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Purpose To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Italian (ACL-RSI(IT)) and examine and evaluate the psychometric properties of the Italian version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction. Methods The ACL-RSI was forward and back translated, culturally adapted and validated one hundred and twenty nine Italian individuals who had undergone ACL reconstruction (94 males, 35 females; age 28 ± 9 years). All patients completed the translated ACL-RSI, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee subjective knee form (IKDC), Tampa Scale of Kinesiophobia (TSK) and the 12-item short form health survey (SF-12). We then analysed the internal consistency, reliability and validity of the newly formed ACLRSI (IT). Results The ACL- RSI(IT) showed excellent internal consistency (Cronbach’s alpha 0.94) and was significantly correlated with the KOOS ‘quality of life’ ( r = 0.61, p < 0.00001), ‘symptoms’ ( r = 0.34, p < 0.00001), ‘pain’ ( r = 0.44, p < 0.00001), and ‘sports’ ( r = 0.40, p < 0.00001) subscales. The ACL-RSI(IT) also correlated significantly with the IKDC ( r = 0.34, p < 0.001), TSK ( r = − 0.48, p < 0.00001) and SF-12 ( r = − 0.40, p < 0.0001) scores. Conclusion The Italian version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery. Level of evidence II.

Objective Frozen Shoulder (FS) is a musculoskeletal pathology that leads to disability, functional decline, and a worsening in quality of life. Physiotherapists are the primary professionals involved in the treatment of FS, and it is essential to determine if their practice aligns with evidence-based suggestions. Aim The aim is to assess the knowledge, skills, and operational strategies of Italian physiotherapists regarding FS and compare them with the existing literature. Methods A web-based, anonymous, and voluntary cross-sectional survey was developed and administered to Italian physiotherapists to evaluate their clinical practices. Results A total of 501 physiotherapists (38.5% female), completed the survey. More than half were under 35 years old (67.8%), declared working in private practice settings or being self-employed (57.1%), and were primarily engaged with musculoskeletal patients (81.8%). For subjects with FS at their first access, 21.4% identified X-rays as the most useful imaging technique to recognize pathologies beyond rehabilitation competence. In terms of general management, the majority reported working with an orthopaedic or physiatrist (47.5%) or in a multidisciplinary team (33.5%). Regarding manual therapy techniques, 63.3% of physiotherapists preferred intense degree mobilization, posterior direction, and moderate pain at the end of the range of motion for low irritable/high stiffness FS; however, there is a lack of consensus for managing very irritable/low stiffness FS. The majority of physiotherapists (57.7%) concurred that stretching improves the balance between metalloproteinase and its inhibitors. Additionally, 48.3% of physiotherapists selected mobile phone videos and messages to improve patients’ compliance with exercises at home and for motivational/educational purposes. Discussion and Conclusion The clinical practices of Italian physiotherapists in FS subjects sometimes deviate from evidence-based recommendations. While some discrepancies may be attributed to the existing uncertainties in the literature regarding knowledge and management strategies for FS patients, the authors recommend a stronger adherence to evidence-based practice. Implications of Physiotherapy Practice Italian PTs’ clinical practices in FS rehabilitation show partial alignment with evidence-based recommendations, particularly in the areas of diagnostic imaging suggestions and clinical assessment. Italian PTs’ clinical practices exhibit partial adherence to evidence-based suggestions regarding the identification of predisposing factors, staging education, and mobilization modalities in FS cases. Italian PTs with Orthopaedic Manipulative Physical Therapists (OMPT) certification, those possessing clinical experience ranging from 6 to 10 years, and individuals working in private practice demonstrate greater appropriateness in terms of knowledge, competence, and adherence to evidence-based clinical practices for FS rehabilitation.

Background Neck pain and whiplash are prevalent disorders with high socio-economic burden. Beliefs and expectations influence their prognosis, causing chronicisation. We aimed to investigate the perspective of the Italian population. Methods We conducted an online survey among Italian adults recruited through social media. The main outcomes were the Whiplash Beliefs Questionnaire (WBQ) total score and its subscales, recovery expectations, and anxiety/stress items. Independent variables were history of neck pain, whiplash, and associated symptoms, with adjustment for age, gender, marital status, employment, and type of job. Associations were assessed using linear regression for WBQ outcomes and proportional odds logistic regression for recovery expectations and anxiety/stress. Results One thousand thirty-four participants were included. Most responders were women (65%, n  = 673) between 35 and 50 years of age (37.6%, n  = 389) and reported working more than 6 h as a white-collar worker (39.7%, n  = 411). Most responders reported negative thoughts about the impact on quality of life (61.9%) and work (31.8%-30.2%). Many distrusted surgery (70.3%) medications (69.7%), and painkillers (51.2%). 23%-36% were not sure about the benefit of conservative strategies like exercise or rest (30.1%). The total score for the Whiplash Beliefs Questionnaire was significantly lower (mean difference = -1.82; p  = 0.002; 95% CI -2.98 to -0.66) among those with recent pain compared to laypersons (i.e., asymptomatic healthy individuals); additionally, significantly higher scores were found for recovery pessimism among those with associated symptoms compared to laypersons (mean difference = 0.45; p  = 0.01; 95% CI 0.09 to 0.79). Overall, laypersons exhibited different beliefs compared to those with recent or chronic neck pain. However, coping strategies, treatment pessimism, recovery expectations and anxiety/depression showed no significant differences ( p  > 0.05). Conclusions This study highlights Italians’ perspectives on neck pain and whiplash, showcasing a nuanced relationship between pain and beliefs. Italian responders reported negative beliefs regarding the impact of neck pain/whiplash and agreed that anxiety and stress influence the perception of pain. Recovery pessimism seems to be perceived more by individuals with symptoms. Future research should integrate individual’s experience from qualitative research into quantitative research.

Background The prevalence and cost of musculoskeletal diseases increased dramatically over the past few decades. Therefore, several institutions have begun to re-evaluate the quality of their musculoskeletal educational paths. However, current standardized questionnaires inadequately assess musculoskeletal knowledge, and other musculoskeletal-specific exams have limitations in implementation. The musculoskeletal 30-question multiple choice questionnaire (MSK-30) was proposed as a new tool for assessing basic musculoskeletal knowledge . Aim To analyse basic musculoskeletal knowledge in a sample of Italian physiotherapists by administering the MSK-30 questionnaire. Methods After a transcultural adaptation process, the MSK-30 was developed and administered to Italian physiotherapists to assess their musculoskeletal knowledge. Participants were invited to participate in the survey via the SurveyMonkey link. Mann-Whitney test and the Kruskal-Wallis test with Bonferroni correction were used to observe the differences between groups in the MSK-30 scores. Results Four hundred-fourteen ( n =414) physiotherapists participated in the survey. The median MSK-30 value was higher in physiotherapists who attended the International Federation of Orthopaedic Manipulative Physical Therapists postgraduate certification than in those who attended unstructured postgraduate training in musculoskeletal condition or in those who had not completed any postgraduate training in this field ( p <0.001). Conclusions This work demonstrates significant differences in the management of musculoskeletal disorders between those with specific postgraduate university education and those without. The findings can contribute to the advancement of the physiotherapy profession in Italy. Authors recommend further research with more robust methodologies to deeper understand this topic. Musculoskeletal conditions will continue to represent a significant portion of primary care visits, and future generations of physiotherapists must be prepared to address this challenge.

Background Artificial Intelligence (AI) Chatbots (e.g., ChatGPT, Microsoft Bing, and Google Bard) can emulate human interaction and may support physiotherapy education. Despite growing interest, physiotherapy students’ perspectives remain unexplored. This study investigated Italian physiotherapy students’ knowledge, use, and perception of the benefits and limitations of AI Chatbots. Methods A cross-sectional study was conducted through Survey Monkey from February to June 2024. One thousand five hundred and thirty-one physiotherapy students from 10 universities were involved. The survey consisted of 23 questions investigating: (a) respondent characteristics, (b) AI Chatbot knowledge and use, (c) perceived benefits, and (d) limitations. Multiple-choice and Likert-scale-based questions were adopted. Factors associated with knowledge, use, and perceptions of AI were explored using logistic regression models. Results Of 589 students (38%) that completed the survey, most were male ( n  = 317; 53.8%) with a mean age of 22 years (SD = 3.88). Nearly all ( n  = 561; 95.3%) had heard of AI Chatbots, but 53.7% ( n  = 316) never used these tools for academic purposes. Among users, learning support was the most common purpose ( n  = 187; 31.8%), while only 9.9% ( n  = 58) declared Chatbot use during internships. Students agreed that Chatbots have limitations in performing complex tasks and may generate inaccurate results (median = 3 out of 4). However, they neither agreed nor disagreed about Chatbots’ impact on academic performance, emotional intelligence, bias, and fairness (median = 2 out of 4). The students agreed to identify the risk of misinformation as a primary barrier (median = 3 out of 4). In contrast, they neither agreed nor disagreed on content validity, plagiarism, privacy, and impacts on critical thinking and creativity (median = 2 out of 4). Young students had 11% more odds of being familiar with Chatbots than older students (OR = 0.89; 95%CI 0.84–0.95; p  = < 0.01), whereas female students had 39% lesser odds than males to have used Chatbots for academic purposes (OR = 0.61; 95%CI 0.44–0.85; p  = < 0.01). Conclusions While most students recognize the potential of AI Chatbots, they express caution about their use in academia. Targeted training for students and faculty, supported by institutional and national guidelines, could guarantee a responsible integration of these technologies into physiotherapy education. Trial registration Not applicable.

Introduction: While low back pain (LBP) is most often associated with musculoskeletal issues, in a minority of cases, it can be caused by serious underlying conditions such as cancer. Recognizing malignancy early remains a major clinical challenge, as the warning signs, known as red flags (RFs), are often vague and inconsistent. Methods: A comprehensive search of six databases (PubMed, Scopus, Google Scholar, Web of Science, Cochrane Library, and SciELO) and grey literature was conducted for studies published from January 1999 to March 2025. Eligible sources included studies describing adult patients with cancer presenting with LBP. Study selection and data extraction were independently performed by two reviewers. Results: We included 70 studies, most of which were case-based, along with reviews and observational research. In these studies, cancer prevalence among patients with LBP ranged from 0.1% to 1.6%, with metastatic disease being the most common finding. A prior history of cancer emerged as the most reliable red flag (specificity up to 0.99), while other signs and symptoms were less consistent. Notably, combining multiple RFs, such as a history of cancer and unexplained weight loss, significantly improved the diagnostic accuracy (LR+ = 10.25 in one study). Conclusions: While current evidence is limited and largely based on case-based studies, some RFs, particularly a history of cancer, show greater diagnostic value. In patients with LBP associated with underlying malignancy, RFs seem to be more useful for ruling in rather than ruling out (i.e., screening) serious pathologies. Most RFs have poor standalone accuracy; however, considering combinations of RFs within the broader clinical context may improve early detection of spinal malignancy in patients with LBP.

Background: Tendinopathy is a degenerative condition caused by mechanical overload, accounting for approximately 30% of musculoskeletal healthcare cases. It progresses through a process characterized by collagen disorganization, altered vascularization, and neuronal ingrowth. Traditional conservative treatments, such as therapeutic exercises, non-steroidal anti-inflammatory drugs, and physical therapies, are useful, but their effectiveness is sometimes only partial and there is a need to search for new potential solutions. Recent interest in oxygen–ozone (O2-O3) therapy stems from preliminary observations suggesting potential anti-inflammatory and regenerative effects. Nevertheless, its clinical role remains speculative and warrants thorough investigation beyond anecdotal evidence. Considering the heterogeneity of clinical presentations and treatment responses among patients, O2-O3 therapy has been proposed as a promising tool for tailoring personalized treatment strategies for tendinopathy. This review critically appraises the available literature concerning the mechanistic rationale and clinical applications of O2-O3 therapy in tendinopathy, with attention to both its theoretical underpinnings and the quality of empirical evidence. Methods: A literature search was conducted on O2-O3 therapy for tendinopathy using PubMed, Cochrane, and Embase, filtering for full-text articles published between 2004 and 2024. Recent clinical trials were included irrespective of evidence level, while excluding systematic reviews, duplicates, and irrelevant studies. Results: Ozone has been shown to modulate oxidative stress, promote neovascularization, and suppress pro-inflammatory cytokines. Both clinical and in vivo studies indicate that O2-O3 therapy relieves pain, enhances tendon healing, and improves biomechanical properties. Some comparative studies suggest that O2-O3 therapy might provide more sustained symptoms control than corticosteroids, but the heterogeneity of follow-up durations and outcome measures prevents definitive conclusions. Conclusions: O2-O3 therapy emerges as a potentially valuable adjunct in the management of chronic tendinopathy, particularly in cases unresponsive to conventional treatments. However, its clinical role remains to be clearly defined and its possible role in personalized medicine needs further exploration, particularly in relation to patient stratification and individualized treatment protocols. Further high-quality randomized controlled trials are warranted to validate its efficacy, determine long-term outcomes, and standardize treatment protocols to ensure safety and reproducibility.

Background Valid and reliable patient-reported outcome measures support health professionals in evaluating the results of clinical research and practice. The Copenhagen Neck Functional Disability Scale (CNFDS) has shown promising measurement properties to measure disability in patients with neck pain, but an Italian version of this questionnaire is not available. The objective of this study was to cross-culturally adapt the CNFDS into Italian (CNFDS-I), and to assess its validity and reliability in patients with neck pain. Methods The CNFDS-I was developed according to well-established guidelines for cross-cultural adaptation of patient-reported outcome measures. A cross-sectional clinimetric study was conducted to evaluate its validity and reliability. Patients with chronic neck pain (pain > 3 months) participated in this study. The following measurement properties (defined by the COSMIN initiative) were assessed: structural validity (exploratory factor analysis), internal consistency (Cronbach’s α), construct validity [by testing hypotheses on expected correlations with the Neck Disability Index (NDI), the Neck Bournemouth Questionnaire (NBQ), and pain Visual Analogue Scale (VAS)]. Test-retest reliability [Intraclass Correlation Coefficient for agreement (ICCagreement)], and measurement error [Smallest Detectable Change (SDC)] were also assessed in 50 clinically stable patients. Floor/ceiling effects and acceptability were calculated. Results One-hundred and sixty-two patients (mean age = 47.9 ± 14.5 years, 70% female) were included. The CNFDS-I exhibited sufficient unidimensionality (one factor explained 83% of the variability) and internal consistency (α = 0.83). Construct validity was sufficient as all correlations with the other questionnaires were as expected ( r  = 0.846 with NDI, r  = 0.708 with NBQ, r  = 0.570 with VAS). Test-retest reliability was excellent (ICCagreement = 0.99, 95% CI from 0.995 to 0.999), while measurement error was equal to 8.31 scale points (27% scale range). No floor/ceiling effects were detected. The average time for filling the questionnaire was two minutes. Conclusions The CNFDS-I proved to be a valid and reliable outcome measure to assess disability in patients with chronic neck pain. Head-to-head comparison studies on the CNFDS-I measurement properties against other disability measures for neck pain (e.g. NDI and NBQ) are required to determine the relative merits of these different measures.

Idiopathic chronic neck pain is a highly disabling musculoskeletal condition. Immersive virtual reality shows a promising efficacy in the treatment of chronic cervical pain through the mechanism of distraction from the pain. This case report describes the management of C.F., a fifty-seven-year-old woman, who suffered from neck pain for fifteen months. She had already undergone a cycle of physiotherapy treatments including education, manual therapy, and exercises, following international guidelines. The patient’s poor compliance did not allow adherence to the exercise’s prescription. Home exercise training through virtual reality was therefore proposed to the patient to improve her adherence to the treatment plan. The personalization of the treatment allowed the patient to resolve in a short time period her problem and return to live with her family peacefully.

Several studies reported the efficacy of exercise therapy in hand and wrist tendinopathy. However, no systematic review synthesized the effect of exercise therapy on these patients. This study aimed to perform a systematic review to summarize evidence if exercise therapy may be considered an effective treatment in conservative management for patients with hand and wrist tendinopathy. This was a systematic review. A literature search in MEDLINE, Cochrane Library, PEDro, and Embase was conducted from their inception until April 10, 2022. Two independent reviewers included the studies administering exercise therapy in patients with hand and/or wrist tendinopathy in the review and extrapolated the data. Methodological quality was assessed using the framework developed by Murad et al for case reports and case series and the PEDro score for clinical trials. Seven case reports, 3 case series, and 2 randomized controlled studies were included and methodologically evaluated, obtaining a low score for all the analyzed studies. The total number of included patients in the analyzed studies was 106, of which 54 were female, 13 were male, and 39 were not specified. The type of exercise was widespread and often not really well described: it varies from eccentric forearm training to mobilization with movement, passing through strengthening exercises, grip proprioception training, and self-management exercises according to the McKenzie method. The dosage was often not precise, making it difficult to reproduce the therapeutic proposals. Exercise therapy was always administered together with different treatments; therefore, its efficacy alone is difficult to distinguish, although in some cases, the patients improved pain and functionality. Evidence on the efficacy of exercise therapy in patients with hand and wrist tendinopathies is limited. Future research is strongly recommended to determine the appropriate dosage of the exercise therapy to determine clinical changes in these patients. •Exercise therapy for wrist and hand tendinopathies is widespread used, but no systematic review summarized evidence.•In literature, the type of exercise was heterogeneous and often not really well described.•Exercise therapy was always administered together with different treatments.•Efficacy of exercise therapy alone is difficult to distinguish, although in some cases, studies reported an improvement of pain and functionality.