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On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 corovirus that spread from Chi between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Corovirus disease 2019) with the need of semi-intensive and intensive care units.

Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

BackgroundSeveral systematic reviews (SRs) assessing the effectiveness of superficial physical agents have been published, but the evidence about their safety remains controversial.ObjectiveTo identify areas where there is evidence of the safety of physical agents by a scoping review.DesignFour databases were systematically searched for including English SRs that explored and reported safety in terms of adverse events (AEs) related to the application of physical agents in outpatient and inpatient physical medicine and rehabilitation settings managed by healthcare professionals, published in January 2011–29 September 2021. The severity of AEs was classified according to the Common Terminology Criteria. Then, AE findings were summarised according to the SR syntheses. Finally, the reporting of the certainty of the evidence was mapped.ResultsOverall, 117 SRs were retrieved. Most of the SRs included randomised controlled trials (77%) and patients with musculoskeletal disorders (67%). The most investigated physical agents were extracorporeal shock wave therapy (ESWT) (15%), transcutaneous electrical nerve stimulation (13%) and electrical stimulation (12%). No AE (35%) was reported in one-third of the included primary studies in SRs, whereas few severe AEs occurred in less than 1% of the sample. Among physical agents, ESWT showed an increased risk of experiencing mild AEs compared with the control. Most SRs reported a qualitative AE synthesis (65.8%), and few reported the certainty of the evidence (17.9%), which was mainly low.ConclusionWe found evidence of safety on several physical agents coming mostly from qualitative synthesis. No significant harms of these interventions were found except for ESWT reporting mild AEs. More attention to the AEs reporting and their classification should be pursued to analyse them and assess the certainty of evidence quantitatively.Review registration https://osf.io/6vx5a/.

ObjectiveA shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based statements about the safety of PAMs.Study design and settingA RAND-modified Delphi Rounds’ survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%.ResultsOverall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17–36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups.ConclusionsThe resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.

To explore the knowledge, use, attitudes towards Evidence-based Medicine, also known as Evidence-based Practice (EBP), and perceived barriers to its dissemination among physiotherapists. Cross-sectional study. Members of the Italian Association of Physiotherapists (n=2000) were invited to participate in an online survey about EBP knowledge and use. The survey questionnaire comprised four sections: (1) respondent characteristics; (2) knowledge of EBP principles; (3) attitude, use and perceived effectiveness of EBP; (4) perceived barriers to implementing EBP in clinical practice. Out of 2000 physiotherapists, 1289 participated in the survey (64.5% response rate). Overall, 90% perceived EBP as useful and necessary for their clinical practice. More than 85% stated that they were familiar with the principles of EBP, 75% reported that they were able to search online databases for relevant information and 60% reported that they were able to understand statistical analyses. However, 56% believed that patient preferences and 39% that clinical expertise are not part of the EBP model. Half stated that they understood and could explain the term 'meta-analysis' but only 17% knew what a forest plot is and just 20% correctly judged the finding of a given meta-analysis. Lack of time was reported as the main barrier to EBP. The majority of Italian physiotherapists overrated their knowledge about EBP, demonstrating a gap between perceived and actual knowledge of EBP in this population.

[...]the highly specialized physician plays a key role when patients are referred for advanced management in the secondary care line. [...]PTs have also been shown to possess the ability for higher selection accuracy for appropriate orthopedic consultation referral for those patients in need of more specific interventions [6,27]. Notably, PTs possessing a musculoskeletal specialization were observed to have higher knowledge for the management of MSD than licensed colleagues [26]. [...]according to “article 6 of Law 43 of the 1st of February 2006” [28], the musculoskeletal specialization in physical therapy is earned during a two years postgraduate program (namely, a Master degree), which follow international educational standards [29]. [...]Moretti et al. questioned the autonomy and the diagnosis of physical therapists in Italy.

BackgroundEvidence-based practice (EBP) is being rapidly adopted by the Italian physiotherapy community, although a knowledge gap persists at clinical level with consequent lack of integration of EBP into ground roots practice. Teaching of EBP during the Bachelor of Science (BSc) undergraduate course in physiotherapy likely has a vital role to play in the spread of knowledge, providing a grounding in the fundamental concepts of EBP.The aim of the present study was to investigate the prevalence of EBP educational content in Italian BSc courses in physiotherapy.MethodsThis is a cross-sectional study during which characteristics of EBP teaching in BSc degree courses of physiotherapy in Italy were collected from institutional websites during the period May to September 2021 with an update in August 2022. We used the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for our manuscript.ResultsForty-two physiotherapy BSc degree programs were retrieved, accounting for all the BSc delivered in the 2021–2022 academic year. Fourteen of these (33.3%) did not report EBP content. Northern universities provided EBP content in 16 out of 18 (88%) degree courses. Central Italian universities provided EBP content in 6 out of 9 (66.6%) degree courses. Southern universities delivered EBP content in 3 out of 9 (33.3%) degree courses. The universities of Sicily and Sardinia provided EBP content in 2 out of 5 (40%) degree courses.The degree courses taught in public universities were more likely to contain EBP material (25 out of 37, 67.4%), compared to those taught within the private system (3 out of 5, 60%).ConclusionsThe prevalence of EBP content within physiotherapy BSc degree programs in Italy can be considered suboptimal, with both regional differences and according to the system (public vs private). The results of this study could be used as a stimulus for increasing investment in the teaching of EBP in Italian physiotherapy degree courses, thereby improving educational standards.

Unvegetated sediment bars are central to river morphodynamics but are rarely used as indicators of channel dynamicity in satellite‐based studies. Linking sediment dynamics and river lateral mobility requires monitoring sustained changes in both water and sediment—the active channel (AC)—to avoid stage‐dependent noise. Yet, such monitoring remains rare. We introduce an automated, globally applicable approach that detects and quantifies activation (erosion) and deactivation (vegetation colonization) by tracking multi‐year sustained AC directional shifts from Sentinel‐2 imagery. Applied to the Po River (Italy), this approach captures trajectories across different morphologies, distinguishing lateral mobility, widening, and narrowing from changes caused by stage‐dependent hydrological forcing. Results identify the exposed sediment‐to‐water ratio as a strong predictor of AC dynamicity, with sediment‐rich reaches showing greater instability and responsiveness to hydrological variations. Our findings demonstrate that incorporating sediment areas alongside the water channel improves understanding of river dynamics, with implications for river restoration and risk mitigation.

The active channel of alluvial rivers delineates areas of geomorphic activity over a defined time window. While increasing satellite data availability enables monthly active channel delineations, multi‐year analyses often rely on temporal aggregates (e.g., annual medians) to reduce computational costs and intra‐annual variability. The potential of monthly information to improve active channels delineation and geomorphic interpretation remains largely unexplored. In this work, we delineated active channels for the Po River (Italy) by aggregating monthly Sentinel‐2 classifications of river water and sediment bars into annual frequency maps at 10 m resolution. Annual aggregation mitigated monthly sediment underestimation (12%) but also amplified model overestimation biases (15%). Monthly classification persistence (e.g., classified as active channel for more than N months/year) was then used to reduce these errors and produce active channel areas that closely match those manually delineated from 30 cm orthophotos. The spatiotemporal variability of monthly classifications also show that the active channel area of dynamic reaches can vary ∼50% over the year. These changes revealed areas most prone to water‐stage fluctuations, sediment transport, as well as zones seasonally or progressively colonized by vegetation—patterns hidden in single orthophotos or annual medians. Less dynamic reaches, by contrast, showed minimal differences between annual and monthly‐based delineation methods. These findings emphasize the importance of adapting temporal aggregation to the river type and process analysed, with sub‐annual resolutions better capturing, in dynamic rivers, seasonal and progressive active channel reconfigurations, along with their interaction with sediment and vegetation dynamics. Plain Language Summary Active river channels show where the river has shaped its bed over a certain time. With today's frequent satellite observations, active channels can be monitored monthly. Yet, long‐term studies still use yearly maps built on summer images or annual medians to reduce processing time and smooth seasonal changes. The role of monthly information in improving annual active channel delineation and better understanding river processes remains unexplored. Here, we mapped yearly active channels of the Po River (Italy) by aggregating Sentinel‐2 monthly classifications of river water and sediment bars. Using the persistence in which a pixel was classified as active channel during the year, we automatically smoothed some classification errors and bias. Monthly data also revealed significant intra‐annual variability, with dynamic reaches changing their active channel area by nearly 50% over the year—dynamics that are missed in single annual images. In less dynamic reaches, results are instead similar whether using monthly or annual data. Overall, results show that in dynamic river reaches sub‐annual data better identify when and how sediment–vegetation interactions start shaping active channel reconfiguration and migration—a mirror to the river's ecological functioning and sediment transport dynamics. Key Points The potential of monthly satellite data to improve spatial and temporal accuracy in annual active channel delineations remains underexplored Using areas persistently classified (>months/year) as active channel throughout a year can improve annual active channel delineations Monthly information reveals intra‐annual active channel variations mostly in dynamic reaches, highlighting seasonal and progressive dynamics

The brown marmorated stink bug, Halyomorpha halys (Stål) (Hemiptera: Pentatomidae), is an invasive polyphagous pest often observed in vineyards. In Europe, a gap needs to be filled in the knowledge on H. halys seasonal dynamics and damage on grapes. With this study, we described the seasonal dynamics of H. halys and its distribution in multi-cultivar vineyards, and we evaluated the damage on grape clusters induced by different pest densities. In vineyards, the seasonal occurrence of H. halys varied across time and grape cultivars, and the pest was more abundant on Cabernet Franc, Merlot and, to a lesser extent, Pinot gris. Moreover, higher densities of H. halys were found on red berry cultivars than on white ones, and on cultivars ripening late in the season. An edge effect was also detected in pest distribution within vineyards, with more stink bugs observed in the borders. In the study on pest infestation density, H. halys caused damage on berries, showing differences in susceptibility among different cultivars and with regard to the time of infestation (i.e., plant phenological stages). Halyomorpha halys infestation induced an increase in Botrytis cinerea and sour rot incidence, which probably represents the main issue related to the impact of brown marmorated stink bug on grapevine.