Journal of Clinical Medicine

Editorial

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2 pages, 172 KiB

Open AccessEditorial

Elderly or ageless? Physical Activity in the Aged Orthopaedic Patient

by Fabio Pigozzi and Vincenzo Denaro

J. Clin. Med. 2020, 9(10), 3243; https://doi.org/10.3390/jcm9103243 - 10 Oct 2020

Cited by 1 | Viewed by 1260

Abstract

Progression of osteoarthritis in the elderly is often a synonym of impaired function, discontinuation of physical activity and sport participation [...] Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

Review

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19 pages, 1146 KiB

Open AccessReview

The Effects of Physical Exercise on Balance and Prevention of Falls in Older People: A Systematic Review and Meta-Analysis

by Giuseppe Francesco Papalia, Rocco Papalia, Lorenzo Alirio Diaz Balzani, Guglielmo Torre, Biagio Zampogna, Sebastiano Vasta, Chiara Fossati, Anna Maria Alifano and Vincenzo Denaro

J. Clin. Med. 2020, 9(8), 2595; https://doi.org/10.3390/jcm9082595 - 11 Aug 2020

Cited by 58 | Viewed by 15804

Abstract

The aims of this systematic review and meta-analysis were to evaluate the effects of physical exercise on static and dynamic balance in the elderly population, and to analyze the number of falls and fallers. A systematic literature search was conducted using PubMed–Medline, Cochrane [...] Read more.

The aims of this systematic review and meta-analysis were to evaluate the effects of physical exercise on static and dynamic balance in the elderly population, and to analyze the number of falls and fallers. A systematic literature search was conducted using PubMed–Medline, Cochrane Central, and Google Scholar to select randomized clinical trials that analyzed the role of exercise on balance and fall rate in patients aged 65 or older. Sixteen articles were included in this review. Applying the Cochrane risk-of-bias tool, three studies were determined to be at low risk of bias, nine at unclear risk of bias, and four at high risk of bias. The meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants’ fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08), and physical performance (p = 0.30) in patients who underwent physical exercise compared to controls. The analysis of the total numbers of falls showed a decreased likelihood of falls in patients who participated in exercise programs (p = 0.0008). Finally, the number of patients who fell at least once was significantly reduced in the intervention group (p = 0.02). Physical exercise is an effective treatment to improve balance and reduce fall rates in the elderly. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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13 pages, 3969 KiB

Open AccessReview

Return to Sport Activity in the Elderly Patients after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis

by Rocco Papalia, Biagio Zampogna, Guglielmo Torre, Lorenzo Alirio Diaz Balzani, Sebastiano Vasta, Giuseppe Papalia, Antonio De Vincentis and Vincenzo Denaro

J. Clin. Med. 2020, 9(6), 1756; https://doi.org/10.3390/jcm9061756 - 05 Jun 2020

Cited by 8 | Viewed by 2351

Abstract

In patients with knee osteoarthritis, when only medial or lateral compartment of the knee is involved, unicompartimental knee arthroplasty (UKA) is a reliable option for addressing the symptoms and restore function. The main aim of the present review is to systematically collect the [...] Read more.

In patients with knee osteoarthritis, when only medial or lateral compartment of the knee is involved, unicompartimental knee arthroplasty (UKA) is a reliable option for addressing the symptoms and restore function. The main aim of the present review is to systematically collect the available evidence concerning the return to sport activity in the elderly patients after UKA. An electronic search was carried out on the following databases; Pubmed-Medline, Cochrane central, and Scopus, searching for randomized controlled trials, prospective cohort studies, retrospective case-control studies, and case series. Data concerning the evaluation of the return to sport (RTS) and of functional outcomes in the elderly patients after UKA surgery. MINORS score was used to assess the risk of methodological biases. Odds ratios and raw proportions were used to report the pooled effect of UKA on the return to sport in comparative and non-comparative studies, respectively. Same level RTS in elderly patients was of 86% (pooled return proportion 0.86, 95%CI 0.78, 0.94), showing also better relative RTS and time to RTS of patients undergoing UKA, in comparison to those undergoing TKA. Sport-specific RTS showed that higher return rates were observed for low-impact sports, whereas high-impact sports prevented a full return to activities. UKA is a valid and reliable option for elderly patients to satisfactorily resume their sport practice, especially for low impact activities. The rate of return to sports following UKA is higher than TKA. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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23 pages, 4547 KiB

Open AccessReview

Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis

by Rocco Papalia, Mauro Ciuffreda, Erika Albo, Chiara De Andreis, Lorenzo Alirio Diaz Balzani, Anna Maria Alifano, Chiara Fossati, Andrea Macaluso, Riccardo Borzuola, Antonio De Vincentis and Vincenzo Denaro

J. Clin. Med. 2020, 9(5), 1576; https://doi.org/10.3390/jcm9051576 - 22 May 2020

Cited by 10 | Viewed by 3430

Abstract

The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of [...] Read more.

The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of postoperative rehabilitation protocols. A systematic search in Pubmed-Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that evaluated the rate of return to sport after RTSA or ATSA. Six retrospective studies, five case series, and one prospective cohort study were included in this review. The overall rate of return to sport was 82% (95% CI 0.76–0.88, p < 0.01). Patients undergoing ATSA returned at a higher rate (90%) (95% CI 0.80–0.99, p < 0.01) compared to RTSA (77%) (95% CI 0.69–0.85, p < 0.01). Moreover, the results showed that patients returned to sport at the same or a higher level in 75% of cases. Swimming had the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%). Thus, RTSA and ATSA are effective to guarantee a significative rate of return to sport in elderly patients. A slightly higher rate was found for the anatomic implant. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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19 pages, 529 KiB

Open AccessReview

Family Caregiver Strain and Challenges When Caring for Orthopedic Patients: A Systematic Review

by Umile Giuseppe Longo, Maria Matarese, Valeria Arcangeli, Viviana Alciati, Vincenzo Candela, Gabriella Facchinetti, Anna Marchetti, Maria Grazia De Marinis and Vincenzo Denaro

J. Clin. Med. 2020, 9(5), 1497; https://doi.org/10.3390/jcm9051497 - 16 May 2020

Cited by 13 | Viewed by 3311

Abstract

Background: Caregivers represent the core of patients’ care in hospital structures, in the process of care and self-care after discharge. We aim to identify the factors that affect the strain of caring for orthopedic patients and how these factors are related to the [...] Read more.

Background: Caregivers represent the core of patients’ care in hospital structures, in the process of care and self-care after discharge. We aim to identify the factors that affect the strain of caring for orthopedic patients and how these factors are related to the quality of life of caregivers. We also want to evaluate the role of caregivers in orthopedic disease, focusing attention on the patient–caregiver dyad. Methods: A comprehensive search on PubMed, Cochrane, CINAHL and Embase databases was conducted. This review was reported following PRISMA statement guidance. Studies were selected, according to inclusion and exclusion criteria, about patient–caregiver dyads. For quality assessment, we used the MINORS and the Cochrane Risk of BIAS assessment tool. Results: 28 studies were included in the systematic review; in these studies, 3034 dyads were analyzed. Caregivers were not always able to bear the difficulties of care. An improvement in strain was observed after behavioral interventions from health-care team members; Conclusions: The role of the caregiver can lead to a deterioration of physical, cognitive and mental conditions. The use of behavioral interventions increased quality of life, reducing the strain in caregivers of orthopedic patients. For this reason, it is important to consider the impact that orthopedic disease has on the strain of the caregiver and to address this topic. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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12 pages, 423 KiB

Open AccessReview

The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly

by Rocco Papalia, Stefano Campi, Ferruccio Vorini, Biagio Zampogna, Sebastiano Vasta, Giuseppe Papalia, Chiara Fossati, Guglielmo Torre and Vincenzo Denaro

J. Clin. Med. 2020, 9(5), 1401; https://doi.org/10.3390/jcm9051401 - 09 May 2020

Cited by 27 | Viewed by 8252

Abstract

Hip and knee replacement is an effective treatment for symptomatic, end-stage hip and knee osteoarthritis, aiming to relieve pain and restore joint function. Several postoperative rehabilitation protocols and physical activities are proposed in routine clinical practice. However, their effect on clinical outcome and [...] Read more.

Hip and knee replacement is an effective treatment for symptomatic, end-stage hip and knee osteoarthritis, aiming to relieve pain and restore joint function. Several postoperative rehabilitation protocols and physical activities are proposed in routine clinical practice. However, their effect on clinical outcome and implant revision in patients undergoing joint replacement is still unclear. A systematic review of the literature was performed through a comprehensive search on online databases including Pubmed-Medline, Cochrane central, and Google scholar. We included all the available studies on postoperative physical activity and rehabilitation protocols after total knee and total hip arthroplasty in patients older than 65 years. The primary endpoint was to evaluate the effect of physical activity and rehabilitation on clinical outcome; the secondary outcome was to determine the effect on patients’ quality of life (QoL) and implant survival. Although the heterogeneity of the rehabilitation protocols and outcome measures did not allow to draw definitive conclusions, most studies suggested that aquatic therapy, ergometer cycling, and fast-track protocols have a beneficial effect on muscle strength, gait speed, and main clinical scores after total hip arthroplasty. Similarly, enhanced rehabilitation protocols produced an improvement in primary and secondary outcomes after total knee arthroplasty. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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17 pages, 264 KiB

Open AccessReview

Common Musculoskeletal Disorders in the Elderly: The Star Triad

by Marco Alessandro Minetto, Alessandro Giannini, Rebecca McConnell, Chiara Busso, Guglielmo Torre and Giuseppe Massazza

J. Clin. Med. 2020, 9(4), 1216; https://doi.org/10.3390/jcm9041216 - 23 Apr 2020

Cited by 52 | Viewed by 9371

Abstract

Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this [...] Read more.

Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

21 pages, 3001 KiB

Open AccessReview

The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis

by Biagio Zampogna, Rocco Papalia, Giuseppe Francesco Papalia, Stefano Campi, Sebastiano Vasta, Ferruccio Vorini, Chiara Fossati, Guglielmo Torre and Vincenzo Denaro

J. Clin. Med. 2020, 9(4), 1167; https://doi.org/10.3390/jcm9041167 - 18 Apr 2020

Cited by 56 | Viewed by 11470

Abstract

The aim of this systematic review and meta-analysis is to determine the role of physical activity as a conservative treatment for older people with knee or hip osteoarthritis. The effect on pain, physical function, stiffness, quality of life, and dynamic balance of Aquatic [...] Read more.

The aim of this systematic review and meta-analysis is to determine the role of physical activity as a conservative treatment for older people with knee or hip osteoarthritis. The effect on pain, physical function, stiffness, quality of life, and dynamic balance of Aquatic Exercise, Land-based Exercise, and Sports were compared in a specific population composed of osteoarthritic patients aged 65 or over. A systematic search using Pubmed-Medline, Google Scholar, and the Cochrane Library was carried out to select randomized clinical trials, observational studies, or case series that evaluated outcome measures after physical activity. Twenty randomized controlled trials (RCTs) and two case series were included in this review. Four trials were at low risk of bias (A), 12 at unclear risk of bias (B), and four at high risk of bias (C). Compared to controls, Aquatic Exercise, Land-based Exercise, Tai Chi, and Yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis. Nevertheless, further studies are required to validate the use of land-based exercise, aquatic exercise, or sport to treat the symptoms of older adults that suffer from knee and hip osteoarthritis. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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15 pages, 657 KiB

Open AccessReview

Biohumoral Indicators Influenced by Physical Activity in the Elderly

by Chiara Fossati, Guglielmo Torre, Paolo Borrione, Arrigo Giombini, Federica Fagnani, Matteo Turchetta, Erika Albo, Maurizio Casasco, Attilio Parisi and Fabio Pigozzi

J. Clin. Med. 2020, 9(4), 1115; https://doi.org/10.3390/jcm9041115 - 13 Apr 2020

Cited by 8 | Viewed by 2721

Abstract

In the scientific landscape, there is a growing interest in defining the role of several biomolecules and humoral indicators of the aging process and in the modifications of these biomarkers induced by physical activity and exercise. The main aim of the present narrative [...] Read more.

In the scientific landscape, there is a growing interest in defining the role of several biomolecules and humoral indicators of the aging process and in the modifications of these biomarkers induced by physical activity and exercise. The main aim of the present narrative review is to collect the available evidence on the biohumoral indicators that could be modified by physical activity (PA) in the elderly. Online databases including Pubmed, Web of science (Medline), and Scopus were searched for relevant articles published in the last five years in English. Keywords and combination of these used for the search were the following: “biological”, “indicators”, “markers”, “physical”, “activity”, and “elderly”. Thirty-four papers were analyzed for inclusion. Twenty-nine studies were included and divided into four categories: cardiovascular (CV) biomarkers, metabolic biomarkers, inflammatory markers-oxidative stress molecules, and other markers. There are many distinct biomarkers influenced by PA in the elderly, with promising results concerning the metabolic and CV indexes, as a growing number of studies demonstrate the role of PA on improving parameters related to heart function and CV risk like atherogenic lipid profile. Furthermore, it is also a verified hypothesis that PA is able to modify the inflammatory status of the subject by decreasing the levels of pro-inflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). PA seems also to be able to have a direct effect on the immune system. There is a strong evidence of a positive effect of PA on the health of elderly people that could be evidenced and “quantified” by the modifications of the levels of several biohumoral indicators. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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18 pages, 47646 KiB

Open AccessReview

Physical Activity for the Treatment of Chronic Low Back Pain in Elderly Patients: A Systematic Review

by Gianluca Vadalà, Fabrizio Russo, Sergio De Salvatore, Gabriele Cortina, Erika Albo, Rocco Papalia and Vincenzo Denaro

J. Clin. Med. 2020, 9(4), 1023; https://doi.org/10.3390/jcm9041023 - 05 Apr 2020

Cited by 41 | Viewed by 10017

Abstract

Chronic low back pain (CLBP) affects nearly 20–25% of the population older than 65 years, and it is currently the main cause of disability both in the developed and developing countries. It is crucial to reach an optimal management of this condition in [...] Read more.

Chronic low back pain (CLBP) affects nearly 20–25% of the population older than 65 years, and it is currently the main cause of disability both in the developed and developing countries. It is crucial to reach an optimal management of this condition in older patients to improve their quality of life. This review evaluates the effectiveness of physical activity (PA) to improve disability and pain in older people with non-specific CLBP. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. Individual risk of bias of single studies was assessed using Rob 2 tool and ROBINS-I tool. The quality of evidence assessment was performed using GRADE analysis only in articles that presents full data. The articles were searched in different web portals (Medline, Scopus, CINAHL, EMBASE, and CENTRAL). All the articles reported respect the following inclusion criteria: patients > 65 years old who underwent physical activities for the treatment of CLBP. A total of 12 studies were included: 7 randomized controlled trials (RCT), 3 non-randomized controlled trials (NRCT), 1 pre and post intervention study (PPIS), and 1 case series (CS). The studies showed high heterogeneity in terms of study design, interventions, and outcome variables. In general, post-treatment data showed a trend in the improvement for disability and pain. However, considering the low quality of evidence of the studies, the high risk of bias, the languages limitations, the lack of significant results of some studies, and the lack of literature on this argument, further studies are necessary to improve the evidences on the topic. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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14 pages, 751 KiB

Open AccessReview

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

by Sebastiano Vasta, Rocco Papalia, Guglielmo Torre, Ferruccio Vorini, Giuseppe Papalia, Biagio Zampogna, Chiara Fossati, Marco Bravi, Stefano Campi and Vincenzo Denaro

J. Clin. Med. 2020, 9(4), 969; https://doi.org/10.3390/jcm9040969 - 31 Mar 2020

Cited by 24 | Viewed by 6711

Abstract

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent two of the most common procedures in orthopedic surgery. The growing need to avoid physical impairment in elderly patients undergoing this kind of surgery puts the focus on the possibility to undertake a [...] Read more.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent two of the most common procedures in orthopedic surgery. The growing need to avoid physical impairment in elderly patients undergoing this kind of surgery puts the focus on the possibility to undertake a preoperative physical activity program to improve their fit and physical health at the time of surgery. A systematic review has been carried out with online databases including PubMed-Medline, Cochrane Central and Google Scholar. The aim was to retrieve available evidence concerning preoperative physical activity and exercise, before total knee or total hip arthroplasty in patients older than 65 years, and to clarify the role of this practice in improving postoperative outcomes. Results of the present systematic analysis showed that, for TKA, most of the studies demonstrated a comparable trend of postoperative improvement of Visual Analogue Scale (VAS), range of movement (ROM) and functional scores, and those of quality of life. There is insufficient evidence in the literature to draw final conclusions on the topic. Prehabilitation for patients undergoing TKA leads to shorter length of stay but not to an enhanced postoperative recovery. Concerning THA, although currently available data showed better outcomes in patients who underwent prehabilitation programs, there is a lack of robust evidence with appropriate methodology. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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16 pages, 332 KiB

Open AccessReview

Central and Peripheral Neuromuscular Adaptations to Ageing

by Riccardo Borzuola, Arrigo Giombini, Guglielmo Torre, Stefano Campi, Erika Albo, Marco Bravi, Paolo Borrione, Chiara Fossati and Andrea Macaluso

J. Clin. Med. 2020, 9(3), 741; https://doi.org/10.3390/jcm9030741 - 09 Mar 2020

Cited by 40 | Viewed by 4823

Abstract

Ageing is accompanied by a severe muscle function decline presumably caused by structural and functional adaptations at the central and peripheral level. Although researchers have reported an extensive analysis of the alterations involving muscle intrinsic properties, only a limited number of studies have [...] Read more.

Ageing is accompanied by a severe muscle function decline presumably caused by structural and functional adaptations at the central and peripheral level. Although researchers have reported an extensive analysis of the alterations involving muscle intrinsic properties, only a limited number of studies have recognised the importance of the central nervous system, and its reorganisation, on neuromuscular decline. Neural changes, such as degeneration of the human cortex and function of spinal circuitry, as well as the remodelling of the neuromuscular junction and motor units, appear to play a fundamental role in muscle quality decay and culminate with considerable impairments in voluntary activation and motor performance. Modern diagnostic techniques have provided indisputable evidence of a structural and morphological rearrangement of the central nervous system during ageing. Nevertheless, there is no clear insight on how such structural reorganisation contributes to the age-related functional decline and whether it is a result of a neural malfunction or serves as a compensatory mechanism to preserve motor control and performance in the elderly population. Combining leading-edge techniques such as high-density surface electromyography (EMG) and improved diagnostic procedures such as functional magnetic resonance imaging (fMRI) or high-resolution electroencephalography (EEG) could be essential to address the unresolved controversies and achieve an extensive understanding of the relationship between neural adaptations and muscle decline. Full article

(This article belongs to the Special Issue Physical Activity in the Elderly and Orthopaedic Surgery)

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