Background Most oncologic patients receiving chemotherapy suffer from neuropathy, which not only severely affects quality of life but also may lead to chemotherapy dose reductions or even discontinuation of cancer therapy. Still, it is difficult to sufficiently control these symptoms with the currently available pharmacological treatments. High tone therapy was reported to be an effective option for neuropathies due to different etiologies. However, to date, there are no studies on high tone therapy in patients with chemotherapy-induced peripheral neuropathy. Methods This randomized, double-blind, and placebo-controlled two-center study was conducted at the Departments of Physical and Rehabilitation Medicine at the Clinics Donaustadt and Ottakring, Vienna, Austria. Patients with histologically verified colorectal carcinoma treated with a platin derivate and neuropathic symptoms were invited to participate. High tone therapy took place in a home-based setting using the HiToP 191 PNP ® or placebo device for three weeks. Neuropathic symptoms and quality of life were assessed via questionnaires. After the follow-up examination, an opt-in was offered to the patients in the placebo group in terms of an open-label treatment with a verum HiToP PNP ® device. In addition, patients with chemotherapy-induced peripheral neuropathy due to various malignant diseases were treated in an open-label setting reflecting a clinical application observation. These patients are reported as a separate group. Results In the verum group, there was a significant reduction of paresthesias and mental stress due to paresthesias from baseline until end of therapy, compared to placebo. These findings were observed in the opt-in subgroup, as well. In the open-label clinical application observation group, intensity and mental stress due to paresthesia, pain, cramps, and intensity of tightness/pressure were significantly lower at the end of therapy, compared to baseline. Conclusions Home-based high tone therapy brought about a significant alleviation in paresthesias and mental stress due to paresthesias in the verum but not the placebo group. In the clinical application observation, a significant alleviation in several further neuropathic symptoms was seen. Trial registration This study was registered at clinicaltrials.gov (NCT06048471, 03/02/2020).

It is estimated that about 50% of geriatric rehabilitation patients suffer from sarcopenia. Thereby, malnutrition is frequently associated with sarcopenia, and dietary intake is the main modifiable risk factor. During hospitalization, older adults are recommended to consume more dietary protein than the current recommended dietary allowance of 0.8 g/kg body weight per day to optimize the recovery of muscular strength and physical function. This prospective pilot study examined the feasibility and preliminary efficacy of short-term protein supplementation with protein-enriched foods and drinks on the hand-grip strength, nutritional status, and physical function of older patients at risk of malnutrition during a three-week inpatient orthopedic rehabilitation stay. The Mini Nutritional Assessment (MNA) tool was used to assess malnutrition. Patients with an MNA score ≤ 23.5 points were randomly assigned to an intervention group (goal: to consume 1.2–1.5 g protein/kg body weight per day) or a control group (standard care). Both groups carried out the same rehabilitation program. Physical recovery parameters were determined at admission and discharge. A trend was recognized for participants in the intervention group to consume more protein than the control group (p = 0.058): 95.3 (SD 13.2) g/day as compared to 77.2 (SD 24.2) g/day, which corresponds to a mean protein intake of 1.6 (SD 0.3) g/kg/day vs. 1.3 (SD 0.5) g/kg/day. Dietary protein supplementation increased body weight by an average of 0.9 (SD 1.1) kg and fat mass by an average of 0.9 (SD 1.2) kg as compared to the baseline (p = 0.039 and p = 0.050, respectively). No significant change in hand-grip strength, body composition, or physical function was observed. In conclusion, short-term intervention with protein-enriched foods and drinks enabled older patients at risk of malnutrition to increase their protein intake to levels that are higher than their required intake. In these older individuals with appropriate protein intake, dietary protein supplementation did not result in a greater improvement in physical recovery outcomes during short-term inpatient rehabilitation. The intervention improved dietary protein intake, but further research (e.g., a full-scale, randomized, controlled trial with sufficient power) is required to determine the effects on physical function outcomes.

Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient's condition.

Background Decreased leg muscle strength is a major determinant of reduced function in patients with knee osteoarthritis (OA). The identification of a strength parameter that is best correlated with functional performance is important for monitoring rehabilitation results. Objective To determine which muscle strength measurements show the highest correlation with functional capacity in patients with severe knee OA shortly before total knee arthroplasty (TKA). Design Cross‐sectional exploratory study. Setting Outpatient rehabilitation department at a university teaching hospital. Patients The sample included 75 patients (51 female) scheduled for primary TKA, recruited through multistage sampling. Methods or Interventions Independent variables were peak isometric, isokinetic concentric, and eccentric leg extensor strength measured on the leg press, as well as peak isometric knee extensor strength measured on the strength chair. Two multiple regression analyses were performed, one including all strength measures and the other including all of the strength ratios. Pearson correlation coefficients were calculated between the strength measures and functional test scores. Main Outcome Measurements Dependent variables were the Timed Up and Go Test (TUG) and the Stair Test (ST). Results The regression analysis including all strength measures could explain 11.9% of the variance of the TUG ( P = .068, not significant [NS]) and 21.5% of the variance of the ST ( P = .009, significant). The regression model for the strength ratios explained 11.8% of the variance of the TUG ( P = .090, NS) and 6.3% of the ST ( P = .217, NS). Conclusions Although univariate analysis confirmed significant correlations between strength measurements and functional tests, multiple regression analysis revealed a higher predictive value for the ST than for the TUG. The use of both muscle strength tests and performance‐based function tests is advisable to evaluate functional impairments of patients with knee OA. Level of Evidence III

BACKGROUND:Muscle injuries are some of the most common injuries in sports; they have a high recurrence rate and can result in the loss of ability to participate in training or competition. In clinical practice, a wide variety of treatment strategies are commonly applied. However, a limited amount of evidence-based data exists, and most therapeutic approaches are solely based on "best practice". Thus, there is a need for consensus to provide strategies and recommendations for the treatment of muscle injuries.METHODS:The 2016 GOTS Expert Meeting, initiated by the German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), focused on the topic of muscle and tendon injuries and was held in Spreewald/Berlin, Germany. The committee was composed of twenty-two medical specialists. Nine of them were delegated to a subcommittee focusing on the nonoperative treatment of muscle injuries. The recommendations and statements that were developed were reviewed by the entire consensus committee and voted on by the members.RESULTS:The committee reached a consensus on the utility and effectiveness of the management of muscle injuries.MAIN RESULTS:the "PRICE" principle to target the first inflammatory response is one of the most relevant steps in the treatment of muscle injuries. Haematoma aspiration may be considered in the early stages after injury. There is presently no clear evidence that intramuscular injections are of use in the treatment of muscle injuries. The ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) should be regarded critically because there is currently no hard evidence to support their use, although they are appropriate in exceptional cases.CONCLUSIONS:The present work provides a structured overview of the various nonoperative treatment strategies of muscle injuries and evaluates their effectiveness with respect to the existing scientific evidence and clinical expertise in the context of basic science on the healing process of muscle injuries. The committee agreed that there is a compelling need for further studies, including high-quality randomized investigations to completely evaluate the effectiveness of the existing therapeutic approaches. The given recommendations may be updated and adjusted as further evidence will be generated.

Die erfolgreiche Therapie von Sehnenverletzungen stellt eine große Herausforderung in der Sportorthopädie dar. Als Behandlungsziel gilt es, eine langfristig erfolgreiche Therapie und eine zeitnahe Reintegration des Athleten in den Trainings- und Wettkampfbetrieb zu gewährleisten. In der Literatur finden sich nur wenige Arbeiten, die die unterschiedlichen Therapieverfahren hinsichtlich ihrer therapeutischen Effektivität beurteilen und hieraus praxisrelevante Behandlungsempfehlungen erarbeiten.

Purpose: Low back and/or pelvic girdle pain is common during pregnancy and may persist after delivery. Therapeutic methods to alleviate pain, with no side effects for mother and child, are of high clinical importance. The consensus statement expresses the position of the Working Group on Evidence-Based Medicine in Physical and Rehabilitation Medicine, the Austrian Society of Physical Medicine and Rehabilitation and the Austrian Pain Society, for the treatment of low back and/or pelvic girdle pain by transcutaneous electrical nerve stimulation (TENS) during pregnancy.Materials and Methods: The literature was reviewed followed by a subsequent interdisciplinary discussion.Results: Diagnostic investigations, therapeutic options, mode of application as well as efficacy and side effects of the method are presented.Conclusion: TENS is a safe therapy for low back and/or pelvic girdle pain in the last trimester of pregnancy with no side effects, low costs and the possibility of home application.

OBJECTIVES:To examine the effects of a time-saving leg-press training program with moderate vibration on strength parameters, pain, and functional outcomes of patients after total knee arthroplasty (TKA) in comparison with functional physiotherapy. DESIGN:Randomized controlled trial. SETTING:Outpatient rehabilitation department at a university teaching hospital. PARTICIPANTS:Patients (N=55) with TKA were randomly allocated into 2 rehabilitation groups. INTERVENTIONS:Six weeks after TKA, participants either underwent isokinetic leg-press training combined with moderate vibration (n=26) of 15 minutes per session or functional physiotherapy (n=29) of 30 minutes per session. Both groups received therapy twice a week for a period of 6 weeks. Participants were evaluated at baseline (6wk after TKA) and after the 6-week rehabilitation program. MAIN OUTCOME MEASURES:The main outcome measure was maximal voluntary contraction (MVC) of the involved leg. Secondary outcome measures were pain assessed with a visual analog scale (VAS), range of motion, stair test, timed Up and Go test, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS:Both groups showed statistically significant improvements in MVC of knee extensors measured on the knee dynamometer (leg-press group: from 0.8±.06 to 1±.09Nm/kg body weight [BW], physiotherapy group: from 0.7±.06 to 0.9±.06Nm/kg BW; P<.05) and in closed kinetic chain on the leg press (leg-press group: from 8.9±.77 to 10.3±1.06N/kg BW, physiotherapy group: from 6.7±.54 to 9.1±.70N/kg BW; P<.05) and in pain at rest (leg-press group: from 2±.36 to 1.3±.36 on the VAS, physiotherapy group: from 1.2±.28 to 1.1±.31; P<.05), WOMAC scores, and functional measurements after 6 weeks of training. There was no significant difference between the 2 groups concerning strength, pain, and functional outcomes after training (P>.05). CONCLUSIONS:Isokinetic leg-press training with moderate vibration and functional physiotherapy are both effective in regaining muscle strength and function after TKA; however, isokinetic leg-press training is considerably less time consuming.

Frage: Welche Arten der Trainingstherapie wirken sich positiv auf die Knochendichte von Gesunden und Patient(inn)en mit verminderter Knochendichte aus?

OBJECTIVES:To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.DESIGN:A randomized clinical trial.SETTING:Supervised physiotherapy (PT) training and home-based EMS.PARTICIPANTS:Patients (N=38; 14 men, 24 women) with bilateral PFPS.INTERVENTIONS:One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40 Hz, with a pulse duration of .2 6ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80 mA.MAIN OUTCOME MEASURES:Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.RESULTS:Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.CONCLUSIONS:A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Muscle injuries are, with 6 to 14%, the most common but neglected and under-estimated sport injuries. Certain muscle groups are predisposed to injury depending on the type of sport. There are many hypothesis as to the cause of muscular injury. The prognosis and the length of treatment are greatly influenced by the quality of the first aid administered at the accident site. Simple measures such as compression, elevation, ice and rest can easily be carried out at this site. The further rehabilitation includes bandages and accompanying measures, such as physical therapy and medication. An early functional and conservative therapy is the treatment of choice. The classification of the extent of injury should be carried out by an experienced sportmedic with regard to a differential diagnosis. Sonography and MRI can supply additional information when it is not clear as to the extent of injury. Resulting from an exact as possible classification can the further treatment and planning of the progress of the rehabilitation be established. The necessary length of the pause from sport and of the rehabilitation depend on the seriousness of the injury.