Il 5 e 6 novembre scorsi si è svolto, presso il Centro Congressi San Raffaele, il 6° Congresso Nazionale della Società Italiana di Fisioterapia (SIF) dal titolo “Dalla teoria alla pratica clinica in fisioterapia”. Lo scopo della SIF è promuovere le attività di ricerca scientifica in tutti gli ambiti di intervento della fisioterapia (clinico, organizzativo, formativo) e favorire la divulgazione delle conoscenze e la pratica clinica basata sulle prove di efficacia. Per questo motivo, ed in questa occasione, alcuni studenti del Corso di Laurea in Fisioterapia dell’Università Vita-Salute San Raffaele hanno avuto la possibilità di esporre i lavori scientifici che hanno preparato come elaborato di tesi. I lavori degli studenti Daniele Botta, Elena Candiani, Mattia Di Meo, Angelo Marco Dirito, Mattia Giacobbe, Sabrina Grappiolo, Elena Santantonio, Valeria Vella e Riccardo Zanoni sono stati selezionati dal comitato scientifico del Congresso per essere esposti come poster o come comunicazione orale. botta Questi lavori scientifici sono il frutto anche delle ottime collaborazioni esistenti tra il Corso di Laurea in Fisioterapia dell’Università Vita-Salute San Raffaele ed alcune realtà implicate nella ricerca traslazionale e clinica, tra cui la Neuroimaging Research Unit, diretta dal Professor Massimo Filippi, ed il gruppo di ricerca clinica di Analisi e Riabilitazione della Funzione Motoria, afferente alla Divisione di Neuroscienze. Inoltre, durante il Congresso SIF, il Professor Mark Elkins, Associate Professor alla Sidney University, Editor di Journal of Physiotherapy (rivista ufficiale della Associazione Australiana dei Fisioterapisti) e fondatore del database PEDro (PEDro is the Physiotherapy Evidence Database), ha consegnato al collega fisioterapista Davide Corbetta il “Premio per la migliore pubblicazione sul Journal of Physiotherapy” nell’anno 2015. Tale pubblicazione origina da un lavoro di tesi di laurea sviluppata con uno studente del Corso di Laurea in Fisioterapia dell’Università Vita Salute San Raffaele. Il dottor Corbetta è un fisioterapista dell’Ospedale San Raffaele, è docente della nostra Università e referente per l’organizzazione dei tirocini clinici degli studenti del Corso di Laurea in Fisioterapia. Siamo estremamente orgogliosi di questi importanti riconoscimenti e dello straordinario lavoro dei nostri ragazzi, che in questo Congresso si sono distinti per serietà e impegno, e che si mettono al servizio del paziente con competenza e grande umanità.

1. Background
In patients affected by coxoarthrosis, total hip replacement
could be necessary. When performing it the surgeon could do
an anterior capsulectomy or a capsulotomy with capsular repair
[1]. They both are accepted methods since currently there aren’t
studies that support the superiority of one of them.
The articular capsule is full of proprioceptive terminations, and
with capsulectomy they are lost [2]; for that reason it is possible
that its conservation and repair may result in better
proprioception and functionality.
The aim of our study is to evaluate differences in functional
activities and proprioception after the two different surgical
approaches.
Results
At the time being it was possible to evaluate only 5 patients at
T0 and T1, so these data are not relevant. There aren’t
statistically significant differences even with non parametrical
statistics, but we’ve seen an improvement in the capsulutomy
group in 6MWT and 30sCST, while capsulectomy group
decreased. In AROM of external rotation and abduction, HOOS
total score, sport activities and symptoms both groups
improved, with capsulotomy slightly better than capsulotomy. In
HOOS pain, ADL and QoL and in all three items of repositioning
error the capsulectomy group increased a little more than
capsulotomy. Finally, in AROM flexion both groups decreased,
with capsulectomy better than capsulotomy.
Materials and methods
Subjects undergo three evaluations: 15 days prior surgery (T0),
50 days after surgery (T1), and three months after surgery (T2).
In these evaluations we study Hip Disability and Osteoarthritis
Outcome Score (HOOS), active range of motion (AROM), active
and passive joint position sense (JPS, it is the ability of a
subject to reproduce the same joint position), 6 Minute Walk
Test (6MWT), and 30 seconds Chair Stand Test (30sCST). To
calculate the JPS, we selected the 80% and 50% of maximum
AROM, and for each angle two trials are repeated. Basing on
the performance of the subject, we evaluate the repositioning
error, defined as the difference, in angle degrees, between the
reproduced angle and the reference angle [3]. To study
repositioning error we then calculated [4]:
• Absolute error, measure of the magnitude of the error,
discounting direction.
• Constant error, the measure of the deviation from the target.
• Variable error, the measure of the consistency in
performance.
An infrared optoelectronic system with passive markers is used
to acquire the position of the lower limb during these tests.
Basing on the MCID of the HOOS, our primary outcome, we
have established a sample size of 94 subjects.
Discussion and conclusions
References:
1. Rizzolatti G. (2005). The mirror neuron system and its function in humans. Anat. Embriol. 210: 419-421.
2. Buccino G. (2014). Action observation treatment: a novel tool in neurorehabilitation. Philos Trans R Soc Lond B Biol Sci. 369 (1644): 20130185
3. Taube W, Lorch M, Zeiter S , Martin Keller S (2014). Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational
balance training . Frontiers Human Neuroscience; 8:972
4. Angyan L, Antall C, Angyan Z. Reproduction of reaching movements to memorized targets in the lack of visual control. Acta Physiol Hung. 2007;94(3):179–8
Effects on proprioception, functional activities and
quality of life of two surgical approaches for total
hip replacement in patients with osteoarthritis
Candiani Elena1, Tettamanti Andrea 1,2, Marco Ometti3, Leonardo Brambilla4, Gianfranco Fraschini3
1 Physiotherapy Degree, Vita-Salute San Raffaele University, Milan
2 Laboratory of Movement Analysis, Division of Neuroscience, San Raffaele Scientific Institute, Milan
3 Department of Orthopedic Surgery, San Raffaele Hospital, Milan
4 Medical Degree, Vita-Salute San Raffaele University, Milan
∆ capsulectomy (%) ∆ capsulotomy (%)
Flexion AROM -20° (-23,2%) -3,5° (-4,2%)
Abduction AROM +4,67° (+25,5%) +6° (+30%)
External rotation AROM +2,33° (+11%) +10° (+33,3%)
Active repositioning
error
-0,37° (+14%) +1,03° (-312,1%)
Passive repositioning
error
+1,66 (+23,4%) -0,01° (+2,9%)
Total repositioning
error
+0,64 (-74,4%) +0,51 (-150%)
HOOS total +33,75 (+81%) +30,31 (+82%)
HOOS symptoms +26,67 (+48,5%) +42,5 (+121,4%)
HOOS pain +46,67 (+105,6%) +41,25 (+89,2%)
HOOS ADL +30,39 (+68,1%) +21,06 (+51,1%)
HOOS sport +2,08 (+5,9%) +18,75 (+100%)
HOOS QoL +56,25 (+450%) +34,37 (+220%)
6MWT -50 (-14,8%) +61 (+26,5%)
30s CST -2 (-31,6%) +1 (+20%)
Discussion and conclusion
At the time being it isn’t possible to make inference on the data
collected.
A properly proprioception is extremely important in THR post-
operative rehabilitation, and it should be part of the treatment.
If we know that a subject has a better proprioception thanks to
the surgical procedure, so it is possible to modify the
rehabilitation program in order to obtain the best result for what
concerns functional activities and quality of life.
Figure 1. Example of an active joint reposition task. The subject
has to flex her hip keeping the knee extended until she touches
the target. Once she reaches it, she comes back to the starting
position, the target is removed, and she has to reproduce the
same joint position.