The distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis.

BACKGROUND: Hip osteoarthritis is a major civilizational challenge of the ageing population, usually due to the reduced function of gait. In the light of this fact, gait analysis has become an important issue for the doctor, the physiotherapist and the patient, as it serves as a useful tool in diagnosis, recovery, and rehabilitation. Pedobarography is one of the most modern gait analysis methods. OBJECTIVE: The aim of this study is to assess the distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis. METHODS: Dynamic foot tests were performed by means of a two-meter RSscan® International platform, equipped with 16.384 sensors with the scanning frequency level exceeding 500 Hz. Patients were divided into two groups: the research group of N= 60 individuals with hip osteoarthritis, aged 52-84; and the control group of N= 32 individuals without hip osteoarthritis, aged 50-74. Data distribution analysis was performed with the Shapiro-Wilk test, followed by a non-parametric Mann-Whitney U test. RESULTS: The differences between the mean results of maximal peak values of pressure and force in such areas as the big toe, metatarsal I, III, IV, V, lateral and medial heel are significantly lower in the research group than in the control group. Only in the area of metatarsal II, the mean value of pressure is higher in the research group than in the control group. For all metatarsals, the midfoot and medial heel mean results of the contact area are significantly higher in the research group than in the control group. The differences between mean load rate were also tested. The test revealed statistical significance of metatarsal II and III, and the medial heel while metatarsal II displayed a higher mean value in the research group than in the control group. CONCLUSION: The distribution of the pressure forces of the foot can indicate imbalances which cause degenerative changes. Therefore, early detection of changes can help in prevention or delay of hip osteoarthritis in conjunction with proper therapy.

The Prevalence of Neck and Back Pain among Paramedics in Poland.

Neck Pain (NP) and low back pain (LBP) are ubiquitous musculoskeletal conditions and some of the major causes of disability worldwide. The aim of the study was to assess the incidence and risk factors of back pain among paramedics and their correlation with the nature of work, anthropometric features and the level of recreational physical activity. A group of 201 individuals (39 females (19.40%); 162 males (80.60%)), licensed to practice as paramedics in Poland completed a questionnaire containing the author's interview as well as the Neck Disability Index (NDI) questionnaire and the Revised Oswestry Disability Index (ODI). Among the examined paramedics, 92% of the subjects reported the presence of back pain in different parts of the spine (36% C; 17% Th; and 85% LBP). The pain intensity, determined by VAS, was on average 4.26 (SD 1.77). The level of disability, assessed by NDI, was 7.67 (SD 5.73) on average, while the ODI was 7.51 (5.90). Work-related spinal strain has a major impact on the intensity and incidence of spinal pain. Spinal pain in paramedics mainly occurs in the lower back.

Influence of Risk Factors on Exercise Tolerance in Patients after Myocardial Infarction-Early Cardiac Rehabilitation in Poland.

(1) Background: Prognosis in patients with cardiovascular diseases is significantly influenced by lifestyle and the control of risk factors. Patients after myocardial infarction require special care and promptly introduced cardiac rehabilitation. The primary aim of this study was to identify risk factors and their influence on exercise tolerance before and after cardiac rehabilitation (CR) provided under the Coordinated Specialist Care Programme-Infarct (CSC-Infarct). (2) Methods: The study was carried out at the Cardiac Rehabilitation Centre of Slupsk Specialist Hospital on a group of 112 patients aged 35-87 (62.78 ± 10.09 years) after myocardial infarction (MI), participating in CSC-Infarct. An exercise test (treadmill ECG test), the 6 min walk test (6MWT), echocardiography, blood test (total cholesterol, HDL, LDL, TG), measurement of diastolic pressure ratio (DPr), waist-to-hip ratio (WHR), and BMI were performed in participants on the first and last day of CR. Rating of perceived exertion was assessed with Borg's scale. (3) Results: The overweight variable had the strongest effect on the increased value of initial: HR rest, HR max, and HR 1 min after exercise compared to subjects with normal BMI. DPr values before and after CR were also higher in overweight patients. Scores of 6MWT were higher in smokers compared to non-smokers. The final MET value was significantly higher in non-diabetic subjects. Hyperlipidaemia was associated with a higher initial HR max and initial HR 1 min after exercise. DPr before CR was also higher. The initial and final MET values were lower in hypertensive patients. Borg's rating of perceived exertion measured after the final exercise test was also higher in hypertensive patients. Hypertension influenced the initial and final 6MWT scores, which were significantly higher in normotensive patients. (4) Conclusions: CR within CSC-infarction in patients after myocardial infarction improves exercise tolerance. Exercise tolerance in post-MI patients with concomitant risk factors is lower compared to post-MI patients without risk factors.

Influence of Occupation on the Prevalence of Spinal Pain among Physiotherapists and Nurses.

(1) Background: Neck pain (NP) and low back pain (LBP) are common musculoskeletal disorders, one of the major causes of disability globally. The aim of the study was to determine the influence of medical occupation (physiotherapist and nurse) on the prevalence of spinal pain, functional status and degree of disability. (2) Methods: a total of 544 people (462 females (84.9%) and 82 males (15.1%)), licensed to practice as a physiotherapist (n1 = 240 (44.1%)) or nurse (n2 = 304 (55.9%)) in Poland completed a special questionnaire designed by the authors of the study, and were assessed using the Neck Disability Index (NDI, Polish language version) and Revised Oswestry Disability Index (ODI, Polish language version). (3) Results: Compared to physiotherapists, nurses were older, shorter, had higher BMI, and longer work experience. In the whole study group, 30.2% of subjects reported NP, 17.7% reported thoracic pain (ThP) and 80.5% reported LBP. During working life, 90.9% of physiotherapists and 97.7% of nurses experienced spinal pain. Pain intensity measured with Visual Analogue Scale (VAS) was higher among nurses (mean 5.37) than among physiotherapists (mean 4.64). Nurses had a higher degree of disability caused by LBP and NP measured with ODI and NDI compared to physiotherapists. (4) Conclusions: Excessive strain of the spine associated with occupational activities has a strong impact on the intensity and frequency of spinal pain episodes. Physiotherapists and nurses mainly suffer from low back pain. Pain scores measured with VAS are higher in nurses than in physiotherapists.

Prevalence and risk of spinal pain among physiotherapists in Poland.

BACKGROUND: The purpose of this study was to determine the prevalence, symptoms of, and risk factors for spinal pain in physiotherapists, as well as to analyse the correlation between these factors and the nature of the work, anthropometric features of the respondents, and the level of their physical activity. METHODS: The study was conducted among 240 physiotherapists (71 male and 169 female) with a mean age of 38.7 years. They were divided into three groups: physical therapy (37), kinesitherapy (158) and massage (45). Physiotherapists were evaluated with a specially designed questionnaire, the postural discomfort chart, the Neck Disability Index (NDI) questionnaire, and the Oswestry Disability Index (ODI) questionnaire. RESULTS: The analysis showed a 91.7% incidence of spinal pain in physiotherapists (91.1% for kinesitherapy, 97.3% for physical therapy, and 88.9% for massage). The study revealed that 50.2% of physiotherapists indicated one to five pain episodes in their careers. Most respondents reported pain in the lumbosacral spine (82%) and the cervical spine (67%). Most respondents (58.5%) scored the pain as moderate (VAS scale). Carrying (62.6%) and torso bending (37.4%) were indicated as the causes of pain. CONCLUSIONS: Physiotherapists demonstrate a high prevalence of spinal pain. Physical activity reduces the frequency of pain episodes.

Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research.

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days' break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

Comparison of the effects of TENS stimulation and water immersion on relieving labour pain suffered byprimiparas.

OBJECTIVES: The aim of this study was to compare pain suffered by primiparas when delivering a child in a traditional way with deliveries where either TENS stimulation or water immersion was used. MATERIAL AND METHODS: Primiparas were divided into 3 groups. In group 1 there were 45 women for whom TENS stimulation was applied during delivery. Group 2 consisted of 38 women who remained in the water during the actual birth of the baby. Group 3 served as the control group and was composed of 32 women. The intensity of pain during delivery was assessed by means of a numerical scale. During the first delivery period, pain was assessed three times at cervical dilation of 2, 3 and 4 fingers. RESULTS: The analysis of pain suffered by primiparas at 2-finger widening showed no statistically significant differences between the groups. However, the analysis of pain experienced at 3-finger opening showed significant differences between the group of women using TENS stimulation in comparison with the control group. When comparing pain at 4-finger opening, statistically significant differences were found between the group of women who delivered in water in comparison to both the control group and the group using TENS stimulation. CONCLUSIONS: TENS stimulation and water immersion are good methods to relieve labour pain; particularly helpful in the first period of labour. They are also safe, alternative, non-pharmacological methods of reducing labour pain.

Risk Factors Associated with Low Back Pain among A Group of 1510 Pregnant Women.

BACKGROUND: Low Back Pain (LBP) is a frequent, very common, and costly health problem. LBP, which occurs during pregnancy, may become a lifelong problem. The aim of this study was to determine the risk factors associated with LBP in pregnant women. METHODS: The study included 1510 pregnant women. A questionnaire assessing demography, lifestyle, prevalence, and characteristics was designed and used in the study. Pain intensity was assessed with the VAS (Visual Analogue Scale). The RMDQ (Roland Morris Disability Questionnaire) was used to assess the effect that low back pain had on the functional capacity of a pregnant woman. Middle (thoracic) and low back pain disability was measured with the help of the ODI (Oswestry Disability Index) questionnaire. RESULTS: The study confirmed that lying/sleeping (49.6%) and sitting positions (38.7%) as well as walking (37.2%) are the most significant factors causing LBP. It was also found that women who had not engaged in physical activity were more likely to experience LBP. CONCLUSIONS: Predisposing factors for LBP in pregnancy are LBP in previous pregnancies, back pain during menstruation, a younger age and a lack of physical activity. Most women in pregnancy with LBP experienced minimal and mild disability.

Inertial Sensors as a Tool for Diagnosing Discopathy Lumbosacral Pathologic Gait: A Preliminary Research.

BACKGROUND: the goal of the study is to ascertain the influence of discopathy in the lumbosacral (L-S) segment on the gait parameters. The inertial sensors are used to determine the pathologic parameters of gait. METHODS: the study involved four patients (44, 46, 42, and 38 years). First, the goal of the survey was to analyze by a noninvasive medical test magnetic resonance imaging (MRI) of each patient. Next, by using inertial sensors, the flexion-extension of joint angles of the left and right knees were calculated. The statistical analysis was performed. The wavelet transform was applied to analyze periodic information in the acceleration data. RESULTS: in the patients with discopathy, the amount of knee flexion attained during stance phase is significantly lower than that of normal (health side), which could indicate poor eccentric control or a pain avoidance mechanism. The biggest differences are observed in the Initial Swing phase. Bending of the lower limb in the knee joint at this stage reaches maximum values during the entire gait cycle. CONCLUSIONS: It has been difficult to quantify the knee angle during gait by visual inspection. The inertial measurement unit (IMU) system can be useful in determining the level of spine damage and its degree. In patients in the first stages of the intervertebral disc disease who may undergo conservative treatment, it may also partially delay or completely exclude the decision to perform a complicated imaging examination which is MRI, often showing a false positive result in this phase of the disease.

The impact of mobilization on hip osteoarthritis.

BACKGROUND: Osteoarthritis is one of the most common joint disorders. It causes pain, stiffness and a decreased range of motion which have a significant impact on daily activities and gait, consequently leading to disability. OBJECTIVE: The aim of this study is to compare hip mobilization with non-weight bearing exercises. METHODS: A total of 57 females aged between 55-65 were divided into 2 groups. In the control group non-weight bearing exercises were conducted, whereas the research group received hip mobilization. RESULTS: The Lequesne index significantly improved in the research group as compared with the control group. Hip function improved both in the control and research groups. Active hip extension increased by 0.54, while active abduction rose by 2.14 after non-weight bearing exercises. In the control group after mobilization both passive and active hip extension increased significantly by 3.53, active abduction by 5 and passive by 4.41, while active and passive internal rotation by 3.82 and 4.56, respectively. In both groups pain decreased. CONCLUSIONS: Mobilization increases hip range of motion, decreases pain and improves hip function more than non-weight bearing exercises.

Motor Evoked Potentials after Supraspinal Stimulation in Pre- and Postoperative Evaluations of Patients with Cervical Radiculopathy.

OBJECTIVE: Pre- and postoperative comparative evaluation of neurophysiological tests and clinical trials. Analysis of the diagnostic value of motor evoked potentials (MEP) induced by a magnetic field after supraspinal stimulation. Evaluation of the sensitivity and specificity of electromyography (EMG) and MEP is achieved. METHODS: EMG, ENG, M-wave, F-wave, and MEP tests were performed on 35 patients with confirmed cervical radiculopathy in pre- and postoperative evaluations. The clinical trial consisted of evaluation of muscle strength, a sensory perception test and evaluation of tendon reflexes and pain severity. RESULTS: The sensitivity of the resting EMG and MEP tests is 24%-67% and 6%-27%, while their specificity is 43%-80% and 86%-100%, respectively. The postoperative evaluation revealed a statistically significant reduction in pain severity (p=0001), an increase in muscle strength in DP (p=0.0431), BB (p=0,0431), and TB (p=0.0272), and improvement of touch sensation in terms of dermatomal innervation in C5 (p=0.0001) and C6 (p=0.0044). CONCLUSIONS: Tests comparing MRI sensitivity to neurophysiological tests show that neuroimaging is more sensitive in diagnostics of patients with cervical radiculopathy; however, clinical neurophysiology tests are more specific in reference to clinical trials.

[Secondary prevention of myocardial infraction]. / Wtórna prewencja zawalu miesnia sercowego.

Results of numerous epidemiological research prove that the development of civilization, density of population, constant changes of human diet based on increased consumption of processed, high-energy food rich in animal protein, sugar, saturated animal fat and change of life standard that is characterized by limiting physical activity and energy output and widespread pollution became favorable conditions (if not causative) increasing the rate circulatory system morbidity, including ischemic heart disease and myocardium infraction. The purpose of presented research is an attempt to answer a question how the patients after myocardium infraction self-estimate their previous style of life. The paper also tries to find the relation between family record of sickness with dietary preferences and physical activity. In purpose to collect the empiric material the scientists used a method of diagnostic soundings. The author's questionnaire was used as a technique of the survey that was performed on a group of 100 patients after myocardium infraction. The patients were chosen randomly and the survey was accomplished in hospitals of Slupsk and Koszalin. Taking care of proper health condition by patients after myocardium infraction is highly unsatisfactory. The results show that in spite of myocardium infraction, 30% of respondents still smoke, 30% use alcohol and 40% use inappropriate diet. Dietary references of the respondents prove the necessity of providing more education concerning healthy diet in everyday life. The respondents ceased systematic physical exercises and the majority of them (62%) does not exercise regularly (32% cured by preservative method and 30% invasion method).

[Late maternity in researchers' and medical staff's opinions]. / Spóznione macierzynstwo w swietle badan i opinii personelu medycznego.

During the last decade in Koszalin hospital 223 women over 35 years old gave birth to their first child. Those numbers made up 1.2% of all births in this time. Medical documents were analyzed to compile a detailed list carrying main problems concerning of this group of women. Older primiparas had a lot of problems with conception, carrying pregnancy to term, pathology of pregnancy and labor. These women cooperated with midwives and doctors very well, and that fact was strongly emphasized by the medical staff. Women over 35 years old declared stronger need of support, aid and knowledge than other groups of patients.