The effect of physiotherapy intervention on the load of the foot and low back pain in pregnancy.

OBJECTIVE: Pregnant women are at elevated risk for functional and structural changes in the movement system. Common problems are loss of foot arch height and low back pain which can have strong influence on the decrease in quality of life. AIMS: The aim of the study was to assess effect of physiotherapy intervention for preventing and treating changes in foot structure as well as low back pain during pregnancy. DESIGN: Parallel intervention study. SETTING: Department of Midwifery, Faculty of Health Sciences, Palacký University Olomouc. METHODS: Twelve healthy pregnant women were randomly divided into the experimental and control groups. The women in the experimental group performed daily exercises aimed at the foot arch. The McGill Pain Questionnaire and the Pregnancy Mobility Index were used to measure level of pain and its impact on quality of life. The Foot Posture Index, Navicular Drop test, Chippaux-Šmirák index, and a podoscope were used to evaluate load and anthropometry of the foot. The data were collected at the turn of the first and second trimester and in the third trimester of pregnancy. RESULTS: Statistically significant differences between the baseline and post-intervention were found only in the control group. Pain score obtained from the visual analogue scale as well as the Pregnancy Mobility Index score increased significantly (p = 0.04, p = 0.03 resp.). The Foot Posture Index results increased significantly on both the right (p = 0.04) and left (p = 0.04) lower limb. Chippaux-Šmirák index significantly increased on the right lower limb (p = 0.03). CONCLUSIONS: The intervention prevented or reduced the changes in the foot structure and low back pain. This intervention can be recommended in primary or secondary prevention to increase quality of life in pregnant women.

Significance of HLA nondependent risk factors of chronic transplant nephropathy for the development of endothelial dysfunction after kidney transplantation.

More than 40% of renal allografts show chronic transplant nephropathy (CTN) early after renal transplantation. Cardiovascular disease is the leading cause of death in this population. Thus endothelial dysfunction represents an early angiopathy causing CTN and atherosclerosis. We sought to evaluate changes in endothelial dysfunction and vascular wall thickness during the first year posttransplantation as well as their association with HLA nondependent risk factors for CTN. At 3 and 52 weeks after grafting, we studied 25 patients without overt atherosclerotic disease and acute posttransplant complications for von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), big endothelin-1 (ET-1), flow-mediated dilatation (FMD), intimal media thickness (IMT), serum total cholesterol (TC), and triglycerides (TAG). FMD and IMT at 52 weeks showed significant correlations (P < .05) with recipient age, and the FMD ratios at 3 and 52 weeks correlated with the time on hemodialysis. Recipient age was significantly correlated with TC and PAI-1 with TAG. vWF was the only parameter that significantly correlated with donor age. There were no significant correlations with creatinine clearance. Decreased TAG approached statistical significance (P = .07) and TC decreased nonsignificantly. The worsening of FMD and ET-1 was not significant. A nonsignificant improvement in IMT was not associated with any analyzed parameters. Our results implied that the time on hemodialysis, the presence of hyperlipoproteinemia, and the recipient age significantly contributed to endothelial dysfunction during the first year after transplantation.