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Institute
- Department Sport- und Gesundheitswissenschaften (65) (remove)
Einleitung
Die Implantation einer Knie- oder Hüft-Totalendoprothese (TEP) ist eine der häufigsten operativen Eingriffe. Im Anschluss an die Operation und die postoperative Rehabilitation stellt die Bewegungstherapie einen wesentlichen Bestandteil der Behandlung zur Verbesserung der Gelenkfunktion und der Lebensqualität dar. In strukturschwachen Gebieten werden entsprechende Angebote nur in unzureichender Dichte vorgehalten. Zudem zeichnet sich ein flächendeckender Fachkräftemangel im Bereich der Physiotherapie ab. Die Tele-Nachsorge bietet daher einen innovativen Ansatz für die postrehabilitative Versorgung der Patienten. Das Ziel der vorliegenden Untersuchung war die Überprüfung der Wirksamkeit einer interaktiven Tele-Nachsorgeintervention für Patienten mit Knie- oder Hüft-TEP im Vergleich zur herkömmlichen Versorgung (usual care). Dazu wurden die Funktionalität und die berufliche Wiedereingliederung untersucht.
Methode
Zwischen August 2016 und August 2017 wurden 111 Patienten (54,9 ± 6,8 Jahre, 54,3 % weiblich) zu Beginn ihrer stationären Anschlussheilbehandlung nach Implantation einer Knie- oder Hüft-TEP in diese randomisiert, kontrolliert, multizentrische Studie eingeschlossen. Nach Entlassung aus der orthopädischen Anschlussrehabilitation (Baseline) führte die Interventionsgruppe (IG) ein dreimonatiges interaktives Training über ein Telerehabilitationssystem durch. Hierfür erstellte ein betreuender Physiotherapeut einen individuellen Trainingsplan aus 38 Übungen zur Verbesserung der Kraft sowie der posturalen Kontrolle. Zur Anpassung des Trainingsplans übermittelte das System dem Physiotherapeuten Daten zur Quantität sowie zur Qualität des Trainings. Die Kontrollgruppe (KG) konnte die herkömmlichen Versorgungsangebote nutzen. Zur Beurteilung der Wirksamkeit der Intervention wurde die Differenz der Verbesserung im 6MWT zwischen der IG und der KG nach drei Monaten als primärer Endpunkt definiert. Als sekundäre Endpunkte wurden die Return-to-Work-Rate sowie die funktionelle Mobilität mittels des Stair Ascend Tests, des Five-Times-Sit-to-Stand Test und des Timed Up and Go Tests untersucht. Weiterhin wurden die gesundheitsbezogene Lebensqualität mit dem Short-Form 36 (SF-36) und die gelenkbezogenen Einschränkungen mit dem Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) evaluiert. Der primäre und die sekundären Endpunkte wurden anhand von baseline-adjustierten Kovarianzanalysen im intention-to-treat-Ansatz ausgewertet. Zusätzlich wurde die Teilnahme an Nachsorgeangeboten und die Adhärenz der Interventionsgruppe an der Tele-Nachsorge erfasst und evaluiert.
Ergebnisse
Zum Ende der Intervention wiesen beide Gruppen einen statistisch signifikanten Anstieg ihrer 6MWT Strecke auf (p < 0,001). Zu diesem Zeitpunkt legten die Teilnehmer der IG im Mittel 530,8 ± 79,7 m, die der KG 514,2 ± 71,2 m zurück. Dabei betrug die Differenz der Verbesserung der Gehstrecke in der IG 88,3 ± 57,7 m und in der KG 79,6 ± 48,7 m. Damit zeigt der primäre Endpunkt keine signifikanten Gruppenunterschiede (p = 0,951). Bezüglich der beruflichen Wiedereingliederung konnte jedoch eine signifikant höhere Rate in der IG (64,6 % versus 46,2 %; p = 0,014) festgestellt werden. Für die sekundären Endpunkte der funktionellen Mobilität, der Lebensqualität und der gelenkbezogenen Beschwerden belegen die Ergebnisse eine Gleichwertigkeit beider Gruppen zum Ende der Intervention.
Schlussfolgerung
Die telemedizinisch assistierte Bewegungstherapie für Knie- oder Hüft-TEP Patienten ist der herkömmlichen Versorgung zur Nachsorge hinsichtlich der erzielten Verbesserungen der funktionellen Mobilität, der gesundheitsbezogenen Lebensqualität und der gelenkbezogenen Beschwerden gleichwertig. In dieser Patientenpopulation ließen sich klinisch relevante Verbesserungen unabhängig von der Form der Bewegungstherapie erzielen. Im Hinblick auf die berufliche Wiedereingliederung zeigte sich eine signifikant höhere Rate in der Interventionsgruppe. Die telemedizinisch assistierte Bewegungstherapie scheint eine geeignete Versorgungsform der Nachsorge zu sein, die orts- und zeitunabhängig durchgeführt werden kann und somit den Bedürfnissen berufstätiger Patienten entgegenkommt und in den Alltag der Patienten integriert werden kann. Die Tele-Nachsorge sollte daher als optionale und komplementäre Form der postrehabilitativen Nachsorge angeboten werden. Auch im Hinblick auf den zunehmenden Fachkräftemangel im Bereich der Physiotherapie und bestehende Versorgungslücken in strukturschwachen Gebieten kann der Einsatz der Tele-Nachsorge innovative und bedarfsgerechte Lösungsansätze bieten.
Wendepunkt für Gesundheit
(2019)
Bisher ist die Ursache für die Entstehung der meisten Skoliosen noch ungeklärt und damit eine kausale Behandlung der Betroffenen unmöglich. Die vorliegende Arbeit geht davon aus, dass der Auslöser für die sogenannte idiopathische Skoliose eine funktionelle Störung von Muskeln ist, die sich in einer verminderten relativen Haltekraft äußert. Durch gezielte willkürliche Muskelanspannungen könnte es möglich sein, kompensatorisch auf die Deformität einzuwirken, um damit ein Fortschreiten zu verhindern bzw. sogar eine Regression hervorzurufen. Insbesondere Patientengruppen mit einem hohen Progressionsrisiko, wie Jugendliche im Wachstumsalter, könnten davon profitieren.
Ein Muskeltraining kann mit unterschiedlichsten Hilfsmitteln und Methoden erfolgen. Eine Möglichkeit bietet auch das Klettern. Im Kern wird daher ein Trainingskonzept zum Therapeutischen Klettern bei Jugendlichen mit Skoliose vorgestellt. Dabei beruft sich der Autor auf das Potsdamer Modell. Dieses Modell erlaubt es, gezielte Kraftübungen systematisiert an der Kletterwand in Absprunghöhe umzusetzen. Materielle Sicherungsmaßnahmen sind dadurch nicht erforderlich und eventuell notwendige Korrekturen bzw. Hilfestellungen können direkt erfolgen. Hauptinhalt eines Trainings nach dem vorgestellten Konzept sind spielerische Bewegungserfahrung innerhalb der Sportart Klettern und ein Systembouldertraining.
In einem beigefügten Übungskatalog werden für letzteres Möglichkeiten der praktischen Umsetzun-gen gegeben. Die Übungen fokussieren sich auf die Aktivierung und das Training wirbelkörperdero-tierender Muskeln. Im Hauptteil einer Trainingseinheit können sie dann in Kombination mit der Kor-rektur der Seitverbiegung und des sagittalen Profils (3D Autokorrektur) unter Aufsicht eines geschul-ten Therapeuten durchgeführt werden. Die Arbeit erhebt den Anspruch, einem Leser vom Fach, die Auswahl der Übungen und die darin enthaltene individuelle Anpassung an den Patienten aus funktionell-anatomischer Sicht zu begründen.
In naher Zukunft wird das Konzept in einer randomisiert kontrollierten Studie untersucht. Alle notwendigen Vorbereitungen wurden im Rahmen dieser Arbeit getroffen.
Background: The pathophysiology behind the subacute but persistent hypercoagulable state after traumatic brain injury (TBI) is poorly understood but contributes to morbidity induced by venous thromboembolism. Because platelets and their microvesicles have been hypothesized to play a role in post-traumatic hypercoagulability, administration of commonly used agents may ameliorate this coagulability. We hypothesized that utilization of aspirin, ketorolac, amitriptyline, unfractionated heparin, or enoxaparin would modulate the platelet aggregation response after TBI. Methods: Concussive TBI was induced by weight drop. Mice were then randomized to receive aspirin, ketorolac, amitriptyline, heparin, enoxaparin, or saline control at 2 and 8 h after TBI. Mice were sacrificed at 6 or 24 h after injury to determine coagulability by rotational thromboelastometry (ROTEM), platelet function testing with impedance aggregometry, and microvesicle enumeration. Platelet sphingolipid metabolites were analyzed by mass spectrometry. Results: ROTEM demonstrated increased platelet contribution to maximum clot firmness at 6 h after TBI in mice that received aspirin or amitriptyline, but this did not persist at 24 h. By contrast, adenosine diphosphate- and arachidonic acid-induced platelet aggregation at 6 h was significantly lower in mice receiving ketorolac, aspirin, and amitriptyline compared with mice receiving saline at 6 h after injury and only arachidonic acid-initiated platelet aggregation was decreased by aspirin at 24 h. There were no differences in microvesicle production at either time point. Platelet sphingosine-1-phosphate levels were decreased at 6 h in the group receiving amitriptyline and increased at 24 h along with platelet ceramide levels at 24 h in the amitriptyline group. Conclusion: After TBI, amitriptyline decreased platelet aggregability and increased contribution to clot in a manner similar to aspirin. The amitriptyline effects on platelet function and sphingolipid metabolites may represent a possible role of the acid sphingomyelinase in the hypercoagulability observed after injury. In addition, inhibition of platelet reactivity may be an underappreciated benefit of low molecular weight heparins, such as enoxaparin. (C) 2019 Elsevier Inc. All rights reserved.
The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.
Unexpected perturbations during locomotion can occur during daily life or sports performance. Adequate compensation for such perturbations is crucial in maintaining effective postural control. Studies utilising instrumented treadmills have previously validated perturbed walking protocols, however responses to perturbed running protocols remain less investigated. Therefore, the purpose of this study was to investigate the feasibility of a new instrumented treadmill-perturbed running protocol. <br /> Fifteen participants (age = 2 8 +/- 3 years; height = 172 +/- 9 cm; weight = 69 +/- 10 kg; 60% female) completed an 8-minute running protocol at baseline velocity of 2.5 m/s (9 km/h), whilst 15 one-sided belt perturbations were applied (pre-set perturbation characteristics: 150 ms delay (post-heel contact); 2.0 m/s amplitude; 100 ms duration). Perturbation characteristics and EMG responses were recorded. Bland-Altman analysis (BLA) was employed (bias +/- limits of agreement (LOA; bias +/- 1.96*SD)) and intra-individual variability of repeated perturbations was assessed via Coefficients of Variation (CV) (mean +/- SD). <br /> On average, 9.4 +/- 2.2 of 15 intended perturbations were successful. Perturbation delay was 143 +/- 10 ms, amplitude was 1.7 +/- 0.2 m/s and duration was 69 +/- 10 ms. BLA showed -7 +/- 13 ms for delay, -0.3 +/- 0.1 m/s for amplitude and -30 +/- 10 ms for duration. CV showed variability of 19 +/- 4.5% for delay, 58 +/- 12% for amplitude and 30 +/- 7% for duration. EMG RMS amplitudes of the legs and trunk ranged from 113 +/- 25% to 332 +/- 305% when compared to unperturbed gait. This study showed that the application of sudden perturbations during running can be achieved, though with increased variability across individuals. The perturbations with the above characteristics appear to have elicited a neuromuscular response during running.
Swimming performance can be improved not only by in-water sport-specific training but also by means of dry land-training (e.g., plyometric jump training [PJT]). This study examined the effects of an 8-week PJT on proxies of muscle power and swimming performance in prepubertal male swimmers. Participants were randomly allocated to a PJT group (PJT; n = 14; age: 10.3 +/- 0.4 years, maturity-offset = -3 +/- 0.3) or a control group (CG; n = 12; age: 10.5 +/- 0.4 years, maturity-offset = -2.8 +/- 0.3). Swimmers in PJT and CG performed 6 training sessions per week. Each training session lasted between 80 and 90 minutes. Over the 8 weeks in-season training period, PJT performed two PJT sessions per week, each lasting between 25 to 30 minutes (similar to 1 hour per week) in replacement of sport-specific swimming drills. During that time, CG followed their regular sport-specific swimming training (e.g., coordination, breathing, improving swimming strokes). Overall training volume was similar between groups. Pre- and post-training, tests were conducted to assess proxies of muscle power (countermovement-jump [CMJ]), standing-long-jump [SLJ]) and sport-specific swimming performances (15-, 25-, and 50-m front-crawl, 25-m kick without push [25-m kick WP], and 25-m front-crawl WP). No training or test-related injuries were detected over the course of the study. Between-group analyses derived from magnitude-based inferences showed trivial-to-large effects in favour of PJT for all tests (ES = 0.28 to 1.43). Within-group analyses for the PJT showed small performance improvements for CMJ (effect-size [ES] = 0.53), 25-m kick WP (ES = 0.25), and 50-m front crawl (ES = 0.56) tests. Moderate performance improvements were observed for the SLJ, 25-m front-crawl WP, 15-m and 25-m front-crawl tests (ES = 0.95, 0.60, 0.99, and 0.85, respectively). For CG, the within-group results showed trivial performance declines for the CMJ (ES=-0.13) and the 50-m front-crawl test (ES = -0.04). In addition, trivial-to-small performance improvements were observed for the SLJ (ES = 0.09), 25-m kick WP (ES = 0.02), 25-m front-crawl WP (ES = 0.19), 25-m front-crawl (ES = 0.2), (SLJ [ES = 0.09, and 15-m front crawl (ES = 0.36). Short-term in-season PJT, integrated into the regular swimming training, was more effective than regular swimming training alone in improving jump and sport-specific swimming performances in prepubertal male swimmers.
Introduction: Cystic fibrosis (CF) is a genetic disease which disrupts the function of an epithelial surface anion channel, CFTR (cystic fibrosis transmembrane conductance regulator). Impairment to this channel leads to inflammation and infection in the lung causing the majority of morbidity and mortality. However, CF is a multiorgan disease affecting many tissues, including vascular smooth muscle. Studies have revealed young people with cystic fibrosis lacking inflammation and infection still demonstrate vascular endothelial dysfunction, measured per flow-mediated dilation (FMD). In other disease cohorts, i.e. diabetic and obese, endurance exercise interventions have been shown improve or taper this impairment. However, long-term exercise interventions are risky, as well as costly in terms of time and resources. Nevertheless, emerging research has correlated the acute effects of exercise with its long-term benefits and advocates the study of acute exercise effects on FMD prior to longitudinal studies. The acute effects of exercise on FMD have previously not been examined in young people with CF, but could yield insights on the potential benefits of long-term exercise interventions.
The aims of these studies were to 1) develop and test the reliability of the FMD method and its applicability to study acute exercise effects; 2) compare baseline FMD and the acute exercise effect on FMD between young people with and without CF; and 3) explore associations between the acute effects of exercise on FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels.
Methods: Thirty young volunteers (10 people with CF, 10 non-CF and 10 non-CF active matched controls) between the ages of 10 and 30 years old completed blood draws, pulmonary function tests, maximal exercise capacity tests and baseline FMD measurements, before returning approximately 1 week later and performing a 30-min constant load training at 75% HRmax. FMD measurements were taken prior, immediately after, 30 minutes after and 1 hour after constant load training. ANOVAs and repeated measures ANOVAs were employed to explore differences between groups and timepoints, respectively. Linear regression was implemented and evaluated to assess correlations between FMD and demographic characteristics, physical activity levels, lung function, maximal exercise capacity or inflammatory hsCRP levels. For all comparisons, statistical significance was set at a p-value of α < 0.05.
Results: Young people with CF presented with decreased lung function and maximal exercise capacity compared to matched controls. Baseline FMD was also significantly decreased in the CF group (CF: 5.23% v non-CF: 8.27% v non-CF active: 9.12%). Immediately post-training, FMD was significantly attenuated (approximately 40%) in all groups with CF still demonstrating the most minimal FMD. Follow-up measurements of FMD revealed a slow recovery towards baseline values 30 min post-training and improvements in the CF and non-CF active groups 60 min post-training. Linear regression exposed significant correlations between maximal exercise capacity (VO2 peak), BMI and FMD immediately post-training.
Conclusion: These new findings confirm that CF vascular endothelial dysfunction can be acutely modified by exercise and will aid in underlining the importance of exercise in CF populations. The potential benefits of long-term exercise interventions on vascular endothelial dysfunction in young people with CF warrants further investigation.