Carlotte Kiekens

• MD
• Researcher at Istituto Ortopedico Galeazzi

Introduction: This review aimed to collect the current evidence from the Cochrane systematic reviews (CSRs) concerning interventions for rehabilitation of people with amputation, in the context of the World Health Organization - Package of Interventions for Rehabilitation. Evidence acquisition: The Cochrane Rehabilitation team led the CSRs' sear...

Medicine has become increasingly receptive to the use of artificial intelligence (AI). This overview of systematic reviews (SRs) aims to categorise current evidence about it and identify the current methodological state of the art in the field proposing a classification of AI model (CLASMOD-AI) to improve future reporting. PubMed/MEDLINE, Scopus, C...

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Prac...

Cochrane Rehabilitation bridges rehabilitation research and the Cochrane community to enhance evidence dissemination and research quality. The year 2022 marked its sixth anniversary with a revision of its mission, vision, and goals. Knowledge translation towards the global south and health policymakers, and research education will be focused more....

Background: While the importance of the upper and lower limbs in locomotion is well understood, the kinematics of the trunk during walking remains largely unexplored. Two decades ago, a casual observation was reported indicating spine lengthening in a small sample of mostly children during walking, but this observation was never replicated. Objecti...

The global demand for end-stage hip and knee osteoarthritis surgical treatment is rising, as is the need of optimal postoperative rehabilitation. Patient stratification is key to provide rehabilitation professionals and policy makers with real-life data in support of early discharge planning and continuous care provision. The aim of this retrospect...

Randomized controlled trials (RCTs) are considered the gold standard of evidence guiding intervention selection in rehabilitation. However, conduct of sufficiently powered RCTs in rehabilitation can be expensive, pose ethical and attrition concerns when participants are assigned to ineffective treatment as usual conditions, and are infeasible with...

Introduction In 2022, Cochrane Rehabilitation developed a new definition of rehabilitation for research purposes with 80 global stakeholders, aiming to support and improve the production and reporting of primary and evidence‐synthesis rehabilitation studies. Objective 1. To compare how Cochrane Systematic Review (CSR) authors describe rehabilitati...

Throughout 2023, Cochrane Rehabilitation’s primary focus was on the Fifth Cochrane Rehabilitation Methodological Meeting, aiming to improve the current state of evidence in rehabilitation, enhancing comprehension of evidence production and synthesis for practical application, and exploring various study designs. Ongoing projects were advanced, such...

According to Cochrane Rehabilitation's recently published definition for research purposes, rehabilitation is inherently complex. Rehabilitation teams frequently implement multiple strategies concurrently, draw on input from a range of different health professionals, target multiple outcomes, and personalize therapeutic plans. The success of rehabi...

Objectives: This overview of Cochrane Systematic Reviews (CSRs) reports on current evidence and its certainty of the effectiveness of interventions for the rehabilitation of people with ischemic heart disease (IHD), included in the World Health Organization Rehabilitation Programme Package of Interventions for Rehabilitation. Methods: We included a...

Objective: To describe the 2-year functional outcomes of nerve transfer (NT) for upper extremity reanimation. Study design: A prospective case series. Setting: A highly specialized rehabilitation hospital for spinal cord injury (SCI) in Italy. Intervention: Upper limb nerve transfer (32 NTs, 15 upper limbs). Participants: Twelve male indiv...

Introduction: The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. Aim: The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telere...

Background and Objectives. This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for persons with upper limb fractures (ULFs), and the quality of the evidence. Materials and Methods. Following the inclusion criteria defined by the World Health Organization, all CSRs tagg...

Rehabilitation providers and policymakers need valid evidence to make informed decisions about the healthcare needs of the population. Whenever possible, these decisions should be informed by randomized controlled trials (RCTs). However, there are circumstances when evidence needs to be generated rapidly, or when RCTs are not ethical or feasible. T...

Research on health policy, systems, and services (HPSSR) has seen significant growth in recent decades and received increasing attention in the field of rehabilitation. This growth is driven by the imperative to effectively address real-life challenges in complex healthcare settings. A recent resolution on 'Strengthening rehabilitation in health sy...

This study aimed to synthesize evidence from studies that addressed the influence of bias domains in randomized controlled trials on rehabilitation intervention effect estimates and discuss how these findings can maximize the trustworthiness of an RCT in rehabilitation. We screened studies about the influence of bias on rehabilitation intervention...

The paper introduces the Special Sections of the European Journal of Physical and Rehabilitation Medicine dedicated to the 5th Methodological Meeting of Cochrane Rehabilitation. It introduces Cochrane Rehabilitation; its vision, mission and goals; discusses why the Methodological Meetings were created; and reports on their organisation and previous...

Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote...

Background: Venous thromboembolism (VTE) is an important complication in rehabilitation practice despite preventive measures. The management can be complicated because patients may have co-existing cardiovascular comorbidities. Objective: To assess the effects of antiplatelet agents in addition to current best medical practice (BMP) compared to...

In May 2023, the historic Resolution on Strengthening Rehabilitation in Health Systems was adopted unanimously by the 194 Member States of the World Health Assembly (WHA), the highest health policy-setting body. The resolution aims to scale up and integrate rehabilitation into health systems as part of Universal Health Coverage (UHC) to address the...

Study design: Prospective cohort study. Objectives: To investigate the sensitivity to change and prognostic validity of Trunk Control Test (TCT) and Thoracic-Lumbar Control Scale (TLC) in terms of mobility in persons with motor complete thoracic spinal cord injury (SCI). Setting: Participants were recruited at an Italian SCI rehabilitation fac...

Objective: As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries. Design: Exploratory cross-sectional survey. Subjects...

Background: Functioning is considered a third indicator of health and a key outcome in rehabilitation. A universal practical tool for collecting functioning information is essential. This tool would be ideally based on the International Classification of Functioning, Disability and Health. Aim: To report the results of the development of country...

Aim This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence. Method Following the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database...

Introduction: Due to the development of the academic field of prosthetics and orthotics (P&O) in recent years, scientific studies in this domain have increased. However, relevant published studies, especially randomized controlled trials (RCTs), are not always of acceptable quality. Therefore, this study aimed to evaluate the methodological and re...

Background: To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recov...

Introduction: Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post-COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" comin...

Cochrane Rehabilitation developed a series of actions to provide the global rehabilitation community with the best available evidence to respond to the COVID-19 pandemic. These initiatives constituted the REH-COVER (Rehabilitation COVID-19 evidence-based response) action. In March 2020, the first initiative started in agreement with the European Jo...

Introduction: Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post-COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" comin...

Introduction: Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" comin...

Introduction: Currently, no evidence exists on specific treatments for post COVID-19 condition (PCC). However, rehabilitation interventions that are effective for similar symptoms in other health conditions could be applied to people with PCC. With this overview of systematic reviews with mapping, we aimed to describe the Cochrane evidence on reha...

Study design: Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol. Setting: Tertiary Reh...

Background Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that...

This paper is supported and co-published by the following journals, and their Editors in Chief: Annals of Physical and Rehabilitation Medicine − Dominic Pérennou American Journal of Physical Medicine & Rehabilitation − Walter Frontera Developmental Neurorehabilitation − Wendy Machalicek European Journal of Physical and Rehabilitation Medicine − Ste...

Objective: To systematically map the current evidence about the characteristics of health systems, providers and patients to design rehabilitation care for post coronavirus disease 2019 (COVID-19) condition. Methods: We conducted a scoping review by searching the databases: MEDLINE®, Embase®, Web of Science, Cochrane COVID-19 Registry and Cochra...

There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the he...

Background: Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool...

Objective This paper aims to describe the evidence on rehabilitation interventions for persons with spinal cord injury (SCI) identified in Cochrane Systematic Reviews (CSRs) selected for inclusion in the WHO PIR. Data Sources The CSRs search was led by Cochrane Rehabilitation team, using the tagging process, using the terms “spinal cord injury” an...

Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: (1) support the conduct of primary studies and systemat...

Objective: Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies a...

Spinal dysraphism (SD) or Spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medici...

Introduction Peroneal nerve entrapment is a frequent cause of foot drop. Despite being frequent, no guidelines exist to recommend surgical or non-invasive treatment, leading to important variations in daily practice. Research question To map variation in daily practice. Materials and methods An online Qualtrics survey was distributed among neuros...

Objective: Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extens...

Background: Sexual dysfunction (SD) is experienced by 50% of stroke survivors, and it is identified as critical in their rehabilitation management, but often remains unaddressed. Objective: To evaluate the effectiveness and adverse events of currently available interventions for SD following stroke. Methods: A summary of the Cochrane Review by...

Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systemati...

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient...

Case description: The jumping stump phenomenon is a peripherally induced movement disorder that is due to peripheral nerve damage. We report on a very resistant case in which different treatment strategies were applied. Objectives: To inform physicians about this condition, its implications, and treatment options. Study design: Case report of...

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM)...

Introduction: Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medici...

Objective: To evaluate the impact of a lower limb amputation for chronic pain and/or functional impairment on pain and participation in daily living activities and to assess the use of prostheses. To improve decision-making for this controversial treatment. Design: Survey. Setting: University hospital. Subjects: Patients who had an amputatio...

Purpose Responding to a recent editorial arguing against defining rehabilitation, we discuss the reasons for developing a classification of rehabilitation for research purposes, its philosophical background and some of the possible risks. Why define Science requires the definition and classification of phenomena to allow replication of experiments...

This commentary is on the original article by Kolaski et al. on pages 1316–1326 of this issue.

Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus u...

After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SC...

Multicentre cross-sectional study. The objective of this study is to evaluate prevalence, location and characteristics of pain in hospital inpatients people with spinal cord injury (SCI). Ten Italian rehabilitation centres specialized in spinal injury care, where inpatients are admitted both after the acute lesion and for late complications (time s...

Background: Multiple organ dysfunction syndrome, defined as altered organ function in critically ill patients, is a possible consequence of COVID-19. Investigating the current evidence is therefore crucial in this pandemic, as early rehabilitation could be effective for the functioning of patients with multiple organ failure. This rapid review ass...

The World Health Organization (WHO) and Cochrane have been collaborating since long time. As a part of "Rehabilitation 2030: a call for action", WHO's Department of Noncommunicable Diseases is developing a Package of Rehabilitation Interventions (PRI) which provides a set of prioritized evidence-based interventions, along with resource requirements...

During its fourth year of existence, Cochrane Rehabilitation went on to promote evidence-informed health decision-making in rehabilitation. In 2020, the outbreak of the COVID-19 pandemic has made it necessary to alter priorities. In these challenging times, Cochrane Rehabilitation has firstly changed its internal organisation and established a new...

Introduction: Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are v...

The COVID-19 pandemic resulted in surge of research activity. Since its outset, efforts have been made to guide the rapid generation of research in medicine. There are gaps in some areas of rehabilitation research for patients with COVID-19. The development of a specific research framework might serve to help monitor the status of research (mapping...

Retrospective chart audit. Firstly determining the prevalence of scoliosis in myelomeningocele (MMC) patients of the University Hospitals Leuven. Secondly analyzing whether there are differences concerning distribution of radiological level, ambulatory status, hydrocephalus, tethered cord, and syringomyelia in MMC patients with/without scoliosis. U...

Objective To report the results of the systematic search performed to identify interventions and related evidence for rehabilitation of individuals with amputation based on the current evidence from Clinical Practice Guidelines (CPGs). Data sources Pubmed, Pedro, CINAHL, Embase, Google Scholar, and multiple guideline databases (date restriction 20...

The International Society of Physical and Rehabilitation Medicine (ISPRM) has recently started an educational initiative named “ISPRM Webinar Series,” broadcasting a series of live interactive online webinar sessions over 3 months. The objectives of the webinars were to connect rehabilitation professionals worldwide, share experiences/expertise, an...

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Although, biomarkers are regarded as an important tool for monitoring injury severity and treatment efficacy, and for predicting clinical evolution in many neurological diseases and disorders including spinal cord injury, there is still a lack of reliable biomarkers for the assessment of clinical course and patient outcome. In this study, a biologi...

There is a need for a common, shared definition of rehabilitation to conduct systematic reviews and identify relevant systematic reviews for knowledge translation purposes, which is an important task of Cochrane Rehabilitation. The present paper aims to introduce and compare existing health-related definitions of rehabilitation and to propose core...

Introduction: During the first three years of its work, Cochrane Rehabilitation was faced with the challenge of defining the inclusion and exclusion criteria of what is rehabilitation on four different occasions: when we worked on classifying all Cochrane Systematic Reviews (CSRs) for relevance to rehabilitation, when we checked for newly publishe...

COVID-19 pandemic is creating collateral damage to persons with disabling conditions of different aetiology. The restrictions imposed to contain the spread of infection is limiting the access to many health services, including rehabilitation. It is expected that such situation will lead to long lasting negative consequences for persons with disabil...

Background: The Covid-19 pandemic is having a great impact on health services. Patients not receiving care due to closure of outpatient services suffer a collateral damage. Our aim was to provide first data on impact of Covid-19 on people experiencing disability in Europe. Methods: We developed an estimation from a survey and publicly available...

This article was accidentally published in Volume 54 issue 5 as well as Volume 54 issue 4 of publishing year 2018 with different DOIs and different page numbers. The correct and citable version of the article remains Antimo MORETTI, Francesca GIMIGLIANO, Chiara ARIENTI, Joel POLLET, Carlotte KIEKENS, Stefano NEGRINI. The Cochrane Rehabilitation eBo...

Covid-19 pandemic is creating collateral damage to outpatients, whose rehabilitation services have been disrupted in most of the European countries. Telemedicine has been advocated as a possible solution. This paper reports the contents of the third Italian Society of Physical and Rehabilitation Medicine (SIMFER) webinar on "experiences from the fi...

Covid-19 is a respiratory infectious disease that can cause respiratory, physical and psychological long-term dysfunctions in patients. First recommendations on respiratory management were published, but they were not based on the specific needs due to Covid-19. In this paper we share the early experiences from the clinical field in Northern Italy,...

Background: The World Health Organization (WHO) has declared obesity as the largest global chronic health problem in adults. In the last years, attention has been drawn to the rehabilitative interventions for patients with obesity. Aim: The aim of this manuscript is to provide Physical and Rehabilitation Medicine physicians with evidence-based r...

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by Covid-19. In a country with almost 5,000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8,900 individual visualizations of the recorded version. The overall inadequa...

Cochrane Rehabilitation (CR) is pursuing the goal of disseminating Cochrane evidence, in line with the Cochrane Knowledge Translation (KT) strategy theme 2: "Packaging, push, and support implementation", through several projects: the CR eBook project, blogshots, and Cochrane Corners. A Cochrane Corner is a KT vehicle in which the contents of the Co...

Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity an...