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Ann Ig. 2022 Sep-Oct; 34(5): 501-514 doi: 10.7416/ai.2022.510

Impact of Covid-19 pandemic on injection-based practice: report from an Italian multicenter and multidisciplinary survey

S. Tenti1, N. Mondanelli2, A. Bernetti3, M. Mangone3, F. Agostini3, M. Capassoni4, S. Cheleschi1, R. De Chiara5, G. Farì6, A. Frizziero7, S. Giannotti2, S. Guiducci4, S. Masiero8, M. Megna6, C. Messina9, L. Moretti10, L. Tognolo8, G. Gigliucci11, V. Santilli3, A. Migliore11, A. Fioravanti1

1 Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
2 Orthopedics and Traumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
3 Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
4 Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
5 Rehabilitation Unit, Azienda Ospedaliera “Pugliese-Ciaccio”, Catanzaro, Italy
6 Physical Medicine and Rehabilitation, Unipolar Spinal Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University of Bari, Italy
7 Outpatient and Orthogeriatric Rehabilitation Unit, Department of Medicine and Surgery, University of Parma, Italy
8 Physical Medicine and Rehabilitation Unit, Department of Neuroscience, University of Padua, Italy
9 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
10 Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University of Bari, Italy
11 Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy.

Abstract

Background.
There are no papers exploring the impact of COVID-19 pandemic on the injection-based practice in patients affected by different rheumatic diseases, including osteoarthritis. The aim was to investigate the impact of COVID-19 pandemic on injection-based practice trough the Italian country. 

Study design.
A survey-based retrospective cross-sectional study

Methods.
An Italian-language questionnaire was developed by a group of senior researchers and distributed by e-mail to some Rheumatology, Orthopedic and Rehabilitation Units from different geographic areas of Italy. The survey included information about the number of injections performed during COVID-19 pandemic (stratified by injected agents and injected joint), in comparison to the pre-pandemic period, and the possible reasons behind an eventual reduction. Responses were collected and descriptive analysis calculated.

Results.
Eleven centers of the National Health Service completed the survey. The activities of the injections services significantly decreased across the country with a percentage of reduction of 60% compared to the pre-pandemic period. A significant reduction of both intra-articular and peri-articular injections was registered. Among intra-articular. treatments, the most affected ones were the hyaluronic acid injections, when compared to corticosteroids. A significant decrease of the total amount of peri-articular injections was observed. The strict government restrictions and the fear of patients to become infected represented the most limiting factors.

Conclusions.
The reported decrease of the injection-based practice in our country during the COVID-19 pandemic highlights the detrimental effects of the COVID-19 pandemic on the management of chronic musculoskeletal diseases with possible negative consequences in terms of disability and quality of life.

KEYWORDS: COVID-19, SARS-CoV-2, musculoskeletal diseases, intra-articular therapy, hyaluronic acid, corticosteroids
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