The Italian Consensus Conference on the role of rehabilitation for children and adolescents with leukemia, central nervous system tumors, and bone cancer, part 2: general principles for the rehabilitation treatment of motor function impairments.

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers.

Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review.

Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.

The tolerance of physiotherapy treatment in patients with COVID-19 and undergoing surgery for fragility hip fracture: An observational study.

ABSTRACT: The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgeryCase-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.

Effect of Game Based Balance Exercises on Rehabilitation After Knee Surgery: A Controlled Observational Study.

Does a rehabilitation protocol based on balance exercises using Serious Game improve walk performance in patients undergoing knee resection and reconstruction for bone primary tumor?. 30 patients undergoing modular prosthetic replacement, following a primary bone tumor, were consecutively enrolled. During each hospitalization a physiotherapy treatment was activated, included 25 min training phase aimed postural and proprioceptive control. In order to better evaluate the walking speed at one-year post surgery in the study group, data were compared with a group of 22 patients treated in a previous period, called the control group, collected retrospectively. The control group differed only for the type of physiotherapy treatment offered. No statistically significant differences emerged from the two groups, regarding baseline characteristics. Walking speed in the study group was improved compared to the control group with a median difference of 0.22 m/s (p = 0.022). A difference was also measured in the speed of centre mass, with a median reduction of 4.5 mm/s (p = 0.005) in the study group, showing an improvement in postural control in stand-up position. Exercises aimed at recovering balance and Serious Game should be proposed in order to improve motor performance and postural control in the medium and long term.

Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors: An observational study.

The purpose of this study was to evaluate compliance and satisfaction of adult patients to intensive rehabilitation treatment during chemotherapy cycles after surgery for bone-musculoskeletal tumours, as well as to identify possible predictive factors. An observational, prognostic, prospective study was conducted. The study enrolled 27 patients who previously had undergone modular knee prosthesis surgery in the period between October 2014 and October 2015. The outcome was compliance to intensive rehabilitation treatment during hospitalisations in the chemotherapy unit and patient satisfaction 6 months' post-surgery. The variables taken into account were linked to the patient's characteristics, to the oncological pathology and to the chemotherapy treatment administered. Patients' compliance was 100% (range, 61-100). The presence of surgery complications (29.6%) produced 5% loss in compliance to treatment; likewise, chemotherapy treatment with prevalent use of ifosfamide reduced compliance to rehabilitation by 6%. The mean patient satisfaction score was 7.9 in the Likert scale from 0 to 10. Intensive physiotherapy starting during chemotherapy administration is a feasible treatment for bone tumour patients that have shown to be able to positively adhere to it. Rehabilitation treatments, within chemotherapy wards, should therefore be promoted according to satisfaction level as reported by patient.

Which factors are associated with the functional recovery in patients undergoing endoprosthetic knee reconstruction following bone tumour resection? - A observational study.

BACKGROUND: The aim of the present study was to explore whether control of balance and other factors were associated with functional recovery and walking performance in the short term in a group of patients receiving modular knee endoprosthetic reconstruction following bone tumour resection in order to provide effective suggestions for a new rehabilitation protocol. METHODS: A cross-sectional study was carried out in the chemotherapy ward of an Italian hospital specialized in bone cancer. All patients consecutively treated using a modular knee endoprosthetic between January 2013 and February 2014 were included in the study. One year after surgery, various measuring instruments were used to assess the functional outcome achieved: Musculoskeletal Tumor Society rating scale, Toronto Extremity Salvage Score and specific motor tests of gait, such as gait speed and resistance. Data concerning the variables involved are as follows: bone resection, knee joint range of motion, quadriceps muscle strength and posture control. Statistical tests included correlation analysis (Pearson and Spearman correlation). RESULTS: Balance control was significantly correlated to all the gait tests performed. Age, duration of chemotherapy and strength of the knee extensor muscles also showed a correlation. Conversely, joint range of motion and resection percentage did not show a significant correlation. CONCLUSIONS: Rehabilitation in patients undergoing knee joint reconstruction due to cancer should include balance control exercises, which involve not only the treated limb but address the entire sensory and motor system. This extends beyond the concept of treatment aimed at improving individual functions such as joint range of motion and muscular strength.