Whole body vibration compared to conventional physiotherapy in patients with gonarthrosis: a protocol for a randomized, controlled study

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is the most common degenerative arthropathy. Load-bearing joints such as knee and hip are more often affected than spine or hands. The prevalence of gonarthrosis is generally higher than that of coxarthrosis.</p> <p>Because no cure for OA exists, the main emphasis of therapy is analgesic treatment through either mobility or medication. Non-pharmacologic treatment is the first step, followed by the addition of analgesic medication, and ultimately by surgery.</p> <p>The goal of non-pharmacologic and non-invasive therapy is to improve neuromuscular function, which in turn both prevents formation of and delays progression of OA. A modification of conventional physiotherapy, whole body vibration has been successfully employed for several years. Since its introduction, this therapy is in wide use at our facility not only for gonarthrosis, but also coxarthrosis and other diseases leading to muscular imbalance.</p> <p>Methods/Design</p> <p>This study is a randomized, therapy-controlled trial in a primary care setting at a university hospital. Patients presenting to our outpatient clinic with initial symptoms of gonarthrosis will be assessed against inclusion and exclusion criteria. After patient consent, 6 weeks of treatment will ensue. During the six weeks of treatment, patients will receive one of two treatments, conventional physiotherapy or whole-body-vibration exercises of one hour three times a week. Follow-up examinations will be performed immediately after treatment and after another 6 and 20 weeks, for a total study duration of 6 months. 20 patients will be included in each therapy group.</p> <p>Outcome measurements will include objective analysis of motion and ambulation as well as examinations of balance and isokinetic force. The Western Ontario and McMaster Universities Arthritis Index and SF-12 scores, the patients' overall status, and clinical examinations of the affected joint will be carried out.</p> <p>Discussion</p> <p>As new physiotherapy techniques develop for the treatment of OA, it is important to investigate the effectiveness of competing strategies. With this study, not only patient-based scores, but also objective assessments will be used to quantify patient-derived benefits of therapy.</p> <p>Trial registration</p> <p>Deutsches Register Klinischer Studien (DRKS) DRKS00000415</p> <p>Clinicaltrials.gov NCT01037972</p> <p>EudraCT 2009-017617-29</p

Einflussfaktoren auf die Verweildauer in der Wirbelsäulenchirurgie

INTRODUCTION Spinal disc herniation, lumbar spinal stenosis and spondylolisthesis are known to be leading causes of lumbar back pain. The cost of low back pain management and related operations are continuously increasing in the healthcare sector. There are many studies regarding complications after spine surgery but little is known about the factors predicting the length of stay in hospital. The purpose of this study was to identify these factors in lumbar spine surgery in order to adapt the postoperative treatment. MATERIAL AND METHODS The current study was carried out as a post hoc analysis on the basis of the German spine registry. Patients who underwent lumbar spine surgery by posterior surgical access and with posterior fusion and/or rigid stabilization, whereby procedures with dynamic stabilization were excluded. Patient characteristics were tested for association with length of stay (LOS) using bivariate and multivariate analyses. RESULTS A total of 356 patients met the inclusion criteria. The average age of all patients was 64.6 years and the mean LOS was 11.9 ± 6.0 days with a range of 2-44 days. Independent factors that were influencing LOS were increased age at the time of surgery, higher body mass index, male gender, blood transfusion of 1-2 erythrocyte concentrates and the presence of surgical complications. CONCLUSION Identification of predictive factors for prolonged LOS may allow for estimation of patient hospitalization time and for optimization of postoperative care. In individual cases this may result of a reduction in the LOS.Einführung Die häufigsten Ursachen für den lumbalen Rückenschmerz stellen Bandscheibenvorfälle, Spinalkanalstenose und Spondylolisthese dar. Damit verbunden sind steigende Kosten im Gesundheitssektor durch operative Interventionen jeglicher Art. Während viele Studien auf die Komplikationsrate nach einem operativen Eingriff an der Lendenwirbelsäule eingehen, ist wenig über Faktoren bekannt, die auf die postoperative Krankenhausverweildauer Einfluss nehmen. Ziel unserer Studie ist es, diese Faktoren zu identifizieren und damit die postoperative Behandlung anzupassen. Material und Methoden Es erfolgte eine Post-hoc-Analyse der prospektiv gesammelten Daten des Deutschen Wirbelsäulenregisters. Eingeschlossen wurden Patienten, die durch einen posterioren chirurgischen Zugang mittels posteriorer Fusion mit oder ohne rigide Stabilisierung, jedoch ohne dynamische Stabilisierung behandelt wurden. Die jeweiligen Patientencharakteristika wurden in Abhängigkeit zur Verweildauer gestellt und anschließend einer uni- bzw. multivariaten Analyse unterzogen. Ergebnisse Insgesamt erfüllten 356 Patienten in einem mittleren Alter von 64,6 Jahren die Ein- und Ausschlusskriterien. Die durchschnittliche Verweildauer lag bei 11,9 (± 6,0) Tagen mit einer Spanne von 2 bis 44 Tagen. Unabhängige Faktoren mit Einfluss auf die Krankenhausverweildauer waren höheres Patientenalter zum Zeitpunkt der Operation, erhöhter „Body Mass Index“ (BMI), männliches Geschlecht, erhaltene Bluttransfusionen, von 1–2 Erythrozytenkonzentraten und das Auftreten von chirurgischen Komplikationen Diskussion Die Kenntnis der Faktoren, die die Krankenhausverweildauer verlängern, ermöglicht eine Schätzung der Hospitalisierungszeit und soll hilfreich sein in der Optimierung der postoperativen Patientenversorgung. Eventuell kann in einzelnen Fällen auch eine Verkürzung des Krankenhausaufenthaltes resultieren

Rotating physician in CHIR-Net. Evaluation of the curriculum

Conduction of and participation in clinical trials is a major challenge for surgical departments especially as job performance in hospitals has increased immensely during the last few years due to economic aspects. Only 11.7 % of published clinical studies are randomized controlled trials. As more and more treatment procedures in medicine have an evidence-based design the aim must be to present randomized controlled trials with an evidence level 1 for an increasing number of surgical therapies. Since 2006 the German National Surgical Trial Network (CHIR-Net) has been established and funded by the Federal Ministry of Education and Research (BMBF) in order to promote the realization of clinical trials in surgery. Thus the basis for the execution of high quality clinical studies in surgery has been extended further. In the individual CHIR-Net centers clinical trials are planned, organized and supervised which requires extensive knowledge of prevalent international standards. Teaching them to rotating physicians is one of the tasks of CHIR-Net. Therefore, a special curriculum for physicians has been developed which is evaluated in this study. From December 2010 to March 2011 an online survey of physicians who had previously rotated in the CHIR-Net was conducted, starting from the Surgical Regional Center (CRZ) Witten-Herdecke/Cologne. A total of 19 partly open and partly closed questions concerning the person, training, duration of the rotation, the funding applied for and the generated scientific output were surveyed. In addition, the curriculum for physicians and rotation time was checked by means of 17 questions in an evaluation matrix. In this article the results of the rotating physician evaluation are presented. The satisfaction of physicians with the training during the rotation is presented as well as an analysis of how many of the submitted publications were directly supported by CHIR-Net. It was also evaluated how many rotating physicians requested funding and what the type of funding was. With the rotating physician model of CHIR-Net a working concept for the training of surgeons in clinical research and the realization of randomized surgical trials was established as a viable solution for the difficult situation of clinical research in the surgical disciplines with the double burden of research and clinical practice