Performance Score (T2D)-A New Perspective in the Assessment of Six-Minute Walking Tests in Pulmonary Rehabilitation

Because absolute changes in outcomes are difficult to interpret and the minimal clinically important difference (MCID) is not suitable to address this challenge, a novel method of classifying outcomes by relating changes to baseline values is warranted. We used the "performance score" (T2D), which reflects individual performance, enabling us to consider the functional status at the beginning of rehabilitation without dealing with the problems of mathematical coupling or regression effects, as encountered in ANCOVA. To illustrate the T2D, we retrospectively analyzed changes in the six-minute walking test (6MWT) in COPD patients undergoing outpatient pulmonary rehabilitation and compared the results with absolute differences related to a predetermined MCID. We evaluated a total of 575 COPD patients with a mean age of 61.4 ± 9.2 years. 6MWT improved significantly, with a mean change of 32.3 ± 71.2. A total of 105/311 participants who had reached the MCID were still classified as "below average" by the T2D. Conversely, 76/264 patients who had not reached the MCID were classified as "above average". This new performance measure accounts for the patient's current status and for changes over time, potentially representing a simple and user-friendly tool that can be used to quantify a patient's performance and response to rehabilitation

Occupational physical activity: the good, the bad, and the proinflammatory

BackgroundPhysical activity (PA) is beneficial for preventing several conditions associated with underlying chronic inflammation, e. g., cardiovascular disease (CVD) and cancer. While an active lifestyle appears to have anti-inflammatory effects, high levels of occupational PA (OPA) were associated with inflammation and elevated mortality risks. We aimed to summarize the current knowledge (1) on the association between inflammation and OPA and (2) its implications for health and mortality.Methods and resultsThis mini-review summarized relevant literature published before January 2023 using established scientific databases and sources. For the primary outcome, observational studies (S) reporting immunological effects (O) in subjects (P), with high (I) vs. low OPA (C), were included. For secondary outcomes, i.e., morbidity and mortality associated with inflammatory processes, (systematic) reviews were included. While “active” occupations and “moderate” OPA appear to have beneficial effects, low (particularly sedentary) and “high-intensity” OPA (particularly including heavy lifting tasks) were associated with inflammation and (CVD and cancer-related) mortality; higher leisure-time PA has been almost consistently associated with lower proinflammatory markers and all-cause mortality risks. Workplace interventions appear to counter some of the observed health effects of unfavorable work strain.ConclusionThe few studies addressing OPA “intensity” and inflammatory markers are largely heterogeneous regarding OPA classification and confounder control. Sedentary and “heavy” OPA appear to promote proinflammatory effects. In addition to targeted management of work-related physical strain and hazardous environmental co-factors, occupational health providers should focus on employer-initiated exercise interventions and the promotion of leisure-time PA

Evidence based medicine in physical medicine and rehabilitation (English version)

In the last twenty years the term “Evidence Based Medicine (EBM)” has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician’s individual expertise, the patient’s needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best “external evidence”. This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management). Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed

The Impact of Thyroid Cancer and Post-Surgical Radioactive Iodine Treatment on the Lives of Thyroid Cancer Survivors: A Qualitative Study

BACKGROUND: Adjuvant treatment with radioactive iodine (RAI) is often considered in the treatment of well-differentiated thyroid carcinoma (WDTC). We explored the recollections of thyroid cancer survivors on the diagnosis of WDTC, adjuvant radioactive iodine (RAI) treatment, and decision-making related to RAI treatment. Participants provided recommendations for healthcare providers on counseling future patients on adjuvant RAI treatment. METHODS: We conducted three focus group sessions, including WDTC survivors recruited from two Canadian academic hospitals. Participants had a prior history of WDTC that was completely resected at primary surgery and had been offered adjuvant RAI treatment. Open-ended questions were used to generate discussion in the groups. Saturation of major themes was achieved among the groups. FINDINGS: There were 16 participants in the study, twelve of whom were women (75%). All but one participant had received RAI treatment (94%). Participants reported that a thyroid cancer diagnosis was life-changing, resulting in feelings of fear and uncertainty. Some participants felt dismissed as not having a serious disease. Some participants reported receiving conflicting messages from healthcare providers on the appropriateness of adjuvant RAI treatment or insufficient information. If RAI-related side effects occurred, their presence was not legitimized by some healthcare providers. CONCLUSIONS: The diagnosis and treatment of thyroid cancer significantly impacts the lives of survivors. Fear and uncertainty related to a cancer diagnosis, feelings of the diagnosis being dismissed as not serious, conflicting messages about adjuvant RAI treatment, and treatment-related side effects, have been raised as important concerns by thyroid cancer survivors

Wiener klinische Wochenschrift / Challenges in rehabilitation of patients with nontraumatic spinal cord dysfunction due to tumors : A narrative review

The incidence of cancer-associated non-traumatic spinal cord dysfunction is rising due to population aging and better cancer treatment. The overall benefit of rehabilitation in specialized facilities for traumatic spinal cord dysfunction has been confirmed many times. Because of their fragility and multiple comorbidities cancer patients still face challenges to complete rehabilitation in the spinal rehabilitation facilities. In this narrative review we describe specific aspects, challenges in rehabilitation and opportunities to improve care. A literature search was performed in the PubMed database from 1 January 1978 to 30 November 2018. The focus was to find publications that discuss challenges and opportunities for rehabilitation of patients with non-traumatic spinal cord dysfunction due to a tumor. Most publications described the benefits of rehabilitation in specialized facilities. There were only few publications about survival and functional outcomes after rehabilitation for this patient population. Overall benefits including fewer complications associated with spinal cord dysfunction, less pain and depression, and better quality of life were shown. Within the past decades increasing number of publications revealed a growing interest for this group of patients. Despite major progress in cancer treatment, patients still have a limited vital prognosis and access to specialized rehabilitation units because of the concerns about the medical complexity. Patients with spinal cord tumors can benefit in areas of functionality, mood, quality of life, and survival from inpatient rehabilitation programs, in spite of the increased medical comorbidities.(VLID)509604