[Effects of inpatient rehabilitation for patients with back pain]. / Effekte der stationären medizinischen Rehabilitation bei Rückenschmerzpatienten.

BACKGROUND: This prospective, randomised longitudinal study examined the effects of inpatient medical rehabilitation. METHOD: Data was collated on the day of admission (n=261), day of discharge (n=261) and 6 months after discharge (n=243). The length of the rehabilitation measure changed every 3 months from 3 weeks (n=127) to 4 weeks (n=134) and back again. On all three specific days the VAS, the Roland-Morris-Questionnaire (RMQ) and the SF-36 were applied. The distance between fingers and floor and the Schober-sign were measured on the first and second day. The Mainz Pain Staging System (MPSS) was used to classify pain chronicity. RESULTS: On the day of discharge all parameters show an improvement. When the differing rehabilitation times are compared we can see the longer period scores better in VAS and Schober. 6 months after the rehabilitation all parameters show a slight improvement over the first day--except VAS--and a deterioration compared to the second--except RMQ. No significant predominance of the 4 week rehabilitation period is recognizable. CONCLUSION: The length of the rehabilitation measure alone seems to have no real effect on the permanence of the positive treatment of back complaints. It has advantages, though, for the result on the day of discharge.

[Health education and health training with osteoarthritis]. / Gesundheitserziehung und Gesundheitstraining bei Arthrose.

Osteoarthrosis is one of the most prevalent diseases in orthopedics. Its impact for the individual patient as well as for the socio-economic system is enormous. An increasing loss of function and pain progress of disease leads to chronic handicap, which severely restricts freedom of a self-determined life and reduces quality of life. Besides conservative and later surgical treatment, health-inducing offers to patients with arthrosis deformans have gained more importance in the process of coping with the illness similar to other chronic diseases. Health education and exercise are supposed to help patients gain more theoretical and practical knowledge of the disease and foster a more positive attitude in order to improve self management. The effect of patient educating programs with respect to self-help activities and socio-economic savings (return to work, days of hospital treatment) could be verified during recent years in many cases of chronic disease, such as rheumatic disease, diabetes and asthma through prospective multicenter studies. Whether special health training in osteoarthrosis leads to similar effects is subject of current studies.

[Using the Lequesne questionnaires for patients with hip and knee disabilities in daily routine to reflect the quality of outcome in rehabilitation]. / Der routinemässige Einsatz des Lequesne-Index zur Ergebnismessung in der orthopädischen Rehabilitation bei Hüft- und Knieerkrankungen.

AIM: Studies in rehabilitation research put great value on patients' self-assessment. Patients with hip or knee diseases who need an orthopaedic rehabilitation suffer mainly pain, reduction of walking distance and other disabilities that impact on the activities of daily life. The Lequesne scores for the hip and knee are an indicator to show the degree of disabilities. The aim of the study was to prove that the Lequesne indices are reliable instruments for the individual to express the outcome of rehabilitation. We tested the Lequesne indices in daily clinical work, in the handling and in the acceptance. METHOD: Since May 1999 the rehabilitation center Bad Eilsen uses the Lequesne questionnaires as self-report questionnaire instruments for patients with hip and knee disabilities. 145 patients with hip and 122 patients with knee diseases filled in the questionnaires correctly and handed them back. RESULTS: The Lequesne indices are able to show developments in both directions; improvement as well as change for the worse. The Lequesne questionnaires are helpful to complete the common clinical parameters. CONCLUSION: Using the Lequesne questionnaires as a self-report instrument in our daily routine we are able to obtain a good reflection of individual health condition and the quality of outcome in rehabilitation.

[Cross cultural adaptation of the lequesne algofunctional indices for german speaking patients with osteoarthritis of the hip and the knee]. / Kulturelle Adaptation des Lequesne-Index für Hüft- und Kniegelenkserkrankungen im deutschen Sprachraum.

The Lequesne Algofunctional Index is a widespread international instrument and recommended by the World Health Organization (WHO) for outcome measurement in hip and knee diseases. Up to now there has been no German version of the questionnaire fulfilling the guidelines for cross-cultural adaptation and providing satisfactory metric quality. Based on these guidelines, we developed the German version of the Lequesne Algofunctional Index regarding osteoarthritis of the hip and knee joints presented in this article. All of the questions it contains have been worded as whole sentences, questions concerning walking performance have been substantiated by examples. In testing of the metric outcome (hip: n = 112; knee: n = 83), both questionnaires showed an excellent reliability (IKK > 0,88). As a validity criterion, the correlation with the WOMAC score was tested. We received a Spearman coefficient between 0,63 and 0,81, indicating a high correlation. Time needed to fill in the Lequesne score was 2 min. in patients, physicians took 1,2 min. to evaluate the questionnaire. Regarding the questionnaires handed back, the Lequesne score showed better results than the WOMAC index. Sensitivity, measured by the "standardized response mean", was good in both regions for the total score. Comparing the data received on pain-related questions, the WOMAC score however showed a better sensitivity. The German version of the Lequesne Algofunctional Index is a suitable outcome instrument to measure the intensity of pain, walking capacity and activity of daily life in patients with osteoarthritis of hip and knee joints.

Effect of bone morphogenetic protein-12 gene transfer on mesenchymal progenitor cells.

Recombinant adenovirus mediated human bone morphogenetic protein-12 gene transfer induced tendon and cartilage-like tissue formation in vivo. The recombinant adenovirus with the human bone morphogenetic protein-12 gene was constructed, and mature human bone morphogenetic protein-12 expression mediated by adenovirus gene transfer was detected by specific antibody. Unlike bone morphogenetic protein-2 gene transfer, bone morphogenetic protein-12 gene transferred mesenchymal progenitor cell line C3H 10T1/2 showed no change of alkaline phosphatase activity, which is the mark of cell differentiation into osteoblastic phenotype. Injection of bone morphogenetic protein-12 gene transferred C3H 10T1/2 cells into nude mice thigh muscles induced tendon and cartilage-like tissue formation. The results indicate bone morphogenetic protein-12 has different effects on mesenchymal progenitor cell differentiation, and it may influence the cell differentiation into a nonosteoblast lineage.

Apoptosis as a mechanism of neuronal cell death following acute experimental spinal cord injury.

The complex biochemical interactions following acute spinal cord injury have undergone considerable investigation recently. Progress has been made in discovering both primary and secondary injury cascades that combine to produce the ultimate neurologic insult. Traditionally, neuronal and supporting cell death following spinal cord injury have focused on necrotic death pathways resulting passively from the actual mechanical tissue damage and inflammatory processes which follow. However, the occurrence of programmed apoptotic cell death which is an actively mediated cellular process may occur following acute spinal cord injury and, if present, may play a role in the ultimate neurologic insult. In this study, we document a chronologically-specific course of apoptotic cell death by the TUNEL assay technique following an acute experimental spinal cord injury in the rat model. In this manner, apoptotic cell death following acute spinal cord injury may play a pivotal role in the secondary injury cascade which produces the ultimate neurologic insult and may allow potential for mediating neuronal survival via anti-apoptotic factors such as the protooncogene Bcl-2.

In vivo gene transfer and overexpression of focal adhesion kinase (pp125 FAK) mediated by recombinant adenovirus-induced tendon adhesion formation and epitenon cell change.

Adhesion formation is a frequent complication of tendon injury repair: however, little is known about its mechanisms. The intracellular focal adhesion kinase (FAK)-related signaling pathway may be one of the mechanisms involved in the induction of tendon adhesions. The replication deficient adenovirus containing the FAK gene (pp125 FAK) was constructed and named Adv-Fak. By in vitro transductions with the recombinant virus, overexpression of the FAK protein was documented in transduced cultured primary tendon cells. By in vivo direct injection of Adv-FAK into the space between the tendon and tendon sheath of White Leghorn chickens, FAK gene transfer with overexpression of the FAK protein was detected by immunohistological staining. The morphology of these stained cells changed from the normal flat shape to cuboid. The group with overexpressed adenovirus-mediated FAK had significant adhesion formation, as seen by increased work of flexion (118.197 +/- 29.616), compared with the group with overexpressed adenovirus-mediated beta-galactosidase (67.507 +/- 36.066) (p < 0.0393) and the group with adenovirus-mediated FAK antisense gene transfer (60.357 +/- 48.562) (p < 0.0211). Histological examination of the samples from tendons with Adv-FAK showed fibers between the tendon and tendon sheath; there were no fibers in the cavities of samples of injured tendons infected with Adv-beta gal. Moreover, at the application site of the former tendons, a thick fiber layer without epitenon cells was built up on the outer surface, whereas a thin fiber layer with clear epitenon cells was observed in the tendons to which Adv-beta gal was applied. Our results show that overexpression of FAK can induce tendon adhesion formation in vivo. This indicates that FAK and the FAK-related signaling pathway may be involved in the process of tendon adhesion formation. Understanding the details of this process may help to prevent tendon adhesion and improve healing.

[Criteria for radiologic evaluation of cement-free hip endoprostheses exemplified by the Spotorno shaft]. / Kriterien zur radiologischen Beurteilung zementfreier Hüftendoprothesen am Beispiel des Spotorno-Schafts.

Roentgenographic evaluation of total hip arthroplasty is based on changes in the marginal zones and in position. The changes in the marginal zones are not subject to any general rule. They are characteristic for the type of prosthesis. In a retrospective study, the roentgenographic findings of 431 spotornofemoral components were evaluated. We analyzed the X-ray pictures of 15 explanted spotornostems in comparison to the pictures of 15 spotornostems that were known to be stable because of revision surgery. We used this method to establish signs of stem loosening. Regression of more than 2 mm and a change in position toward varus or valgus were observed only in loose prostheses. We therefore considered these radiological changes to be an indication of loosening. Radiolucent lines up to 2 mm wide are typical for the spotornostem in the area of the prosthesis shoulder and the calcar region; when they appear in the mid- or distal section, they are also considered an indication of loosening. Radiolucent lines more than 2 mm wide indicate loosening in any case. Early in the postoperative course, the parameter of the femoral canal is already much lower in loose prostheses than in stable prostheses. An ill-fitting position in the femoral canal therefore shows a poor prognosis. Local hypertrophy of the femoral cortex or a base formation were more common in loose spotornostems. We also considered these changes to be indicator of an unfavorable prognosis.