Karin Pieber

Effects of whole-body vibration in patients with multiple sclerosis: a pilot study

Objective: To examine whether a whole-body vibration (mechanical oscillations) in comparison to a placebo administration leads to better postural control, mobility and balance in patients with multiple sclerosis. Design: Double-blind, randomized controlled trial. Setting: Outpatient clinic of a university department of physical medicine and rehabilitation. Subjects: Twelve multiple sclerosis patients with moderate disability (Kurtzkes Expanded Disability Status Scale 2.5-5) were allocated either to the intervention group or to the placebo group. Interventions: In the intervention group a whole-body vibration at low frequency (2.0-4.4 Hz oscillations at 3-mm amplitude) in five series of 1 min each with a 1-min break between the series was applied. In the placebo group a Burst-transcutaneous electrical nerve stimulation (TENS) application on the nondominant forearm in five series of 1 min each with a 1-min break between the series was applied as well. Main outcome measures: Posturographic assessment using the Sensory Organization Test, the Timed Get Up and Go Test and the Functional Reach Test immediately preceding the application, 15 min, one week and two weeks after the application. The statistical analysis was applied to the change score from preapplication values to values 15 min, one week and two weeks post intervention. Results: Compared with the placebo group the intervention group showed advantages in terms of the Sensory Organization Test and the Timed Get Up and Go Test at each time point of measurement after the application. The effects were strongest one week after the intervention, where significant differences for the change score (p=0.041) were found for the Timed Get Up and Go Test with the mean score reducing from 9.2 s (preapplication) to 8.2 s one week after whole-body vibration and increasing from 9.5 s (preapplication) to 10.2 s one week after placebo application. The mean values of the posturographic assessment increased from 70.5 points (preapplication) to 77.5 points one week after whole body vibration and increased only from 67.2 points (preapplication) to 67.5 points one week after the placebo application. No differences were found for the Functional Reach Test. Conclusion: The results of this pilot study indicated that whole-body vibration may positively influence the postural control and mobility in multiple sclerosis patients.

Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review.

OBJECTIVE To review different types of electrotherapy for the treatment of painful diabetic peripheral neuropathy. METHODS A structured search of the electronic database MEDLINE was performed from the time of its initiation to July 2009. Articles in English and German were selected. RESULTS The efficacy of different types of electrotherapy for painful diabetic peripheral neuropathy has been evaluated in 15 studies; the effects of transcutaneous electrical nerve stimulation are consistent. The beneficial effects of prolonged use have been reported in three large studies and one small study. The effects of frequency-modulated electromagnetic neural stimulation were assessed in one large study, and a significant reduction in pain was reported. Treatment with pulsed and static electromagnetic fields has been investigated in two small and three large studies, and analgesic benefits have been reported. In one large study focusing on pulsed electromagnetic fields, no beneficial effect on pain was registered. Only small studies were found concerning other types of electrotherapy, such as pulsed-dose electrical stimulation, high-frequency external muscle stimulation or high-tone external muscle stimulation. The conclusions drawn in these articles are diverse. Shortcomings and problems, including a poor study design, were observed in some. CONCLUSION Further randomized, double-blind, placebo-controlled studies comprising larger sample sizes, a longer duration of treatment, and longer follow-up assessments are required.

Do kinaesthetic tapes affect plantarflexor muscle performance

Abstract This study aimed to examine the effects of application of kinaesthetic tapes on plantarflexor muscle performance. We hypothesised that taping of the triceps surae muscle would improve plantarflexor muscle strength and endurance with no significant effect on drop jump performance. Using a repeated-measures design, all performance measures were obtained in 24 volunteers on two separate occasions: without tapes and after application of kinaesthetic tapes. Performance tests included measurements of isometric plantarflexor muscle strength and the associated electromyographic activity of the gastrocnemius muscle, an isokinetic fatigue resistance test (30 contractions at 180° · s−1) and assessments of drop jump performance. The taping-intervention was associated with an increase in gastrocnemius electromyographic activity. However, significant increases in isometric strength were only found at fully dorsiflexed ankle positions (+12% at −20°). Strength gains were negatively correlated to baseline strength (r = −.58). The intervention did not affect the results of the isokinetic fatigue and drop jump tests. The application of kinaesthetic tapes over the triceps surae muscle promotes an increase in isometric strength and gastrocnemius muscle activity. Our data suggest that these effects are joint-angle dependent and more prominent in weaker individuals. By contrast, the taping-intervention improves neither drop jump performance nor muscular endurance.

Magnetfeldtherapie – Ergebnisse hinsichtlich evidence based medicine

SummaryTherapy with electromagnetic fields has a very old tradition in medicine. The indications are widespread, whereas little is known about the effects. Controlled randomizied studies with positive results for pulsed electromagnetic fields (PEMF) are available for osteotomies, the healing of skin wounds, and osteoarthritis. Comparison of the studies is difficult because of the different doses applied and intervals of therapy. Therefore recommendations regarding an optimal dosis and interval are, depending on the disease, quite variable.ZusammenfassungDie Magnetfeldtherapie ist eine sehr alte physikalische Therapiemodalität, wobei die Wirkung der permanenten und niederfrequent pulsierenden elektromagnetischen Felder (PEMF) bereits seit 2000 Jahren Gegenstand der Heilkunde ist. Bei den unterschiedlichsten Erkrankungen wird die Magnetfeldtherapie empfohlen und teilweise ohne stichhaltige, in randomisierten Studien bestätigte Erfolge angewendet. Ein nachweislich positiver Effekt der Magnetfeldtherapie konnte bisher in mehreren randomisierten Studien bei der Knochenheilung, der Wundheilung und als Analgetikum bei degenerativen Gelenkserkrankungen gefunden werden. Eine exakte Empfehlung hinsichtlich der Therapiedauer und Intensität kann leider aufgrund der fehlenden Datenlage nicht gegeben werden.

Health care utilisation in subjects with osteoarthritis, chronic back pain and osteoporosis aged 65 years and more: mediating effects of limitations in activities of daily living, pain intensity and mental diseases

SummaryMusculoskeletal diseases (MDs) have major consequences for the individual, and also for society and may thus lead to increased use of health care. It was the aim of this study to explore health care utilisation in patients with self-reported osteoarthritis, chronic back pain or osteoporosis compared with people of the same age without those diseases, based on data of the Austrian health interview survey including 3,097 subjects aged ≥ 65 years. Patients with MDs in our study visited a general practitioner (GP) and were hospitalised significantly more often compared with persons without the respective diseases. Problems in the activities of daily living (ADLs), pain intensity and anxiety/depression influenced GP consultations. Complex factors explain the higher health care utilisation in subjects with MDs in our study. Our results indicate that integrated strategies are needed to manage those patients, which should focus on management of ADL problems, pain and mental health.ZusammenfassungMuskuloskeletale Erkrankungen (MEs) haben schwerwiegende Folgen für die betroffenen PatientInnen, die dann meist mehr Versorgungsleistungen des Gesundheitssystems benötigen, sowie für die Gesellschaft. Es war das Ziel dieser Studie die Versorgungsleistungen des Gesundheitssystems bei 3097 ≥ 65 Jahre alten PatientInnen, die bei der österreichischen Gesundheitsbefragung angaben, Arthrose, chronischen Rückenschmerz und/oder Osteoporose zu haben, zu analysieren und mit Personen ohne die jeweilige(n) Erkrankung(en) zu vergleichen. PatientInnen mit MEs in unserer Studie besuchten im Vergleich zu Personen ohne die jeweilige Erkrankung öfter einen Praktischen Arzt/ Hausärztin (PA) und wurden öfter stationär aufgenommen. Probleme bei den Aktivitäten des täglichen Lebens (ADLs), Schmerzintensität und psychische Begleiterkrankungen beeinflussen die Häufigkeit der PA-Besuche. Unsere Resultate zeigen, dass verschiedene Faktoren bei PatientInnen mit MEs die Versorgungsleistungen des Gesundheitssystems bedingen. Integrierte Interventionen sind erforderlich, die die ADL-Probleme, die Schmerzen und die psychische Begleiterkrankungen verbessern.

Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?: A Randomized Controlled Trial

Objective The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs. Design This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used. Results In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12–20 days) in the early rehabilitation and 21 days [IQR, 13–34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13–23 days] vs. 21 days [IQR, 13–34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected. Conclusions An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Synergistic effect of pain and deficits in ADL towards general practitioner visits.

BACKGROUND Pain and activities of daily living (ADLs) deficits are common problems among elderly people who visit general practitioners (GPs). OBJECTIVE To examine whether the probability of visiting a GP is related to deficits in ADLs and pain, and whether these factors act synergistically towards GP visits. METHODS A total of 3097 subjects aged ≥65 years from the Austrian Health Interview Survey formed the cohort. Visiting the GP in the last 4 weeks, chronic pain (CP; pain for at least 3 months) and deficits in ADLs across 11 dimensions were reported. Binary logistic regression models were applied and were stepwise controlled for possible confounders. Based on odds ratios (OR), the synergy index (SI), population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated. RESULTS Overall, 61.0% visited their GP; 51.2% were affected by ADL deficits and 42.2% by CP. In subjects with ADL deficits, the OR for GP consultation was 1.32 (95% confidence interval [CI] 1.11-1.56) and in subjects with CP, 1.93 (95% CI 1.63-2.27) in the fully adjusted model. The OR for those affected by both was 2.56 (95% CI 2.08-3.15); SI was 1.82 (95% CI 1.04-3.18), PAF was 0.27 (95% CI 0.08-0.47) and RERI was 0.70 (95% CI 0.13-1.27). CONCLUSION There is a strong synergistic effect of CP and deficits in ADL in patients ≥65 years on visiting the GP. Prevention, screening, treatment and rehabilitation in this population should focus on both CP and ADL deficits.

The use of the International Classification of Functioning, Disability and Health to classify the factors influencing mobility reported by persons with an amputation: An international study

Background: Amputation of lower limb results in limitations in mobility which are amenable to multiple rehabilitation interventions. The challenges faced by the persons with lower limb amputation vary internationally. The International Classification of Functioning, Disability and Health provides a common language to describe the function of persons with lower limb amputation across various countries. Objectives: This article reports the concepts in mobility important to persons with lower limb amputation across six countries using the International Classification of Functioning, Disability and Health. Study design: Qualitative study using focus groups and individual interviews. Methods: Focus groups and individual interviews of persons with lower limb amputation were organised across six countries to identify the issues faced by patients with an amputation during and after their amputation, subsequent rehabilitation and on an ongoing basis in their daily life. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Functioning, Disability and Health categories. International Classification of Functioning, Disability and Health categorical frequencies were analysed to represent the prevalence and spread of International Classification of Functioning, Disability and Health categories by location. Results: A total of 133 patients were interviewed. A large percentage (93%) of the identified concepts could be matched to International Classification of Functioning, Disability and Health categories for quantitative analysis. Conclusion: The important concepts in mobility were similar across different countries. The comprehensiveness of International Classification of Functioning, Disability and Health as a classification system for human function and its universality across the globe is demonstrated by the large proportion of the concepts contained in the interviews from across the study centres that could be matched to International Classification of Functioning, Disability and Health categories. Clinical relevance The activity and participation restrictions faced by a person with lower limb amputation vary internationally and are amenable to multiple rehabilitation interventions. The International Classification of Functioning, Disability and Health may provide a common language to report and quantify the various concepts important to the patient in their rehabilitation journey.

Mobility in persons with lower extremity amputations and influencing factors: Using the International Classification of Functioning, Disability and Health to quantify expert views

Background: International Classification of Function, Health and Disability provides a common framework and universal language for rehabilitation professionals across the globe. Objectives: To identify problems in functioning and mobility relevant to persons with lower-limb amputation from an expert’s point of view and quantify these problems using the International Classification of Function, Health and Disability. Study design: Qualitative study using electronic and paper surveys. Methods: Electronic or paper survey was done across six countries targeting clinicians involved in pre- and post-amputation care. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Function, Health and Disability categories. Categorical frequency analysis was completed for the combined data and for each location. Results: A total of 183 experts from 6 different countries responded to the survey. A total of 2171 concepts were identified, 82% of which could be linked to a second-level International Classification of Function, Health and Disability category. The categorical frequency analysis revealed that the categories of walking, design and construction of buildings for public and private use and sensation of pain were the most frequently occurring concepts and was similar across the six countries. Conclusion: The International Classification of Function, Health and Disability can be utilised as a common framework for communication among clinicians involved in rehabilitation of persons with lower-limb amputation across the globe. The most important factors that were identified by experts in amputee rehabilitation working in different international locations were similar. Clinical relevance The challenges faced by the clinicians involved in care of persons with lower extremity amputation vary across different parts of the world. The overarching goal for the clinician irrespective of the location is to improve mobility and quality of life of their clients. The International Classification of Function, Health and Disability provides a common language between the various stakeholders in amputee rehabilitation across the globe.

Rehabilitation bei Sportverletzungen

Die Rehabilitation nach Sportverletzungen dient, durch die indikationsspezifische Behandlung von Verletzungen und dem Ausgleich verletzungsbedingter funktioneller Defizite, der bestmoglichen Wiederherstellung der Funktions- und Sportfahigkeit (Freiwald 2009). Die vollstandige Wiederherstellung nach schweren Sportverletzungen ist oftmals nicht moglich. Eine grostmogliche Wiederherstellung der ursprunglichen Struktur und Funktion bzw. Fahigkeiten ist meist das eher erreichbare Ziel. Die Ruckkehr zum Sport ist vielfach auf einem niedrigeren, auf gleichem oder bei langfristigen Trainingsprozessen auf einem hoheren Niveau moglich (Engelhardt et al. 1997; Renstrom 1997; Engelhardt et al. 2005).