Othmar Schuhfried

Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy.

OBJECTIVE To assess the inter-rater and intra-rater reliability and validity of the original and a modified Medical Research Council scale for testing muscle strength in radial palsy. DESIGN Prospective, randomized validation study. PATIENTS Thirty-one patients with peripheral paresis of radial innervated forearm muscles were included. METHODS Wrist extension, finger extension and grip strength were evaluated by manual muscle testing. Dynamometric measurement of grip strength was performed. Pair-wise weighted kappa coefficients were calculated to determine inter-rater and intra-rater reliability. The 2 scores were compared using the signed-rank test. Spearmans correlation coefficients of the maximal relative force measurements with the median (over-raters) Medical Research Council and modified Medical Research Council scores were calculated to determine validity. RESULTS Inter-rater agreement of the Medical Research Council scale (finger extension: 0.77; wrist extension: 0.78; grip strength: 0.78) and the modified Medical Research Council scale (finger extension: 0.81; wrist extension: 0.78; grip strength: 0.81) as well as intra-rater agreement of the Medical Research Council scale (finger extension: 0.86; wrist extension: 0.82; grip strength: 0.84) and the modified Medical Research Council scale (finger extension: 0.84, wrist extension: 0.81; grip strength: 0.88) showed almost perfect agreement. Spearmans correlation coefficients of the maximal relative force measurements with the median Medical Research Council and modified Medical Research Council score were both 0.78. CONCLUSION Medical Research Council and modified Medical Research Council scales are measurements with substantial inter-rater and intra-rater reliability in evaluating forearm muscles.

Exercise training increases endothelial progenitor cells and decreases asymmetric dimethylarginine in peripheral arterial disease: A randomized controlled trial

BACKGROUND Supervised exercise training (SET) is recommended as initial treatment to improve walking capacity in peripheral arterial disease (PAD) patients with intermittent claudication. Various mechanisms by which SET yields beneficial effects are postulated, however data regarding its influence on angiogenesis are scarce. Thus, we designed a prospective randomized controlled trial to study the impact of SET on markers of angiogenesis and endothelial function in PAD. METHODS Forty PAD patients were randomized to SET on top of best medical treatment (SET+BMT) for 6 months versus best medical treatment (BMT) only. Endothelial progenitor cells (EPC) were assessed by whole-blood flow cytometry (co-expression of CD34+ CD133+ KDR+) and cell culture assays (endothelial cell-colony forming units, circulating angiogenic cells, migration assay) at baseline, 3, 6 and 12-months after inclusion. Changes of plasma levels of asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 (SDF-1) and maximum walking distance were determined. RESULTS EPC - measured by flow cytometric and cell culture techniques - increased significantly upon training paralleled by a significant decrease of ADMA when compared to the BMT group (p<0.05). Six months after training cessation, the beneficial effect of SET on EPC diminished, but maximum walking distance was significantly improved compared to baseline and controls (p<0.05). No significant changes were observed for VEGF and SDF-1 plasma levels in time course. CONCLUSIONS SET increases circulating EPC counts and decreases ADMA levels reflecting enhanced angiogenesis and improved endothelial function, which might contribute to cardiovascular risk reduction.

Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials

OBJECTIVE To assess the effectiveness of pulsed electromagnetic fields compared with placebo in the management of osteoarthritis of the knee. DATA SOURCES A systematic review of PubMed, EMBASE, and the Cochrane Controlled Trials Register. METHODS Randomized, controlled trials reporting on the blinded comparison of pulsed electromagnetic fields with placebo were included. Validity was tested according to the Jadad Scale. Studies were pooled using fixed-effects and random-effects models after exclusion of publication bias and assessment of heterogeneity. Sensitivity analyses and meta-regression were performed to test the stability of our findings. RESULTS Nine studies, including 483 patients, were pooled. No significant difference could be shown for pain (weighted mean difference 0.2 patients; 95% confidence interval (CI): -0.4 to 0.8) or stiffness (weighted mean difference 0.3; 95% CI: -0.3 to 0.9). There was a significant effect on activities of daily living (weighted mean difference 0.8; 95% CI 0.2-1.4, p = 0.014) and scores (standardized mean difference 0.4; 95% CI: 0.05-0.8, p = 0.029). We saw only statistically insignificant differences between studies with different treatment protocols. CONCLUSION Pulsed electromagnetic fields improve clinical scores and function in patients with osteoarthritis of the knee and should be considered as adjuvant therapies in their management. There is still equipoise of evidence for an effect on pain in the current literature.

Chronaxie and accommodation index in the diagnosis of muscle denervation.

Paternostro-Sluga T, Schuhfried O, Vacariu G, Lang T, Fialka-Moser V: Chronaxie and accommodation index in the diagnosis of muscle denervation. Am J Phys Med Rehabil 2002;81:253–260. Objective To determine the sensitivity of the combined measurement of chronaxie and the accommodation index in the qualitative diagnosis of muscle denervation with needle electromyography and to compare quantitative diagnoses. Design Ninety-three neurogenic muscles diagnosed by needle electromyography were consecutively included for measurement of chronaxie and the accommodation index in this prospective study. The sensitivity of qualitative diagnosis was assessed for all muscles, separately for the acute and subacute-chronic denervation phase and for the complete and partial denervation. Results The combined measurement of chronaxie and the accommodation index showed a 90% sensitivity to needle electromyography for qualitative diagnosis of muscle denervation for all muscles. A 100% sensitivity was found for the acute denervation phase and for complete denervation. The subacute-chronic denervation phase revealed a 86% sensitivity, and partial denervation had a 88% sensitivity. The kappa coefficients did not show satisfactory agreement in quantitative diagnosis, and Bowker’s test revealed a statistically significant underestimation of muscle denervation for measurement of chronaxie. Conclusion The combined measurement of chronaxie and the accommodation index can be recommended for the screening of neurogenic lesions in the acute denervation phase.

Impact of exercise training on inflammation and platelet activation in patients with intermittent claudication.

BACKGROUND Serum markers of inflammation and platelet activation are related to cardiovascular risk. Cardiovascular risk reduction is a major treatment goal in patients with peripheral arterial disease (PAD). Although current guidelines recommend supervised exercise training (SET) for PAD patients with intermittent claudication, its contribution to risk reduction remains unclear. Aim of the present study was to assess the impact of SET on inflammation and platelet activation as surrogates for cardiovascular risk. METHODS Fifty-three patients with intermittent claudication were randomly assigned to SET on top of best medical treatment (BMT) for 6 months (SET-group) or to BMT only (BMT-group). High sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and fibrinogen as well as soluble P-selectin (sP-sel), prothrombin fragment 1+2 (F1.2) and monocyte-platelet aggregates (MPA) were determined at study entry, after 3, 6 and 12 months. RESULTS While clinical improvement, reflected by an increase of walking capacity, was observed upon SET, no lasting changes of markers of inflammation and platelet activation were found within the SET-group during the training period. Compared to the BMT-group no improvements of these markers were observed in response to training at any time point (all p >0.05). CONCLUSION Regular SET added no further anti-inflammatory effect and had no effect on platelet activation when provided on top of BMT in PAD patients with intermittent claudication.

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.

Excitability of chronic hemiparetic muscles: determination of chronaxie values and strength-duration curves and its implication in functional electrical stimulation

Central nervous system disorders affect the anatomy and physiology of the lower motoneuron. This fact has an impact on the stimulation parameters, especially on the duration of the stimulating impulses, for functional electrical stimulation in chronic hemiparetic patients. The aim of this study was thus to test the excitability and to determine chronaxie values and strength-duration curves of weak wrist and finger extensor muscles and spastic finger and wrist flexor muscles in the hemiparetic arm. Twelve patients with chronic hemiplegia (>6 months after the onset of the cerebral lesion) participated in the study. A constant current stimulator was used. As to chronaxie values no significant differences were found between the extensor muscles (mean /spl plusmn/ SD: 0.44 /spl plusmn/ 0.16 ms) and flexor muscles (mean /spl plusmn/ SD: 0.36 /spl plusmn/ 0.22 ms). A moderate variability was seen for both extensor muscles (0.2-0.8 ms) and flexor muscles (0.1-0.9 ms). These values are well within the normal range determined for innervated muscles. All strength-duration curves were completely normal for each muscle. We conclude that in chronic hemiparetic muscles, impulses of the same duration can be used as in muscles of healthy subjects.

Fourier analysis of impedance rheography for peripheral arterial occlusive disease.

This study identified those harmonics from the frequency spectrum of electrical impedance rheographic signals that discriminate between patients with and without peripheral arterial occlusive disease (PAOD). Ninety-four patients with suspected PAOD were evaluated by impedance rheography and ankle-arm blood pressure index. The leg with the lower ankle-arm index was used in the analysis and a haemodynamically relevant PAOD was assumed at an ankle-arm index lower than 0.85. The frequency spectrum of the impedance signals of the shank was calculated by means of a fast Fourier transformation algorithm. The first ten harmonics were used as independent variables in a stepwise logistic regression analysis to evaluate the dependent variable PAOD. In the regression analysis only the third harmonic was accepted (P<0.0001). The correct classification of the patients was 90%. In conclusion, by means of Fourier analysis of impedance rheographic signals, a high accuracy in the diagnosis of PAOD can be achieved.

Helium–Neon Laser Irradiation: Effect on the Experimental Pain Threshold

Abstract.The aim of this double-blind study was to examine the effects of helium–neon laser irradiation on the mechanical (pressure algometry) and electrical (1 ms monophasic square-wave pulses, 50 Hz) pain threshold. 32 pain-free subjects were randomly assigned to either the experimental group (helium–neon laser stimulation: 5 mW, 10 min) or the placebo group (sham stimulation). Laser or sham stimulation and pain threshold ascertainment were carried out on the dorsal aspect of the forearm area. The contralateral arm served as an untreated control. The groups were compared with each other and with the control arm.No significant differences were found between the laser stimulation and the sham stimulation in changes of either the mechanical or the electrical pain threshold. There were no changes in the mechanical pain threshold through laser stimulation and sham stimulation with respect to the untreated contralateral arm. After laser stimulation electrical pain threshold was significantly higher (p<0.01) in the treated arm than in the untreated contralateral arm, because this threshold decreased in the contralateral arm. This was not the case in sham treatment.The data suggest that helium–neon laser stimulation does not raise the experimental pain threshold in healthy subjects compared to placebo treatment. After helium–neon laser stimulation there was a decrease of the electrical pain threshold in the contralateral arm. To disclose the mechanism of this effect further experimental investigations under strict electrophysiological conditions are required.

Donor site morbidity of the prelaminated fasciomucosal and fasciocutaneous radial forearm flap: a comparative study

Abstract In order to reconstruct intraoral lining defects after radical tumor resection, mucosal prelamination of the fascia of the distal radial forearm flap was performed in ten patients. By this method a physiologic reconstruction with mucus-producing tissue could be achieved. Preservation of skin and subcutaneous tissue enabled primary closure of the donor site. The exposed median nerve and flexor tendons could be covered by well-vascularized tissue with, hopefully, less donor site morbidity. To investigate this, eight prelamination patients were compared to five patients in whom conventional fasciocutaneous distal radial forearm flaps were harvested. Follow-up was 6–25 months (mean 12.8 months). All patients with prelaminated forearm flaps revealed excellent functional and cosmetic results. Restricted hand function and a poor cosmetic result were found in 40% of the fasciocutaneous flap patients. Subjective cold intolerance could be objectified using thermography, but could not be confirmed, using rheography and photoplethysmography.