[Exercise-Based Prehabilitation In Orthopaedics, Cardiology And Oncology]. / Trainingsbasierte Prähabilitation in der Orthopädie, Kardiologie und Onkologie.

Prehabilitation (prehab) aims to prepare patients for surgery, to reduce perioperative complications and to improve postoperative recovery. Pre-operative interventions depend on the indication and the specific patient characteristics and life circumstances. In orthopaedics, the focus is on preoperative improvement of physical performance, function and muscle strength through specific strength, mobility and sensomotoric training. In cardiology, endurance training and respiratory therapy are used in the preoperative phase, as well as coordination and strengthening exercises and occupational therapy to improve physical fitness and performance and reduce cardiovascular risk factors. In oncology, prehab is used preoperatively and also in addition to chemotherapy or radiotherapy to reduce medical side effects and to increase tolerance to cancer therapies (e. g. surgery, chemotherapy, radiotherapy). Exercise interventions in oncology differ according to the type of cancer (e. g. combined strength and endurance training, respiratory therapy, high-intensity interval training and walking). Study results often show positive effects on health resources using prehab. However, further high-quality clinical intervention studies are needed to confirm the clinical benefits of prehab for implementation in routine care.

Effects of exercise prehabilitation before anterior cruciate ligament reconstruction on functional outcomes during pre- and postoperative rehabilitation - protocol for a single-blinded randomised controlled trial.

BACKGROUND: Although a benefit of preoperative training prior to anterior cruciate ligament (ACL) reconstruction is likely, there is no consensus on the optimal content (criteria-based programme), supervision (one-on-one guidance or self-administered training) and general setting of preoperative training after ACL injuries. The purpose of this trial is to investigate the efficacy of an individually adaptive, guided, structured and criteria-based preoperative rehabilitation programme in comparison to a non-guided and self-administered home training programme. METHODS: The planned single-blinded randomised controlled trial study was approved by the ethics committee of the German Sport University on June 14, 2022 (ethics application no. 093/2022) and prospectively registered (DRKS-ID: DRKS00030312; date of registration: 26.09.2022). N = 114 participants between 16 and 60 years of age with a unilateral ACL rupture and scheduled ACL reconstruction with a hamstring or quadriceps tendon autograft will be randomly (block-randomisation, 1:1 allocation) and blinded assigned to one of two groups: intervention group (structured, criteria-based, guided prehabilitation training) and comparator group (non-guided, self-administered home training). After surgical reconstruction, patients of both groups participate in the same standard, functional measurement-guided, postoperative rehabilitation programme. Stepwise increasing the functional requirements of the assessments, all participants participate in testing at the day of anamnesis (t1), 1-7 days before surgical reconstruction (t2), day of surgical reconstruction (t3) and 30 (t4), 60 (t5), 90 (t6) and 180 (t7) days post-reconstruction. The primary outcome is the overall self-reported knee condition, assessed by the sum score of all sub-scales of the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include functional outcomes (range of motion, knee flexors and extensors and plantar flexors strength/torque, functional postural control, jumping ability), workability and return to sport (RTS) (psychological readiness, RTS success). DISCUSSION: The planned study targets to fill a gap in the evidence regarding effective designs of prehabilitation training before surgical ACL reconstruction. Potential difficulties that could affect the conduct of the study are lack of treatment adherence of the patients and high dropout. TRIAL REGISTRATION: German Register of Clinical Trials DRKS-ID: DRKS00030312 . Registered on 26 September 2022.

Interventions for preventing back pain among office workers - a systematic review and network meta-analysis.

OBJECTIVE: Back pain is common in the working population. This systematic review with network meta-analysis (NMA) aimed to compare the effects of interventions for preventing back pain among office workers. METHODS: We searched eight databases and additional sources up to March 2021. We included randomized controlled trials (RCT) and cluster RCT focusing on office workers, comparing work-related interventions aimed at preventing back pain (defined as pain in any part of the spine) to a control condition and assessing back pain and/or work absence. Further outcomes considered were adverse events and participants' satisfaction. We performed both frequentist and component NMA. Risk of bias (RoB) was evaluated using RoB 2 and certainty of the evidence (CoE) was assessed using GRADE. RESULTS: We screened 9809 records and included 24 studies with a total of 7080 participants. RoB was assessed as "some concerns" or "high" for all studies and outcomes. Included studies investigated multicomponent interventions, ergonomics, physical activity, education, behavioral interventions and no/minimal interventions. Effects were mostly not statistically significant and based on low/very low CoE. Physical activity probably reduces days of work absence slightly [mean difference (MD) -1.10, 95% confidence interval (CI) -2.07- -0.13], and combining physical activity and ergonomics may reduce back pain intensity (standardized MD -0.41, 95% CI -0.80- -0.02) when compared to no/minimal intervention. A large proportion of participants were satisfied with the interventions, adverse events were rarely assessed. CONCLUSIONS: We observed mostly minor effects of interventions on back pain and work absence among office workers. The practical relevance of these effects is questionable.

The Association between Multidirectional Speed Performance, Dynamic Balance and Chronological Age in Young Soccer Players.

The ability to maintain a stable single-leg balance stance during a fast change of direction movement is a fundamental aspect both for improving sport-specific skills and for prevention strategies. The aim of this cross-sectional study was to investigate the associations between multidirectional speed performance (MDS), dynamic balance performance (DBP), and chronological age in young and uninjured soccer players. In addition, it was examined whether chronological age and balance can predict variance in speed performance. One-hundred forty-six young male soccer players (age range 11-19) performed the y-balance test (YBT) and the lower extremity functional test (LEFT). Descriptive statistics, Pearson correlation, and multiple regression analysis were executed. The analyses were carried out on the further variables: for the DBP, the YBT composite score % (CS dominant leg/CS non-dominant leg) and limb symmetry index % (LSI) were used; for the MDS, the LEFT time in seconds (s) was used. Findings revealed LEFT scores to have a significant association with chronological age (p = 0.000), CS dominant (p = 0.019) and LSI (p = 0.044) of the YBT. In addition, CS dominant and chronological age explained the variance of the LEFT by 44%, regardless of LSI. To conclude, MDS revealed a strong association with DBP of the dominant side but a small association with LSI. In addition, a small association was found between quick LEFT times and older players. Finally, MDS variance can be predicted from DBP of the dominant side and chronological age in young soccer players. The tests used in this study could be useful screening tools for the detection of performance deficits, the implementation of prevention training programs, and the optimization of selection strategies in soccer academies.

Work-related interventions for preventing back pain-protocol for a systematic review and network meta-analysis.

BACKGROUND: Back pain is a widespread health problem that accounts for substantial disability and high costs. The workplace is considered to critically affect the occurrence and persistence of back pain and therefore offers an important opportunity for preventive interventions. Various work-related intervention strategies including both single- and multicomponent interventions have been developed and evaluated so far. To determine their effectiveness, a method of analysis is needed that particularly meets the challenges of the multidimensionality and diversity of these interventions. This planned systematic review and network meta-analysis aims to compare the effects of different work-related interventions for preventing non-specific back pain in people within a formal employment-related context. METHODS: We will search the following databases: CENTRAL, MEDLINE, Web of Science, CINAHL, PsycINFO, PEDro, SPORTDiscus, and Academic Search Premier from their inception onwards, as well as additional sources. Randomized controlled trials (RCTs) and cluster-RCTs will be considered if they (1) include people within a formal employment-related context, (2) include people without back pain or mixed samples (i.e., people with and without back pain), (3) compare one or more work-related preventive intervention(s) to a control condition, and (4) assess non-specific back pain (incidence or/and pain intensity), ability to work (numbers of participants or/and numbers of days absent from work), intervention-related adverse events or/and self-reported satisfaction with the intervention. Random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate. We will calculate summary effect sizes for each comparison of interventions and rank interventions according to their P scores. If feasible, we will conduct additional component network meta-analyses. We plan to conduct subgroup analyses for job exposure, intervention duration, baseline back pain, different localizations of back pain, and gender. Risk of bias will be assessed using RoB 2 and the certainty of the evidence will be rated using the GRADE approach. DISCUSSION: This systematic review aims to identify work-related intervention strategies as well as components within work-related interventions that are effective for preventing back pain. We expect the results to provide guidance for selecting the most promising interventions and foster the purposeful use of resources. Additionally, they may inform the development and implementation of work-related interventions as well as the design of future research in this field. TRIAL REGISTRATION: PROSPERO CRD42021232469.

The Reliability of Common Functional Performance Tests within an Experimental Test Battery for the Lower Extremities.

The main aim of this study was to determine the test-retest reliability of an experimental functional test battery: Y-balance test (YBT), single-leg countermovement jump (SLCMJ), single-leg hop for distance (SLH), side-hop (SH), speedy-jump (SJ), agility-T (AT), and lower extremity functional test (LEFT). Secondary aims were (1) to determine the mean range for the limb symmetry index (LSI) and (2) to detect significant differences in performance between test-retest sessions. Twenty-two healthy adults (14 males, 8 females; age 23.3 ± 3.9) were tested by the same rater during two different sessions (T1-T2), with a seven-day interval, under the same conditions. Reliability analysis showed good-to-excellent reliability (0.89 < ICC < 0.97; 0.80 < α < 0.98) for the test battery. LSI ranged from 95.9 ± 6.7% (SH-T1) to 104.4 ± 12.5% (SLCMJ-T2). Repeated measures ANOVA detected significant performance differences between sessions in the LEFT (p = 0.009) and for non-dominant sides in the SLH (p = 0.015), SH (p = 0.007), and SJ (p = 0.011). The high reliability of the test battery suggests a potential use in clinical sports practice. The LSI range of ≥95% was proposed as a benchmark for healthy adults. Learning effect seems to have played a crucial role in the T2 improvements of the non-dominant side for hop performances (SLH, SH, SJ) and speed performance (LEFT).

[Functional Testing as Guideline Criteria for Return to Competition after ACL Rupture in Game Sports]. / Funktionelle Tests als Entscheidungskriterium für die Rückkehr von Spielsportlern nach einer Ruptur des vorderen Kreuzbandes.

A rupture of the anterior cruciate ligament (ACL) represents a severe injury in game sports, which is time and cost-intensive for athletes and clubs alike. As the lower extremities are subjected to multiple forms of strain and high demands are placed on them, athletes in games like soccer are affected more often than others. The point of return-to-play after such severe injuries is often preceded by long periods of rehabilitation. However, these periods often vary strongly. Multiple approaches are being discussed to estimate the point of return-to-play using functional test procedures. However, no general consensus has been reached regarding the relevant parameters, available test procedures and interpretation of test results. Based on the requirement profile of soccer as a game sport, this review evaluates functional tests regarding the requirements strength, speed, agility, and movement quality as a coordinative feature. In addition to tests regarding individual forms of strain, this review also discusses combined test protocols. It describes performance variants and scientific quality criteria as well as the potential for practical implementation. While jumps can detect side-to-side asymmetries only through additional equipment such as force plates or markers, hop tests are more suitable for implementation and allow for an easier assessment of side-to-side asymmetries. Although several combined test protocols exist, none of them measures the entire requirement profile for games sports. To decrease the number of re-injuries after ACL rupture, a combined test protocol with a selection of the described scientifically reliable functional tests should be created and implemented as a return-to-competition guideline as well as pre-injury screening prior and during the season.

Analysis of work ability and work-related physical activity of employees in a medium-sized business.

BACKGROUND: Work-related physical activity (PA) and work ability are of growing importance in modern working society. There is evidence for age- and job-related differences regarding PA and work ability. This study analyses work ability and work-related PA of employees in a medium-sized business regarding age and occupation. METHODS: The total sample consists of 148 employees (116 men-78.38% of the sample-and 32 women, accounting for 21.62%; mean age: 40.85 ± 10.07 years). 100 subjects (67.57%) are white-collar workers (WC), and 48 (32.43%) are blue-collar workers (BC). Work ability is measured using the work ability index, and physical activity is obtained via the Global Physical Activity Questionnaire. RESULTS: Work ability shows significant differences regarding occupation (p = 0.001) but not regarding age. Further, significant differences are found for work-related PA concerning occupation (p < 0.0001), but again not for age. Overall, more than half of all subjects meet the current guidelines for physical activity. CONCLUSION: Work ability is rated as good, yet, a special focus should lie on the promotion during early and late working life. Also, there is still a lack of evidence on the level of work-related PA. Considering work-related PA could add to meeting current activity recommendations.

Motor activity as a way of preventing musculoskeletal problems in string musicians.

The health status of performing artists, especially musicians, was not an issue for medical research until the 1980s. Musicians tend to suffer from health-related problems, as playing an instrument demands long and intensive practice. This paper provides a literature review of health problems of string players in particular. It analyzes whether their problems are playing-related or if various parameters potentially influence their health state, and it subsequently presents a concept of efficient training. Health disorders and diseases are individual. In order to ensure efficient prevention, a profile of qualification, including physical and psychological aspects as well as key skills, allows developing an individual training schedule and thus should be included in the process of prevention. Physical performance plays a decisive role and is more important than commonly thought. Strength, endurance, and flexibility in particular have an immense influence on the musician's performance. Playing an instrument requires both physical and mental skills, and all too often this leads to excessive demands. It is necessary to highlight the possible causes and provide the musician with a therapeutic intervention and educational work. As the demand for preventative work in this field grows steadily, this paper draws a detailed concept of a therapeutic intervention.