[Study of the functional capacity and health status of patients with hip as well as knee osteoarthritis]. / A csípo-, valamint térdízületi arthrosisos betegek funkcióképességének és egészségi állapotának vizsgálata.

INTRODUCTION: Hip as well as knee osteoarthritis are common diseases. There are numerous therapeutic possibilities to address the problem. OBJECTIVE: To study the effectiveness of the complex conservative treatment in patients with hip as well as knee osteoarthritis. METHOD: In addition to a self-made questionnaire, we applied the visual analogue scale, the Functional Independence Measure, the Barthel Index and the Medical Outcomes Study (MOS) - 36-Item Short-Form Health Survey. Apart from these, joint range of motion was measured. The members of the examined group had different physiotherapy treatments (thermal water, physiotherapy, classic Swedish massage, Bemer treatment, wraps, physiotherapy). RESULTS: The results of the visual analogue scale and the Barthel Index were significantly different between the two measurements. Regarding the Functional Independence Measure, we did not find significant difference between the two groups. As for measuring the study group's health condition, we observed improvement in the case of both the physical and mental health dimensions. During the examination of joint range of motion in the study group, after analyzing the participants' data, we detected improvement, except for the passive extension of the left knee. CONCLUSION: The 3-week complex conservative therapy can be an appropriate form of treatment to improve the functionality and the health condition in the case of hip as well as knee osteoarthritis. Orv Hetil. 2022; 163(48): 1917-1922.

Trunk alignment in different standing positions in healthy subjects and stroke patients -a comparative study with a simple method for the everyday practice.: Trunk alignment in healthy and stroke subjects.

OBJECTIVES: Weight-bearing (WB) on the lower extremities is an important outcome parameter in the rehabilitation of poststroke hemiparesis. However, the patients often regain this ability by compensatory movement patterns. METHODS: Our goal was to characterize with a simple method the trunk alignment of healthy subjects and stroke patients (n = 17 for both groups) during standing and following lateral weight shift (WS). To describe trunk alignment, five markers were placed on the subjects' back, and the angles of the trunk at both sides were defined by the lines drawn from the posterior angle of the acromion and the iliac crest on the same body side to the seventh thoracic spinal process. Weight distributions on the lower extremities during standing and lateral WS were determined with a force platform. RESULTS: The patients had significantly limited WB capacity on their paretic limb, which was accompanied with significant asymmetry in the trunk alignment during standing and following WS to the paretic side. DISCUSSION: Our results show that this patient population tends to use abnormal compensatory movement patterns to optimize weight shifting, and changes of trunk alignment play a key role in this. This should be taken into consideration during rehabilitation.

[Hungarian validation of the Clubfoot Disease-Specific Instrument]. / Dongaláb-specifikus életminoség-kérdoív magyar adaptációja.

INTRODUCTION: Congenital structural clubfoot is the most common congenital deformity of the foot. Despite successful treatment, the affected side may present signs of athrophy, differences in length, functional maldevelopment and in some cases it may also result in pain. Although several international studies have been investigating the quality of life of individuals with clubfoot, no research has been done in Hungary. Patient-based assessment is used for the evaluation of the effectiveness of treatment and for the comparison of the traditional versus the Ponseti method. AIM: To gain permission for the use of the internationally most well-known Clubfoot Disease-Specific Instrument (hereafter: 'Clubfoot Specific Questionnaire') consisting of 10 items and two subscales, and furthermore, to adapt its parent and child-version for Hungary and to carry out the internal and external validity testing of the measure. METHOD: The Questionnaire was completed by 75 individuals (44 boys, 28 girls) belonging to three age groups (under age 12, aged 12-17.99 years and those aged above 18); the mean age was 12.45 years (range: 2-44 years). The measures used: the Hungarian version of the 'Clubfoot Specific Questionnaire' (adapted versions for the given age groups), and the Hungarian version of EQ-5D-3L to measure the general quality of life. RESULTS: Both the parent- and the child-version of the 'Clubfoot Specific Questionnaire' showed adequate internal validity (parent-version: 0.872, child-version: 0.923); the individual items showed medium to strong correlations with the EQ-5D-3L dimensions besides the existing significant connections. CONCLUSION: The Hungarian adaptation of the measure proved to be successful. The validated questionnaire provides a further tool for the assessment of the quality of life of individuals with clubfoot and also for the evaluation of the success rate of therapies. Orv Hetil. 2018; 159(31): 1269-1277.

[Analysis of plantar pressure patterns among obese population]. / Elhízott populációra jellemzo talpnyomásminták vizsgálata.

INTRODUCTION: Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. AIM: The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. METHOD: 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. RESULTS: Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). CONCLUSIONS: Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

[Motivations for foreign employment and carrier change among Hungarian physiotherapists]. / Külföldi munkavállalás és pályaelhagyási indítékok a magyar gyógytornászok körében.

INTRODUCTION: An increasing motivation can be experienced among professional workers within the Hungarian healthcare system towards foreign employment or career change. AIM: The aim of the authors was to assess Hungarian physiotherapists' migration and career changing behaviour and to understand the underlying factors. METHOD: A national survey in Hungary from April to August, 2014 was performed. Only physiotherapists who practice in Hungary were included (n = 215). RESULTS: The results suggest that age (p<0.05) and the rate of financial appreciation experienced in the workplace (p<0.01) significantly affect the appearance of migratory thoughts. Those physiotherapists who do not feel themselves financially appreciated, are 55 times more likely to search for employment outside the country's borders [OR = 55.28 CI (95%) = 18.85 to 161.12]. The most common causes for that are unfavourable financial (p<0.01) and moral recognition (p<0.01). CONCLUSIONS: In order to prevent our already highly-qualified colleagues from leaving the country or from considering to leave the profession we should concentrate on increasing the financial and moral appreciation of the profession within the Hungarian healthcare system.

[HEALTH INSURANCE ASPECTS OF PHYSIOTHERAPEUTIC CARE OF NEUROLOGY DISORDERS IN OUTPATIENT CARE]. / A NEUROLÓGIAI KÓRKÉPEK FIZIOTERÁPIÁS ELLÁTÁSÁNAK EGÉSZSÉGBIZTOSÍTÁSI VONATKOZÁSAI A JÁRÓBETEG-SZAKELLÁTÁSBAN.

BACKGROUND AND PURPOSE: The aim of our study is to analyse the ambulatory rehabilitation care of patients with neurological disorders in the field of physiotherapy. METHODS: Data derive from the database of the Hungarian National Health Insurance Fund Administration (year 2009). The analyses covered patients with diagnosis "G00-G99 Diseases of the nervous system" according to the International Classification of Diseases and underwent physiotherapy treatment. RESULTS: In 2009 altogether 190986 patients with neurological disorders received physiotherapy treatment in outpatient care, representing 1331675 cases and got 388.215 million Hungarian Forint health insurance reimbursement. The number of patients with nerve, nerve root and plexus disorders was 39 patients/10 000 population for males and 66 patients/10000 population for females. The number of patients with cerebral palsy and other paralytic syndromes was 49 patients/10000 population for males and 35 patients/10000 population for females. The number of patients with episodic and paroxysmal disorders was 33 patients/10000 population for males and 52 patients/10000 population for females. CONCLUSION: In the outpatient physiotherapy care the utilization indicators for female patients were higher in nerve, nerve root and plexus disorders and episodic and paroxysmal disorders, while in cerebral palsy and other paralytic syndromes the utilization by male patients was higher. There are important age and gender inequalities in the utilization of physiotherapy care of patients with neurological disorders.

[Utilization of physiotherapy services for traumatic disorders of the lower extremity in ambulatory care]. / A fizioterápiás jellegu tevékenységek igénybevételi mutatói a járóbeteg-szakellátásban az alsó végtag traumatológiai kórképei esetében.

INTRODUCTION: Limited information is available on physiotherapy treatment of lower extremity injuries. AIM: The purpose of this study included analysis of the utilization of outpatient physiotherapy services in case of injuries of the lower extremity. METHOD: Data derived from the database of the National Health Insurance Fund Administration, Hungary. The number of cases undergoing physiotherapy activities after lower extremity injuries were determined. RESULTS: In 2009 the average number of cases undergoing physiotherapy activities following lower extremity injuries per 10,000 persons were the following: "hip and thigh injuries" 249.75 male cases and 443.7 female cases; "knee and leg injuries" 927.64 male cases and 668.25 female cases, and "ankle and foot injuries" 307.58 male cases and 245.75 female cases. CONCLUSIONS: According to this study, the number of physiotherapy activities for patients with injuries of the lower extremity showed significant differences between genders.

Treatment and ergonomics training of work-related lower back pain and body posture problems for nurses.

AIMS: The purpose of the study was to measure the effectiveness of a spine training programme (Back School) in nurses who have been living with chronic low back pain. It was hypothesised that active therapy, ergonomics and education called Back School will significantly decrease the pain intensity levels and improve the body posture of the study participants. BACKGROUND: A chronic low back pain is a significant work-related health problem among healthcare workers around the world. Proper body posture is essential for decreasing pain in healthcare workers who have history of chronic low back pain. By teaching proper body posture and with the creation of occupational settings that are 'spine-friendly' hospitals and other healthcare settings can significantly lower the suffering of their nursing staff. DESIGN: Single-blinded randomised controlled trial was utilised with six- and 12-months follow-up. METHODS: The study was carried out at the University of Pecs, Faculty of Health Sciences from 2007 to 2008 involving 124 nurses with low back pain. Participants were randomly assigned to the study group (who have received ergonomics training and education called Back School) with an intervention conducted once a week for a six-week period. The control group received passive physiotherapy once a week for a six-week period. Further follow-up measurements were conducted at six and 12 months, respectively. The study variables and outcome measures were pain intensity and body posture (angle of thoracic kyphosis and lumbar lordosis). The pain intensity was investigated with the Visual Analogue Scale. Body posture was recorded and analysed with the Zebris biomechanical motion analysis system. RESULTS: The statistical analysis of repeated measures indicated a significant decrease in back pain intensity after the therapy in both groups, compared with measurements before the therapy; however, the BS group showed significantly better results during the six-month and one-year follow-up period. The biomechanical analysis of postures after the therapy in the BS group showed significant improvements over the control group; during the follow-up, the difference was still significant, yet slightly reduced. CONCLUSIONS: This study has shown that a significant reduction in the pain intensity and improvement in body posture can be achieved by the usage of the active physical therapy methods (Back School) in nurses who are experiencing chronic lower back pain. RELEVANCE TO CLINICAL PRACTICE: The Back School programme when compared with the passive physical therapies (such as massage, ultrasound treatment, etc.) shows significant improvement in reduction in pain and greatly improves the posture of healthcare workers. The adoption of the Back School programme for the treatment of the healthcare workers with chronic low back problems should be a treatment of choice and standard that should be adopted when designing occupational healthcare policies and procedures.

When does mechanical plantar stimulation promote sensory re-weighing: standing on a firm or compliant surface?

The purpose of this study was to investigate the effect of different types of mechanical stimulation of the sole on standing postural stability in healthy, young adults. Fifty subjects (34 women, 16 men; mean age 23 ± 2 (mean ± SE)) stood barefoot on fixed force plates both with open and closed eyes on firm surface and then on compliant surface (foam). A modified clinical test of sensory interaction on balance protocol was employed to assess the center of gravity (COG) excursions along anteroposterior (AP) and mediolateral (ML) axes on each surface and visual condition. After the baseline measurement, a stimulation was applied with an elastic spiked layer topped to the firm and then foam surface, and the COG excursions were measured during the stimulation, and then at least 30 min after the stimulation of the spiked layer, we used 10 min of manual static and glide pressure applied to the plantar surface of both feet. Immediately after manual stimulation, static balance parameters were measured again. Results showed that after manual stimulation, the sway path with closed eyes decreased significantly on the AP and ML directions on firm surface conditions. The spiked layer caused significantly decreased sway path on firm platform in both directions, but it was ineffective on compliant surface. Our results established that the activation of plantar mechanoreceptors by 10-min manual stimulation can partially compensate subjects for the absence of visual input and the lack of accurate pressure information from the supporting surface, too.

[Treatment options of bone defects in revision of total knee replacement]. / Csontdefektusok megoldási lehetoségei revíziós térdprotetikában.

UNLABELLED: Total condylar knee replacement presently has more than 10 years of history in Hungary. Besides a large number of routine primary implantations, the number of exchange arthroplasties performed due to aseptic loosening is continuously growing as well. One of the most significant difficulties of revision interventions is the management of bone defects. OBJECTIVE: Aim of present study is to describe the treatment options of bone deficiencies found during knee arthroplasties. Indication criteria of different methods are introduced together with the results of revision operations dealing with bone defects in the authors' patient sample. METHOD: Between 1995 and 2001, 35 revision total knee replacements have been performed at the authors' institute where significant bone defects had to be dealt with. Because of aseptic loosening, unior bicondylar implant revision has been carried out in 24 cases and total condylar prosthesis revision in 11 cases. With 14 patients autologous bone, in 7 cases allogenic cancellous bone and in two cases structural allografts have been used. Metal augmentation of the prosthesis in itself was applied in 4 patients, in 8 further patients in combination with bone grafts. RESULTS: During physical and radiological control examination of 31 knees in average 3 years after the operation, authors found good clinical results in all cases except one. Bone grafts showed good remodeling, and the implants were all fixed well on the control radiographs except of the one failed case. With this patient, collapse of the structural allograft used for reconstruction of a large medial tibial defect was evident and the tibial component became loose. CONCLUSIONS: Based on international literature data and their own experiences, authors conclude that aseptic loosening of total knee endoprostheses can be managed with good results even if it is combined with massive bone loss. For a successful revision, an appropriate technical background, personal skills and a well-functioning bone bank is unavoidable. For the management of tibial defects, authors highly recommend the usage of long stem extensions.

Radiographic parameters of the hip joint from birth to adolescence.

BACKGROUND: Various qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages. OBJECTIVE: To perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip. MATERIALS AND METHODS: Radiographs were examined from 355 children (age 0-16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance. RESULTS: Before the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower.

Long-term results of derotational femoral varus osteotomy in Legg-Calvé-Perthes disease: 26-year follow-up.

The long-term results of 30 patients (31 hips) who underwent derotational femoral varus osteotomy for Legg-Calvé-Perthes disease are presented. Pain, leg-length discrepancy, Trendelenburg sign, and range of motion at the operated hip were examined clinically. Radiographic analysis included measurement of the Wiberg angle, epiphyseal index, acetabular index, and the Mose index. All were found to be satisfactory for patients in the good/fair category. Good/fair results were obtained in 27 (87%) of 31 hips according to Catterall's postoperative classification. Four patients were classified in the poor category due to severe restriction of movement and constant hip pain. Therefore, derotational femoral varus osteotomy is recommended for the treatment of patients with Legg-Calvé-Perthes disease.

[Surgical complications and their treatment options in total knee replacement]. / A teljes condylaris térdprotetika sebészi komplikációi és azok megoldási lehetóségei.

INTRODUCTION: One of the most important achievements of modern orthopedics is the treatment of degenerative disorders of the knee joint with endoprostheses. The most often used type of knee prosthesis implanted in our times is the total condylar one. With increasing numbers of prosthesis operations the number of complications is also increasing. AIM: Knowledge of diagnostic and treatment principles of complications is important for all institutions applying knee prostheses. The aim of present study is to report the authors' experience with the most important surgical problems following knee arthroplasty. PATIENTS/METHODS: At the Department of Orthopedics of the University of Pécs between 1993 and 1999 344 primary total condylar prostheses were implanted. Based on their own cases, the authors show the most important surgical problems after total knee arthroplasty. RESULTS: In their patient sample they observed infections, patellofemoral complaints and supracondylar femoral fractures being the commonest complications. Besides these problems they faced with some rare ones, like instability of the artificial joint and temporary peroneal palsy. Probably because of the relatively short follow up period, the authors had to perform only one revision procedure due to aseptic mechanical problems. The incidence of the most common complications in the authors' patient material is described as well as the principles and results of the applied treatment methods. Own experiences are compared with data from the literature. CONCLUSIONS: Although knee arthroplasty complications can be variable and followed by serious consequences, even the most significant ones can be managed with methods which provide the option of healing and restoration of knee functions.