Development of the Italian version of the Consultation and Relational Empathy (CARE) measure: translation, internal reliability, and construct validity in patients undergoing rehabilitation after total hip and knee arthroplasty.

PURPOSE: To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. MATERIALS AND METHODS: The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. RESULTS: Face validity was high. Patients answered all questions and the "does not apply" option was never selected. Internal reliability (Cronbach's α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. CONCLUSIONS: The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA.IMPLICATIONS FOR REHABILITATIONInternal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure.The Italian CARE measure can be used to assess patient's perceived therapist's empathy in patients undergoing physical therapy after THA and TKA.Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts.

Dispersion of shoulder helical axes during upper limb movements after muscle fatigue.

Shoulder complex control of motion is influenced by neuromuscular function and can be quantified through the analysis of helical axes (HAs) dispersion. Muscle fatigue is a variable able to influence neuromuscular control, altering muscle activation timing and proprioception. The aim of the study was to describe shoulder complex HAs dispersion after muscle fatigue during upper limb movements of young healthy subjects. Thirty healthy right-handed volunteers (age 23.2 ± 2.6 years) were asked to perform a test made up of 15 humerothoracic flexion and rotation movements using both upper limbs in two different recording sessions. After each session, muscles of the tested movement were fatigued in isometric condition at dominant side. After fatigue, subjects repeated the test. Kinematics was recorded by an optoelectronic system and HAs dispersion was computed using Mean Distance (MD) and Mean Angle (MA) for the entire Range of Motion (RoM) and in portions of RoM. After fatigue of shoulder flexion muscles, greater MD (p = 0.001) and MA (p = 0.019) were found on the dominant side. After fatigue of shoulder rotation muscles, greater MD and MA were found on the dominant (p = 0.002 for MD; p = 0.047 for MA) and non-dominant (p = 0.038 for MD; p = 0.019 for MA) sides. Independently of fatigue, greater MA was found in portions of RoM with higher external resistance torque in flexion and rotation tasks. Muscle fatigue increases shoulder complex HAs dispersion, probably due to alteration in neuromuscular control. This data should be considered when exercise involving upper arms are proposed to subjects undergoing fatigue.

Dispersion of knee helical axes during walking in young and elderly healthy subjects.

Knee joint rotation center displacement can be estimated in vivo through the analysis of helical axis (HAs) dispersion. HAs can be analyzed during walking, providing information on joint stability. The study aim was to describe knee HAs dispersion during walking in dominant and non-dominant legs of young and elderly healthy subjects. Twenty young (YG: age 23.3 ± 2.4 years) and twenty elderly (EG: age 69.3 ± 4.6 years) healthy subjects were asked to walk on a treadmill at a self-selected speed with reflective markers placed bilaterally on thighs and shanks to detect HAs dispersion and knee kinematics with an optoelectronic system. HAs dispersion was described during the following four phases of gait cycle: (1) flexion from 95% of the previous gait cycle to 10% of the subsequent gait cycle, (2) extension from 10% to 40%, (3) flexion from 40% to 75% and (4) extension from 75% to 95% of the gait cycle. Mean Distance (MD) and Mean Angle (MA) were used as HAs dispersion indexes during each gait phase. Participants showed greater MD and MA in sagittal and frontal planes during the first and second phases. EG revealed higher MD (p = 0.001) and MA (p < 0.001) during the first phase and higher MA (p = 0.001) during the fourth phase in both dominant and non-dominant legs on the sagittal plane. HAs dispersion could be related to the amount of forces acting on knee (first two phases) and knee degeneration (elderly). These results may be used as reference data in further studies on HAs dispersion in presence of knee pathologies or after knee surgery or rehabilitation.

Action observation and motor imagery in performance of complex movements: evidence from EEG and kinematics analysis.

Motor imagery (MI) and action observation (AO) are considered effective cognitive tools for motor learning, but little work directly compared their cortical activation correlate in relation with subsequent performance. We compared AO and MI in promoting early learning of a complex four-limb, hand-foot coordination task, using electroencephalographic (EEG) and kinematic analysis. Thirty healthy subjects were randomly assigned into three groups to perform a training period in which AO watched a video of the task, MI had to imagine it, and Control (C) was involved in a distracting computation task. Subjects were then asked to actually perform the motor task with kinematic measurement of error time with respect to the correct motor performance. EEG was recorded during baseline, training and task execution, with task-related power (TRPow) calculation for sensorimotor (alpha and beta) rhythms reactive with respect to rest. During training, the AO group had a stronger alpha desynchronization than the MI and C over frontocentral and bilateral parietal areas. However, during task execution, AO group had greater beta synchronization over bilateral parietal regions than MI and C groups. This beta synchrony furthermore demonstrated the strongest association with kinematic errors, which was also significantly lower in AO than in MI. These data suggest that sensorimotor activation elicited by action observation enhanced motor learning according to motor performance, corresponding to a more efficient activation of cortical resources during task execution. Action observation may be more effective than motor imagery in promoting early learning of a new complex coordination task.