Current Trends and Variations in the Treatment of Unicameral Bone Cysts of the Humerus: A Survey of EPOS and POSNA Members.

BACKGROUND: A variety of treatment methods have so far been described for unicameral bone cysts (UBC). However, to the best of our knowledge, no particular consensus has yet been reached on when to operatively treat a patient with a humeral UBC. Therefore, members of the European Pediatric Orthopedic Society (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to characterize current treatment preferences. METHODS: An online electronic questionnaire was sent out to all registered EPOS and POSNA members. The survey comprised 45 questions related to the diagnosis, treatment, and follow-up characteristics of patients with UBCs of the humerus. Particular questions related to the nonoperative or surgical treatment of pathologic proximal humerus and humeral shaft fractures were also included. RESULTS: In total, 444 participants (132 EPOS and 292 POSNA members) responded, of whom 400 were actively involved in UBC treatment. The preferred diagnostic modalities to confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% prefer no treatment at all except when the fracture risk is deemed high (then 53% recommend surgery); 71% of respondents would treat painful UBCs with surgery. Most common surgical techniques comprise curettage (45%), artificial bone substitutes (37%), corticosteroid injection (29%), or intramedullary stabilization (eg, rodding; 24%).Fractured, nondisplaced and mildly displaced proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely displaced pathologic proximal humerus fractures are treated less often conservatively (36%) than surgically (40%), and severely displaced humerus shaft fractures are preferably treated surgically (63%) by intramedullary stabilization (60%). CONCLUSIONS: There is great variation among EPOS and POSNA members with regards to the diagnosis and treatment of UBCs in the humerus. Although some consensus on general treatment principles is seen, specific surgical treatment indications vary.Prospective randomized-controlled studies are needed to evaluate the outcomes of the different surgical approaches compared with nonoperative strategies. LEVEL OF EVIDENCE: Level V-expert opinion.

Galactobacter caseinivorans gen. nov., sp. nov. and Galactobacter valiniphilus sp. nov., two novel species of the family Micrococcaceae, isolated from high bacterial count raw cow's milk.

Four Gram-stain positive, rod-shaped bacterial isolates, strains JZ R-183T, JZ RK-117, DI-46 and JZ R-35T, were recovered from bulk tank raw cow's milk from three different dairy farms in Germany. Analysis of their 16S rRNA gene sequences indicated that these isolates belonged to the family Micrococcaceae, closely related to the genera Arthrobacter, Neomicrococcus,Glutamicibacter and Citricoccus. The 16S rRNA gene sequence similarity between the isolates and the next related type strains was below 97.3 %. Phylogenetic analysis of 16S rRNA, recA and gyrB genes revealed that these isolates formed two different groups in an independent cluster within the family Micrococcaceae. Chemotaxonomic analyses determined anteiso-C15 : 0 as predominant fatty acid, but also large amounts of iso-C15 : 0, iso-C16 : 0 and iso-C17 : 0 were detected. The menaquinones MK-9(H2) and MK-7(H2) were present in all of the isolates and the polar lipid pattern contained the phospholipids diphosphatidylglycerol, phosphatidylglycerol and phosphatidylinositol and a glycolipid. The peptidoglycan type of the isolates was A4α, with alanine, lysine and glutamate as dominating cell wall amino acids. The fatty acid and menaquinone profile differentiated the strains from the genera Arthrobacter, Neomicrococcus,Citricoccus and Glutamicibacter. The results of phylogenetic, phenotypic and chemotaxonomic analyses indicated that the isolates belonged to two novel species of a novel genus, for which the names Galactobacter caseinivorans gen. nov., sp. nov. and Galactobacter valiniphilus sp. nov. are proposed. The type strains are JZ R-183T (=DSM 107700T=LMG 30902T) and JZ R-35T (=DSM 107699T=LMG 30901T).

The contribution of fast growing, psychrotrophic microorganisms on biodiversity of refrigerated raw cow's milk with high bacterial counts and their food spoilage potential.

Storage of raw milk in the bulk tank creates an environment which selects for psychrotrophic bacteria. Results from earlier studies suggested that the microbiota of bulk tank milk with high bacterial counts is dominated by single, cold-adapted species with high growth rates at low temperatures. We checked this assumption in more detail and analyzed the microbial diversity of 48 samples from bulk tank raw cow's milk with bacterial counts >100,000 cfu/mL from different geographic regions by culture-dependent and -independent methods. Contrary to presumptions from earlier studies, only the minority (24%) of samples was dominated by a single bacterial species and diversity was not correlated with bacterial counts. The dominating species in this group of samples were identified as psychrotrophic Acinetobacter and Pseudomonas species, related to poor hygiene and spoilage, or mesophilic, mastitis-related Streptococcus species and Escherichia coli. This shows that storage of raw milk under refrigeration does not always lead to a selection of cold-adapted bacteria. Approximately half of the raw milk isolates showed either lipolytic or proteolytic activity at 10 °C or 4 °C. Consistent or increased enzymatic activity at cold temperatures was detected for Acinetobacter spp. and Pseudomonas spp., but also for genera with minor abundance, e.g. Carnobacterium and Arthrobacter.

Intraoperative Diagnosis of Periprosthetic Joint Infection Using a Novel Alpha-Defensin Lateral Flow Assay.

BACKGROUND: The present study investigates the novel Synovasure periprosthetic joint infection (PJI) lateral flow test device for detection of alpha-defensin and attempts to determine its diagnostic accuracy for the intraoperative diagnosis of PJI and compares it to frozen section. METHODS: Forty consecutive patients, who underwent revision surgery, between September 2014 and September 2015 were included. The patients underwent 29 revision total knee arthroplasties and 11 revision total hip arthroplasties. Twelve patients had a confirmed PJI based on Musculoskeletal Infection Society criteria, and 28 patients were considered aseptic. RESULTS: The overall accuracy to detect PJI using the lateral flow assay was 85% (95% CI 70%-93%). The device has a positive predictive value of 80% (95% CI 44%-96%) and a negative predictive value of 87% (95% CI 68%-96%) and showed a sensitivity of 67% (95% CI 35%-89%) and specificity of 93% (95% CI 75%-99%). Frozen section had a lower sensitivity (58% [95% CI 29%-84%]) but a higher specificity (96% [95% CI 80%-100%]). Receiver operator curve analysis demonstrates an area under the curve of the Synovasure PJI Lateral Flow Test Kit and frozen section of 0.80 and 0.77, respectively. CONCLUSION: The present study suggests that the intraoperative lateral flow test is at least equivalent to intraoperative frozen section and is a useful tool to confirm the absence of PJI. Although the clinical results are promising, they are not as good as previous studies using alpha-defensin levels measured in a laboratory.

Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair.

INTRODUCTION: Full thickness rotator cuff tears are a common cause of shoulder pain and disability. While the role of the rotator cuff seems to be well known, the clinical significance of the biceps tendon for shoulder function has still been a subject of controversy. The aim of this study was to evaluate differences between tenodesis or tenotomy in simultaneous rotator cuff repair. METHODS: For this retrospective study 53 consecutive patients (25f/28m, Ø age 58 years) undergoing arthroscopic double row rotator cuff reconstruction and suture bridge repair were included. The LHB was treated with tenodesis (n = 24) or tenotomy (n = 29). Clinical examination was carried out for all patients after an average of 34 months (range 27­38) following arthroscopic surgery. The Constant score, level of pain, range of motion in flexion and abduction, and isometric force for the operated and healthy shoulder in flexion and abduction were recorded. RESULTS: Patients in the tenodesis and tenotomy group reached similar good result regarding the Constant score (86.6 ± 11.9 vs. 81.3 ± 12.2; P = 0.120), pain (median 0, range 0­8 vs. Median 0, range 0­10; P = 0.421), and range of motion (flexion: median 180°, range 90°­180° vs. median 180°, range 90°­180°; P = 0.833; abduction: median 180°, range 90°­180° vs. median 180°, range 120°­180°; P = 0.472). Postoperative popeye sign was found only in one patient (1.9 %). At the time of postoperative follow-up, no patient reported cramping of the biceps. Isometric forces in abduction of the tenotomy group (mean 4.7 ± 2.9 kg; maximum 5.5 ± 2.8 kg) was significant lower compared to the tenodesis group (mean 6.6 ± 3.0 kg, P = 0.019; maximum 7.7 ± 2.9 kg, P = 0.007) and compared to healthy shoulders (mean 6.1 ± 3.0 kg P = 0.004; maximum 7.4 ± 3.1 kg, P = 0.001), all other measurements were similar. CONCLUSION: According to our results arthroscopic biceps tenodesis and tenotomy are valuable procedures in simultaneous rotator cuff repair regarding function, pain, and range of motion. However, the tenotomy group showed reduced strength in abduction. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Inter-Rater Reliability of Pain Provocation Tests for Painful Lumbar Facet Joints. A Pilot Study.

BACKGROUND: With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints. If a clinically significant level of inter-rater reliability were to be determined, this study could constitute a first step towards establishing the clinical utility of this new set of tests in the structural diagnosis of low back disorders. MATERIAL AND METHODS: Patients participating in this study were recruited in a specialist hospital throughout June 2015 until September 2016. Both female and male patients with current LBP, with or without buttock or lower extremity symptoms were screened for inclusion. Patients had preferably to be 50 years or older in order to be included in this study. The upper age limit was set at 90 years. They also had to be fluent in German to be able to follow verbal instructions. Exclusion criteria comprised the presence of red flags, surgical spinal fusion at any level of the lumbar spine, discectomy within the past 12 months, radiculopathy and/or radicular pain, interventional treatments for the IVD, SIJs or ZAJs within the past three months, psychiatric disorders, current litigation issues concerning back pain, and central nervous system diseases. Three certified manual therapy instructors tested patients independently. Fleiss' kappa values and percent agreements were calculated. RESULTS: Subjects included a sample of 48 patients (15 males and 33 females) with a mean age of 66.48 years (range 33 - 90) presenting at a specialist hospital with low back pain. The new pain provocation tests for lumbar zygapophyseal joints showed moderate reliability (Fleiss' κ = 0.46) and an overall percent agreement of 68.8%. Separate tests for the zygapophyseal joints of L5-S1 showed fair reliability (Fleiss' κ = 0.37) and an overall percent agreement of 64.6%. Unidimensional tests that were used in the study to exclude the intervertebral disc as a nociceptive generator showed fair reliability as well (average κ of 0.28 and 0.39, respectively). Neither drop outs nor adverse events occurred. CONCLUSION: The new pain provocation tests for lumbar zygapophyseal joints showed clinically significant levels of inter-rater reliability. Validation of these tests against fluoroscopy-guided medial branch blocks is warranted.

10 Years of Arthroscopic Latarjet Procedure: Outcome and Complications.

BACKGROUND: The treatment of anterior glenohumeral instability with a Bankart repair combined with a capsular plication is a frequently used arthroscopic technique. Latarjet created an open bone block procedure in 1954 for the treatment of anteroinferior glenohumeral instability. This procedure has been further developed by Lafosse in 2003 for arthroscopic surgery. The aim of this study is to evaluate the clinical outcome and complications of the latter procedure, most notably infection rate and nerve damage. MATERIALS AND METHODS: 132 shoulders (106 males/19 females, 68 right/64 left) were included in this retrospective study. Patients were included if treatment was performed for anterior instability and if the patient's instability severity index score was at least 4, or if a revision procedure was performed after a prior unsuccessful arthroscopic or open capsule and labral repair. Treatment included the arthroscopic transfer of the coracoid process for the anterior stabilization of the shoulder joint. The disabilities of the arm, shoulder, and hand score were evaluated postoperatively in 76 patients and compared with the results found in the literature. Mean followup was 20.1 [±14.09] months. RESULTS: The rate of recurrent glenohumeral instability which needed revision surgery after the arthroscopic Latarjet procedure was 6.1% (n = 8). There were no severe neurovascular complications seen in our cohort. In 32 cases, re-operation was performed due to subjective discomfort because of screw impingement or postoperative shoulder stiffness. CONCLUSION: The all-arthroscopic Latarjet procedure developed by Lafosse is a valid and reliable method for the treatment of shoulder instability. Our favorable results indicating that this procedure can prevent chronic shoulder luxation are repeatable, and the rate of postoperative recurrence is low.

Validation, Intrarater and Interrater Reliability Study of the Lateral-Anterior Drawer Test for Detecting Posterior Cruciate Ligament Ruptures: Study Protocol of a Prospective Controlled Single-Blinded Cross-Sectional Study.

INTRODUCTION: Commonly used clinical tests for posterior cruciate ligament (PCL) rupture detection exhibit several limitations, thus requiring more precise clinical PCL tests. The lateral-anterior drawer (LAD) test has been proposed as a manually applied testing alternative but not yet been evaluated in vivo. METHODS AND ANALYSIS: Fifteen patients presenting with an MRI-confirmed acute or chronic unilateral PCL rupture and 15 subjects with no prior knee injury in their medical history will be included in this prospective single-blinded cross-sectional cohort study. Three examiners with different lengths of working experience (range 1-30 years), blinded to MRI outcomes and patient history, will use the LAD test on both knees of each participant to test for PCL integrity. Examiners will independently document the PCL status of each knee on a blank case report form. Fleiss-Kappa values will be calculated to investigate whether the LAD test shows clinically significant interrater and intrarater reliability. Furthermore, LAD test outcomes will be compared with MRI which serves as reference standard to check for concurrent validity. Moreover, LAD test accuracy with respect to tester experience will be evaluated. ETHICS AND DISSEMINATION: The study will be conducted in agreement with the World Medical Association Declaration of Helsinki (2013). Ethical permission (EK16-081-0616) to conduct this study was obtained from the review board of the city of Vienna on 1 September 2016. All personal and research data will be used in accordance with the Austrian Federal Data Protection Act and will be anonymised before publication in relevant international peer-reviewed journals. TRIAL REGISTRATIONNUMBER: DRKS00013268; Pre-results.

Isolation and characterization of Corynebacterium spp. from bulk tank raw cow's milk of different dairy farms in Germany.

We detected Corynebacterium spp. in raw milk samples of three farms by means of a selective, tellurite-containing medium. The isolated strains were identified based on full 16S rRNA gene sequences and partial rpoB gene sequences as C. xerosis, C. variabile, C. lactis, C. callunae, C. confusum, C. glutamicum and C. crudilactis. The identification based on 16S rRNA and rpoB sequences was not reliable for isolates of C. xerosis. Chemotaxonomic markers of the isolates, fatty acids, acyl type of peptidoglycan, presence and length of mycolic acids, quinone patterns, and polar lipids, were in accord with the known characteristics of these species. Biochemical profiles, analyzed with the API Coryne system, were able to differentiate all groups, but were unable to identify the strains due to an inappropriate database for raw-milk associated corynebacteria. Most of the tested isolates showed a single-substance resistance against oxacillin, but three single isolates were classified as multidrug resistant.

How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey.

BACKGROUND: Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain. METHODS: A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older. RESULTS: The 1­year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10). CONCLUSIONS: Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.

Rotational gait patterns in children and adolescents following tension band plating of idiopathic genua valga.

Literature suggests that children and adolescents with idiopathic genua valga present with considerable gait deviations in frontal and transverse planes, including altered frontal knee moments, reduced external knee rotation, and increased external hip rotation. This study aimed to evaluate gait parameters in these patients after surgical correction using tension band plating (TBP). We prospectively evaluated 24 consecutive, skeletally immature patients, who received full-length standing radiographs and three-dimensional gait analysis before and after correction, and compared the results observed to a group of 11 typically developing peers. Prior to TBP the cohort showed significantly decreased (worse) internal frontal knee moments compared to the control group. After axis correction the mean and maximum knee moments changed significantly into normalized knee moments (p < 0.0001). In the transverse plane, only the foot progression angle (p = 0.020) changed significantly following intervention. Post-correction knee moments were similar to controls (p = 0.175), but the patient cohort exhibited a significantly decreased knee external rotation (p = 0.004) and increased external hip rotation (p < 0.001) during gait. In addition, the effect of transverse plane changes on knee moments in patients with restored, straight limb axis was calculated. Hence, patients with restored alignment but persistence of decreased external knee rotation demonstrated significantly greater knee moments than those without rotational abnormalities (p = 0.001). This study found that frontal knee moments during gait normalized in children with idiopathic genua valga after surgery. However, decreased external knee rotation and increased external hip rotation during gait persisted in the study cohort. Despite radiological correction, decreased external rotation during gait was associated with increases in medial knee loading. Surgical correction for children with genua valga but normal knee moments may be detrimental, due to redistribution of dynamic knee loading into the opposite joint compartment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1617-1624, 2017.

[Prevalence of self-reported musculoskeletal pain in the Austrian population]. / Prävalenz von auf eigenen Angaben basierenden muskuloskelettalen Schmerzen der österreichischen Bevölkerung.

INTRODUCTION: The objective of this study was to document the prevalence of musculoskeletal pain in the Austrian population, to analyze the specific pain of affected individuals and to compare the characteristics of the group of persons with pain to those without pain. METHODOLOGY: Representative samples of the Austrian general population were selected by the "quota procedure". 500 persons, aged 15 years and older were questioned in face-to-face interviews. RESULTS: 36.4% of all questioned individuals had experienced pain in the musculoskeletal system within the last three weeks, primarily in the region of the spine. Most of the very severe pain was located in the neck area (22%). The groups of persons with and without pain differed significantly in age, occupation, occupational group, region of residence within Austria, and family status. In a regressive analysis higher age remained the only significant variable. In seeking treatment, of significant importance were higher pain intensity and higher education level, and longer time since pain onset. CONCLUSION: The high prevalence of musculoskeletal pain in the Austrian population, particularly in the advanced age group not only requires targeted and high quality treatment of the affected persons, but also attention to appropriate preventive measures.

Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial.

The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.

A controlled examination of medical and psychosocial factors associated with low back pain in combination with widespread musculoskeletal pain.

BACKGROUND: Little is known about chronic low back pain (CLBP) in combination with widespread musculoskeletal pain (WMP). OBJECTIVE: This study examined factors that may be common to these conditions, with the objective of detecting factors that could improve the course of these diseases. DESIGN: This was a prospective case control study. PATIENTS AND INTERVENTION: A group of patients with CLBP and WMP (CLBP+WMP group, n=97) was compared with a group of individuals who were pain-free and without a history of musculoskeletal problems (control group, n=97) and with a group of patients with CLBP but without WMP (CLBP-only group, n=52). The mean age of the participants was 42.9 years (SD=8.74); 76% were women, and 24% were men. MEASUREMENTS: A total of 74 variables were measured, including sociodemographic, physical, and psychosocial variables. After univariate examination for group differences and analyses of variables available for all 3 groups, logistic regression on selected factors was performed. The alpha level was set at .05, but was adjusted to avoid randomly significant results. RESULTS: For a number of variables, significant differences among the 3 groups were observed. For regression model 1 for the CLBP+WMP and control groups, 4 out of 9 variables showed significant likelihood tests: income (lower in the WMP group), depression, anxiety, and fear-avoidance behavior. For regression model 2, 2 out of 13 variables showed significant likelihood tests: endurance capacity (more in the CLBP+WMP group) and balance capability (worse in the CLBP+WMP group). The models predicted at least 91.2% of all cases to the correct group. The regression analysis regarding the CLBP+WMP and CLBP-only groups predicted 86.7% of all cases to the correct group. Three out of 10 variables showed significant likelihood tests: high disability, fear-avoidance behavior, and number of treatments. LIMITATIONS: Some variables in testing the patients with WMP and the individuals who were pain-free were not used with the patients with CLBP only. CONCLUSIONS: Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

[Motivation for physical activity - a survey in a Central European state]. / Motivation zur Bewegung - Eine Umfrage in einem zentraleuropäischen Staat.

INTRODUCTION: Physical activity has high importance in the prevention of diseases, particularly where lifestyle diseases are concerned. To motivate a person to be physically active often proves to be difficult in clinical practice. Thus it was the aim of this study to find out through interviews how to best motivate most notably the part of the population that is less active. METHODS: 500 persons aged from 15 years onwards were asked in face-to-face interviews about their leisure activities, self-assessment of their personal fitness, and about inhibiting and motivating factors in connection with their physical activity. RESULTS: Only every second interviewed person is intentionally active in order to improve his/her own fitness. The better part of the inactive population can envisage introducing more physical activity into their everyday life. There are various reasons that instigate to be more active: above all, the recommendation of doctors, but also the wish for physical wellbeing or group dynamics act as a stimulant. Would there be an advertising campaign promoting the importance of physical activity, top athletes and physicians would have the most motivating impact. CONCLUSION: A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.

[Treatment with crystal singing bowls for chronic spinal pain and chronobiologic activities - a randomized controlled trial]. / Quarzklangschalentherapie bei Wirbelsäulenbeschwerdenund chronobiologische Vorgänge - eine randomisiertekontrollierte Studie.

INTRODUCTION: This prospective randomized controlled trial examined the effect of harmonic vibrations of crystal singing bowls on the perception of pain, subjective wellbeing and chronobiologic activities (quality of sleep) in patients with chronic unspecific spinal pain. SUBJECTS AND METHODS: 54 persons with chronic, unspecific spinal pain participated in the study. The treatment group (IG) received 6 units of a singing bowl therapy, the placebo group (KG) received a placebo treatment. The control group (NG) was not treated at all. Pain intensity, pain disability and quality of life were evaluated right before and 1 week after the intervention, pulse rate and skin conductance were measured during 3 therapeutic sessions. A 24-hour measurement of the heart rate variability to evaluate quality of sleep was made four times. Before and after each session the Multidimensional Mood State Questionnaire (MDBF) was filled out. RESULTS: IG and KG had significant lower pain intensities compared to the NG. The NG even experienced an increase in pain intensity. The results of the MDBF suggest an unspecific relaxing effect of the intervention in IG and KG. Twice during the treatment a significant decrease of the pulse rate could be observed. CONCLUSION: Under the given conditions the hypothesis of pain relief and chronobiologic changes in patients with chronic spinal pain by a treatment with crystal singing bowls compared to placebo could not be confirmed.