Hippotherapy for patients with multiple sclerosis: A multicenter randomized controlled trial (MS-HIPPO).

BACKGROUND: Evidence-based complementary treatment options for multiple sclerosis (MS) are limited. OBJECTIVE: To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients. METHODS: A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity. RESULTS: Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03-4.63, p = 0.047) between intervention ( n = 32) and control ( n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (-6.8, p = 0.02) and spasticity (-0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 ( p < 0.001) in physical health score and 14.4 ( p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54). CONCLUSION: Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.

Study of the effectiveness of hippotherapy on the symptoms of multiple sclerosis - Outline of a randomised controlled multicentre study (MS-HIPPO).

BACKGROUND: Hippotherapy is a form of therapeutic riding which is used in the treatment of neurological and muscular disorders. Until now there has not been any high-quality randomised study that has proven its effectiveness. OBJECTIVE: The aims of this study are to evaluate whether hippotherapy (as add-on to physiotherapy and/or pharmacotherapy) is superior to the standard treatment (physiotherapy and/or pharmacotherapy as prior to the study) in terms of balance function and other patient relevant outcomes in patients with multiple sclerosis. METHODS: The MS-HIPPO study is a prospective, randomised, examiner-blinded, controlled multicentre study. Patients were randomised to one of two groups: 12 weeks of hippotherapy accompanied by physiotherapy and/or pharmacotherapy (intervention) or 12 weeks of physiotherapy and/or pharmacotherapy as prior to the study (control). The primary endpoint is the change in balance function, as measured by the Berg Balance Scale (BBS). The treatment comparison is evaluated using a covariance analysis with baseline BBS, centre, age, gender and EDSS as covariates. Secondary endpoints include fatigue, quality of life, pain intensity and spasticity. RESULTS AND CONCLUSIONS: The described study is the first randomised study evaluating the benefits of hippotherapy for patients with multiple sclerosis. In 5 national centres ten study physicians will screen potential participants. The expected results will help to improve the knowledge on non-pharmaceutical therapeutic options in this field.

Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre.

INTRODUCTION: Parents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified. MATERIALS AND METHODS: In cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs. Direct non-medical costs include all costs not directly related to medical services such as transportation. Indirect costs include lost productivity measured in lost income from wages. Parents were retrospectively queried on costs and refunds incurred during the child's first and sixth year of life. The questionnaire was sent out to 198 families with children born between 1980 and 2000. Costs were adjusted for inflation to the year 2006. Children were stratified into five groups according to the severity of their current health status. RESULTS: Fifty-four families responded and could be included into the analysis (27.7%). Depending on severity, total direct non-medical and indirect costs in the first year of life ranged between an average of euro1654 in children with no or mild (remaining) cardiac defects and an average euro2881 in children with clinically significant (residual/remaining) findings. Mean expenses in the sixth year of life were as low as euro562 (no or mild (remaining) cardiac defects) and as high as euro5213 (potentially life-threatening findings). At both points in time, the highest costs were lost income and transportation; and day care/ babysitting for siblings was third. DISCUSSION: Families of children with congenital cardiac disease and major sequelae face direct non-medical and indirect costs adding up to euro3000 per year on average. We should consider compensating families from low socioeconomic backgrounds to minimise under-use of non-medical services of assistance for their children.

Mechanographic characteristics of adolescents and young adults with congenital heart disease.

The present study comprised 29 adolescents and young adults (15 females, 14 males; aged 14.1-23.9 years) with congenital heart disease (CHD) and focused on the interaction between the biomechanical system and CHD. Individuals were characterized by auxological (height, weight), dynamometric (MIGF, maximal isometric grip force) and mechanograpic parameters (Vmax, maximal velocity; PJF, peak jump force; PJP, peak jump power; time of five stand-ups in chair-rising test). PJF, PJP and MIGF were transformed into height-related SD-scores. MIGF-SDS and PJP-SDS were lower in the CHD patients than in reference individuals. PJP-SDS was lower than PJF-SDS. PJP-SDS was correlated to Vmax (r = 0.62) and to the time of five-stand-ups in chair-rising (r = -0.62). Transcutaneous oxygen saturation and NYHA classes were correlated to Vmax (r = 0.42 and r = -0.57, respectively) and to chair-rising performance (r = -0.60 and r = 0.50, respectively). To conclude, individuals with CHD are characterized by an impaired inter- and intramuscular coordination, which is characterized by a greater decrease in muscular power than muscle force.

Motor development in children with congenital cardiac diseases compared to their healthy peers.

Their perceptual and motor experiences determine the physical and motor development of children, and impact also on their emotional, psychosocial, and cognitive development. Our aim, therefore, was to evaluate motor development in children with congenitally malformed hearts compared to their healthy peers. We compared 194 children, with a mean age of 10.0 years, and standard deviation of 2.7 years, representing the entire spectrum of congenital cardiac disease, to a control group of 455 healthy children, having a mean age 9.6 years, with standard deviation of 2.17 years. The bodily coordination test for children was used to examine motor development. Of the children with congenitally malformed hearts, 26.8% showed moderate, and 31.9% had severe disturbances of motor development, compared to 16.5% and 5.5% of the control group, the p-value for these differences being less than 0.001. The mean motor quotient adjusted for age and gender was lower in the children with congenitally malformed hearts than in their healthy peers, at 79.6, with standard deviation of 18.9 as opposed to 96.6, with standard deviation of 15, this difference having a p-value of less than 0.001. Depending on the presence, and/or the degree, of residual sequels, the children with congenitally malformed hearts were divided into two subgroups, with either no or mild residual sequels, or with significant sequels. The mean motor quotient was lower in those with significant residual sequels, at 75, with standard deviation of 19.3, as opposed to 83, with standard deviation of 17.9, the p-value for this difference being less than 0.01. In both subgroups, the mean motor quotient was lower, with a p-value of less than 0.01, than in the control group. Our findings show that children with congenitally malformed hearts have deficits in their motor development, these being found in the presence of no or mild sequels, as well as with significant residual sequels. Parental overprotection may contribute to these findings.

Wireless Holter transmission in suspected dysrhythmias.

BACKGROUND: In patients with a history of possible dysrhythmias, documentation of an episode is mandatory before any form of treatment is given. Holter recordings with wireless telemetry offer the possibility of continuously recording electrocardiograms for days or even weeks with instantaneous analysis of the data in the physician's office. METHODS: Thirty-seven patients (20 male; median age, 8.4 years; range, 0.1-22 years), were investigated by using a telemetric Holter system (M120, Schiller, Switzerland), that is, intermittent transmission of the electrocardiographic data to a remote server using cell phone frequencies, with a median duration of the recordings of 6.5 days (range 1-42 days). RESULTS: Recording quality was sufficient in all patients. Problems were related to electrode disconnections only, which were adjusted by contacting the patients. Twenty-eight of 37 recordings showed decisive findings. Of the 28 patients, no treatment was indicated in 16 patients, as subjective symptoms did not correlate with dysrhythmias; psychotherapy was indicated in 2 patients; antiarrhythmic medication was initiated or intensified in 5 patients; radiofrequency ablation was successfully performed in 5 patients; and 1 patient received an ICD. In 6 of 9 patients with negative Holter findings, a loop recorder implantation (Medtronic, Minneapolis, Minn) was indicated. In 1 patient, no dysrhythmias were recorded; however, when invasively investigated, ventricular tachycardia was detected and successfully treated by radiofrequency ablation. In 2 patients, no decision has been made to date. CONCLUSIONS: Wireless Holter recordings are useful in detecting dysrhythmias with rare occurrence, are less expensive and less invasive compared with implantable loop recorders, and offer the patient rather wide geographic ranges with sufficient signal quality.

Outcome of muscle and bone development in congenital heart disease.

Muscles and bones of patients with congenital heart disease (CHD) are subject to various potentially deleterious influences during growth. The aim of the present study was to analyse the outcome of bone and muscle parameters in adolescents and young adults with a spectrum of CHD. Bone and muscle parameters of the forearm were examined at two standard sites, 4% and 65%, in 29 adolescents and young adults with CHD, aged 14-24 years, by quantitative computed tomography. For the entire study population, bone and muscle parameters did not deviate significantly from the reference values except for age- and gender-corrected body height (ASDS-height: -0.6+/-1.2, p=0.01). Both age- and gender- and height- and gender-corrected (HSDS) abnormal bone mass (BMC) was found at the distal radius in patients with Fontan repair (ASDS-BMC4%: -1.5+/-0.9, p=0.008; HSDS-BMC4%: -1.2+/-1.0, p=0.05) and in those in NYHA class III (ASDS-BMC4%: -1.3+/-0.4, p=0.001; HSDS-BMC4%: -1.4+/-0.5, p=0.004). There was minimal overlap between Fontan patients (n=6) and NYHA class III (5 Fontan patients were in NYHA class I or II). In conclusion, most patients with CHD show a normal muscle and bone development in proportion to their reduced body height. Further follow-up is required to determine whether patients in a worse clinical status (NYHA III) and those with single ventricle physiology are at increased risk of osteoporosis and fractures.