TY - JOUR A1 - Kiefer, Thomas A1 - Krahl, Dorothea A1 - Hirt, Carsten A1 - Völler, Heinz A1 - Voelkel, Lorenz A1 - Daeschlein, Georg T1 - Influence of treatment caused impairments on anxiety and depression in patients with cancer of the Esophagus or the Esophagogastric junction JF - Journal of gastrointestinal cancer N2 - Purpose After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated. Method Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed. Results We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0-13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0-15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety. Conclusions Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression. KW - Anxiety KW - Depression KW - Esophagus carcinoma KW - Exocrine pancreas KW - insufficiency KW - Rehabilitation KW - Steatorrhea Y1 - 2019 U6 - https://doi.org/10.1007/s12029-018-00193-7 SN - 1941-6628 SN - 1941-6636 VL - 51 IS - 1 SP - 30 EP - 34 PB - Springer CY - New York ER - TY - GEN A1 - Puerto Valencia, Laura Maria A1 - Arampatzis, Adamantios A1 - Beck, Heidrun A1 - Dreinhöfer, Karsten E. A1 - Drießlein, Drießlein A1 - Mau, Wilfried A1 - Zimmer, Julia-Marie A1 - Schäfer, Michael A1 - Steinfeldt, Friedemann A1 - Wippert, Pia-Maria T1 - RENaBack: Low back pain patients in rehabilitation: Study Protocol for a Multicenter, Randomized Controlled Trial T2 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe N2 - Background Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. Methods The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). Discussion An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. Trial registration DRKS, DRKS00020373. Registered on 15 April 2020 T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 772 KW - Chronic low back pain KW - Aftercare KW - Individualized therapy KW - Randomized controlled trial KW - Rehabilitation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-554683 SN - 1866-8364 SP - 1 EP - 18 PB - Universitätsverlag Potsdam CY - Potsdam ER - TY - JOUR A1 - Puerto Valencia, Laura Maria A1 - Arampatzis, Adamantios A1 - Beck, Heidrun A1 - Dreinhöfer, Karsten E. A1 - Drießlein, Drießlein A1 - Mau, Wilfried A1 - Zimmer, Julia-Marie A1 - Schäfer, Michael A1 - Steinfeldt, Friedemann A1 - Wippert, Pia-Maria T1 - RENaBack: Low back pain patients in rehabilitation: Study Protocol for a Multicenter, Randomized Controlled Trial JF - Trials N2 - Background Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. Methods The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). Discussion An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. Trial registration DRKS, DRKS00020373. Registered on 15 April 2020 KW - Chronic low back pain KW - Aftercare KW - Individualized therapy KW - Randomized controlled trial KW - Rehabilitation Y1 - 2021 U6 - https://doi.org/10.1186/s13063-021-05823-3 SN - 1745-6215 SP - 1 EP - 18 PB - Springer Nature / BMC CY - Heidelberg ER - TY - JOUR A1 - Muschalla, Beate A1 - Jöbges, Michael T1 - Prevalence and Characteristics of Work Anxiety in Medical Rehabilitation Patients BT - a cross-sectional observation study JF - Archives of Physical Medicine and Rehabilitation N2 - Objective: To investigate frequency, type, and characteristics of work anxieties in patients with somatic illness. Design: Cross-sectional observation study. Setting: Neurology, orthopedic, and cardiology rehabilitation clinics. Participants: Patients (N=4610; age, 18-65y) with work anxieties. Interventions: Not applicable. Main Outcome Measures: Patients who scored high on at least 2 of 9 items in the work-anxiety screening questionnaire and who reported impairment were investigated with a differential diagnostic interview on work anxieties and with the Mini-International Neuropsychiatric Interview on non work-related common mental disorders. Patients also filled out a self-rating questionnaire on their subjective symptom load and sociodemographic data. Results: Approximately 20% to 27% of the investigated inpatients in somatic rehabilitation (altogether n=393) received a work-anxiety diagnosis. Patients with orthopedic illness report highest work anxiety and have previous longest sick leave (20.6wk in the past 12mo). Patients with orthopedic illness suffer from work-related adjustment disorder with anxiety, social anxieties, and workplace phobias, whereas patients with cardiac illness are more often affected by hypochondriac anxieties. Anxieties of insufficiency and worrying occur equally in all indications. Conclusions: About a quarter of patients in somatic rehabilitation are in need of additional diagnostic attention owing to work anxieties. Differential diagnostic of work anxiety is needed for initiating adequate therapeutic action. Somatic rehabilitation physicians should be aware of work anxieties in their patients, especially in patients with orthopedic illness with previous long-term sick leave. (c) 2017 by the American Congress of Rehabilitation Medicine KW - Anxiety KW - Mental health KW - Rehabilitation KW - Sick leave KW - Workplace Y1 - 2017 U6 - https://doi.org/10.1016/j.apmr.2017.06.017 SN - 0003-9993 SN - 1532-821X VL - 99 IS - 1 SP - 57 EP - 64 PB - Elsevier CY - Philadelphia ER - TY - JOUR A1 - Busch, Aglaja A1 - Blasimann, Angela A1 - Henle, Philipp A1 - Baur, Heiner T1 - Neuromuscular activity during stair descent in ACL reconstructed patients BT - a pilot study JF - The Knee N2 - Background: The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction. Method: Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26 +/- 10 years; height: 175 +/- 6 cm; mass: 75 +/- 14 kg) and 10 healthy matched controls (age: 31 +/- 7 years; height: 175 +/- 7 cm; mass: 68 +/- 10 kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (alpha = 0.05). Results: Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p < 0.05). Conclusion: Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations. (C) 2018 Elsevier B.V. All rights reserved. KW - Knee KW - Neuromuscular control KW - Sensorimotor control KW - Electromyography KW - Rehabilitation Y1 - 2019 U6 - https://doi.org/10.1016/j.knee.2018.12.011 SN - 0968-0160 SN - 1873-5800 VL - 26 IS - 2 SP - 310 EP - 316 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Heidler, Maria-Dorothea A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Determinants of Return to Work After Multicomponent Cardiac Rehabilitation JF - Archives of Physical Medicine and Rehabilitation N2 - Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect. KW - Acute coronary syndrome KW - Cardiac rehabilitation KW - Coronary artery bypass grafting KW - Motivation KW - Rehabilitation KW - Return to work Y1 - 2019 U6 - https://doi.org/10.1016/j.apmr.2019.04.003 SN - 0003-9993 SN - 1532-821X VL - 100 IS - 12 SP - 2399 EP - 2402 PB - Elsevier CY - Philadelphia ER - TY - JOUR A1 - Rauch, Bernhard A1 - Davos, Constantinos H. A1 - Doherty, Patrick A1 - Saure, Daniel A1 - Metzendorf, Maria-Inti A1 - Salzwedel, Annett A1 - Völler, Heinz A1 - Jensen, Katrin A1 - Schmid, Jean-Paul T1 - The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation. KW - Rehabilitation KW - acute coronary syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality KW - hospital readmission Y1 - 2016 U6 - https://doi.org/10.1177/2047487316671181 SN - 2047-4873 SN - 2047-4881 VL - 23 SP - 1914 EP - 1939 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Hirschmüller, Anja A1 - Konstantinidis, Lukas A1 - Baur, Heiner A1 - Müller, Steffen A1 - Mehlhorn, Alexander A1 - Kontermann, Julia A1 - Grosse, Ulrich A1 - Südkamp, Norbert P. A1 - Helwig, Peter T1 - Do changes in dynamic plantar pressure distribution, strength capacity and postural control after intra-articular calcaneal fracture correlate with clinical and radiological outcome? JF - Injury : international journal of the care of the injured N2 - Fractures of the calcaneus are often associated with serious permanent disability, a considerable reduction in quality of life, and high socio-economic cost. Although some studies have already reported changes in plantar pressure distribution after calcaneal fracture, no investigation has yet focused on the patient's strength and postural control. Method: 60 patients with unilateral, operatively treated, intra-articular calcaneal fractures were clinically and biomechanically evaluated >1 year postoperatively (physical examination, SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis including plantar pressure distribution). Results were correlated to clinical outcome and preoperative radiological findings (Bohler angle, Zwipp and Sanders Score). Results: Clinical examination revealed a statistically significant reduction in range of motion at the tibiotalar and the subtalar joint on the affected side. Additionally, there was a statistically significant reduction of plantar flexor peak torque of the injured compared to the uninjured limb (p < 0.001) as well as a reduction in postural control that was also more pronounced on the initially injured side (standing duration 4.2 +/- 2.9 s vs. 7.6 +/- 2.1 s, p < 0.05). Plantar pressure measurements revealed a statistically significant pressure reduction at the hindfoot (p = 0.0007) and a pressure increase at the midfoot (p = 0.0001) and beneath the lateral forefoot (p = 0.037) of the injured foot. There was only a weak correlation between radiological classifications and clinical outcome but a moderate correlation between strength differences and the clinical questionnaires (CC 0.27-0.4) as well as between standing duration and the clinical questionnaires. Although thigh circumference was also reduced on the injured side, there was no important relationship between changes in lower leg circumference and strength suggesting that measurement of leg circumference may not be a valid assessment of maximum strength deficits. Self-selected walking speed was the parameter that showed the best correlation with clinical outcome (AOFAS score). Conclusion: Calcaneal fractures are associated with a significant reduction in ankle joint ROM, plantar flexion strength and postural control. These impairments seem to be highly relevant to the patients. Restoration of muscular strength and proprioception should therefore be aggressively addressed in the rehabilitation process after these fractures. KW - Intra-articular calcaneal fracture KW - Calcaneus KW - Muscle strength KW - Peak torque KW - Plantar pressure distribution KW - Proprioception KW - Postural control KW - Balance KW - Gait KW - Rehabilitation Y1 - 2011 U6 - https://doi.org/10.1016/j.injury.2010.09.040 SN - 0020-1383 VL - 42 IS - 10 SP - 1135 EP - 1143 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Gärtner, Mirijam A1 - Nottebrock, Henning A1 - Fourie, Helanya A1 - Privett, Sean D. J. A1 - Richardson, David M. T1 - Plant invasions, restoration, and economics perspectives from South African fynbos JF - Perspectives in plant ecology, evolution and systematics N2 - Restoration is gaining importance in the management of plant invasions. As the success of restoration projects is frequently determined by factors other than ecological ones, we explored the ecological and financial feasibility of active restoration on three different invaded sites in South Africa's Cape Floristic Region. The aim of our study was to identify cost-effective ways of restoring functional native ecosystems following invasion by alien plants. Over three years we evaluated different restoration approaches using field trials and experimental manipulations (i.e. mechanical clearing, burning, different soil restoration techniques and sowing of native species) to reduce elevated soil nutrient levels and to re-establish native fynbos communities. Furthermore we investigated the possibility of introducing native fynbos species that can be used for sustainable harvesting to create an incentive for restoration on private land. Diversity and evenness of native plant species increased significantly after restoration at all three sites, whereas cover of alien plants decreased significantly, confirming that active restoration was successful. However, sowing of native fynbos species had no significant effect on native cover, species richness, diversity or evenness in the Acacia thicket and Kikuyu field, implying that the ecosystem was sufficiently resilient to allow autogenic recovery following clearing and burning of the invasive species. Soil restoration treatments resulted in an increase of available nitrogen in the Acacia thicket, but had no significant effects in the Eucalyptus plantation. However, despite elevated available soil nitrogen levels, native species germinated irrespective whether sown or unsown (i.e. regeneration from the soil seed bank). Without active introduction of native species, native grasses, forbs and other shrubs would have dominated, and proteoids and ericoids (the major fynbos growth forms) would have been under-represented. The financial analysis shows that income from flower harvesting following active restoration consistently outweighs income following passive restoration, but that the associated increase in income does not always justify the higher costs. We conclude that active restoration can be effective and financially feasible when compared to passive restoration, depending on the density of invasion. Active restoration of densely invaded sites may therefore only be justifiable if the target area is in a region of high conservation priority. KW - Biological invasions KW - Cost-benefit analysis KW - Degradation KW - Exotic species KW - Flower harvesting KW - Rehabilitation Y1 - 2012 U6 - https://doi.org/10.1016/j.ppees.2012.05.001 SN - 1433-8319 VL - 14 IS - 5 SP - 341 EP - 353 PB - Elsevier CY - Jena ER -