Introduction: cross-education (CE), a phenomenon whereby training a muscle leads to performance improvements in the untrained contralateral homologous muscle, has significant clinical applications in rehabilitation. Studies suggest that the primary mechanisms underlying this phenomenon are central neurophysiological adaptations, including increased cortical excitability, reduced interhemispheric and intracortical inhibition, which facilitate bilateral activation of the motor cortex. Additionally, peripheral-systemic phenomena may also contribute to the transfer effect. However, CE is still not fully understood to date. Objective: This review aims to investigate the presence of studies in the literature that demonstrate the effectiveness of cross-education as a therapeutic strategy for enhancing the rehabilitation process in patients with musculoskeletal disorders by improving functional outcomes. Materials and Methods: the research was developed using the PICOS model to define the eligibility criteria for the study sample. The review was conducted in accordance with PRISMA and PERSIST guidelines, consulting the databases: PubMed, Scopus, and SPORTDiscus, between August and October 2024, without filters for time or language limitations. Article screening was performed using Rayyan, while the risk of bias was assessed with the RoB 2 tool, classifying each study as low, medium, or high risk. Results: the search identified 2,305 articles, of which 11 were included following the selection process, published between 2009 and 2024. The methodological quality of the studies is heterogeneous, with 6 classified as low risk, 4 as high risk, and 1 as having some concerns. Randomization was generally reported, but in some cases, there were issues with balancing between groups and a lack of specific analyses on adherence to the intervention. Nine articles examined lower limb pathologies, primarily ACLR, and only two focused on upper limb conditions. The intervention protocols were centered on strength training (9 articles) or neuromuscular training (2 articles). Despite the limited number of studies, significant improvement was observed in neuromuscular control and both static-dynamic balance with neuromuscular training. Strength-focused approaches suggest integrating cross-education into early rehabilitation to decrease muscular decline, but the persistence of long-term gains is uncertain. No clear correlation was found between increased strength and improvement in daily functionality, or neuromuscular function. Conclusions: this review appears to encourage the implementation of CE in the rehabilitation protocol for patients with unilateral musculoskeletal disorders, using various training types to improve balance and stability or to reduce muscle decline and increase strength. However, the limited number of studies require further research to better understand its effectiveness and long-term benefits.
Introduzione: la cross-education (CE) è il fenomeno per cui l'allenamento di un muscolo porta a miglioramenti prestazionali anche dell’omologo controlaterale non allenato. Tale fenomeno ha applicazioni cliniche significative in riabilitazione. Gli studi suggeriscono che i principali meccanismi alla base di questo fenomeno siano degli adattamenti neurofisiologici centrali: l’aumento dell’eccitabilità corticale, la riduzione dell’inibizione interemisferica e intracorticale, che facilitano l’attivazione bilaterale della corteccia motoria. Tuttavia ad oggi la CE non è ancora del tutto compresa e anche la sua applicabilità in ambito riabilitativo non è ben definita. Obiettivo: lo scopo della revisione è di indagare la presenza di studi in letteratura che dimostrino l’efficacia della cross-education, come strategia terapeutica di implemento del percorso riabilitativo, in pazienti con disturbi muscoloscheletrici nel migliorare outcome funzionali. Materiali e Metodi: la ricerca è stata sviluppata sul modello PICOS per definire i criteri di eleggibilità del campione di studio; è stata condotta seguendo le linee guida PRISMA e PERSIST, consultando i database: PubMed, Scopus e SPORTDiscus, tra aprile e settembre 2024, senza filtri per limiti temporali o linguistici. Lo screening degli articoli è stato effettuato utilizzando Rayyan mentre il rischio di bias è stato valutato con lo strumento RoB 2, classificando ciascuno studio come a basso, medio o alto rischio. Risultati: la ricerca ha identificato 2305 articoli, includendone 11 pubblicati tra il 2009 e il 2024. La qualità metodologica degli studi è eterogenea: sebbene la randomizzazione sia generalmente riportata, in alcuni casi si sono notate criticità nel bilanciamento dei gruppi e nell’analisi dell’aderenza all'intervento. Nove studi riguardano patologie dell'arto inferiore (principalmente ACLR) e due dell'arto superiore, con protocolli focalizzati su allenamento di forza o neuromuscolare. È stato osservato un miglioramento nel controllo neuromuscolare e nell’equilibrio-stabilità con l’allenamento neuromuscolare, mentre l’allenamento di forza supporta l’uso precoce della CE per ridurre il declino muscolare e aumentare la forza; nonostante ciò i guadagni a lungo termine restano incerti. Non emerge una chiara correlazione tra l’aumento di forza e il miglioramento della funzionalità o della funzione neuromuscolare. Conclusione: le evidenze sembrano incoraggiare l’uso della CE come strategia terapeutica in pazienti con patologie muscoloscheletriche unilaterali per un migliore percorso riabilitativo sia in termini di guadagno di forza che di equilibrio-stabilità; tuttavia si rendono necessari ulteriori studi
La Cross-education come strategia terapeutica per il miglioramento di Outcome Funzionali in pazienti con Disordini Muscoloscheletrici: una Revisione Sistematica della Letteratura
PASCARELLA, DAVIDE
2023/2024
Abstract
Introduction: cross-education (CE), a phenomenon whereby training a muscle leads to performance improvements in the untrained contralateral homologous muscle, has significant clinical applications in rehabilitation. Studies suggest that the primary mechanisms underlying this phenomenon are central neurophysiological adaptations, including increased cortical excitability, reduced interhemispheric and intracortical inhibition, which facilitate bilateral activation of the motor cortex. Additionally, peripheral-systemic phenomena may also contribute to the transfer effect. However, CE is still not fully understood to date. Objective: This review aims to investigate the presence of studies in the literature that demonstrate the effectiveness of cross-education as a therapeutic strategy for enhancing the rehabilitation process in patients with musculoskeletal disorders by improving functional outcomes. Materials and Methods: the research was developed using the PICOS model to define the eligibility criteria for the study sample. The review was conducted in accordance with PRISMA and PERSIST guidelines, consulting the databases: PubMed, Scopus, and SPORTDiscus, between August and October 2024, without filters for time or language limitations. Article screening was performed using Rayyan, while the risk of bias was assessed with the RoB 2 tool, classifying each study as low, medium, or high risk. Results: the search identified 2,305 articles, of which 11 were included following the selection process, published between 2009 and 2024. The methodological quality of the studies is heterogeneous, with 6 classified as low risk, 4 as high risk, and 1 as having some concerns. Randomization was generally reported, but in some cases, there were issues with balancing between groups and a lack of specific analyses on adherence to the intervention. Nine articles examined lower limb pathologies, primarily ACLR, and only two focused on upper limb conditions. The intervention protocols were centered on strength training (9 articles) or neuromuscular training (2 articles). Despite the limited number of studies, significant improvement was observed in neuromuscular control and both static-dynamic balance with neuromuscular training. Strength-focused approaches suggest integrating cross-education into early rehabilitation to decrease muscular decline, but the persistence of long-term gains is uncertain. No clear correlation was found between increased strength and improvement in daily functionality, or neuromuscular function. Conclusions: this review appears to encourage the implementation of CE in the rehabilitation protocol for patients with unilateral musculoskeletal disorders, using various training types to improve balance and stability or to reduce muscle decline and increase strength. However, the limited number of studies require further research to better understand its effectiveness and long-term benefits.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/75772