App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial

Introduction: New app-based programs for postoperative rehabilitation have been developed, but no long-term study has been published to date. Thus, a prospective randomized control trial with 2-year follow-up was performed to evaluate the effectiveness of app-based rehabilitation (GenuSport) compared to a control group after total knee arthroplasty (TKA). Methods: Between April and October 2016, 60 patients were enrolled in the study. Twenty-five patients were lost to follow-up, leaving 35 patients undergoing TKA for inclusion. In this group, twenty patients received app-based exercise program and 15 were randomized to the control group. The mean age was 64.37 +/- 9.32 years with a mean follow-up of 23.51 +/- 1.63 months. Patients in the app group underwent an app-based knee training starting on the day of surgery; whereas, patients in the control group underwent regular physiotherapy. Functional outcome scores using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and VAS of pain were analyzed. Results: In the short term, significant differences between the app group and control group in time of 10-m walk (19.66 +/- 7.80 vs. 27.08 +/- 15.46 s; p = 0.029), VAS pain at rest and activity (2.65 +/- 0.82 vs. 3.57 +/- 1.58, respectively 4.03 +/- 1.26 vs. 5.05 +/- 1.21; p < 0.05) were observed. In the long term, a variety of different tendencies was found, highest in KSS Function with 76.32 +/- 16.49 (app group) vs. 67.67 +/- 16.57 (control group) (p = 0.130). Additionally, patients in the app group required less painkillers (10.0% vs. 26.7%) and more likely to participate in sports (65.0% vs. 53.3%). Conclusions: An app-based knee trainer is a promising tool in improving functional outcomes such as KSS function score and VAS after TKA

Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date?

Meniscus therapy is a challenging process. Besides the respective surgical procedure such as partial meniscectomy, meniscus repair, or meniscus replacement, early postoperative rehabilitation is important for meniscus regeneration and return to sport and work as well as long-term outcome. Various recommendations are available. However, the current literature lacks information concerning the actual early rehabilitation in daily routine recommended by orthopedic surgeons. Thus, the purpose of this study was to investigate currently used standard early rehabilitation protocols in the daily routine of orthopedic surgeons. This study investigated the recommendations and concepts for early rehabilitation after meniscus therapy given by German, Austrian, and Swiss orthopedic institutions. Standardized criteria such as weight bearing, range of motion, use of an orthosis, and rehabilitation training were analyzed according to the conducted surgical procedure: partial meniscectomy, meniscus repair, or meniscus replacement. The analysis of standard rehabilitation concepts for partial meniscectomy (), meniscus repair (), and meniscus replacement () showed significantly earlier functional rehabilitation in all criteria after partial meniscectomy in contrast to meniscus repair techniques (). In addition, significant restrictions were found in full weight bearing, full range of motion, and the use of braces. In summary, a wide range of recommendations for weight bearing, ROM, brace therapy, and mobilization is available, particularly after meniscus repair and meniscus replacement. Most concepts are in accordance with those described in the current literature. Further research is necessary to enhance the scientific evidence on currently used early rehabilitation concepts after meniscus therapy

Die Relevanz der Corporate Brand in der Markenarchitekturgestaltung internationaler Finanzdienstleister

Die Relevanz der Corporate Brand in der Markenarchitekturgestaltung internationaler Finanzdienstleister

PLOS ONE / The societal costs of chronic pain and its determinants: The case of Austria

Background Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain. Methods A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in for year 2016. Results Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance. Conclusion This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area.(VLID)494508