR from the perspective of cancer survivors (CSs) and stakeholders, developing a CS-VR-Onco. Methods: We held five focus groups with 17 CSs who were employed at the time of diagnosis, to discuss their work reintegration experiences. After analyzing the focus group conversations, the CS-VR-Onco was developed. During a group interview, eleven stakeholders explored barriers/facilitations in assessing the work functioning of CSs by using the CS-VR-Onco. We applied the framework method and thematic analysis. Results: For the focus groups, the CS-VR-Onco of 85 categories emerged, and the ICF chapters of Mental functions, Exercise and tolerance functions, Interpersonal interactions and relationships, Major life areas, General tasks and demands, Mobility, Support and relationships, and Attitudes were prioritized. For the group interview, stakeholders’ perspectives can be synthetized into two themes: close to the lived experience and usability criteria. Stakeholders confirmed the categories of the CS-VR-Onco, a checklist that should be used through an integrated approach across multiple disciplines. Conclusions: The adapted CS-VR-Onco reflects the CSs’ lived experiences of work reintegration and the factors that have influenced this process. The CS-VR-Onco was described as complete and usable through an integrated approach.

2022 - Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial [Articolo su rivista]
LA PORTA, Fabio; Lullini, Giada; Caselli, Serena; Valzania, Franco; Mussi, Chiara; Tedeschi, Claudio; Pioli, Giulio; Bondavalli, Massimo; Bertolotti, Marco; Banchelli, Federico; D'Amico, Roberto; Vicini, Roberto; Puglisi, Silvia; Clerici, Pierina Viviana; Chiari, Lorenzo; and PRECISA Group members, ; LA PORTA, Fabio; Caselli, Serena; Clerici, Pierina Viviana; Cavazza, Stefano; Serraglio, Valeria; Vannini Maria Cristina, ; Bovolenta, Federica; Lullini, Giada; Puglisi, Silvia; Gallo, Angela; Mussi, Chiara; Bertolotti, Marco; Scotto, Roberto; Lancellotti, Giulia; Franco, Valzania; Francesca, Falzone; Monica, Montanari; Maria Luisa De Luca, ; Malagoli, Emanuela; Elisa, Franchini; Luisa, Palmisano; Franca, Serafini; Tedeschi, Claudio; Gioacchino, Anselmi; Valentina, D’Alleva; Mariangela Di Matteo, ; Rosalinda, Ferrari; Costi, Stefania; Filomena, Simeone; Giulia, D’Apote; Alessandra, Rizzica; Galavotti, Maria Beatrice; Marta, Ghirelli; Giulio, Pioli; Bendini, Chiara; Lancellotti, Giulia; Massimo, Bondavalli; Eleni, Georgopoulos; D'Amico, Roberto; Balduzzi, Sara; Vicini, Roberto; Banchelli, Federico; Lorenzo, Chiari; Sabato, Mellone; Alice, Coni
abstract

Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.

2022 - Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review [Articolo su rivista]
Cagliari, M.; Bressi, B.; Bassi, M. C.; Fugazzaro, S.; Prati, G.; Iotti, C.; Costi, S.
abstract

Objective: Men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) experience the loss of bone mineral density (BMD) and lean body mass, which can increase their risk of falls and fractures. Physical exercise programs with appropriate components and dosage are suggested to preserve BMD and muscle strength, thereby potentially reducing accidental falls and fractures and associated morbidity and mortality. These benefits can be obtained if exercise programs are feasible and safe and if patient adherence is adequate. This systematic review investigates the feasibility and safety of exercise programs aimed at preventing the risk of accidental falls and fractures and BMD loss in men with PCa undergoing ADT. Methods: MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from database inception to June 7, 2021. Randomized controlled trials were included when they analyzed the feasibility and safety of experimental exercise programs targeting bone health in men with PCa receiving ADT. Two reviewers independently selected the studies, assessed their methodological quality, and extracted the data. Exercise feasibility was measured through recruitment, retention, and adherence rates. Exercise safety was measured through the number, type, and severity of adverse events. Furthermore, the components, setting, intensity, frequency, and duration of exercise programs were extracted. Results: Ten studies were included, with a total of 633 participants. Exercise consisted of a combination of aerobic, resistance, and impact-loading exercise or football training. Exercise is feasible in men with PCa undergoing ADT, although football training should be prescribed with caution for safety reasons. Conclusion: Multicomponent exercise programs targeting bone health seem feasible and safe in this population; however, adverse events should be systematically documented according to current guidelines. Impact: The study shows that men with PCa receiving ADT can safely perform exercise programs to preserve bone health and supports that those programs should become part of lifestyle habits. Lay Summary: Men with PCa who are receiving ADT can safely perform exercise programs to preserve bone health and should make exercise an important part of their lifestyle.

2022 - Feasibility and safety of physical exercise in men with prostate cancer receiving androgen deprivation therapy and radiotherapy: A study protocol [Articolo su rivista]
Bressi, B.; Iotti, C.; Cagliari, M.; Cavuto, S.; Fugazzaro, S.; Costi, S.
abstract

Introduction Androgen deprivation therapy (ADT) and radiotherapy (RT) increase survival in selected patients with prostate cancer. Nevertheless, the side effects of these therapies are associated with an increased risk of accidental falls and fractures and a decreased quality of life. Preliminary evidence suggests that physical exercise can be a valid strategy to reduce the side effects of ADT and RT in men with prostate cancer. Despite this knowledge, most patients with prostate cancer are insufficiently active, and there is a lack of data on the safety and adherence to the recommended dose of physical exercise. This study protocol is designed to examine the feasibility and safety of a multicomponent experimental physical exercise intervention targeting psychophysical and cognitive functions and the quality of life in this population. Methods and analysis This is a pilot feasibility study. Twenty-five men currently treated with ADT and RT for prostate cancer will be invited to participate in a 20-week, multicomponent physical exercise intervention, including supervised and unsupervised exercise sessions and meeting the current recommendation for exercise in cancer. The primary outcomes are physical exercise feasibility (recruitment, adherence and drop-out rates) and safety (adverse events related and unrelated to the intervention). The secondary outcomes are muscle strength, balance, fatigue, symptoms of anxiety and depression, cognitive function, quality of life, and patient satisfaction. We will also record the number of accidental falls and fractures occurring during the intervention and at 1 year of follow-up. Ethics and dissemination The study has received ethics approval from The Area Vasta Nord Local Ethics Committee (Province of Reggio Emilia, 23 June 2020, Number 520/2020/SPER/IRCCSRE). Recruitment began in September 2020 and will be completed in September 2021. The results will be disseminated through scientific journals and conference presentations. Trial registration number NCT04500080.

2022 - How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study [Articolo su rivista]
Boni, Laura; Gradellini, Cinzia; Miari, Monica; Cocconi, Patrizia; Montorsi, Annalisa; Capone, Roberto; Costi, Stefania; Di Leo, Silvia; Puglisi, Chiara; Ghirotto, Luca
abstract

The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals.

2022 - Inflammatory burden and persistent CT lung abnormalities in COVID-19 patients [Articolo su rivista]
Besutti, G.; Giorgi Rossi, P.; Ottone, M.; Spaggiari, L.; Canovi, S.; Monelli, F.; Bonelli, E.; Fasano, T.; Sverzellati, N.; Caruso, A.; Facciolongo, N.; Ghidoni, G.; Simonazzi, A.; Iori, M.; Nitrosi, A.; Fugazzaro, S.; Costi, S.; Croci, S.; Teopompi, E.; Gallina, A.; Massari, M.; Dolci, G.; Sampaolesi, F.; Pattacini, P.; Salvarani, C.
abstract

Inflammatory burden is associated with COVID-19 severity and outcomes. Residual computed tomography (CT) lung abnormalities have been reported after COVID-19. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed 2–3 and 6–7 months after COVID-19, in severe COVID-19 pneumonia survivors. C-reactive protein (CRP) curves describing inflammatory burden during the clinical course were built, and CRP peaks, velocities of increase, and integrals were calculated. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Of the 259 included patients (median age 65 years; 30.5% females), 202 (78%) and 100 (38.6%) had residual, predominantly non-fibrotic, abnormalities at 2–3 and 6–7 months, respectively. In age- and sex-adjusted models, best CRP predictors for residual abnormalities were CRP peak (odds ratio [OR] for one standard deviation [SD] increase = 1.79; 95% confidence interval [CI] = 1.23–2.62) at 2–3 months and CRP integral (OR for one SD increase = 2.24; 95%CI = 1.53–3.28) at 6–7 months. Hence, inflammation is associated with short- and medium-term lung damage in COVID-19. Other severity measures, including mechanical ventilation and LOS, but not D-dimer, were mediators of the relationship between CRP and residual abnormalities.

2022 - Modifications of Chest CT Body Composition Parameters at Three and Six Months after Severe COVID-19 Pneumonia: A Retrospective Cohort Study [Articolo su rivista]
Besutti, Giulia; Pellegrini, Massimo; Ottone, Marta; Bonelli, Efrem; Monelli, Filippo; Farì, Roberto; Milic, Jovana; Dolci, Giovanni; Fasano, Tommaso; Canovi, Simone; Costi, Stefania; Fugazzaro, Stefania; Massari, Marco; Ligabue, Guido; Croci, Stefania; Salvarani, Carlo; Pattacini, Pierpaolo; Guaraldi, Giovanni; Giorgi Rossi, Paolo
abstract

We aimed to describe body composition changes up to 6-7 months after severe COVID-19 and to evaluate their association with COVID-19 inflammatory burden, described by the integral of the C-reactive protein (CRP) curve. The pectoral muscle area (PMA) and density (PMD), liver-to-spleen (L/S) ratio, and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, and IMAT) were measured at baseline (T0), 2-3 months (T1), and 6-7 months (T2) follow-up CT scans of severe COVID-19 pneumonia survivors. Among the 208 included patients (mean age 65.6 ± 11 years, 31.3% females), decreases in PMA [mean (95%CI) -1.11 (-1.72; -0.51) cm2] and in body fat areas were observed [-3.13 (-10.79; +4.52) cm2 for TAT], larger from T0 to T1 than from T1 to T2. PMD increased only from T1 to T2 [+3.07 (+2.08; +4.06) HU]. Mean decreases were more evident for VAT [-3.55 (-4.94; -2.17) cm2] and steatosis [L/S ratio increase +0.17 (+0.13; +0.20)] than for TAT. In multivariable models adjusted by age, sex, and baseline TAT, increasing the CRP interval was associated with greater PMA reductions, smaller PMD increases, and greater VAT and steatosis decreases, but it was not associated with TAT decreases. In conclusion, muscle loss and fat loss (more apparent in visceral compartments) continue until 6-7 months after COVID-19. The inflammatory burden is associated with skeletal muscle loss and visceral/liver fat loss.

2022 - Physical exercise habits, lifestyle behaviors, and motivation to change among men with prostate cancer: a cross-sectional study [Articolo su rivista]
Bressi, B.; Iotti, C.; Cagliari, M.; Fugazzaro, S.; Cavuto, S.; Bergamaschi, F. A. M.; Moscato, A.; Costi, S.
abstract

Purpose: To describe the physical exercise (PE) habits, lifestyle, and motivation to change toward healthier behaviors in patients newly diagnosed with prostate cancer (PCa). Methods: A cross-sectional study was conducted in an Italian hospital setting. Men newly diagnosed with PCa were consecutively invited to participate in a structured interview that was conducted either in person or by telephone. Results: The mean age of the 40 participants was 70.5 ± 6.6 (range 50–84). Most participants (65%) reported they were physically active, but more than half of the sample did not reach the recommended PE level. However, 40% of participants would be interested in participating in an exercise program. Only 10% of participants were current smokers, but 90% drank alcohol, and 62.5% were overweight/obese. Almost all participants were not willing to change their habits. Conclusions: A high proportion of Italian men are insufficiently active when diagnosed with PCa. Moreover, even when exposed to behavioral risk factors, they are not willing to change their lifestyle. Health-care professionals who deal with men newly diagnosed with PCa should take advantage of the teachable moment and apply strategies that support patients’ motivation to exercise and adherence to healthier lifestyles. Trial registration: The study was prospectively registered in ClinicalTrial.gov NCT03982095 on June 11, 2019.

2022 - Rehabilitation Interventions for Post-Acute COVID-19 Syndrome: A Systematic Review [Articolo su rivista]
Fugazzaro, S.; Contri, A.; Esseroukh, O.; Kaleci, S.; Croci, S.; Massari, M.; Facciolongo, N. C.; Besutti, G.; Iori, M.; Salvarani, C.; Costi, S.
abstract

Increasing numbers of individuals suffer from post-acute COVID-19 syndrome (PACS), which manifests with persistent symptoms, the most prevalent being dyspnea, fatigue, and musculoskeletal, cognitive, and/or mental health impairments. This systematic review investigated the effectiveness of rehabilitation interventions for individuals with PACS. We searched the MEDLINE, Embase, Cochrane Register of Controlled Trials, CINHAL, Scopus, Prospero, and PEDro databases and the International Clinical Trials Registry Platform for randomized controlled trials (RCTs) up to November 2021. We screened 516 citations for eligibility, i.e., trials that included individuals with PACS exposed to exercise-based rehabilitation interventions. Five RCTs were included, accounting for 512 participants (aged 49.2–69.4 years, 65% males). Based on the revised Cochrane risk-of-bias tool (RoB 2.0), two RCTs had “low risk of bias”, and three were in the “some concerns” category. Three RCTs compared experimental rehabilitation interventions with no or minimal rehabilitation, while two compared two active rehabilitation interventions. Rehabilitation seemed to improve dyspnea, anxiety, and kinesiophobia. Results on pulmonary function were inconsistent, while improvements were detected in muscle strength, walking capacity, sit-to-stand performance, and quality of life. Pending further studies based on qualitatively sound designs, these first findings seem to advocate for rehabilitation interventions to lessen disability due to PACS.

2022 - Rehabilitation of Difficult-to-Wean, Tracheostomized Patients Admitted to specialized unit: Retrospective Analyses Over 10-years. [Articolo su rivista]
Costi, Stefania; Brogneri, Antonio; Bagni, Chiara; Pennacchi, Giulia; Beneventi, Claudio; Tabbì, Luca; Dell'Orso, Daniela; Fantini, Riccardo; Tonelli, Roberto; Maria Beghi, Gianfranco; Clini, Enrico
abstract

Introduction: Rehabilitation outcomes of difficult-to-wean tracheostomized patients have been reported in relatively small case studies and described for a limited time span. This study de-scribes the characteristics and clinical outcomes of a large cohort of tracheostomized patients admitted to a specialized weaning unit over 10 years. Methods: We retrospectively analyzed da-ta collected from January 2010 to December 2019 on difficult-to-wean tracheostomized patients who underwent comprehensive rehabilitation. Clinical characteristics collected at admission were the level of comorbidity (by the Cumulative Illness Rating Scale – CIRS) and the clinical se-verity (by the Simplified Acute Physiology Score – SAPS II). The proportions of patients weaned, decannulated, and able to walk, the change in autonomy level according to the Bristol Activities of Daily Living (BADL) Scale, and the setting of hospital discharge was assessed and compared in a consecutive 5-year time periods (2010-2014 and 2015-2019) subgroup analysis. Results: A to-tal of 180 patients were included in the analysis. Patients’ anthropometry and preadmission clin-ical management in acute care hospital were similar across years, but the categories of underlying diagnosis changed (p<0.001) (e.g. chronic obstructive pulmonary disease – COPD – decreased), while the level of comorbidities increased (p=0.003). Decannulation rate was 45.6%. CIRS and SAPS II at admission were both significant predictors of clinical outcomes. The proportion of pa-tients whose gain in BADL score increased ≥2 points decreased over time. Conclusions: This study confirms the importance of rehabilitation in the weaning units for the severely disabled subset of tracheostomized patients. Comorbidities and severity at admission are significantly as-sociated with rehabilitation outcomes at discharge.

2022 - Reliability and construct validity of the Activities Scale for Kids in Italian children with cerebral palsy [Articolo su rivista]
Costi, S.; Filippi, M. C.; Braglia, L.; Beccani, L.; Corradi, I.; Bruzzi, E.; Signorelli, C.; Pelosin, E.
abstract

Purpose: To investigate internal consistency and construct validity of the of the Activities Scale for Kids performance (ASKp) in Italian children with cerebral palsy (CP). Methods: This cross-sectional study was conducted from 2014 up to 2019 and consisted in the single self-administration of the Italian ASKp to 206 children aged 5–15, with unilateral or bilateral CP, classified on the basis of the Gross Motor Function Classification System (GMFCS). Results: The ASKp showed good internal consistency (Chronbach’s α 0.91, 95% CI 0.89–0.93). It distinguished between children and adolescents (70.3 ± 16.6 versus 83.0 ± 18.0, respectively; p < 0.001), unilateral and bilateral CP clinical manifestations (82.5 ± 13.6 versus 72.4 ± 19.0, respectively; p = 0.002), children with and without intellectual disability (60.3 ± 18.3 versus 77.2 ± 17.3, respectively; p < 0.001). It also distinguished children using assistive devices for indoor mobility from children who did not use devices or those who use devices only for outdoor mobility (66.1 ± 18.3 versus 83.6 ± 12.8 and versus 80.4 ± 17.4, respectively; both p < 0.001). Conclusions: The ASKp could help integrate the perspective of children with CP in their rehabilitation process. Trial registration: ClinicalTrials.gov Identifier: NCT03325842IMPLICATIONS FOR REHABILITATION The ASKp is a valid and widely used measure for several ICF domains of activities and participation in pediatrics. It has never been formally validated in children with CP, although this disorder causes restrictions in everyday activities. Recently, the culturally adapted Italian version of the ASKp has been tested in typically developing Italian children, confirming its high acceptability and providing evidence of construct validity. This study confirms the internal consistency reliability and the construct validity of the Italian ASKp when applied to the population with CP. The ASKp can support rehabilitation professionals in planning therapeutic intervention targeted to relevant goals.

2022 - Return to work of Italian cancer survivors: A focus on prognostic work-related factors [Articolo su rivista]
Paltrinieri, S.; Vicentini, M.; Mancuso, P.; Mazzini, E.; Fugazzaro, S.; Rossi, P. G.; Costi, S.
abstract

BACKGROUND: Return to work (RTW) enhances the general well-being and social participation of cancer survivors (CSs). OBJECTIVE: To describe the predictive value of work-related factors on the RTW process of CSs. The work accommodations, the perceived workload, and the barriers and facilitations of RTW are also reported. METHODS: This population-based cross-sectional survey was conducted in the Province of Reggio Emilia from July 2016 to July 2017. CSs who were 20-59 years old, first diagnosed with cancer, and employed at diagnosis were recruited. RESULTS: The majority of CSs (140/266, 53%) returned to work without difficulties, 42% reported difficulties, and 5% did not RTW. CSs who were shift workers (sex and age-adjusted Relative Risk [adj-RR] 1.30; 95% CI 0.94 -1.78) and who worked at night (adj-RR 1.36 95% CI 0.99 -1.86), in the evening (adj-RR 1.23; 95% CI 0.95 -1.57) and on Sundays (adj-RR 1.15; 95% CI 0.81 -1.63) perceived more difficulties. Physically demanding work and a long commute seemed to negatively impact RTW. Accommodations in work tasks (37%) or schedule (26%) were implemented. Workload was not acceptable for 18% of CSs. The main barriers concerned energy and drive functions, whereas remunerative employment was the foremost facilitation. CONCLUSIONS: Healthcare professionals should address work-related factors that might influence RTW with personalized interventions of vocational rehabilitation.

2022 - Sex differences and rehabilitation needs after hospital discharge for COVID-19: an Italian cross-sectional study [Articolo su rivista]
Fugazzaro, Stefania; Denti, Monica; Mainini, Carlotta; Accogli, Monia Allisen; Bedogni, Ginevra; Ghizzoni, Daniele; Bertolini, Anna; Esseroukh, Otmen; Gualdi, Cecilia; Schiavi, Margherita; Braglia, Luca; Costi, Stefania
abstract

COVID-19 can result in persistent symptoms leaving potential rehabilitation needs unmet. This study aims to describe persistent symptoms and health status of individuals hospitalised for COVID-19 according to the International Classification of Functioning, Disability and Health domains of impairments, limitations in activity, and participation restrictions.

2022 - “Like before, but not exactly”: the Qualy-REACT qualitative inquiry into the lived experience of long COVID [Articolo su rivista]
Schiavi, M.; Fugazzaro, S.; Bertolini, A.; Denti, M.; Mainini, C.; Accogli, M. A.; Bedogni, G.; Ghizzoni, D.; Esseroukh, O.; Gualdi, C.; Costi, S.
abstract

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) affect millions of individuals worldwide. Rehabilitation interventions could support individuals during the recovery phase of COVID-19, but a comprehensive understanding of this new disease and its associated needs is crucial. This qualitative study investigated the experience of individuals who had been hospitalized for COVID-19, focusing on those needs and difficulties they perceived as most urgent. Methods: This naturalistic qualitative study was part of a single-center mix-method cross-sectional study (REACT) conducted in Italy during the first peak of the SARS-CoV-2 pandemic. The qualitative data collection took place through a telephone interview conducted 3 months after hospital discharge. The experience of individuals discharged after hospitalization for COVID-19 was investigated through the main research question – “Tell me, how has it been going since you were discharged?”. Two secondary questions investigated symptoms, activities, and participation. Data were recorded and transcribed verbatim within 48 h. An empirical phenomenological approach was used by the researchers, who independently analyzed the data and, through consensus, developed an interpretative model to answer the research question. Translation occurred after data was analyzed. Results: During the first peak of the COVID-19 pandemic, 784 individuals with COVID-19 were discharged from the hospitals of the Local Health Authority of the Province of Reggio Emilia (Italy); 446 were excluded due to the presence of acute or chronic conditions causing disability other than COVID-19 (n. 339), inability to participate in the study procedures (n. 56), insufficient medical documentation to allow for screening (n. 21), discharge to residential facilities (n. 25), and pregnancy (n. 5). Overall, 150 individuals consented to participate in the REACT study, and 56 individuals (60.7% male, average age 62.8 years ±11.8) were interviewed in June–July 2020, up to data saturation. Persistent symptoms, feelings of isolation, fear and stigma, emotional distress, a fatalistic attitude, and return to (adapted) life course were the key themes that characterized the participants’ experience after hospital discharge. Conclusions: The experience as narrated by the participants in this study confirms the persistence of symptoms described in PASC and highlights the sense of isolation and psychological distress. These phenomena may trigger a vicious circle, but the participants also reported adaptation processes that allowed them to gradually return to their life course. Whether all individuals are able to rapidly activate these mechanisms and whether rehabilitation can help to break this vicious circle by improving residual symptoms remain to be seen. Trial registration: ClinicalTrials.com NCT04438239.

2021 - A social-healthcare pathway to facilitate return to work of cancer survivors in Italy: The UNAMANO project [Articolo su rivista]
Paltrinieri, S.; Ricchi, E.; Mazzini, E.; Cervi, E.; Sandri, E.; Fugazzaro, S.; Costi, S.
abstract

Return to work (RTW) is a major goal to promote cancer survivors' social participation. OBJECTIVE: This study describes the multidisciplinary social-healthcare pathway called UNAMANO, conceived to support RTW in this population. METHODS: UNAMANO was developed by the Azienda USL-IRCCS di Reggio Emilia, in partnership with the local branch of the Italian Medical Association, nonprofit associations, vocational training institutions, social cooperatives, a labour union, and a chartered accounting firm. RESULTS: UNAMANO is directed towards employed individuals diagnosed with cancer living in the province of RE. It was developed through four actions: A) training healthcare professionals on work-related occupational rehabilitation; B) dissemination among community and stakeholders; C) recruitment and training of volunteers; D) cancer survivor engagement and provision of a personalized comprehensive intervention. This consists in providing information and either occupational therapy to overcome barriers and facilitate RTW or social support through re-training and tailored job search strategies based on individual risk of job loss. CONCLUSIONS: UNAMANO is the first Italian multidisciplinary social-healthcare pathway supporting RTW of cancer survivors. Addressing a wide area of cancer survivors' needs, it provides personalized intervention to resolve work-related issues. We propose this patient-centred RTW model to promote an easier transition from hospital to community.

2021 - Beyond lockdown: The potential side effects of the sars-cov-2 pandemic on public health [Articolo su rivista]
Paltrinieri, S.; Bressi, B.; Costi, S.; Mazzini, E.; Cavuto, S.; Ottone, M.; De Panfilis, L.; Fugazzaro, S.; Rondini, E.; Rossi, P. G.
abstract

Lockdowns to contain the spread of the SARS-CoV-2 have disrupted routines and behaviors, which could lead to a worsening of lifestyle and an increase in the burden of non-communicable diseases. This study aimed to describe the changes in physical activity, diet, alcohol drinking, and cigarette smoking during lockdown. A self-administered online survey addressing adults living in a province in northern Italy was advertised through websites and social media. Citizens could access the survey in anonymity from 4 May until 15 June 2020. A total of 1826 adults completed the survey, with a worsening of physical activity (35.1%), diet (17.6%), alcohol drinking (12.5%), and cigarette smoking (7.7%) reported. In contrast, 33.5% reported an improvement in diet, 12.6% in alcohol drinking, 5.3% in physical activity and 4.1% in cigarette smoking. Female sex, young adult age, suspension of work activity, and symptoms of psychological distress were the factors associated with a greater likelihood of change, which was frequently for the worse. Lockdown had an impact on lifestyle, with some net beneficial effects on diet and mostly negative effects on physical activity. Public health measures should be implemented to avoid long-term negative effects of the lockdown, supporting individuals more prone to change for the worse.

2021 - Can a pathological model improve the abilities of the paretic hand in hemiplegic children? the PAM-AOT study protocol of a randomised controlled trial [Articolo su rivista]
Verzelloni, J.; Errante, A.; Beccani, L.; Filippi, M.; Bressi, B.; Cavuto, S.; Ziccarelli, S.; Bozzetti, F.; Costi, S.; Pineschi, E.; Fogassi, L.; Ferrari, A.
abstract

Introduction Action Observation Treatment (AOT) is an innovative therapeutic approach consisting in the observation of actions followed by subsequent repetition. In children with unilateral cerebral palsy (UCP), it improves upper limb function in daily activities. The standard paradigm of AOT requires the observation of healthy models; however, it has been demonstrated that the mirror neuron system of children with UCP is more activated by observation of pathological models, showing a similar motor repertoire, than by the healthy model, suggesting that AOT based on pathological models is superior to the standard paradigm of AOT in the functional rehabilitation of the affected upper limb of children with UCP. Methods and analysis This protocol describes an active two-arm randomised controlled evaluator-blinded trial. Twenty-six children with UCP will participate in 3 weeks of intensive AOT: the experimental group will observe a pathological model, while the control group will observe a typically developed model. The primary outcome is the spontaneous use of the paretic hand, measured with the Assisting Hand Assessment. Secondary outcome measures are the Melbourne Assessment of Unilateral Upper Limb Function, the ABILHAND-Kids and the Activities Scale for Kids-performance. Assessments will be performed at baseline (T0), at the end of intensive AOT (T1), at 8-12 weeks (T2) and at 24-28 weeks (T3) after the end of intensive AOT. Ethics and dissemination The trial was approved by the Area Vasta Emilia Nord Ethics Committee (AVEN prot. n. 133117, 29 November 2018), and it was prospectively registered on ClinicalTrials.gov. The results will be submitted for publication to a peer-reviewed journal, discussed with parents of children participating in the trial and disseminated at suitable conferences. Trial registration number NCT04088994; Pre-results.

2021 - Changes in clinical characteristics and outcomes of patients admitted to inpatient cardiac rehabilitation [Articolo su rivista]
Costi, S; Tonelli, R; Brogneri, A; Florini, A; Tilocca, N; Vicentini, M; Baroncini, S; Cerulli, M; Clini, E.
abstract

Aims: Cardiac rehabilitation (CR) have proven to be effective and beneficial in middle-aged and older patients. However, solid data in large cohorts of elderly individuals are yet to be explored. This retrospective study investigated the general characteristics, outcomes, and the level of re-sponse of patients referred to CR over 13 consecutive years. Methods: We reviewed the medical records of patients admitted to Villa Pineta Rehabilitation Hospital for exercise-based CR from 2006 to 2018. Patients’ baseline characteristics and changes following CR in upper limb weight-lifting test (ULW), 30-second sit-to-stand test (30STS), and the 6-minute walking test (6MWT) with associated Borg-related dyspnea (D) and fatigue (F) were collected. We also calculated the number of individuals reaching the minimal clinically relevant change (MCRC) following CR for each outcome. Results: 1551 patients (70.2 ± 9.7 years, 66% men) with complete data set were in-cluded in the analysis. Coronary artery bypass graft and cardiac valve replacement surgery were the most frequent surgical procedures leading to CR referral (41.1% and 35.8%, respectively). The patients’ age (p = 0.03), number of total comorbidities (p < 0.0001), and post-surgical complica-tions (p = 0.02) significantly increased over time. In contrast, the average absolute changes in ULW, 30STS and 6MWT with associated D and F, and the proportion of patients reaching the re-spective MCRC, remained constant over the same period. Conclusion: Patients admitted to exer-cise-based CR were older and had more comorbidities and complications over time. Outcomes, however, were not influenced in terms of absolute change nor clinically meaningful response.

2021 - Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study [Articolo su rivista]
Crisafulli, O.; Trompetto, C.; Puce, L.; Marinelli, L.; Costi, S.; Abbruzzese, G.; Avanzino, L.; Pelosin, E.
abstract

Day-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case–control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related

2021 - Effectiveness comparison between carbon spring and hinged ankle-foot orthoses in crouch gait treatment of children with diplegic cerebral palsy: A randomized crossover trial [Articolo su rivista]
Borghi, C.; Costi, S.; Formisano, D.; Neviani, R.; Pandarese, D.; Ferrari, A.
abstract

BACKGROUND: Children with cerebral palsy (CP) often present a loss of effectiveness of the plantarflexors/knee-extensors couple that leads to crouch gait. When treating a child with crouch gait by means of ankle foot orthoses, preserving or restoring push off power is a key issue.AIM: To compare carbon-fiber spring (Carbon Ankle Seven (R) [CAFO], Ottobock (R) HealthCare, Duderstadt, Germany) and hinged ankle-foot orthoses (HAFO) effectiveness in improving functionality and walking ability in children with diplegic CP and crouch gait.DESIGN: Randomized crossover trial.SETTING: Hospital center.POPULATION: Ten children with diplegic CP and crouch gait, 5 males and 5 females, aged 11 (4) years.METHODS: The gait of each child was evaluated by means of instrumental gait analysis with both CAFO and HAFO, in a randomized order and after a 4-week adaptation period. The primary outcome measure was the change in ankle power generation. As secondary outcome measures, knee joint kinematics, stride length, walking speed, Observational Gait Scale, and preferred orthosis were considered.RESULTS: The median of the energy produced in stance was superior with CAFO (+2.2 J/kg, IQR 4.7, P=0.006), and the energy absorbed inferior (-3.3 J/kg, IQR 4.3, P=0.011). No statistically significant difference was found for any other parameter. Preference of the children was equally distributed between the two orthoses.CONCLUSIONS: No evident superiority of CAFO with respect to HAFO was found in improving gait performance of children with CP and crouch gait. Nevertheless, the results suggest the possibility that CAFO permits an energy saving and reduction of the more compromising deficits.CLINICAL REHABILITATION IMPACT: The final choice of the participants indicates that CAFOs are preferred by older and heavier children, but the preference does not correlate with the performance of the orthoses during gait.

2021 - Esercizio fisico per la salute. Guida al programma di esercizio fisico per pazienti con carcinoma prostatico sottoposti a ormonoterapia e radioterapia [Altro]
Bressi, Barbara; Cagliari, Maribel; Costi, Stefania; Fugazzaro, Stefania
abstract

Guida al programma di esercizio fisico per pazienti con carcinoma prostatico sottoposti a ormonoterapia e radioterapia

2021 - How did italian adolescents with disability and parents deal with the covid-19 emergency? [Articolo su rivista]
Faccioli, S.; Lombardi, F.; Bellini, P.; Costi, S.; Sassi, S.; Pesci, M. C.
abstract

The COVID-19 emergency has imposed distanced education and has interrupted most rehabilitation services. Adolescents with disabilities have been isolated, and the burden on their families has been exacerbated. A cross-sectional survey was administered to adolescents with disability and to parents of disabled children to describe their experience during lockdown and their concerns or expectations about rehabilitation. A sample of 53 adolescents and 239 parents completed the survey. Adolescents were ages 13–18 years old (45.3% female). Most parents were between 35 and 55 years old (84.9% female). While 53.6% of the parents reported no positive effects of the lockdown, 92.5% of the adolescents expressed favorable consequences. The increased time spent with family members was judged positively by 27.2% of parents and by 64.2% of adolescents. Concern for their child’s disability was expressed by 47.3% of parents, while 73.6% of adolescents expressed concerns regarding the ban on meeting friends. In both groups, anxiety symptoms were correlated with the fear of contracting COVID-19 and with financial problems. Parents would have liked even more remote support from school and healthcare professionals, which was available for most participants. Thus, socioeconomic support, assistive technology and telerehabilitation strategies might help families with disabilities during a lockdown.

2021 - IMPLICATIONS OF COVID-19 ON LIFESTYLE CHANGES: AN ITALIAN CROSS-SECTIONAL SURVEY [Poster]
Costi, Stefania; Bressi, Barbara
abstract

2021 - Insufficienza respiratoria acuta e cronica (cap.21). [Capitolo/Saggio]
Bonsignore, Mr; Clini, E; Confalonieri, M; Costi, S; Crimi, C; Crisafulli, E; Longhini, F; Marchioni, A; Nava, S; Navalesi, P; Pisani, L; Spanevello, A; Tonelli, R.
abstract

Non disponibile

2021 - Letter to the editor: Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study [Articolo su rivista]
Bressi, Barbara; Paltrinieri, Sara; Fugazzaro, Stefania; Costi, Stefania
abstract

2021 - Looking ahead in Pulmonary Rehabilitation [Articolo su rivista]
Clini, E; Costi, S.
abstract

Not available

2021 - Observational studies of rehabilitation during the COVID-19 pandemic [Articolo su rivista]
Polastri, M.; Costi, S.
abstract

2021 - Physical exercise and lifestyle behaviours among men with prostate cancer: a cross sectional study [Poster]
Bressi, Barbara; Costi, Stefania
abstract

2021 - Physical exercise for bone health in men with prostate cancer receiving androgen deprivation therapy: a systematic review [Articolo su rivista]
Bressi, Barbara; Cagliari, Maribel; Contesini, Massimiliano; Mazzini, Elisa; Bergamaschi, Franco Antonio Mario; Moscato, Alfredo; Bassi, Maria Chiara; Costi, Stefania
abstract

PURPOSE: Androgen deprivation therapy (ADT) is a treatment used in men with prostate cancer (PCa); however it is responsible for many adverse effects, with negative impact on quality of life. ADT causes loss of bone mineral density (BMD) and skeletal muscle mass, alteration of body composition, and cognitive function, which altogether lead to increased risk of accidental falls and fractures. This systematic review analyses the effectiveness of physical exercise (PE) in preventing accidental falls and fractures and reducing the loss of BMD in men with PCa receiving ADT.METHODS: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for articles between database inception and September 2, 2020. Eligible studies included randomized controlled trials (RCTs) investigating the effects of exercise on bone health in men with PCa receiving ADT.RESULTS: Nine RCTs were included. Experimental PE consisted in multicomponent programmes that involved aerobic, resistance, impact-loading exercise, and football training. None of the RCTs investigated the risk of accidental falls and fractures, while two trials reported beneficial effects of PE on lumbar spine, hip, and femoral shaft BMD. No further significant difference was detected in the outcomes investigated.CONCLUSION: Evidence of the effectiveness of PE to prevent the risk of accidental falls and fractures and BMD loss is lacking. Nevertheless, clinical guidelines recommend PE as a part of the clinical management of men with PCa receiving ADT due to its known numerous health benefits. Research should focus on PE strategies to prevent accidental falls, a clinically relevant outcome in this vulnerable population.TRIAL REGISTRATION: The study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444 ) on 04/28/2020.

2021 - Poor Sleep during the First Peak of the SARS-CoV-2 Pandemic: A Cross-Sectional Study [Articolo su rivista]
Costi, Stefania; Paltrinieri, Sara; Bressi, Barbara; Fugazzaro, Stefania; Giorgi Rossi, Paolo; Mazzini, Elisa
abstract

2021 - Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study [Articolo su rivista]
Bertozzi, Lucia; Negrini, Stefano; Agosto, Devis; Costi, Stefania; Anthony Guccione, Andrew; Lucarelli, Piergiorgio; Hugo Villafane, Jorge; Pillastrini, Paolo
abstract

Purpose: To determine the impact of smartphone use on neck impairment and functional limitation in university students. Methods: A cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017. The inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18e30 years. Participants completed questionnaires that measured general characteristics of smartphone use and demographic characteristics. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); and cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device. Results: A total of 238 volunteers were recruited (22.4 ± 2.2 years of age, 53.4% males), 35.9% of whom were overweight (>25 BMI). Regarding neck pain, 42.4% reported mild pain, 8.4% had moderate pain, and the remaining 49.2% had no pain. NDI-I and VAS were 3.8 ± 3.8 and 13.6 ± 18.4 mm, respectively. The pain categories did not influence the variables. No significant correlations were observed between the number of hours spent and posture (CROM) while using a smartphone and neck pain and NDI-I. Conclusion: While half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime.

2021 - Prevalence and associated factors of COVID-19 across Italian regions: a secondary analysis from a national survey on physiotherapists [Articolo su rivista]
Simone, Gambazza; Silvia, Bargeri; Isabella, Campanini; Roberto, Meroni; Andrea, Turolla; Greta, Castellini; Silvia, Gianola; Technical Commette of AIFI (Simone Gambazza, Scientific; Bargeri, Silvia; Bertozzi, Lucia; Campanini, Isabella; Cattaneo, Davide; Chiarotto, Alessandro; Corbetta, Davide; Costi, Stefania; Meroni, Roberto; Mezzarobba, Susanna; Innocenti, Tiziano; Pelosin, Elisa; Petrarca, Maurizio; Rossettini, Giacomo; Testa, Marco; Turolla, Andrea; Vanti, Carla; Castellini, Greta; Gianola), Silvia
abstract

Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19.

2021 - Psychoeducational and rehabilitative intervention to manage cancer cachexia (PRICC) for patients and their caregivers: Protocol for a single-arm feasibility trial [Articolo su rivista]
Buonaccorso, L.; Bertocchi, E.; Autelitano, C.; Allisen Accogli, M.; Denti, M.; Fugazzaro, S.; Martucci, G.; Costi, S.; Tanzi, S.
abstract

Introduction Half of all patients with cancer experience cachexia, with the prevalence rising above 80% in the last weeks of life. Cancer cachexia (CC) is a complex relational experience that involves the patient-family dyad. There are no studies on the association between the psychoeducational component and the rehabilitative component of dyads for supporting more functional relationships in the management of CC. The primary objective of this study is to evaluate the feasibility of a psychoeducational intervention combined with a rehabilitative intervention on dyads. The secondary objective is to improve the quality of life (QoL) and acceptability of the intervention. Methods and analysis This mixed-methods study with a nonpharmacological interventional prospective includes 30 consecutive cancer patients with cachexia and refractory cachexia and their caregivers, assisted by the Specialised Palliative Care Team. The recruitment will last 1 year. The intervention involves two components: (1) psychoeducational intervention: 3 weekly face-to-face consultations between dyads and trained nurses to help the dyads cope with involuntary weight loss and strengthening dyadic coping resources and (2) rehabilitation intervention: 3 biweekly educational sessions between dyads and trained physiotherapists focused on self-management, goal-setting, physical activity with three home exercise sessions per week. The primary endpoint will be in adherence to the intervention, indicated by a level of completion greater than or equal to 50% in both components. The secondary endpoints will be QoL (Functional Assessment of Anorexia-Cachexia Therapy), caregiver burden (Zarit Burden), physical performance (Hand-Grip strength and 30 seconds sit-to-stand test), and the acceptability of the intervention (ad hoc semi-structured interviews with the dyads and the healthcare professionals). Ethics and dissemination The study was approved by the Ethics Committee Area Vasta Emilia Nord, Azienda USL-IRCSS Reggio Emilia, Italy, number: 73/2019/SPER/IRCCSRE. The authors will provide the dissemination of the results through publication in international scientific journals. Trial registration number NCT04153019.

2021 - Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial [Articolo su rivista]
Tenconi, Sara; Mainini, Carlotta; Rapicetta, Cristian; Braglia, Luca; Galeone, Carla; Cavuto, Silvio; Merlo, Domenico F; Costi, Stefania; Paci, Massimiliano; Fugazzaro, Stefania
abstract

Surgery for Non Small Cell Lung Cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness.

2021 - Rehabilitative practice in Europe: roles and competencies of physiotherapists. Are we learning something new from COVID-19 pandemic? [Articolo su rivista]
Polastri, M; Lazzeri, M; Jacome, C; Vitacca, M; Costi, S; Clini, E; Marques, A.
abstract

Not available

2021 - Self-management in stroke survivors: Development and implementation of the look after yourself (lay) intervention [Articolo su rivista]
Fugazzaro, S.; Denti, M.; Accogli, M. A.; Costi, S.; Pagliacci, D.; Calugi, S.; Cavalli, E.; Taricco, M.; Bardelli, R.
abstract

Objective: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital rehabilitation phase: the Look After Yourself (LAY) in-tervention. Methods: After extensive literature search, the LAY intervention was developed by in-tegrating the Chronic Disease Self-Management Program, based on the self-efficacy construct of social cognitive theory, with evidence-based key elements and input from stroke survivors. Results: the LAY intervention aims to implement self-management skills in stroke survivors, enabling them to be active in goal setting and problem solving using action plans and to facilitate the critical transition from hospital to community. It includes both group sessions to facilitate sharing of experi-ences, social comparison, vicarious learning, and increase motivation and one-to-one sessions fo-cused on setting feasible action plans and on teaching personalized strategies to prevent falls. Stand-ardization is ensured by manuals for facilitators and patients. Conclusion: The LAY intervention is the first Italian program to support early self-management in stroke rehabilitation; it has been ex-perimented and its efficacy proven in improving self-efficacy, mental health, and activities of daily living, and detailed results have been published. The LAY intervention is described according to the TIDieR checklist.

2021 - The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients [Articolo su rivista]
Besutti, Giulia; Pellegrini, Massimo; Ottone, Marta; Cantini, Michele; Milic, Jovana; Bonelli, Efrem; Dolci, Giovanni; Cassone, Giulia; Ligabue, Guido; Spaggiari, Lucia; Pattacini, Pierpaolo; Fasano, Tommaso; Canovi, Simone; Massari, Marco; Salvarani, Carlo; Guaraldi, Giovanni; Rossi, Paolo Giorgi; Canovi, Simoneg; Massari, Marcoh; Salvarani, Carloi; Guaraldi, Giovannif; Rossi, Paolo Giorgie; Grilli, Roberto; Marino, Massimiliano; Formoso, Giulio; Formisano, Debora; Bedeschi, Emanuela; Perilli, Cinzia; la Rosa, Elisabetta; Bisaccia, Eufemia; Venturi, Ivano; Vicentini, Massimo; Campari, Cinzia; Gioia, Francesco; Broccoli, Serena; Iotti, Valentina; Mancuso, Pamela; Nitrosi, Andrea; Foracchia, Marco; Colla, Rossana; Zerbini, Alessandro; Ferrari, Anna Maria; Pinotti, Mirco; Facciolongo, Nicola; Lattuada, Ivana; Trabucco, Laura; de Pietri, Stefano; Danelli, Giorgio Francesco; Albertazzi, Laura; Bellesia, Enrica; Corradini, Mattia; Mag-Nani, Elena; Pilia, Annalisa; Polese, Alessandra; Incerti, Silvia Storchi; Zaldini, Piera; Bonanno, Orsola; Revelli, Matteo; Pinto, Carmine; Venturelli, Francesco; Teopompi, Elisabetta; Gallina, Annalisa; Bertellini, Annalisa; Costi, Stefania; Fugazzaro, Stefania
abstract

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

2020 - Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis [Articolo su rivista]
Alboresi, Silvia; Sghedoni, Alice; Borelli, Giulia; Costi, Stefania; Beccani, Laura; Neviani, Rita; Ferrari, Adriano
abstract

A group of diplegic cerebral palsied (CP) children presents six precise signs that can be easily observed during clinical examinations, physiotherapy sessions and everyday activities. These signs are: startle reaction, upper limbs in startle position, averted-eye gaze, grimaces, eye blinking and posture freezing.

2020 - Assessment of Physical Function in Children with Cerebral Palsy: Convergent Validity between the Gross Motor Function Measure and the Activities Scale for Kids [Poster]
Costi, S; Alboresi, S; Mecugni, D; Ferrari, A; Boggiani, E; Bressi, B; Paltrinieri, S
abstract

Physical function is crucial to participation in life activities and must always be accurately assessed in children with cerebral palsy (CP)1. The Activities Scale for Kids performance (ASKp) is currently used for this purpose, but its psychometric properties have not yet been completely verified in children with CP2, the principal cause of disability in industrialized countries3. Recently, the reliability of the Italian version of the scale was confirmed in this population and initial proof of validity was collected. However, there is no gold standard that can serve as a criterion. We verified the ASKp convergent validity with respect to the Gross Motor Function Measure-66 (GMFM-66), the gold standard in the assessment of gross motor abilities in this population

2020 - Construct Validity of the Activities Scale for Kids Performance in Children with Cerebral Palsy: Brief Report [Articolo su rivista]
Costi, S.; Mecugni, D.; Beccani, L.; Alboresi, S.; Bressi, B.; Paltrinieri, S.; Ferrari, A.; Pelosin, E.
abstract

Aims: This study collects evidence of construct convergent validity of the Activity Scale for Kids performance (ASKp), comparing its results with the 66-item Gross Motor Function Measure (GMFM-66) and with the Gross Motor Function Classification System (GMFCS) and testing the ASKp’s ability to discriminate between individuals with different functional capabilities. Methods: This cross-sectional study involved 60 children with spastic cerebral palsy (CP) assessed with the GMFM-66 who self-administered the Italian version of the ASKp. Results: Children were 10.9 (±3) years old with GMFCS Level I–III. Moderate correlations were found between GMFM and ASKp scores (r = 0.577; p < .001), and between GMFCS levels and ASKp score (rs = −0.541, p < .001). The ASKp discriminated between children with different functional capabilities, determined by the GMFCS (F = 18.2, p < .001). Conclusions: ASKp is valid to assess physical functioning, a crucial domain in rehabilitation of children with spastic CP. Trial registration: ClinicalTrials.gov Identifier: NCT03325842.

2020 - Cross-cultural validation of Activities Scale for Kids: the performance of healthy Italian children [Articolo su rivista]
Costi, S.; Bressi, B.; Cavuto, S.; Braglia, L.; Ferrari, A.; Pelosin, E.
abstract

BACKGROUND: The assessment of physical performance is a key element in the rehabilitation of individuals with disabilities, and understanding patients' perception of their abilities is of foremost importance for the success of the whole process. The Activities Scale for Kids performance (ASKp) is one of the few reliable and responsive outcome measures that allows children and adolescents to accurately report their physical functioning in typical activities for this age. The performance version of the ASKp has recently been translated and culturally adapted to the Italian context. METHODS: This cross-sectional study was implemented to describe the ASKp score distribution in a population of Italian school aged individuals. RESULTS: A population of 209 Italian children with a mean age of 10.96 years (SD 2.92, range 5-15) participated in this study during the academic year 2017/18. The ASKp score ranged from 52.58 to 100, with a mean value of 89.07 points (SD 10.57). Scores greater than 90 were attained for 57.4% of participants, confirming the ceiling effect of this assessment tool when administered in healthy children (95% CI: 50.4-64.2%). The ASKp was able to differentiate between different levels of physical performance according to different developmental ages (P<0.001), and it confirmed the ability to distinguish between children with typical development and those with disability (P<0.001). CONCLUSIONS: The results of this study provide the first evidence of construct validity of the Italian version of the ASKp. These results will help clinicians to interpret ASKp scores of children with musculoskeletal limitations.

2020 - Factors influencing return to work of cancer survivors: a population-based study in Italy [Articolo su rivista]
Paltrinieri, Sara; Vicentini, Massimo; Mazzini, Elisa; Ricchi, Elena; Fugazzaro, Stefania; Mancuso, Pamela; Giorgi Rossi, Paolo; Costi, Stefania
abstract

Little is known about return to work (RTW) of cancer survivors (CSs) in Central and Southern Europe. This study investigates the RTW rate of Italian CSs, describes their sick leave (SL) pattern, and explores factors affecting their RTW process. Methods A population-based cross-sectional survey involving CSs registered at the Cancer Registry of Reggio Emilia Province (Italy) was launched in July 2016. Eligibility was restricted to individuals with first diagnosis of cancer in 2012 (stages I–III), aged 20–59, and employed at the time of diagnosis. Results Of the 266 individuals interviewed, 140 (52.6%) were reintegrated without difficulty, 113 (42.5%) returned to work with some difficulty, and 13 did not RTW (4.9%). The majority of CSs (56%) took SL for some periods during treatment. Age > 50 years and higher income seemed to facilitate RTW (RR = 0.65, 95% CI 0.49–0.88 and RR = 0.72, 95% CI 0.54–0.97, respectively), while being divorced acted as a barrier compared to being married (RR = 1.45, 95% CI 1.04–2.01). Individuals uncertain about the type of company they were working for reported greater difficulty in RTW (RR = 1.68, 95% CI 1.03–2.72). Individuals who had undergone chemotherapy and those perceiving physical limitations had a higher risk of difficulty in the RTW process (RR = 1.79, 95% CI 1.42–2.24 and RR = 1.59, 95% CI 1.25–2.02, respectively). Conclusions Most CSs did RTW, with 2/3 combining work and treatment. However, almost half reported difficulty in RTW process. Factors affecting this process should be addressed throughout context-specific social and healthcare pathways aimed at preventing difficulties and potential job loss in this population.

2020 - Feasibility and Safety of Physical Exercise on Bone Health in Men with Prostate Cancer Receiving Androgen Deprivation Therapy: Systematic Review of the literature  [Poster]
 , ; Bressi, B; Cagliari, M; Iotti, C; Fugazzaro, S; Bassi, Mc; Costi, S
abstract

Androgen deprivation therapy (ADT) is a treatment used in patient with prostate cancer (PCa) but is responsible of loss of bone mineral density (BMD), cognitive dysfunction and alteration of body composition, incrising the risk of accidental falls and fractures1,2. Physical exercise (PE) has been proposed as a strategy to preserve bone mass and reduce the incidence of falls and fractures in the elderly population3. This systematic review aims to analyze the feasibility and safety of PE programme on bone health in PCa patients receiving ADT, and determine which dose and components are considered effective.

2020 - Occupational therapy in rehabilitation of complex patients: protocol for a superiority randomized controlled trial [Articolo su rivista]
Costi, S.; Pellegrini, M.; Cavuto, S.; Fugazzaro, S.
abstract

Patient-centered, interprofessional occupational therapy is feasible in complex patients in the early phase of rehabilitation, and it contributes to meet needs in the domains of self-care, productivity, and leisure, promoting social role. We planned this single-center single-blind two-arm parallel individual patient randomized controlled trial, to verify the superiority of interprofessional experimental occupational therapy (EOT) compared to standard rehabilitation (SR) in producing higher levels of patients’ social participation assessed by the Reintegration to Normal Living Index. EOT is a patient-centered, hospital/home-based rehabilitation intervention based on the Canadian Model of Occupational Performance and Engagement. This appropriately powered study will provide evidence regarding the effectiveness of EOT on the recovery of social participation in the critical transition of complex patients from hospital to the home setting.

2020 - Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting [Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Sdanganelli, Antonia; Gozzi, Filippo; Musarò, Lorenzo; Fantini, Riccardo; Tabbì, Luca; Andreani, Alessandro; Cappiello, Gaia; Costi, Stefania; Castaniere, Ivana; Clini, Enrico
abstract

Introduction- Chronic Critical Illness (chronic CI) is a condition associated to patients surviving an episode of acute respiratory failure (ARF). The prevalence and the factors associated with the development of chronic CI in the population admitted to a Respiratory Intensive Care Unit (RICU) have not been yet elucidated. Methods- An observational prospective cohort study was undertaken at the RICU of the University Hospital of Modena (Italy). Patients mechanically ventilated with ARF in RICU were enrolled. Demographics, severity scores (APACHEII, SOFA, SAPSII), and clinical condition (septic shock, pneumonia, ARDS) were recorded on admission. Respiratory mechanics and inflammatory-metabolic blood parameters were measured both on admission and over the first week of stay. All variables were tested as predictors of chronic CI through univariate and multivariate analysis. Results- chronic CI occurred in 33 out of 100 patients observed. Higher APACHEII, the presence of septic shock, diaphragmatic dysfunction (DD) at sonography, multidrug-resistant (MDR) bacterial infection, the occurrence of a second infection during stay, and a C-reactive protein (CRP) serum level inceasing 7 days over admission were associated with chronic CI. Septic shock was the strongest predictor of chronic CI (AUC=0.92 p<0.0001). Conclusions- Chronic CI is frequent in patients admitted to RICU and mechanically ventilated due to ARF. Infection-related factors seem to play a major role as predictors of this syndrome.

2020 - The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study [Articolo su rivista]
Messina, R; Dallolio, L; Fugazzaro, S; Ricci, P; Iommi, M; Bardelli, R; Costi, S; Denti, M; Accogli, Ma; Cavalli, E; Pagliacci, D; Fantini, Mp; Taricco, M
abstract

Abstract Objective To test the efficacy of a self-management intervention for stroke survivors vs. usual care. Methods Using a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services. Results Eighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention. Conclusion The intervention was efficacious in improving self-efficacy, mental health and activities of daily living. Practice implications Structured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.

2020 - The Multi-morbidity Patient (chapter 35). [Capitolo/Saggio]
Tonelli, Roberto; Crisafulli, Ernesto; Costi, Stefania; Clini, Enrico.
abstract

The patients with chronic obstructive pulmonary disease (COPD) are elderly and complex individuals with comorbidities (multi-morbidity COPD), that reflect the coexistence of other medical conditions alongside their established lung and airways impairment. The identification of these associated conditions represents an important step towards the characterization of the patients’ disabilities and to an appropriate referral for comprehensive rehabilitation. The literature suggests that the number of comorbidities does not affect adherence or outcomes of pulmonary rehabilitation in multi-morbidity COPD patients. Notwithstanding, specific coexisting conditions may have a peculiar impact on the extent of the gains provided by the rehabilitation course. To optimize rehabilitation, clinicians should be aware of any specific needs associated with complex multi-morbidity COPD patients.

2020 - Therapeutic Education and Physical Activity to Support Self-management of Cancer-related Fatigue in Hematologic Cancer Patients: Protocol of a Feasibility Randomized Controlled Trial [Articolo su rivista]
Denti, M.; Accogli, M. A.; Costi, S.; Fugazzaro, S.
abstract

Introduction: Hematologic malignancies account for nearly 8% of new cancer diagnosis in Italy. Cancer-related fatigue (CRF) is one of the most distressing symptoms reported by patients with cancer. As CRF has a multifactorial etiology, physical activity and therapeutic education may be beneficial for managing CRF, both during and after cancer treatment. However, there is a lack of evidence specific to hematologic malignancies. This paper describes the protocol of a feasibility study on Therapeutic Education and Physical Activity (TEPA) intervention to support self-management of CRF in patients with hematologic malignancies. Methods: TEPA was addressed to newly diagnosed adult individuals with hematologic malignancy able to take part in a rehabilitation programme at the AUSL-IRCCS of Reggio Emilia. The protocol was developed in 2 phases. Phase I was an observational cohort study involving a convenience sample of 10 participants with the aim to evaluate the feasibility of the assessment schedule and to register longitudinal clinical data regarding CRF (FACIT-F), psychologic distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), physical performance (TUG and 6MWT) and habitual level of physical activity during first months after diagnosis. Phase II (underway) is a feasibility randomized controlled trial (TEPA) involving a convenience sample of 40 participants and comparing 2 parallel active interventions (Therapeutic Education versus Therapeutic Education and Physical Activity) on top of usual care. The primary aim is to estimate the feasibility of TEPA, measured by the adherence rate to the intervention. Secondary aims are: to estimate the effect size of TEPA in terms of changes in CRF, psychological distress, QoL, physical performance and habitual level of physical activity (measured as in Phase I); to collect patient satisfaction, perception of usefulness of the TEPA intervention and data on long-term adherence to an active lifestyle. Data are collected in both phases at the time of diagnosis and then at 1-, 3- (completion of intervention) and 7-month follow-up. Discussion: Data on feasibility and effect size of TEPA will be analyzed upon completion of Phase II, allowing us to design a large, adequately powered RCT to verify the effectiveness of this intervention on CRF management in patients with hematologic cancer. Trial registration: clinicaltrials.gov; Trial registration number: NCT03403075

2020 - Work-related factors influencing return to work of cancer survivors: a cross-sectional survey in Italy [Poster]
Paltrinieri, S; Vicentini, M; Mancuso, P; Mazzini, E; Giorgi Rossi, P; Costi, S
abstract

Return to work (RTW) process of cancer survivors (CSs) is an emerging health issue. It has recently been demonstrated that individuals treated for cancer are 1.4 times more likely to be unemployed compared to healthy controls. Moreover, 1/3 of this population is represented by working-age individuals. Work reintegration is a major goal of rehabilitation because it improves quality of life and social participation of CSs.

2020 - distance-Problem Based Learning (d-PBL) for the education of healthcare professionals: the experience of the Bachelor Degree in Physiotherapy at UNIMORE [Abstract in Atti di Convegno]
Costi, Stefania; Lotti, Antonella
abstract

Italian University to massively adopt distance education strategies. Physiotherapy students’ learning styles privilege active participation, and problem-based learning (PBL) is an active learning strategy that improves the healthcare professionals’ skill to apply high-level knowledge. We describe the implementation of the "Self-management in rehabilitation” teaching module delivered at distance through the PBL strategy (d-PBL) at the Degree in Physiotherapy of the University of Modena and Reggio Emilia

2019 - Baseline exercise tolerance and perceived dyspnea to identify the ideal candidate to pulmonary rehabilitation: a risk chart in COPD patients. [Articolo su rivista]
COSTI, Stefania; Crisafulli, Ernesto; Trianni, Ludovico; BEGHE', Bianca; Faverzani, Silvia; Scopelliti, Giuseppe; Chetta, Alfredo; CLINI, Enrico
abstract

Background The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 minutes (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results- (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion- This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.

2019 - Explicit Motor Imagery for Grasping Actions in Children With Spastic Unilateral Cerebral Palsy [Articolo su rivista]
Errante, Antonino; Bozzetti, Francesca; Sghedoni, Silvia; Bressi, Barbara; Costi, Stefania; Crisi, Girolamo; Ferrari, Adriano; Fogassi, Leonardo
abstract

Background: Motor Imagery (MI) refers to mental simulation of a motor action without producing any overt movement. Previous studies showed that children with Unilateral Cerebral Palsy (UCP) are impaired in implicit MI, as demonstrated by the performance of Hand Laterality Judgment tasks. The aim of this study was to examine the specificity of explicit MI deficits in UCP children.Methods: A group of UCP children (n = 10; aged 9-14) performed a mental chronometry task consisting in grasping an object and placing it into a container, or in imagining to perform the same action. As control, a group of typically developing (TD) children, matched by age, performed the same task. Movement durations for executed and imagined trials were recorded. A subgroup of 7 UCP children and 10 TD children also underwent a session of functional MRI to examine the activation of parieto-frontal areas typically associated to MI processes, during the imagination of reaching-grasping actions performed with the paretic hand.Results: Behavioral results revealed the existence of a correlation between executed and imaginedmovement durations both in TD and UCP groups. Moreover, the regression analysis in TD children showed that higher scores in mental chronometry tasks were positively correlated to increased bilateral activation of the intraparietal sulcus (IPS), superior parietal lobule (SPL), and dorsal premotor (PMd) cortex. A similar analysis revealed in the UCP group a positive correlation between a higher score in the mental chronometry task and bilateral activations of IPS, and to activation of contralesional, right PMd, and putamen during imagination of grasping movements.Conclusions: These results provide new insights on the relationship between MI capacity and motor deficits in UCP children, suggesting the possibility of the use of explicit MI training to improve patient's upper limb motor functions.

2019 - Indagine sui fattori lavorativi che condizionano il rientro al lavoro dei pazienti oncologici: studio epidemiologico sulla provincia di Reggio Emilia [Abstract in Atti di Convegno]
Paltrinieri, S; Vicentini, M; Mazzini, E; Ricchi, E; Fugazzaro, S; Mancuso, P; Giorgi Rossi, P; Costi, S
abstract

• INTRODUZIONE: il rientro al lavoro (RAL) è uno degli obiettivi della riabilitazione in ambito oncologico, perché influisce positivamente sulla reintegrazione sociale del paziente. Per favorire il RAL, è importante conoscerne i determinanti, in particolare quelli legati alle caratteristiche del lavoro e modificabili. Tuttavia, in Italia mancano dati inerenti a questo argomento. • OBIETTIVI: stimare la proporzione di RAL nei pazienti oncologici ed identificare i fattori che influiscono sulle difficoltà percepite nel RAL. • METODI: da luglio 2016 a luglio 2017, nella provincia di Reggio Emilia è stata condotta una survey su tutti gli individui in età lavorativa (20-59 anni alla diagnosi), con tumore maligno infiltrante in stadio I-III incidente nel 2012 censiti dal Registro Tumori, occupati al momento della diagnosi e vivi nel periodo in studio. Sono stati esclusi gli individui con tumori della cute non melanomatosi, in fase di recidiva o di progressione nel periodo in studio. Ai soggetti eleggibili, è stata inviata una lettera con l’informativa ed il consenso a partecipare. Dopo contatto telefonico, è stato preso un appuntamento per compilare il questionario. Sono stati calcolati i rischi relativi (RR) con modelli log-binomiale. • RISULTATI: dei 594 individui contattati ne sono stati intervistati 266. Il 75% degli intervistati erano lavoratori dipendenti, di cui il 70% in aziende private. I lavoratori presso aziende che contano meno di 250 dipendenti e i contratti a tempo indeterminato rappresentano rispettivamente il 67% e l’88%. Mentre tra i lavoratori autonomi, la categoria più rappresentata è quella dei lavoratori in proprio (41%). Solo 13 non sono rientrati a lavoro. Tra i 253 che sono rientrati al lavoro (95%), 113 (43%) hanno percepito difficoltà e l’82% ha percepito il carico lavorativo non sopportabile. I lavoratori dipendenti incerti riguardo la natura dell’azienda (pubblicaprivata) hanno avuto più difficoltà nel RAL (RR=1,68;IC95%1,03-2,72), così come i lavoratori con contratto a tempo determinato (RR=1,37;IC95%0,96-1,95). Tra i dipendenti e gli autonomi, le persone che hanno percepito maggiori difficoltà nel RAL sono quelle che lavorano su turni (RR=1,30;IC95%0,94-1,78), di sera (RR=1,23;IC95%0,95-1,57) e di notte (RR=1,36;IC95%0,99-1,86). Complessivamente, i lavoratori che descrivono il lavoro come fisicamente stressante tendono a percepire un RAL più problematico (RR=1,19;IC95%0,92-1,55), situazione non analoga per coloro che invece descrivono il lavoro come psicologicamente stressante (RR=0,86;IC95%0,67-1,10). CONCLUSIONI Quasi la totalità degli intervistati è tornata al lavoro, fra questi la metà ha percepito difficoltà nel rientro. I fattori che hanno creato maggiori difficoltà sono i contratti anomali (l’incertezza riguardo la natura dell’azienda, tempo determinato), l’orario lavorativo (turni, serale e notturno) e il carico fisico. Sarebbe opportuno che questi fattori fossero presi in considerazione nella definizione del programma riabilitativo volto a facilitare il RAL.

2019 - Mirror Neuron System Activation in Children With Unilateral Cerebral Palsy During Observation of Actions Performed by a Pathological Model [Articolo su rivista]
Errante, Antonino; Di Cesare, Giuseppe; Pinardi, Chiara; Fasano, Fabrizio; Sghedoni, Silvia; Costi, Stefania; Ferrari, Adriano; Fogassi, Leonardo
abstract

Recent evidence suggested that Action Observation Therapy (AOT), based on observation of actions followed by immediate reproduction, could be a useful rehabilitative strategy for promoting functional recovery of children affected by unilateral cerebral palsy (UCP). AOT most likely exploits properties of the parieto-premotor mirror neuron system (MNS). This is more intensely activated when participants observe actions belonging to their own motor repertoire.

2019 - P27 Psycho-social process underlying motivations to participate in a research study: a grounded theory study in patients with nonsmall cell lung cancer [Abstract in Rivista]
Costi, Stefania
abstract

Background and Objective: Non-small cell lung cancer (NSCLC) represents 85% of lung cancers, and no standardized and well-studied rehabilitation approaches are available [1]. The willingness to participate in an experimental study and treatment compliance are critical issues that emerged in the conduct of clinical research, also in the rehabilitation field [2]. Aim of this study was to analyze the psychosocial process that occurs when it is proposed to patients with NSCLC to participate in a rehabilitation research project, and what brings them to join that. Materials and methods: This was a Grounded Theory qualitative study, part of a larger project (PuReAIR) aimed to analyze the effectiveness of a rehabilitative intervention in patients with NSCLC that is currently in place in the AUSL-IRCCS of Reggio Emilia. Subjects were recruited among those participating in the PuReAIR project, and subsequent snowball sampling was adopted. A semi-structured interview was used to investigate patients experience. Data were encoded by constructing of conceptual categories to build a theory. Results: A total of 9 subjects were included in this study. The analysis of the data revealed that the investigated process is based on two main categories: i) trust in science and ii) in the subject that proposes the study, reinforced by a strong perception of the established therapeutic relationship with the operators -in the foreground the Physiotherapists- and fed by the positive feedback. Conclusions: The proposal to participate in an experimental rehabilitative treatment, advanced immediately after the diagnosis of cancer, was welcomed by the patients. Being able to take advantage of a new therapy opportunity, that does not involve risks and that is perceived as help for oneself and others, are important elements for the patient, who can help in the decision to adhere to the experimentation.

2019 - Programme of perioperative pulmonary rehabilitation in surgically treated lung cancer patients: preliminary data [Abstract in Rivista]
Costi, Stefania
abstract

Background and Objective: Non-small Cell Lung Cancer (NSCLC) comprises 85% of all lung cancers. Lung resection is the election treatment but surgery might have a significant impact on Quality of Life (QoL) and physical condition. Pulmonary rehabilitation (PR), both before and after surgery, including aerobic and strength exercises, could reduce symptoms and morbidity and improve exercise capacity, pulmonary function and QoL. Aim: investigate the efficacy of intensive PR on exercise capacity for NSCLC patients surgically treated.

2019 - Return to work of cancer survivors in Europe: systematic review of the literature [Abstract in Rivista]
Costi, Stefania
abstract

Background and Objective: Cancer incidence and survival are growing. Over 1/3 of cancer survivors (CSs) are in their working-age [1]. CSs experience pain, fatigue, cognitive dysfunction, mood disorders that may adversely affect social functioning [2]. Systematic reviews show 64% employment rate for CSs, with high variability in different contexts (range 24% -94%) [3]. We reviewed the recent literature on the employment rate of CS in Europe, investigating the factors influencing the return to work (RTW).

2019 - Single-Subject Design: Experimental Designs for Research and for Clinical Practice [Abstract in Rivista]
Costi, Stefania
abstract

Background: The individual variability among people presenting motor impairments often leads to the difficulty to obtain an adequate sample size in the conduction of trials in physiotherapy. Furthermore, in clinical practice, it is often difficult to recognize the relationship between the administration of a treatment and its expected results. Psychological and educational sciences often use single-subject design (SSD) studies to explore behaviours under experimental conditions. This study design allows to test the relationship between an independent variable, the treatment, and a dependent variable, the main outcome of interest. The purpose of this work is to present researchers and clinicians the methodology of the SSD studies and their application in physiotherapy both in research context and everyday practice [1].

2019 - Undergoing head and neck cancer surgery: A grounded theory [Articolo su rivista]
Losi, Elisabetta; Guberti, Monica; Ghirotto, Luca; DI LEO, Silvia; Bassi, Maria C; Costi, Stefania
abstract

Surgery is the treatment of choice in most head and neck cancers. Very often, the surgery is radical with high impact on the psychosocial, functional and aesthetic fields. The aim of this study is to gain a deeper understanding of the patient's, clinician's and key informant's point of view when surgery is proposed, to improve the quality of pathways in terms of patients' practical, psychological and relational needs. We followed a Grounded Theory approach with semi-structured interviews. Seventeen participants (six patients, nine healthcare professionals and two volunteers) were interviewed immediately before surgery. The study generated a process of "persuading the patient of an obligation" as the core category. The other principal categories that emerged highlighted the patients' doubts and fears regarding the surgery consequences and, in parallel, strategies employed by the healthcare professionals to rebut hindering issues impeding surgery. In particular, healthcare professionals involved patients in an affiliation process through simplified communication to sustain the choice of surgery; the family plays a supportive role in this process. The interplay between the organisational process and patients' experience results in "I will let you convince me" at the end of the decision-making process, where the main aim was to save and be saved.

2019 - VALIDAZIONE TRANS-CULTURALE DELLA SCHEDA DI VALUTAZIONE ACTIVITIES SCALE FOR KIDS PERFORMANCE (ASKP): STIMA DELL’AFFIDABILITÀ DELLA VERSIONE ITALIANA NELLA POPOLAZIONE CON PARALISI CEREBRALE INFANTILE [Poster]
Costi, Stefania
abstract

La paralisi cerebrale infantile (PCI) è la più comune causa di disabilità dell’infanzia. I bambini con PCI sperimentano spesso difficoltà nelle attività della vita quotidiana, pertanto la misurazione delle loro performance in queste attività, diviene un aspetto prioritario dell’intervento riabilitativo. La Activities Scale for Kids performance (ASKp) è una scala validata su bambini con disturbi muscoloscheletrici (Young, 2000), il cui utilizzo è diffuso anche nella popolazione con PCI (James, 2014), in quanto ha il vantaggio di cogliere la percezione del paziente rispetto alla propria abilità (Young, 1995). L’obiettivo di questo studio è ottenere una stima dell’affidabilità della versione italiana della scala ASKp (Fabbri, 2016) nella popolazione con PCI.

2018 - Approccio del Fisioterapista nella presa in carico del paziente con lombalgia cronica: indagine esplorativa presso l'AziendA USL di Reggio Emilia [Articolo su rivista]
Santis, De; Costi, Stefania; Bassi, Sandra; Lombardi, Francesco; Rancati, JACOPO MATTEO
abstract

Background: Chronic Low Back Pain (CLBP) is currently considered a biopsychosocial syndrome, where individual, physical, occupational, psychological and social risk factors coexist. The available research indicates that physiotherapists (PTs) theoretically endorse the proposed biopsychosocial approach to treatment, yet very few are adopting this approach in clinical practice. Aim: The purpose of this exploratory survey is to obtain a detailed view of physiotherapists’ perceptions in their local setting, with specific reference to the operators’ kind of approach and professional skills in the treatment of CLBP. Methods: The survey tool was a focus group, based on a simulated clinical case conducted with expert operators selected on a voluntary basis. The results of the interview were analyzed using a qualitative-inductive method. Results: The analysis shows results related to three interconnected macro areas: the physiotherapists’ professional skills/training, evaluation tools, and organizational structure. Physiotherapists’ skills should be reinforced with training dedicated to communication-relational aspects and supported by assessment tools necessary to screen and evaluate psychosocial factors. As regards organizational structure, it takes the opportunity to design a clinical path or structure specialized in outpatient services for patients with chronic low back pain (CLBP). Conclusion: Some results are aligned with the literature. In particular, the need to reinforce physiotherapists’ inter-relational skills and to support them with the intervention of other specialists (multidisciplinary team) in the case of problems not strictly of their competence. The role of management is to identify organizational solutions to creating clinical pathways to reduce dispersion and to reinforce the professionals’ expertise.

2018 - Employment rate and predictors of return to work in European cancer survivors: a systematic review. [Poster]
Paltrinieri, Sara; Mazzini, Elisa; Fugazzaro, Stefania; Pellegrini, Martina; Bassi, Maria Chiara; Tedeschi, Claudio; Vicentini, Massimo; Costi, Stefania
abstract

Cancer incidence and survival are both increasing. Over 1/3 of cancer survivors (CSs) are in their working age1. CSs experience pain, fatigue, cognitive dysfunction, and mood disorders that may adversely affect social functioning2. Systematic reviews show a 64% employment rate for CSs, with high variability in different contexts (range 24% 94%)3. We reviewed the recent literature on the employment rate of CSs in Europe, investigating the factors influencing their return to work (RTW)

2018 - Home-based occupational therapy to reduce disability and enhance social reintegration in complex patients in Reggio Emilia. [Abstract in Atti di Convegno]
Costi, Stefania
abstract

Mini Oral Sessions 2: Friday, June 8, 2018, 13:30-14:15 110 In the last 3 years, a multidisciplinary research group developed a project focusing on occupational therapy (OT) for complex patients admitted to Rehabilitation Unit of the IRCCS-ASMN. The aim was promoting recovery of the best level of independence in ADL and finding strategies to return to a satisfying social life. The study showed statistically significant improvement in COPM in patients treated with OT + standard rehabilitation care, and allowed researchers to focus some patients unmet needs, dealing with social reintegration.

2018 - I fattori che influiscono sul rientro al lavoro dei pazienti oncologici: studio epidemiologico condotto a Reggio Emilia [Poster]
Paltrinieri, S; Fugazzaro, S; Vicentini, M; Mancuso, P; Giorgi rossi, P; Mangone, L; Ricchi, E; Mazzini, E; Costi, S
abstract

2018 - Occupational Therapy in Complex Patients: A Pilot Randomized Controlled Trial [Articolo su rivista]
Pellegrini, Martina; Formisano, Debora; Bucciarelli, Veronica; Schiavi, Margherita; Fugazzaro, Stefania; Costi, Stefania
abstract

INTRODUCTION: To determine effect size and feasibility of experimental occupational therapy (OT) intervention in addition to standard care in a population of complex patients undergoing rehabilitation in a hospital-home-based setting. METHOD: 40 complex patients admitted to the rehabilitation ward of the Local Health Authority-Research Institute of Reggio Emilia (Italy) were randomized in a parallel-group, open-label controlled trial. Experimental OT targeting occupational needs in the areas of self-care, productivity, and leisure was delivered by occupational therapists. Standard care consisted of task-oriented rehabilitation delivered by a multiprofessional team. RESULTS: The experimental OT intervention was completed by 75% of patients assigned to this group. The average changes in the Canadian Occupational Performance Measure (COPM) performance score significantly and clinically favored experimental OT [-3,06 (-4.50; -1.61); delta > 2 points, resp.]. Similar trends were detected for COPM satisfaction and independence in instrumental activities of daily living (ADL). At follow-up, level of social participation was higher for patients treated with experimental OT (p = 0.043) than for controls. CONCLUSIONS: Experimental OT was feasible in complex patients in a hospital-home-based setting. It ameliorated both patients' performance and satisfaction in carrying out relevant activities and improved independence in instrumental ADL. The trial is registered with ClinicalTrials.gov NCT02677766.

2018 - Occupational therapy for complex inpatients with stroke: identification of occupational needs in post-acute rehabilitation setting [Articolo su rivista]
Schiavi, Margherita; Costi, Stefania; Pellegrini, Martina; Formisano, Debora; Borghi, Sergio; Fugazzaro, Stefania
abstract

Purpose: Inpatients admitted to rehabilitation express needs not linked to disease causing hospitalization. This observational cross-sectional study identifies features and occupational needs of complex inpatients during rehabilitation, focusing on function and ability, regardless of diagnosis. Method: This study included sixteen adult inpatients with stroke, deemed complex according to Rehabilitation Complexity Scale-Extended, at admission to Rehabilitation ward (from July 2014 to February 2015). Patients with primary psychiatric disorders, language barriers, cognitive or severe communication deficits were excluded. Upon admission, a multidisciplinary team collected data on general health, independence in daily activities (Modified Barthel Index), fatigue (Fatigue Severity Scale), resistance to sitting and ability to perform instrumental activities (Instrumental Activities of Daily Living). The occupational therapist identified occupational needs according to Canadian Occupational Performance Measure. Results: Inpatients enrolled in this study were dependent in basic ADL, limited in instrumental ADL and easily fatigable. Their occupational needs related to self-care (75%) and, to a lesser extent, productivity (15%) and leisure (10%). According to inpatients, rehabilitation process should firstly address self-care needs, followed by productivity and leisure problems. Conclusions: Despite small sample size, this study described patterns of occupational needs in complex inpatients with stroke. These results will be implemented in client-centered rehabilitation programs to be tested in a phase-two trial. [NCT02173197]Implications for RehabilitationPriority occupational needs of complex inpatients with stroke during rehabilitation are focused on self-care area.Productivity and leisure problems also arise in early post-acute phase.Client-centered rehabilitation programs should firstly address self-care needs and, later on, they should also focus on the recovery of family and social roles.

2018 - RETURN TO WORK IN ITALIAN CANCER SURVIVORS: THE INNOVATIVE SOCIAL-HEALTH CARE NETWORK [Relazione in Atti di Convegno]
Paltrinieri, S; Rondini, E; Fugazzaro, S; Gozzi, C; Costi, S; Mazzini, E.
abstract

The Local Health Authority of Reggio Emilia, supported by the Manodori Foundation, decided to implement this innovative social-health care pathway that was created together with other 14 organizations in the Province of Reggio Emilia: they are Associations, labor union, training institutions, social cooperatives, and so on… Together, we created a network to address the need to go back to work of cancer patients. What happens to the working age patients with cancer in Reggio Emilia? First of all first of all the HCPs who meet the patients for diagnostic or curative reasons ask for information about the work situation. On the basis of this very first information collected, if the patient is judged at risk to lose the job he is referred to the network hub of UNA MANO: the Informa-salute service. Here, a Nurse, together with other trained personnel, make the first true assessment of the risk to lose the job. If the patients is judged at low risk, he still receive information regarding… If the patient is judged at risk to lose the job, he is sent to the OT that make a deep, second level of assessment. After this, if the risk is confirmed as moderate, the patients will received a personalized intervention targeted to… If the risk is judged very high, or the patient as already lost the job, the social part of the network is activated to implement a personalized intervention targeted to…

2018 - Return to work in European Cancer survivors: a systematic review [Articolo su rivista]
Paltrinieri, Sara; Fugazzaro, Stefania; Bertozzi, Lucia; Bassi, Maria Chiara; Pellegrini, Martina; Vicentini, Massimo; Mazzini, Elisa; Costi, Stefania
abstract

Return to work (RTW) of cancer survivors (CSs) fluctuates in different contexts. This systematic review searched for recent data on the RTW rate of CSs in Europe, investigating associated factors.

2018 - Therapeutic patients education program in addition to physical activity to engage onco-heamatological patients in managing cancer-related fatigue [Abstract in Atti di Convegno]
Costi, Stefania
abstract

Dealing with Cancer-Related Fatigue (CRF) is the first unmet need reported by onco-haematological patients, and it’s due to the disease and to treatment side effects. It is known that Physical Activity (PA) could be beneficial in CRF’s management and that most patients need accurate information about consented PA and disease management. Several studies showed that Therapeutic Patient Education (TPE) Programs could help people with chronic illnesses to manage their conditions, but their application is still poor or not well structured.

2017 - Employment rate and predictors of return to work in people treated for oncologic diseases: a systematic review [Poster]
Paltrinieri1, Sara; Fugazzaro1, Stefania; Mazzini1, Elisa; Pellegrini1, Martina; Bassi1, Chiara; Tedeschi1, Claudio; Costi, Stefania
abstract

Countries with an high development index are experiencing increase in both life expectation and in working age. This features will bring aged people with chronic disease, including cancer, in the workforce. Epidemiologic data show that approximately half of the new diagnosis and more than 1/3 of cancer survivors are people between 15 and 64 years [1]. Return to work (RTW) is a significant issue in this population because it might help to maintain or restore a satisfactory health status, to preserve social participation and social role, to restore self-perception of own identity and also to increase quality of life. Additionally, RTW has relevant direct negative effects on the social cost supported by Health Services, patients and families. In Italy, the socio-economic influence of loss of productivity due to cancer related consequences, was estimated in more than 8 billions of impact on the employing companies [2]. For this reason, we conducted this systematic review of the literature with the aim to investigate the employment status in European cancer survivors.

2017 - PRELIMINARY DATA OF AN EARLY PULMONARY REHABILITATION PROGRAMME IN SURGICALLY TREATED LUNG CANCER PATIENTS [Poster]
Mainini, C; Bardelli, R; Kopliku, B; Sobral Rebelo, Pf; Cantarelli, L; Tenconi, S; Rapicetta, C; Piro, R; Costi, S; Galeone, C; Ruggiero, P; Tedeschi, C; Fugazzaro, S
abstract

Non-small cell lung cancer is the most common type of lung cancer. Surgery appears to be the most effective treatment in early stage although it has important impact on quality of life. Pulmonary rehabilitation (PR), both before and after surgery, could reduce symptoms and morbidity and improve exercise capacity, pulmonary function and quality of life. Aim. Assess the efficacy of a pre and post-operative PR programme (PUREAIR) for lung cancer patients on exercise capacity and quality of life.

2017 - PUREAIR protocol: Randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer [Articolo su rivista]
Fugazzaro, Stefania; Costi, Stefania; Mainini, Carlotta; Kopliku, Besa; Rapicetta, Cristian; Piro, Roberto; Bardelli, Roberta; Rebelo, Patricia Filipa Sobral; Galeone, Carla; Sgarbi, Giorgio; Lococo, Filippo; Paci, Massimiliano; Ricchetti, Tommaso; Cavuto, Silvio; Merlo, Domenico Franco; Tenconi, Sara
abstract

Background: Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. Methods: We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25m at Six-Minute Walk Test. Discussion: Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. Trial registration: ClinicalTrials.gov Registry n. NCT02405273[31.03.2015].

2017 - Partecipare ad uno studio riabilitativo di ricerca per pazienti con NSCLC: GT sul processo psico-sociale alla base delle motivazioni [Poster]
Ferrari, Filippo; Montermini, Chiara; Ghirotto, Luca; Mainini, Carlotta; Fugazzaro, Stefania; Costi, Stefania
abstract

L’incidenza e la sopravvivenza dei tumori è in aumento nel mondo occidentale, tuttavia non è ancora stata individuata la strategia riabilitativa migliore per facilitare il recupero del migliore stato di salute1. Studi qualitativi hanno indagato le motivazioni che inducono i pazienti con tumore ad accettare o rifiutare di partecipare ad uno studio sperimentale: se da una parte c’è la speranza di poterne trarre beneficio, dall’altra vi sono le preoccupazioni legate alla sperimentazione e una generale maggiore fiducia nei protocolli di terapia standard2. L’esercizio fisico costituisce un elemento fondamentale all’interno dei programmi riabilitativi rivolti a pazienti con tumore. Tuttavia, la sua efficacia dipende dal livello di aderenza al protocollo (>80% per ottenere buoni risultati), che può essere influenzato da fattori personali e contestuali3.

2017 - Resezione polmonare per tumore al polmone e riabilitazione intensiva: revisione sistematica e definizione del protocollo PuReAIR. [Relazione in Atti di Convegno]
Cantarelli, L; Mainini, C; Bardelli, R; Sobral Rebelo, Pf; Tenconi, S; Rapicetta, C; Piro, R; Costi, S; Galeone, C; Ruggiero, P; Tedeschi, C; Fugazzaro, S; Kopliku, B
abstract

2017 - THERAPEUTIC PATIENT EDUCATION (TPE) IN STROKE: EFFICACY OF LAY -LOOK AFTER YOURSELF- SELF-MANAGEMENT PROGRAM [Poster]
Bardelli, R1; Fugazzaro, S1; Accogli, Ma1; Denti, M1; Altavilla, A1; Maisto, G1; Cavalli, E2; Pagliacci, D4; Calugi, S2; Dallolio, L2; Messina, S2; Costi, S; Cavazza, S3; Tedeschi, C1; Taricco, Mariangela
abstract

Guidelines recommend Therapeutic Patient Education (TPE) in stroke patients, but there are no strong evidences of efficacy (variability in type, timing and setting of existing programs). Aim: to develop and evaluate the efficacy of a standardized TPE program on empowerment of self-management (SM) for stroke inpatient and facilitation of social reintegration after rehabilitation discharge.

2016 - Brainstoming as a tecqnique to identify stroke inpatients needs in therapeutic education during rehabilitation [Abstract in Rivista]
Maisto, G; Altavilla, A; Accogli, Ma; Denti, M; Roberta, B; Cavalli, E; Pagliacci, D; Calugi, S; Costi, Stefania; Cavazza, S; Tedeschi, C; Taricco, M; Fugazzaro, S; Gagliano, G.
abstract

The aim of this study is to identify the main needs of stroke patients admitted to Therapeutic Pateint Education Programme in rehabilitation, detected with brainstorming technique

2016 - Collaborative goal-setting and action plans in therapeutic patient education for stroke patients in rehabilitation phase [Abstract in Rivista]
Accogli, Ma; Denti, M; Altavilla, A; Maisto, G; Bardelli, R; Bosi, S; Cavalli, E; Pagliacci, D; Calugi, S; Costi, Stefania; Cavazza, S; Tedeschi, C; Taricco, M; Fugazzaro, S.
abstract

Therapeutic Patient Education Programs for stroke survivors are recommended by several guidelines, but their application is still poor or not well structured either in the post acute phase and in the long term. We conducted a satellite study focusing on stroke patients Action Plans

2016 - Defining therapeutic patient education in post-stroke rehabilitation: usual care and preliminary data of an Italian self-management early intervention for stroke survivors (LAY - look after yourself) [Abstract in Rivista]
Fugazzaro, S; Bardelli, R; Accogli, Ma; Denti, M; Altavilla, A; Piccinini, M; Maisto, G; Cavalli, E; Pagliacci, D; Calugi, S; Costi, Stefania; Cavazza, S; Tedeschi, C; Taricco, M.
abstract

The aim of this study is to define Usaul Care in non structured therapeutic patient education in stroke rehabilitation and to develop a standardized therapeutic patient education program for post acute stroke patients

2016 - I disturbi del sonno nelle cerebropatie in età pediatrica: single case study e analisi qualitativa sull'utilizzo di un sistema di postura nel sonno [Articolo su rivista]
Paola, Piccinini; Costi, Stefania; Silvia, Paoli
abstract

I bambini con cerebropatie gravi presentano elevata incidenza di disordini del sonno determinati da fattori fisici e ambientali. abbiamo valutato l'efficacia del sistema di postura Sleepform nel trattamento dei disturbi del sonno del bambino con cerebropatia grave e abbiamo rilevato l'opinione dei genitori sull'ausilio

2016 - Modulating the motor system by action observation in right Hemiplegic Cerebral Palsy: an fMRI study [Abstract in Atti di Convegno]
Errante, A; Di Cesare, G; Fasano, F; Costi, Stefania; Sghedoni, S; Bressi, B; Volpe, V; Ferrari, Adriano; Fogassi, Leonardo
abstract

Cerebral Palsy (CP) is a major cause of motor disability in children. Among CP children, approximately one third is affected by Hemiplegic Cerebral Palsy (HCP), resulting in abnormal motor function of one body side. In recent years, it hab been suggested that the systematic use of observation of goal-directed actions followed by their execution (Action Observation Treatment, AOT) may become a rehabilitative strategy that improves the process of functional recovery in patients with stroke, Parkinson Disease and in orthopedic patients. AOT has been found effective also in HCP children.

2016 - PRELIMINARY DATA AND FEASIBILITY OF AN EARLY PULMONARY REHABILITATION PROGRAM IN SURGICALLY TREATED LUNG CANCER PATIENTS [Poster]
Sobral Rebelo, P; Mainini, C; Bardelli, R; Kopliku, B; Tenconi, S; Rapicetta, C; Piro, R; Costi, Stefania; Tedeschi, C; Fugazzaro, S.
abstract

Background. Non-Small Cell Lung Cancer is one of the most frequent cancers. The election treatment for NSCLC is lung resection by increasing survival, nevertheless, it has a relevant impact in patients quality of life and functional conditioning. Therefore there is a growing interest in investigating the potential effects of a pulmonary rehabilitation program, either before and after surgery, aiming to improve patients' physical and mental condition. Aim. Assess the immediate and long-term effects of a perioperative pulmonary rehabilitation program for lung cancer patients surgically treated.

2016 - Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence? [Articolo su rivista]
Mainini, Carlotta; Rebelo, Patrícia Fs; Bardelli, Roberta; Kopliku, Besa; Tenconi, Sara; Costi, Stefania; Tedeschi, Claudio; Fugazzaro, Stefania
abstract

Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2-4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes.

2016 - Transcultural validation of Activities Scale for Kids (ASK): translation and pilot test [Articolo su rivista]
Fabbri, Lucia; Neviani, Rita; Festini, Filippo; Costi, Stefania
abstract

The Activities Scale for Kids performance (ASKp) is one of the few self-assessment questionnaires in pediatric rehabilitation that measures child perception in performance of daily routine activities. ASKp is composed of 30 questions designed to explore activities and participation in children and teenagers with musculoskeletal disorders. Scores assess level of physical ability, identify appropriate treatment and monitor changes over time. We undertook this cross-cultural validation study to achieve a culturally adapted Italian version of ASKp, to be tested on Italian children.

2016 - “Therapeutic patient education (TPE) in stroke survivors: defining usual care and preliminary data of a self-management program (LAY- Look After Yourself-) [Poster]
Bardelli, R.; Fugazzaro, S.; Accogli, M. A; Denti, M; Altavilla, A; Piccinini, M; Maisto, G; Cavalli, E.; Pagliacci, D; Calugi, S; Costi, Stefania; Cavazza, S; Tedeschi, C; Taricco, M.
abstract

Therapeutic Patient Education (TPE) is an educational process that enable patients to acquire and maintain abilities to optimally manage their lives with their condition. It is patient-centred and it includes: organized awareness, information, self-care learning and psychosocial support. It is designed to help patients and their families understand the disease and treatments, cooperate with health-care providers, live healthily and maintain or improve quality of life (QoL). It should also contribute to reducing the cost of long-term care to patients and society. The Stanford Patient Education Research Center set up a wide variety of TPE interventions for people with chronic conditions (CDSMP, arthritis, diabetes, pain, HIV…) supported by literature. Guidelines recommed to include TPE in stroke care to improve self-management (SM) and there is some evidence that self-efficacy is an important variable associated with various post-stroke outcomes (QoL, depression, ADL, physical functioning). Goal-setting, individualized approach and professional support may also be common strategies between SM programs and the rehabilitation process. Nevertheless, until now in literature there is a large variability in type, timing, contents and setting of these interventions and the optimal format for stroke survivors is still not clear: further studies are needed.

2015 - Analisi delle competenze del fisioterapista nella gestione del dolore nei pazienti ambulatoriali e proposta di un percorso di aggiornamento professionale: dati preliminari di un before-and-after study [Articolo su rivista]
Rancati, Jacopo Matteo; Albertini, Chiara; Capone, Roberto; Scaltriti, Sara; Costi, Stefania
abstract

Introduzione. Il monitoraggio e contenimento del dolore è un obiettivo cui tutti i professionisti sanitari sono chiamati a rispondere. La letteratura testimonia che nei percorsi formativi di base non vi sono insegnamenti specificamente dedicati. Materiali e metodi. Presso l'AUSL di Reggio Emilia è stato strutturato un progetto di auditing sul tema oggetto di studio. Il ciclo dell’audit è stato sviluppato nelle prime cinque fasi: la verifica dell’efficacia del cambiamento sarà oggetto di un ulteriore studio a distanza di un anno dalla prima rilevazione dati (1° quadrimestre 2016). Per implementare il processo di cambiamento è stato strutturato un percorso di sviluppo professionale utile a far emergere i bisogni formativi dei fisioterapisti afferenti ai servizi ambulatoriali,. Sono state utilizzate metodiche didattiche finalizzate a stimolare l'auto analisi ed il confronto tra pari, ponendo gli operatori di fronte ad un’indagine circa lo stato dell'arte circa del servizio ed alle raccomandazioni dell'OMS. Risultati. Gli indicatori di processo analizzati hanno posto in evidenza alcuni scostamenti nella rilevazione dati rispetto agli standard aziendali. Il percorso di sviluppo professionale ha fatto emergere alcuni bisogni formativi rispetto alla gestione della terapia farmacologia (nell’ambito di competenza della professione) e circa la necessità di condividere strategie comuni per effettuare scelte omogenee, rendicontare le attività e registrare gli outcome. I risultati di apprendimento individuali e di gruppo testimoniano lo sviluppo di tali competenze. Discussione. Lo studio mette in luce la necessità di integrare le competenze dei fisioterapisti circa la gestione del dolore. Il percorso formativo proposto ha dato la possibilità ai fisioterapisti di sviluppare tali competenze attraverso la costruzione partecipata di strumenti di supporto decisionale uniformi ed allineati con le raccomandazioni evidence based, oltre che di strategie condivise per facilitare la comunicazione tra professionisti e la registrazione degli outcome come previsto nelle linee guida. Altri studi di dimensioni campionarie adeguate devono essere condotti per poter confutare questi risultati in modo valido e generalizzabile

2015 - “Validazione trans-culturale della scala di valutazione Activities Scale for Kids performance (ASKp): stima dell'affidabilità della versione italiana nella popolazione con PCI”. [Poster]
Bruzzi, Elena; Costi, Stefania; Signorelli, Chiara; Cristina Filippi, Maria; Alboresi, Silvia; Ferrari, Adriano
abstract

La paralisi cerebrale infantile (PCI) è la più comune causa di disabilità dell’infanzia; i bambini con PCI sperimentano spesso difficoltà nelle ADL e il miglioramento della perfomance in questi compiti diviene un aspetto prioritario dell’intervento riabilitativo. Al fine di individuare obiettivi di trattamento appropriati e misurare gli effetti del proprio intervento, gli operatori della riabilitazione devono disporre di strumenti di valutazione validi nel contesto di applicazione. Nell’ambito della riabilitazione pediatrica sono state sviluppate numerose scale di valutazione, la maggior parte delle quali non sono formalmente tradotte e validate nel contesto italiano; una di queste è la Activities Scale for Kids (ASKp) che, ad oggi, è l’unico questionario di autovalutazione in abito pediatrico creato per indagare la percezione che il bambino ha in merito alla sua disabilità o limitazione nelle ADL; la validità della ASKp nella sua versione originale, in lingua inglese, è stata testata attraverso opportuni studi su bambini con disabilità di natura muscolo-scheletrica conseguente a varie patologie. Essa non è mai stata validata nella popolazione di bambini con PCI. Lo scopo di questo studio è quello di testare la versione italiana culturalmente adattata della scala ASKp nella popolazione con PCI. MATERIALI E METODI In questo studio con disegno trasversale viene testata l’affidabilità della ASKp attraverso la sua somministrazione ad un campione di bambini e adolescenti italiani, tra i 5 e i 15 anni, nelle diverse forme cliniche di emiplegia e di diplegia dovute a PCI. Trattandosi di una scala autosomministrata, sono esclusi i bambini e gli adolescenti con ritardo mentale moderato o grave. RISULTATI Ad oggi sono stati inclusi nello studio 83 bambini e adolescenti (47 maschi e 36 femmine), con un’età media di 10 anni e 6 mesi, nella maggior parte diplegici (49 pazienti). Nell’89% dei casi il livello cognitivo dei bambini è risultato nella norma. Un quarto dei pazienti necessita di ausili per spostarsi all’esterno, mentre una proporzione quasi analoga necessita di ausili per spostarsi intra–extramoenia. Il punteggio minimo ottenuto nella ASKp è 26, quello massimo 100 e il punteggio medio 78,4. L’affidabilità, testata tramite l’α di Cronbach, è pari a 0.93 (IC 0.90-0.96). La ASKp si è dimostrata in grado di discriminare livelli diversi di autonomia tra pazienti con livello cognitivo nella norma e pazienti con lieve ritardo mentale e tra pazienti che utilizzano ausili per spostarsi negli ambienti chiusi e pazienti che non li utilizzano o vi fanno ricorso solo per gli spostamenti in spazi aperti. I risultati parziali ad oggi ottenuti non ci hanno permesso di rilevare altre capacità discriminative. CONCLUSIONI La misura della performance dei bambini con PCI nelle attività quotidiane è un outcome importante per il team riabilitativo, che può indirizzare il team verso obiettivi concreti e funzionali. È fondamentale avere a disposizione scale di valutazione delle ADL robuste e focalizzate sui bambini. La versione italiana della ASKp è affidabile nella popolazione con PCI.

2014 - Effectiveness of standing frame on constipation in children with cerebral palsy: a single-subject study [Articolo su rivista]
Rivi, Elena; Filippi, Mariacristina; Fornasari, Elisa; Mascia, Maria Teresa; Ferrari, Adriano; Costi, Stefania
abstract

Children with cerebral palsy (CP) and quadriplegia or severe diplegia suffer from highly reduced mobility and consequent constipation. Clinicians recommend standing frames to exercise the support reaction in this population, sharing the opinion that the upright position may facilitate intestinal transit, although no evidence supports this assumption. We conducted this study to determine the effects of the standing frame on spontaneous evacuation in children with CP. Moreover, we studied its effects on the frequency of induction of evacuation, the characteristics of the stool and the pain suffered by the child due to constipation and/or evacuation. We implemented a single-subject research design in one chronically constipated child with CP and quadriplegia, Gross Motor Function Classification System Level V. To monitor the effects of the standing frame, we measured the outcome of interest throughout the study using a daily diary and the Bristol Stool Scale. This study was approved by the local Ethics Committee. This study has several limitation; primarily, the use of a single-subject research design only makes possible the visual analysis of data obtained from a unique patient. So, by themselves, data obtained do not allow us any generalization for the target population. Future research should verify our results collecting more data and also investigating the effect of the standing-frame on respiratory functions. Although the standing frame did not affect the frequency of evacuations or the characteristics of the stool, its employment reduced the inductions of evacuation and the related pain suffered by the child. However, this study has several limitations, such as the lack of generalization due to the fact that we studied a unique patient and the overall brevity of the study due to external circumstances. Therefore, we suggest future research to verify our results, also investigating the effect of the standing frame on respiratory functions. Relevance to clinical practice. The standing frame may positively influence the management of constipation of these children, possibly improving their quality of life.

2013 - AFO orthoses in children with CP: the effectiveness is associated with the gait pattern. [Abstract in Rivista]
Ferrari, Adriano; Costi, Stefania
abstract

Despite the AFO orthoses for children with CP are a widely used tool, their effectiveness has not yet been clearly demonstrated by experimental evidence, both for what concerns the effects on the walking pattern, and for what regards the aspects of activity and performance [1]. In the literature, the majority of the studies that evaluates the effectiveness of orthoses does not divide the children according to the pattern of movement, and bases the evaluation on uniform targets for all. The present work, dividing the patients into 4 forms (where the patients are more skilled from 1st to 4th form, Ferrari et al. [2]), tested the effectiveness of orthoses, demonstrating the need for an individualized approach based on the walking pattern of each single patient.

2012 - Anthropometry as Measure of Risk in COPD Patients (chapter 145) [Capitolo/Saggio]
E., Crisafulli; Costi, Stefania; Clini, Enrico
abstract

In the last decade, Chronic Obstructive Pulmonary Disease (COPD) has been redefined and newly approached not only as an airway-disease condition, but as a multi-component disease including extra-pulmonary manifestations, such as peripheral muscle weakness and malnutrition.The evaluation of body composition (as a part of nutritional assessment) fairly integrates the simple body mass index (BMI) measure by measuring the individual’s active metabolism (fat free mass, FFM). Indeed, BMI and FFM are both parameters correlated with many COPD-strong out- comes. In several epidemiological studies of COPD population admitted to both in- or outpatient rehabilitation programmes, the estimated prevalence of weight loss ranges from 17% to 53%. Nonetheless, weight reduction, together with FFM depletion, is a common feature in emphysema as well as in chronic bronchitis.A nutritionally depleted patient is usually defined by a BMI of £ 20 kg/m2. Several studies aimed at evaluating the prognostic value of BMI in COPD patients have documented that BMI £ 25 kg/m2 and weight reduction of >3 kg/m2 are strong predictors of mortality. Moreover, other studies confirmed that FFM and measurement of the cross-sectional area of muscle mass (mid-thigh and mid-arm) also correlate to survival rates.In future research, studies looking at other anthropometric, metabolic and functional factors able to predict the long-term survival should be welcomed in patients with other diseases, such as pul- monary fibrosis, similarly leading to chronic respiratory failure.

2012 - Effectiveness of AFO orthoses in children affected by cerebral palsy: Clinical evaluation does not always define patient satisfaction [Abstract in Rivista]
Ferrari, Adriano; Neviani, R.; Borghi, C; Costi, Stefania
abstract

Orthoses represent one of the tools most frequently used for the rehabilitation course of children affected by cerebral palsy (CP). A number of studies tried to evaluate the effectiveness of orthoses [1]. At present time no homogeneous results were found, both for what concerns their impact on the motor performance, and, mainly, for what concerns their effect in the fields of activities and participation [2]. These fields are still now very slightly explored. As indicated by [2], it is therefore necessary to deeper explore these issues in order to improve the rehabilitation care.

2012 - INTER-LABORATORY REPEATABILITY OF GAIT ANALYSIS MEASUREMENTS. [Abstract in Rivista]
Benedetti, MARIA GRAZIA; Merlo, Andrea; Baccini, M.; Costi, Stefania; Campanini, I.; Cutti, G. A.; Mazzoli, D.; Manca, M.; Leardini, A.
abstract

Sharing data among motion analysis laboratories is a top priority in gait analysis research [1], but it can result in a large number of inconsistencies. Repeatability of the typical gait analysis measurements has been assessed over subjects, examiners, sessions, protocols, but rarely over laboratories [2]. Our purpose is to explore the consistency of routine gait analyses on a single healthy subject once performed in different clinical laboratories.

2011 - Broncopneumopatia cronica ostruttiva [Capitolo/Saggio]
Paci, Matteo; Baccini, Marco; Bernabei, Roberto; Marchionni, Niccolò; Costi, Stefania
abstract

La BPCO è una patologia progressivamente invalidante che frequentemente obbliga l’anziano ad abbandonare anche le più elementari attività della vita quotidiana, con elevati costi di gestione della patologia, sia diretti (diagnostici, farmacologici, riabilitativi) che indiretti (adattamenti dell’ambiente di vita, assistenza al domicilio, mortalità prematura). Per queste ragioni l’intervento riabilitativo è riconosciuto quale cardine del trattamento di questa patologia.

2011 - Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment. [Articolo su rivista]
Benedetti, Mg; D'Apote, G; Faccioli, S; Costi, Stefania; Ferrari, Adriano
abstract

BACKGROUND: Excessive ankle plantar flexion (equinus foot) is a common problem in cerebral palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment.AIM: This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through gait analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective.DESIGN: Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type.SETTING: OutpatientsPOPULATION: Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months).METHODS: Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics and EMG of affected lower limbs.RESULTS: Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss' Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment.CONCLUSION: Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. CLINICAL REHABILITATION IMPACT: Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.

2011 - Functional recovery following physical training in tracheotomised and chronically ventilated patients. An observational prospective cohort study. [Articolo su rivista]
Clini, Enrico; Crisafulli, E; Degli Antoni, F; Beneventi, C; Costi, Stefania; Fabbri, Leonardo; Nava, S.
abstract

Background: Rehabilitation is a non-pharmacological therapy able to restore health status and reversing the patient’s disability. Since the efficacy of this treatment in critically ill patients is not enough documented, the present study aimed to assess whether the degree of change in individual’s functional status after comprehensive rehabilitation may influences the in-hospital clinical outcomes in a population of long-term ventilated patients.Methods: In a prospective cohort study we observed 77 tracheotomized patients (aged 75±7 yrs) admitted for difficult weaning in a regional weaning centre (RICU). Care plan including peripheral muscle training was delivered on a daily basis. Demographic, anthropometric and functional characteristics were measured at admission in all patients. Pre-to-post change in basic activity of daily living score (Δ-BADL), survival and weaning success rate were recorded as clinical outcomes. Pearson’s correlation analysis and a linear regression model with Δ-BADL as the dependent variable were performed to test the predictive power of any measurement taken at baseline.Results: Sixty-seven patients (87%) survived whereas 55 of them (74%) succeded weaning during stay in RICU. Δ-BADL was +2.53 point (SD 2.03, median 2). Performance of the broadest muscle of back (BMB) at baseline predicted Δ-BADL (β 0.388, 95% CI 0.111-1,664, p=0.026). Probability to remain ventilator-free (p=0.043) and to survive (p=0.001) differed across the categories of Δ-BADL (0=no change, 1-2=least improvement, and >2=improvement above median change). Conclusions: Mortality rate and weaning success vary according to the degree of change in basic activities following active training in tracheotomised, ventilated and difficult-to-wean patients. Broadest muscle of back performance was the only significant predictor of change in these activities.

2011 - Progettare per moduli interdisciplinari e interprofessionali [Articolo su rivista]
Lotti, A.; Costi, S.
abstract

2011 - Protocollo di osservazione-imitazione per il recupero dell’arto plegico. Considerazioni sulle prime esperienze. [Articolo su rivista]
Bossi, G; Beccani, L; Costi, Stefania; Filippi, Mc
abstract

Protocollo di osservazione-imitazione per il recupero dell’arto plegico. Considerazioni sulle prime esperienze.

2010 - Detection of the Centre of Pressure for the Double-Contact Problem between Feet and Platform in Gait Analysis [Capitolo/Saggio]
Cocconcelli, Marco; Rubini, Riccardo; Ferrari, A.; Costi, Stefania
abstract

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2010 - Outcome evaluation of surgery treatment by means of gait analysis in children with cerebral palsy: the normality pattern is not an effective term of comparison [Abstract in Atti di Convegno]
Neviani, R.; Costi, Stefania; Borghi, C.; Ferrari, Adriano; Faccioli, S.; Ferrari, A.
abstract

INTRODUCTION: Among the treatments available for the rehabilitation of the alterations of walking in children affected by Cerebral Palsy (CP), multilevel surgery is one of the most effective and used solutions despite its irreversible nature. Increasingly literature provides evidences of the large benefits afforded by Gait Analysis (GA) in the process of surgery decision making and in the choice of the most appropriate surgery tecnique [1]. However, besides the diagnostic process, GA can be used in order to measure accurately and effectively the outcome of the treatment [1]. The aim of the present study is to demonstrate how deviations in the kinematic pattern of walking provoked by a surgery treatment can determine i) an improvement in the motor performance and ii) an increase in the autonomy level in action, also when they vary in the opposite direction with respect to the normal pattern.METHODS: 15 dipelgic children with purely spastic forms of CP (age range 7 – 17 years) classified in one of the four forms of diplegia proposed by [2] and addressed by a clinical examination to undergo a functional surgery treatment on the lower limbs, participated in the study. The aim of the surgery treatment was to improve the motor performance and the autonomy level in walking. The treatments adopdet included tendon and muscolar lengthenings, and interventions of skeleton correction. The motor performance exhibited by the subjects was measured both by means of the Gross Motor Function Measure 88 (GMFM) by using merely the dimension D and E [3], and of GA, the day before (session PRE) and after six months (session POST) the surgery intervention. The kinematic of at least three gait cycles for each limb was acquired through the protocol Total3DGait [4] by means of an 8 cameras Vicon MX+ system (Vicon Motion System, UK). The 9 kinematic variables relative to the sagittal, frontal and transverse plane rotations of the hip, knee and ankle and the 4 relative to the rotations on the sagittal and frontal plane of the segments pelvis and trunk obtained during the PRE and POST sessions were compared with respect to the normality bands [4]. In particular, for each of the 13 kinematic variables considered, set of 3 mean waveforms were computed from the gait cycles acquired in the two sessions PRE and POST and from the normality bands. For each subject, the approach of the 13 mean waveforms of the POST session towards the normality, with respect to the ones of the session PRE, was computed in terms of offset (Off) and Range of Movement (ROM). In particular, positive values of Off and ROM indicate an approach of the POST mean waveforms to the normal ones in the absolute and range terms. RESULTS: The GMFM values obtained were positive in 13 cases over 15, with a percentage mean value of 3.4 and a standard deviation of 6.1. The following table reports the mean and the standard deviation values relative to Off and ROM obtained from the 13 kinematics variable considered for each of the 15 subjects enrolled. p1p2p3p4p5p6p7p8p9p10p11p12p13p14p15ROMmean-0.3-1.60.4-0.70.22.11.3-0.5-0.31.8-0.50.8-0.91.50.2sd3.36.64.09.04.25.76.12.56.43.73.65.54.62.74.3Offmean0.3-2.00.20.9-0.33.3-0.60.53.23.72.6-0.11.11.4-0.2sd5.85.16.44.95.98.25.53.08.414.96.95.47.66.24.1Table 1: mean and standard deviations (sd) values obtained for Off and ROM over the 13 kinematics variables considered for the 15 subjects (p1 – p15).DISCUSSION: The GMFM data obtained revealed an improvement in the autonomy level in action in 13 cases over 15. On the contrary, the elevated values of the standard deviations together with mean values close to 0 of Off and ROM parameters, demonstrate that the kinematic waveforms obtained in the POST session did not approach the normality pattern homogeneously among the different joints of a single subject. Therefore, the comparison of the GA data with respect to the normality bands was not effective in the asses

2010 - Proposta di esame PiTrAv per valutare le competenze professionalizzanti nel CL in Fisioterapia: la prospettiva di studenti e tutor clinici. [Abstract in Rivista]
Costi, Stefania; Sandra Bassi, Pt; Maria Pia Padalino, Pt; Luisa Montanari, Pt; Elena Ferrari, Pt; Marco Altimani, Ptstudent; Ferrari, Adriano
abstract

Nel CL in Fisioterapia (CLF) l’esame di tirocinio del III anno deve garantire la competenza professionale.[1] Presso il CLF del nostro Ateneo applichiamo una modalità di esame finale di tirocinio definita PiTrAv. L’acronimo sintetizza le sue tre fasi: Pianificazione, Trattamento, AutoValutazione. Esso valuta l’abilità di risoluzione di un problema clinico e le abilità gestuali e relazionali che gli studenti adottano per risolvere efficacemente un problema in situazione reale. L’indagine qualitativa ha lo scopo di evidenziare le opinioni dei tutor clinici e degli studenti partecipanti all’esame per verificarne la validità “di facciata” in qualità di esame abilitante alla professione fisioterapista. MATERIALI E METODISono stati auto-somministrati dei questionari individuali, anonimi, a risposta aperta breve rivolti agli studenti e ai tutor clinici-valutatori nell’esame PiTrAV. La somministrazione è avvenuta prima della comunicazione agli studenti del voto ottenuto. Le risposte ai questionari sono state analizzate da due fisioterapisti indipendenti, ricorrendo ad un terzo parere in caso di disaccordo. RISULTATIStudenti: PiTrAv è stato giudicato completo e globale, facendo emergere competenze professionali di ragionamento clinico e presa in carico del paziente e rendendo evidenti le competenze mancanti. Le criticità sollevate riguardano l’elevato stress percepito e la emotività vissuta nella situazione. I tempi di esame sono stati giudicati da molti studenti inadeguati per esprimere pienamente le competenze professionali e le abilità di ragionamento clinico. Tutor clinici: PiTrAv è stato giudicato in grado di far emergere competenze professionalizzanti di presa in carico, di ragionamento clinico e relazionali. Le criticità evidenziate riguardano la mancanza di un livello accettabile di performance oggettivo, univoco e condiviso, la durata complessiva dell’esame e l’ingente impegno organizzativo. CONCLUSIONIPiTrAV sembra essere un valido strumento per certificare l’acquisizione di abilità professionalizzanti degli studenti fisioterapisti. Esso misura l’abilità di integrazione delle conoscenze teoriche e tecnico-comportamentali, finalizzata a risolvere problemi attraverso il ragionamento clinico.

2010 - THE ROLE OF GAIT ANALYSIS IN ESTABLISHING THE FUNCTIONAL SURGERY PROGRAM IN DIPLEGIC CP CHILDREN. [Abstract in Rivista]
Faccioli, S; Reverberi, S; Neviani, Rita; Costi, Stefania; Benedetti, MARIA GRAZIA; Giannini, S; Ferrari, Adriano
abstract

Orthoses represent one of the tools most frequently used for the rehabilitation course of children affected by cerebral palsy (CP). A number of studies tried to evaluate the effectiveness of orthoses [1]. At present time no homogeneous results were found, both for what concerns their impact on the motor performance, and, mainly, for what concerns their effect in the fields of activities and participation [2]. These fields are still now very slightly explored. As indicated by [2], it is therefore necessary to deeper explore these issues in order to improve the rehabilitation care. This study aims at verifying the effectiveness of the orthoses on motor performance, with relation to gross motor abilities and patient satisfaction.

2009 - Effectiveness of an at-work exercise program in the prevention and management of neck and low back complaints in nursery school teachers [Articolo su rivista]
Pillastrini, Paolo; Mugnai, Raffaele; Bertozzi, Lucia; Costi, Stefania; Curti, Stefania; Mattioli, Stefano; Violante, Francesco Saverio
abstract

The aim of the study was to determine the effectiveness of an extension-oriented exercise program in the prevention and management of low back/neck pain in nursery school teachers. A Cluster Randomized Controlled Trial was utilized. Seventy-one nursery school teachers working in nine school buildings were randomly divided into two groups, with each school as a unit of randomization. All the teachers in both groups received an ergonomic brochure; teachers in the experimental group also received an extension-oriented exercise program, conducted by a physical therapist. Data were collected at baseline and at a two-month follow-up. The primary outcome measure recorded was the level of disability (Roland Morris Disability Questionnaire and Oswestry Disability Index), while secondary outcome measure included the evaluation of cervical and lumbar physical discomfort (Visual Analogue Scale). At follow-up, a significant improvement was registered in the experimental group as compared to the control group for all the outcomes evaluated. In conclusion an extension-oriented exercise program may be a useful strategy to prevent low back and neck complaints and to reduce consequent LBP functional disability among nursery school teachers.

2009 - Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: A 3 year cross-over trial [Articolo su rivista]
Pillastrini, Paolo; Mugnai, Raffaele; Bertozzi, Lucia; Costi, Stefania; Curti, Stefania; Guccione, Andrew; Mattioli, Stefano; Violante, Francesco S.; Mugnai, Raffaele
abstract

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers

2009 - Effects of early inpatient rehabilitation after acute exacerbation of COPD [Articolo su rivista]
Clini, Enrico; Ernesto, Crisafulli; Costi, Stefania; Giuseppina, Rossi; Cristina, Lorenzi; Fabbri, Leonardo; Nicolino, Ambrosino
abstract

We have undertaken an observational retrospective cohort study to assess feasibility and clinical effectiveness of early rehabilitation in patients recovering from acute exacerbation of COPD (AECOPD).A cohort of 1826 inpatients (73% male, age 70±8 yrs, FEV1 50±16% pred.) admitted to a pulmonary rehabilitation (PR) program and completing at least 15 sessions were divided into categories according to their dyspnoea grade (Medical Research Council -MRC scores 2 to 5) as assessed before AECOPD. The pre-post changes in 6 minute walking distance test (6MWD), perceived end-effort dyspnoea (Borg scale), and self-reported quality of life (St George respiratory Questionnaire: SGRQ) were measured throughout. Absolute change in 6MWD (52 [95%CI 45 to 59], 65 [95%CI 60 to 70], 63 [95%CI 59 to 66], and 70 [95%CI 67 to 74] meters in MRC-2 to 5 respectively) and the percentage of patients achieving the minimal clinically important difference (MCID) of +54 m (40, 55, 57, and 61%, respectively, p=0.001) differed across MRC grades. Proportion of patients able to reach ≥350 m at the 6MWD after PR was higher in MRC 4 and 5 (18 and 22%) as compared to MRC 2 and 3 (6 and 15%). Early PR in a cohort of AECOPD patients is feasible and it is associated to clinically meaningful improvement in exercise tolerance independent on the severity of dyspnoea. The proportion of patients reaching the limit of ≥350 m after this intervention is higher in the most severe patients.

2009 - Effects of unsupported upper extremity training in patients with chronic airway obstruction: a randomized clinical trial. [Articolo su rivista]
Costi, Stefania; Ernesto, Crisafulli; Francesca Degli, Antoni; Claudio, Beneventi; Fabbri, Leonardo; Clini, Enrico
abstract

Introduction: Recent guidelines on pulmonary rehabilitation (PR) recommend upper extremity exercise training (UEET) in patients with chronic obstructive pulmonary disease (COPD). However, literature still questions the effectiveness of systematic UEET in this population.Objective: We aimed to verify the effects of unsupported UEET on functional exercise capacity, ability to perform activities of daily living (ADL) and symptoms perceived during activities involving upper extremity in COPD patients.Methods: We conducted a randomized trial comparing the effects of unsupported UEET plus PR (Intervention) to those of PR alone (Control). Change in 6-minute ring test (6MRT) was the primary outcome; ADL field test (4 shuttle stations), dyspnea score as assessed by Medical Research Council (MRC) scale, London Chest Activity of Daily Living scale (LCADL), and 6-minute walked distance (6MWT) served as secondary outcomes of the study . Results: Fifty COPD patients were consecutively randomized into the two groups and completed the study. At the end of rehabilitation period, 6MRT specifically improved in Intervention (p<0.001) but not in Control group; number of rings moved at 6MRT, shuttles completed at the ADL field test, 6MWT and MRC significantly and greatly changed (p<0.01) in Intervention as compared with Control group. At 6-month follow-up, rings moved at 6MRT (p=0.039) and LCADL (p=0.001) were still significantly better in Intervention as compared with Control group.Conclusion: Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of COPD patients. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients’ autonomy over and above standard PR.

2009 - ORTESI MODULARE ASTRAGALO CALCANEARE (OMAC): STUDY OF ITS EFFICACY IN THE CORRECTION OF THE VALGUS-PRONATUS FOOT IN CHILDREN WITH CEREBRAL PALSY.  Gait & Posture 30 · October 2009  [Abstract in Rivista]
Ferrari, Adriano; Costi, Stefania; Flori, G; Neviani, Rita; Raggi, M; Cutti, A.
abstract

Ankle Foot Orthoses (AFOs) are frequently prescribed for ambulatory children with Cerebral Palsy (CP) to improve their walking pattern. In particular, AFOs are currently indicated to prevent and correct the equinus-valgus-pronatus foot deformity. However, several studies indicated that walking with AFOs impairs the second and the third rocker [1]. A new model of orthosis, named the “Ortesi Modulare Astragalo Calcaneare” (OMAC, fig 1), has been recently proposed and patented. This orthosis was designed to overcome the AFOs limitations, that is preventing the equinus-valgus-pronatus foot but preserving the second and third rocker. The purpose of this study was to assess the efficacy and the compliance of the use of the OMAC with respect the AFO in children with CP.

2009 - Ortesi modulare astragalo calcaneare (OMAC): Study of its efficacy in the correction of the valgus-pronatus foot in children with cerebral palsy [Relazione in Atti di Convegno]
Ferrari, Alberto; Costi, Stefania; Ferrari, Adriano; Flori, Gessica; Neviani, Rita; Raggi, Michele; Cutti, Andrea
abstract

2009 - Short-Term Efficacy of Upper-Extremity Exercise Training in Patients With Chronic Airway Obstruction: A Systematic Review. [Articolo su rivista]
Costi, Stefania; M., Di Bari; P., Pillastrini; D'Amico, Roberto; E., Crisafulli; C., Arletti; Fabbri, Leonardo; Clini, Enrico
abstract

Background, Objectives, and Measurements Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by accessory muscles of ventilation, which competitively participate in arm elevation. This systematic review of randomized controlled trials (RCTs) concerning patients with CAO addresses the effects of upper-extremity exercise training (UEET), added to lower-extremity training or comprehensive pulmonary rehabilitation, on the following patient-centered outcomes: exercise capacity, symptoms, ability to perform daily activities, and health-related quality of life. METHODS:/b> Studies were retrieved using comprehensive database and hand-search strategies. Two independent reviewers determined study eligibility based on inclusion criteria. A detailed description of treatments was mandatory. Reviewers rated study quality and extracted information on study methods, design, intervention, and results. RESULTS: /b> Forty publications were evaluated. Four RCTs met the inclusion criteria but had serious methodological limitations, which introduce possible biases that reduce their internal validity. The outcomes measured were heterogeneous, and the results were inconsistent regarding maximal exercise capacity, dyspnea, and health-related quality of life. No effect of UEET was demonstrated for measures of arm fatigue. Limitations and CONCLUSIONS:/b> The limited methodological quality of the studies retrieved prevented us from performing a meta-analysis, the results of which could be misleading. This systematic review shows that there is limited evidence examining UEET and that the evidence available is of poor quality. Therefore, a recommendation for the inclusion or exclusion of UEET in pulmonary rehabilitation programs for individuals with CAO is not possible. Further research is needed to definitively ascertain the effects of this training modality on patient-centered outcomes.

2008 - Commencing rehabilitation in the ICU. [Articolo su rivista]
Clini, Enrico; F., Degli Antoni; Costi, Stefania; L., Trianni
abstract

Rehabilitation is an integral part of the management of patients inIntensive Care Units (ICUs).The most important aim in this area isto enhance the patient's overall functional capacity and to restorehis/her respiratory and physical independence, thus decreasing the risks of bed-rest and associated complications.The evidence for applying a weaning protocol and physiotherapytechniques (postures, percussion/vibration, limb exercise, and active mobilization) in these patients has proved to be effective according to the application rationale of each process. However, todate, there are only strong recommendations concerning the evidence-based strategies to speed weaning from mechanical ventilation.Early physiotherapy may be effective in the ICU: nonetheless,most techniques need to be further studied in a wider population.In particular, evidence supporting physiotherapy interventionsis limited as there are no studies examining the specific effectsof interventions on long-term outcomes.

2008 - Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation [Articolo su rivista]
Crisafulli, E; Costi, Stefania; Luppi, Fabrizio; Cirelli, G; Cilione, C; Coletti, O; Fabbri, Leonardo; Clini, Enrico
abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is often associated with other chronic diseases. These patients are often admitted to hospital based rehabilitation programmes. OBJECTIVES: To determine the prevalence of chronic comorbidities in patients with COPD undergoing pulmonary rehabilitation and to assess their influence on outcome. DESIGN: Observational retrospective cohort study. SETTING: A single rehabilitation centre. PATIENTS: 2962 inpatients and outpatients with COPD (73\% male, aged 71 (SD 8) years, forced expiratory volume in 1 s (FEV(1)) 49.3 (SD 14.8)\% of predicted), graded 0, 1 or >/=2 according to the comorbidity categories and included in a pulmonary rehabilitation programme. Measurements: The authors analysed the number of self-reported comorbidities and recorded the Charlson Index. They then calculated the percentage of patients with a predefined positive response to pulmonary rehabilitation (minimum clinically important difference (MCID)), as measured by improvement in exercise tolerance (6 min walking distance test (6MWD)), dyspnoea (Medical Research Council scale) and/or health related quality of life (St George's Respiratory Questionnaire (SGRQ)). RESULTS: 51\% of the patients reported at least one chronic comorbidity added to COPD. Metabolic (systemic hypertension, diabetes and/or dyslipidaemia) and heart diseases (chronic heart failure and/or coronary heart disease) were the most frequently reported comorbid combinations (61\% and 24\%, respectively) among the overall diseases associated with COPD. The prevalence of patients with MCID was different across the comorbidity categories and outcomes. In a multiple categorical logistic regression model, the Charlson Index (OR 0.72 (96\% CI 0.54 to 0.98) and 0.51 (96\% CI 0.38 to 0.68) vs 6MWD and SGRQ, respectively), metabolic diseases (OR 0.57 (96\% CI 0.49 to 0.67) vs 6MWD) and heart diseases (OR 0.67 (96\% CI 0.55 to 0.83) vs SGRQ) reduced the probability to improve outcomes of rehabilitation. CONCLUSIONS: Most patients with COPD undergoing pulmonary rehabilitation have one or more comorbidities. Despite the fact that the presence of comorbidities does not preclude access to rehabilitation, the improvement in exercise tolerance and quality of life after rehabilitation may be reduced depending on the comorbidity.

2007 - Effectiveness of erdosteine in elderly patients with bronchiectasis and hypersecretion: A 15-day, prospective, parallel, open-label, pilot study [Articolo su rivista]
Ernesto, Crisafulli; Orietta, Coletti; Costi, Stefania; Emanuela, Zanasi; Cristina, Lorenzi; Sasa, Lucic; Fabbri, Leonardo; Marco, Bertini; Clini, Enrico
abstract

BACKGROUND: Mucus plugging and hypersecretion have been associated with an increased relative risk of death in patients with bronchiectasis who may or may not have chronic obstructive pulmonary disease (COPD), which is of prognostic relevance in the elderly. However, chest physiotherapy and/or the use of mucoactive agents is considered to be an effective therapeutic model in treating patients with COPD and bronchiectasis. OBJECTIVE: The objective of this study was to test the effectiveness of oral erdosteine in treating elderly patients with bronchiectasis and chronic mucus hypersecretion who have been referred to a pulmonary rehabilitation program. METHODS: In this 15-day, prospective, parallel, open label, pilot study, elderly patients with bronchiectasis, hypersecretion, a noncurrent smoking status, who had been consecutively enrolled at Ospedale Villa Pineta's Pulmonary Rehabilitation Center, Pavullo-Modena, Italy, were randomized into 2 treatment groups. Group 1 consisted of those patients receiving PO erdosteine 225 mg BID and chest physiotherapy; group 2 comprised those patients receiving chest physiotherapy alone. Forced lung volumes, arterial blood gases, respiratory muscle strength, walking capacity (as measured by 6-minute walking test [6MWT]), and visual analog scale (VAS) symptoms (cough and dyspnea) were recorded at enrollment and at the conclusion of the study. Mucus density (MD), mucus purulence (MP), and mucus volume produced (MVP) were assessed using a 3-point scale (0 = best or low; 1 = moderate; and 2 = worst or high) at baseline and at 5-day time points during the study period. All measurements were assessed by personnel blinded and not directly associated with the study administration. RESULTS: Thirty patients (21 [70%] male and 9 [30%] female; mean [SD] age, 71 [11] years; and mean [SD] weight, 66 [3] kg) were enrolled. Characteristics were similar in the 2 groups at baseline. At day 15, significant improvements were observed in 6MWT, VAS cough, and VAS dyspnea (P < 0.01) in both groups. However, a significant improvement in forced expiratory volume in 1 second and forced vital capacity (in milliliters) was observed only in group i (0.2 [0.3]; P < 0.05). At day 15, improvement was observed in mean (SD) in MD, MP, and MVP scores for both groups. Significant changes, however, were observed in all 3 measurements in group 1 (-0.80 [0.22], -0.71 [0.51], and 1.01 [0.39], respectively), whereas a significant improvement was observed only in MD (-0.55 [0.44]) and MVP (0.45 [0.62]) in group 2. The improvement in MVP observed in group 1 was significantly better than that observed in group 2 (P < 0.05). CONCLUSION: This pilot study found that a regimen of PO erdosteine 225 mg BID in addition to routine chest physiotherapy provided some physiologic and clinical benefits in the treatment of these elderly patients with bronchiectasis and chronic mucus hyper-secretion.

2007 - Effects of a walking aid in COPD patients receiving oxygen therapy [Articolo su rivista]
E., Crisafulli; Costi, Stefania; F., DE BLASIO; G., Biscione; F., Americi; S., Penza; E., Eutropio; F., Pasqua; Fabbri, Leonardo; Clini, Enrico
abstract

STUDY OBJECTIVES: To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister. DESIGN: Randomized crossover trial. SETTING: Physiopathology laboratory of three rehabilitation centers. PATIENTS AND INTERVENTIONS: We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality). MEASUREMENTS AND RESULTS: The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline. CONCLUSIONS: This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.

2007 - Respiratory muscles training in COPD patients [Articolo su rivista]
Ernesto, Crisafulli; Costi, Stefania; Fabbri, Leonardo; Clini, Enrico
abstract

It is known that respiratory muscles undergo adaptation in response to overload stimuli during exercise training in stable COPD patients, thus resulting in significant increase of respiratory muscle function as well as the individual's improvements. The present article reviews the most updated evidence with regard to the use of respiratory muscle training (RMT) methods in COPD patients. Basically, three types of RMT (resistive training, pressure threshold loading, and normocapnic hyperpnea) have been reported. Frequency, duration, and intensity of exercise must be carefully considered for a training effect. In contrast with the plentitude of existing data inherent to inspiratory muscle training (IMT), literature is still lacking in showing clinical and physiological studies related to expiratory muscle training (EMT). In particular, while it seems that IMT is slightly superior to EMT in providing additional benefits other than respiratory muscle function such as a reduction in dyspnea, both the effects and the safety of EMT is still to be definitively elucidated in patients with COPD.

2006 - Capitolo 14 "Valutazione delle attività della vita quotidiana" [Capitolo/Saggio]
Costi, Stefania; Cristina Lorenzi, Maria; Clini, Enrico
abstract

2006 - Inspiratory muscle training: a way to breathe more easily [Articolo su rivista]
Clini, Enrico; Costi, Stefania
abstract

nd

2006 - Perspectives that influence action plans for chronic obstructive pulmonary disease [Articolo su rivista]
Costi, Stefania; Brooks, D; Goldstein, R. S.
abstract

Prompt treatment of acute exacerbations (AEs) in chronic obstructive pulmonary disease (COPD) improves quality of life and reduces the use of health care resources. Although patient self-management through an individualized action plan (AP) can help with early initiation of therapy, its use is critically dependent on the patient recognizing the features of an exacerbation.

2006 - Repeated pulmonary rehabilitation in severe and disabled COPD patients [Articolo su rivista]
Micaela, Romagnoli; Daniela, Dell'Orso; Cristina, Lorenzi; Ernesto, Crisafulli; Costi, Stefania; Daniela, Lugli; Clini, Enrico
abstract

BACKGROUND: The optimal frequency of delivering a pulmonary rehabilitation program (PR) is not yet a well established issue. It is still unclear whether repeated PR at established intervals will result in effective maintenance or further improvement in the patient's health status. OBJECTIVES: To investigate whether more frequently repeated PR in patients with COPD (1) leads to similar short and long-term physiological gains, and (2) decreases the burden due to hospitalization. METHODS: Thirty-five disabled COPD patients (FEV(1) below 50\% predicted, MRC score 3) in a stable state were studied in a randomized controlled trial. After completing an initial inpatient PR program, they were randomly assigned to either group 1 (performing a second and a third PR after 6 and 12 months) or group 2 (performing only a second PR after 12 months). RESULTS: Lung functions, exercise capacity (by means of a timed walk test - 6MWT), peak-effort dyspnea (D) and leg fatigue (F), and health-related quality of life by means of SGRQ were assessed prior to (T1, T3, T5) and after (T2, T4, T6) each PR program: the same measures were taken on an outpatient basis at T3 in group 2. The number of hospital admissions (HA) and days spent in the hospital (DH) were also recorded over the year. The two groups did not differ in any parameter at baseline. 6MWD, D, F and SGRQ improved to the same level (p = 0.05) after each PR in both groups. However, the baseline level of D, F and SGRQ symptoms and impact scores progressively improved over time in group 1 but not in group 2. After 12 months, a larger amount of patients in Group 1, as compared to Group 2, reported H10 DH/year (p < 0.0001). CONCLUSIONS: In severe and disabled COPD, a more frequently repeated inpatient PR may lead to some additional physiological and clinical benefits over 1 year.

2006 - Update in pulmonary rehabilitation. [Articolo su rivista]
Costi, Stefania; Crisafulli, E; FABBRI L., M; Clini, Enrico
abstract

nd

2005 - Il core curriculum del Fisioterapista. Scienza Riabilitativa. [Articolo su rivista]
Costi, Stefania
abstract

Viene presentato il core curriculum del Fisioterapista

2004 - Rehabilitation of COPD patients: which training modality? [Articolo su rivista]
Clini, Enrico; Costi, Stefania; M., Romagnoli; F., Florini
abstract

Non pharmacological therapy has been gaining more interest and has been evolving rapidly over the last decade as an essential part of therapy for COPD patients. Pulmonary Rehabilitation (PR), the most important non pharmacological treatment in patients with COPD, has a primary goal: to achieve the highest possible level of individual exercise tolerance, thus reducing the primary and/or secondary health care utilisation. The aim of the present review is to focus the role of exercise training in these patients as well as to address the question on which training methods are the most beneficial. We have therefore undertaken a MEDLINE-based search including the terms: pulmonary rehabilitation, exercise, lung disease/obstructive. Several strategies based on endurance or strength training are nowadays implemented during PR programmes in order to maximise the benefits for each patient. The impaired function of ambulation muscles causing breathlessness as one of the more frequent symptoms in many COPD, suggests that training the lower extremities is the most important goal to achieve during pulmonary rehabilitation of these patients. On the other hand, as muscle strength appears to be an independent contributor to survival and utilisation of health care resources, it seems largely justified also to include this further modality in the PR program of these patients. In conclusion, both modalities are effective and useful for COPD patients. However, whether resistance training should be administered to all COPD and which is the optimal length of strength training still needs to be elucidated.

2003 - Classe di laurea 2: Professioni sanitarie riabilitative. Corso di Laurea in Fisioterapia [Capitolo/Saggio]
Bertozzi, Lucia; Pillastrini, Paolo; Costi, Stefania; Bielli, Silvia
abstract

2003 - Linee guida per la formazione del fisioterapista [Capitolo/Saggio]
Avallone, V; Bertozzi, L; Bozzolan, M; Caruso, P; Costi, Stefania; Ferrari, Mg; Marcovich, R; Robutti, R; Vinciguerra, Smg
abstract

Il volume descrive le linee guida per la formazione del Fisioterapista

2003 - Non-pharmacological treatment for chronic obstructive pulmonary disease. [Articolo su rivista]
Clini, Enrico; Costi, Stefania; Silvano, Lodi; Giuseppina, Rossi
abstract

Evidence-based guidelines on treatment of patients with Chronic Obstructive Pulmonary Disease (COPD) have recently been developed. Non-pharmacological therapy of COPD has been receiving more interest and has been evolving rapidly in the last decade as an essential part of COPD treatment. In fact, non-pharmacological treatment is a complementary approach mainly in the advanced stages of COPD. Most of these care options appear to benefit patients in terms of quality of life and cost-effectiveness. The aim of the present review is to survey the most important non-pharmacological treatments for COPD (smoking cessation, rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation, and surgery) and their usefulness based on the currently available evidence. This review is based on an evaluation of the literature using a multimethod approach. A computerized MEDLINE search from 1966 through June 2003 was undertaken using the search terms pulmonary rehabilitation, surgery, smoking cessation, respiratory insufficiency/failure, and lung disease/obstructive. Non pharmacological treatment of COPD is a real option to successfully treat these patients and prevent further deterioration. All the included therapies are based on actual scientific evidence for patient benefits. To date, smoking cessation, comprehensive rehabilitation and long-term oxygen therapy are widely accepted as therapies which may positively impact the long-term management of COPD patients.