{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:21:21Z","timestamp":1760149281466,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Digital ulcers (DUs) are the most common complication in patients with Systemic Sclerosis (SSc). They cause pain with hand dysfunction and negatively impact activities of daily and working life. Our study aims to evaluate the efficacy of a combined treatment of manual therapy and ultrasound therapy in SSc patients with ischemic DU (IDU) compared to manual therapy alone. Materials and Methods: We conducted a before-and-after study (non-randomized study). We enrolled a consecutive series of IDU patients undergoing rehabilitation treatment and divided them into two groups: a treatment group consisting of patients undergoing a combination of manual therapy and US water immersion and a standard care group consisting of patients subjected to manual therapy alone. At the time of the first visit (T0) and at the end of the 4-week rehabilitation period (T1), we evaluated functional capacity, pain intensity, ulcer evolution, and quality of life. Results: In the treatment group, we observed a statistically significant improvement in the functional capacity of the hand (DHI: 28.15 \u00b1 11.0 vs. 19.05 \u00b1 8.83; p &lt; 0.05), pain (NRS: 5.55 \u00b1 1.2 vs. 2.9 \u00b1 1.09; p &lt; 0.05), and PSST score (24.4 \u00b1 4.0 vs. 16.2 \u00b1 2.36; p &lt; 0.05). In the standard care group, we observed a statistically significant improvement only for the functional capacity of the hand (DHI: 28.85 \u00b1 9.72 vs. 22.7 \u00b1 7.68; p &lt; 0.05). Finally, from the comparison between the treatment group and the standard care group, we observed statistically significant improvements in pain (2.9 \u00b1 1.09 vs. 4.5 \u00b1 1.07; p &lt; 0.05) and in the PSST scale (16.2 \u00b1 2.36 vs. 20.4 \u00b1 4.02; p &lt; 0.05). Furthermore, at the end of treatment in the treatment group, 15 ulcers (62.5%) were completely healed, while in the standard care group, only 3 ulcers were completely healed (14.3%). Conclusions: Combined treatment with manual therapy and ultrasound therapy appears to be useful in the management of IDU in patients with scleroderma.<\/jats:p>","DOI":"10.3390\/medicina59071335","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T05:42:01Z","timestamp":1689831721000},"page":"1335","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Immersion Ultrasound Therapy in Combination with Manual Therapy in the Treatment of Ischemic Digital Ulcers in Systemic Sclerosis"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5035-2288","authenticated-orcid":false,"given":"Dalila","family":"Scaturro","sequence":"first","affiliation":[{"name":"Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-2891","authenticated-orcid":false,"given":"Antimo","family":"Moretti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1630-1575","authenticated-orcid":false,"given":"Fabio","family":"Vitagliani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, University of Catania, 90121 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuliana","family":"Guggino","sequence":"additional","affiliation":[{"name":"Rheumatology Section, Biomedical Department of Internal Medicine, University Hospital \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, University of Palermo, 90100 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-130X","authenticated-orcid":false,"given":"Davide","family":"Lo Nardo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, University of Catania, 90121 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenza","family":"Lauricella","sequence":"additional","affiliation":[{"name":"Paolo Giaccone University Hospital, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0976-925X","authenticated-orcid":false,"given":"Giovanni","family":"Iolascon","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Letizia Mauro","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"ref_1","first-page":"961","article-title":"Systemic sclerosis\/scleroderma: A treatable multisystem disease","volume":"78","author":"Hinchcliff","year":"2008","journal-title":"Am. 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