ABSTRACT
OBJECTIVES: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. DESIGN: Pre-planned secondary analysis of a randomized controlled, non-blinded trial. SETTING: Outpatient clinic of a German university hospital. SUBJECTS: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. INTERVENTIONS: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. MAIN MEASURES: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. RESULTS: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. CONCLUSIONS: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.
Subject(s)
Acupuncture Therapy , Temporomandibular Joint Disorders , Tension-Type Headache , Humans , Tension-Type Headache/diagnosis , Tension-Type Headache/etiology , Tension-Type Headache/therapy , Exercise Therapy , Headache , Temporomandibular Joint Disorders/therapy , Treatment OutcomeABSTRACT
Playing Related Musculoskeletal Disorders (PRMD) belong to the most prevalent medical ailments affecting musicians' health and career. This study documents the effect of a physiotherapeutic treatment as well as functional impairments of PRMD on the musculoskeletal system. In total, 32 music students suffering from PRMD were examined in Hanover Medical School (MHH) before and after they received twelve physiotherapeutic treatments, which were carried out over 20â min each over 6 weeks. Additionally, 32 healthy music students, matched by age and gender, were examined at one time point in the MHH to explore which musculoskeletal restrictions are associated with PRMD. The examination included the evaluation of the pain on the Visual Analogue Scale for pain (VAS), a body composition, and body posture measurement, the finger-to-floor distance, the range of motion of the cervical spine, the pressure pain and muscular hypertension examination, the temporomandibular joint-test, the Beighton score screening test, and the testing of the widespread pain score (WSP). After analyzing the data of the patient group (PG) a significant reduction of pain level on the VAS from an average pain of 6.31 to 3.53 was found (large effect). Additionally, a significant reduction of the pressure pain of the M. levator scapulae, the M. rhomboideus, the M. sternocleidomastoideus on the left side and the paravertebral muscles of the cervical spine on the right side after the treatment of the patients could be detected. Regarding the WSP, the positive testing significantly differed, showing a 28% positive testing in the patient group vs. a positive testing of 9% in the control group (CG). As hypermobility is a common phenomenon in musicians, the percentage of those being diagnosed with generalized hypermobility by using the Beighton score in both groups (PG: 37.5%; CG: 25%) was remarkably higher compared to previous studies. In this study, a short course of manual therapy, client tailored for each musician's specific problem, was shown to reduce pain levels in musicians with PRMD.
ABSTRACT
OBJECTIVE: Musculoskeletal pain is a common problem among professional musicians as well as music students. Studies have emphasized the effectiveness of music-specific physiotherapy for affected musicians. This study was designed to evaluate if physiotherapy treatment of pain-affected music students had an impact on pain perception as well as psychological well-being. To explore the possible development of musculoskeletal pain, depression, and anxiety, a second sample of pain-free music students, matched for age and gender, was examined twice at identical time intervals. METHODS: A convenience sample of 31 university music students with moderate to severe musculoskeletal pain and 31 pain-free music students, matched in age and gender, were included in the study. Both groups were examined physically and completed biographical, music-related, and psychological questionnaires. Perceived pain intensity was assessed with a visual-analogue scale (VAS), and depression and anxiety symptoms were assessed with the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HAD). Music students with pain received a series of 12 sessions of musician-specific physiotherapy, while controls waited for the same amount of time for retesting. RESULTS: On the 10-cm VAS, music students with pain reported an average improvement in pain intensity from a baseline of 6.25 (SD 1.95) to 2.7 (2.03) after the intervention, while the controls (music students without pain) did not change. Furthermore, music students with pain indicated higher depression and anxiety scores as compared to the control group before and after therapy. After intervention, music students with pain with higher BDI-II scores demonstrated clinical improvement concerning depression, but no significant improvement in mental health was found in the pain group taken as a whole. CONCLUSION: Physiotherapy was effective in reducing pain symptoms in music students affected by chronic musculoskeletal pain. However, physiotherapy did not improve mental health in pain-affected music students. Additional psychotherapeutic interventions may be needed to support music students with psychological comorbidities such as depression and anxiety.
Subject(s)
Musculoskeletal Pain , Music , Humans , Musculoskeletal Pain/therapy , Mental Health , Depression/therapy , Anxiety/therapyABSTRACT
OBJECTIVES: To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache. METHODS: In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/-13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated. RESULTS: Both, acupuncture (baseline to six-weeks change scores: mean: -2(standard deviation: 2.5 points), three months: -2.4(2.4), six-months -2.7(3.6)) and the combination of acupuncture and medical training therapy (-2.7(4.9), -2.2(4.0), -2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (-0.3(2.0), -0.5(1.6), -0.9(2.6)) or usual care alone (-0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred. CONCLUSIONS: Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.
Subject(s)
Acupuncture Therapy , Tension-Type Headache , Adult , Female , Humans , Male , Acupuncture Therapy/methods , Anxiety/therapy , Depression/therapy , Prospective Studies , Quality of Life , Tension-Type Headache/diagnosis , Middle AgedABSTRACT
OBJECTIVES: The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache. DESIGN: This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes. SETTING: The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School.Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months. MAIN OUTCOME MEASURES: Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication.Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = -38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (-25%, standard deviation = 20%, 0.014) and for minimal pain intensity (-35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care. CONCLUSIONS: In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.
Subject(s)
Acupuncture Therapy , Tension-Type Headache/therapy , Adult , Exercise Therapy , Female , Humans , Male , Medicine, Chinese Traditional , Middle Aged , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.
Subject(s)
Breast Neoplasms , Cancer Survivors , Self-Control , Breast Neoplasms/therapy , Fatigue/etiology , Fatigue/therapy , Female , Humans , Quality of Life , Surveys and Questionnaires , SurvivorsABSTRACT
SHORT COMMUNICATION: During the Ramadan fasting (RF) month, participants restrict some activities during day time, particularly consumption of food and beverages. In Germany, Muslims fast about 18-19 h a day when Ramadan falls in the summer. This longer period of restriction could lead to the changes of the body physiology, anthropometric parameters and biological mediators. OBJECTIVES: This study aimed to determine the effect of Ramadan fasting on cytokines (Interleukin (IL)-1ß. IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF)-α) during RF in Germany. Correlations of cytokines with anthropometric parameters were also determined. METHODS: Fifty healthy adult males were recruited and divided into two equal groups: fasting group (FG) and non-fasting group (NFG). FG was evaluated at T1: one week before, T2: mid-, T3: last days of, and T4: one week after Ramadan. The NFG were evaluated only at T1 and T3. RESULTS: In FG significant alterations of IL-1ß was observed. Insignificant differences were found between the FG and NFG at T1 and T3 concerning the measured cytokines. Circulating IL-1ß increased significantly from T2 to T4 and from T3 to T4. At T3, TNF-α was correlated significantly with anthropometric parameters such as the body weight, the skeletal muscle mass and the fat free mass, whilst IL-12 was correlated significantly with the skeletal muscle mass, the fat free mass and the body water mass at T4. CONCLUSIONS: Significant Alterations of IL-1ß during RF in FG were observed. Anthropometric parameters correlate with TNF-α and IL-12 levels during at T3 and T4, respectively.
Subject(s)
Cytokines , Fasting , Adult , Body Weight , Humans , Islam , Male , Prospective StudiesABSTRACT
CONTEXT: Cancer-related fatigue (CRF) is one of the most burdensome symptoms in breast cancer survivors (BCSs), accompanied by reduced health-related quality of life (HRQOL). OBJECTIVES: This study investigated the influence of a multimodal therapy (MT; psychoeducation, eurythmy therapy, painting therapy, and sleep education/restriction), or a combination therapy (CT; MT plus aerobic training [AT]) on HRQOL in BCS with chronic CRF in comparison with AT alone. METHODS: One hundred and twenty-six BCSs with CRF were included in a pragmatic comprehensive cohort study and allocated either per randomization or by preference to MT, CT, or AT. The EORTC QLQ-C30 core questionnaire was used to measure HRQOL. All analyses on HRQOL parameters were done in an explorative intention. RESULTS: Patients were assigned to MT (n = 44), CT (n = 54), or AT (n = 28). CT was significantly superior to AT after 10 weeks of intervention (T1) in improving physical function. MT was found to have significant superiority over AT at T1 and T2 for physical functioning, emotional functioning, insomnia, and financial problems as well as role functioning, cognitive, social functioning, and fatigue 6 months later (T2). CONCLUSION: A multimodal approach appears to be a suitable concept for BCS with chronic CRF. A confirmatory study with larger samples should demonstrate the superiority of MT and adapted CT in HRQOL compared with the current treatment AT found in these explorative analyses.
Subject(s)
Breast Neoplasms/physiopathology , Exercise/physiology , Cancer Survivors , Exercise Therapy/methods , Fatigue/physiopathology , Female , Health Status , Humans , Middle Aged , Prospective Studies , Quality of Life , Sleep/physiology , Sleep Initiation and Maintenance Disorders/physiopathology , Surveys and QuestionnairesABSTRACT
Cancer diagnosis often substantially affects patient's physical, psychological, and emotional status. Most patients with cancer experience declining of energy, activity levels, social-cultural participation, and relationships. In addition, cancer progression and adverse effects of aggressive cancer treatment often cause debilitating pain, fatigue, weakness, joint stiffness, depression, emotional instability, limited mobility, poor nutritional status, skin breakdown, bowel dysfunction, swallowing difficulty, and lymphedema leading into functional impairment and disability that can be addressed through rehabilitation care. Comprehensive care models by involving cancer rehabilitation have resulted in significant improvement of patient's quality of life. Although cancer rehabilitation has been implemented in many high-income countries, it is either not yet or suboptimally delivered in most low- and middle-income countries. In this review, we discussed gaps regarding cancer rehabilitation services and identified opportunities to improve quality of cancer care in developing countries. Future collaborations among international organizations and stakeholders of health care delivery systems are required to initiate and improve high-quality cancer rehabilitation in the developing countries.
Subject(s)
Healthcare Disparities/statistics & numerical data , Neoplasms/rehabilitation , Physical and Rehabilitation Medicine/methods , Quality of Health Care , Cancer Survivors/psychology , Developing Countries , Humans , Neoplasms/psychology , Physical and Rehabilitation Medicine/standards , Quality of Life , Socioeconomic FactorsABSTRACT
Since the first publication of learning objectives for the interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" in undergraduate medical education in 2004 a revision is reasonable due to heterogenous teaching programmes in the faculties and the introduction of the National Competence Based Catalogue of Learning Objectives in Medicine as well as the "Masterplan Medical Education 2020". Therefore the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation started a structured consensus process using the DELPHI-method to reduce the learning objectives and arrange them more clearly. Objectives of particular significance are emphasised. All learning objectives are assigned to the cognitive and methodological level 1 or to the action level 2. The learning objectives refer to the less detailed National Competence Based Catalogue of Learning Objectives in Medicine. The revised learning objectives will contribute to further progress in competence based and more homogenous medical teaching in core objectives of Rehabilitation, Physical Medicine, and Naturopathic Treatment in the faculties.
Subject(s)
Catalogs as Topic , Competency-Based Education , Physical and Rehabilitation Medicine/education , Rehabilitation/education , Societies, Medical , Societies, Scientific , Curriculum , Germany , Humans , NaturopathyABSTRACT
BACKGROUND: Cancer-related fatigue (CRF) and insomnia are major complaints in breast cancer survivors (BC). Aerobic training (AT), the standard therapy for CRF in BC, shows only minor to moderate treatment effects. Other evidence-based treatments include cognitive behavioral therapy, e.g., sleep education/restriction (SE) and mindfulness-based therapies. We investigated the effectiveness of a 10-week multimodal program (MT) consisting of SE, psycho-education, eurythmy- and painting-therapy, administered separately or in combination with AT (CT) and compared both arms to AT alone. METHODS: In a pragmatic comprehensive cohort study BC with chronic CRF were allocated randomly or by patient preference to (a) MT, (b) CT (MT + AT) or (c) AT alone. Primary endpoint was a composite score of the Pittsburgh Sleep Quality Index and the Cancer Fatigue Scale after 10 weeks of intervention (T1); a second endpoint was a follow-up assessment 6 months later (T2). The primary hypothesis stated superiority of CT and non-inferiority of MT vs. AT at T1. A closed testing procedure preserved the global α-level. The intention-to-treat analysis included propensity scores for the mode of allocation and for the preferred treatment, respectively. RESULTS: Altogether 126 BC were recruited: 65 were randomized and 61 allocated by preference; 105 started the intervention. Socio-demographic parameters were generally balanced at baseline. Non-inferiority of MT to AT at T1 was confirmed (p < 0.05), yet the confirmative analysis stopped as it was not possible to confirm superiority of CT vs. AT (p = 0.119). In consecutive exploratory analyses MT and CT were superior to AT at T1 and T2 (MT) or T2 alone (CT), respectively. CONCLUSIONS: The multimodal CRF-therapy was found to be confirmatively non-inferior to standard therapy and even yielded exploratively sustained superiority. A randomized controlled trial including a larger sample size and a longer follow-up to evaluate multimodal CRF-therapy is highly warranted. TRIAL REGISTER: DRKS-ID: DRKS00003736 . Recruitment period June 2011 to March 2013. Date of registering 19 June 2012.
Subject(s)
Breast Neoplasms/complications , Cancer Survivors/psychology , Combined Modality Therapy/methods , Exercise Therapy/methods , Fatigue/therapy , Sleep Initiation and Maintenance Disorders/therapy , Adult , Aged , Breast Neoplasms/psychology , Cognitive Behavioral Therapy , Cohort Studies , Fatigue/etiology , Fatigue/psychology , Female , Humans , Middle Aged , Mindfulness , Paintings , Prospective Studies , Random Allocation , Research Design , Sleep , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/psychology , Treatment Outcome , Young AdultABSTRACT
Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care. The three most important types of services are acute, postacute, and long-term rehabilitation services. Health-related rehabilitation services for patients with SCI must be able to provide high-quality equipment and a well-trained, highly specialized and multiprofessional team of rehabilitation workers. The principles of payment for SCI rehabilitation services vary according to the organization of health care systems, which primarily depends on the sources of money (eg, from national health care systems, other health insurances, or out of pocket). Funding systems and payment criteria may influence service provision and justice in service delivery. It is important to analyze the provision of rehabilitation services and the related funding system using uniform assessment and evaluation tools.
Subject(s)
Models, Organizational , Physical Therapy Modalities/economics , Rehabilitation Centers/economics , Spinal Cord Injuries/economics , Spinal Cord Injuries/rehabilitation , Delivery of Health Care/economics , Germany , Humans , Insurance, Health/statistics & numerical data , National Health ProgramsABSTRACT
In this sham-controlled study, 53 patients received 10 sessions of acupuncture treatment over 5 weeks to investigate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. The results showed significant favorable effects of verum acupuncture on quality of life. Both interventions showed sustained and clinically relevant effects on pain. PURPOSE: Standard analgesic treatment is associated with adverse events in patients with osteoporosis, especially elderly and/or comorbid patients. As acupuncture has gained widespread acceptance as a complementary treatment modality with few side effects, the aim of this study was to evaluate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. METHODS: In total, 53 patients with vertebral compression fractures, osteoporosis-associated spinal deformities, and resultant pain were randomly allocated to the verum acupuncture with deep needling of specific points following the principles of traditional Chinese medicine (n = 29) or control acupuncture group with superficial needling of non-acupuncture points (n = 24). All patients received 10 sessions of standardized verum or control acupuncture treatment over 5 weeks. Pain (VAS score 1-100) and quality of life (QUALEFFO-41) were measured at the start of treatment (T0), before each acupuncture session (T1), and at 1 (T2) and 3 months (T3) post-treatment. RESULTS: Both acupuncture treatments significantly reduced activity-related pain and pain at rest over time. The verum acupuncture group experienced a significantly greater reduction in mean pain intensity at rest than the control group. In the control group, quality of life improved only temporarily post-treatment (T2) and slightly declined at the end of the follow-up period (T3). In contrast, patients in the verum acupuncture group experienced continuous and significant improvements in quality of life up to 3 months after treatment (T3). CONCLUSIONS: Both types of acupuncture were equally effective in producing sustained, clinically relevant pain relief in patients with osteoporosis. Verum acupuncture had stronger and longer-lasting effects on quality of life and pain at rest. The possible reasons for these findings include the specificity of acupuncture point selection and the performance of needle stimulation.
Subject(s)
Acupuncture Therapy/methods , Musculoskeletal Pain , Osteoporosis , Quality of Life , Aged , Female , Humans , Male , Middle Aged , Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/etiology , Musculoskeletal Pain/psychology , Musculoskeletal Pain/therapy , Osteoporosis/complications , Osteoporosis/physiopathology , Osteoporosis/psychology , Pain Management/methods , Pain Measurement/methods , Pilot Projects , Treatment OutcomeABSTRACT
OBJECTIVE: Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. METHODS: Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. RESULTS: Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. CONCLUSION: The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.
Subject(s)
Musculoskeletal Diseases/rehabilitation , Occupational Health Services/organization & administration , Patient Care Team/organization & administration , Adult , Chronic Disease , Cooperative Behavior , Feasibility Studies , Focus Groups , Germany , Humans , Interprofessional Relations , Male , Middle Aged , Practice Guidelines as Topic , Rehabilitation Centers/organization & administrationABSTRACT
OBJECTIVE: Mastication may be able to activate endogenous pain inhibitory mechanisms and therefore lead to modulation of nociceptive processing. The purpose of this study was to examine the possible effect of food consistency on noxious input from the spinal system. METHODS: Three groups of adult male Sprague-Dawley rats were given an injection of complete Freund adjuvant in a hind paw 10 days after eating soft or hard food (one group received a saline injection-the control group [C]; the other group (D) received no injection). Nocifensive behavior was assessed with the use of the hot plate and tail flick assays at 1, 3, 6, and 12 hours and at 6.5 days after injection for groups A/B, and c-Fos activity was assessed in the brain after testing. Groups C/D had hot plate testing at 1 hour and 6.5 days. The data were analyzed by general linear modeling and 1-way analysis of variance. RESULTS: There was a small increase in the hot plate percent maximum possible effect (MPE) from -45.7 to -61.1 in group A over the length of the experiment, but a very small decrease for group B over the same period (-33.5 to -28.8). For the saline control group, there was a small increase toward 0 %MPE over the same time frame (-15.0 to 1.7). The %MPE differences were significant between groups A and C (P < .0005), but not significant between the other groups (F = 13.34, df = 2, P = .001, observed power = 99%). Using the pooled results (all time points), the differences between all groups were significant (P < .0005). There were no significant differences in the tail flick test. c-Fos was mainly observed in the raphe pallidus area with significant differences between groups A and B at 3 and 6 hours after injection of CFA (P = .027 and .022, respectively). CONCLUSIONS: The results of this study indicate that food consistency (hardness) influences nocifensive behavior in this animal model via a descending pathway operating at the supraspinal level.
Subject(s)
Chronic Pain/physiopathology , Food , Nociception , Temporomandibular Joint/physiopathology , Animals , Behavior, Animal , Disease Models, Animal , Male , Rats , Rats, Sprague-Dawley , Spinal CordABSTRACT
UNLABELLED: HYPOTHESE: Cancer-related fatigue (CRF) and sleep disorders are some of the most wearing and common symptoms in disease-free breast cancer patients (BC). Aerobic training (AT) is the treatment with the best available evidence, even though it seems to be insufficient with regards to improvements in cognitive fatigue. We introduced a new multimodal therapy concept (MM) consisting of psycho-, sleep-education and new approaches based on anthroposophic medicine such as eurythmy and painting therapy. STUDY DESIGN: This pilot study will test the implementation of MM and yield first results of the MM and AE in our centres. METHODS: 31 out of 34 patients suffering from BC and CRF were fully assessed in a ten-week intervention study. 21 patients chose MM and 10 decided on AT. CRF was measured with the help of the Cancer Fatigue Scale (CFS-D), and the global quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI). We also captured autonomic regulation (aR) and patients' satisfaction with questionnaires. Statistical analysis was done with SAS 9.1.3 for windows. RESULTS: The new MM therapy can be implemented with high satisfaction among patients. Significant improvements were found in the MM group with regards to CFS-D, global quality of sleep, sleep efficiency (PSQI), aR and rest/activity regulation compared to baseline (all p<0.05). In the AT group aR orthostatic-circulatory and rest/activity regulation improved significantly (p<0.05), too. However, no improvement in cognitive fatigue was seen in either group. CONCLUSION: The multimodal therapy concept was feasible and improved cancer fatigue, sleep quality, autonomic and rest-/activity regulation in breast cancer patients. It may therefore constitute a valuable treatment option in addition to aerobic training for BC patients with CRF. A further study with larger sample size needs to be carried out to assess the efficacy of combined multimodal-aerobic therapy.
Subject(s)
Breast Neoplasms/therapy , Exercise , Fatigue/etiology , Fatigue/therapy , Aged , Breast Neoplasms, Male/complications , Breast Neoplasms, Male/therapy , Chronic Disease , Combined Modality Therapy/adverse effects , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot ProjectsABSTRACT
Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as "medicine in health resorts" (or "health resort medicine"). Health resort medicine includes "all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation". Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called hydrotherapy, and the use of climatic factors for therapy is called climatotherapy. Reflecting the effects of health resort medicine, it is important to take other environmental factors into account. These can be classified within the framework of the ICF (International Classification of Functioning, Disability and Health). Examples include receiving health care by specialised doctors, being well educated (ICF-domain: e355), having an environment supporting social contacts (family, peer groups) (cf. ICF-domains: d740, d760), facilities for recreation, cultural activities, leisure and sports (cf. ICF-domain: d920), access to a health-promoting atmosphere and an environment close to nature (cf. ICF-domain: e210). The scientific field dealing with health resort medicine is called health resort sciences. It includes the medical sciences, psychology, social sciences, technical sciences, chemistry, physics, geography, jurisprudence, etc. Finally, this paper proposes a systematic international discussion of descriptions in the field of Health Resort Medicine, Balneology, Medical Hydrology and Climatology, and discusses short descriptive terms with the goal of achieving internationally accepted distinct terms. This task should be done via a structured consensus process and is of major importance for the publication of scientific results as well as for systematic reviews and meta-analyses.
Subject(s)
Balneology/methods , Health Resorts/classification , Meteorology/methods , Water Supply , Balneology/standards , Health Resorts/standards , Humans , Internationality , Meteorology/standards , SpecializationABSTRACT
As any patient may require rehabilitation and physical therapies, all physicians need to acquire at least a basic knowledge of Physical and Rehabilitation Medicine (PRM). In 2005 PRM teaching was implemented in all phases of the curriculum for medical students in Germany. The curriculum includes, among others, the following topics: principles of rehabilitation; the model of the International Classification of Functioning, Disability and Health (ICF); principles and effects of physiotherapy and occupational therapy; indications and contraindications for PRM interventions. Teaching of PRM topics is implemented from the first week in all phases of the curriculum, as: (i) lectures in the module "Introduction to Medicine (Propaedeuticum)"; (ii) a cross-sectional course entitled "Rehabilitation, Physical Medicine and Naturopathic Treatment (RPMN)"; (iii) single lectures on PRM in other fields; (iv) elective mandatory courses on the social model of rehabilitation, balneology, and others; and (v) the option to choose PRM as a subject for practical training. All modules are evaluated regularly by the students. Global ratings of the module "Propaedeuticum" were good, and of the cross-sectional course "RPMN" very good. The advanced part of the practical training was rated highly by the students. In conclusion, the implementation of teaching of PRM and other rehabilitation topics in undergraduate medical education is a successful concept that fulfils the criteria for education in medical school set out by the American Association of Academic Physiatrists.
Subject(s)
Education, Medical, Undergraduate , Physical and Rehabilitation Medicine/education , Rehabilitation/education , Complementary Therapies/education , Curriculum , Disabled Persons/classification , Disabled Persons/rehabilitation , Education, Medical, Undergraduate/methods , Humans , Models, Educational , Occupational Therapy/education , Physical Therapy Modalities/education , Program EvaluationABSTRACT
Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.
Subject(s)
Physical and Rehabilitation Medicine , Rehabilitation , Clinical Competence , Critical Pathways , Evidence-Based Medicine , Humans , Interdisciplinary Communication , Patient Care Team , Physical and Rehabilitation Medicine/organization & administration , Professional Competence , Rehabilitation/organization & administration , Role , WorkforceABSTRACT
OBJECTIVE: This study evaluated if patients with complex regional pain syndrome (CRPS) would have an increase in range of motion (ROM) after myofascial release and a similar ROM decrease after jaw clenching, whereas in healthy subjects these effects would be minimal or nonexistent. METHODS: Documentation of patients with CRPS (n = 20) was established using the research diagnostic criteria for CRPS, questionnaires, average pain intensity for the past 4 weeks, and the temporomandibular index (TMI). Healthy subjects (n = 20, controls) also underwent the same testing. Hip ROM (alpha angle) was measured at 3 time points as follows: baseline (t1), after myofascial release of the temporomandibular joint (t2), and after jaw clenching for 90 seconds (t3). Comparison of the CRPS and control groups was made using t tests. RESULTS: Mean TMI total score and mean pain reported for the last 4 weeks were significantly different between the 2 groups (P < .0005). Hip ROM at t1 was always slightly higher compared to t3, but t2 was always lower in value compared to t1 or t3 for both groups. The differences of all hip ROM values between the groups were significant (P < .0005). Moreover, the difference between t1 or t3 and t2 was significantly different within the CRPS group (t1 = 48.7 degrees ; t2 = 35.8 degrees ; P < .0005). CONCLUSIONS: The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.