Effect of passive ankle movement in the sitting position on the symptoms of chronic venous insufficiency with long-term observation.

BACKGROUND: Chronic venous insufficiency (CVI) is the most common vascular disease. One major risk factor for its development is either long-term sitting or standing in the same position and the nature of the work performed. OBJECTIVES: This study aims to assess the effectiveness of passive ankle movement in the sitting position performed using the Bella Vena robot for the symptoms of CVI with long-term observation. MATERIAL AND METHODS: A group of 58 patients (mean age: 59.69 ±14.59 years) with CVI in CEAP (Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)) classification categories 2 and 3, and a group of 37 (mean age: 51.49 ±14.86 years) healthy volunteers performing sedentary work for at least 6 h during the working day were enrolled into the study. The total duration of observation lasted 8 months (8 visits), during which the following parameters were assessed at the beginning and end of this period: pain intensity (according to the visual analogue scale (VAS)), level of saturation on the toe, pulse rate, and lower limb Doppler ultrasound evaluation of reflux parameters. RESULTS: The exercises used in people with CVI resulted in a significant reduction (p ≤ 0.01) in the occurrence of symptoms. Among all respondents, after 8 months of exercise, a significant reduction in pain level according to the VAS of the lower limbs, an improvement in saturation at the toe level, and a reduction in venous reflux was recorded (p ≤ 0.05). CONCLUSIONS: Home exercises with the use of an automatic exercise rehabilitation device alleviated significant symptoms in patients with CVI and improved the calf muscle pump.

Assessment of the Reliability of the DoboMed Exercise Method Mastery Evaluation Scale in People with Adolescent Idiopathic Scoliosis.

BACKGROUND: Conservative treatment of lateral idiopathic curvatures of the spine is a difficult and complex therapeutic process that is not always successful. Repeated assessments of the patient's mastery of a given exercise may significantly increase the effectiveness of conservative treatment. The aim of the study was to assess the credibility of an original scale for evaluating DoboMed exercise proficiency in a group of people with adolescent idiopathic scoliosis. MATERIALS AND METHODS: The study was conducted in a group of 41 patients with juvenile idiopathic scoliosis aged 10 to 16 years. In each patient, during a 3-week exercise period, the mastery of the Dobomed exercise method was assessed according to the authors original scale. Four physical therapists conducted this study. RESULTS: The Kendall-Smith concordance coefficient was used in the statistical analysis. On the basis of Kendalls W coefficient, Spearmans R coefficient of similarity was calculated to describe the correlation of all possible pairs of orderings. There was a high level of agreement between the therapists in the assessment of the key elements for mastering the method. CONCLUSION: 1. The original method mastery evaluation scale has clinical value in monitoring the progress of exercises according to the Dobomed method. 2. A high level of agreement between the therapists was noted for those features that are important in mastering the method. 3. Standardisation of our scale for evaluating mastery of DoboMed exercises will allow patients to be monitored with regard to their performance of the exercises also by their parents.

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels.

Background: Societal aging - as a global demographic phenomenon - shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods: The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60-74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results: Mean study group age was 66.5 ± 4.1 years () and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 µg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53-8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77-0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02-1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion: Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

Jak Inhibitors for Treatment of Autoimmune Diseases: Lessons from Systemic Sclerosis and Systemic Lupus Erythematosus.

Systemic sclerosis and systemic lupus erythematosus represent two distinct autoimmune diseases belonging to the group of connective tissue disorders. Despite the great progress in the basic science, this progress has not been translated to the development of novel therapeutic approaches that can radically change the face of these diseases. The discovery of JAK kinases, which are tyrosine kinases coupled with cytokine receptors, may open a new chapter in the treatment of so far untreatable diseases. Small synthetic compounds that can block Janus kinases and interact directly with cytokine signalling may provide therapeutic potential in these diseases. In this review, we discuss the therapeutic potential of Jak kinases in light of the cytokine network that JAK kinases are able to interact with. We also provide the theoretical background for the rationale of blocking cytokines with specific JAK inhibitors.

Thromboembolic Adverse Drug Reactions in Janus Kinase (JAK) Inhibitors: Does the Inhibitor Specificity Play a Role?

Recent advances in immunology enabled the characterization of several signal transmitting pathways responsible for proper cytokine and chemokine signaling. Among them, Janus kinases (JAKs) are essential components of receptor activation systems. The discovery of JAK kinases enabled the synthesis of JAK kinase inhibitors (JAKi or Jakinibs), which have proven to be efficacious in the treatment of hematologic malignancies and several rheumatological disorders and continue to be investigated in many clinical indications. Blocking multiple cytokines belonging to several cytokine families with a single small molecule may, however, create a potential risk for the patients. Recently, a higher risk of thromboembolic complications, namely, deep vein thrombosis and pulmonary embolism, has been recognized as the main concern during treatment with Jakinibs. At present, it is not entirely clear whether this increased risk is related to direct cytokine blockade, the presence of concomitant diseases in treated patients or other unknown circumstances that work together to increase the risk of this side effect. In this review, we discuss data on the risk of thromboembolic side effects, with special emphasis on the mechanism that may be responsible for this increased risk. Many indirect data indicate that higher thromboembolic risk may be related to the specificity of JAK inhibitor action, such that preferentially blocking one signaling pathway upsets the balance between pro and anti-thrombotic activities.

Predicting Adverse Outcomes in Healthy Aging Community-Dwelling Early-Old Adults with the Timed Up and Go Test.

BACKGROUND: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions. METHODS: The study included 160 community-dwelling individuals aged 60-74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death. RESULTS: Cohort characteristics: age 66.8±4.2 years (mean±SD), 3.81±2.23 diseases, 4.29±3.60 medications or supplements, and good functional status (MMSE 29.0±1.5, Barthel Index 98.1±8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9-27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41-19.1), falls (9.38%; 95% CI=4.86-13.9), death (0.63%; 95% CI=0-1.85) and no institutionalization. A higher probability of CE was associated with age ≥70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤0.8 m/s (P=0.028) and TUG >9 s (P<0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07-1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551-0.766, P=0.004) and Youden's J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643). CONCLUSION: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.

Frailty Phenotype: Evidence of Both Physical and Mental Health Components in Community-Dwelling Early-Old Adults.

BACKGROUND: Demographic aging results in increased incidence of old-age disability. Frailty is a major factor contributing to old-age disability. The aim of this study was to investigate the prevalence of the frailty phenotype as defined by Fried et al and to estimate the need for associated preventative interventions in early-old community-dwelling inhabitants of the southern industrial region of Poland, as well as to investigate the defining components of the frailty phenotype. METHODS: The study group consisted of 160 individuals with an average age of 66.8 ± 4.2 years ( ± SD), 71 (44.4%) of study participants were women. The cohort was randomized out of over 843 thousand community-dwelling Upper Silesian inhabitants aged 60-74 years, who agreed to participate in this project. A comprehensive geriatric assessment (CGA), frailty phenotype test (as described by Fried et al) blood tests and bioimpedance body structure analysis was completed for study participants. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale (IADL), Mini-Mental State Examination (MMSE), the Timed Up and Go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA), and Geriatric Depression Scale - Short Form (GDS-SF). RESULTS: Prefrailty was diagnosed in 24.4% of the subjects (95% Confidence Interval (CI) = 17.7-31.0%; 31% in women and 19.1% in men, P=0.082) and frailty in 2.5% subjects (95% CI 0.1-4.9%; more frequently in women: 4.2% versus 1.1% in men, P=0.046). Having one or more positive frailty criteria was positively associated with depression (odds ratio (OR)=2.85, 95% CI=1.08-7.54, P=0.035) and negatively associated with MMSE score (OR=0.72, 95% CI=0.56-0.93, P=0.012) and fat-free mass (OR=0.96, 95% CI=0.92-0.99, P=0.016) in multivariate logistic regression analysis adjusted for age, sex, disease prevalence, number of medications, functional tests (Barthel Index, IADL, MMSE, GDS-SF), BMI, bioimpedance body composition score, and blood tests. CONCLUSION: At least 25% of the early-old community-dwelling population would benefit from a frailty prevention program. The frailty phenotype reflects both physical and mental health in this population.

Conservative management strategies and stress level in children and adolescents with idiopathic scoliosis. / Poziom stresu u dzieci i mlodziezy leczonych z powodu skoliozy idiopatycznej w zaleznosci od sposobu leczenia zachowawczego.

OBJECTIVES: The objective of the study was to evaluate the stress level in children and adolescents with idiopathic scoliosis (IS) treated conservatively using the Dobosiewicz Method (DoboMed) approach in correlation with the clinical parameters and brace therapy. METHODS: The study group (SG) comprised 63 patients (54 girls), in mean age 14.7 years. DoboMed approach was used in all studied patients (31 of them had also a brace (orhosis)). The clinical analysis included also body mass index (BMI) z-scores, age at diagnosis, spinal curvature location and the duration of brace correction. The patients completed the Bad Sobernheim Stress Questionnaire Deformity (BSSQ-Deformity) and Bad Sobernheim Stress Questionnaire Brace (BSSQ-Brace) questionnaires twice, ie., at the beginning and at the end of the hospitalization. RESULTS: IS patients experienced low or moderate deformity-related stress (58.7% and 36.5% respectively). A significantly higher stress level (BSSQ-Deformity) was revealed in the combination therapy group compared to kinesiotherapy group (p<0.05). In brace wearers, the orthosis-related was higher than the deformity-related stress (p<0.0001). A significant correlation was observed between the BSSQ-Deformity score vs. age, BMI z-score and number of hospitalizations (p<0.05). Deformity stress level was significantly related to the Cobb's angle in both analyzing subgroups. CONCLUSIONS: Stress level in IS patients is related to the severity of the disease irrespectively to the method of treatment. Brace wearing is a factor provoking and increasing stress level. Stress level related to bracing is higher than trunk deformity related. Higher stress levels were significantly correlated with age, BMI z-score and number of hospitalizations. Complex therapy should include also psychological support for young patients with IS.

A Controlled Trial of the Efficacy of a Training Walking Program in Patients Recovering from Abdominal Aortic Aneurysm Surgery.

BACKGROUND: Major surgical procedures as well as general anesthesia contribute to muscle weakness and posture instability and may result in increased postoperative complications and functional disorders resulting from an elective operation. OBJECTIVES: We aim to state the significance of backward walking as a form of interval march training with patients after abdominal aortic aneurysm surgery. MATERIAL AND METHODS: Sixty-five patients were randomly divided into three subgroups and three various models of physiotherapy were applied. The participants were males, aged 65-75 years, with stable cardiologic status, absence of neurological disorders, and non-symptomatic aneurysm - non-ruptured, no pain complaints and no motor system impairments. The control group had only routine physiotherapy, since therapeutic groups I and II also had walking exercises, forward in group II and backward in group I. Both experimental groups were applied interval training. The patient data analyzed was as follows: hospitalization period-days; 6-min walking test-distance (m), training heart rate (1/min), mean speed (km/h), MET; spirometry test-FVC(L), FEV1(L), FEV1/FVC and PEF(L/s). RESULTS: The hospital stay period in all groups did not vary significantly. Statistical analysis showed that patients with backward walking had a statistically significantly lower reduction of walking distance in the corridor test when compared to the control group (p < 0.05). After the operation, a significant reduction of mean speed in the control group was noted in comparison with both the forward and backward walking groups (p < 0.05). No significant differences were noted between the experimental groups in average walking speed as well as in heart rate in all observed groups. CONCLUSIONS: Physical training applied to patients after major abdominal aortic aneurysm surgery influences sustaining the level of exercise tolerance to a small extent. Both backward and forward walking seem to be alternative methods when compared to classic post-surgery physiotherapy.

An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur.

PURPOSE: The experiment was designed to evaluate and compare the efficacy of focused shockwave and radial shockwave in symptomatic heel spur treatment. Postural balance tests were used to ensure the objectivity of evaluations. METHODS: Forty three patients with symptomatic heel spur were divided into two comparative groups that received respectively focused shockwave therapy (the FSWT group; 2000 impulses, 4 Hz, 0.4 mJ/mm2) and radial shockwave therapy (the RSWT group; 2000 impulses, 8 Hz, 5 bars + 2000 impulses, 8 Hz, 2.5 bars). Each patient received 5 treatments at weekly intervals. Before therapy started and 1, 3, 6 and 12 weeks after it ended, the intensity of pain experienced by the patients was assessed and static balance tests were performed on a force platform. RESULTS: Successive measurements showed that the intensity of all kinds of pain under consideration was decreasing gradually and statistically significantly in both groups. The percentage reduction in pain intensity was similar between the groups. The standard deviation of the COP in the anterior-posterior and medial-lateral directions, 95% confidence ellipse area and COP velocity kept varying throughout the experiment, but in none of the groups changes were statistically significant. CONCLUSIONS: Focused shockwave therapy and radial shockwave therapy improve the well-being of patients with symptomatic heel spur significantly and comparably. Posturography cannot deliver unambiguous data for tracking changes that the two therapies induce in these patients.

Cervical Pain in Young Professional Musicians - Quality of Life.

BACKGROUND: The education of young musicians requires teaching them appropriate prophylaxis in order to avoid spinal overload and the development of postural defects. The aim of the study was to assess the quality of life of young musicians with cervical pain. MATERIAL AND METHODS: The study involved a group of 45 young musicians divided into three subgroups depending on the musical instrument they played, namely the violin, cello and piano. The total follow-up period was 18 weeks. The patients were tested at 6-week intervals using the NDI, SF-36 and a VAS scale to assess pain intensity. RESULTS: The degree of disability was moderate in all the groups. The level of general physical health was the lowest in the cello group. Pain intensity was also moderate in all the groups. CONCLUSIONS: 1. Short-term follow-up revealed no changes in the quality of life of young musicians playing various instruments. 2. Prophylaxis should be implemented particularly in cellists.

Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study.

The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm(2)) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

The Impact of the Derotational Mobilization of Manual Therapy According to Kaltenborn-Evjenth on the Angle of Trunk Rotation in Patients with Adolescent Idiopathic Scoliosis--Pilot Study, Direct Observation.

BACKGROUND: The use of manual therapy in the treatment of scoliosis has been controversial. Scientific reports do not clearly indicate its effectiveness or harmfulness. The aim of this study was to determine the effectiveness of passive and active derotation techniques of manual therapy according to Kaltenborn-Evjent on the reduction of the angle of trunk rotation in patients with idiopathic scoliosis. MATERIAL AND METHODS: The study enrolled 33 female patients from the Department of Rehabilitation who were diagnosed with adolescent idiopathic scoliosis. The patients were divided into two groups according to the curve location (SRS classification). Group A consisted of 17 women, aged 14.±2.4 years, with single-curve scoliosis in the thoracolumbar segment and group B was composed of 16 women, aged 15±2.24 years, with double-curve scoliosis in the thoracic and lumbar segments. In both groups, the angle of trunk rotation, the magnitude of thoracic kyphosis and lumbar lordosis were measured twice, before and after each session of derotation techniques. RESULTS: Both groups demonstrated a positive impact of active and passive derotation techniques on the angle of trunk inclination. The greatest difference was observed after a session of active derotation in the patients with lumbar scoliosis. The angle of trunk rotation decreased on average by 4.5°±1.14°. No correlations were found between the curve angle values and the degree of thoracic derotation after the application of these techniques. CONCLUSION: Derotational mobilization techniques may be a valuable complement to scoliosis treatment methods as they increase their effectiveness.

Short-term effects of combination of several physiotherapy methods on the respiratory function - a case report of adolescent idiopathic scoliosis.

UNLABELLED: The aim of the study was to evaluate the positive effects of combination of several physiotherapy methods on the respiratory function on example of a case report. MATERIAL AND METHODS: 14 years old girl with an adolescent idiopathic scoliosis (AIS), right thoracic (primary curve, Cobb angle = 40°, AVR = 12°) and left lumbar (secondary curve, Cobb angle = 33°, AVR = 24°) participated in the study. She was 2 years after menarche. She underwent stationary (in-patient) treatment for 3 weeks with use of standard medical care (DoboMed). Treatment also included manual therapy (OMT Kaltenborn-Evjenth) and Dynamic Brace System (DBC) device, produced by Meditrack. Then she continued exercises at home. Respiratory system function was analyzed with use of SpiroPro electronic spirometer (Jaeger) and the strength of respiratory muscles with use of portable digital pressure meter equipped with the Omega PX 25 ± 35 kPa pressure transducer. Range of movement of the spine was examined with Rippstein V plurimeter, angle of apical trunk rotation (ATR) with the Bunnell scoliometer. Measurement was performed 4 times: before treatment, after one week and 3 weeks after the beginning of the treatment and 3 months after finalization of the treatment period. RESULTS: Examination showed that DoboMed medical care treatment, manual therapy and use of DBC device in period of 3 weeks caused improvement of respiratory parameters (MIP - maximal inspiration pressure by 6.7%; MEP - maximal expiratory pressure by 12.6%, PEF - peak expiratory flow by 16.1%). Spinal range of lateral movement and angle of apical trunk rotation has also improved. CONCLUSION: In short term treatment, the manual therapy aided with DBC system has improved the respiratory parameters and trunk morphology values. Such a composition of various physiotherapy methods can help to conduct further specialized exercises of DoboMed method.