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Gianola S.,Orthopedic Institute Galeazzi | Agostini M.,Laboratory of Kinematics and Robotics | Castellini G.,COF Lanzo Hospital | Corbetta D.,San Raffaele Hospital | And 8 more authors.
Physical Therapy | Year: 2013

Background. Systematic reviews (SRs) have become increasingly important for informing clinical practice; however, little is known about the reporting characteristics and the quality of the SRs relevant to the practice of rehabilitation health professionals. Objective. The purpose of this study was to examine the reporting quality of a representative sample of published SRs on rehabilitation, focusing on the descriptive, reporting, and bias-related characteristics. Methods. A cross-sectional study was conducted by searching MEDLINE for aggregative and configurative SRs indexed in 2011 that focused on rehabilitation as restorative of functional limitations. Two reviewers independently screened and selected the SRs and extracted data using a 38-item data collection form derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The data were analyzed descriptively. Results. Eighty-eight SRs published in 59 journals were sampled. The median compliance with the PRISMA items was 17 (63%) out of 27 items (interquartile ratio=13-22 [48%-82%]). Two thirds of the SRs (n=66) focused on interventions for which efficacy is best addressed through a randomized controlled trial (RCT) design, and almost all of these SRs included RCTs (63/66 [95%]). More than two thirds of the SRs assessed the quality of primary studies (74/88 [84%]). Twenty-eight reviews (28/88 [32%]) meta-analyzed the results for at least one outcome. One half of the SRs reported positive statistically significant findings (46%), whereas a detrimental result was present only in one review. Conclusions. This sample of SRs in the rehabilitation field showed heteroge-neous characteristics and a moderate quality of reporting. Poor control of potential source of bias might be improved if more widely agreed-upon evidence-based reporting guidelines will be actively endorsed and adhered to by authors and journals. © 2013 American Physical Therapy Association.

Gianola S.,University of Milan Bicocca | Gianola S.,Irccs Orthopedic Institute Galeazzi | Castellini G.,University of Milan | Agostini M.,Laboratory of Kinematics and Robotics | And 13 more authors.
Spine | Year: 2016

Study Design. Methodological review of randomized controlled trials (RCTs). Objective. To assess the quality of reporting of rehabilitation interventions for mechanical low back pain (LBP) in published RCTs. Summary of Background Data. Reporting of interventions in RCTs often focused on the outcome value and failed to describe interventions adequately. Methods. We systematically searched for all RCTs in Cochrane systematic reviews on LBP published in the Cochrane Database of Systematic Reviews until December 2013. The description of rehabilitation interventions of each RCT was evaluated independently by 2 of the investigators, using an ad hoc checklist of 7 items. The primary outcome was the number of items reported in sufficient details to be replicable in a new RCT or in everyday practice. Results. We found 11 systematic reviews, including 220 eligible RCTs, on LBP. Of those, 185 RCTs were included. The median publication year was 1998 (I-III quartiles, 1990 to 2004). The most reported items were the characteristics of participants (91.3%; 95% confidence interval [CI], 87.3-95.4), the intervention providers (81.1%; 95% CI, 75.4-86.7), and the intervention schedule (69.7%; 95% CI, 63-76). Based on the description of the intervention, less than one fifth would be replicable clinically. The proportion of trials providing all essential information about the participants and interventions increased from 14% (n=7) in 1971 to 1980 to 20% (n=75) in 2001 to 2010. Conclusion. Despite the remarkable amount of energy spent producing RCTs in LBP rehabilitation, the majority of RCTs failed to report sufficient information that would allow the intervention to be replicated in clinical practice. Improving the quality of intervention description is urgently needed to better transfer research into rehabilitation practices. © 2016 Wolters Kluwer Health, Inc.

Turolla A.,Laboratory of Kinematics and Robotics | Turolla A.,University of Sheffield | Daud Albasini O.A.,University of Chile | Oboe R.,Laboratory of Kinematics and Robotics | And 8 more authors.
Computational and Mathematical Methods in Medicine | Year: 2013

Background. Haptic robots allow the exploitation of known motor learning mechanisms, representing a valuable option for motor treatment after stroke. The aim of this feasibility multicentre study was to test the clinical efficacy of a haptic prototype, for the recovery of hand function after stroke. Methods. A prospective pilot clinical trial was planned on 15 consecutive patients enrolled in 3 rehabilitation centre in Italy. All the framework features of the haptic robot (e.g., control loop, external communication, and graphic rendering for virtual reality) were implemented into a real-time MATLAB/Simulink environment, controlling a five-bar linkage able to provide forces up to 20 [N] at the end effector, used for finger and hand rehabilitation therapies. Clinical (i.e., Fugl-Meyer upper extremity scale; nine hold pegboard test) and kinematics (i.e., time; velocity; jerk metric; normalized jerk of standard movements) outcomes were assessed before and after treatment to detect changes in patients' motor performance. Reorganization of cortical activation was detected in one patient by fMRI. Results and Conclusions. All patients showed significant improvements in both clinical and kinematic outcomes. Additionally, fMRI results suggest that the proposed approach may promote a better cortical activation in the brain. © 2013 Andrea Turolla et al.

Andrea T.,Laboratory of Kinematics and Robotics | Michela A.,Laboratory of Kinematics and Robotics | Carla Z.,Laboratory of Kinematics and Robotics | Pawel K.,Laboratory of Kinematics and Robotics | And 6 more authors.
2011 International Conference on Virtual Rehabilitation, ICVR 2011 | Year: 2011

Many applications of virtual reality appeared in different fields of the rehabilitation medicine. Nevertheless poor evidences of their effectiveness still exist. The aim of this original paper was to present the results of a retrospective analysis of 10 years of a non-immersive VR system application, for the treatment of the motor upper limb impairment in stroke patients. We observed a significant improvement in the motor outcomes, compared to standard rehabilitation, nevertheless a translation of the same effect on harder outcome such as independence wasn't observed. © 2011 IEEE.

Paredes L.P.,Laboratory of Kinematics and Robotics | Farina D.,University of Gottingen | Shin Y.-I.,University of Gottingen | Shin Y.-I.,Pusan National University | Turolla A.,Laboratory of Kinematics and Robotics
International IEEE/EMBS Conference on Neural Engineering, NER | Year: 2015

Here we investigate whether torque or myoelectric control was more efficient during active, robotic-assisted therapy. Eleven hemiparetic stroke patients employed the RehaArm-robot, which consist of an exoskeleton that supports the entire arm and measures in real time the joint position and moment of the shoulder, in four sessions of one hour on consecutive days. At each session, the patients repeatedly performed basic movements of the shoulder in passive and active mode. During the passive mode, subjects learnt the movements. During the active mode, subjects were asked to complete 40 task repetitions in 20 min for each modality, torque and myoelectric control. The number of repetitions achieved, completion rate (CR), was tracked for each control modality as well as subjects' opinion about the ease of use of each modality. The results showed that the severe-to-moderate group (Fugl-Meyer Motor Assessment of the Upper Extremity<=40) achieved a significantly higher CR in myoelectric control than in torque control (p<0.05). For the mild group (>40), the CR was very similar for both control modalities. Subjectively, the two groups considered both control modalities similarly easy to use, being the myoelectric control slightly easier (higher median and middle fifty values). These results support the higher efficacy of the myoelectric control for active, robotic-assisted therapy. © 2015 IEEE.

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