Martin Nuhr

Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain.

STUDY DESIGN Cross-cultural adaptation and cross-sectional psychometric testing. OBJECTIVES To develop and validate a cross-cultural version of the Roland-Morris Questionnaire for use in German-speaking patients with low back pain. SUMMARY OF THE BACKGROUND DATA Clinical research related to the management of back pain would be facilitated enormously if a small number of patient-oriented questionnaires became widely used. If the transposition of a questionnaire from its original cultural context is done by simple translation, it is unlikely to be successful because of language and cultural differences. Therefore, a simple direct translation of a questionnaire from one language to another does not permit its use in clinical trials. METHODS The instrument was translated and back-translated, pretested, and reviewed by a committee. The German version of the Roland-Morris Questionnaire was tested in 125 patients with low back pain. The study was conducted at the spa resort at Senftenberg, Austria, which is visited by patients from all countries of German-speaking Europe. Reliability and concurrent construct validity were assessed with Pearsons correlation coefficient on the Roland-Morris Questionnaire scores compared with the scales of the Medical Outcome Study Short Form-36 questionnaire. RESULTS Pearsons correlation coefficient for test-retest reliability of the German version was r = 0.82 (P = 0.0001), and Cronbachs alpha was 0.81. The concurrent validity was r = 0.81 (Roland-Morris Questionnaire/pain rating; P = 0.0001), r = 0.48 (Roland-Morris Questionnaire/forward bending; P = 0.0001), and r = -0.47 (Roland-Morris Questionnaire/lateral bending; P = 0.0001). Correlation between the functional scales of the Medical Outcome Study Short Form-36 questionnaire and the Roland-Morris Questionnaire sum scores ranged from r = -0.29 (emotional limitations; P = 0.0011) to r = -0.71 (physical limitations; P = 0.0001). CONCLUSION Because the German version of the Roland-Morris Questionnaire seems to be reliable and valid for the assessment of the functional status in German-speaking patients with low back pain, the use of this translated instrument can be recommended in future clinical trials.

Muscle strength as a predictor of long‐term survival in severe congestive heart failure

The objective of the study was to test the relationship between isolated muscle strength and outcome, and its significance in the context of other exercise variables.

Aerobic capacity in adult dermatomyositis/polymyositis patients and healthy controls

OBJECTIVE Assessment of myositis patients has relied on symptoms, strength testing, and serum muscle enzyme activity. Recently, functional assessments and evaluation of strength by dynamometry and of disease activity by magnetic resonance imaging have also been added. Aerobic testing in selected patients has been considered useful. DESIGN Case-control study. SETTING University Hospital, Vienna, Austria. PATIENTS Twenty-two subjects (8 outpatients with chronic dermatomyositis and 3 outpatients with chronic polymyositis, and 11 healthy controls) participated, allowing the identification of 11 case-control pairs matched by age (+/-3 years) and gender (mean age, 48+/-14 yrs; ratio of women to men, 18/4). MAIN OUTCOME MEASURES Target parameters were peak oxygen uptake (peak VO2) to estimate aerobic exercise capacity and peak isometric torque for muscle strength. Creatine phosphokinase (CPK) was measured to assess elevation of muscle enzymes. RESULTS The mean peak VO2 in patients with dermatomyositis/polymyositis was 15.3 mL/min/kg (SD = 5.8) and in the healthy controls 28.7 mL/min/kg (SD = 7.8). Cardiorespiratory capacity expressed as peak VO2 was thus significantly reduced at 53% (p = .0001) of the control value. Muscle strength expressed as peak isometric torque was significantly lower (p = .01) in patients (mean 148+/-73 Nm) when compared to the control group (mean 261+/-99 Nm). In myositis patients peak VO2 and peak isometric torque correlate well with each other (r = .7631; p = .0001), but not at all with serum CPK levels (r = .056; p = .869). CONCLUSION Peak VO2 is significantly diminished in patients with dermatomyositis/polymyositis, compared with age- and sex-matched controls. Serum CPK did not significantly correlate with VO2. Aerobic exercise testing may be a useful assessment parameter in selected patients with dermatomyositis/ polymyositis.

PHYSICAL PERFORMANCE AND HEALTH-RELATED QUALITY OF LIFE IN MEN ON A LIVER TRANSPLANTATION WAITING LIST

Twenty-six men on a liver transplant waiting list (12 had alcoholic cirrhosis, 8 suffered from posthepatitic cirrhosis, and 6 from cirrhosis of other etiologies) were eligible for this observation. Nineteen subjects underwent exercise testing to determine oxygen uptake at anaerobic threshold. In all patients dynamometry was performed to determine isokinetic muscle strength of knee extensor muscles, and handgrip. Quality of life was evaluated in all patients with the MOS SF-36 questionnaire. Child-Pugh A patients showed 54 +/- 8%, Child-Pugh B patients 36 +/- 2%, and Child-Pugh C patients 31 +/- 4% of VO2 max predicted at the anaerobic threshold (Kruskal-Wallis ANOVA, p < 0.05). Isokinetic muscle strength of the quadriceps femoris (left/right) was 149 +/- 20/134 +/- 14 Nm in Child-Pugh A, 108 +/- 16/114 +/- 19 Nm in Child-Pugh B, and 89 +/- 10/81 +/- 11 Nm in Child-Pugh C patients (Kruskal-Wallis ANOVA, p < 0.05). MOS-SF36 revealed a Child-Pugh class dependent reduced functional status (Kruskal-Wallis ANOVA, p < 0.05). No significant differences in target parameters were found when analysed according to the etiology of cirrhosis. Patients on the liver transplant waiting list do have a stage dependent reduction in physical health. These data are the basis for longitudinal studies measuring the effects of preoperative rehabilitation programs in these patients.

AEROBIC CAPACITY, MUSCLE STRENGTH AND HEALTH-RELATED QUALITY OF LIFE BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION: PRELIMINARY DATA OF AN AUSTRIAN TRANSPLANTATION CENTRE

OBJECTIVE Patients before orthotopic liver transplantation usually show a reduced physical performance status, which impacts on their daily life and social participation. This pilot study aimed to evaluate endurance capacity, muscle strength, and quality of life before and after orthotopic liver transplantation in patients in an Austrian transplantation centre. SUBJECTS Fifteen patients (male/female = 10:5) were included in the pilot study. METHODS Exercise testing, strength testing of knee extensor muscles and of handgrip, and quality of life (SF-36 health survey) were assessed before and after orthotopic liver transplantation (after 1-2 months). RESULTS The oxygen uptake at the anaerobic threshold (VO2AT) and isokinetic strength testing of quadriceps femoris muscle did not change significantly from baseline, before transplantation to follow-up after orthotopic liver transplantation. Before orthotopic liver transplantation, quality of life was hampered concerning functional status, emotional role, vitality, and general health perception. Significant improvements of social functioning (p=0.032), vitality (p=0.006), mental health (p=0.004) and general health perception (p=0.002) could be found for this study population after orthotopic liver transplantation. CONCLUSION The results of this pilot study including a population of an Austrian transplantation centre indicate deficits of physical performance as well as reduced quality of life in patients before and after orthotopic liver transplantation.

Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial.

SummaryBackgroundCalcific tendonitis of the shoulder is often associated with chronic pain and impairment of function. Extracorporeal Shockwave therapy (ESWT) is considered to be a treatment option. We compared the effects of two different ESWT regimens.Methods43 patients (57 shoulders) with symptomatic calcific tendonitis of the shoulder for more than six months were included in a double-blinded study. Thirty-one shoulders were treated at the area of maximum pain with application of 2×2000 impulses of 0.28mJ/mm2 at an interval of two weeks (treatment group) and 26 shoulders with 2×2000 impulses of <0.07mJ/mm2 at an interval of two weeks (control group), without pretreatment analgesia. Shoulder function (Constant score) and pain (visual analogue scale, VAS) were assessed before treatment and at one week, three months and seven months after treatment. Shoulder X-rays were performed at the 3- and 7-month follow-up visits.ResultsImprovement in Constant score was significantly higher in the treatment group at all follow-up visits (p<0.05). Seven months post-treatment, calcifications dissolved completely in 19% of the treatment group and 8% of the control group, and a >50% reduction was observed in 19% and 8% respectively. With regard to reduction of pain, there was significant improvement in the treatment group compared with the control group at the 1-week follow-up (p<0.05). However, at the 3-month and 7-month visits, no significant between-group difference in pain could be detected.ConclusionAs applied, ESWT with an energy flux density of 0.28mJ/mm2 led to a significantly greater improvement in shoulder function and a slightly higher, nonsignificant, rate of > 50% disintegration of calcific deposits compared with the control group. However, this did not result in reduction of pain.

Aerobic Exercise as Additive Palliative Treatment for a Patient with Advanced Hepatocellular Cancer

SummaryAerobic exercise is known to improve biopsychosocial outcomes in cancer patients. Currently, exercise is not regarded as a quality-of-life intervention for patients with advanced cancer. The aim of this case study was to determine the feasibility and effects of an aerobic exercise programme for a patient with advanced hepatocellular cancer.After written informed consent, a 55-year-old male patient with advanced hepatocellular carcinoma participated in an aerobic exercise programme of precise intensity, duration and frequency, consisting of ergometer cycling 2 times a week, carried out for a period of 6 weeks. Exercise testing and a 6-min walk were performed, and the patient’s quality of life was assessed.The feasibility, safety and beneficial effects of the programme were proven for this patient. At the end of the exercise programme, peak work capacity had increased by 20.3%. The patient has experienced an improvement in physical performance, which was underlined by the 6-min walk. Quality of life has been improved (physical functioning, vitality, mental health, role functioning/ emotional, social functioning).Knowledge about the benefits of aerobic exercise for patients suffering from advanced cancer is not yet widespread. Nevertheless, aerobic exercise initiated and executed with appropriate care may serve as a useful additional means of palliative treatment in some patients with advanced cancer.ZusammenfassungAerobes Ausdauertraining hat bekannte positive Effekte auf biopsychosoziale Parameter von Krebspatienten. Derzeit gilt Trainingstherapie nicht als lebensqualitätsverbessernde Maßnahme für Patienten mit fortgeschrittenen Karzinomen. Ziel dieser Fallstudie war es, die Machbarkeit und Effekte eines aeroben Ausdauertrainingsprogramms bei einem Patienten mit fortgeschrittenem hepatozellul7#x00E4;ren Karzinom zu bestimmen. Nach schriftlicher Einwilligung nahm ein 55jähriger männlicher Patient mit fortgeschrittenem hepatozellulärem Karzinom an einem aeroben Ausdauertraining, das nach den Regeln der medizini-schen Trainingslehre durchgeführt wurde, teil. Dabei handelte es sich um ein Fahrradergometertraining, welches zweimal wöchentlich über einen Zeitraum von 6 Wochen durchgeführt wurde. Ergometrien, sechsminütige Gehtests sowie Lebensqualitätsuntersuchungen wurden durchgeführt. Machbarkeit, Sicherheit und positive Effekte des Trainingsprogramms konnten für diesen Patienten bewiesen werden. Nach Beendigung des Trainingsprogramms hatte sich die Leistungsfähigkeit des Patienten um 20,3% verbessert. Der Patient gab eine deutliche Verbesserung seiner körperlichen Leistungsfähigkeit an, was durch das Ergebnis des sechsminütigen Gehtests unterstrichen wurde. Die Lebensqualität verbesserte sich in den Domänen „Körperliche Leistungsfähigkeit“, „Vitalität“, „Mentale Gesundheit“, „Emotionale Rollenfunktion“ und „Soziale Kompetenz“. Das Wissen um positive Effekte aeroben Ausdauertrainings bei Patienten mit fortgeschrittenen Karzinomen und infauster Prognose ist derzeit noch nicht stark verbreitet. Dennoch kann aerobes Ausdauertraining, wenn es entsprechend den Gesetzen der medizinischen Trainingslehre durchgeführt wird, eine sinnvolle Ergänzung in der palliativen Behandlung mancher Patienten mit fortgeschrittener Krebserkrankung darstellen.

Safety of a combined strength and endurance training using neuromuscular electrical stimulation of thighs muscles in patients with heart failure and bipolar sensing cardiac pacemakers

ZusammenfassungFür Patienten mit schwerer chronischer Herzinsuffizienz ist Ausdauer- und Krafttraining durch neuromuskuläre Elektrostimulation (NMES) eine effektive und nicht belastende Alternative zum aktiven Training. Wegen möglicher elektromagnetischer Interferenz werden Herzschrittmacherpatienten häufig von einer NMES-Behandlung ausgeschlossen. Ziel dieser Pilotstudie war die Untersuchung der Sicherheit eines kombinierten NMES-Ausdauer- und Krafttrainingsprotokolles für Patienten mit Herzschrittmachern.In die Studie wurden sieben Patienten mit schwerer chronischer Herzinsuffizienz und implantierten Herzschrittmachern mit bipolar wahrnehmenden Elektroden eingeschlossen und ein ärztlich supervidiertes kombiniertes Ausdauer- und Krafttraining mittels NMES unter Pulsmonitoring durchgeführt. Das NMES-Protokoll bestand aus biphasischen, symmetrischen Rechteckimpulsen mit unterschiedlichen Frequenzen von 8 Hz bis 50 Hz, Impulsdauern bis 60 s (8 Hz), 4s (15 Hz), 4 s (30 Hz) und 6 s (50 Hz), sowie Amplituden bis ±100 mA (alle Frequenzen). Die Stromapplikation erfolgte über Oberflächenelektroden (8×13 cm) im Bereich der Streck- und Beugemuskulatur beider Oberschenkel.Eine akute elektromagnetische Interferenz trat im Verlauf eines Sicherheitschecks (Telemetriemonitoring) vor Beginn der NMES-Therapie bei keinem der Patienten auf. Den 7 Patienten wurden während jeweils 20 NMES-Therapie-Einheiten komplikationslos bei insgesamt 23.380 Einschaltphasen 2.194,08×103 Stimuli appliziert. Es wurden keine Änderungen der simultan registrierten Herzfrequenz detektiert und keine Fehlfunktion des Schrittmachers festgestellt.Die Durchführung eines kombinierten NMES-Ausdauer-und Krafttrainingsprogrammes der Oberschenkelmuskulatur erscheint bei Patienten mit Herzinsuffizienz und implantierten bipolaren Herzschrittmachern unter Berücksichtigung der beschriebenen Elektrodenlagen und Parametergrenzen sicher.SummaryNeuromuscular electrical stimulation (NMES) is an effective and non-strenuous therapy to enhance the strength and endurance capacity of the skeletal muscles in patients with severe chronic heart failure. NMES in patients with pacemakers is controversial because potential electromagnetic interference may result in pacemaker malfunction. Therefore, such patients are in general excluded from NMES. The aim of this pilot study was to evaluate the safety of a combined NMES protocol to increase strength and endurance capacity of the skeletal muscles in patients with heart failure and implanted pacemakers.Seven patients with chronic heart failure and implanted cardiac pacemakers with bipolar sensing leads received NMES treatment of thigh muscles, using a combined protocol comprising biphasic, symmetric, rectangular constant current impulses at different frequencies (8–50 Hz), pulse width up to 60 s (8 Hz), 4 s (15 Hz), 4 s (30 Hz), and 5 s (50 Hz), and amplitudes up to ±100 mA (all frequencies) applied to both knee extensor and flexor muscles via surface electrodes (8×13 cm each).Acute electromagnetic interference during a safety procedure (telemetric monitoring) before therapeutic NMES application was not observed in any of the patients. The 7 patients received during 20 therapeutic NMES sessions a total of 23,380 on-phases, comprising 2194.08×103 biphasic electrical pulses, without adverse events. Heart rate monitoring during stimulation and pacemaker interrogation revealed no abnormalities.NMES treatment of thigh muscles using a combined NMES protocol to enhance strength and endurance capacity appears to be safe in patients with heart failure and implanted pacemakers with bipolar sensing, as far as the described electrode configuration and parameter range is applied.

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy.

ABSTRACT In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fishers Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fishers Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.

Aerobes Ausdauertraining für Krebspatienten

ZusammenfassungMit zunehmender Zahl an mittelbis langfristig überlebenden Krebspatienten steigt der Bedarf an Mitteln zur Behandlung der physischen und psychischen Begleiterscheinungen und Nebenwirkungen der Krebserkrankung und ihrer onkologischen Therapie. Verminderte körperliche Leistungsfähigkeit, Erschöpfung/Fatigue, Übelkeit, Gewichtsverlust, psychologischer Distreß, Körperschemastörungen, Abhängigkeit und verminderte Lebensqualität sind Kurz- und Langzeitfolgen bei Krebserkrankungen.Wir beschreiben die wissenschaftliche Datenlage erstens über Effekte des aeroben Ausdauertrainings bei Krebspatienten, und über die Machbarkeit des aeroben Ausdauertrainings, zweitens unter onkologischer Therapie und drittens bei Patienten mit fortgeschrittener Krebserkrankung.Die Daten aus der Literatur belegen, daß aerobes Ausdauertraining als additive Therapiemaßnahme hilft, die Dekonditionierung und körperlichen Einschränkungen zu überwinden und somit zur Rehabilitation und zur Besserung der Lebensqualität von Krebspatienten beitragen kann. Die Machbarkeit des aeroben Ausdauertrainings konnte auch für Patienten, die an fortgeschrittener Krebserkrankung leiden, demonstriert werden. Aerobes Ausdauertraining hat sich als positiv für Krebspatienten erwiesen, da es die Rekonditionierung ermöglicht, wodurch den Patienten die Rückkehr zu einem aktiven Lebensstil ermöglicht wird. Aerobes Ausdauertraining scheint eine effektive Möglichkeit zu sein, die Folgen einer Krebserkrankung zu vermindern und damit zur Steigerung der Lebensqualität beizutragen.SummaryWith the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short- and long-term sequelae of cancer.We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer.The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there by contribute to rehabilitation and quality of life of cancer patients. Feasibility of aerobic exercise has been demonstrated also for patients suffering from advanced cancer. Aerobic exercise has been shown to provide benefits to cancer patients. It enables these patients to recover their physical function and to return to an active lifestyle. Aerobic exercise seems to be an effective possibility to reduce sequelea of cancer and to increase quality of life.