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Summary Purpose The aim of this systematic review was to focus on the effect of biofeedback on smoking cessation. Material and methods This review was conducted following the PRISMA guidelines. Peer-reviewed original articles including biofeedback and/or neurofeedback training as an intervention for smoking cessation were included. The PubMed, MEDLINE, Web of Science, Scopus, and Cochrane Library databases were screened for trials published up to July 2021. The effects on smoking rates and smoking behavior, and biofeedback/neurofeedback training measures are summarized here. Results In total, three articles fulfilled the inclusion criteria. The total Downs and Black checklist scores ranged from 11 to 23 points, showing that the articles were of poor to good methodological quality. The included studies were heterogeneous, both in terms of treatment protocols and in terms of outcome parameters. Pooling of data for a meta-analysis was not possible. Therefore, we were limited to describing the included studies. The included biofeedback study demonstrated that skin temperature training might improve the patients’ ability to raise their skin temperature aiming at stress alleviation. All three studies reported positive effects of biofeedback/neurofeedback in supporting smokers to quit. Furthermore, individualized electroencephalography neurofeedback training showed promising results in one study in modulating craving-related responses. Conclusion The results of the present review suggest that biofeedback/neurofeedback training might facilitate smoking cessation by changing behavioral outcomes. Although the investigated studies contained heterogeneous methodologies, they showed interesting approaches that could be further investigated and elaborated. To improve the scientific evidence, prospective randomized controlled trials are needed to investigate biofeedback/neurofeedback in clinical settings for smoking cessation.

Many cancer patients are cured from their malignant tumor, but may suffer from long-term, chemotherapy-induced peripheral neuropathy. This frequent and often disabling condition results from treatment with anticancer drugs including microtubulin-targeting agents such as taxanes, vinca alkaloids, and some immunotoxins; platinum compounds; certain proteasome inhibitors like bortezomib; and immunomodulatory drugs such as thalidomide. Moreover, immune checkpoint inhibitors can cause an autoimmune-mediated peripheral neuropathy. Neuropathic symptoms include pain, numbness, tingling, or cold hypersensitivity in the hands and feet, as well as motor weakening or disorders of the autonomous nerve system. Medical treatment is often unsatisfactory. First-line options include antidepressants like duloxetine, venlafaxine or amitriptyline, and antineuropathic drugs like gabapentin or pregabalin. In addition, topical therapies with capsaicin or lidocaine have been applied. In severe cases, medication with tramadol or opioids may be required for painful paresthesia. Physiotherapy, sensory integrative occupational therapy, and various physical agents can be helpful. The course of disease, however, is usually protracted, and the symptoms generally gradually decrease. In this short overview, we describe medical and physical treatment options for chemotherapy-induced peripheral neuropathy.

Summary Background The carpal tunnel syndrome is the most common entrapment neuropathy in the general population. A conservative treatment should be considered in mild to moderate cases. The aim of this study was to assess the effect of a focused extracorporeal shock wave therapy in the treatment of mild to moderate carpal tunnel syndrome. Material and Methods In this study 30 patients were randomly assigned into 2 groups. Subjects in the study group received three sessions of focused extracorporeal shock wave therapy, whereas the control group underwent a sham therapy. Patients were evaluated 3 and 12 weeks after treatment. The primary outcome was the visual analogue scale score. Secondary outcome measurements included hand grip strength, Boston Carpal Tunnel Syndrome Questionnaire, SF-36 Health Survey and electrodiagnostic measurements. Results A significant improvement of visual analogue scale at week 3 (p = 0.018) and week 12 (p = 0.007) as well as hand grip strength at week 12 (p = 0.019) could be observed in the study group. The study group showed a significantly better sensory nerve conduction velocity at week 12 than the control group, before correcting for multiple testing, and also a significant improvement in distal motor latency of the median nerve at week 12 (p = 0.009) as well as in both questionnaires (SF-36 subscale bodily pain, p = 0.020 and severity symptom scale, p = 0.003). No such improvement was observed in the control group. Conclusion Focused extracorporeal shock wave therapy is an effective and noninvasive treatment method for mild to moderate carpal tunnel syndrome.

Purpose of Review Focused extracorporeal shockwave therapy (fESWT) is a physical treatment modality developed over the last 25 years for musculoskeletal indications. It has many indications in the field of physical medicine and rehabilitation (PM&R) and is effective, time-efficient, and cost-efficient. This review focuses on basics and on clinical indications as well as on significant trends in fESWT. Recent Findings In PM&R, stimulation of healing processes in tendons, surrounding tissue, and bones via mechanotransduction seems to be a relevant biological effect. The International Society for Medical Shockwave Treatment (ISMST) describes different types of indications (such as approved standard indications—in accordance with most scientific evidence—like calcifying tendinopathy of the shoulder, plantar fasciitis lateral epicondylopathy of the elbow, greater trochanter pain syndrome, patellar tendinopathy, Achilles tendinopathy and bone non-union, common empirically tested clinical uses, exceptional or expert indications, and experimental indications). Summary fESWT is a relevant treatment option in PM&R and regenerative medicine. In recent years, historical paradigms (for example, application in cancer patients) have changed and new indications (such as nerve regeneration, myofascial trapezius syndrome, low back pain, dermatosclerosis, and lymphedema) are supported. Future translational research should focus on establishing actual exceptional indications and experimental indications for clinical routine.

Background The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status and upper and lower extremity strength. Methods Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies—both randomized controlled and uncontrolled—which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted. Results Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI − 1.10 [− 2.19, − 0.01] L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 [3.42, 14.51] kg and 95% CI 23.42 [11.95, 34.88] kg, respectively). Conclusion RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.

Introduction: In the current absence of specific functional fracture risk assessment technology, the planning of physical exercise interventions for cancer patients suffering from increased bone fracture risk remains a serious clinical challenge. Until a reliable, solely technical solution is available for the clinician, fracture risk assessment remains an inter- and multidisciplinary decision to be made by various medical experts. The aim of this short paper is depicting how this challenge should be approached in the clinical reality according to Austrian experts in cancer rehabilitation, presenting the best-practice model in Austria. Following referral from the specialist responsible for the primary cancer treatment (oncologist, surgeon, etc.), the physiatrist takes on the role of rehabilitation case manager for each individual patient. Fracture risk assessment is then undertaken by specialists in radiology, orthopedics, oncology, and radiation therapy, with the result that the affected bone regions are classified as being at highly/slightly/not increased fracture risk. Following internal clearance, exercise planning is undertaken by a specialist in exercise therapy together with the physiatrist based on the individual’s fracture risk assessment. In the case in which the patient shows exercise limitations due to additional musculoskeletal impairments, adjuvant physical modalities such as physiotherapy should be prescribed to increase exercisability. Conclusion: Exercise prescription for cancer patients suffering from increased fracture risk is an inter- and multidisciplinary team decision for each individual patient.

Summary Purpose This pilot study aimed to describe physical performance, self-reported physical activity, health-related quality of life, anxiety and depression in patients who were assigned from Austrian self-help groups for multiple myeloma patients. These parameters were then discussed in the context of clinical decision-making concerning the recommended type of regular physical activity and exercise. Methods Members of the self-help groups were invited to participate. Physical performance and physical activity were assessed with the 6 min walk test (6MWT), handgrip strength test, timed up and go test (TUG), Tinetti performance oriented mobility assessment (POMA), falls efficacy scale (FES), international physical activity questionnaire (IPAQ), health-related quality of life (EORTC QLQ-C30) and the hospital anxiety and depression scale (HADS). Results A total of 40 patients (female:male = 15:25, mean age: 63.8 ± 9.0 years, range 41–80 years) were identified. In total 20 (50%) reached the performance of healthy peers in the tests 6MWT, handgrip strength, TUG and POMA, while 50% showed at least 1 result below the reference value or cut-off-point for each test. Self-reported activity levels were high. Patients showed a tendency to overestimate the risk of falling but a case by case analysis revealed a tendency for underestimating the actual performance in the respective tests (TUG, POMA). Conclusion The performance of healthy peers was reached by a substantial number of the participants in tests of physical performance and they reported high levels of physical activity. Nevertheless, they tended to overestimate the specific risk of falling. Patients with notably impaired physical performance might be suitable to perform regular physical activity and exercise in an individual therapy, whereas those with good physical performance are suited for training in exercise groups; however, individual contraindications and clinical considerations should be noted in a multiprofessional and interdisciplinary setting.

Summary Background There is no final consensus regarding the ideal surgical technique for the treatment of patellar dislocation. The aim of this retrospective pilot study was to describe muscle strength, body composition, self-reported physical performance, and pain in male patients after patellar dislocation treatment with two different surgical techniques: medial patellofemoral ligament (MPFL) reconstruction vs. the Elmslie-Trillat procedure. Methods Isokinetic testing of knee extensor muscles was performed using a Biodex System 3 pro dynamometer at an angular velocity of 60°/s. Body composition was measured with bioelectrical impedance analysis (Nutribox). Self-reported physical performance and pain were assessed by the SF-36 subscales of physical functioning, role physical and bodily pain. The outcome variables of peak torque normalized to participant’s body mass (Nm/kg), lean body mass, phase angle, self-reported physical performance, and pain were compared between the study groups. Results Of the 12 included male patients, 6 had been treated with MPFL reconstruction (age: median = 33 years, range = 18–38 years; BMI: median = 26 kg/m2, range = 23–29) and 6 with the Elmslie-Trillat procedure (age: median = 26 years, range = 19–32 years; BMI: median = 23 kg/m2, range = 19–28). No statistically significant differences were found between the groups in any outcome parameter of muscle strength, body composition, self-reported physical performance, or pain. Conclusions The results of the present pilot study revealed that MPFL reconstruction shows equal results to the Elmslie-Trillat procedure, with respect to isokinetic knee muscle strength, body composition, self-reported physical performance and pain in male patients suffering from recurrent patellar dislocation.

Summary Background The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma. Methods A narrative review of the relevant scientific literature and presentation of clinical experiences. Results In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation. Conclusion In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.

Summary Background With the intention of enabling people a phased return to work after long-term sick leave the so-called “Wiedereingliederungsteilzeitgesetz” (WIETZ) was implemented in Austria on 1 July 2017. Methods To explore the overall awareness about the WIETZ and the value of physical modalities together with further supporting measures in return to work of cancer survivors, a survey by using a self-constructed questionnaire was performed in 30 experts 6 months after the WIETZ came into force. Results The awareness of Austrian specialists regarding the WIETZ seems to be excellent. Regarding expert opinions, return to work in cancer survivors is notable hampered in workplaces with great physical stress even in times of the WIETZ, whereas for professions in offices and banks it is easier to return to work, with and without WIETZ. The highest impact on return to work seems to be due to exercise, as an intervention of the field of physical medicine and rehabilitation to improve sensorimotor functions and to increase endurance capacity as well as muscular strength. Conclusion Early information about cancer rehabilitation and the WIETZ seems to be necessary to facilitate return to work of cancer survivors. Furthermore, exercise interventions seem to be the most important measures from the field of physical medicine and rehabilitation.

Background Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes. Research questions Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity? Methods This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated. Results Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort. Significance Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. Clinical Trials Reg. No clinicaltrials.gov (NCT02545764).

Summary Background This study determined to what extent the underpinning of physiotherapeutic interventions with the evidence-based motivational psychological concept of the self-determination theory (SDT) by Ryan and Deci can increase motivation and enjoyment of movement in obese adolescents. Methods In this study 12 obese adolescents aged 14–18 years were offered a targeted group-specific sports program including a home exercise program of 8 weeks. The group leaders were trained in the SDT and supported to integrate motivational aspects. A SDT-based questionnaire by Kohake and Lehnert was used to evaluate motivational interventions. Results In total, seven (58%) patients finished the study. In the before-after comparison there were little changes in motivation. Results showed that contrary to expectations the motivation of the obese adolescents to move and to participate in the study was generally high. In the study, more internalized forms of motivation dominated, the highest quality form of motivation. Conclusion Digital technologies could be a successful way to further increase motivation and compliance of our target group. This MotiMove study is a basis for future research programs and empower physiotherapists and movement experts to develop and implement training programs for obese adolescents and children.

Background: The aim of this pilot study was to describe the acceptance and feasibility of an exercise intervention in breast cancer patients of Turkish origin in Austria by using a hand-held swingi...

Summary Purpose The purpose of the study was to investigate whether additional reminders could enhance adherence to a 12-week program consisting of regular physical activity. Methods The study collective consisted of pensioners insured with the Austrian Insurance Fund for Civil or Public Servants. They were made aware of our program through the public service union. The subjects were randomized to an intervention group (group A) that received reminders and to a control group (group B) that did not receive such notifications. Adherence to physical activity was assessed by the use of diaries. Results Group A performed 96 min more moderate intensity regular physical activity per week than group B (group A median 269 min, r = 0–1560 min; group B median 173 min, r = 0–2700 min). The Mann–Whitney U-test showed no significant differences (p = 0.080) between the study groups. There was no difference in muscle strengthening activity (group A: median: 2, r = 0–13 sessions; group B: median: 2, r = 0–20 sessions). Conclusion The major positive observation was that both the experimental and control group participants exceeded the recommended level of physical activity. Nevertheless, there were some differences concerning the minutes of physical activity performed in favor of the intervention group.

Purpose: To systematically review literature for interventional studies and their impact on autonomic dysfunction assessed by heart rate variability in cancer patients.Methods: Research was...

Purpose Cancer patients sometimes show immobilizing musculoskeletal conditions which prohibit active exercise due to severe bodily pain. Therefore, before starting a rehabilitative exercise program, the pain has to be reduced to enable the patient to participate actively in the exercise program. Extracorporeal shock wave therapy (ESWT, the application of radial and/or focused shock waves with low or high energy) has been shown to be effective and efficient in the treatment of musculoskeletal disorders. However, one historical paradigm was the fact that, in the past, cancer was seen as a contraindication for the use of ESWT. Methods Clinical note to present indications, benefits, and contraindications of shock wave treatment in cancer patients. Results Malignant tumors in the treatment area have to be seen as a contraindication for the use of ESWT treatment. Cancer itself—in the form of the underlying disease—is not a contraindication for the treatment with radial and focused shock wave therapy with low or high energy. Plantar fasciitis and calcaneal spurs, calcified shoulder, tennis elbow or Achilles tendinopathy, and delayed healing and chronic wounds are typical approved standard indications for ESWT, and are allowed when the malignant tumor is not in the treatment area. There are also other musculoskeletal and non-musculoskeletal indications (e.g., myofascial syndrome, erectile dysfunction, polyneuropathy, and lymphedema) that are relevant for cancer survivors. These indications are recommended by the International Society for Medical Shockwave Treatment (ISMST) for “common empirically tested clinical use” and as exceptional indications/expert indications. Conclusion ESWT is a safe and relevant modality for the supportive care and rehabilitation of cancer patients.

Purpose The implementation of a new online conference tool, with the goal of providing competent answers, information, and support from experts in their fields, about diagnosis, treatment, and rehabilitation in breast cancer patients. Methods The implementation process and data of the first online conference are described. Results Following the idea and initiative of a breast cancer survivor, and under the umbrella of a leading oncologist in breast cancer treatment, and with the cooperation of further leading experts in the fields, plus their therapeutic teams, the new online conference SURVIVA 2018 was implemented as an innovative platform—free of charge, online, and with easy and anonymous access—to provide breast cancer survivors with in-depth information and help from the leading Austrian experts in their fields. This first online conference for German-speaking breast cancer survivors is an innovative and modern concept, which seems to have been very well accepted. Conclusion This concept could also be of interest to survivors of other cancer entities.

Summary Background Sleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients. Methods In this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 18–65 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questionnaire (SF-MPQ) and sleep quality (sleep onset latency, interrupted sleep due to pain, sleep duration and recovering effect of sleep) was assessed. Results In this study 121 patients (male 32, female 89, mean age 49 ± 9 years) could be analyzed. Of the patients 38.8% needed more than 30 min for falling asleep, 63.6% reported sleep fragmentation, 30.6% slept less than 5 h and 60.3% reported no recovering effect of sleep. The strongest associations between pain characteristics and sleep quality were found for pain intensity and affective pain aspects. Logistic regression analyses revealed that one point more in the total score of SF-MPQ increased the odds of needing more than 30 min for falling asleep, waking up more than 3 times due to pain, sleeping less than 5 h, and perceiving the sleep as non-recovering, by 6%. Adjusting for physical and psychological quality of life lowered the odds ratios and the association was no longer significant. Conclusion The results underline the importance of paying attention to sleep quality in patients with chronic pain. The results also indicate that psychological factors might mediate the association between pain and sleep quality.

Modern cancer care with increasing survival rates puts the focus on rehabilitation in cancer survivorship which has been shown to have a key role in improving patients’ quality of life, functional performance, and participation [1]. There is an increasing interest to optimize the rehabilitation process, namely to have both—effective and also safe rehabilitation measures [1]. In their publication “Clinical questions on rehabilitation in cancer patients with skeletal metastasis: a content analysis of the multidisciplinary tumor board records” Yamanaka et al. describe a content analysis in the multidisciplinary tumor board records in the Department of Rehabilitation Medicine of the Nara Medical University in Japan, which was established particularly for discussing bone metastases [2]. They discussed 168 consecutive patients with skeletal metastasis from January 2017 to September 2019 and conclude that there are three important aspects of patients suffering from metastatic bone disease, namely occurrence of skeletal events, patient age, and growth speed of tumors [2]. The authors mention that rehabilitation-related questions may reflect patients’ functional needs that occur more frequently in patients with pathological fractures or neurological symptoms, older patients, and patients with slow-growth tumors [2]. We fully agree with the authors and greatly appreciate their approach of a multidisciplinary tumor board to answer clinically relevant questions before and during cancer rehabilitation. To our opinion, “Tumor Board for Cancer Rehabilitation” is a clinically relevant option to support rehabilitative strategies in cancer patients. In November 2010, the worldwide first “Tumor Board for Cancer Rehabilitation” has been implemented at the Comprehensive Cancer Centre (CCC) Vienna of the Medical University of Vienna, Austria [3, 4]. Since this time, this tumor board became a very important interdisciplinary and multi-professional help to plan rehabilitation and supportive strategies in challenging cancer patients [3, 4]. In this tumor board, very challenging and complex cases are discussed to plan their rehabilitation. Their most important issues are decreased physical performance and fatigue, metastatic or lytic bone lesions, brain lesions, chemotherapy-induced peripheral neuropathy, and also cardiovascular and pulmonary disease and/or side effects of necessary (cancer) treatment, metabolic dysregulation, and lymphedema [5,6,7,8,9]. Referring to specialists from different medical specialties such as oncology, physical and rehabilitation medicine, radiology, radiation oncology, surgery, cardiology, and orthopedics (and traumatology) attend the board. Furthermore, nutritionists, sports scientists, physiotherapists, massage therapists, and psychologists complete this interdisciplinary and multi-professional tumor board [3, 4]. All of these tumor board members are involved in the rehabilitation process, and therefore, their decision helps to define individual rehabilitation concepts for challenging cancer patients with their individual functional deficits and medical conditions [5,6,7,8,9]. After the tumor board meeting, there results a decision with (1) a contraindication for the start of rehabilitation due to different dangerous clinical issues, but in most cases, there is (2) an individual rehabilitation concept with prescriptions concerning exercise and physiotherapy, and further treatment modalities such as extracorporeal shockwave therapy, other physical modalities, and additional prescriptions for pharmacological treatment (of pain), nutrition, and psychological interventions (psycho-oncology) [1, 3, 4, 9]. It has been shown that most cancer patients, including those suffering from the advanced disease (for example, metastatic bone and/or brain disease), are able to perform effective and safe exercise and rehabilitation, given that individual contraindications and clinical considerations using a multi-professional and interdisciplinary setting are checked and excluded before [1, 3, 4, 9]. Furthermore, as cancer rehabilitation aims to improve functional status and participation, several returns to work aspects are discussed at the time of this special tumor board before starting exercise during the rehabilitation process [10]. This due to the fact that it has been shown that besides other interventions exercise seems to be one of the most important measures for a successful return to work [10]. This special tumor board has found good acceptance in its members and in the discussed patients [3]. In 2015, it has been integrated into “CCC-Platform for Side effects-Management, Supportive Care & Rehabilitation” to unite all medical disciplines involved in a cancer-specific issue and to improve quality of care [1, 3]. Cancer survivors wish to be integrated into their normal daily life, and cancer rehabilitation is able to improve functional status, quality of life, and participation. Therefore, it has to be thoroughly planned—for example, with the help of such a specialized tumor board—and after this to be early integrated into the cancer care continuum. To our opinion, such “Tumor Boards for Cancer Rehabilitation” are able to give a solid basis for further active supportive and rehabilitative strategies in cancer patients. Future research should focus on the effectiveness and efficiency of such boards. This could be a step into the future of cancer survivorship. Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M (2020) Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 42(1):2–7. https://doi.org/10.1080/09638288.2018.1514665 Article PubMed Google Scholar Yamanaka N, Tsukamoto S, Ishida Y, Shigematsu H, Hasegawa M, Sajiki M, Mano T, Tanaka Y, Kido A (2020) Clinical questions on rehabilitation in cancer...

Dieses Kapitel soll einen kurzen Uberblick uber ausgewahlte physikalisch-medizinische Assessment-Methoden in der Rehabilitation von Patientinnen und Patienten mit onkologischen Erkrankungen geben. Dabei sind unterschiedliche Defizite bei onkologischen Patientinnen und Patienten zu berucksichtigen, die durch die Erkrankung sowie deren Behandlung moglicherweise verursacht werden. Diese sind z. B. Einschrankungen der gesundheitsbezogenen Lebensqualitat, Schmerz, Fatigue und Einschrankungen der korperlichen Leistungsfahigkeit.

Die Polyneuropathie bei Patientinnen und Patienten mit onkologischen Erkrankungen kann als paraneoplastisches Syndrom sowie infolge einer Tumorbehandlung auftreten.

Purpose: Suture anchor repair is a fairly new surgical technique for quadriceps tendon ruptures. It is supposed to be superior to the standard transosseus sutures because of biomechanical superiori...

Summary Background Literature about lymphedema and its influence on the ability to work and employability is limited. The aim of the present study was to investigate the opinion of Austrian experts on factors influencing the ability to work and employability in patients suffering from lymphedema. Methods A self-administered questionnaire consisting of 6 questions was sent to 12 Austrian lymphedema experts with 6 different specializations from May to August 2016. These experts were asked about suitable and unsuitable professions, the possible influence of lymphedema on the ability to work and employability as well as about existing and additional measures to improve the return to work. Results The reply rate was 100% (12 out of 12). All experts agreed that lymphedema can restrict the ability to work and employability. The leading reason for limited ability to work and employability was restricted mobility or function of the affected limb along with time-consuming therapeutic modalities, pain and psychological stress. The most suitable job named was teacher and the most unsuitable job named was cook. As easements for return to work, early rehabilitation, self-management, coping strategies, patient education, employer’s goodwill and employer’s cooperation were reported. Furthermore, experts stressed the need for an adjustment of the legal framework as well as low-barrier and more therapy offers. Conclusions Adjusted work demands seem to be of greater importance to support the ability to work and employability than recommendations for specific job profiles alone. Experts suggest an adjustment of the legal framework for affected patients, claiming a right for early rehabilitation as well as for life-long therapy. Even though some clinically useful conclusions may be drawn from this article, further research in the field is warranted.

Temporomandibular disorders are a common musculoskeletal condition causing severe pain, physical and psychological disability. The effect and evidence of osteopathic manipulative treatment and osteopathy in the cranial field is scarce and their use are controversial. The purpose of this pilot study was to evaluate the effectiveness of osteopathic manipulative treatment and osteopathy in the cranial field in temporomandibular disorders.A randomized clinical trial in patients with temporomandibular disorders was performed. Forty female subjects with long-term temporomandibular disorders (3 months) were included. At enrollment, subjects were randomly assigned into two groups: (1) osteopathic manipulative treatment group (20 female patients) and (2) osteopathy in the cranial field group (20 female patients). Examination was performed at baseline (E0) and at the end of the last treatment (E1), consisting of subjective pain intensity with the Visual Analog Scale, Helkimo Index and SF-36 Health Survey. Subjects had five treatments, once a week. 36 subjects completed the study (33.7 ± 10.3 y).Patients in both groups showed significant reduction in Visual Analog Scale score (osteopathic manipulative treatment group: p = 0.001; osteopathy in the cranial field group: p 0.001), Helkimo Index (osteopathic manipulative treatment group: p = 0.02; osteopathy in the cranial field group: p = 0.003) and a significant improvement in the SF-36 Health Survey - subscale "Bodily Pain" (osteopathic manipulative treatment group: p = 0.04; osteopathy in the cranial field group: p = 0.007) after five treatments (E1). All subjects (n = 36) also showed significant improvements in the above named parameters after five treatments (E1): Visual Analog Scale score (p 0.001), Helkimo Index (p 0.001), SF-36 Health Survey - subscale "Bodily Pain" (p = 0.001). The differences between the two groups were not statistically significant for any of the three target parameters.Both therapeutic modalities had similar clinical results. The findings of this pilot trial support the use of osteopathic manipulative treatment and osteopathy in the cranial field as an effective treatment modality in patients with temporomandibular disorders. The positive results in both treatment groups should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field and support the importance of an interdisciplinary collaboration in patients with temporomandibular disorders. Implications for rehabilitation Temporomandibular disorders are the second most prevalent musculoskeletal condition with a negative impact on physical and psychological factors. There are a variety of options to treat temporomandibular disorders. This pilot study demonstrates the reduction of pain, the improvement of temporomandibular joint dysfunction and the positive impact on quality of life after osteopathic manipulative treatment and osteopathy in the cranial field. Our findings support the use of osteopathic manipulative treatment and osteopathy in the cranial field and should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field in patients with temporomandibular disorders. Rehabilitation experts should consider osteopathic manipulative treatment and osteopathy in the cranial field as a beneficial treatment option for temporomandibular disorders.

Background: Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included.Methods: A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool.Results: Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded.Conclusions: RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored.Implications for rehabilitationBreast cancer-related lymphedema affects a considerable proportion of breast cancer patients and is debilitating on the physical, functional, social, and psychological domain.At the current time breast cancer related lymphedema is incurable but well manageable by a number of physical therapy modalities, especially complete decongestive therapy (CDT).One of the encouraging treatment methods is resistance exercise.

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.

In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.

Aim of this pilot study was to describe feasibility and acceptance of an exercise intervention by using an unique swinging-ring system with the goal to promote long-term exercise behaviour in cancer patients. The included cancer patients (n = 13, male:f emale (m:f) = 7:6, age = 56 ± 11, range 38–74a) were invited to perform a home-based exercise intervention. All participants of this pilot study were instructed how to use the smovey® Vibroswing. They could choose how to use the swinging-ring system, for example only indoor or only outdoor (single or in a group) or both. Feasibility and acceptance were assessed after 12 months (T2). Handgrip strength (Jamar hand dynamometer) and health-related quality of life (QOL, SF-36 Health survey) were assessed at baseline (T1) and after 12 months (T2). A total of 10 (77 %) patients (m:f = 5:5, 59 ± 9 years, range = 46–74) could be assessed at baseline and after 12 months. The exercise intervention showed no adverse events and was well accepted. Approximately 77 % of patients of the study population have been exercising for more than 12 months. Furthermore, this intervention was able to increase handgrip strength in the participants. QOL improved as well in all domains. The results of this small pilot study indicate that regular physical exercise with this swinging-ring system seems to be safe, and to promote long-term exercise behaviour of the included patients. Furthermore, this study population showed benefits in terms of increased handgrip strength and of improved QOL.

The present open single-centre, descriptive and comparative pharmacokinetic study aimed to investigate the efficacy of iontophoresis to enhance transdermal delivery by measuring concentration vs. time profiles of diclofenac in local tissue and in plasma in two separate study periods. Period 1 determined diclofenac concentrations in both calf muscles simultaneously by using microdialysis after applying diclofenac gel topically as a single dose of 5 g with or without iontophoresis in eight healthy volunteers. In period 2, the same dose was applied to another 8 volunteers to determine plasma concentrations of diclofenac either with or without iontophoresis in a cross over design. In period 1, tissue concentrations were found to be under the limit of detection of 0.5 ng/ml both with and without iontophoresis in all subjects. In period 2, after iontophoresis in 75 % of study participants, plasma concentrations of diclofenac could be determined, but only in 25 % without iontophoresis. Although area under the concentration-time-curve (AUC, 187.97 ± 315.92 vs. 22.92 ± 42.44 ng*min/ml) and maximum concentration (Cmax, 2.06 ± 3.79 vs. 0.22 ± 0.41 ng/ml) values showed a numerically clear trend for higher values with iontophoresis compared to passive diffusion, no significant difference could be found due to high inter-individual variability. In total, 18.75 % of all subjects presented adverse events. Despite a higher percentage of subjects showed detectable plasma levels of diclofenac after iontophoresis, iontophoresis failed to achieve potentially more effective topical concentrations. The typical mechanism of iontophoresis like electromigration, electroosmosis and increased subcutaneous circulation could be responsible for the results of the present observation. Additional clinical studies are needed to justify the transdermal delivery of diclofenac by using iontophoresis.

An innovative form of whole body vibration therapy on a treatment bed (Evocell®) to fight against the disabling and isolating symptom of postoperative incontinence in a prostate cancer patient is presented. A supervised program with outpatient active pelvic floor training and a novel form of synchronous high-intensity whole body vibration therapy using the Evocell® device was performed in a patient with postprostatectomy stress urinary incontinence. The patient had previously failed regular pelvic floor exercise. During the intervention, namely a whole body vibration treatment in a lying position on a treatment bed, the patient performed active and passive pelvic floor exercises under professional guidance. Over a period of 6 weeks after starting treatment, the patient regained continence (usage of 1 safety pad). Furthermore, his ability to work increased (return to work) and his ability to attend social activities improved.

Biomechanical studies have shown the use of suture anchors (SA) to be superior to the traditional transosseous sutures (TS) in the repair of quadriceps tendon rupture (QTR). This study aimed to analyze and compare the functional outcomes of patients treated for quadriceps tendon ruptures using suture anchors or transosseous sutures. Patients having undergone suture anchor repair or transosseous suture repair for quadriceps tendon rupture between 2010 and 2015 at one of the two participating hospitals were included. Patients from site A underwent TS repair (TS group) while patients from site B underwent SA repair (SA group). Exclusion criteria included previous or concomitant injuries of the involved knee, penetrating injuries and pre-existing neurological conditions. Clinical outcome was assessed by subjective scores (Lysholm and Tegner Scores, International Knee Documentation Committee (IKDC) Score, Visual Analog Scale (VAS) for pain), quadriceps isokinetic strength testing, Insall-Salvati Index (ISI), and physical examination. Non-parametrical statistical analysis was conducted using the Mann-Whitney U test. Twenty-seven patients were included in the study of which 17 patients (63%) were available for follow-up (SA group: 9, TS group: 8). All patients were male with a mean age of 62.7 (SD: 8.8) and 57.9 (SD: 12.7) years for the SA group and TS group, respectively. The groups did not differ in terms of demographic characteristics. No clinically significant differences were identified between the two groups. There were no re-ruptures in either group. Treatment of quadriceps tendon rupture using suture anchors provides a clinically valid alternative treatment to the gold-standard transosseous suture repair.

Congenital fiber-type disproportion is a rare condition, histologically characterized by a relative type 1 fiber hypotrophy. The main clinical feature is mild-to-severe muscle weakness. In this report, we present the case of a 21-year-old patient with congenital fiber-type disproportion in an outpatient rehabilitative setting to evaluate the feasibility and results of an assessment battery, including bioimpedance analysis (BIA), dynamometry, 3D gait analysis, 6‑min walk test (6MWT), and the timed up and go test (TUG). The patient had a notable decrease in all functional scores. BIA: lean body mass, 38.4 kg (50.2 ± 5.3), body fat, 1.6% (12.4 ± 4.4); hand dynamometry: 18.5 kg left/20.0 kg right (44.8 ± 6.6); walking speed, 58 cm/s (122.7 ± 11.1), step length, 43.0 cm (61.6 ± 3.5); 6MWT: 478.5 m (638 ± 44); TUG: 9.4 s (8.1 ± 1.0). No adverse events were reported. The tests used were easily applicable in clinical routine and well tolerated by our patient.

This pilot study aimed to investigate feasibility, acceptance, and effects of biofeedback-assisted mental training in a population of fifteen 10-year-old pupils in an Austrian elementary school. Participants were instructed in relaxation techniques by using biofeedback. Before intervention, after 6 weeks with active mental training and with regular instructions by the teacher, and after a further time period of 6 weeks without instructions, attention and concentration improved. The results indicate feasibility, good acceptance, and beneficial effects of biofeedback-assisted mental techniques in Austrian elementary school pupils.

Aim Muscle injuries and extensive exercise are associated with cyclo-oxygenase dependent formation of inflammatory prostaglandins. Since the effect of topical administration of non-steroidal anti-inflammatory drugs (NSAIDs) on local cyclo-oxygenase is unknown, the present exploratory, open label, non-randomized study set out to measure exercise induced release of prostaglandins before and after epicutaneous administration of diclofenac. Methods Microdialysis was used to determine the local interstitial concentration of PGE2 and 8-iso-PGF2α as well as diclofenac concentrations in the vastus lateralis under rest, dynamic exercise and during recovery in 12 healthy subjects at baseline and after a treatment phase applying a total of seven plasters medicated with 180 mg of diclofenac epolamine over 4 days. Results At baseline PGE2 concentrations were 1169 ± 780 pg ml−1 at rest and 1287 ± 459 pg ml−1 during dynamic exercise and increased to 2005 ± 1126 pg ml−1 during recovery. After treatment average PGE2 concentrations were 997 ± 588 pg ml−1 at rest and 1339 ± 892 pg ml−1 during exercise. In contrast with the baseline phase no increase in PGE2 concentrations was recorded during the recovery period after treatment (PGE2 1134 ± 874 pg ml−1). 8-iso-PGF2α was neither affected by exercise nor by treatment with diclofenac. Local and systemic concentrations of diclofenac were highly variable but comparable with previous clinical pharmacokinetic studies. Conclusions We can hypothesize an effect of topical diclofenac epolamine plaster on limiting the increase of local concentrations of the pro-inflammatory prostaglandin PGE2 induced in the muscle of healthy human subjects following standardized physical exercise. No effect of diclofenac treatment on 8-iso-PGF2α concentrations was observed, mainly since isoprostane is produced by a free radical-catalyzed lipid peroxidation mechanism independent of cyclo-oxygenases.

Glioblastoma multiforme (GBM) still harbors a fatal prognosis. The involvement of the neurocognition and psyche poses unique challenges for care provision by relatives. We lack data about the caregivers’ perspective on the end-of-life (EOL) phase of GBM patients to improve counseling and support. In this study we investigated the experiences of 52 caregivers of deceased GBM patients treated in Austria. We used a questionnaire developed by the University Medical Centre of Amsterdam for exploration of the EOL-phase in glioma patients. The caregivers (17 men, 34 women) completed the questionnaire in median three years after the patients’ death. 29 % of caregivers reported that they felt incompletely prepared for their tasks, however, those with higher education levels felt significantly better informed. 29 % suffered from financial difficulties, which was associated with burnout (60 %) and reduced quality of life (QOL). The patients’ most common symptoms reported by caregivers were fatigue (87 %), reduced consciousness (81 %) and aphasia (77 %). 22 % of patients were bedbound during their last three months increasing to 80 % in the last week of life. The reported QOL of caregivers was very low and did not differ between caregivers of patients, who died at home (40 %) and caregivers of patients, who died in hospital (46 %). The caregiver reported that their QOL was only slightly better than the QOL they attributed to the patients. Furthermore, the high frequency of financial difficulties, burnout symptoms and feelings of insufficient information emphasize the urgent need for support and training dedicated to caregivers.