Objective The aim of this review is to identify the best evidence to define rehabilitative approaches to acute and post-acute phases of coronavirus 2019 (COVID-19) disease. Methods A literature search (of PubMed, Google Scholar, PEDro and Cochrane databases) was performed for relevant publications from January to April 2020. Results A total of 2,835 articles were retrieved, and the search resulted in a final total 31 published articles. A narrative synthesis of the selected articles was then performed. Some studies examine the effect of the pandemic on rehabilitation services and provide suggestions for a new reorganization of these services. Other studies focus on COVID-19 sequelae, formulating recommendations for rehabilitative interventions. Conclusion For COVID-19 patients, an integrated rehabilitative process is recommended, involving a multidisciplinary and multi-professional team providing neuromuscular, cardiac, respiratory, and swallowing interventions, and psychological support, in order to improve patients’ quality of life. The intervention of a physician expert in rehabilitation should assess the patient, and a dedicated intervention set up after thorough assessment of the patient’s clinical condition, in collaboration with all rehabilitation team professionals. LAY ABSTRACT Rehabilitation, in a multidisciplinary and multi-professional setting, plays a pivotal role in the management of Covid-19 patients, focusing on respiratory and motor functions and it is therefore crucial to establish treatment strategies to guarantee an optimal recovery of these patients. We performed a review of the scientific literature. All the studies concerning respiratory rehabilitation treatments for Covid-19 patients were included. Respiratory rehabilitation has the goal of improve respiratory symptoms, preserve function and reduce complications and disability; it also has positive effects on the psychological sphere, reducing anxiety and depression that can frequently develop in this context.

Aging and sedentary life style are considered independent risk factors for many disorders. Under these conditions, accumulation of dysfunctional and damaged cellular proteins and organelles occurs, resulting in a cellular degeneration and cell death. Autophagy is a conserved recycling pathway responsible for the degradation, then turnover of cellular proteins and organelles. This process is a part of the molecular underpinnings by which exercise promotes healthy aging and mitigate age-related pathologies. Irisin is a myokine released during physical activity and acts as a link between muscles and other tissues and organs. Its main beneficial function is the change of subcutaneous and visceral adipose tissue into brown adipose tissue, with a consequential increase in thermogenesis. Irisin modulates metabolic processes, acting on glucose homeostasis, reduces systemic inflammation, maintains the balance between resorption and bone formation, and regulates the functioning of the nervous system. Recently, some of its pleiotropic and favorable properties have been attributed to autophagy induction, posing irisin as an important regulator of autophagy by exercise. This review article proposes to bring together for the first time the “state of the art” knowledge regarding the effects of irisin and autophagy. Furthermore, treatments on relation between exercise/myokines and autophagy have been also achieved.

Case StudyOpen Access IntroductionThe lifetime prevalence of neck pain in Western populations has been estimated at around 70%, while annual or point prevalence rates range from 10% to 35% [1][2][3]. Chronic neck pain (CNP) can be defined as pain experienced in the anatomic region of the cervical spine between C1 and C7 and the surrounding musculature only, in accordance with the criteria set by the International Association for the Study of Pain and the American Pain Society which defines the condition as chronic when pain persists beyond 3 months regards the normal tissue healing time [4,5]. Many factors contribute to the development of CNP and many have not yet been identified. However, it is known that pain can become more complex in its pathophysiology than its original injury. Chronic musculoskeletal pain, like CNP for instance, usually develops as a result of an injury or an insult followed by neurogenic inflammation, hyperalgesia, and allodynia; then occurs a central sensitization followed by a loss of nociceptive control [6,7].Clinical guidelines for CNP treatment recommends cervical mobilization, thoracic spine thrust manipulation, flexibility exercises for specific muscles group (anterior/medial/posterior scalene, upper trapezius, elevator scapulae, pectoralis minor, and pectoralis major), the use of coordination, strengthening, and endurance exercises to reduce neck pain and headache. To improve recovery in patients with whiplash-associated disorder, clinicians should educate the patient to be more confident in coming back at a well-being status [8]. It is well known that there are many therapeutic strategies for CNP, but the long term effects of individual rehabilitation approaches are limited. Between the flexibility muscles exercises, the relaxation of myofascial trigger points (MTrPs) in the splenius capitis, elevator scapulae, or upper trapezius muscles as a clinical entity seems to contribute to CNP [9]. Moreover, the reported pain elicited by active MTrPs in the neck and shoulder muscles has been shown to contribute to symptoms of mechanical neck pain [10,11]. An MTrP is defined as a hyperirritable focus within a taut band of skeletal muscle that is painful However, no studies have investigated the effects of mesotherapy on MTrPs to improve chronic neck pain and function. Moreover the efficacy of mesotherapy was confirmed as a viable option as an additional treatment in an overall rehabilitation treatment planning in other research on chronic lower back pain [13]. Mesotherapy was introduced 50 years ago by Michel Pistor, a French physician who used this technique as a novel analgesic therapy for a variety of rheumatologic disorders. Mesotherapy is a minimally invasive technique that consists of subcutaneous injections of drugs and, occasionally, plant extracts, homeopathic agents, or other bioactive substances [14][15][16].The pharmacological effects of intradermal administration do not entirely account for the observed clinical benefits of mesotherapy. The needle dry prick activates the cutan...

Facet joint syndrome (FJS) is an arthritis-like condition of the spine that can be a significant source of low back pain (LBP). Ozone therapy (OT) could be an additional treatment method. We evaluated the therapeutic results of percutaneous injection of ozone to ablate acute LBP caused by FJS. Methods: A 73-year-old Caucasian woman was treated by OT: one ozone injection (20 µg/mL) per week for 3 weeks under ultrasound guidance. After a break of 1 week, she performed exercises for aquatic rehabilitation (twice a week for 4 weeks). Results: The outcome measure was pain relief for ≥6 months according to the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory (BPI) test. From baseline to 1 month after OT, a reduction in pain was documented and the result was maintained at 6-month follow-up. Conclusion: OT followed by aquatic exercises could be efficacious against the LBP caused by FJS.

High-flow nasal cannula (HFNC) has often been used in the treatment of acute respiratory failure during pulmonary rehabilitation setting. The aim of this retrospective study was to investigate the utility of HCFN during the early rehabilitation in COVID-19 pneumonia. Twenty-two patients (10 males and 12 females, mean age 64.5 ± 5.9 years) with COVID-19 pneumonia were considered. Medical data and rehabilitative scales were used to evaluate acute hypoxemic respiratory failure (PaO2/FiO2 < 300), treated with HFNC three times during evaluation. Overall clinical outcomes from the evaluation of the synergy between HFNC strategy and rehabilitation were evaluated. A statistically significant improvement was observed at T2 (and of treatment) in 1 minute sit to stand test (1STST) (4 ± 3 vs. 17 ± 5, p < 0.05), short physical performance battery (SPPB) (4.3 ± 2.81 vs. 9.15 ± 2.39, p < 0.05), SpO2% post effort (93 ± 1.26 vs. 98 ± 1.01, p < 0.05), respiratory rate post effort (RR) (24 ± 3.91 vs. 20 ± 3.13, p < 0.05), heart rate (HR) (97 ± 11.9 vs. 87 ± 9.17, p < 0.05), P/F rate (235 ± 7.35 vs. 331 ± 10.91, p < 0.05), SpO2 (86 ± 4.54 vs. 97 ± 1.01 p < 0.05), RR (20 ± 4 vs. 12 ± 1.39, p < 0.05). Then, treated HFNC patients showed a good improvement in physical performance at T2 and a good compliance with treatments proved to be extremely useful in the control and reduction of dyspnea and fatigue symptoms.

Background: Obstructive sleep apnoea (OSA) is characterized by repetitive narrowing and collapse of pharyngeal airway during sleep, leading to apnoea or hypopnoea. In this context, myofunctional therapy and myofascial release might be effective, despite the literature on the combination of these approaches is still scarce.Objectives: This randomized controlled trial aimed to assess the efficacy of oro-facial myofunctional therapy combined with myofascial release in terms of functioning in patients with mild OSA.Methods: Patients aged from 40 to 80 years with diagnosis of mild OSA were randomly allocated into intervention group (oro-facial myofunctional therapy plus myofascial release) and control group (only oro-facial myofunctional therapy). At the baseline (T0), after 4 weeks (T1), and after 8 weeks (T2), the following outcomes were assessed: apnoea/hypopnoea index (AHI), average oxygen saturation (SpO 2 ), sleep time spent with oxygen saturation < 90% (T90), snoring index, and Pittsburgh Sleep Quality Index (PSQI).Results: Out of the 60 patients enrolled, 28 (aged 61.46 ± 8.74 years) complete the treatment in the intervention group and 24 (aged 60.42 ± 6.61 years) in the control group. There were no significant differences in AHI between groups. A significant difference was reported for ΔT0-T1 SpO2 (p = .01), T90 (p = .030), ΔT0-T1 and ΔT0-T2 snoring index (p = .026 and <.001 respectively), and ΔT0-T1 and ΔT0-T2 Pittsburgh Sleep Quality Index (p = .003 and <.001 respectively). Conclusion:Taken together, a combination of oro-facial myofunctional therapy and myofascial release showed a potential treatment for sleep quality in patients with mild OSA. Future studies are necessary to better investigate the role of these interventions in OSA patients.