European core curriculum in neurorehabilitation

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

Safety and efficacy of incobotulinum toxin type A (NT 201-Xeomin) for the treatment of post-stroke lower limb spasticity: a prospective open-label study

BACKGROUND

In recent years, NT 201, a new botulinum toxin type A (BTX-A) free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity.

AIM

To assess the safety and evaluate the effects of BTX-A NT 201 free from complexing proteins for the treatment of post-stroke lower limb spasticity evaluating spasticity grade, passive ankle dorsi-flexion motion, and muscle's spasms, as well as its efficacy and rate of satisfaction for patients and for the physicians.

DESIGN

Prospective open-label study.

POPULATION

Patients (71) with post-stroke lower limb spasticity at least 5 months by the event.

METHODS

Intramuscular injections of BTX-A NT 201 in soleus, medial, and lateral gastrocnemius with a maximum total dose of 180 U. Each patients was assessed at baseline, 30, and 90 days after treatment using Modified Ashworth Scale, Spasm Frequency Scale, evaluating passive ankle dorsi-flexion motion, and the rate of satisfaction for patients and investigators.

RESULTS

Patients treated with BTX-A NT 201 reported a statistically significant reduction in muscle tone and spasms daily increasing passive ankle dorsi-flexion at 30 days, persisting also at 90 days of follow-up.

CONCLUSION

BTX-A NT 201 for the treatment of post-stroke lower limb spasticity was safe and efficacious reducing muscle tone and spasms, and improving passive ankle dorsi-flexion movement.

CLINICAL REHABILITATION IMPACT

These results confirmed the safety and effectiveness of a new type of BTX-A, with low immunogenity, useful to improve rehabilitative treatment of post-stroke lower limb spasticity.

Italian consensus on EULAR recommendations 2005 for the management of hip osteoarthritis

The recommendations for the management of osteoarthritis (OA) of the hip were proposed by EULAR in 2005. Among the most important objectives of the expert charged to provide these recommendations were their wide dissemination and implementation. Thus, the information generated can be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. According with that previously executed for the EU-LAR recommendation 2003 for the knee, the Italian Society of Rheumatology (SIR) has organised a Consensus on the EULAR recommendations 2005 for the management of hip OA. To obtain an acceptability as large as possible, the group of experts was composed by many physicians interested in the management of hip OA, including Orthopaedics, Rheumatologists, Physiatrists, and General Practitioners. Main aim of the Consensus was to analyse the acceptability and applicability of the recommendations according to own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that the specialists involved in the management of hip OA strongly encourage the dissemination of the EULAR 2005 recommendations also in Italy.

The European physical and rehabilitation medicine journal network: historical notes on national journals

AIM

In the last 40 years, physical and rehabilitation medicine (PRM) has made significant steps forward in Europe with the foundation of the European Federation of Physical Medicine and Rehabilitation (EFPMR) (1963) which gave rise to the European Society of Physical and Rehabilitation Medicine (ESPRM) (2004) the European Academy of Rehabilitation Medicine (1970), the PRM Section of the European Union of Medical Specialists (1974), and the European Board of PRM (1991). Our journal, formerly Europa Medico-physica (1964), the official journal of the EFPMR, now European Journal of Physical and Rehabilitation Medicine (EJPRM) and official journal of the ESPRM since 2008, is distinct for its steadfast European vocation, long-standing Mediter-ranean interests and connections with various national scientific societies. Jointly with the ESPRM, efforts are under way to set up the European Physical and Rehabilitation Medicine Journal Network (EPRMJN). The aim of this article is to present a profile of the national journals in the EPRMJN so as to give a better overview of how the scientific part of PRM in Europe has developed within a national perspective.

METHODS

A profile of the following national journals is presented: Annals of Physical and Rehabilitation Medicine (France), Fizikalna i rehabilitacijska medicina (Physical and Rehabilitation Medicine) (Croatia), Neurorehabilitation (Bulgaria), Physical and Rehabilitation Medicine Portuguese Society Journal (Portugal), Physical Medicine, Rehabilitaton, Health (Bulgaria), Physikalische Medizin - Rehabilitationsmedizin - Kurort-medizin/Journal of Physical and Rehabilitation Medicine (Germany and Austria) Prevention and Rehabilitation (Bulgaria), Rehabilitacija (Rehabilitation) (Slovenia), Rehabilitación (Madr) (Spain), Turkish Journal of Physical Medicine and Rehabilitation (Turkey).

CONCLUSION

Some national journals in Europe have a very long history and tradition of research and education. Having a better knowledge of these realities, usually hidden to the international readership owing to the English language barrier, could promote science in our specialty.

National journals of physical rehabilitation medicine in Europe: a survey

BACKGROUND

The European Physical and Rehabilitation Medicine Journal Network (EPRMJN), a joint initiative between the European Society Physical and Rehabilitation Medicine (ESPRM) and the European Journal of Physical and Rehabilitation Medicine (EJPRM), has the aim to increase scientific knowledge among PRM specialists and foster collaboration among physical and rehabilitation medicine (PRM) journals. This article reports the results of a survey of national PRM journals in Europe we conducted to obtain an overview of the current state of PRM research in the European setting.

RESULTS

Every year 682 PRM papers are published in a total of 66 issues per 3 294 page in the 16 national journals that responded to our survey, out of the 21 published in 15 countries; 12 countries have no PRM journals and two did not respond. Some 94% of the journals responding to the survey have a research aim and 88% an educational aim; all journals use a peer-review process (75% blinded); on average, 58.8 submissions are received per year, of which 6.7% are invited papers; the rejection rate is 21.4%. The majority of papers report original research, and main topics are musculoskeletal and neurological rehabilitation.

CONCLUSION

Since the national journals published in Europe have a good peer review process and publish mainly original articles, it is possible that good research can be found. A major problem is the English language barrier to wider readerships, as many researchers publish only in their native language. The EPRMJN aims to discover this research and make it accessible to international audiences through systematic collection of articles appearing in the national journals of the EPRMJN and publication of content summaries on the ESPRM website.

Developing ICF core set for subjects with traumatic brain injury: an Italian clinical perspective

AIM

The objective of this empirical study is to describe functioning and health of individuals with traumatic brain injury (TBI) and to identify the most common problems using the International Classification of Functioning Disability and Health (ICF). The specific aims are to describe the prevalence of problems in functioning as defined by the ICF of individuals with TBI, and to identify categories that explain most of the variance of the external standards.

METHODS

261 TBI patients from 24 Italian centres members of the Italian Network were consecutively enrolled into the study between July 2008 and January 2009. The study was conducted as an empirical cross-sectional study.

RESULTS

The Extended ICF checklist captures the problems of TBI patients: many problems were reported within body function and body structure, but the most impaired categories were in Activity and Participation domain: the impaired categories reflect restrictions in challenging activities or activities related to later stages of recovery. The Environmental Factors in ICF were most frequently scored as facilitators: the support of the family is the most important environmental factor emerged, together.

CONCLUSION

This study describes and identifies the most common problems in functioning of persons with TBI in an Italian sample. It emphasizes the importance of approaching the description of functioning and disability from a comprehensive perspective including not only body functions and structures but also activities and participation domains and environmental factors.

[Assessment of function recovery in patients with total knee prosthesis]

The aim of this study was to analyse the evolution of motor performance in a group of patients who underwent surgical knee replacement. We also assessed patient satisfaction at 3 and 9 months after the operation. Sixty-two patients (40 women, 22 men, mean age 72.4 years) underwent isokinetic evaluation associated with surface EMG. All the patients had undergone a total prosthetic knee joint replacement for arthrosis, and had followed a standardised 30-day rehabilitation program at our centre for recovery of knee joint function, strengthening of the flexor-extensor muscles and restoration of ambulation as best as possible. Each of these patients underwent isokinetic evaluations 3 months and 9-10 months after their operation. The isokinetic test consisted of carrying out 5 flexion-extensions of the knee at an angular velocity of 60 degrees/second, followed by an endurance test of 30 repetitions of flexion-extension of the knee at 120 degrees/second. This isokinetic test provided data on extensor strength and flexor strength; furthermore, specifically designed software allowed simultaneous visualisation of the surface EMG tracing, torque and joint excursion. The first analysis showed a macroscopic decrease in the strength of the flexor-extensor muscles of the knee. This muscle weakness was clearly evident 3 months after the operation and was particularly pronounced for the extensor muscles of the operated limb compared with the muscles of contralateral, unoperated limb. Muscle weakness was still present 9 months after the operation although there had been a considerable improvement compared with 6 months previously; the imbalance in the flexor/extensor ratio, which differed from that in the contralateral, unoperated limb, was noted to be still present. The surface EMG demonstrated persistent myoelectrical activity in the flexors even when the extensor activity was predominant: this is an expression of imbalance between agonists-antagonists. A questionnaire administered to the patients about their satisfaction with the operation revealed that 9 months after the surgery 23 patients still complained of continuous joint pain with increased loads, 27 complained of frequent pain with load-bearing and only 12 no longer complained of any disturbance, manifesting full satisfaction with the operation. Total knee replacement is thus a valid treatment in those cases in which degenerative joint disease necessitates a radical solution. Nevertheless, dissatisfaction with the operation is common, and may be due to persistence of joint pain and incomplete joint recovery of joint function or muscle strength. In our series of patients, we found that although there was progressive recovery of strength of both the flexor and extensor muscles, a considerable imbalance remained between the operated and unoperated limbs; this finding was also confirmed by the surface EMG investigation.

[Clinical scientific research with ionizing radiation in Italy. The standards-setting and legal aspects]

INTRODUCTION

The paper reviews the laws that regulate the clinical scientific research with ionizing radiations in Italy. Although recent (all introduced after 1990), the laws are a maze of rules sometimes contradictory and unclear, with frequent cross-references which make them difficult to disentangle. The aim of the paper is to provide the researcher with a technical and legal guide to find his/her way in the labyrinth of rules, and to constitute a basis for a possible future rationalization of the regulations.

MATERIALS AND METHODS

The contents of the article n. 108 of the law by decree 230/1995 and of the Minister's Decree 21/11/1997 together with the ICRP 62 (introduced in Italy by the Minister's Decree 21/11/1997) are extensively reviewed. The authors stress the fact that these laws apply only to prospective, but not to retrospective studies. The procedure to obtain ministerial authorization of the research project is illustrated, together with the possibility of a bureaucratic shortcut whereby the ethical committee states that the project conforms to ICRP 62. Special attention is paid to the cases of contrast between the ICRP 62 and previously promulgated laws: dose thresholds in non-therapeutic research, research on pregnant women or in child-bearing age and the issue of the preliminary assessment of new radiopharmaceuticals on monkeys (recommended by ICRP 62 but strongly restricted by the law by decree 116/1992). As for studies with radiopharmaceuticals, the problem of the double authorization required by the Minister's Decree 21/11/1997 and by the memorandum 10/07/1997, n. 8 of the Ministry of Health is also discussed.

DISCUSSION AND CONCLUSIONS

The authors express the opinion that the Minister's Decree 21/11/1997, together with ICRP 62, render invalid all previous rules and regulations which contrast with them. The Minister's Decree 21/11/1997 and ICRP 62 are practical and exhaustive and offer the researchers and ethical committees precise and reliable guidelines. The paper aims to offer a contribution for the rationalization of the rules that regulate the field. To this regard, an accurate design of the future regulations, reflecting Euratom Directive 43/97 is expected by May 13, 2000. The authors' conclusion is that laws must regulate, not strangulate, clinical scientific research with ionizing radiations: incongruities, uncertainties and bureaucratic excesses must be corrected.