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PubMed2004

Rehabilitation in rheumatoid arthritis: a critical review.

This article considers the evidence for effectiveness and timing of rehabilitation for people with rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow-up periods, small sample sizes). Evidence to date is that symptomatic relief results from thermotherapy, laser therapy, acupuncture and assistive devices. In the short-term, comprehensive occupational therapy (in established rheumatoid arthritis), orthoses, and mind-body approaches can help maintain function. Over at least a one-year period, the following are effective in reducing pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic exercise therapy, hand exercises and hydrotherapy; and cognitive-behavioural therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long-term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well-designed clinical trials are needed recruiting people with early disease using patient-centred outcomes.

Journal Article↗
PubMed2003

Pharmacotherapy and behavioral intervention for peripheral arterial disease.

Lower-extremity peripheral arterial disease is a chronic disease process resulting from atherosclerotic obstruction of major vessels supplying the legs. A significant manifestation of systemic atherosclerosis, it is estimated to affect more than 10 million adults in the United States alone. The reported incidence is a conservative estimate, because many patients who suffer from symptoms of peripheral arterial disease attribute them to "normal aging" and may not report them to their physician. Additionally, physicians may miss the diagnosis if a comprehensive history and vascular examination are not a routine part of their assessment. The hallmark symptom of peripheral arterial disease is intermittent claudication, defined as reproducible muscular leg pain that is precipitated by exercise and relieved by rest. Intermittent claudication not only limits functional capacity and adversely affects quality of life but is also an ominous predictor of increased risk for myocardial infarction, stroke, and cardiovascular death. Due to the chronicity of atherosclerosis, medical intervention is most successful when a comprehensive team approach is utilized, involving the patient, family, and vascular health professionals. Treatment for peripheral arterial disease is aimed at first, minimizing symptoms and disease progression via smoking cessation, supervised exercise therapy, pharmacotherapy, and/or revascularization, and second, minimizing the risk of cardiovascular mortality via risk factor identification and reduction, and the use of antiplatelet therapy.

Arterial Occlusive Diseases↗
PubMed1993

Newer concepts in the medical management of patients with congestive heart failure.

Congestive heart failure (CHF) remains a major cause of morbidity and mortality in the United States, especially among the elderly. Although an underlying disturbance in cardiac function can be identified in most patients, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. The renin-angiotensin system (RAS) is integrally involved in the pathophysiology of CHF. Originally considered a humoral system, the RAS is now known to exist and operate within cardiac and vascular tissues. The importance of tissue-specific renin-angiotensin systems in CHF is presently under investigation. Most patients with symptomatic CHF benefit from the administration of an ACE inhibitor. Certain asymptomatic patients, such as those with severe left ventricular (LV) dysfunction and those who are at high risk for LV remodeling after anterior wall myocardial infarction, may also benefit from ACE inhibitor therapy. Diuretics and nitrates improve symptoms and often cardiac output in many patients with CHF. Although many new inotropic agents have been tested in CHF patients, none appear clinically superior to digitalis glycosides. The efficacy of digitalis glycosides in CHF may in part result from sympathoinhibitory properties such as the activation of baroreceptor mechanisms. Despite the fact that many CHF patients die from arrhythmias, treatment of asymptomatic ventricular arrhythmias in these patients is not recommended. Patients with symptomatic or sustained ventricular arrhythmias are best treated by a physician experienced in cardiac electrophysiology. Therapy with beta-blocking drugs for CHF patients is controversial. Anticoagulants are recommended for selected patients with CHF. Finally, exercise therapy may improve functional capacity in some patients with CHF through its effects on peripheral blood vessels and skeletal muscle tissues.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

[Diet and physical activity in the treatment of obesity].

There is strong evidence from studies that hypocaloric, low-fat diets and physical activity can induce weight loss in obese patients. Nutrition therapy and increased physical activity improve obesity-associated risk factors and can prevent or delay comorbidities. Combined interventions of nutrition, physical activity and behavior therapy provide the most successful therapy for weight loss and weight maintenance. While exercise activity alone reduces weight only slightly, the combination of both, diet- and exercise-therapy, leads to significant weight reduction. Moreover, exercise activity reduces the diet-induced loss of fat-free mass and favors weight reduction through an increased metabolic rate. Nutrition therapy, physical activity and behavior therapy are basic components of a comprehensive weight loss therapy and weight control program in obesity.

Cardiovascular Diseases↗
PubMed1977

[Experience with the use of a complex of therapeutic-rehabilitative measures in rural psychiatric hospitals].

A total of 100 chronic mental patients with schizophrenia, epilepsy and oligophrenia who had stayed in a rural hospital for a long time, were treated with restorative therapy including the complex of influences: psychopharmacological drugs, differential regimens of treatment and supervision, psychotherapy, treatment by employment and entertainment, exercise therapy and occupational therapy. The use of this complex demonstrate the improvement of the mental state in 82 patients, 30 patients could be discharged from the hospital. The role of the psycho-social influences for the mollification of pathological symptomatics characteristics of the chronic contingents of patients is discussed.

Exercise Therapy↗
PubMed1987

[Use of physical training in the rehabilitation of patients with post-infarct heart failure].

The effect of exercise was examined in 15 postmyocardial-infarction patients showing clinical signs of heart failure; 17 patients were taken as controls. The drills continued for 11 months and included exercise therapy, bicycle ergometry and rationed walks. In addition to a considerable increase in physical working capacity, the patients doing exercise showed more favorable hemodynamic response to stress that featured a greater stroke index, a smaller heart rate increment and a more significant fall in specific peripheral resistance. In the control patients, hemodynamic response to stress grew worse, while physical working capacity remained basically unchanged.

Adult↗
PubMedDate not supplied

[Controlled kinesitherapy of patients after surgical myocardial revascularisation in early rehabilitation period].

Kinesitherapy in the form of controlled individually dose-adjusted aerobic exercise in patients early (2-4 weeks) after surgical revascularization of the myocardium increases physical performance and cardiorespiratory reserve of the organism. The above kinesitherapy is indicated for all the patients early after surgical revascularization of the myocardium. Monitoring of the heart rate allowed individual adjustment of the exercise regime with estimation of each training session, weekly and month loads. This insures safety of the trainees and improves methodology of providing exercise therapy.

Exercise Test↗
PubMed2004

Effect of high-volume and -intensity endurance training in heart transplant recipients.

BACKGROUND: A recommended component of heart transplant recipients (HTR) is endurance-oriented exercise therapy. However, the trainability of HTR after transplantation is vague. We examined the effect of high-volume and -intensity exercise training on exercise performance in HTR, compared with HTR undergoing regular rehabilitation training, and sedentary healthy subjects (SHS). METHODS: We studied four groups of individuals; of those, three groups were HTR. Subjects were a regularly trained HTR group of denervated (HTR-D; N = 15), reinnervated (HTR-R; N = 26) hearts, a high-volume and -intensity endurance-training group (training time 7-20 h.wk(-1); HTR-ET; N = 12), and a group of sedentary healthy subjects (SHS; N = 21). All participants performed cardiopulmonary exercise testing. RESULTS: The HTR-ET achieved a significantly higher performance (255 +/- 47 W, VO(2max) of 45.2 +/- 6.9 mL.kg(-1).min(-1)) in contrast to all other groups (HTR-D: 119 +/- 17 W, VO(2max) of 17.4 +/- 4.5 mL.kg(-1).min(-1); HTR-R: 119 +/- 17 W, VO(2max) of 16.9 +/- 3.7 mL.kg(-1).min(-1); SHS: 184 +/- 19 W, VO(2max) of 35.0 +/- 6.9 mL.kg(-1).min(-1)). The HR at maximal power output in the HTR-ET was 169 +/- 17 bpm and similar to SHS (164 +/- 17 bpm), but significantly higher than HTR-D (125 +/- 16) and HTR-R (142 +/- 10). Maximal lactate concentration (LAmax) of HTR-ET was 9.9 +/- 2.2 mmol.L(-1), comparable to SHS (9.2 +/- 2.1 mmol.L(-1)), and significantly higher than HTR-D (5.5 +/- 1.5 mmol.L(-1)) and HTR-R (5.1 +/- 1.0 mmol.L(-1)). CONCLUSIONS: Data suggest that HTR can perform high-volume and -intensity exercise training, reaching exercise performance comparable to or even exceeding values of sedentary or moderately trained healthy subjects.

Adult↗
PubMed1996

Verbal encouragement: effects on maximum effort voluntary muscle action.

OBJECTIVE: To examine the effects of verbal encouragement on the peak force of the elbow flexors during an isometric muscle action. METHODS: A crossover design whereby 20 subjects were divided into 10 2 x 2 Latin squares was undertaken. Peak forces were measured on a Kin-Com dynamometer, and electromyographic (EMG) activity was also recorded from the biceps brachii. All subjects completed trials with and without verbal encouragement. RESULTS: Mean peak force increased (P < 0.05) from 296 to 311 N (5%) when verbal encouragement was presented. A spectral analysis of the EMG activity showed no changes (P > 0.05) to the median frequency in the condition where verbal encouragement was present. CONCLUSIONS: These findings have ramifications for training and exercise therapy. An awareness of the effects of verbal encouragement is important when motivating athletes and patients to attain maximum performance during exercise.

Adult↗
PubMed2002

Lower back and elbow injuries in golf.

Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf. Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club. In the case of the lower back injury, evaluation was based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathy was an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional 'hitting' programme was used to treat the problem. The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are 'fanatical' and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries.

Back Injuries↗
PubMed2004

Cost-effectiveness of exercise training to improve claudication symptoms in patients with peripheral arterial disease.

Exercise rehabilitation is a proven, yet poorly available, treatment for intermittent claudication, the primary symptom of peripheral arterial disease (PAD). Exercise rehabilitation is effective, non-invasive, and associated with minimal cardiovascular risk in appropriate patients. Percutaneous transluminal angioplasty (PTA), especially of the iliac segment, is an alternative effective treatment for claudication. There are, however, minimal data currently available to compare the cost-effectiveness of these two interventions. We compared the cost-effectiveness of 3- and 6-month exercise programs with that of iliac PTA without stenting, using the incremental cost-effectiveness ratio [ICER = (Cost2 - Cost1)/(Effectiveness2 - Effectiveness1)]. The ICER represented the price of an additional meter walked derived from each treatment based on conservative models of success of each procedure and specific care assumptions. PTA and exercise efficacy data were derived from a literature review and exercise costs were modeled per the current CPT code 93668. Effectiveness was defined as absolute claudication distance (ACD) at 3 and 6 months. Three treatment alternatives were assessed: (1) no treatment, (2) PTA, and (3) exercise rehabilitation. At 3 months, PTA was more effective than exercise therapy and resulted in an additional 38 meters at an additional cost of $6719, for an ICER of $177/meter. At 6 months, however, exercise was more effective than PTA, resulting in an additional 137 meters walked, and costs less ($61 less per meter gained). In conclusion, exercise rehabilitation at 6 months is more effective and costs less than PTA, and is therefore cost-saving. The cost-effectiveness and availability of claudication treatments has national implications for future PAD care; however, data to inform these care choices can best be obtained in prospective clinical trials.

Angioplasty, Balloon↗
PubMed2000

A pilot study on the effects of exercise in patients with systemic lupus erythematosus.

OBJECTIVE: A pilot study was designed to assess the efficacy and safety of different exercise therapies on patient-reported fatigue and functional status. METHODS: Ten patients with systemic lupus erythematosus (SLE) were randomly placed in either an aerobic exercise group (group 1: n = 5) or a range of motion/muscle strengthening (ROM/MS) exercise group (group 2: n = 5). Outcome measures assessed at baseline and the end of the study were fatigue, functional status, disease activity, cardiovascular fitness, isometric strength, bone mineral density (BMD) of the lumbar spine and femoral neck, and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation, respectively. RESULTS: Both aerobic and ROM/MS types of exercise were safe and did not worsen SLE disease activity. Patients in both exercise groups showed some improvement in fatigue, functional status, cardiovascular fitness, and muscle strength. Both groups showed increased bone turnover, but BMD was unchanged. Eighty percent of the patients met the compliance standard for the study. CONCLUSIONS: This pilot study shows the feasibility of exercise for SLE patients. The potential value of this approach shows promise in the routine management of these patients.

Activities of Daily Living↗
PubMed2003

[What Expectations do Mental Disordered People have about the Treatment in an Psychiatric Hospital?]

Patiens are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develope itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61 %) of the patients were at admission ready for answering a self designed questionnaire. Only 4 % of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45 %), somatic illness (43 %) and mental health problem (42 %). A pharmacological therapy expected in totally 61 % of the patients. Mostly were expected drugs against depressive disorders (32 %), drugs against addiction (31 %) and tranquilizers (29 %). Only 10 % of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76 % of the patients. To have a speak with the doctor is with 69 % a first rank desire, followed by speaking with the psychologist (60 %), the nurses (58 %) and the patients comrades (56 %). Psychotherapy in a narrower sense expect only 40 % of the patients. Furthermore there are privacy and recreation throug promenades in front of the expectations (69 %), followed by relaxation (59 %), occupational therapy (55 %) and sports or acitive exercise therapy (54 %). 75 % of the patients want to be informed about the therapy. 69 % want to cooperate with planning of the therapy. Only 21 % commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.

Journal Article↗
PubMed2003

[What do psychiatric patients expect of inpatient psychiatric hospital treatment?].

Patients are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develop itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61%) of the patients were at admission ready for answering a self designed questionnaire. Only 4% of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45%), somatic illness (43%) and mental health problem (42%). A pharmacological therapy expected in totally 61% of the patients. Mostly were expected drugs against depressive disorders (32%), drugs against addiction (31%) and tranquilizers (29%). Only 10% of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76% of the patients. To have a speak with the doctor is with 69% a first rank desire, followed by speaking with the psychologist (60%), the nurses (58%) and the patients comrades (56%). Psychotherapy in a narrower sense expect only 40% of the patients. Furthermore there are privacy and recreation through promenades in front of the expectations (69%), followed by relaxation (59%), occupational therapy (55%) and sports or active exercise therapy (54%). 75% of the patients want to be informed about the therapy. 69% want to cooperate with planning of the therapy. Only 21% commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.

Adult↗
PubMed1992

Treatment of urinary incontinence in the elderly.

Urinary incontinence affects millions of American men and women. Treatment consists of drug therapy, exercises, mechanical devices, surgery, and injection therapy. This article reviews the advantages and disadvantages of all treatment modalities for this common medical problem.

Female↗
PubMed1989

[Manual therapy in the combined treatment of spinal osteochondrosis].

The article reflects the experience in the work of the manual therapy consulting-room at the Smela town hospital named after N. A. Semashko in Chernigov Province from November 1985 to December 1987 inclusive. The author presents the results of treatment of 906 outpatients. The optimal number of the manual therapy procedures during the first course was six. The procedures took place every other day. Manual therapy was administered together with massage, exercise therapy, electrophysical procedures, traction and fixation elements. The results of the treatment were good in 85.8%, satisfactory in 11.5% and bad in 2.7% of the cases.

Adult↗