Gert Kaluza

Physical therapy and active exercises--an adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients.

Abstract The aim of this study was to compare the effect of a physical therapy regimen including active exercises with the current standard treatment on reduction of pain 6 weeks and 6 months after whiplash injury caused by motor vehicle collision. Two hundred patients were enrolled in a prospective randomized controlled trial. In the standard group, treatment consisted of immobilization with a soft collar over 7 days. In the physical therapy group, patients were scheduled for 10 physical therapy appointments including active exercises within 14 days after enrollment. Pain intensity was rated by all patients daily during the first week, the sixth week, and 6 months after recruitment, using a numeric rating scale (0–10). Data analyses were performed by comparing the mean (over 1 week) pain scores between the two different treatment groups. Ninety‐seven patients were randomly assigned to the standard treatment group and 103 to the physical therapy group. During the first week, there was no significant difference in mean pain intensity between the standard treatment group (4.76 ± 2.15) and the physical therapy group (4.36 ± 2.14). However, after 6 weeks, mean pain intensity was significantly (p = 0.002) lower in the physical therapy group (1.49 ± 2.26 versus 2.7 ± 2.78). Similarly, after 6 months, significantly (p < 0.001) less pain was reported in the physical therapy group (1.17 ± 2.13) than the standard treatment group (2.33 ± 2.56). We conclude that a physical therapy regimen which includes active exercises is superior in reducing pain 6 weeks and 6 months after whiplash injury compared to the current standard treatment with a soft collar.

Komorbidität, Multimedikation und Befinden bei älteren Patienten mit chronischen Schmerzen

Zusammenfassung. Mittels eines standardisierten Interviews wurden konsekutive Patienten [3 Schmerzpraxen (n=117), 2 Geriatriekliniken (n=86), 1 Schmerzklinik (n=60)] mit chronischen Schmerzen und mindestens einer weiteren Diagnose (im Durchschnitt: Diagnosen in 5 weiteren Organsystemen) im Alter von ≥65 Jahren (Durchschnittsalter: 76,29±7,40 Jahre, Anteil der Frauen: 73,3%) befragt. Insgesamt wurden 7,31±2,66 Medikamente mit einer Höchstzahl von 19 Medikamenten eingenommen. Fast 75% der Patienten gaben an, Schmerzlinderung sei am ehesten durch Schonverhalten zu erreichen. Jeder zweite Patient fühlte sich häufig traurig und niedergeschlagen. Häufigste Beschwerden waren trockener Mund, Schlafstörungen, Müdigkeit, Verstopfung und Schwindel. Die Patienten aus der Geriatrie waren durch höheres Lebensalter, höhere Schulbildung, geringere Schmerzausbreitung, -intensität und -dauer, geringere Anzahl verordneter Schmerzmedikamente, aber auch durch stärker ausgeprägte Komorbidität und stärkere funktionale Beeinträchtigung gekennzeichnet. Die Schmerzzentrumspatienten wiesen häufiger Schmerzen im Bereich von Hüfte und Becken auf, nahmen häufiger nur Stufe-I-Analgetika und gaben seltener eine regelmäßige Einnahme der Medikamente an. Sie fühlten sich am stärksten in ihren sozialen Kontakten beeinträchtigt, hatten aber die größte Hoffnung auf Besserung ihres Zustands. Abstract. Consecutive patients with a minimum age of 65 years and at least one additional diagnosis participated in a standardized interview during the initial assessments in two geriatric hospitals (n=86), a multidisciplinary pain center (n=60), and three primary care practices (n=117). The average age of the total sample was 76.29 years (SD=7.40); females constituted 73.3% of the sample. The average number of drugs consumed by the patients amounted to 7.31 (SD=2.66) with a maximum number of 19 drugs. Nearly threequarters of the patients indicated a reduction in their pain by avoiding physical activity. Every second patient often felt depressed and without energy. The most frequent symptoms were a dry mouth, sleep disorders, fatigue, constipation, and dizziness. Patients from the geriatric hospitals were older and better educated, reported fewer painful body regions, indicated lower intensity and duration of pain as well as a lower number of pain medications. On the other hand, they were characterized by a higher intensity of comorbidity and by increased functional impairment. Patients from the pain clinic suffered more frequently from pain in the hip and the pelvis. They took stage I analgesics more often and admitted more frequently to adjusting the drug consumption to changes in well-being and situational factors. They felt the highest amount of impairment in their social activities. Nevertheless, they expressed the highest confidence in future improvement.

[Comorbidity, multiple medication, and well-being in elderly patients with chronic pain].

Zusammenfassung. Mittels eines standardisierten Interviews wurden konsekutive Patienten [3 Schmerzpraxen (n=117), 2 Geriatriekliniken (n=86), 1 Schmerzklinik (n=60)] mit chronischen Schmerzen und mindestens einer weiteren Diagnose (im Durchschnitt: Diagnosen in 5 weiteren Organsystemen) im Alter von ≥65 Jahren (Durchschnittsalter: 76,29±7,40 Jahre, Anteil der Frauen: 73,3%) befragt. Insgesamt wurden 7,31±2,66 Medikamente mit einer Höchstzahl von 19 Medikamenten eingenommen. Fast 75% der Patienten gaben an, Schmerzlinderung sei am ehesten durch Schonverhalten zu erreichen. Jeder zweite Patient fühlte sich häufig traurig und niedergeschlagen. Häufigste Beschwerden waren trockener Mund, Schlafstörungen, Müdigkeit, Verstopfung und Schwindel. Die Patienten aus der Geriatrie waren durch höheres Lebensalter, höhere Schulbildung, geringere Schmerzausbreitung, -intensität und -dauer, geringere Anzahl verordneter Schmerzmedikamente, aber auch durch stärker ausgeprägte Komorbidität und stärkere funktionale Beeinträchtigung gekennzeichnet. Die Schmerzzentrumspatienten wiesen häufiger Schmerzen im Bereich von Hüfte und Becken auf, nahmen häufiger nur Stufe-I-Analgetika und gaben seltener eine regelmäßige Einnahme der Medikamente an. Sie fühlten sich am stärksten in ihren sozialen Kontakten beeinträchtigt, hatten aber die größte Hoffnung auf Besserung ihres Zustands. Abstract. Consecutive patients with a minimum age of 65 years and at least one additional diagnosis participated in a standardized interview during the initial assessments in two geriatric hospitals (n=86), a multidisciplinary pain center (n=60), and three primary care practices (n=117). The average age of the total sample was 76.29 years (SD=7.40); females constituted 73.3% of the sample. The average number of drugs consumed by the patients amounted to 7.31 (SD=2.66) with a maximum number of 19 drugs. Nearly threequarters of the patients indicated a reduction in their pain by avoiding physical activity. Every second patient often felt depressed and without energy. The most frequent symptoms were a dry mouth, sleep disorders, fatigue, constipation, and dizziness. Patients from the geriatric hospitals were older and better educated, reported fewer painful body regions, indicated lower intensity and duration of pain as well as a lower number of pain medications. On the other hand, they were characterized by a higher intensity of comorbidity and by increased functional impairment. Patients from the pain clinic suffered more frequently from pain in the hip and the pelvis. They took stage I analgesics more often and admitted more frequently to adjusting the drug consumption to changes in well-being and situational factors. They felt the highest amount of impairment in their social activities. Nevertheless, they expressed the highest confidence in future improvement.

Stress reactivity of intraocular pressure after relaxation training in open-angle glaucoma patients

The present study was based on the hypothesis that stress may contribute to increased intraocular pressure (IOP) in open-angle glaucoma patients. It is investigated whether IOP reactivity to a mental stressor test (MST) can be influenced by relaxation training. Twenty three patients with open-angle glaucoma were randomly assigned either to a training group (TG) or to a waiting-list control group (CG). Prior to as well as after the completion of the training all patients were exposed to the MST. IOP and heart rate as well as self-ratings of psychological strain were assessed three times: (1) at baseline, (2) after exposition to the stressor, and (3) after a 10-min relaxation phase. Results provide evidence that the MST is a valid procedure to induce psychophysiological activation and that elevated IOP levels in open-angle glaucoma patients might be provoked by stressing situations. However, participation in the relaxation training did not influence IOP stress reactivity.

Changing unbalanced coping profiles-A prospective controlled intervention trial in worksite health promotion

Abstract Effective coping is based upon a broad variety of available strategies and a good balance between instrumental and palliative coping efforts. Thus, stress management training (SMT) should focus on broadening and balancing individual coping-profiles. This study investigated changes in coping profiles after participation in SMT at the worksite. The sample consisted of 82 healthy working persons who participated in a 12-week-SMT and 55 matched controls without intervention. The SMT consisted of six training elements: three of them (assertiveness, cognitive restructuring and time management) addressed instrumental coping and the other three (relaxation, physical activity and scheduling of pleasant activities) focussed on palliative coping. All subjects filled in standardized questionaires on coping, well-being and strain before and after the training. Cluster analyses performed on initial coping scores resulted in a 3-cluster solution: (1) “active flexible coping” (n = 53), (2) “problem-focused coping” (n = 40) and (3) “resignative avoidant coping” (n = 44). Analyses of covariance revealed that SMT-participants of Cluster 2 showed significant improvements regarding emotion-focused coping and those of Cluster 3 regarding problem-focused coping compared to controls of the same cluster. There were also significant associations between these clusterspecific changes of coping and improvements of well-being. In consequence, the SMT improved coping by supplementing one-sided initial coping-profiles.

Diagnostik und Therapie akuter Beschwerden nach „HWS-Distorsion“ in Deutschland

ZusammenfassungDie HWS-Distorsion ist von großer klinischer und sozioökonomischer Bedeutung. Eine Vielzahl von Problemen im Hinblick auf Diagnostik, Klassifikation, Therapie und Begutachtung sind bis heute nicht oder nur unzureichend gelöst. Ziel der vorliegenden Umfrage war es den aktuellen Stand des Vorgehens beim Vorliegen einer akuten HWS-Distorsion an chirurgischen und unfallchirurgischen Kliniken in Deutschland zu evaluieren. Es wurden 1568 Kliniken in Deutschland angeschrieben und um die Beantwortung eines standardisierten, einseitigen Fragebogens zur Diagnostik, Klassifikation und Therapie der HWS-Distorsion gebeten. Zudem wurde nach der subjektiven Einschätzung der Ärzte zum Beschwerdebild gefragt. Beantwortet wurden 540 (34,44%) Fragebögen. Bezüglich der klinischen Untersuchung besteht Konsens. Konventionelle Röntgenaufnahmen der HWS in 2 Ebenen werden routinemäßig in 82,6% der Kliniken indiziert. Für die Anordnung von Funktionsaufnahmen (durchschnittlichen 39,1%) ergibt sich ein sehr inhomogenes Bild. HWS-Distorsionen werden in 68,9% der Kliniken nicht, in 13,2% nach der „Quebec Task Force“ und in 13,9% nach Erdmann klassifiziert. Die HWS-Krawatte gehört in 85,6% zum therapeutischen Vorgehen; 30% der Patienten wird lediglich eine Krawatte verordnet, 55,6% erhalten zusätzlich Physiotherapie. Bei 8,3% wird nur Krankengymnastik verordnet. Nach der subjektiven Einschätzung der Ärzte sind psychologische Faktoren für chronische Verläufe, nicht aber für die Akutphase von Bedeutung. Die große Variabilität der Maßnahmen zur Diagnostik, Klassifikation und Behandlung an deutschen Kliniken spiegelt die bekannten Probleme im Umgang mit dem Beschwerdebild der HWS-Distorsion wieder. Aktuelle wissenschaftliche Erkenntnisse zur funktionellen Behandlung sind bisher nur in begrenztem Maße in den klinischen Alltag übernommen worden.AbstractWhiplash injury of the cervical spine is a relevant medical and socioeconomic problem, which is still the subject of controversy. We performed a survey to evaluate the current status of diagnostics, classification, treatment, and doctors’ subjective opinions at surgical and trauma departments in Germany. A total of 1568 hospitals were addressed to answer a standardized questionnaire on their proceedings and opinions concerning whiplash injury. We received 540 (34.44%) completed questionnaires. There was overall agreement concerning the need for physical examination. The radiological assessment included an a.p. and a lateral plain X-ray of the cervical spine in 82.6%. The indication for functional X-rays in flexion/extension was inconsistent. On average they were performed in 39.1% of all patients. In most cases (68.9%) whiplash injury was not classified; 13.2% of doctors used the classification according to the Quebec Task Force and 13.9% according to Erdmann. A cervical collar was prescribed in 85%. While 30% of patients received only a cervical collar, 55.6% underwent additional physiotherapy. Only 8.3% were treated by physiotherapy without immobilization. The doctors’ subjective opinions indicated psychological factors to be important for long-lasting problems, but not for the acute period of complaints. There is no homogeneous concept for diagnostics, classification, and treatment of patients who suffered a whiplash injury in Germany. This situation reflects the current problems in management of this condition. Scientific evidence for functional treatment to avoid adverse influence of immobilization by cervical collars has not yet been transferred to our daily routine in Germany.

[Diagnosis and therapy of acute complaints after "whiplash injury" in Germany. Results of a representative survey at surgical and trauma departments in Germany].

ZusammenfassungDie HWS-Distorsion ist von großer klinischer und sozioökonomischer Bedeutung. Eine Vielzahl von Problemen im Hinblick auf Diagnostik, Klassifikation, Therapie und Begutachtung sind bis heute nicht oder nur unzureichend gelöst. Ziel der vorliegenden Umfrage war es den aktuellen Stand des Vorgehens beim Vorliegen einer akuten HWS-Distorsion an chirurgischen und unfallchirurgischen Kliniken in Deutschland zu evaluieren. Es wurden 1568 Kliniken in Deutschland angeschrieben und um die Beantwortung eines standardisierten, einseitigen Fragebogens zur Diagnostik, Klassifikation und Therapie der HWS-Distorsion gebeten. Zudem wurde nach der subjektiven Einschätzung der Ärzte zum Beschwerdebild gefragt. Beantwortet wurden 540 (34,44%) Fragebögen. Bezüglich der klinischen Untersuchung besteht Konsens. Konventionelle Röntgenaufnahmen der HWS in 2 Ebenen werden routinemäßig in 82,6% der Kliniken indiziert. Für die Anordnung von Funktionsaufnahmen (durchschnittlichen 39,1%) ergibt sich ein sehr inhomogenes Bild. HWS-Distorsionen werden in 68,9% der Kliniken nicht, in 13,2% nach der „Quebec Task Force“ und in 13,9% nach Erdmann klassifiziert. Die HWS-Krawatte gehört in 85,6% zum therapeutischen Vorgehen; 30% der Patienten wird lediglich eine Krawatte verordnet, 55,6% erhalten zusätzlich Physiotherapie. Bei 8,3% wird nur Krankengymnastik verordnet. Nach der subjektiven Einschätzung der Ärzte sind psychologische Faktoren für chronische Verläufe, nicht aber für die Akutphase von Bedeutung. Die große Variabilität der Maßnahmen zur Diagnostik, Klassifikation und Behandlung an deutschen Kliniken spiegelt die bekannten Probleme im Umgang mit dem Beschwerdebild der HWS-Distorsion wieder. Aktuelle wissenschaftliche Erkenntnisse zur funktionellen Behandlung sind bisher nur in begrenztem Maße in den klinischen Alltag übernommen worden.AbstractWhiplash injury of the cervical spine is a relevant medical and socioeconomic problem, which is still the subject of controversy. We performed a survey to evaluate the current status of diagnostics, classification, treatment, and doctors’ subjective opinions at surgical and trauma departments in Germany. A total of 1568 hospitals were addressed to answer a standardized questionnaire on their proceedings and opinions concerning whiplash injury. We received 540 (34.44%) completed questionnaires. There was overall agreement concerning the need for physical examination. The radiological assessment included an a.p. and a lateral plain X-ray of the cervical spine in 82.6%. The indication for functional X-rays in flexion/extension was inconsistent. On average they were performed in 39.1% of all patients. In most cases (68.9%) whiplash injury was not classified; 13.2% of doctors used the classification according to the Quebec Task Force and 13.9% according to Erdmann. A cervical collar was prescribed in 85%. While 30% of patients received only a cervical collar, 55.6% underwent additional physiotherapy. Only 8.3% were treated by physiotherapy without immobilization. The doctors’ subjective opinions indicated psychological factors to be important for long-lasting problems, but not for the acute period of complaints. There is no homogeneous concept for diagnostics, classification, and treatment of patients who suffered a whiplash injury in Germany. This situation reflects the current problems in management of this condition. Scientific evidence for functional treatment to avoid adverse influence of immobilization by cervical collars has not yet been transferred to our daily routine in Germany.

Ergebnisse der frühfunktionellen krankengymnastischen Übungsbehandlung nach HWS-Distorsion

ZusammenfassungFragestellung. Effektivität der frühfunktionellen Physiotherapie im Vergleich zur Standardtherapie mittels weicher Zervikalstütze nach HWS-Distorsion. Methodik. Prospektiv-randomisierte Therapievergleichsstudie an 168 Patienten mit den Hauptzielvariablen Schmerzen und Beeinträchtigung, die mittels numerischer Ratingskalen (0–10) gemessen wurden. Ergebnisse. In der Standardtherapiegruppe betrugen die gemittelten Werte für Schmerzen initial 4,75 und für Beeinträchtigung 4,76, in der Physiotherapiegruppe 4,50 für Schmerzen und 4,39 für Beeinträchtigung. Nach 6 Wochen hatten sich in der Standardtherapiegruppe die Werte für Schmerzen auf 2,66 und für Beeinträchtigung auf 2,40 reduziert. Die Werte in der Physiotherapiegruppe waren mit 1,40 für Schmerzen und 1,29 für Beeinträchtigung signifikant niedriger als in der Standardtherapiegruppe. Schlussfolgerung. Die frühfunktionelle krankengymnastische Übungsbehandlung der akuten HWS-Distorsion ist der Therapie mit der weichen Zervikalstütze signifikant überlegen.AbstractBackground. Diagnostic evaluation and therapeutic management of acute neck pain after whiplash is a frequent but unsolved clinical problem. Long-lasting symptoms and disability are common. Former studies proposed beneficial effects of physiotherapy in the early management of whiplash injury. The purpose of this study was to assess the effects of early active mobilization versus standard treatment with a soft cervical collar. Methods. Between August 1997 and February 2000 a prospective randomized clinical trial with a total of 168 patients was performed. Of these patients 81 (31 male, 50 female; average age 28,78 years) were randomly assigned to the standardtherapy group, which received a soft cervical collar, and 87 (31 male, 56 female; average age 29,62 years) to the early mobilization group, treated by physiotherapy. Study participants documented pain and disability twice (baseline and six week follow-up) during a one week period by diary, using numeric rating scales ranging from 0 to 10. Results. The initial mean pain intensity (4,75) reported by the standard therapy group was similar to disability (4,76). There were no significant differences to initial pain (4,50) and disability (4,39) reported by the early mobilization group. The mean pain intensity reported by the standard therapy group after 6 weeks was 2,66 and disability was 2,40. The mean pain intensity indicated by physiotherapy group was 1,44 and mean disability was 1,29. The differences between the groups were both significant. Conclusions. Early mobilization is superior to the standardtherapy regarding pain intensity and disability. We conclude that mobilization should be recommended as the new adequate standard-therapy in the acute management of whiplash injury.

Effects of Self-Relaxation Methods and Visual Imagery on IOP in Patients with Open-Angle Glaucoma

In this study, the effects of a training in relaxation and visual imagery on the intra-ocular pressure (IOP) of patients with primary open-angle glaucoma were investigated. Twenty-three patients, aged 24-69 years, were assigned either to a training group or to a waiting-list control group. The intervention included a basic programme (BP) of standard autogenic relaxation exercises and an advanced programme (AP) in which special exercises in ocular relaxation and imagination of aqueous humour drainage were conducted. IOP was measured before and after each training session. Twenty-four-hour IOP profiles were ascertained, and the water drinking test to provoke maximum IOP levels was performed during clinical assessments prior to the training, between the BP and the AP and after termination of the training. Results indicate only slight short-term changes of IOP levels immediately after each training session. However, during the course of the BP as well as of the AP a relevant decrease in IOP could be measured. Twenty-four-hour IOP profiles as well as the water drinking test also showed significant reductions of IOP during time. Medication could be reduced for 56% of the initially treated patients. The findings suggest that relaxation and visual imagery techniques can be beneficial in reducing elevated IOP levels in patients with open-angle glaucoma though the conclusiveness of the data is limited due to methodological shortcomings.

Salutogene Faktoren bei chronischen Rückenschmerzen

Zusammenfassung. Theoretischer Hintergrund: In der Studie werden Ruckenschmerzen in einer salutogenetischen Perspektive untersucht. Risikofaktoren chronischer Ruckenschmerzen wie korperliche und psychosoziale Arbeitsbelastungen sind gut, wahrend protektive Faktoren, die den Stress-Schmerz-Zusammenhang moderieren, bisher noch wenig untersucht sind. Fragestellung: Moderieren soziale Unterstutzung, Arbeitszufriedenheit und sportliche Aktivitat den Zusammenhang zwischen Arbeitsbelastungen und Ruckenschmerzaktivitat (RSA)? Methode: 1420 Beschaftigte aller Berufsgruppen eines Universitatsklinikums beantworteten einen standardisierten “Fragebogen zur Gesundheit“, der Starke, Dauer und Haufigkeit von Ruckenschmerzen, korperliche und psychosoziale Arbeitsbelastungen, sowie als potentielle Protektivfaktoren die generelle Arbeitszufriedenheit, die soziale Unterstutzung und die Haufigkeit korperlicher Aktivitat erfasste. Ergebnisse: Es zeigten sich Alters- Geschlechts- und Bildungseffekte auf die RSA sowie ein positi...