Physiotherapy Treatment Research Articles

Platelet-Rich Plasma Therapy for Rotator Cuff Injuries: A Comprehensive Review of Current Evidence and Future Directions.

Rotator cuff injuries are a prevalent cause of shoulder pain and disability, significantly impacting daily activities and quality of life. Platelet-rich plasma (PRP) therapy has emerged as a potential treatment for these injuries, aiming to enhance healing by delivering concentrated platelets and growth factors. This review comprehensively evaluates the current evidence regarding PRP therapy for rotator cuff injuries. It examines clinical trial data, comparing PRP therapy with conventional treatments such as physical therapy and surgical intervention. The review also explores the biological mechanisms of PRP, including its role in promoting tendon repair and regeneration through growth factors and cytokines. In addition, it addresses variables that may affect PRP therapy outcomes, including preparation techniques, injection methods, and patient-specific factors. The review highlights the need for standardized protocols and further research to optimize PRP therapy and address existing gaps in knowledge. Future directions include exploring combined treatment approaches and assessing long-term outcomes to refine PRP therapy's role in rotator cuff injury management. This review aims to provide valuable insights into the effectiveness of PRP therapy, contributing to improved treatment strategies and enhanced patient outcomes.

Critical Appraisal of Clinical Trials Evaluating Physical Therapy Treatments for Temporomandibular Disorders: A Scoping Review

ABSTRACTBackgroundPhysical therapy seems the most promising treatment for temporomandibular disorders (TMD), although their effectiveness is controversial in general, due to high heterogeneity regarding study designs, applied treatments and outcomes measures.ObjectivesThe aim of this scoping review is to analyse the methodological characteristics of clinical trials evaluating physical therapy treatments in subjects with TMD.MethodsA systematic search was conducted in Medline/PubMed, SPORTDiscus, Scopus, Web of Science, SciELO, Cochrane, ScienceDirect and EMBASE databases on 31 October 2023. Clinical trials evaluating physical therapy interventions in patients older than 18 years with TMD, published in English or Spanish languages. Data regarding content reporting of study designs, sample characteristics, interventions and outcome measures was extracted. Descriptive summary statistics were reported.ResultsThe search retrieved 15 322 records, and 136 were included. There were 107 randomised clinical trials, 5 non‐randomised controlled trials and 24 non‐controlled trials. Most studies had moderate to high risk of bias, small sample sizes (median, 44 subjects) and short follow‐up periods (1–3 months). The most common diagnostic criteria used was the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (48.9%). The most reported experimental interventions were manual therapy (40.4%), exercise (30.2%) and electrotherapy modalities (27.2%), and the most common outcome measure domains were pain (83.8%), range of movement (61.8%), disability (45.6%) and mechanosensitivity (29.4%). There was poor content reporting of experimental interventions.ConclusionsCurrent literature of clinical trials of physical therapy interventions for TMD has moderate to high risk of bias, poor content reporting, small sample size and short‐term follow‐ups which limit internal and external validity, as well as applicability into clinical practice.

Effect of Pediatric Physical Therapy Interventions on Congenital Muscular Torticollis: A Systematic Review.

This review explores the current pediatric physiotherapy approaches for treating infants with congenital muscular torticollis (CMT). CMT is a common musculoskeletal condition characterized by an unequal position of the neck due to unilateral shortening of the sternocleidomastoid muscle. Our comprehensive literature search assessed articles published between 2014 and March 2024. The review emphasizes various pediatric physical therapy interventions, such as manual therapy, stretching, soft tissue mobilization techniques, kinesio taping, and microcurrent therapy, along with parental education. The effectiveness of these interventions was assessed in terms of improving the cervical range of motion, reducing muscle tightness, correcting head posture, and improving functional outcomes in infants with CMT. The review underlines the need for early diagnosis and prompt initiation of physiotherapy interventions in order to improve treatment outcomes and reduce long-term musculoskeletal complications associated with CMT. Future research directions are also highlighted to improve our understanding and treatment of this common pediatric condition.

Pelvic Floor Disorders Due to Anal Sexual Activity in Men and Women: A Narrative Review.

Recent evidence shows that consensual anal penetrative intercourse has become more prevalent, not only limited to gay, bisexual, and other men who have sex with men but also for women who are in a sexual relationship with men. The aim of this review was to study the influence of consensual anal intercourse on pelvic floor function and the role of pelvic floor physical therapy treatment in preventing or treating consensual anal intercourse-induced anodyspareunia and/or fecal incontinence. We reviewed 68 references that showed that anal penetrative intercourse is a risk factor for anodyspareunia and fecal incontinence in both men and women. This risk of anal intercourse may increase with emotional discomfort, an overactive pelvic floor, lack of lubrication, frequency of anal penetrative intercourse, and hard practice (BDSM: bondage and discipline, dominance and submission, sadism, and masochism). It seems that pelvic floor physical therapists play an essential role in preventing and treating pelvic floor dysfunctions due to anal intercourse, which can lead to anodyspareunia and fecal incontinence; the treatment includes education, pelvic floor training with and without biofeedback, electric stimulation, manual therapy, and dilatators. Further studies are warranted to enhance our understanding of the causes and treatment efficacy of pelvic floor dysfunctions due to anal penetrative intercourse.

Antimicrobial Functionalization of Surfaces by a Chimeric Adhesive Protein.

The main aim of this work is to account for the prevention and control of microbial growth on surfaces of interest in medical technology. Surface modification is often achieved by physiotherapy or chemical treatments that can involve time-consuming steps, hazardous reagents, and harsh conditions. One of the ways to overcome these drawbacks is the use of surface-active proteins such as hydrophobins. They can form stable protein layers on different surfaces, serving as anchoring points for other molecules of interest. The fungal hydrophobin Vmh2, already exploited for its adhesive ability, has been fused with the antimicrobial peptide GKY20, forming the chimeric protein used herein for functionalizing polystyrene (PS) and bacterial cellulose (BC). As a natural biomass, BC has multiple advantages, including biodegradability, low cost, renewability, high purity, and excellent mechanical properties. The chimeric protein has been proven to successfully adhere to both surfaces. A strong decrease in biofilm formation on PS and a good bactericidal effect of BC have been demonstrated. These findings provide evidence of an alternative strategy to obtain functional composites using a green, easy process.

Dry needling techniques as a treatment for improving disability and pain in patients with different types of headache: A systematic review and meta-analysis

BackgroundHeadaches, a widespread neuromuscular ailment, pose a significant burden on individuals and society, necessitating both pharmacological and non-pharmacological interventions. Dry needling (DN) has surfaced as a notable non-pharmacological alternative for addressing headaches. We aim to compare DN intervention with the control group in the management of different types of headaches. MethodsA comprehensive meta-analysis was conducted, encompassing a systematic exploration of five electronic databases up to May 2023, with studies assessed for validity using the Cochrane risk of bias tool. Eligible studies included those with a control group, which could consist of sham interventions, physiotherapy, or pharmacological treatments. Outcomes related to disability, headache intensity, and frequency were extracted and analyzed. ResultsOut of 4304 studies screened, 13 randomized controlled trials (RCTs) were included in this systematic review, of them 10 RCTs were included in the meta-analysis. A significant decline in the disability score and headache intensity was evident in the DN group compared to the control group, one and three-month follow-ups. Specifically, substantial reductions in headache frequency were prominent after one and three months post-intervention. ConclusionDry needling manifests as a potent intervention, diminishing headache intensity and frequency, albeit with lower impact on disability scores. The observed benefits were especially pronounced after one and three months, though the heterogeneous nature of some data analyses mandates further detailed studies to gain a clearer understanding of DN's efficacy on the assessed outcomes.

Effect of William Exercise and Blackburn Exercise in Patients with Chronic Low Back Pain: A Randomized Control Trial

Background: Low back pain (LBP) physiotherapy treatment, mostly focuses on low back area and lower limb. Fewer physiotherapists and studies correlate the upper back and LBP. The present study was conducted to see the effect of lumbar stabilization (William) exercise and scapular stabilization (Black burn) exercise in chronic low back pain (CLBP) patients. Methods: Total 28 subjects were allocated randomly by the lottery method in two different treatment groups, Group-A (William exercise + black burn exercise group) and Group-B (William exercise). Pain intensity was measured by numeric pain rating scale (NPRS), and functional disability score by Roland - Morris disability questionnaire (RMDQ). Statistical analysis was done using SPSS V.20. Result: Within group analysis showed statistically significant difference in NPRS score(Z =-3.320, p < 0.001), RMDQ score(Z = -3.300, p < 0.001) in group A. Whereas NPRS score (Z = -3.341, p < 0.001), RMDQ score (Z = -3.202, p < 0.001) in group B. Comparison of baseline data showed no statistically significant difference in NPRS score (U=89, p=0.668) and RMDQ score (U=84, p=0.518) in both the groups. At the end of 4 weeks of intervention, data showed statistically significant difference in NPRS score (U=51.5, p=0.024) and RMDQ score (U=52.5, p=0.035) between both the groups. Conclusion: This study concludes that William exercise is good for the CLBP patients but William exercise and Blackburn exercise shows superior results in pain reduction and also reduced back related disability and restored functioning in CLBP patients. Keywords: Low back pain, William exercise, Scapular stabilization, black burn exercise

Exploring the impact of physiotherapy on health outcomes in older adults with chronic diseases: a cross-sectional analysis.

This study evaluates the impact of physiotherapy interventions on health outcomes and explores the correlation between physiotherapy session characteristics and improvements in health among older individuals. In a cross-sectional design, 384 older adults with chronic conditions such as arthritis, osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), diabetes, and hypertension were recruited. The proportion of arthritis (39.1%) and hypertension (45.8%) was notably high. Participants receiving physiotherapy showed significant improvements in pain levels (mean reduction from 5.09 to 2.95), mobility scores (improvement from 3.0 to 3.96), and functional independence. A positive correlation was identified between the frequency of physiotherapy sessions and pain reduction (r = 0.26, p = 0.035), and a stronger correlation between session duration and both pain reduction (r = 0.38, p = 0.002) and mobility improvement (r = 0.43, p = 0.001). High satisfaction rates with physiotherapy were reported, and age was found to be a significant negative predictor of health outcomes (Coef. = -0.3402, p = 0.0009). Physiotherapy interventions significantly improve health outcomes in older adults with chronic diseases.

Is One Enough? The Effectiveness of a Single Session of Education and Exercise Compared to Multiple Sessions of a Multimodal Physiotherapy Intervention for Adults With Spinal Disorders in an Advanced Practice Physiotherapy Model of Care: A Randomized Controlled Trial.

OBJECTIVE: To assess the effectiveness of a single session of education and exercise compared with multiple sessions of a multimodal physiotherapy intervention for adults with spinal disorders in an advanced practice physiotherapy specialized spine model of care. DESIGN: Pragmatic randomized controlled trial. METHODS: We randomized patients with spinal disorders, who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physiotherapist, to a single session of education and prescription of an exercise program (n = 52) or multiple sessions (6 in total) of a multimodal physiotherapy intervention (n = 54). The primary outcomes were the short form Brief Pain Inventory pain severity scale (BPI-S) and the Brief Pain Inventory pain interference scale (BPI-I), and secondary outcomes included disability, quality of life, catastrophization, and satisfaction. Linear mixed models were used to assess differences between groups across time points at 6, 12, and 26 weeks. RESULTS: There were no significant between-group differences on the BPI-S and only a significant improvement at 6 weeks on the BPI-I in the multiple-session group (mean difference: -0.96/10; 95% CI, -1.87 to -0.05). There were no other statistically significant differences between groups, except for satisfaction where participants in the multiple-session group reported statistically significantly greater satisfaction on the 9-item Visit-Specific Satisfaction Questionnaire and the MedRisk questionnaire. Both groups saw significant improvements over time on all outcomes except for the BPI-S. CONCLUSION: Adding supervised multimodal physiotherapy sessions did not result in better clinical outcomes when compared to a single session of education and exercise. Patients were more satisfied with the multiple-session approach. J Orthop Sports Phys Ther 2024;54(10):1-13. Epub 9 September 2024. doi:10.2519/jospt.2024.12618.

A Prospective Qualitative Inquiry of Patient Experiences of Cognitive Functional Therapy for Chronic Low Back Pain During the RESTORE Trial.

Cognitive functional therapy (CFT) is a person-centered biopsychosocial physiotherapy intervention that has recently demonstrated large, durable effects in reducing pain and disability in people with chronic low back pain (CLBP). However, exploration of the treatment process from the patients' perspectives, including the process of gaining control and agency over CLBP, is relatively understudied in this patient population. This qualitative study explored the experiences of eight participants from the RESTORE trial through longitudinally following their experiences, including interviews during baseline, mid-treatment, end-treatment, and 12-month follow-up. Data were analyzed according to a narrative approach. Findings described the overarching narrative themes of "The Journey to Self-Management." Within this overarching narrative, four distinct narratives were identified, beginning with "Left High and Dry," capturing the experience of isolation and abandonment with CLBP before commencing CFT, and concluding with three narratives of the experience of CFT from the start of treatment through to the 12-month follow-up. These included "Plain, Smooth Sailing," describing a journey of relative ease and lack of obstacles; "Learning the Ropes and Gaining Sea Legs," capturing an iterative process of learning and negotiating setbacks; and "Sailing Through Headwinds," describing the experience of struggle to gain agency and control over CLBP through CFT. Clinicians treating individuals with CLBP can use these insights to more effectively facilitate self-management, and people living with CLBP may find resonance from the narrative themes to support their journeys.

Motor sensory physiotherapy intervention in premature infants in neonatal intensive care unit (NICU)

Purpose: The purpose of this study is to explore the importance of implementing a customized motor sensory physiotherapy program by recording data about the total days spent and weight gain of preterm infants in Neonatal Intensive Care Unit. Methods: Randomized clinical trial of a sample of thirty (30) preterm infants split in two 15-member groups, one intervention group and one control group. An adapted program of motor sensory physiotherapy techniques, while in NICU, was implemented to the intervention group while nothing was implemented to the control group. Both groups met the same entry criteria. The same protocol of motor sensory physiotherapy was applied in the intervention group during the whole period of the study. Results: Data show that customized motor sensory physiotherapy while in NICU improves weight gain and reduces total days of stay. Discussion: Even though adapted motor sensory physiotherapy intervention has a positive impact on the development and outcome of preterm infants in NICU, more research is required on the physiotherapy techniques by studying a larger sample size in NICU.

Assessment of the economic value of physiotherapy treatment for economically effective results

The purpose of the study was to compare the pricing of physiotherapy treatment in various countries of the world. A comparative analysis of the cost of physiotherapy was conducted in the United Kingdom, Germany, Slovenia, Spain, Switzerland, Ireland, Canada, Indonesia, New Zealand, and Australia. The cost of physiotherapy was calculated considering 10 sessions per course of treatment in each clinic. The study determined that the cost of physiotherapy and massage varied substantially depending on the region and the medical institution. In the London clinic, the cost of 10 sessions of physiotherapy ranges from USD 721.62 to USD 1,818.49, depending on the duration of the procedures, and 10 massage sessions – from USD 787.23 to USD 1,115.24. In Switzerland, the same 45-minute course of physiotherapy costs USD 1,150, and an hour-long massage – USD 1,100. Financial costs for these procedures are substantially lower in Slovenia and Indonesia. In a Slovenian clinic, a course of 10 sessions of physiotherapy costs from USD 331.1 to USD 551.83, and massage – from USD 364.21 to USD 540.79. In Indonesia, the same course of physiotherapy is offered for USD 590.21-780.95, and massage – for USD 394.75-592.12. The cost of physiotherapy and massage procedures was directly related to the level of life and economic conditions in the country. In the United Kingdom and Switzerland, high health costs are explained by a high level of life and a developed medical infrastructure, while in Slovenia and Indonesia, services are more accessible to the public. Based on this, the most economically profitable solution for physiotherapy and massage is the introduction of batch sessions, which reduces the cost per session overall. In addition, financial costs are reduced due to reduced time for the procedure and the use of telemedicine during the rehabilitation session. This study helps to assess the pricing of physiotherapy procedures and further optimise national schemes with the formation of the most financially effective programmes

Evolution of treatment for unspecific back pain: From past to future.

Unspecific back pain (UBP) has long puzzled medical professionals. Historically, back pain (BP) was often attributed to mystical causes, treated with incantations or herbal concoctions. The Middle Ages shifted towards empirical practices, though still intertwined with superstition, using methods like leeches and bloodletting. The Renaissance introduced systematic healthcare approaches, laying the foundation for modern medicine. The 20th century saw significant advancements with diagnostic imaging, pharmacotherapy, physical therapy, and surgical interventions, though UBP remained elusive. Recent decades have seen a paradigm shift towards multidisciplinary approaches, addressing BP's multifactorial nature through holistic methods considering biomechanical, psychosocial, and lifestyle factors. This shift integrates quantitative research with hermeneutic interpretation, emphasizing evidence-based guidelines. Non-pharmacological interventions such as exercise therapy, electrotherapy, cognitive behavioral therapy, and mindfulness-based stress reduction have gained prominence, empowering individuals in their recovery. Technological innovations like virtual reality and artificial intelligence offer personalized treatment plans, optimizing outcomes. The future of BP treatment holds promise with advancements in regenerative medicine, neuromodulation, telemedicine, and remote monitoring platforms, enhancing accessibility and continuity of care, especially in underserved communities. However, challenges such as the opioid epidemic and healthcare disparities remain, necessitating judicious prescribing practices and equitable resource distribution. The evolving treatment landscape for UBP reflects the dynamic interplay between scientific progress, clinical innovation, and societal needs, aiming to alleviate the burden of back pain and improve quality of life.

Effects of Physiotherapy Interventions (Exercise Therapy and Electrotherapy) on Knee Osteoarthritis in Patients with Different Pain Intensity Categories

Effects of Physiotherapy Interventions (Exercise Therapy and Electrotherapy) on Knee Osteoarthritis in Patients with Different Pain Intensity Categories

Physiotherapy experiences of injured immigrant workers in Quebec: an intersectional perspective.

Immigrant workers are more likely to suffer work-related injuries compared to native-born Canadians. Their physical rehabilitation usually involves physiotherapy. This study sought to better understand the experiences of injured immigrant workers receiving compensation and physiotherapy treatments. We conducted a qualitative study using an interpretive descriptive methodology. Semi-structured interviews were completed with 10 compensated immigrant workers about the physiotherapy services they received. Transcripts were analyzed thematically and with an intersectional lens. Two major themes were identified: 1) complex pathways to physiotherapy, and 2) key pillars of physiotherapy experiences. The first theme demonstrates that a lack of familiarity with the health and compensation systems, delayed access to physiotherapy, and cumulative burdens complicate the care of immigrant workers. The second theme shows that moral/emotional support, pain relief, and the recognition of sociocultural beliefs and fears are key aspects to improving the experiences of care for these workers. This study offers new insights into physiotherapy in the context of a work injury, which may help physiotherapists adapt care to the complex needs of immigrant workers. The intersectional lens used in the analysis offers interesting ways of accounting for the multiple social identities of these workers.

Efficacy of ultrasound-guided galvanic electrolysis technique and physical therapy in patients with Achilles' tendinopathy: A pilot randomised controlled trial.

Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille's tendinopathy (AT). The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3months, aged 25-60years. Patients were randomised in two groups receiving the same physiotherapy treatment (2sessions per week for 8weeks). In addition, the experimental group received three USGET stimulations, one every 15days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p> 0.337). At T2, there was a statistical difference in VISA-A (p= 0.010) and its subscales and VAS (p= 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p< 0.001) and its subscales Pain (p= 0.004), Function (p= 0.003) and Sport (p= 0.002), but the EG patients showed a greater improvement. No adverse events were reported. The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT.

Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial.

Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.

Pain Intervention for Osteoporotic Compression Fracture, From Physical Therapy to Surgery: A Literature Review.

Osteoporotic vertebral compression fractures (OVCF) significantly contribute to increased morbidity and mortality in aging populations. When adjusted for age, South Korea has the highest global prevalence of OVCF, with rates of 544 per 100,000 men and 1,575 per 100,000 women. Moreover, patients with OVCF are at a heightened risk of additional fractures, with the risk of new vertebral fractures being up to 5-fold higher. Therefore, in treating patients with OVCF, it is essential to address the current symptoms and take preventive measures against further fractures. Although pharmacological treatment is crucial, it may be insufficient for all patients with OVCF, with more severe cases often requiring physical therapy or surgical intervention. This review aimed to explore effective physical therapy methods for patients with OVCF and summarize surgical techniques for high-risk older patients with various underlying conditions.

Association of Rate of Functional Recovery With Therapy Time and Content Among Adults With Acquired Brain Injuries in Inpatient Rehabilitation

ObjectiveTo examine associations among the time and content of rehabilitation treatment with self-care and mobility functional gain rate for adults with acquired brain injury. DesignRetrospective cohort study using electronic health record and administrative billing data. SettingInpatient rehabilitation unit at a large, academic medical center. ParticipantsAdults with primary diagnosis of stroke, traumatic brain injury, or nontraumatic brain injury admitted to the inpatient rehabilitation unit between 2012 and 2017 (N=799). InterventionsNot applicable. Main Outcome MeasuresGain rate in self-care and mobility function, using the Functional Independence Measure. Hierarchical regression models were used to identify the contributions of baseline characteristics, units, and content of occupational therapy, physical therapy, and speech-language pathology treatment to functional gain rates. ResultsMedian length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received an mean of 10.62 units of therapy (SD, 2.05) daily. For self-care care gain rate, the best-fitting model accounted for 32% of the variance. Occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain rate, the best-fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with mobility gain rate. ConclusionsMore activities of daily living in occupational therapy is associated with faster improvement on self-care function for adults with acquired brain injury, whereas more bed mobility in physical therapy was associated with slower improvement. A potential challenge with value-based payments is the alignment between clinically appropriate therapy activities and the metrics by which patient improvement are evaluated. There is a risk that therapists and facilities will prioritize activities that drive improvement on metrics and deemphasize other patient-centered goals.

Gene therapy for Duchenne Muscular Dystrophy: assessing the readiness of Italian centres of expertise.

Duchenne muscular dystrophy (DMD) is a heritable disorder that causes a rapid and progressive loss of ambulatory skills. There is no curative therapy for this pathology, that is currently managed with a combination of physiotherapy and pharmacological interventions limiting the progression of the disease (e.g. corticosteroids, cardiac medications). However, a new opportunity is represented by gene therapy, a promising treatment that, however, requires significant expertise during the whole delivery of care and a solid organisational infrastructure. An organisational strategy that could effectively support its delivery to DMD patients in Italy is the hub-and-spoke model. However, an accurate portrait of the present network of DMD centres of expertise in Italy and of their readiness in the delivery of gene therapy is paramount, to facilitate access to this experimental medicine in the future. In this context, the present study aimed to map the DMD centres of expertise in Italy and later evaluate their preparedness in terms of gene therapy delivery. For this purpose, a series of items was proposed to 30 centres in Italy, of which 20 responded. After assessing the readiness of the involved centres in terms of patient preparation, therapy infusion, close surveillance, and long-term follow-up, we proposed a suitable organizational model, namely a flexible hub-and-spoke model, for the delivery of gene therapy in the Italian DMD network and solutions to tackle the challenges emerged from the survey. Overall, the present study detected an adequate readiness of the Italian DMD centres of expertise, despite observing a significant room for improvement in digital infrastructures, culture, and training.