Retropubic vs. transobturator tension-free vaginal tape for female stress urinary incontinence: 3-month results of a randomized controlled trial.

BACKGROUND: We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape (TVT) with those of transobturator tape (TVT-O) as primary treatment for stress urinary incontinence (SUI) in women. STUDY DESIGN: The study was conducted at 25 gynecology units in Austria and Germany; regional and academic hospitals participated. A total of 569 patients were randomly assigned to undergo TVT or TVT-O. RESULTS: A total of 480 patients (85%) were examined at 3 months. A negative cough stress test with stable cystometry to 300 ml was seen in 87% of patients after TVT and in 84% after TVT-O; 64% and 59% of patients, respectively, reported no pad use, and 88% of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement (PGI-I) scale. Quality of life (QoL) as assessed with the SF-12 Health Survey, Kings' Health Questionnaire, (KHQ), and EuroQol-5D (EQ-5D) was significantly improved in both arms, with no differences between arms. There were no significant differences in postoperative pain or complications. CONCLUSIONS: Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems (ClinicalTrials.gov NCT 00441454).

Efficacy of individualized Chinese herbal medication in osteoarthrosis of hip and knee: a double-blind, randomized-controlled clinical study.

OBJECTIVES: The objective of this study was to determine the efficacy of individually designed herbal formulas according to the rules of Traditional Chinese Medicine (TCM) in patients with osteoarthritis of the hip and knee. DESIGN: This was a randomized, controlled, double-blind study with two parallel groups. SETTINGS/LOCATION: This study was conducted at the University-centre in Gars am Kamp/Austria and was organized by the Institute of TCM and Complementary Medicine of the Danube University Krems /Austria. SUBJECTS: The study comprised female and male patients with osteoarthritis of hip or knee aged between 45 and 75 years. INTERVENTIONS: Patients were randomized into a treatment with individualized, water-based herbal decoctions prepared in a standardized cooking process (Verum group) or to a treatment with nonspecific presumably ineffective, water-based herbal decoctions (Control group). OUTCOME MEASURES: The primary outcome was the comparison of change between the intervention groups in the Western Ontario and McMaster Universities lower limb global index questionnaire (WOMAC global index) between baseline and week 20. Secondary outcomes included subscales of WOMAC for pain (A), stiffness (B), and functional impairment (C) and general quality of life in the form of the SF-36 questionnaire. RESULTS: Altogether, 102 patients were randomized in this trial. The demographic and medical baseline characteristics were comparable in the 2 groups. The change of the WOMAC global index and all three subscales was significant in both groups between week 20 and baseline (verum group, global WOMAC: at baseline 47 [SD ± 11.8] and at week 20: 24 (SD ± 18.3); change of mean 23; p > 0.001; control group; global WOMAC: at baseline: 48 (SD ± 14.7) and at week 20: 25 (SD ± 18.3); change of mean 23; p > 0.001). However, there was no significant difference (p = 0.783) between the treatment groups. There were significant changes in the subscales "physical functioning," "bodily pain," "vitality," "social-functioning," and "role-physical" of the SF-36 in both study groups between 20 weeks and baseline, but again no significant difference between the groups. There were no drug-related serious adverse events. CONCLUSIONS: While the individual prescription consisting of medicinal herbs according to TCM diagnosis investigated in this trial tend to improve the osteoarthritis, the same effect was also achieved with the nonspecific prescription.

An estimation of the frequency of surgery for posthysterectomy vault prolapse.

INTRODUCTION AND HYPOTHESIS: We tried to estimate the frequency of surgery for posthysterectomy vault prolapse. METHODS: We contacted all 86 departments of gynecology in Austria and asked them about total number of hysterectomies and total number of operations for vault prolapse. We then calculated a percentage of patients undergoing surgery for posthysterectomy vault prolapse. RESULTS: Sixty-five of 86 public hospitals replied (response rate 76%) and reported a total of 7,645 hysterectomies and 577 operations for vault prolapse for the year 2005, giving a percentage of 7.16 for surgery for posthysterectomy vault prolapse. On the assumption that vault prolapse takes on the average 10 years to develop and that the number of hysterectomies decreased by 10% over 10 years, we calculated a modified frequency of 6.52%. CONCLUSIONS: We were able to calculate an estimation of the frequency for posthysterectomy vault prolapse requiring surgical repair between 6% and 8%.

A simple teaching tool for training the pelvic organ prolapse quantification system.

The pelvic organ prolapse quantification (POPQ) system is currently the most common and specific system describing different prolapse stages. Nevertheless, its use is not yet accepted worldwide in routine care. Our aim was to develop a simple teaching tool for the POPQ system capable of simulating different stages of uterovaginal prolapse for use in medical education with hands on training. We constructed a moveable and flexible tool with an inverted Santa Claus' cap, which simulated the vaginal cuff and the tassel at the end representing the cervix. A wooden embroidery frame fixed the cap and served as the hymen, the reference point for all measurements. Inside the cap, we sewed buttons to define the anatomic landmark points Aa and Ap located 3 cm distal from the frame. After explaining the device to the students, we used the three-by-three grid for recording the quantitative description of the pelvic organ support. First, each student had to demonstrate a specific prolapse with his cap device. Then, a prolapse was simulated on the cap, and the student had to take the relevant measurements and record them in the POPQ grid. The main training effect to understand the POPQ system seems to be the possibility for each trainee to simulate a three-dimensional prolapse with this flexible vagina model.

[Is Qi Gong suitable for the prevention of low back pain?]. / Ist Qi Gong zur Prävention Idiopathischer Wirbelsäulenstörungen geeignet?

Low back pain is one of the main problems of health care, and has many causes. To prevent low back pain daily activities are highly important--static work as well as dynamic movement--carried out in an ergonomic and economical way. Studies have shown that the compliance of patients with regard to exercise training and ergonomic recommendations is not very high. The main posture of Qi Gong training is similar to the recommended posture by low back schools. Qi gong exercises respect basic physiological and ergonomic principles of movement in every way. Qi Gong fulfils the most important criteria for the prevention and therapy of idiopathic low back pain. Qi Gong training requires no special equipment. It is simple and can be undertaken everywhere. A growing number of people have become interested in Qi Gong, and train regularly and effectively. Low back pain rarely occurs in such people, and therefore Qi Gong should be considered as one of the most effective means of prevention.

[Splints in occupational therapy of the hand in an Austrian central hospital--current status]. / Die ergotherapeutische Schienenversorgung der Hand in einem österreichischen Zentralkrankenhaus--eine Bestandsaufnahme.

Ergotherapeutic splinting is essential in the treatment of diseases, injuries and innate deformities of the hand. However due to its high material and staff costs, a definitely diagnosed indication is a prequisite for prescription. A retrospective study was performed using the Krankenhausinformationssystem (KIS) to establish the total number of hand splints prescribed by the Department of Physical Medicine and Rehabilitation of the General Hospital of Vienna from 1/1992 until 8/1998, as well as referring doctors/departments and diagnoses leading to referral were recorded and descriptively evaluated. The total number of patients was 1972. 1236 (63%) of the cases were referred by surgical departments/branches, 410 (20%) by internal departments, 151 (8%) by the neurological department and 175 (9%) by other departments. The diagnosis leading to referral were rheumatoid arthropathies (542 = 26%), peripheral nerve lesions (458 = 22%), tendon lesions (201 = 10%), Dupuytren' contractures after surgery (184 = 8%), degenerative joint diseases (82 = 4%), conditions after fractures (55 = 2.5%), patients after amputations (50 = 2.3%), disorders of the central nervous system (53 = 2.5%), focus removals (40 = 2%) and tendovagintis (35 = 1.7%). The remaining 19% were referred due to surgical repositionings, soft tissue injuries, local infections and various other diagnoses. The majority of ergotherapeutic splintings was prescribed due to forms of rheumatic or rheumatoid diseases, peripheral nerve lesions as well as hand surgery. In this study documenting the clinical practice of a medical center was primarily aimed at providing the basis for further discussion of both factual and economic aspects of future developments in splinting.

Step aerobic vs. cycle ergometer training: effects on aerobic capacity, coordinative tasks, and pleasure in untrained adults--a randomized controlled trial.

The purpose of the study was to evaluate the impact of step aerobic (StA) and cycle ergometer training (CET) on physical performance, coordination, and pleasure, during workout. Forty untrained persons (40-70 years) were randomly assigned to either of the two regimens. Prior to and after three months of training, we investigated the participants' physical performance with a cycle ergometer test and by testing coordinative tasks (upper extremities: tapping test; lower extremities: one-leg stance). After the training period, visual analog scales were used to evaluate personal assessment (pleasure, wellbeing, team spirit, interest in prolongation of training). StA increased the relative oxygen uptake at the anaerobic threshold (RVO2AT) while CET increased the relative maximal oxygen uptake (RVO2max) to a statistically significant extent. However, intergroup comparison failed to show group-specific differences. Concerning coordinative tasks, the members of the StA group achieved a significant time reduction for both hands' tapping test. However, only the improvement in left-handed tapping was significantly higher than that achieved by members of the CET group. Despite the absence of group-specific differences, CET members showed a statistically significant change when comparing the duration of pre- with post-training time for one-leg stance under proprioceptive conditions. Team spirit was significantly higher in the StA group than in the CET group. Except for the time reduction in left-handed tapping, the present study found no group-specific differences in physical performance and coordination. Participating in a StA class has a more cohesive effect on the individual members than attending a CET group.