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Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Background and Aims Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time-consuming data processing procedures are undertaken. However, in clinical practice simple-real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable "off-the-shelf" sensor-software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements. Methods 24 healthy participants (9 female, 15 male, age 29 +/- 4 years, height 177 +/- 11 cm, weight 73 +/- 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass-correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement). Results ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040-0.733, RMSE: 9.7 degrees-20.3 degrees, bias: 1.2 degrees-50.7 degrees) and insufficient agreement during complex shoulder movements (ICC: 0.104-0.453, RMSE: 10.1 degrees-23.3 degrees, bias: 1.0 degrees-55.9 degrees). Peak angular velocity (ICC: 0.202-0.865, RMSE: 14.6 degrees/s-26.7 degrees/s, bias: 10.2 degrees/s-29.9 degrees/s) and mean angular velocity (ICC: 0.019-0.786, RMSE:6.1 degrees/s-34.2 degrees/s, bias: 1.6 degrees/s-27.8 degrees/s) were inconsistent. Conclusions The "off-the-shelf" sensor-software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU-software-solutions may increase measurement accuracy and permit their integration into everyday clinical practice.
Background and Aims Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time-consuming data processing procedures are undertaken. However, in clinical practice simple-real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable "off-the-shelf" sensor-software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements. Methods 24 healthy participants (9 female, 15 male, age 29 +/- 4 years, height 177 +/- 11 cm, weight 73 +/- 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass-correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement). Results ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040-0.733, RMSE: 9.7 degrees-20.3 degrees, bias: 1.2 degrees-50.7 degrees) and insufficient agreement during complex shoulder movements (ICC: 0.104-0.453, RMSE: 10.1 degrees-23.3 degrees, bias: 1.0 degrees-55.9 degrees). Peak angular velocity (ICC: 0.202-0.865, RMSE: 14.6 degrees/s-26.7 degrees/s, bias: 10.2 degrees/s-29.9 degrees/s) and mean angular velocity (ICC: 0.019-0.786, RMSE:6.1 degrees/s-34.2 degrees/s, bias: 1.6 degrees/s-27.8 degrees/s) were inconsistent. Conclusions The "off-the-shelf" sensor-software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU-software-solutions may increase measurement accuracy and permit their integration into everyday clinical practice.
Progression or impediment of fundamental motor skills performance (FMSP) in children depends on internal and environmental factors. Shoes as an environmental constraint are believed to affect these movements as children showed to perform qualitatively better with sports shoes than flip-flop sandals. However, locomotor performance assessments based on biomechanical variables are limited. Therefore, the objective of this experiment was to assess the biomechanical effects of wearing shoes while performing fundamental motor skills in children. Barefoot and shod conditions were tested in healthy children between the age of 4 and 7 years. They were asked to perform basic and advanced motor skills including double-leg stance, horizontal jumps, walking as well as counter-movement jumps, single-leg stance and sprinting. Postural control and ground reaction data were measured with two embedded force plates. A 3D motion capture system was used to analyse the spatiotemporal parameters of walking and sprinting. Findings showed that the parameters of single- and double-leg stance, horizontal and counter-movement jump did not differ between barefoot and shod conditions. Most of the spatiotemporal variables including cadence, stride length, stride time, and contact time of walking and sprinting were statistically different between the barefoot and shod conditions. Consequently, tested shoes did not change performance and biomechanics of postural control and jumping tasks; however, the spatiotemporal gait parameters indicate changes in walking and sprinting characteristics with shoes in children.
The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. Methods-Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen kappa and Fleiss kappa coefficients (absolute), Kendall tau b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]). Results-Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels). Conclusions-The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.
We sought to investigate the effects of wearing a mobile respiratory gas analysis system during a treadmill test on blood lactate (bLa) concentrations and commonly applied bLa thresholds. A total of 16 recreational athletes (31 +/- 3 years, V0205: 58 6 ml min(-1)-kg(-1)) performed one multistage treadmill test with and one without gas exchange measurements (GEM and noGEM). The whole bLa curve, the lactate threshold (LT), the individual anaerobic thresholds according to Stegmann(IAT(sr)) and Dickhuth (IAT(Di)), and a fixed bLa concentration of 4 mmob.l(-1) (OBLA) were evaluated. The bLa curve was shifted slightly leftward in GEM compared to noGEM (P<0.05), whereas the heart rate response was not different between conditions (P= 0.89). There was no difference between GEM and noGEM for LT (2.61 +/- 0.34 vs. 2.64 +/- 0.39 m(-1) s(-1) P=0.49) and IAT(st) (3.47 +/- 0.42 vs. 3.55 +/- 0.47m-s(-1), P=0.12). However, IATD(Di) (3.57 +/- 0.39 vs. 3.66 +/- 0.44m-s(-1), P<0.01) and OBLA (3.85 +/- 0.46 vs. 3.96 +/- 0.47m-s-1, P<0.01) occurred at slower running velocities in GEM. The bLa response to treadmill tests is mildly affected by wearing a mobile gas analysis system. This also applies to bLa thresholds located at higher exercise intensities. While the magnitude of the effects is of little importance for recreational athletes, it might be relevant for elite athletes and scientific studies.
Eccentric (ECC) exercises might cause muscle damage, characterized by delayed-onset muscle soreness, elevated creatine kinase (CK) levels and local muscle oedema, shown by elevated T2 times in magnet resonance imaging (MRI) scans. Previous research suggests a high inter-individual difference regarding these systemic and local responses to eccentric workload. PURPOSE: To analyze ECC exercise-induced muscle damage in lumbar paraspinal muscles assessed via MRI. METHODS: Ten participants (3f/7m; 33±6y; 174±8cm; 71±12kg) were included in the study. Quantitative paraspinal muscle constitution of M. erector spinae and M. multifidius were assessed in supine position before and 72h after an intense eccentric trunk exercise bout in a mobile 1.5 tesla MRI device. MRI scans were recorded on spinal level L3 (T2-weighted TSE echo sequences, 11 slices, 2mm slice thickness, 3mm gap, echo times: 20, 40, 60, 80, 100ms, TR time: 2500ms). Muscle T2 times were calculated for manually traced regions of interest of the respective muscles with an imaging software. The exercise protocol was performed in an isokinetic device and consisted of 120sec alternating ECC trunk flexion-extension with maximal effort. Venous blood samples were taken before and 72h after the ECC exercise. Descriptive statistics (mean±SD) and t-testing for pre-post ECC exercises were performed. RESULTS: T2 times increased from pre- to post-ECC MRI measurements from 55±3ms to 79±28ms in M. erector spinae and from 62±5ms to 78±24ms in M. multifidius (p<0.001). CK increased from 126±97 U/L to 1447±20579 U/L. High SDs of T2 time and CK in post-ECC measures could be due to inter-individual reactions to ECC exercises. 3 participants showed high local and systemic reactions (HR) with T2 time increases of 120±24% (M. erector spinae) and 73±50% (M. multifidius). In comparison, the remaining 7 participants showed increases of 11±12% (M. erector spinae) and 7±9% (M. multifidius) in T2 time. Mean CK increased 9.5-fold in the 3 HR subjects compared with the remaining 7 subjects. CONCLUSIONS: The 120sec maximal ECC trunk flexion-extension protocol induced high amounts of muscle damage in 3 participants. Moderate to low responses were found in the remaining 7 subjects, assuming that inter-individual predictors play a role regarding physiological responses to ECC workload.