[Analysis of Sickness-Related Days of Absence among Soldiers of the German Armed Forces from 2008 to 2018 Part 1: Retrospective Analysis with Comparison to the Statutory Health Insurance System]. / Analyse der krankheitsbedingten Fehltage von Soldatinnen und Soldaten der Bundeswehr von 2008 bis 2018 Teil 1: Retrospektive Analyse mit Vergleich zur Gesetzlichen Krankenversicherung.

BACKGROUND: Sickness-related absences are of particular importance both in the German armed forces and in the civilian sector. THE AIM OF THIS STUDY: was to analyze the incidence of sick leave among soldiers in comparison to the working population covered by the statutory health insurance (SHI) system. METHOD: According to the systematics of the SHI, the key figures on incapacity to work in the period 2008-2018 are calculated in an age- and gender-standardized manner. Likewise, a list of the TOP 20 ICD-10 diagnoses in relation to incapacity to work was determined, and their average annual rates of change were calculated for trend analysis. RESULTS: The annual rate of sick leave among soldiers was between 1.5 and 2.3%, which was lower than that of the SHI (3.1 to 5.0%). The duration of illness (sick days per case) among soldiers was between 9.0-15.6 days per year, compared with 10.9-14.4 days in the SHI system. The sickness frequency (cases per 100 persons) was lower among soldiers (48.2-75.0 cases) than in the SHI (96.8-131.0 cases). Most days of absence among soldiers were due to "respiratory infections (J06)" with 13.2%, "stress reactions (F43)" with 8.7%, "other infectious gastroenteritis and colitis (A09)" with 6.5%, "back pain (M54)" with 4.4% and "depressive episode (F32)" with 4.0% of all days of absence and were comparable to the values in SHI. "Depressive episode (F32)", "injuries (T14)", sreactions (F43)", "respiratory infections (J06)" and "pregnancy complaints (O26)" showed the highest rates of increase of+6.1% to+3.6% of days off work. CONCLUSION: For the first time, it was possible to compare the sickness rate of soldiers with that of the general population in Germany, which may also provide indications for further measures for primary, secondary and tertiary prevention. The lower sickness rate among soldiers compared with the general population is mainly due to a lower incidence of illness, with a similar duration and pattern of illness, but with an overall upward trend. The ICD-10 diagnoses "Depressive episode (F32)," "injuries (T14)," "stress reactions (F43)," "acute upper respiratory tract infections (J06)" and "pregnancy complaints (O26)," which are increasing at an above-average rate in relation to the number of days absent, require further analysis. This approach seems promising, for example, to generate hypotheses and ideas for further improvement of health care.

Rehabilitation of Patients with Osseointegrated Prosthesis after Transfemoral Amputation - Literature-based Recommendation for Postoperative Rehabilitative Procedure. / Rehabilitation bei Patienten mit osseointegrierten Prothesen nach transfemoraler Amputation ­ literaturbasierte Nachbehandlungsempfehlung.

BACKGROUND: Osseointegrative implantation after amputation of the lower extremity is a special treatment option. Physiotherapeutic treatment is important for the functional outcome. This study systematically evaluated existing follow-up treatment protocols to establish a literature-based recommendation for postoperative rehabilitation procedures. METHODOLOGY: A PubMed literature search was conducted on December 10, 2020, using the following search terms: (osseo-integrat* OR endo-exo OR boneanchored OR bone anchored) AND (prosthe*) AND (leg OR lower limb* OR lower extremit* OR transfem* OR transtib*) AND (rehabilitation). 113 publications were found in this context. 10 of them met inclusion criteria. The Cochrane risk of bias tool was used to determine the publications' quality. RESULTS: Three systematic rehabilitation protocols have been described: Osseointegrated Prostheses for the Rehabilitation of Amputees protocol, Osseointegration Group of Australia Accelerated protocol and Radboud Amputation: rehabilitation protocol for endo-exo femoral prosthesis. There are clear differences in the duration of the rehabilitation protocols. The quality of published studies is limited due to the high risk of bias and low evidence levels (mainly III - V). A concept for long-term rehabilitation has not been described yet. CONCLUSIONS: There are various protocols for rehabilitation after treatment with osseointegrative prosthesis. Gradually increasing axial weight bearing started shortly after surgery; step-by-step gait training, adaptation of the prosthesis to the new biomechanics and critical patient selection and pre-operative training have been proven useful for successful rehabilitation. Controlled comparative studies, standardised outcome measurements or comparative studies between different protocols are not available. Models for multi-level long-term care have not been described in the literature so far.

The Relationship between Ergometric Treadmill or Bicycle Performance and Isokinetic Trunk Strength - A Retrospective Analysis.

The relationship between trunk strength and athletic performance is well known. In the past, trunk strength and athletic performance were measured in field tests. Previous studies encouraged sport-specific analyses. The goal of this study was to investigate whether there is a relation between ergometrically measured treadmill or bicycle endurance and isokinetic trunk strength. This retrospective analysis included 1334 bicycle and 1838 treadmill ergometry examinations in 1149 subjects. Bicycle and treadmill ergometer performance were analysed in relation to isokinetic trunk strength. Statistics were performed by Pearson correlation and mixed or generalised linear models. Higher treadmill and bicycle power correlated with higher isokinetic trunk strength, with highest absolute trunk strength in the treadmill group. For both running and cycling endurance, a positive correlation with trunk strength could be quantified in regression models. Increased ergometry endurance and lower flexion/extension ratios are connected weakly. Ergometry performance had the strongest correlation with extension trunk strength (r=0.312-0.398 for bicycle ergometry and r=0.168-0.229 for treadmill ergometry, p<0.001). We encourage prospective studies using both kinds of ergometry to evaluate the effect of trunk strengthening to enhance sport-specific endurance performance. Weight-adapted trunk strength values showed overall greater correlation to trunk strength and we recommend the use of weight-adapted values.

An evaluation of the significance of individual endogenous risk factors and medical and orthopaedic conditions on physical fitness in military executives.

As part of occupational health promotion in the Bundeswehr (military services of the Federal Republic of Germany), top-ranking executives were offered a medical examination and training program. The participants were subjected to retrospective evaluation. The aim of this study was to determine to what extent risk factors for the development of internal and orthopaedic conditions are present in military executives and how these factors affect physical fitness. To collect their medical history, a total of 122 male subjects answered a questionnaire aimed at evaluating private and occupational stress factors. This process was followed by an internal and orthopaedic examination. A lactate performance test (treadmill or bicycle ergometry) was conducted. The results showed that the presence of hypertension correlates with reduced fitness. While orthopaedic conditions had no negative influence on executives' fitness, high body mass index and waist circumference, mental stress, and older age did. It is recommended that executives undergo professionally guided endurance and weight training on a regular basis in order to prevent the development of internal and orthopaedic conditions.

An Evaluation of the Significance of Work-Related Influence Factors on Fitness and the Development of Medical and Orthopaedic Conditions in Military Executives.

Occupational health promotion is an effective tool to improve the state of health of employees. As part of occupational health promotion in the German Bundeswehr, top-ranking military executives are offered a medical examination and training programme. Health-related data is collected as a basis for training and lifestyle counselling. This data was subjected to a retrospective evaluation in order to identify occupational risk factors and their correlation with cardiovascular resilience, trunk strength, and the development of orthopaedic and internal disorders. A total of 122 military executives (all male, age 54.6 ± 4.2 years) answered a questionnaire aimed at evaluating private and occupational stress factors. The medical history was followed by a medical and orthopaedic examination involving a lactate performance test (treadmill or bicycle ergometry) and an isometric trunk strength measurement. The data obtained was then statistically evaluated. For military executives, work-related travelling and commuting involve a high risk of medical and orthopaedic conditions. Regular exercise leads to improved fitness levels. In order to prevent medical problems, military executives working long hours should regularly take part in fitness and weight training under professional instructions.

Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study.

Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.