Background: Spinal cord injury is a multisystem disease which compromises independence and quality of life; remote care models represent an opportunity for long-term management of complications. The aim of this study was to explore remote care models for chronic spinal cord injury patients. Methods: A systematic review of the literature was carried out. Five databases (PubMed, CINAHL, Web of Science, Cochrane Library, Google Scholar) were systematically explored with a time limit of five years. Included studies were assessed using Jadad Score and PEDro Scale. Results: Four RCTs were included in this systematic review. In all studies, multidisciplinary home care supported by technology were compared with in-person models. Remote care models were effective in managing pressure injury, infection, and muscle atrophy and improve quality of life. Conclusions: Remote care models can be a key tool for improving self-efficacy, decreasing hospitalizations and preventing long-term mortality.

Spinal cord injury (SCI) represents a complex pathological event, which requires continuous and highly specialized territorial interventions. The literature highlights disadvantages faced by people with SCI in accessing local services. This study aimed to investigate the concept of territorial continuity for SCI, reconstructing patients and healthcare professionals’ perspectives, to identify facilitators, barriers and opportunities. Methods: a Focus Group (FG) qualitative study was conducted at Piacenza Ausl; four FGs were carried out; a research team member moderated FGs using thematic guides, while an observer was responsible for noting non-verbal aspects. Meetings lasted between 90 and 120 min and were audio-recorded. Transcript analysis involved the identification of units of meaning, which were grouped into general themes. Results: Final analysis highlighted 435 verbatim, grouped into 21 initial themes, that converged into 5 emerging themes: “SCI continuity as multidisciplinary teamwork”; “The need for rehabilitation as a driver of territorial continuity”; “Reinventing everyday life after SCI”; “Barriers and facilitators”; and “The future of territorial care”. Discussion: Patients and healthcare professionals highlighted the absence of a defined treatment path and the lack of reference points, thus generating disorientation and need for information. Among the proposals, telemedicine, empowering the case manager’s role, promoting specific training courses and rethinking community hospitals were supported.

Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles’ endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future.

Background: Animal-assisted activities (AAA) are participative interventions, designed to lower hospitalization-related stress and anxiety, enhance communicative readiness, improve quality of life and encourage human–animal interaction. The aim of the present study was to evaluate AAA effects in the context of intensive rehabilitation of patients with spinal cord injury (SCI), traumatic brain injury (TBI), stroke. Methods: AAA in this study were structured by a local specialized association, for small groups of patients (5/7 a time), biweekly; each session lasted 60 min. Each patient participated in 10 sessions of AAA. Evaluation rating scales were administered at T0 (before the first session) and T1 (after the last session, five weeks later) as follows: Neurobehavioral Rating Scale (NRS) in case of patient with stroke/TBI without disorder of consciousness; Hospital Anxiety and Depression Scale (HADS) for SCI patients. Results: A total of 50 patients concluded the study. NRS score for joined TBI and stroke populations varied from a T0 mean value of 32.34 [C.I. 26.83–37.35] to 17.21 [C.I. 12.66–21.76] (46.7%); this difference proved to be statistically significant (p = 0.000). Stroke patients had a 57.6% NRS lowering by mean 28.10 [C.I. 20.55–35.65] points to 12 [C.I. 6.6–17.36], which was significant (p = 0.000); similarly, TBI patients showed a mean decrease of 35.8% points from the initial 41.6 points [C.I. 37.29–45.93] to 26.76 [C.I. 21.94–31.59] (p = 0.002). As for HADS scores a smaller improvement was found in the cohort of SCI patients: anxiety registered a 1 mean point decrease at T1 (21.5%), from the initial 6.5 points [C.I. 3.80–9.34] to 5.1 ones [C.I. 3.17–7.11]. This variation was near the threshold of significance (p = 0.05). Depression domain, instead, improved by 2.35 mean points (37%), from the 6.35 initial points [C.I. 3.45–9.26] to the final 4 [C.I. 2.15–5.98] with reaching of a significant p value (p = 0.03). ANCOVA did not confirm this last value and showed no influence of age and gender on outcome variations. Discussion: AAA showed preliminary evidence to decrease neurobehavioral disorders in patients with high-complexity neurological diseases, particularly stroke and TBI. The role of AAA in SCI patients remains unclear. Future studies should address confounders’ role for these populations, particularly severity of disease. Furthermore, AAA interventions will have to be studied on larger samples, deepening the exact phase to introduce AAA for neurological patients. Lastly, qualitative studies are needed to explore patients’ lived experiences.