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This work aims to describe a well standardized therapeutic path in reference to the article "Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress-Part 1 in the form of a practical guide for manual therapist,

A simple treatment plan for manual therapists is presented based on current evidence-based literature, it is designed to lessen chronic pain and inflammation in the Irritable Bowel Syndrome (IBS). A chronic continuous or intermittent gastrointestinal tract dysfunction, IBS appears due to dysregulation of brain-gut-microbe communication. An overview of its management using Osteopathic Manipulative Treatment (OMT) is described. In IBS OMT focuses on the nervous and circulatory systems, spine, viscera, thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow and address somatic dysfunction. Lymphatic and venous congestion is treated by the Lymphatic Pump Techniques and stimulation of Chapman's Reflex Points. The food itself, food allergies and intolerance could contribute to symptom onset or even cause IBS. Furthermore the "microbiota" greatly impacts on the bi-directional braingut axis communication. This paper also provides appropriate dietary modifications for patients with IBS.

Background: Rehabilitation is increasing the need to use codes in order to make both a functional diagnosis and a therapeutic intervention as correct and targeted as possible. Thus, it is very important to integrate the model of Regional Interdependence (RI) in the classical rehabilitation evaluation methods, since it will be of help for understanding, solving dysfunctional problems, and improving the patient management, which is often difficult given the fact that there is no concordance on functional tests and timing of treatments. The RI should be added to the functional evaluation each time that a patient presents symptoms in a specific location, which interest also distal regions. This is due to the functional and anatomical connections of the myofascial system, vascular, autonomic nervous system (ANS), the peripheral nervous system (PNS) and the neuroimmunoendocrine system. The RI can be summarized into three groups that are correlated when it comes to applying it practically: upper, bottom and front quadrant. Adding the concept of RI to the clinical and therapeutically practice, it would have positive effects on improving the quality of life and allocate better health's resources. The aim of this paper is to make the functional assessment in clinical practice faster and more standardized.

An analytical observational study was conduct using a web-based questionnaire. Evidence-based practice is one of the most relevant concern of all health professions. This research has been done taking account of demographic information, attitudes and skills in reference to Evidence Based Practice (EBP) for application in the daily clinical practice. To describe beliefs and behaviors of physiotherapists from two Italian regions about EBP and its implementation in clinical practice, their knowledge in this field and the perception of its benefits and barrier in application in clinical practice. The participants completed a designed questionnaire, whose purpose was to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. This survey was activated through the TSRM-PSTRP registers of Marche and Umbria regions that sent the questionnaire to all the registered physiotherapists. There was a response rate of 7.64% for Marche region, equal to a sample of 132 physiotherapists, and a response rate of 12.99% for Umbria region, equal to a sample of 110 physiotherapists, for a total sample of 242 physiotherapists. The questionnaire was filled out through an online Google platform called “Forms”. The responses were summarized for each item and the logistic regression analyses and the chi-square test were used to examine relationships among variables. The respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices and that the quality of patient care was better when evidence were used. For physiotherapists from Umbria, with more than 15 years of qualification, the following answers are statistically significant (p<0.05): “the application of EBP is necessary in the practice of physical therapy, EBP helps me making decisions about patient care and I actively seek practice guidelines pertaining to areas of my practice and EBP improves the quality of patient care”. For physiotherapists from Marche, with more than 15 years of qualification, the following answers are statistically significant (p<0.05): “EBP helps me making decisions about patient care, I actively seek practice guidelines pertaining to areas of my practice and I am confident in my ability to find relevant research to answer my clinical questions”. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated to younger therapists with fewer years of qualification. Physical therapists stated they have a positive attitude about EBP and they are interested in learning or improving the necessary skills to implement EBP. They noticed that they needed to increase the use of evidence in their daily practice.

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a "framework" of reference. Managing patients through this "framework" would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new "framework" will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.