Background: Chemotherapy, as well as opioid and antiemetic drugs, can contribute to constipation in oncological patients. This systematic review aims to analyse the potential of specific rehabilitation strategies and alternative strategies for improving constipation symptoms, with the goal of incorporating these strategies into a dedicated protocol for managing cancer-related constipation. This could potentially reduce the dosages of or eliminate the need for constipation medications. Methods: A systematic search was conducted on PubMed, Scopus and Web of Science. The review included studies analysing constipation complaints in cancer patients treated with rehabilitation, acupuncture and osteopathy. Results: The review included 16 studies in line with PRISMA and PICOS criteria. Most studies showed that physical exercise, abdominal massage, TENS, acupuncture and education on the correct defecation position positively impacted the management of constipation and quality of life in oncological patients. A physiotherapy program involving massages as well as aerobic and resistance training improved constipation in oncological women, regardless of age, sex and frailty. A combination of abdominal massage, abdominal muscle stretching and education on proper defecation position alleviated the severity of constipation and related depression. However, the outcomes regarding TENS were yet inconsistent. Another technique, becoming increasingly common for constipation, and demonstrating positive results, involved stimulating trigger points through acupressure and acupuncture. Conversely, osteopathic and superficial manipulations more frequently required constipation medications than did the other alternative approaches. However, no existing studies have proposed a specific protocol to manage cancer-related constipation. Conclusions: The results of the studies confirm the positive influences of rehabilitation, osteopathy and acupuncture on constipation and pain in oncological patients. Nevertheless, further studies are required to establish the best type, timing and duration of treatment, as well as how the stage and location of the cancer and the cause of constipation (drug-induced or functional) impact the results.

Background: Knee osteoarthritis (OA) is a prevalent condition among adults that leads to knee joint pain and dysfunction. Over the past two decades, local intra-articular knee injection therapy has gained popularity due to the advent of platelet-rich plasma (PRP), hyaluronic acid (HA), and the novel peripheral blood-derived mononuclear cells (PBMNCs). This study aimed to compare the therapeutic efficacy of intra-articular injections of PBMNCs, HA, and PRP combined with hyaluronic acid (PRP-HA) for treating degenerative knee OA classified as stages II and III, according to the Kellgren and Lawrence (KL) scale. Methods: This retrospective observational study involved adults with moderate-to-moderately severe knee OA treated at the University Hospital of Catania, Italy. The subjects were divided into three groups and treated with intra-articular injections of HA, PRP-HA, or PBMNCs. The outcome measures assessed were as follows: the Numerical Rating Scale, the Western Ontario and McMaster Universities Arthritis Index, the Timed Up and Go, the International Knee Documentation Committee score, a 10-meter walking test, and the Physical score and the Mental score on the SF-12. This study included a total of 46 adults, 30 females and 16 males, with a mean age of 63.7 ± 10.9 years. Results: HA, PRP-HA, and PBMNCs demonstrated comparable effectiveness for improving the NRS score and all the other outcomes at 6 months. Additionally, PRP-HA and PBMNCs also enhanced knee flexion and the International Knee Documentation Committee score. However, none of the three treatments led to a significant improvement on the 10-meter walking test. No serious adverse effects were reported. Conclusions: In this study, injections of HA, PRP-HA, and PBMNCs all demonstrated positive outcomes for up to 6 months post-treatment in the subjects suffering from knee OA.

Background: Research on the combined effects of Naldemedine and targeted rehabilitation for managing opioid-induced constipation (OIC) is limited. This retrospective study aims to explore their use in chronic pain patients with OIC. Methods: The study examined 53 patients with OIC, comparing outcomes between those receiving Naldemedine with targeted physical exercise (28 in Naldemedine + Rehabilitation group) and those receiving Naldemedine alone (25 in Naldemedine alone group). Assessments at baseline (T0), 14 ± 2 days (T1), and three months (T2) included Numerical Rating Scale (NRS), Patient Assessment of Constipation Quality of Life (PAC-QoL) and Bowel Function Index (BFI). Results: Combining Naldemedine with rehabilitation led to higher patient satisfaction at three months compared to Naldemedine alone, while no significant between-group differences were observed in abdominal pain relief or bowel function. After 14 days of treatment, both groups demonstrated improvements in NRS, BFI, PAC-QoL total score, and PAC-QoL subscale for satisfaction ( p = 0.716, p = 0.886, p = 0.585, p = 0.431). After three-month, Naldemedine + Rehabilitation group showed significantly higher satisfaction levels compared to those on Naldemedine alone, as indicated by PAC-QoL total score and sub-score for satisfaction ( p = 0.031, p = 0.0163). Conclusions: The implementation of a combined approach involving targeted physical exercise alongside Naldemedine treatment showed promising results in enhancing patients' satisfaction.