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Mazzeo S, Pancani S, Sodero A, Castagnoli C, Politi AM, Barnabè M, Ciullini F, Baccini M, Grippo A, Hakiki B, Macchi C, Cecchi F. Depressive Symptoms Moderate the Association Between Functional Level at Admission to Intensive Post-Stroke Rehabilitation and Effectiveness of the Intervention. J Geriatr Psychiatry Neurol 2024; 37:222-233. [PMID: 37828783 DOI: 10.1177/08919887231204543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Previous studies showed that depression acts as an independent factor in functional recovery after stroke. In a prospective cohort of patients admitted to intensive inpatient rehabilitation after a stroke, we aimed to test depression as a moderator of the relationship between the functional level at admission and the effectiveness of rehabilitation at discharge. METHODS All patients admitted to within 30 days from an ischemic or hemorrhagic stroke to 4 intensive rehabilitation units were prospectively screened for eligibility to a multicenter prospective observational study. Enrolled patients underwent an evidence-based rehabilitation pathway. We used clinical data collected at admission (T0) and discharge (T1). The outcome was the effectiveness of recovery at T1 on the modified Barthel Index (proportion of achieved over potential functional improvement). Moderation analysis was performed by using the PROCESS macro for SPSS using the bootstrapping procedure. RESULTS Of 278 evaluated patients, 234 were eligible and consented to enrolment; 81 patients were able to answer to the Hospital Anxiety and Depression Scale (HADS) and were included in this analysis. The relationship between the functional status at admission and rehabilitation effectiveness was significant only in persons with fewer depressive symptoms; depression (HADS cut-off score: 5.9) moderated this relationship (P = .047), independent from age and neurological impairment. CONCLUSIONS Our results suggest that depression moderates between the functional status at admission and the functional recovery after post-stroke rehabilitation. This approach facilitates the identification of subgroups of individuals who may respond differently to stroke rehabilitation based on depression.
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Affiliation(s)
- Salvatore Mazzeo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | | | | | - Monica Barnabè
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Liuzzi P, Grippo A, Sodero A, Castagnoli C, Pellegrini I, Burali R, Toci T, Barretta T, Mannini A, Hakiki B, Macchi C, Lolli F, Cecchi F. Quantitative EEG and prognosis for recovery in post-stroke patients: The effect of lesion laterality. Neurophysiol Clin 2024; 54:102952. [PMID: 38422721 DOI: 10.1016/j.neucli.2024.102952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE There is emerging confidence that quantitative EEG (qEEG) has the potential to inform clinical decision-making and guide individualized rehabilitation after stroke, but consensus on the best EEG biomarkers is needed for translation to clinical practice. This study investigates the spatial qEEG spectral and symmetry distribution in patients with a left/right hemispheric stroke, to evaluate their side-specific prognostic power in post-acute rehabilitation outcome. METHODS Resting-state 19-channel EEG recordings were collected with clinical information on admission to intensive inpatient rehabilitation (within 30 days post stroke), and six months post stroke. After preprocessing, spectral (Delta-to-Alpha Ratio, DAR) and symmetry (pairwise and hemispheric Brain Symmetry Index) features were extracted. Patients were divided into Affected Right and Left (AR/AL) groups, according to the location of their lesion. Within each group, DAR was compared between homologous electrode pairs and the pairwise difference between pairs was compared across pairs in the scalp. Then, the prognostic power of qEEG admission metrics was evaluated by performing correlations between admission metrics and discharge mBI values. RESULTS Fifty-two patients with hemorrhagic or ischemic stroke (20 females, 38.5 %, median age 76 years [IQR = 22]) were included in the study. DAR was significantly higher in the affected hemisphere for both AR and AL groups, and, a higher frontal (to posterior) asymmetry was found independent of the side of the lesion. DAR was found to be a prognostic marker of 6-months modified Barthel Index (mBI) only for the AL group, while hemispheric asymmetry did not correlate with follow-up outcomes in either group. DISCUSSION While the presence of EEG abnormalities in the affected hemisphere of a stroke is well recognized, we have shown that the extent of DAR abnormalities seen correlates with disability at 6 months post stroke, but only for left hemispheric lesions. Routine prognostic evaluation, in addition to motor and functional scales, can add information concerning neuro-prognostication and reveal neurophysiological abnormalities to be assessed during rehabilitation.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Scuola Superiore Sant'Anna, Istituto di BioRobotica, Viale Rinaldo Piaggio 34, Pontedera, Italy.
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Chiara Castagnoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Ilaria Pellegrini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Rachele Burali
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Tanita Toci
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Teresa Barretta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Università di Firenze, Dipartimento di Medicina Sperimentale e Clinica, Largo Brambilla 3, Firenze, Italy
| | - Francesco Lolli
- Università degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Viale Morgagni 50, Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Di Scandicci 269, Firenze, Italy; Università degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Viale Morgagni 50, Firenze, Italy
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3
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Pellicciari L, Basagni B, Paperini A, Campagnini S, Sodero A, Hakiki B, Castagnoli C, Politi AM, Avila L, Barilli M, Romano E, Pancani S, Mannini A, Sensoli F, Salvadori E, Poggesi A, Grippo A, Macchi C, Baccini M, Carrozza MC, Cecchi F. Trunk Control Test as a Main Predictor of the Modified Barthel Index Score at Discharge From Intensive Post-acute Stroke Rehabilitation: Results From a Multicenter Italian Study. Arch Phys Med Rehabil 2024; 105:326-334. [PMID: 37625531 DOI: 10.1016/j.apmr.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI. DESIGN Multicentric retrospective observational cohort study. SETTING Two Italian inpatient rehabilitation units. PARTICIPANTS A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes. RESULTS All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P<.001) independently predicted discharge mBI (adjusted R2=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R2 of 65.1%. On the other side, the model with the TCT only presented an R2 of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R2 increase up to 68.5%. CONCLUSIONS TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI.
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Affiliation(s)
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Lucia Avila
- Fondazione Don Carlo Gnocchi onlus, Marina di Massa, Italy
| | | | | | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Federico Sensoli
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
| | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; SOD Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Sodero A, Campagnini S, Paperini A, Castagnoli C, Hochleitner I, Politi AM, Bardi D, Basagni B, Barretta T, Guolo E, Tramonti C, Pancani S, Hakiki B, Grippo A, Mannini A, Nacmias B, Baccini M, Macchi C, Cecchi F. Predicting the functional outcome of intensive inpatient rehabilitation after stroke: results from the RIPS Study. Eur J Phys Rehabil Med 2024; 60:1-12. [PMID: 37934187 PMCID: PMC10938041 DOI: 10.23736/s1973-9087.23.07852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The complexity of stroke sequelae, the heterogeneity of outcome measures and rehabilitation pathways, and the lack of extensively validated prediction models represent a challenge in predicting stroke rehabilitation outcomes. AIM To prospectively investigate a multidimensional set of variables collected at admission to inpatient post-stroke rehabilitation as potential predictors of the functional level at discharge. DESIGN Multicentric prospective observational study. SETTING Patients were enrolled in four Intensive Rehabilitation Units (IRUs). POPULATION Patients were consecutively recruited in the period December 2019-December 2020 with the following inclusion criteria: aged 18+, with ischemic/haemorrhagic stroke, and undergoing inpatient rehabilitation within 30 days from stroke. METHODS This is a multicentric prospective observational study. The rehabilitation pathway was reproducible and evidence-based. The functional outcome was disability in activities of daily living, measured by the modified Barthel Index (mBI) at discharge. Potential multidimensional predictors, assessed at admission, included demographics, event description, clinical assessment, functional and cognitive profile, and psycho-social domains. The variables statistically associated with the outcome in the univariate analysis were fed into a multivariable model using multiple linear regression. RESULTS A total of 220 patients were included (median [IQR] age: 80 [15], 112 women, 175 ischemic). Median mBI was 26 (43) at admission and 62.5 (52) at discharge. In the multivariable analysis younger age, along with better functioning, fewer comorbidities, higher cognitive abilities, reduced stroke severity, and higher motor functions at admission, remained independently associated with higher discharge mBI. The final model allowed a reliable prediction of discharge functional outcome (adjusted R2=77.2%). CONCLUSIONS The model presented in this study, based on easily collectable, reliable admission variables, could help clinicians and researchers to predict the discharge scores of the global functional outcome for persons enrolled in an evidence-based inpatient stroke rehabilitation program. CLINICAL REHABILITATION IMPACT A reliable outcome prediction derived from standardized assessment measures and validated treatment protocols could guide clinicians in the management of patients in the subacute phase of stroke and help improve the planning of the rehabilitation individualized project.
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Affiliation(s)
- Alessandro Sodero
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Section of Neuroscience, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | - Erika Guolo
- IRCCS Don Gnocchi Foundation, Florence, Italy
| | | | | | | | | | | | - Benedetta Nacmias
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Section of Neuroscience, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Claudio Macchi
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Don Gnocchi Foundation, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Barbato C, Antonucci L, Pellicciari L, Castagnoli C, Hochleitner I, Paperini A, Pancani S, Verdesca S, Basagni B, Macchi C, Cecchi F. Italian translation and transcultural validation of an assessment tool for community ambulation in stroke survivors: the modified Functional Walking Categories (mFWC). Physiother Theory Pract 2023; 39:2706-2714. [PMID: 35775498 DOI: 10.1080/09593985.2022.2094303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Community ambulation ability is one of the most important functional loss after stroke. The assessment of the level of community walking plays an important role in the multidimensional bio-psycho-social approach, to improve quality of life and social participation of stroke survivors. The modified Functional Walking Categories (mFWC) is a worldwide widely used tool to assess community ambulation in stroke survivors, but no Italian version is yet available. OBJECTIVE To cross-culturally adapt the mFWC into Italian and to assess its validity and reliability. METHODS According to the international guidelines, a multistep translation and cultural adaptation were conducted and revised by a committee of experts. Patients admitted to intensive inpatient rehabilitation with a sub-acute stroke were recruited. Inter- and intra-rater reliability and construct validity were studied. RESULTS Sixty patients with sub-acute stroke were prospectively enrolled in this study. Findings showed almost perfect intra- and inter-rater reliability (k = 1.000 [95% CI 1.000-1.000] and k = 0.984 [95% CI 0.955-1.000], respectively). The construct validity of the scale was satisfactory, as 100.0% a-priori hypotheses were met. CONCLUSIONS The Italian mFWC offers a valid tool for measuring community ambulation in stroke patients. Our work provides a validated and a cross-cultural adapted Italian version of the mFWC to accurately measure community ambulation both in clinical and research settings in Italy.
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Affiliation(s)
- Carmen Barbato
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | - Anita Paperini
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Silvia Pancani
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Sonia Verdesca
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Claudio Macchi
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- PROMISE@LAB IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Hochleitner I, Pellicciari L, Castagnoli C, Paperini A, Politi AM, Campagnini S, Pancani S, Basagni B, Gerli F, Carrozza MC, Macchi C, Alt Murphy M, Cecchi F. Intra- and inter-rater reliability of the Italian Fugl-Meyer assessment of upper and lower extremity. Disabil Rehabil 2023; 45:2989-2999. [PMID: 36031950 DOI: 10.1080/09638288.2022.2114553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the intra- and inter-rater reliability motor and sensory functioning, balance, joint range of motion and joint pain subscales of the Italian Fugl-Meyer Assessment (FMA) Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) at the item- subtotal- and total-level in patients with sub-acute stroke. MATERIALS AND METHODS The FMA was administered to 60 patients with sub-acute stroke (mean age ± SD = 75.4 ± 10.7 years; 58.3% men) and independently rated by two physiotherapists on two consecutive days. Intra- and inter-reliability was studied by a rank-based statistical method for paired ordinal data to detect any systematic or random disagreement. RESULTS The item-level intra- and inter-rater reliability was satisfactory (>70%). Reliability level >70% was achieved at subscale and total score level when one- or two-points difference was considered. Systematic disagreements were reported for five items of the FMA-UE, but not for FMA-LE. CONCLUSIONS The Italian version of the FMA showed to be a reliable instrument that can therefore be recommended for clinical and research purposes.Implications for rehabilitationThe FMA is the gold standard for assessing stroke patients' sensorimotor impairment worldwide.The Italian Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) is substantially reliable within and between two raters at the item, subtotal, and total score level in patients with sub-acute stroke.The use of FMA in the Italian context will provide an opportunity for international comparisons and research collaborations.
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Affiliation(s)
| | | | | | | | | | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | | | | | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Pellicciari L, Sodero A, Campagnini S, Guolo E, Basagni B, Castagnoli C, Hochleitner I, Paperini A, Gnetti B, Avila L, Romano E, Grippo A, Hakiki B, Carrozza MC, Mannini A, Macchi C, Cecchi F. Factors influencing trunk control recovery after intensive rehabilitation in post-stroke patients: a multicentre prospective study. Top Stroke Rehabil 2023; 30:109-118. [PMID: 34994302 DOI: 10.1080/10749357.2021.2016099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trunk control plays a crucial role in the stroke rehabilitation, but it is unclear which factors could influence the trunk control after an intensive rehabilitation treatment. OBJECTIVES To study which demographic, clinical and functional variables could predict the recovery of trunk control after intensive post-stroke inpatient rehabilitation. METHODS Subjects with acute, first-ever stroke were enrolled and clinical and data were collected at admission and discharge. The primary outcome was considered the trunk control measured by the Trunk Control Test (TCT). The data were analyzed by a univariate and multivariate logistic regressions. RESULTS Two hundred forty-one post-stroke patients were included. All baseline variables significantly associated to TCT at discharge in the univariate analysis (i.e. gender, NIHSS neglect item at admission, presence of several complexity markers, TCT total score at admission, NIHSS total score, pre-stroke modified Rankin Scale, Fugl-Meyer Assessment motor and sensitivity score) were entered in the multivariate analysis. The multivariate regression showed that age (p = .003), admission NIHSS total score (p = .001), admission TCT total score (p < .001) and presence of depression (p = .027) independently influenced the TCT total score at discharge (R2 = 61.2%). CONCLUSIONS Age, admission neurological impairment (NIHSS total score), trunk control at the admission (TCT total score), and presence of depression independently influenced the TCT at discharge. These factors should be carefully assessed at the baseline to plan a tailoring rehabilitation treatment achieving the best trunk control performance at discharge.
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Affiliation(s)
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | - Lucia Avila
- Fondazione Don Carlo Gnocchi, Marina di Massa, Italy
| | | | - Antonello Grippo
- SOD Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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8
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Castagnoli C, Pancani S, Barretta T, Pellicciari L, Campagnini S, Basagni B, Gucci C, Sodero A, Guolo E, Hakiki B, Grippo A, Mannini A, Macchi C, Cecchi F. Correlates of participation six months after stroke in an Italian population: results from the RIPS (Post-Stroke Intensive Rehabilitation) Study. Eur J Phys Rehabil Med 2023; 59:125-135. [PMID: 36723055 PMCID: PMC10172846 DOI: 10.23736/s1973-9087.23.07639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stroke survivors report physical, cognitive, and psychological impairments, with a consequent limitation of participation. Participation is the most context-related dimension of functioning, but the literature on participation in Italian stroke patients is scant. AIM This study aimed to describe the recovery of participation six months after stroke with a validated Italian version of the Frenchay Activity Index (FAI) and to investigate potential correlates with higher participation scores. DESIGN The study is a prospective observational study. SETTING The cohort of patients was enrolled in four intensive inpatient rehabilitation units of IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy. POPULATION Adults addressing postacute intensive inpatient rehabilitation after an ischemic or hemorrhagic stroke occurred within 30 days from recruitment were prospectively enrolled. METHODS Data were collected at admission to intensive inpatient rehabilitation, and a six-month follow-up. The primary outcome was participation, measured by a validated Italian version of the FAI; only patients whose data included both anamnestic FAI and FAI at six months follow-up were included in this analysis. The data were analyzed by univariate and multivariate linear regressions. RESULTS A cohort of 105 patients (median age 78 years [interquartile range, IQR=21]; 46.7% males) with completed FAI at follow-up were included in this study. The sample reported a FAI median score of 28 (IQR=8) at admission (referred to the participation in the 3-6 months before the stroke) and 13 (IQR=20) at follow-up. All items were significantly affected, with the exception of reading and making trips. The multivariate regression for all patients with good participation before the stroke (N.=101), showed that 6 months after the stroke a higher FAI Score was independently associated with better functioning in activities of daily living (modified Barthel Index) (B=0.133; P=0.015), and absence of cognitive impairment (B=4.755; P=0.027); a lower stroke severity in the postacute phase (NIHSS B=-0.832; P=0.001) and a higher prestroke FAI Score (B=0.410; P=0.028) were also independently related to follow-up FAI Score. CONCLUSIONS In our cohort of patients addressing postacute stroke rehabilitation, prestroke participation levels were on average good, while they were severely reduced six months after stroke for all the considered items except reading and making trips. Higher FAI at follow-up was independently associated with a higher functional level and no cognitive impairment at follow-up, with lower stroke severity in the postacute phase, as well as a higher anamnestic participation score. CLINICAL REHABILITATION IMPACT Our results suggest that investigating prestroke participation may be highly relevant to predict, and possibly address, participation recovery after stroke.
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Affiliation(s)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | | | | | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy - .,Sant'Anna School of Advanced Studies, The Biorobotics Institute, Pontedera, Pisa, Italy
| | | | - Camilla Gucci
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy.,Section of Neuroscience, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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9
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Chiavilli M, Campagnini S, Baretta T, Castagnoli C, Paperini A, Politi AM, Pellicciari L, Baccini M, Basagni B, Marignani S, Bardi D, Sodero A, Lombardi G, Guolo E, Navarro JS, Galeri S, Montesano A, Falco L, Rovaris MG, Carrozza MC, Macchi C, Mannini A, Cecchi F. Design and implementation of a Stroke Rehabilitation Registry for the systematic assessment of processes and outcomes and the development of data-driven prediction models: The STRATEGY study protocol. Front Neurol 2022; 13:919353. [PMID: 36299268 PMCID: PMC9588928 DOI: 10.3389/fneur.2022.919353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Stroke represents the second preventable cause of death after cardiovascular disease and the third global cause of disability. In countries where national registries of the clinical quality of stroke care have been established, the publication and sharing of the collected data have led to an improvement in the quality of care and survival of patients. However, information on rehabilitation processes and outcomes is often lacking, and predictors of functional outcomes remain poorly explored. This paper describes a multicenter study protocol to implement a Stroke rehabilitation Registry, mainly based on a multidimensional assessment proposed by the Italian Society of Physical and Rehabilitation Medicine (PMIC2020), in a pilot Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation, to provide a systematic assessment of processes and outcomes and develop data-driven prediction models of functional outcomes. METHODS All patients with a diagnosis of ischemic or haemorrhagic stroke confirmed by clinical assessment, admitted to intensive rehabilitation units within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled. Measures will be taken at admission (T0), at discharge (T1), and at follow-up, 3 months (T2) and 6 months (T3) after the stroke. Assessment variables include anamnestic data, clinical and nursing complexity information and measures of body structures and function, activity and participation (PMIC2020), rehabilitation interventions, adverse events and discharge data. The modified Barthel Index will be our primary outcome. In addition to classical biostatistical analysis, learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. CONCLUSIONS This study will test the feasibility of a stroke rehabilitation registry in the Italian health context and provide a systematic assessment of processes and outcomes for quality assessment and benchmarking. By the development of data-driven prediction models in stroke rehabilitation, this study will pave the way for the development of decision support tools for patient-oriented therapy planning and rehabilitation outcomes maximization. CLINICAL TIAL REGISTRATION The registration on ClinicalTrials.gov is ongoing and under review. The identification number will be provided when the review process will be completed.
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Affiliation(s)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Teresa Baretta
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Donata Bardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Erika Guolo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - Lucia Falco
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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10
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Antonucci L, Barbato C, Pellicciari L, Paperini A, Hochleitner I, Castagnoli C, Verdesca S, Lucidi G, Marignani S, Pancani S, Basagni B, Macchi C, Cecchi F. Italian translation and cross-cultural validation of an assessment tool for participation in stroke survivors: the Frenchay Activities Index. Neurol Sci 2022; 43:4297-4306. [PMID: 35179673 DOI: 10.1007/s10072-022-05949-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Participation needs to be assessed objectively, to state accurate rehabilitation objectives. The Frenchay Activities Index (FAI) is a widely used tool to measure participation in stroke patients. To date, no cross-culturally validated Italian version of FAI is available. This study provides a translation and cross-cultural adaptation of FAI into Italian, assessing its validity and reliability in sub-acute stroke patients. METHODS According to international guidelines, a multistep translation and cultural adaptation protocol of forward and backward translations was conducted by qualified linguists and independent native English translators and revised by a healthcare committee. Patients admitted to intensive inpatient rehabilitation after stroke were recruited. Structural validity, reliability (internal consistency, inter- and intra-rater reliability and measurement error), and construct validity were studied. RESULTS One hundred and seventy-three patients were included in this study. No significant observations in terms of comprehensibility and conceptual equivalence of the FAI Italian version emerged. The exploratory factorial analysis revealed the presence of two subscales (i.e., domestic chores and work/leisure). The internal consistency resulted good for the first and second subscale (α = 0.821 and 0.716, respectively). Intra- and inter-reliability showed an ICC > 0.90 for both subscales. SEM = 5.75% and 2.33% and MDC = 15.85% and 6.48% were found for the first and second subscale, respectively. Construct validity of first subscale was satisfactory, as 100.0% a priori hypotheses were met, while for the second subscale it was moderate, as 66.6% a priori hypotheses were respected. CONCLUSION FAI-I provides a tool for professionals to measure participation in Italian stroke patients in health and social care settings.
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Affiliation(s)
- Laura Antonucci
- Physical and Rehabilitation Medicine, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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11
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Pancani S, Lombardi G, Sofi F, Gori AM, Boni R, Castagnoli C, Paperini A, Pasquini G, Vannetti F, Molino Lova R, Macchi C, Cecchi F. Predictors of Mortality in 433 Nonagenarians Inside the Mugello Study: A 10 Years Follow-Up Study. J Aging Health 2022; 34:1071-1080. [PMID: 35499248 DOI: 10.1177/08982643221091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to identify the predictors of mortality in a cohort of nonagenarians inside the "Mugello study" after 10 years follow-up. METHODS Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors. RESULTS The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption. DISCUSSION Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.
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Affiliation(s)
| | | | - Francesco Sofi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy.,Atherothrombotic Unit, Careggi University Hospital, Florence, Italy
| | - Roberta Boni
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | - Claudio Macchi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
| | - Francesca Cecchi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
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12
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Pancani S, Lombardi G, Sofi F, Gori AM, Boni R, Castagnoli C, Paperini A, Pasquini G, Vannetti F, Lova RM, Macchi C, Cecchi F. 12-month survival in nonagenarians inside the Mugello study: on the way to live a century. BMC Geriatr 2022; 22:194. [PMID: 35279074 PMCID: PMC8918304 DOI: 10.1186/s12877-022-02908-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”. Methods Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview. Results The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival. Conclusions Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02908-9.
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13
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Basagni B, Hakiki B, Campagnini S, Salvadori E, Grippo A, Paperini A, Castagnoli C, Hochleitner I, Politi AM, Gemignani P, Mosca IE, Franceschini A, Bonotti EB, Sodero A, Mannini A, Pellicciari L, Poggesi A, Macchi C, Carrozza MC, Cecchi F. Critical issue on the extinction and inattention subtest of NIHSS scale: an analysis on post-acute stroke patients attending inpatient rehabilitation. BMC Neurol 2021; 21:475. [PMID: 34879861 PMCID: PMC8653531 DOI: 10.1186/s12883-021-02499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aims to evaluate the diagnostic performance of NIHSS extinction and inattention item, compared to the results of the Oxford Cognitive Screen (OCS) heart subtest. Additionally, the possible role of the NIHSS visual field subtest on the NIHSS extinction and inattention subtest performance is explored and discussed. Methods We analysed scores on NIHSS extinction and inattention subtest, NIHSS visual field subtest, and OCS heart subtest on a sample of 118 post-stroke patients. Results Compared to OCS heart subtest, the results on NIHSS extinction and inattention subtest showed an accuracy of 72.9% and a moderate agreement level (Cohen’s kappa = 0.404). Furthermore, a decrease in NIHSS accuracy detecting neglect (61.1%) was observed in patients with pathological scores in NIHSS visual field item. Conclusions Extreme caution is recommended for the diagnostic performance of extinction and inattention item of NIHSS. Signs of neglect may not be detected by NIHSS, and may be confused with visual field impairment. Trial registration This study refers to an observational study protocol submitted to ClinicalTrials.gov with identifier: NCT03968627. The name of the registry is “Development of a National Protocol for Stroke Rehabilitation in a Multicenter Italian Institution” and the date of the registration is the 30th May 2019.
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Affiliation(s)
- Benedetta Basagni
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy. .,The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
| | - Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Chiara Castagnoli
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Ines Hochleitner
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Angela Maria Politi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Paola Gemignani
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Irene Eleonora Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Azzurra Franceschini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Enrico Bacci Bonotti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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14
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Cecchi F, Diverio M, Arienti C, Corbella E, Marrazzo F, Speranza G, Del Zotto E, Poggianti G, Gigliotti F, Polcaro P, Zingoni M, Antonioli D, Avila L, Barilli M, Romano E, Landucci Pellegrini L, Gambini M, Verdesca S, Bertolucci F, Mosca I, Gemignani P, Paperini A, Castagnoli C, Hochleitner I, Luisi ML, Lucidi G, Hakiki B, Gabrielli MA, Fruzzetti M, Bruzzi A, Bacci Bonotti E, Pancani S, Galeri S, Macchi C, Aprile I. Development and implementation of a stroke rehabilitation integrated care pathway in an Italian no profit institution: an observational study. Eur J Phys Rehabil Med 2021; 56:713-724. [PMID: 33494558 DOI: 10.23736/s1973-9087.20.06195-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND To standardize assessment and coordinate processes in stroke rehabilitation, an integrated care pathway (ICP) was developed in an Italian Rehabilitation and Research Institution by a knowledge-translation interdisciplinary process, from evidence-based guidelines to rehabilitation practice. The ICP was implemented in two pilot Tuscan rehabilitation Centers. AIM The purpose of this study was to describe ICP development and assess the ICP effects on postacute stroke inpatient rehabilitation outcomes. DESIGN Prospective observational study, before and after comparison. SETTING Two Tuscan inpatient rehabilitation centers. POPULATION Patients accessing either centers for intensive rehabilitation after acute stroke. METHODS Two cohorts were prospectively recruited before (2015-2017) and after (2018) implementation of the pathway. The primary outcome was change in activities of daily living disability, assessed by the modified Barthel Index (mBI) from admission to discharge. Secondary outcomes included length of stay (LOS), adverse outcomes, and changes in communication ability, trunk control, pain, ambulation, bladder catheter (Y/N), bedsores (Y/N). RESULTS In 2015-2017, 443 postacute stroke patients (mean age 77±11 years, 47% women), while in 2018, 84 patients (mean age 76±13 years, 61% women) were admitted to the two facilities. Comparing the 2018 vs. the 2015-17 cohort, the mean mBI increase was not substantially different (26 vs. 24 points), nor were LOS (37±18 vs. 36±16 days), adverse outcomes, discharge destination, and improvement of ambulation, pain, and communication (P>0.05). Instead, a significantly higher improvement of trunk control (trunk control test: 69.6±33.2 vs. 79.0±31.3, P=0.019), and a higher percentage of bedsore resolution (13% vs. 5%, P=0.033), and bladder catheter removal (37% vs. 17% P<0.001) were observed in 2018 vs. 2015-2017. CONCLUSIONS Compared to prior practice, ICP was associated to improvement of trunk control recovery, bladder catheter removal, and bedsores resolution. Further ICP implementation on a larger scale is needed to verify improvements of stroke inpatient rehabilitation outcomes. CLINICAL REHABILITATION IMPACT An evidence-based stroke rehabilitation ICP was interdisciplinary developed and implemented in two rehabilitation centers of a multicenter Italian health group. ICP implementation as to inpatient intensive postacute stroke rehabilitation was associated to improved trunk control recovery, bladder catheter removal, and bedsore resolution. Further ICP implementation will allow multicenter studies and quality benchmarking.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lucia Avila
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | - Irene Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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15
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Hakiki B, Paperini A, Castagnoli C, Hochleitner I, Verdesca S, Grippo A, Scarpino M, Maiorelli A, Mosca IE, Gemignani P, Borsotti M, Gabrielli MA, Salvadori E, Poggesi A, Lucidi G, Falsini C, Gentilini M, Martini M, Luisi MLE, Biffi B, Mainardi P, Barretta T, Pancani S, Mannini A, Campagnini S, Bagnoli S, Ingannato A, Nacmias B, Macchi C, Carrozza MC, Cecchi F. Predictors of Function, Activity, and Participation of Stroke Patients Undergoing Intensive Rehabilitation: A Multicenter Prospective Observational Study Protocol. Front Neurol 2021; 12:632672. [PMID: 33897593 PMCID: PMC8060493 DOI: 10.3389/fneur.2021.632672] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation. Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers. Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes. Clinical Trial Registration:ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Bagnoli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Assunta Ingannato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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16
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Cecchi F, Carrabba C, Bertolucci F, Castagnoli C, Falsini C, Gnetti B, Hochleitner I, Lucidi G, Martini M, Mosca IE, Pancani S, Paperini A, Verdesca S, Macchi C, Alt Murphy M. Transcultural translation and validation of Fugl–Meyer assessment to Italian. Disabil Rehabil 2020; 43:3717-3722. [DOI: 10.1080/09638288.2020.1746844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C. Carrabba
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - C. Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - B. Gnetti
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - G. Lucidi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M. Martini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - I. E. Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S. Pancani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A. Paperini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S. Verdesca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C. Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M. Alt Murphy
- Institute for Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Cecchi F, Pancani S, Molino-Lova R, Castagnoli C, Paperini A, Boni R, Gori G, Macchi C. Independent Functioning in Nonagenarians Living in a Rural Italian Community: The Mugello Study. J Appl Gerontol 2019; 39:259-268. [PMID: 31232132 DOI: 10.1177/0733464819858575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nonagenarians are a fast-growing population deserving specific research. We explored the prevalence and characteristics of functionally independent nonagenarians from a rural community-dwelling Italian population. Data were collected in the Mugello Study; 475 persons aged ≥90 years (median age, 92) underwent a home-based clinical and functional assessment, including psychosocial, clinical, functional, and lifestyle history and status and physical and instrumental examinations. Sixty-eight (15%) persons reported no need for help in basic and instrumental daily living activities. Among variables significantly associated with independent functionality after age- and gender-adjusted cross-sectional analysis, lower body mass index (BMI; p = .034) and depressive symptoms (p = .028), higher current physical activity (p < .001), better cognitive status (p = .033), and lower medication intake (p = .048) were associated with reporting no disability in the logistic regression analysis. Disability was mainly associated with current lifestyle-related potentially modifiable factors. Thus, lifestyle-oriented multidimensional interventions, should be developed and evaluated for their potential effects on functionality, even in the oldest old.
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Affiliation(s)
- F Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Pancani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - C Castagnoli
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A Paperini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - R Boni
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Gori
- Humanitas Association, Florence, Italy
| | - C Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Italy
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Cecchi F, Pancani S, Vannetti F, Boni R, Castagnoli C, Paperini A, Pasquini G, Sofi F, Molino-Lova R, Macchi C. Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study. Intern Emerg Med 2017; 12:1167-1173. [PMID: 29071662 PMCID: PMC5691100 DOI: 10.1007/s11739-017-1762-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023]
Abstract
People aged 90 and older represent a fast-growing population segment who deserve specific attention and research. Aging is associated with a progressive decrease in hemoglobin concentration, which predicts adverse outcome, such as mortality, morbidity, frailty and disability. Whether this association is independent from increased prevalence of comorbidity, causing both anemia and reduced physical function is yet under debate. The aim of this study is to explore the relationship between hemoglobin concentration and self-reported disability and reduced physical performance in a community dwelling population of nonagenarians. Data presented were collected in the framework of the Mugello Study, a clinical epidemiologic survey of nonagenarians living in the Mugello area (Tuscany, Italy). 251 persons (177 women, age 93.2 ± 3.3 years; 74 men, age 92.2 ± 2.5 years) underwent a blood draw. Along with hemoglobin concentration, self-reported disability (basic and instrumental activities of daily living), physical performance (Short Physical Performance Battery), self-reported physical activity and muscular strength (handgrip measurement) were assessed. Covariates, inherent sociodemographic and health indicators and comorbidities were also included in the analysis. This study confirms that anemia is very common in the oldest old, with a significantly higher prevalence in males (50% in men vs 24% in women). Multiple linear regression analysis, including all the comorbid conditions as confounding factors, shows that hemoglobin concentration is independently associated with handgrip strength, self-reported physical activity and disability in dressing, and taking a shower/bath. In conclusion, results from this study confirm that in the oldest old, low hemoglobin concentration is strongly associated with self-reported disability and decline of physical performance independent of comorbidity.
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Affiliation(s)
- Francesca Cecchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Silvia Pancani
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Federica Vannetti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Roberta Boni
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Chiara Castagnoli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Anita Paperini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Guido Pasquini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesco Sofi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Molino-Lova
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Pasquini G, Cecchi F, Bini C, Molino-Lova R, Vannetti F, Castagnoli C, Paperini A, Boni R, Macchi C, Crusco B, Ceppatelli S, Corigliano A. The outcome of a modified version of the Cheneau brace in adolescent idiopathic scoliosis (AIS) based on SRS and SOSORT criteria: a retrospective study. Eur J Phys Rehabil Med 2016; 52:618-629. [PMID: 27145218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Bracing therapy for patients with adolescent idiopathic scoliosis (AIS) continues to be a controversial issue. As a consequence, to achieve an adequate level of evidence, there is a strong need for specific studies conducted according to standard outcome and management criteria. AIM To assess the outcomes of a modified version of the Cheneau brace, ("Cheneau-P") in patients with AIS, based on SRS and SOSORT criteria. DESIGN Retrospective study. SETTING Scoliosis Unit of a Clinical Center. POPULATION Sixty-seven patients, 56 females and 11 males. METHODS Inclusion criteria were: diagnosis of AIS, age ≥10 years, Risser Score 0-2, Cobb degrees 20-40, no previous treatment, beginning of brace treatment within 1 year after menarche and minimum 2-year follow-up. According to SRS criteria, bracing outcomes were classified, as follows: "improved" (reduction of the curve ≥6°), "unchanged" (5° curve progression or reduction), "worsened" (≥6° curve progression), and "over 45°" (curve exceeding 45° or undergone surgery during the follow-up). The outcomes "improved" and "unchanged" were considered as successful outcomes. Groups and related subgroups were created according to curve type (thoracic, thoraco-lumbar, lumbar and double major) and magnitude (20°-30°; 30°-40°) and to skeletal age (Risser score 0, 1, 2). A separate analysis was also performed on the 37 patients, 30 females and 7 males, who completely fulfilled the SRS eligibility criteria, showing spinal curves between 25 and 40 Cobb degrees. RESULTS In the whole group SRS outcome after bracing treatment was successful in 93% and in 81% of patients, at per protocol (PP) and intention to treat (ITT) analysis, respectively, the latter also including drop-outs as worst outcomes. Cobb angles significantly decreased in all subgroups except in patients showing double major curves, lower curve magnitude (20-30°) and Risser score 2. Rib humps and balance rate also significantly improved in the whole sample (12.78±4.54 at T0 vs. 6.83±4.33 at T1 P<0.001; 60% at T0 vs. 94% at T1 P<0.001, respectively). In the subgroup that completely fulfilled the SRS eligibility criteria, the outcome was successful in 92% and 83% of patients, at PP and ITT analysis, respectively, the latter also including, even in this case, drop-outs as worst outcomes. CONCLUSIONS This study shows that in patients with AIS the treatment with the "Cheneau-P" brace is associated with a remarkably high rate of successful outcomes, both in the whole sample and in the subgroup of patients completely fulfilling the SRS criteria. CLINICAL REHABILITATION IMPACT The "Cheneau-P" brace proved effective as a conservative treatment for AIS by stabilizing curve progression and limiting the need for surgical treatment.
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Cecchi F, Paperini A, Molino Lova R, Pasquini G, Boni R, Castagnoli C, Vannetti F, Padua L, Macchi C. Pain in patients attending outpatient rehabilitation: results of a pilot study. Intern Emerg Med 2015; 10:351-7. [PMID: 25666513 DOI: 10.1007/s11739-015-1199-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
The aim of the study was to investigate pain occurrence, characteristics and correlations in an outpatient rehabilitation setting. This was an observational pilot study. The setting was an outpatient rehabilitation facility. The subjects included all patients attending physiotherapy in the week 25th to 29th September 2010 and the interventions were made using self-administered questionnaire. Ongoing pain was assessed by a yes-no question, pain intensity by a numeric rating scale (NRS) ranging 0-10. Pain-related medication was investigated, along with pain characteristics, patient treatment expectations, life satisfaction, and catastrophism. Of the 201 patients, 12 were excluded and 189 enrolled (age 63.6 ± 15.6; 70.4% women). Pain (mean NRS = 5.6 ± 2.4) was reported by 60.9% patients (66% orthopedic and 40% neurological). In 87.8% cases, pain was chronic (>6 months). According to patients reporting pain, the main objectives of treatment were both pain relief and functional recovery for 51%; pain relief for 24.9%; functional recovery for 22.8%. Low treatment expectations were reported by 15.3% patients; catastrophism by 40.7%; 28.6% patients were on pain medication: use of drugs was related to age (p = 0.005), pain intensity (p = 0.009) and catastrophism (p = 0.0003). In a multivariate analysis, pain was independently correlated with an orthopedic versus neurological diagnosis (p = 0.000), and with reduced treatment expectations (p = 0.020), while independent of age (p = 0.74) gender (p = 0.22), and catastrophism (0.17). A high prevalence of pain was observed in outpatients undergoing rehabilitation. Pain was chronic in most cases. Pain relief was the most desired treatment outcome by patients reporting pain. Pain complaint was independently correlated to orthopedic vs neurological diagnosis and to reduced treatment expectations.
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Affiliation(s)
- Francesca Cecchi
- Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy,
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Cecchi F, Pasquini G, Paperini A, Boni R, Castagnoli C, Pistritto S, Macchi C. Predictors of response to exercise therapy for chronic low back pain: result of a prospective study with one year follow-up. Eur J Phys Rehabil Med 2014; 50:143-151. [PMID: 24429917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Low back pain (LBP) management is a critical public health issue in all developed countries. Most approaches show evidence of effects only in the short term. AIM To identify predictors of functional outcome on discharge and at 1 year. DESIGN Prospective cohort study. SETTING Outpatient rehabilitation department. POPULATION Patients aged >18 addressed to exercise therapy for persisting LBP. METHODS The individually designed physiotherapy program provided 7 sessions (45'); patients were given advice to stay active and continue exercise program on discharge. Baseline (T0) assessment included: age, sex, time since onset, pain-related drug use, previous treatments, job, physical activity, pain (NRS) and Mental Health (SF36 sub-score); at follow-up (T2), we also enquired to on adherence to exercise prescription, physical activity, drugs. The primary outcome measure was the Roland and Morris Disability Questionnaire (RMDQ) patients scoring improvement >30% (minimal clinical important difference) were classified as respondent. RESULTS 211 completed follow-up (70% women; age 70.4±11.9). Average RMDQ score was reduced by 35% at T1 and by 31% at T2; NRS by 28% (T1) and 24% (T2); 125 patients (59%) were responders on discharge; 106 (50%) at follow-up. Only higher baseline NRS predicted poor response to treatment at T1 (OR=0.83, 95% CI: 0.71-0.95, P=0.012)). At T2, older age (OR=0.94, 95% CI: 0.91-0.98, P=0.003), drug use (OR=0.18, 95% CI: 0.08-4,69, P<0.001) and previous treatments (OR 0.33, 95% CI: 0.15 to 0.71, P=0.004) were significantly associated with poor response, while, baseline mental health (OR=1.1, 95% CI: 1.01-1.24, P=0.02) and adherence to exercises for LBP (OR=2.10, 95% CI: 1.03-4.42, P=0.04) predicted improved outcome. CONCLUSIONS The individually designed exercise therapy program for chronic LBP was associated to clinically significant functional improvement both on discharge and at 1 year. Only severe pain intensity predicted poor treatment response on discharge. At one year, younger age and better mental health predicted improved outcome, while use of drugs and previous LBP treatments were associated with worse response. Adherence to the exercise program almost doubled the probability of a favorable outcome. CLINICAL REHABILITATION IMPACT Adherence to an extensive individually designed exercise therapy program improves long term functional outcome of chronic low back pain.
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Affiliation(s)
- F Cecchi
- Don Gnocchi Foundation, Florence, Italy -
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Doni A, Sironi M, Musso T, Castagnoli C, Gobbi M, Valentino S, Tartari S, Bottazzi B, Garlanda C, Mantovani A. 70. Cytokine 2013. [DOI: 10.1016/j.cyto.2013.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cecchi F, Molino-Lova R, Paperini A, Boni R, Castagnoli C, Gentile J, Pasquini G, Macchi C. Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up. Intern Emerg Med 2011; 6:413-21. [PMID: 21153893 DOI: 10.1007/s11739-010-0499-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 11/24/2010] [Indexed: 11/29/2022]
Abstract
The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. Poor outcome was defined as NPQ score improving <30% (minimal clinically important difference-MCID-NPQ). The potential predictors included demographics, general health and psychological factors, neck pain history, and the clinical features described by NPQ. From January 2008 to June 2009, 212 patients were consecutively assessed for eligibility: 178 were enrolled and 162 completed follow-up (mean age = 65.3; 75% women). Baseline NPQ average score (40.7 + 17.1) improved by MCID on discharge (26.1 + 16.3) and at 1 year (28.5 + 17.3%). The poor outcome was reported by 45% patients on discharge and by 56% at follow-up. Pain-related medication intake independently predicted poor short- (OR 4.24; 95% CI 1.83-9.84; p = 0.001) and long-term (OR 2.69; 95% CI 1.19-6.06; p = 0.017) outcome, and catastrophizing (OR 2.91; 95% CI 1.31-6.48; p = 0.009) predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.
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Affiliation(s)
- Francesca Cecchi
- Fondazione Don Gnocchi, Scientific Institute, Firenze, Presidio Via Caccini, Via Caccini 18, 50141 Florence, Firenze FI, Italy.
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Cordani N, Pozzi S, Martynova E, Fanoni D, Borrelli S, Alotto D, Castagnoli C, Berti E, Viganò MA, Mantovani R. Mutant p53 subverts p63 control over KLF4 expression in keratinocytes. Oncogene 2010; 30:922-32. [DOI: 10.1038/onc.2010.474] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ostorero A, Castagnoli C, Fumagalli M, Alotto D, Cambieri I, Casarin S, Casimiri R, Stella M. Acellular glycerolised dermis supports keratinocyte growth and differentiation. Burns 2009. [DOI: 10.1016/j.burns.2009.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ciaramitaro P, Stella M, Castagnoli C, Risso D, Costa P, Faccani G, Isoardo G, Verrua R, Musso T, Alasia ST. Neurophysiological and clinical study of pain in postburn hypertrophic scars. Burns 2009. [DOI: 10.1016/j.burns.2009.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stella M, Risso D, Bollero D, Capocelli R, Primiceri C, Castagnoli C. Treatment of extensive burns by means of skin allografts. Burns 2007. [DOI: 10.1016/j.burns.2006.10.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stella M, Cassano P, Cuccuru F, Ganem J, Gangemi E, Zingarelli E, Cairo M, Castagnoli C. Post-burn pathological scar management. Burns 2007. [DOI: 10.1016/j.burns.2006.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bosia G, Castagnoli C, Dardo M, Marangoni G. Observation of structure in Cerenkov pulses from extensive air showers using fast techniques. Nature 2005; 225:532-3. [PMID: 16056592 DOI: 10.1038/225532a0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/1969] [Indexed: 11/08/2022]
Affiliation(s)
- G Bosia
- Laboratorio di Cosmo-geofisica del Consiglio Nazionale delle Richerche, Istituto di Fisica Generale dell'Università, Torino
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Conforto F, Gerecitano M, Castagnoli C, Turani F, Tanga I. Crit Care 2004; 8:P59. [DOI: 10.1186/cc2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Alotto D, Ariotti S, Graziano S, Verrua R, Stella M, Magliacani G, Castagnoli C. The role of quality control in a skin bank: tissue viability determination. Cell Tissue Bank 2002; 3:3-10. [PMID: 15256893 DOI: 10.1023/a:1021846703301] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
New surgical procedures requiring viable skin have increased rapidly over the last few years. The cell viability assessment in allograft skin is a major step forward in burn treatment, since it is well-known that taking is correlated with grafted tissue viability. Various methods, both qualitative and quantitative, are currently used. Although qualitative assays (histomorphology, immunocytochemistry) are routinely performed in our laboratory, there arose a need to set up a standardised quantitative assay in an attempt to obtain a cut-off value so that the skin sample could be determined valid or not for grafting. Therefore, two different tetrazolium salt compounds MTT and WST-1, were compared in order to determine their efficacy in the evaluation of tissue viability. Several experimental conditions were analysed: 1- cellular cultures of keratinocytes and fibroblasts, 2- fresh skin tissue samples, 3- the same specimen tested daily for at least 2 weeks, 4- after cryopreservation and thawing. Viable cells were analysed by the cleavage of tetrazolium salts to formazan by cellular enzymes. The formazan dye produced by metabolically active cells was then quantified by measuring the absorbance of the dye solution at the appropriate wavelength. It was seen that WST-1 is easier to handle, more stable, has a wider linear range, accelerated colour development and is more sensitive than MTT on fresh specimens and cell suspension. However, after 72 hours of storage at 4 degrees C, most of the WST-1 tested specimens no longer gave any absorbance signal, whilst MTT specimens were seen to give a signal for more than two weeks. Moreover, after thawing WST-1 tested samples were almost negative, whilst MTT samples continued to give strong signals. In conclusion, WST-1 assay offers rapid and precise results as to the cell viability of fresh allografts and cell cultures, whilst the MTT method is much more useful in establishing viability after long conservation and cryopreservation. In our clinical experience, allografts transplanted at 72 hr post-harvesting or after cryopreservation showed a mean of take more than of 80%, demonstrating that the MTT system is more reliable for the determination of allograft viability. Studies are ongoing with larger clinical cohorts to establish the precise cut-off value for skin graft validation.
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Affiliation(s)
- D Alotto
- Ospedale CTO, Dept. of Plastic Surgery and Burn Unit "Skin Bank", Via Zuretti 29, Turin, 10126, Italy
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Parisi L, Valente G, Serrao M, Castagnoli C, Cardinali P, Valletta L, Tramutoli R, Amabile G. RR interval variation, sympathetic skin reflex and QT dispersion in the assessment of autonomic function in peripheral neuropathy. Electromyogr Clin Neurophysiol 1999; 39:461-8. [PMID: 10627930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In recent years, two simple non-invasive tests, sympathetic skin response (SSR) and RR interval variation (RRIV) have been used to assess autonomic function (Wang et al., 1994; Drory et al., 1995; Chassande et al., 1996; Bordet et al., 1996; Spitzer et al., 1997). Their easy performance by an electromyographic (EMG) machine and successful clinical correlation (Shahani et al., 1990) have made them routine in autonomic assessment in several EMG laboratories. More recently QT dispersion on electrocardiogram (ECG) has been shown to have increased in patients with diabetic neuropathy and several autonomic dysfunctions (Wei et al., 1995; Lengyel et al., 1997; Langen et al., 1997; Axelrod et al., 1997). In order to evaluate the diagnostic value of the RR interval variation, sympathetic skin response and QT dispersion combined, we performed the three tests on a group of 37 patients with several peripheral neuropathies with and without clinical signs of dysautonomia. All patients were studied using an electromyograph (EMG). The results of the SSR, RRIV and QT dispersion combined have shown abnormal values in all patients with neuropathy and clinical dysautonomia and in some patients without clinical signs of dysautonomia, suggesting a subclinical autonomic dysfunction. The principal finding of this study is that the evaluation of the RRIV, SSR and QT dispersion combined may contribute to the assessment of dysautonomia in patients with somatic neuropathy and that they may be currently performed by an electromyograph.
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Affiliation(s)
- L Parisi
- Servizio di Neurologia, Ospedale Regina Apostolorum, Albano
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Aglietta M, Alpat B, Alyea ED, Antonioli P, Badino G, Bari G, Basile M, Berezinsky VS, Bersani F, Bertaina M, Bertoni R, Bonoli G, Bosco A, Bruni G, Cara Romeo G, Castagnoli C, Castellina A, Chiavassa A, Chinellato JA, Cifarelli L, Cindolo F, Conforto G, Contin A, Dadykin VL, De Silva A, Deutsch M, Dominici P, Dos Santos LG, Emaldi L, Enikeev RI, Fabbri FL, Fulgione W, Galeotti P, Ghetti C, Ghia P, Giusti P, Granella R, Grianti F, Guidi G, Hafen ES, Haridas P, Iacobucci G, Inoue N, Kemp E, Khalchukov FF, Korolkova EV, Korchaguin PV, Korchaguin VB, Kudryavtsev VA, Lau K, Luvisetto M, Maccarone G, Malguin AS, Mantovani R, Massam T, Mayes B, Megna A, Melagrana C, Mengotti Silva N, Morello C, Moromisato J, Nania R, Navarra G, Panaro L, Periale L, Pesci A, Picchi P, Pinsky L, Pless IA, Pyrlik J, Ryasny VG, Ryazhskaya OG, Saavedra O, Saitoh K, Santini S, Sartorelli G, Selvi M, Taborgna N, Talochkin VP, Tang J, Trinchero GC, Tsuji S, Turtelli A, Uman I, Vallania P, Van Buren G, Vernetto S, Vetrano F, Vigorito C, von Goeler E, Votano L, Wada T, Weinstein R, Widgoff M, Yakushev VF, Yamamoto I, Zatsepin GT, Zichichi A. Upper limit on the prompt muon flux derived from the LVD underground experiment. Int J Clin Exp Med 1999. [DOI: 10.1103/physrevd.60.112001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Castagnoli C, Trombotto C, Ariotti S, Millesimo M, Ravarino D, Magliacani G, Ponzi AN, Stella M, Teich-Alasia S, Novelli F, Musso T. Expression and role of IL-15 in post-burn hypertrophic scars. J Invest Dermatol 1999; 113:238-45. [PMID: 10469310 DOI: 10.1046/j.1523-1747.1999.00647.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hypertrophic scarring is a skin disorder that occurs after wounding and thermal injury. There is accumulating evidence that immunologic processes such as infiltration of activated T lymphocytes and altered cytokine production may play a role in the formation of hypertrophic scars. Interleukin-15, a cytokine identified as a T cell growth factor, also acts as a chemoattractant for T cells and has pro-inflammatory properties. We investigated the expression and the role of this cytokine in hypertrophic scarring. IL-15 expression was compared in skin biopsies of hypertrophic scars (HS) both in active (AHS) and in remission (RHS) phases, in normotrophic scars (NTS) and in normal skin using reverse transcriptase-polymerase chain reaction and immunohistochemistry. IL-15 expression in HS was significantly higher than in NTS or normal skin. Furthermore, AHS expressed higher levels of IL-15 than RHS. Immunohistologic analysis of AHS samples showed strong IL-15 immunoreactivity in keratinocytes and Langerhans cells in the epidermis and in macrophages, fibroblasts, and dermal dendritic cells in the dermis. High levels of IL-15 expression in AHS correlated with abundant infiltration of activated CD3+ cells. Ex vivo experiments indicate that IL-15 can sustain the proliferative response of T cells derived from AHS but not from RHS and NTS. In addition, IL-15 prevents both cytokine deprivation and activation-induced apoptosis of T cells derived from AHS. Taken together, these results suggest that IL-15 can be involved in the recruitment, proliferation, and apoptosis inhibition of T cells in AHS. The findings that the evolution from an AHS to a RHS is associated with a decrease in IL15 expression, and with a loss of IL-15 responsiveness in ex vivo-cultured T cells, indicate that this cytokine plays an important role in the biology of pathologic scar formation.
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Affiliation(s)
- C Castagnoli
- Department of Plastic Surgery, Traumatological Centre, Turin, Italy
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35
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Bernabei P, Rigamonti L, Ariotti S, Stella M, Castagnoli C, Novelli F. Functional analysis of T lymphocytes infiltrating the dermis and epidermis of post-burn hypertrophic scar tissues. Burns 1999; 25:43-8. [PMID: 10090383 DOI: 10.1016/s0305-4179(98)00128-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The cytokine profile of T cell clones (TCC) from the dermis and epidermis of burn patients with hypertrophic scars (HS) in active (AHS) and remission phases (RHS) was determined in this study. We found that AHS tissues are heavily infiltrated by Type 0-Type 1 polarized CD3+ lymphocytes producing high IFN-gamma and low IL-4 levels. Analysis of their surface marker phenotype showed that the high IFN-gamma production was shared equally between the CD4+ TCRalpha/beta and CD8+ TCRalpha/beta clones. The profile of TCC from RHS tissues revealed pronounced infiltration of Type 0-Type 1 polarized lymphocytes with an even more evident Type 1 profile. However, the levels of IFN-gamma produced by RHS-derived TCC were 4-6 times lower than those produced by AHS-derived TCC. These data show that high levels of IFN-gamma produced by Type 0-Type 1 lymphocytes infiltrating HS are a feature of AHS, whereas reduction of this ability to produce high levels of IFN-gamma, though without a shift towards a Type 0-Type 2 phenotype through an increase in IL-4, is characteristic of RHS.
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Affiliation(s)
- P Bernabei
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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36
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Alessio M, Gruarin P, Castagnoli C, Trombotto C, Stella M. Primary ex vivo culture of keratinocytes isolated from hypertrophic scars as a means of biochemical characterization of CD36. Int J Clin Lab Res 1998; 28:47-54. [PMID: 9594363 DOI: 10.1007/s005990050017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The CD36 antigen is a molecule which is ectopically expressed on epidermal keratinocytes of hypertrophic scars and is a good candidate for a marker for a broad range of skin pathologies. Most marker studies have been performed using immunohistochemical techniques on fixed skin sections. Our aim was to investigate the biochemical features of the CD36 expressed in pathological keratinocytes and to find an in vitro model for the study of the regulation of its expression. Here we show how keratinocytes isolated from hypertrophic scars can be cultivated in vitro and employed as a model for the study of these cells. We demonstrated that the antigenic features of the CD36 expressed on keratinocytes of hypertrophic scars are identical to those described for the CD36 expressed by other cell types. The molecule was expressed on the surface of keratinocytes which were non-adherent in vitro. Adherent and proliferating keratinocytes, as well as normal keratinocytes, were CD36 negative both at the surface and intracellularly. The in vitro proliferating cells from hypertrophic scars, but not the normal keratinocytes, showed intracellular expression of CD36 after long-term culture and cell stratification, suggesting a regulated expression of CD36 in pathological keratinocyte differentiation.
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Affiliation(s)
- M Alessio
- DIBIT, San Raffaele Scientific Institute, Milan, Italy
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37
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Castagnoli C, Trombotto C, Ondei S, Stella M, Calcagni M, Magliacani G, Alasia ST. Characterization of T-cell subsets infiltrating post-burn hypertrophic scar tissues. Burns 1997; 23:565-72. [PMID: 9568325 DOI: 10.1016/s0305-4179(97)00070-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this study, skin-infiltrating cells were characterized in both the active and remission phases of post-burn hypertrophic scar biopsies. Immunohistochemistry examination of active phase samples showed an abundant presence of Langerhans cells, T cells, macrophages, a low presence of natural killer cells and the lack of B lymphocytes. In active hypertrophic scars T lymphocytes infiltrate deep into the superficial dermis and are also observed in the epidermis: CD3+ cells were present at about 222 +/- 107 per 0.25 mm2. In particular the analysis of lymphocyte subpopulations showed that CD4+ T cells predominate in the dermis as well as in the epidermis of active hypertrophic scars whereas CD8+ cells were less well represented (CD4/CD8 ratio is 2.06). This distribution was also shown in remission phase samples and in normotrophic scar specimens, although the lymphocyte number was significantly lower. Approximately 70 per cent of T lymphocytes present in the tissue involved in active phase hypertrophic scar samples were activated (positive with anti-HLA-DR and IL-2 receptor antibodies) which is significantly higher than remission phase hypertrophic and normotrophic scars, in which positivity was 40 and 38 per cent, respectively. Upon activation, the lesional lymphocytes release several cytokines, locally and transiently, that interact with specific receptors in response to different stimulation. Central to the immune hypothesis of hypertrophic scars is that some of the T-cell lymphokines act on keratinocytes, fibroblasts and other cell types to induce changes characteristic of these scars. The presence and close proximity of activated T lymphocytes and antigen-presenting cells of various phenotypes in both the epidermis and dermis of hypertrophic tissues provides strong circumstantial evidence of a local immune response. However, the manner in which T cells achieve and maintain their activated state in hypertrophic tissues is not yet known, and both antigen-dependent and independent mechanisms may contribute.
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Affiliation(s)
- C Castagnoli
- Piedmont Foundation of Studies and Research in Burns, Turin, Italy
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38
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Teich Alasia S, Castagnoli C, Calcagni M, Stella M. The influence of progress in the treatment of severe burns on the quality of life. Acta Chir Plast 1996; 38:119-21. [PMID: 9037787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The problems related to burns treatment can be considered among the oldest and most passionating in history of medicine. Since the early forties amazing progresses have been done in the comprehension of the physiopathology of burns. The fast development of resuscitating techniques determined a remarkable reduction of mortality in the first phase; in a similar way through new concepts in the project and construction of intensive care facilities dedicated to burns, where patients can be isolated and a high standard of environmental control can be guaranteed, together with new topical and systemic antibacterial treatment protocols, a significant reduction of infectious complications has been achieved. Concerning surgical treatment early tangential excision and cultured epidermal grafts can be considered the cornerstones of burn therapy. Quality of life of burnt patients have been greatly ameliorated by these technical advances. Burn sequelae however remain the main concern of survivors because of the many controversial aspects of burn scar physiopathology and treatment. Along my career many endeavours I dedicated in this important research field. I will then report the results of most interesting clinical and experimental studies carried out in the last 30 years by our group in collaboration with basic researchers. All the work done in this domain enhance our hope that good results can really improve quality of life in burns: this is the goal for those who dedicated the whole life to relieve the suffering of these badly injured patients.
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Affiliation(s)
- S Teich Alasia
- Piedmont Foundation for Studies and Researches on Burns, Turin, Italy
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39
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Castagnoli C, Castellina A, Saavedra O, Kirina TM, Kokoulin RP, Petrukhin AA. Observation of electromagnetic interactions of high energy muons deep underground. Phys Rev D Part Fields 1995; 52:2673-2683. [PMID: 10019484 DOI: 10.1103/physrevd.52.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Castagnoli C, Stella M, Magliacani G, Ferrone S, Richiardi PM. Similar ectopic expression of ICAM-1 and HLA class II molecules in hypertrophic scars following thermal injury. Burns 1994; 20:430-3. [PMID: 7999272 DOI: 10.1016/0305-4179(94)90036-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In previous studies we have shown that HLA Class II antigens are expressed by keratinocytes and fibroblasts in hypertrophic scars. Because of the potential role of immunological events in the pathogenesis of hypertrophic scars, in the present study we have tested hypertrophic scars for the expression of intercellular adhesion molecule-1 (ICAM-1), a molecule which plays an important role in immunological phenomena. Immunoperoxidase staining with anti-ICAM-1 MoAb of 10 hypertrophic scar samples detected this molecule on epidermal keratinocytes and on about 30 per cent of fibroblasts at the site of lymphoid infiltration. The expression of ICAM-1 in hypertrophic scars was similar to that of HLA Class II antigens. Since the concomitant expression of ICAM-1 and HLA Class II by keratinocytes is known to enhance their antigen-presenting properties, the present results support the possibility that immunological events play a role in the disruption of the normal processes of wound healing and tissue remodelling which result in hypertrophic scars.
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Affiliation(s)
- C Castagnoli
- Department of Genetics, Biology and Medical Chemistry, Turin University, Italy
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Peruccio D, Castagnoli C, Stella M, D'Alfonso S, Momigliano PR, Magliacani G, Alasia ST. Altered biosynthesis of tumour necrosis factor (TNF) alpha is involved in postburn hypertrophic scars. Burns 1994; 20:118-21. [PMID: 8198715 DOI: 10.1016/s0305-4179(06)80007-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The present study shows that the decrease of TNF alpha in postburn hypertrophic scars is due to a decrease in the steady-state level of TNF alpha mRNA and thus to an altered biosynthesis of the cytokine. Thirteen scars, including seven hypertrophic and six normotrophic scars, were tested for TNF alpha mRNA production by a semiquantitative reverse polymerase chain reaction (PCR) method. TNF beta and beta actin were tested as a control. Six out of six normotrophic scar samples amplified with primers for TNF alpha showed a positive PCR signal up to the 1:32 dilution. On the contrary all the hypertrophic tested samples (7/7) had a positive PCR signal only at the 1:1 or 1:2 dilution. All samples, both normotrophic and hypertrophic, were homogeneous as to TNF beta production.
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Affiliation(s)
- D Peruccio
- Dip. di Genetica, Biologia e Chimica Medica, Università di Torino, Italy
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42
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Abstract
The percentage of TNF alpha- and beta-positive cells was analyzed in hypertrophic scar (N = 13), normotrophic scar (N = 7), and normal skin (N = 6) biopsies using monoclonal antibodies and immunoperoxidase staining of cryostat tissue sections. Samples were first characterized for infiltrating cells. In hypertrophic samples there was a significant increase in activated infiltrating cells, capable of producing TNF beta and IL-1 beta. In contrast, the percentage of TNF alpha-positive cells was significantly lower than that detected in normotrophic scars. In fact, in hypertrophic scar samples a positive staining with anti-TNF alpha mAb was restricted to 8% of tissue-infiltrating cells compared to 35.4% of the cells present in normotrophic scars; 12% of infiltrating cells were stained in normal skin sections. These results suggest that TNF alpha may be important for normal wound healing and that hypertrophic scarring might be partially a consequence of a low amount of TNF alpha.
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Affiliation(s)
- C Castagnoli
- Department of Genetics, Biology, Turin University, Italy
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43
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Castagnoli C, Stella M, Magliacani G, Alasia ST, Richiardi P. Anomalous expression of HLA class II molecules on keratinocytes and fibroblasts in hypertrophic scars consequent to thermal injury. Clin Exp Immunol 1990; 82:350-4. [PMID: 1700745 PMCID: PMC1535117 DOI: 10.1111/j.1365-2249.1990.tb05451.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Immunoperoxidase staining of skin sections obtained from 11 hypertrophic scars, six normotrophic scars and three samples of normal skin were performed using anti-HLA monoclonal antibodies (HLA-DR, -DQ, class I), anti-interleukin-2 receptor (IL-2R) and anti-CD1. Sections from all hypertrophic scars showed an anomalous expression of HLA-DR molecules on keratinocytes and fibroblasts. Moreover hypertrophic scars were characterized by dense infiltrates of IL-2R-positive cells and by the presence of abundant Langerhans (CD1+) cells in the epidermis and dermis. These results support the hypothesis that immunologic mechanisms play an important role in hypertrophic scarring and point to an involvement of cell-mediated immune phenomena.
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Affiliation(s)
- C Castagnoli
- Department of Genetics, Biology and Medical Chemistry, Turin University, Italy
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44
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Castagnoli C, Peruccio D, Stella M, Magliacani G, Mazzola G, Amoroso A, Richiardi P. The HLA-DR beta 16 allogenotype constitutes a risk factor for hypertrophic scarring. Hum Immunol 1990; 29:229-32. [PMID: 1980921 DOI: 10.1016/0198-8859(90)90117-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nineteen patients that had developed hypertrophic scars subsequent to thermal injury were typed for HLA class II allogenotypes with the restriction fragment length polymorphism technique. A significant association was found with DR beta 16 (pc = 1.45 x 10(-4); relative risk = 12.25). This finding adds evidence to other data suggesting that immunologic phenomena are involved in pathologic scarring. Moreover, the results presented here have allowed an identification of a genetically determined risk factor for hypertrophic scar formation located in the HLA region.
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Affiliation(s)
- C Castagnoli
- Dipartimento di Genetica, Biologia e Chimica Medica, Università di Torino, Italy
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45
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Costa S, Annecchino G, Vardanega G, Castagnoli C, Ruzzi GP. [Propofol and tetanus]. Minerva Anestesiol 1990; 56:39-40. [PMID: 2215980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Costa
- Servizio di Anestesia e Rianimazione, Ospedale Civile-Castelfranco Veneto, Treviso, ULSS n. 13, Regione Veneto
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46
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Aglietta M, Badino G, Bologna G, Castagnoli C, Castellina A, Fulgione W, Galeotti P, Saavedra O, Trinchero G, Vernetto S, Dadykin VL, Khalchukov FF, Kortchaguin VB, Kortchaguin PV, Kudryavtsev VA, Malguin AS, Ryasny VG, Ryazhskaya OG, Yakushev VF, Zatsepin GT. Neutron flux generated by cosmic-ray mouns at 5200 hg/cm2 s.r. underground. Depth-neutron intensity curve. ACTA ACUST UNITED AC 1989. [DOI: 10.1007/bf02525079] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Peruccio D, Crepaldi T, Castagnoli C, Lecchi M, Resegotti L, Miniero R, Guerra MG, Richiardi P. Expression of class I-like alloantigens on leukemic cells is not correlated with the amount of HLA-A,B,C molecules. Tissue Antigens 1988; 31:270-3. [PMID: 3165227 DOI: 10.1111/j.1399-0039.1988.tb02094.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The expression of class I-like allospecificities on leukemic blasts is not correlated to the amount of HLA-A,B,C molecules, as measured with MoAb W6/32 and IIF, nor with the quantitative expression of HLA-A molecules evaluated by absorption studies.
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Affiliation(s)
- D Peruccio
- Dipartimento di Genetica, Biologia e Chimica Medica sez. di Genetica dell'Universitá, Torino, Italy
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48
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Peruccio D, Crepaldi T, Lovisone E, Paolino F, Foa R, Castagnoli C, Gabrielli A, Cappa PM, Richiardi P. HLA class I- like antigen expression on human leukemic cells. Tissue Antigens 1987; 30:76-83. [PMID: 2890221 DOI: 10.1111/j.1399-0039.1987.tb01601.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The expression of HLA class I- like molecules was analyzed on human acute and chronic leukemic cells. The presence on leukemic cells of class I- like molecules, absent on the patient's normal lymphocytes, was examined by complement- dependent lymphocytotoxicity using platelet absorbed alloantisera that recognize HLA-linked, 45-12 kd, beta-2-microglobulin associated molecules, selectively expressed on PHA-activated cells. A positive reactivity of the anti- class I- like alloantisera was found in 50% of the acute leukemias (cALL, T-ALL and AML), independently of the lineage of differentiation, while chronic lymphocytic leukemias (B-CLL) were constantly negative. It is suggested that beta-2-microglobulin associated HLA molecules may represent markers of leukemic blast activation and/or maturation state.
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Affiliation(s)
- D Peruccio
- Dipartimento di Genetica, Biologia e Chimica Medica, University of Torino, Italy
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49
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Aglietta M, Badino G, Bologna GF, Castagnoli C, Fulgione W, Galeotti P, Saavedra O, Trinchero G, Vernetto S, Dadykin VL, Kortchaguin VB, Kortchaguin PV, Malguin AS, Ryassny VG, Ryazhskaya OG, Talochkin VP, Zatsepin GT, Yakushev VF. Monopole search with the Mont Blanc LSD experiment. ACTA ACUST UNITED AC 1986. [DOI: 10.1007/bf02514876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Alberini C, Bari G, Basile M, Cara Romeo G, Castelvetri A, Cifarelli L, Contin A, Del Papa C, Galli D, Iacobucci G, Maccarrone GC, Massam T, Motta F, Nania R, Odorico R, Prisco G, Rinaldi G, Sartorelli G, Barbagli G, Pelfer PG, Casaccia R, Laasko I, Rindi A, Susinno GC, Votano L, Cardone F, Di Sciascio G, Scrimaglio R, D'Alí G, Aglietta M, Castagnoli C, Castellina A, Fulgione W, Morello C, Periale L, Trinchero G, Vallania P, Vernetto S, Badino G, Bergamasco L, Cini G, Dardo M, Galeotti P, Navarra G, Saavedra O, Meunier R, Rohrbach F, Zichichi A, Berezinsky VS, Dadykin VZ, Khalchukov FF, Kortchaguin PV, Kortchaguin VB, Korolkova EV, Kudryavtsev VA, Malguin AS, Markov MA, Ryassny VG, Ryazhskaya OG, Talochkin VP, Yakushev VF, Zatsepin GT. The large-volume detector (LVD) of the Gran Sasso Laboratory. ACTA ACUST UNITED AC 1986. [DOI: 10.1007/bf02514845] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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