[Sustainability in Outpatient Pulmonary Rehabilitation in Patients with Asbestosis - Results of an 8-Year Follow Up]. / Nachhaltigkeit in der ambulanten pneumologischen Rehabilitation bei Patienten mit Asbestose.

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis and focused on keeping up sustainability effects. METHODS: 157 male patients aged 65.2 ±â€Š5.7 years suffering from asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. In the immediately following phase 2, the patients completed once a week for 3 hours over 12 weeks further therapeutic applications with the main focus on exercise therapy and sports and were subsequently transferred to health sports groups near to residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 20 months (T5) after T3. 61 patients (73.5 years ±â€Š5.6) were re-examined 6 years after T5 (T6) without any interim care. RESULTS: 72.1 % of the 61 patients (n = 44) carried out health sports twice a week in T5 as well as in T6 eight years after T1 and were able to maintain their physical performance (6-minute walk test, hand force, PWC test) as well as the perceived quality of life (SF-36, baseline/transition dyspnea index) according to age, while the rehab effects of the 17 patients breaking off any sporting activities after T3 fell significantly (p < .01) below the starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized in the long term by a regular training. The results underline the necessity of integrating aftercare strategies into the concept of rehabilitation with special consideration of perceived self-efficacy.

[Knee school as a secondary preventive approach : The sustainable treatment of occupational gonarthrosis]. / Das Kniekolleg als sekundärpräventiver Ansatz : Die nachhaltige Behandlung berufsbedingter Gonarthrose.

BACKGROUND: 2-6 months after successful medical rehabilitation in gonarthrosis, the positive effects remit without the implementation of adequate aftercare strategies. OBJECTIVES: A prospective comparative study aimed to investigate whether and to what extent the sustainability model of knee school for the secondary preventive treatment of occupational gonarthrosis is able to maintain positive treatment effects in the medium term. MATERIAL AND METHODS: A total of 292 male employees from the building trade went through the three-week phase 1 of the biopsychosocial knee college with a focus on ergonomics and muscle strength training. In the following 12 months (Phase 2), the participants were contacted several times by telephone in order to motivate them to continue the training. While 178 employees voluntarily and locally continued their training in selected fitness centers with financial support (VG 1), and 38 employees opted for an individual home program (VG 2), 76 participants stopped all training (KG). RESULTS: After Phase 1, all groups showed significant improvements in the parameters mobility, as well as stretch ability and strength endurance of the thigh muscles, complaints of the knee and quality of life. While the parameters in VG 1 continued to develop positively after 12 months, the measured values in VG 2, with the exception of muscle strength, moderately remitted. By contrast, a significant decline in the measurement values partly below the status quo ante was observed for the KG. CONCLUSIONS: As part of the aftercare, financially supported training in a fitness center with accompanying regular telephone contacts for male construction workers with knee discomforts shows positive effects if the participation is voluntary. Organized training in the fitness center is superior to individual home programs.

[Improvement of lasting effects in outpatient pulmonary rehabilitation with special regard to exercise therapy and sports]. / Verbesserung von Nachhaltigkeitseffekten in der ambulanten pneumologischen Rehabilitation unter besonderer Berücksichtigung der Sporttherapie.

BACKGROUND: The aim of this study was to evaluate the effects of outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the Hamburg model, the OMR focuses on keeping up lasting effects. METHOD: In the frame of a pre-experimental study, 113 male asbestosis patients aged 66.1+/-5.8 years participated 6 hrs. a day five times a week over a period of three weeks in phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied for 3 hrs. once a week over a period of twelve weeks (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near their places of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test) as well as health-related quality of life (SF-36), dyspnea (BDI/TDI) and oxygen partial pressure (pO2) were significantly improved in T2. These positive effects could be confirmed in T3. 89 patients (79%) were doing health-related sports regularly 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 24 patients breaking off any sporting activities wore off again down to and even below the starting condition at T1. CONCLUSIONS: In spite of a restrictive pulmonary disease, specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training once a week. Thus, the results emphasize the necessity to include strategies of aftercare in the concept of rehabilitation.

[Short- and long-term effects of the outpatient medical rehabilitation for patients with asbestosis]. / Kurz- und langfristige Effekte der Ambulanten Medizinischen Rehabilitation für Patienten mit Asbestose.

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the model of Hamburg the OMR focuses on keeping up lasting effects. METHODS: In the frame of a pre-experimental study 104 male patients aged 65.7 +/- 5.5 years suffering asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied over a period of 12 weeks one time weekly 3 h at a time (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near at place of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test, PWC Test) as well as health-related quality of life (SF-36) of the patients were significantly improved in T2. Whereas the parameter "vital capacity" and "forced expiratory volume" showed no change over the period of investigation data of "oxygen partial pressure" was significantly increased, too. These positive effects could be confirmed in T3. 82 patients (79%) were doing sports due to health regularly still 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 22 patients breaking off any sporting activities wore off again to and even below starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training one time weekly. That way the results emphasize the necessity to put strategies of aftercare into the concept of rehabilitation.

[Ultrasonic Quantification of spinal configuration and postural capacity for evaluation of different muscle strengthening programs in the therapy of back pain]. / Die ultraschalltopometrische Quantifizierung der Wirbelsäulenform und der Halteleistungsfähigkeit für die Evaluation verschiedener Muskelkräftigungsprogramme in der Therapie von Rückenschmerzen.

AIM: The aim of this study was the evaluation of the effectiveness of different muscle strengthening programs in the therapy of back pain. METHODS: 102 male longshoremen aged from 29 to 63 years with chronic back pain since > two years, matched by pain intensity and functional limitations, were randomized to three test groups (TG) and one control group (CG). The test persons carried out a program for intensified muscle strengthening over a period of six months one to two times weekly in a therapeutic practice (TG1), in a health club (TG2) and in a gymnastic group (TG3). The CG did not complete any intervention. Ultrasound topometry for recording spinal configuration and postural capacity as well as the determination of pain intensity and functional limitations were used as instruments of assessment. RESULTS: The data obtained for the CG remained virtually unchanged over the period of investigation. In contrast a decrease of pain intensity and functional limitations could be proved for all TG. Furthermore, the training programs induced both an improved postural capacity while performing the arm-raising test and an increasingly erect sagittal spinal profile. The power of effectiveness was on a homogeneous level for the medical training therapy (0.41), the fitness training (0.4) and the spinal gymnastics (0.41). CONCLUSION: The three muscle strengthening programs investigated have equally favorable effects on the parameters evaluated and are qualified as effective strategies in the therapy for chronic spinal discomforts.

[Influence of sports mechanic demands in competitive tennis on the thoracolumbar spinal profile]. / Der Einfluss sportmechanischer Anforderungen im Leistungstennis auf das thorakolumbale Wirbelsäulenprofil.

The aim of this study was to evaluate the influence of the sports mechanic demands of competitive tennis on the thoracolumbar spinal profile. For that reason the spinal curvature (C7 - S2) of 123 male active gymnasts aged 23,8 +/- 4,5 years with a sporting exposure of 14,4 +/- 3,8 years and of 1347 age and gender matched non- and recreational sportsmen was recorded by means of the non-invasive ultrasonic-controlled contact rod. In the sagittal projection no differences between both groups were found. However, in control and sports group the dominant side of the arms induced statistically significant differences for all parameters describing spinal curvature in the frontal and transversal plane, data evaluated showed a relevant increase in the tennis group. Furthermore, the criterion both-handed hitting technique in fore and backhand caused an additional extension of lateral inclination, pelvic and pelvic-shoulder tilt as well as pelvic-shoulder rotation to the hitting side of the arms. After examining the sports-specific mechanic strain the measuring values are to interpret as a functional adaptation to the tennis-specific demands. But there is only a reduced correlation with the results of epidemiologic studies taking the incidence and prevalence of spinal injuries in competitive tennis into special account. So the tennis-specific modifications of spinal profile are not to characterise a priori as pathogen.

[Effects of elastic lumbar belts on the effect of a muscle training program for patients with chronic back pain]. / Auswirkungen elastischer Lumbal-Stützgurte auf den Effekt eines Muskeltrainingsprogrammes für Patienten mit chronischen Rückenschmerzen.

QUESTION: Aim of the study was to evaluate the influence of elastic lumbar belts on the effect of muscle training for patients with low back pain. METHODS: 97 male subjects aged from 23 to 42 years with and without low back pain participated in the investigation. The low back pain patients (n = 63) were randomized into a training group without and a training group with elastic lumbar belts and a control group. The subjects with healthy backs (n = 34) were divided age-matched into a training group with elastic lumbar belts and a control group. The three training groups took part in a muscle strenghtening program over 8 weeks. The control groups did not receive any alternative physiotherapeutic treatment. All groups were tested at the beginning, after 8 weeks and further 6 months later. RESULTS: The data obtained for the control groups remained virtually unchanged over the period of investigation. However, a significant increase of the muscle flexibility of the lower limbs could be proved for the training groups. Furthermore the coordination between the lumbar spine and pelvis when flexing the trunk deeply forward was more leveled out for the training groups with patients suffered low back pain. The results confirmed a reduction for pain severity and for limitations in activities of daily living as well. The modifications for the criteria investigated were significant stronger for the training group with patients using the elastic lumbar belt. CONCLUSIONS: The effectiveness of the muscle strengthening program for patients with low back pain could be improved significantly by means of the elastic lumbar belt as an applicable therapy instrument in the functional rehabilitation of spinal injuries.