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Kjær BH, Cools AM, Johannsen FE, Trøstrup J, Bieler T, Siersma V, Magnusson PS. To allow or avoid pain during shoulder rehabilitation exercises for patients with chronic rotator cuff tendinopathy-Study protocol for a randomized controlled trial (the PASE trial). Trials 2024; 25:135. [PMID: 38383459 PMCID: PMC10880378 DOI: 10.1186/s13063-024-07973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Rotator cuff (RC) tendinopathy is the most reported shoulder disorder in the general population with highest prevalence in overhead athletes and adult working-age population. A growing body of evidence support exercise therapy as an effective intervention, but to date there are no prospective randomized controlled trials addressing pain as an intervention variable. METHODS A single-site, prospective, pragmatic, assessor-blinded randomized controlled superiority trial. Eighty-four patients aged 18-55 years with chronic (symptom duration over 3 months) RC tendinopathy are randomized 1:1 to receive shoulder exercise during which pain is either allowed or avoided. The intervention period lasts 26 weeks. During that period, participants in both groups are offered 8 individual on-site sessions with an assigned sports physiotherapist. Participants perform home exercises and are provided with a pain and exercise logbook and asked to report completed home-based exercise sessions and reasons for not completing sessions (pain or other reasons). Patients are also asked to report load and the number of sets and repetitions per sets for each exercise session. The logbooks are collected continuously throughout the intervention period. The primary and secondary outcomes are obtained at baseline, 6 weeks, 26 weeks, and 1 year after baseline. The primary outcome is patient-reported pain and disability using the Shoulder PAin and Disability Index (SPADI). Secondary outcomes are patient-reported pain and disability using Disability Arm Shoulder and Hand short-form (Quick DASH), and shoulder pain using Numeric Pain Rating Scale. Objective outcomes are shoulder range of motion, isometric shoulder muscle strength, pain sensitivity, working ability, and structural changes in the supraspinatus tendon and muscle using ultrasound. DISCUSSION The results of this study will contribute knowledge about the treatment strategies for patients with RC tendinopathy and help physiotherapists in clinical decision-making. This is the first randomized controlled trial comparing the effects of allowing pain versus avoiding pain during shoulder exercises in patients with chronic RC tendinopathy. If tolerating pain during and after exercise proves to be effective, it will potentially expand our understanding of "exercising into pain" for this patient group, as there is currently no consensus. TRIAL REGISTRATION ClinicalTrials.gov NCT05124769. Registered on August 11, 2021.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Ann M Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, B3, Entrance 46, 9000, Gent, Belgium
| | - Finn E Johannsen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Jeanette Trøstrup
- The Danish Clinical Quality Program-National Clinical Registries (RKKP), Regionshuset Aarhus, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Oster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Peter S Magnusson
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Department of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Zilmer CK, Kristensen MT, Magnusson SP, Bährentz IB, Jensen TG, Zoffmann SØ, Palm H, Bieler T. Intensified acute in-hospital physiotherapy for patients after hip fracture surgery: a pragmatic, randomized, controlled feasibility trial. Disabil Rehabil 2023:1-10. [PMID: 38037849 DOI: 10.1080/09638288.2023.2288672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Intensified acute in-hospital physiotherapy (IP) after hip fracture (HF) may enhance patient's ability to regain basic mobility at discharge. The primary objective was to assess the feasibility of IP. Secondary to estimate the effect of IP on regained basic mobility at discharge. MATERIALS AND METHODS In a pragmatic, randomized, unblinded feasibility trial, 60 patients (mean age 79 years, 41 women) with HF and an independent pre-fracture basic mobility level were randomized (2:1) to IP with two daily sessions on weekdays focusing on functional training and weight-bearing activities (n = 40) versus usual care (UC) physiotherapy once daily (n = 20). Feasibility outcomes included physiotherapy completion rates, reasons for non-successful completion, and adverse events. The primary effect outcome was recovery of basic mobility (Cumulated Ambulation Score (CAS)). RESULTS Eighty-two percent of the sessions in the IP group were successfully- or partially completed versus 94% of the sessions in the UC group. No adverse events occurred. The main reason for not completing physiotherapy was fatigue. At discharge (median 7 days), 50% in the IP group had regained their pre-fracture basic mobility level (CAS = 6) versus 16% in the UC group; odds ratio = 5.33, 95%CI [1.3;21.5]. CONCLUSIONS IP seems feasible for patients after HF surgery, and it may enhance recovery. Fatigue was the primary obstacle to completing IP.
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Affiliation(s)
- Camilla Kampp Zilmer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Orthopedic Surgery M, Institute of Sports Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Inger Birgitte Bährentz
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Giver Jensen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Signe Østergaard Zoffmann
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Molitor M, Jimenez MTB, Hahad O, Witzler C, Finger S, Garlapati VS, Rajlic S, Knopp T, Bieler T, Aluia M, Wild J, Lagrange J, Blessing R, Rapp S, Schulz A, Kleinert H, Karbach S, Steven S, Ruf W, Wild P, Daiber A, Münzel T, Wenzel P. Aircraft noise exposure induces pro-inflammatory vascular conditioning and amplifies vascular dysfunction and impairment of cardiac function after myocardial infarction. Cardiovasc Res 2023:7005408. [PMID: 36702626 DOI: 10.1093/cvr/cvad021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
AIMS Traffic noise may play an important role in the development and deterioration of ischemic heart disease. Thus, we sought to determine the mechanisms of cardiovascular dysfunction and inflammation induced by aircraft noise in a mouse model of myocardial infarction (MI) and in humans with incident MI. METHODS AND RESULTS C57BL/6J mice were exposed to noise alone (average sound pressure level 72 dB; peak level 85 dB) up to 4d, resulting in pro-inflammatory aortic gene expression in the myeloid cell adhesion/diapedesis pathways. Noise alone promoted adhesion and infiltration of inflammatory myeloid cells in vascular/cardiac tissue, paralleled by an increased percentage of leukocytes with a pro-inflammatory, reactive oxygen species (ROS)-producing phenotype and augmented expression of Nox-2/phospho-NFκB in peripheral blood. Ligation of the LAD resulted in worsening of cardiac function, pronounced cardiac infiltration of CD11b+ myeloid cells and Ly6Chigh monocytes and induction of interleukin (IL) 6, IL-1β, CCL-2 and Nox-2, being aggravated by noise exposure prior to MI. MI induced stronger endothelial dysfunction and more pronounced increases in vascular ROS in animals preconditioned with noise. Participants of the population-based Gutenberg Health Cohort Study (median follow-up:11.4y) with incident MI revealed elevated CRP at baseline and worse LVEF after MI in case of a history of noise exposure and subsequent annoyance development. CONCLUSION Aircraft noise exposure before MI substantially amplifies subsequent cardiovascular inflammation and aggravates ischemic heart failure, facilitated by a pro-inflammatory vascular conditioning. Our translational results suggest, that measures to reduce environmental noise exposure will be helpful in improving clinical outcome of subjects with MI.
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Affiliation(s)
- M Molitor
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - M T Bayo Jimenez
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - O Hahad
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - C Witzler
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - S Finger
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - V S Garlapati
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - S Rajlic
- Department of Cardiothoracic and Vascular Surgery, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - T Knopp
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - T Bieler
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - M Aluia
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - J Wild
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - J Lagrange
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Université de Lorraine, Inserm, DCAC, Nancy, France; CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - R Blessing
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - S Rapp
- Department of Cardiology, Preventive Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - A Schulz
- Department of Cardiology, Preventive Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - H Kleinert
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Mainz, Germany, Langenbeckstraße 1, 55131 Mainz, Germany
| | - S Karbach
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - S Steven
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - W Ruf
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - P Wild
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
- Department of Cardiology, Preventive Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - A Daiber
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - T Münzel
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
| | - P Wenzel
- Department of Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main
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Bieler T, Magnusson SP, Siersma V, Rinaldo M, Schmiegelow MT, Beck T, Krifa AM, Kjær BH, Palm H, Midtgaard J. Effectiveness of promotion and support for physical activity maintenance post total hip arthroplasty-study protocol for a pragmatic, assessor-blinded, randomized controlled trial (the PANORAMA trial). Trials 2022; 23:647. [PMID: 35964101 PMCID: PMC9375375 DOI: 10.1186/s13063-022-06610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Total hip arthroplasty is considered an efficacious procedure for relieving pain and disability, but despite that objectively measured physical activity level remains unchanged compared to pre-surgery and is still considerably lower than that of a healthy age- and sex-matched population 6–12 months post-surgery. Since there is a graded relationship between physical activity level and functional performance, increasing physical activity may enhance the outcome of the procedure. This study aims to investigate whether promotion and support of physical activity initiated 3 months after total hip arthroplasty complementary to usual rehabilitation care can increase objective measured physical activity 6 months post-surgery. Methods The trial is designed as a pragmatic, parallel group, two-arm, assessor-blinded, superiority, randomized (1:1), controlled trial with post intervention follow-up 6 and 12 months after total hip arthroplasty. Home-dwelling, independent, and self-reliant patients with hip osteoarthritis are provisionally enrolled prior to surgery and re-screened about 2–3 months post-surgery to confirm eligibility. Baseline assessment is conducted 3 months post-surgery. Subsequently, patients (n=200) are randomized to either a 3-month, multimodal physical activity promotion/education intervention or control (no further attention). The intervention consists of face-to-face and telephone counselling, patient education material, pedometer, and step-counting journal. The primary outcome is objectively measured physical activity, specifically the proportion of patients that complete on average ≥8000 steps per day 6 months post-surgery. Secondary outcomes include core outcomes (i.e., physical function, pain, and patient global assessment) and health-related quality of life. Furthermore, we will explore the effect of the intervention on self-efficacy and outcome expectations (i.e., tertiary outcomes). Discussion By investigating the effectiveness of a pedometer-driven, face-to-face, and telephone-assisted counselling, behavior change intervention in complementary to usual rehabilitation, we hope to deliver applicable and generalizable knowledge to support physical activity after total hip arthroplasty and potentially enhance the outcome of the procedure. Trial registration www.clinicaltrials.govNCT04471532. Registered on July 15, 2020.
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Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark.,Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 8, Building 8, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, building 24, entrance R, 1353, Copenhagen K, Denmark
| | - Mie Rinaldo
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Morten Torrild Schmiegelow
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Torben Beck
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | | | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 10, Building 10, 2400, Copenhagen, NV, Denmark
| | - Henrik Palm
- Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Nielsine Nielsens Vej 6, Building 6, 2400, Copenhagen, NV, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Nordstjernevej 41, 2600, Glostrup, Denmark
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Wild J, Ringen J, Knopp T, Bieler T, Molitor M, Muenzel T, Waisman A, Wenzel P, Karbach S. Acute induction of psoriasis-like skin inflammation disturbes vascular tone and provokes a rapid blood pressure response in mice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Psoriasis is the most common chronic skin disease worldwide. Furthermore, it is an independent cardiovascular risk factor. Several genetic and inducible murine models reproduce specific aspects of the human disease. In mice genetically overexpressing IL-17A in keratinocytes or dendritic cells, we coulod show both aspects of the disease: cutaneous hallmarks and the vascular phenotype. The most popular inducible model consists of topical application of Imiquimod (IMQ), a Toll-like receptor 7/8 agonist. In this model, cardiovascular aspects have not been studied yet. Therefore, we examined vascular and hemodynamic effects in this most popular murine psoriasis model.
Methods
C57BL/6J mice were treated with 5% IMQ or sham cream. During treatment, we measured bodyweight, skin thickness and skin water loss. After 10 days, aortic relaxation studies were performed. For assessment of vascular inflammation, inflammatory cell infiltration into the aortic tissue was investigated by flow cytometric analysis. To record physical activity, blood pressure and heart rate, carotid catheters were implanted two weeks before treatment with IMQ. Blood pressure and heart rate were continuously recorded by receiver platforms.
Results
IMQ treatment resulted in severe skin inflammation and induced a skin barrier defect resulting in a 7-fold increase of transcutaneous water loss (from 11±6 ml/m2h to 77±30 ml/m2h). Physical activity decreased more than 50% after d1 of treatment and normalized at d7. Telemetric recording revealed a reflex tachycardia at 1d of IMQ-application (from 492±21 bpm to 524±20 bpm) followed by a significant reduction of heart rate for the next two days (456±18bpm). Systolic blood pressure showed a similar trend: after a fast increase (from 120±13 mmHg to 127±18 mmHg), blood pressure dropped below baseline at d2/3 with a subsequent recovery. We could display a highly significant positive correlation between blood pressure and heart rate during the treatment (R=0.6; p≤0.0001). Aortas from animals after 10d of IMQ-treatment showed an increased infiltration of CD45+ and CD11b+ inflammatory cells but no change of responsiveness to endothelium dependent and independent vasodilators in organ chamber studies.
Conclusion
Skin treatment with IMQ had severe implications on the hemodynamic system: After an initial peak of heart rate and blood pressure, mice showed significantly lower values for two days with a subsequent full recovery. Moreover, bodyweight and physical activity were significantly altered during treatment. Our data indicate that skin inflammation and inflammatory skin barrier disruption by IMQ forces a compensatory whole-body response. 10 days of IMQ-treatment resulted in vascular inflammation without mediating vascular dysfunction. In summary, we could reveal that IMQ-induced psoriasis, as the most popular murine psoriasis model worldwide, has extensive effects on the cardiovascular system.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Boehringer Ingelheim Foundation “Novel and neglected cardiovascular risk factors: molecular mechanisms and therapeutic implications”German Federal Ministry for Education and Research (BMBF EDU-V24)
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Affiliation(s)
- J Wild
- University Medical Center of Mainz, Center for Cardiology, Mainz, Germany
| | - J Ringen
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - T Knopp
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - T Bieler
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - M Molitor
- University Medical Center of Mainz, Center for Cardiology, Mainz, Germany
| | - T Muenzel
- University Medical Center of Mainz, Center for Cardiology, Mainz, Germany
| | - A Waisman
- University Medical Center of Mainz, Mainz, Germany
| | - P Wenzel
- University Medical Center of Mainz, Center for Cardiology, Mainz, Germany
| | - S Karbach
- University Medical Center of Mainz, Center for Cardiology, Mainz, Germany
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Inter-Day Test-Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD. Patient Relat Outcome Meas 2021; 12:117-128. [PMID: 34104024 PMCID: PMC8179805 DOI: 10.2147/prom.s306352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
Introduction In patients with COPD, the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and EuroQol 5D (EQ-5D-3L) are widely used patient reported outcome measures (PROMs) of respiratory symptoms, anxiety, depression and quality of life. Despite established validity, responsiveness and minimal important change (MIC), the reproducibility and especially important agreement parameters remain unreported in these frequently used PROMs. The aim of this study was to investigate the inter-day test–retest reliability and agreement of the CAT, CCQ, HADS and EQ-5D-3L in patients with severe and very severe COPD (FEV1 <50%) eligible for hospital-based pulmonary rehabilitation. Patients and Methods Fifty patients (22 females, mean [SD] age 67 [9] yrs.; FEV1 32[9] %; 6-minute walk distance 347 [102] meters; CAT 21 [6] points; BMI: 26 [6] kg/m2) completed the questionnaires (CAT, CCQ, HADS, EQ-5D-3L) in combination with functional performance test instructed by one assessor on test-day one (T1) and by another assessor 7–10 days later on test-day two (T2). Results The inter-day test–retest reliability ICC was 0.88 (LL95CI: 0.80) for CAT; 0.69 (LL95CI: 0.46) for CCQ; 0.86 (LL95CI: 0.75) and 0.90 (LL95CI: 0.82) for HADS-anxiety (A) and depression (D) and 0.87 (LL95CI: 0.76) for EQ-5D-VAS. The corresponding agreements within a single measurement (standard error of measurement, SEM) and for repeated measurement errors (smallest real difference, SRD) were respectively 2.1 and 2.9 points for CAT; 0.5 and 0.7 points for CCQ total; 1.3 and 1.9 points for HADS-A; 0.9 and 1.3 points for HADS-D and 6.8 and 9.7 VAS-score for EQ-5D-3L, respectively. Ceiling/flooring effect was present in <5% for all questionnaires. Conclusion In patients with severe and very severe COPD, the CAT, CCQ, HADS and EQ-5D-3L questionnaires presented moderate to excellent inter-day test–retest reliability, and no floor or ceiling effect was documented for any of the questionnaires. Only CAT and HADS had an acceptable SRD below the established MIC for assessing change over time on group level, and none of the PROMS were fit to assess individual changes over time.
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Affiliation(s)
- Henrik Hansen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Bieler T, Kristensen ALR, Nyberg M, Magnusson SP, Kjaer M, Beyer N. Exercise in patients with hip osteoarthritis - effects on muscle and functional performance: A randomized trial. Physiother Theory Pract 2021; 38:1946-1957. [PMID: 33956561 DOI: 10.1080/09593985.2021.1923096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: It is believed that clinical management of osteoarthritis should address muscle weakness to improve physical function and prevent disability and frailty.Objectives: This sub-study investigated the effects of supervised progressive resistance training (RT), supervised Nordic Walking (NW), and unsupervised home-based exercise (HBE) on muscle and functional performance; and associations between these exercise-induced changes in persons with hip osteoarthritis.Methods: Forty-two patients with hip osteoarthritis were recruited from a larger RCT (NCT01387867). All the groups (RT, n = 15; NW, n = 12; HBE, n = 15) exercised 1 h 3 times/week for 4 months. Quadriceps cross-sectional area (QCSA, MRI-determined); quadriceps strength (QMVC); leg extensor power (LEP); functional performance (chair stands (30sCS); stair climbs (TSC); and 6-minute walk (6MWT)) were assessed at baseline and 4 months.Results: Per protocol analyses (one-way ANOVA and Bonferroni test) showed significant between-group differences for improvements in QCSA in the most symptomatic leg favoring RT versus NW (2.3 cm2, 95% CI [0.6, 3.9]) and HBE (2.3 cm2 [0.8, 3.9]); and 30sCS (1.8 repetitions [0.2-3.3]), and 6MWT (35.1 m [3.5-66.7]) favoring NW versus HBE. Associations existed between exercise-induced changes in QCSA and QMVC (r = 0.366, p = .019) for the most symptomatic leg and between changes in 6MWT and QMVC (r = 0.320, p = .04) and LEP (r = 0.381, p = .01), respectively, for the least symptomatic leg.Conclusions: Resistance training appeared effective for improving muscle mass, but less effective for improving muscle strength, power, and functional performance. Only exercise-induced changes in muscle strength and power of the least symptomatic leg, not the most symptomatic leg, were related to changes in functional performance.
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Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen NV, Denmark
| | | | - Mette Nyberg
- Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen NV, Denmark.,Institute of Sports Medicine, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen NV, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen NV, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen NV, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Bieler T, Anderson T, Beyer N, Rosthøj S. The Impact of Self-Efficacy on Activity Limitations in Patients With Hip Osteoarthritis: Results From a Cross-Sectional Study. ACR Open Rheumatol 2020; 2:741-749. [PMID: 33241664 PMCID: PMC7738804 DOI: 10.1002/acr2.11198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Pain and activity limitations are the main health complaints in osteoarthritis. We explored pathways between pain and activity limitations in a chain mediation model that involved self‐efficacy, physical activity behavior, and muscle function in patients with hip osteoarthritis not awaiting hip replacement. Methods We used cross‐sectional, baseline data from a randomized controlled trial on 152 patients with clinical hip osteoarthritis according to the American College of Rheumatology not awaiting hip replacement. The associations between pain, self‐efficacy, self‐reported physical activity, muscle function (leg extensor power), and activity limitations (performance‐based and self‐reported activity limitation outcomes) were modeled using structural equation models. Results The effect of pain on performance‐based activity limitation was fully mediated by self‐efficacy, physical activity, and muscle function. Of the total effect of self‐efficacy on performance‐based activity limitation, the direct effect accounted for 63% (95% CI: 45%‐82%), whereas the indirect effect via physical activity constituted 16% (95% CI: 1%‐30%) and the indirect effect via muscle function constituted 21% (95% CI: 9%‐32%). In contrast, physical activity and muscle function had no effect on self‐reported activity limitations, whereas pain had a direct effect and an indirect effect mediated by self‐efficacy. Conclusion Our results suggest that self‐efficacy should be taken into consideration in prevention and treatment of activity limitations in patients with hip osteoarthritis not awaiting hip replacement. Coupling exercise with programs of self‐efficacy enhancement could potentially increase the positive effects of exercise.
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Affiliation(s)
- Theresa Bieler
- Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Nina Beyer
- University of Copenhagen, Copenhagen, Denmark
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Gylling AT, Eriksen CS, Garde E, Wimmelmann CL, Reislev NL, Bieler T, Ziegler AK, Andersen KW, Bauer C, Dideriksen K, Baekgaard M, Mertz KH, Bayer ML, Bloch-Ibenfeldt M, Boraxbekk CJ, Siebner HR, Mortensen EL, Kjaer M. The influence of prolonged strength training upon muscle and fat in healthy and chronically diseased older adults. Exp Gerontol 2020; 136:110939. [PMID: 32277977 DOI: 10.1016/j.exger.2020.110939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/10/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical muscle function and brain hippocampus size declines with age, accelerating after the age of 60. Strength training over a few months improves physical function, but less is known about how long-term strength training affects physical function and hippocampus volume. Therefore, we aimed to investigate the effect of 1-year strength training of two different intensities upon muscle mass, function, and hippocampus volume in retirement-age individuals. METHODS In this multidisciplinary randomized controlled trial (clinicaltrials.gov: NCT02123641), participants were allocated to either a) supervised, heavy resistance training (HRT, n = 149, 3/wk), b) moderate intensity resistance training (MIT, n = 154, 3/wk) or c) non-exercise activities (CON, n = 148). 451 participants were randomized (62-70 yrs., women 61%, ≈80% with a chronic medical disease) and 419 were included in the intention-to-treat analysis (n = 143, 144 and 132; HRT, MIT and CON). Changes in muscle power (primary outcome), strength and size, physical function, body composition, hippocampus volume and physical/mental well-being were analyzed. FINDINGS Of the participants (HRT + MIT), 83% completed training at least 2/week. Leg extensor power was unchanged in all groups, but strength training had a positive effect on isometric knee extensor strength in both groups, whereas an increased muscle mass, cross-sectional area of vastus lateralis muscle, a decreased whole-body fat percentage, visceral fat content and an improved mental health (SF-36) occurred in HRT only. Further, chair-stand performance improved in all groups, whereas hippocampus volume decreased in all groups over time with no influence of strength training. INTERPRETATION Together, the results indicate that leg extensor power did not respond to long-term supervised strength training, but this type of training in a mixed group of healthy and chronically diseased elderly individuals can be implemented with good compliance and induces consistent changes in physiological parameters of muscle strength, muscle mass and abdominal fat.
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Affiliation(s)
- Anne Theil Gylling
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark.
| | - Christian Skou Eriksen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Ellen Garde
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark
| | - Cathrine Lawaetz Wimmelmann
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark
| | - Nina Linde Reislev
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark
| | - Theresa Bieler
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark; Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark
| | - Andreas Kraag Ziegler
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Kasper Winther Andersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark
| | - Christian Bauer
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Department of Technology, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Kasper Dideriksen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Maria Baekgaard
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Kenneth Hudlebusch Mertz
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Monika Lucia Bayer
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Mads Bloch-Ibenfeldt
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
| | - Carl-Johan Boraxbekk
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Department of Radiation Sciences, Umeå University, S-901 87 Umeå, Sweden
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark; Department of Neurology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark
| | - Erik Lykke Mortensen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M81 and Centre for Translational Research, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, N, Denmark
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Hansen H, Bieler T, Beyer N, Kallemose T, Wilcke JT, Østergaard LM, Frost Andeassen H, Martinez G, Lavesen M, Frølich A, Godtfredsen NS. Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial. Thorax 2020; 75:413-421. [PMID: 32229541 PMCID: PMC7231436 DOI: 10.1136/thoraxjnl-2019-214246] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE Pulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR). OBJECTIVE To investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 <50% eligible for routine hospital-based, outpatient PR. METHODS In this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks' follow-up from baseline. The primary analysis was based on the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS The primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: -6.6 to 24.9)) or at 22 weeks' follow-up (-5.3 metres (95% CI: -28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test p<0.01). CONCLUSION PTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design. Trial registration number ClinicalTrials.gov (NCT02667171), 28 January 2016.
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Affiliation(s)
- Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thomas Kallemose
- Clinical Research Center, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jon Torgny Wilcke
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
| | | | | | - Gerd Martinez
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Marie Lavesen
- Department of Respiratory Medicine and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Nina Skavlan Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
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Ellegaard M, Bieler T, Beyer N, Kjaer M, Jørgensen NR. The effect of 4 months exercise training on systemic biomarkers of cartilage and bone turnover in hip osteoarthritis patients. Transl Sports Med 2020. [DOI: 10.1002/tsm2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Maria Ellegaard
- Department of Clinical Biochemistry Rigshospitalet Copenhagen Denmark
| | - Theresa Bieler
- Department of Physical & Occupational Therapy Bispebjerg and Frederiksberg Hospital, University of Copenhagen Copenhagen Denmark
| | - Nina Beyer
- Institute for Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen Bispebjerg and Frederiksberg Hospital, University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Niklas R. Jørgensen
- Department of Clinical Biochemistry Rigshospitalet Copenhagen Denmark
- University of Southern Denmark Odense Denmark
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12
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Mertz KH, Reitelseder S, Jensen M, Lindberg J, Hjulmand M, Schucany A, Binder Andersen S, Bechshoeft RL, Jakobsen MD, Bieler T, Beyer N, Lindberg Nielsen J, Aagaard P, Holm L. Influence of between-limb asymmetry in muscle mass, strength, and power on functional capacity in healthy older adults. Scand J Med Sci Sports 2019; 29:1901-1908. [PMID: 31353627 DOI: 10.1111/sms.13524] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Numerous daily tasks such as walking and rising from a chair involve bilateral lower limb movements. During such tasks, lower extremity function (LEF) may be compromised among older adults. LEF may be further impaired due to high degrees of between-limb asymmetry. The present study investigated the prevalence of between-limb asymmetry in muscle mass, strength, and power in a cohort of healthy older adults and examined the influence of between-limb asymmetry on LEF. METHODS Two hundred and eight healthy older adults (mean age 70.2 ± 3.9 years) were tested for LEF (400 m walking and 30-seconds chair stand). Furthermore, maximal isometric and dynamic knee extensor strength, leg extensor power, and lower limb lean tissue mass (LTM) were obtained unilaterally. RESULTS Mean between-limb asymmetry in maximal muscle strength and power ranged between 10% and 13%, whereas LTM asymmetry was 3 ± 2.3%. Asymmetry in dynamic knee extensor strength was larger for women compared with men (15.0 ± 11.8% vs 11.1 ± 9.5%; P = .005) Leg strength and power were positively correlated with LEF (r2 = .43-.46, P < .001). The weakest leg was not a stronger predictor of LEF than the strongest leg. Between-limb asymmetry in LTM and isometric strength was negatively associated with LEF (LTM; r2 = .12, P = .005, isometric peak torque; r2 = 0.40, P = .03.) but dynamic strength and power were not. CONCLUSION The present study supports the notion that in order to improve or maintain LEF, healthy older adults should participate in training interventions that increase muscle strength and power, whereas the effects of reducing between-limb asymmetry in these parameters might be of less importance.
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Affiliation(s)
- Kenneth H Mertz
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Reitelseder
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Jensen
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jonas Lindberg
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Morten Hjulmand
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Aide Schucany
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Binder Andersen
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Rasmus L Bechshoeft
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Theresa Bieler
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob Lindberg Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Holm
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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13
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Intra- and inter-rater reproducibility of the 6-minute walk test and the 30-second sit-to-stand test in patients with severe and very severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3447-3457. [PMID: 30425474 PMCID: PMC6203115 DOI: 10.2147/copd.s174248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In patients with COPD, the 6-minute walk test (6MWT) and the 30-second sit-to-stand test (30sec-STS) are widely used as clinical outcome measures of walking capacity, lower limb muscle strength, and functional ability. Due to a documented learning effect, at least two trials are recommended for assessment. The aim of our study was to investigate the intra- and inter-rater reliability and agreement of the two tests in patients with severe and very severe COPD (FEV1 <50%). Patients and methods Fifty patients (22 females; mean [SD]: age 67 [9] years, FEV1 predicted 32 [9]%) were assessed with the 6MWT and the 30sec-STS twice by the same assessor on test-day 1 (T1) and by another assessor 7–10 days later on test-day 2 (T2). Results The 6MWT intra- and inter-rater reliability (intraclass correlation coefficient, ICC1.1) was 0.98 (lower limit 95% CI: 0.94) and 0.96 (lower limit 95% CI: 0.94), respectively, and agreement (standard error of the measurement, SEM) was 14.8 and 20.5 m, respectively. The 30sec-STS intra- and inter-rater reliability and agreement results were, respectively, ICC1.1 0.94 (lower limit 95% CI: 0.90) and 0.92 (lower limit 95% CI: 0.86), with SEM of 0.97 and 1.14 repetitions. There was no difference (95% CI: −5.3; 8.1) between the 6MWT distances on T1, while the mean walking distance improved 7.9 m (0.0 m; 15.8 m) from T1 to T2. Improvement on the same test date was less likely (OR: 3.6 [95% CI: 1.1; 11.8], Fisher’s exact test, P=0.047) in patients who walked less than 350 m in the 6MWT. We found no clinically relevant learning effect in the 30sec-STS. Conclusion In patients with severe and very severe COPD the 6MWT and the 30sec-STS showed excellent intra- and inter-rater reliability and acceptable agreement. No learning effect was documented for the tests when performed on the same day. Our data suggest that in clinical practice using different assessors is acceptable, and that a single test trial may be sufficient to assess patients with severe and very severe COPD.
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Affiliation(s)
- Henrik Hansen
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Beyer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Godtfredsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Hansen H, Bieler T, Beyer N, Godtfredsen N, Kallemose T, Frølich A. COPD online-rehabilitation versus conventional COPD rehabilitation - rationale and design for a multicenter randomized controlled trial study protocol (CORe trial). BMC Pulm Med 2017; 17:140. [PMID: 29145831 PMCID: PMC5689178 DOI: 10.1186/s12890-017-0488-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 01/18/2023] Open
Abstract
Background Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program and 30–50% drop-out before completion. The main reasons are severe symptoms, inflexible accessibility and necessity for transportation. Currently there are no well-established and evident rehabilitation alternatives. Supervised online screen rehabilitation could be a useful approach to increase accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). Methods This study is a randomized assessor- and statistician blinded superiority multicenter trial with two parallel groups, employing 1:1 allocation to the intervention and the comparison group.On the basis of a sample size calculation, 134 patients with severe or very severe COPD and eligible to conventional hospital based outpatient COPD rehabilitation will be included and randomized from eight different hospitals. The CORe intervention group receives group supervised resistance- and endurance training and patient education, 60 min, three times/week for 10 weeks at home via online-screen. The CCRe comparison group receives group based supervised resistance- and endurance training and patient education, 90 min, two times/week for 10 weeks (two hospitals) or 12 weeks (six hospitals) in groups at the local hospital. The primary outcome is change in the 6-min walking distance after 10/12 weeks; the secondary outcomes are changes in 30 s sit-to-stand chair test, physical activity level, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline assessments. Discussion The study will likely contribute to knowledge regarding COPD tele-rehabilitation and to which extent it is more feasible and thereby more efficient than conventional COPD rehabilitation in patients with severe and very severe COPD. Trial registration Clinicaltrials.gov Identifier: NCT02667171. Registration data: January 28th 2016.
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Affiliation(s)
- Henrik Hansen
- Research Unit for Chronic Diseases and Telemedicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark. .,Research Unit for Chronic Diseases and Telemedicine, University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark.
| | - Theresa Bieler
- Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Center, Hvidovre University Hospital, Hvidovre, Denmark
| | - Anne Frølich
- Research Unit for Chronic Diseases and Telemedicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark
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Bieler T, Siersma V, Magnusson SP, Kjaer M, Beyer N. Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis. Physiother Res Int 2017; 23. [DOI: 10.1002/pri.1697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - S. Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute for Clinical Medicine; University of Copenhagen; Copenhagen Denmark
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Eriksen CS, Garde E, Reislev NL, Wimmelmann CL, Bieler T, Ziegler AK, Gylling AT, Dideriksen KJ, Siebner HR, Mortensen EL, Kjaer M. Physical activity as intervention for age-related loss of muscle mass and function: protocol for a randomised controlled trial (the LISA study). BMJ Open 2016; 6:e012951. [PMID: 27913559 PMCID: PMC5168596 DOI: 10.1136/bmjopen-2016-012951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/04/2016] [Accepted: 11/08/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Physical and cognitive function decline with age, accelerating during the 6th decade. Loss of muscle power (force×velocity product) is a dominant physical determinant for loss of functional ability, especially if the lower extremities are affected. Muscle strength training is known to maintain or even improve muscle power as well as physical function in older adults, but the optimal type of training for beneficial long-term training effects over several years is unknown. Moreover, the impact of muscle strength training on cognitive function and brain structure remains speculative. The primary aim of this randomised controlled trial is to compare the efficacy of two different 1 year strength training regimens on immediate and long-lasting improvements in muscle power in retirement-age individuals. Secondary aims are to evaluate the effect on muscle strength, muscle mass, physical and cognitive function, mental well-being, health-related quality of life and brain morphology. METHODS AND ANALYSIS The study includes 450 home-dwelling men and women (62-70 years). Participants are randomly allocated to (1) 1 year of supervised, centre-based heavy resistance training, (2) home-based moderate intensity resistance training or (3) habitual physical activity (control). Changes in primary (leg extensor power) and secondary outcomes are analysed according to the intention to treat principle and per protocol at 1, 2, 4, 7 and 10 years. ETHICS AND DISSEMINATION The study is expected to generate new insights into training-induced promotion of functional ability and independency after retirement and will help to formulate national recommendations regarding physical activity schemes for the growing population of older individuals in western societies. Results will be published in scientific peer-reviewed journals, in PhD theses and at public meetings. The study is approved by the Regional Ethical Committee (Capital Region, Copenhagen, Denmark, number H-3-2014-017). TRIAL REGISTRATION NUMBER NCT02123641.
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Affiliation(s)
- Christian Skou Eriksen
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
| | - Ellen Garde
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nina Linde Reislev
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Cathrine Lawaetz Wimmelmann
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Andreas Kraag Ziegler
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
| | - Anne Theil Gylling
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
| | - Kasper Juel Dideriksen
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Neurology, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Department of Orthopedic Surgery M, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Demark
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Bieler T, Siersma V, Magnusson S, Kjaer M, Beyer N. OP0006-HPR Even in The Long Run Nordic Walking Is Superior To Strength Training and Home Based Exercise for Improving Physical Function in Older People with Hip Osteoarthritis - An RCT. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bieler T, Magnusson SP, Christensen HE, Kjaer M, Beyer N. Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study. Disabil Rehabil 2016; 39:1414-1421. [DOI: 10.1080/09638288.2016.1198426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Theresa Bieler
- Musculoskeletal Rehabilitation Research Unit, Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Musculoskeletal Rehabilitation Research Unit, Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Elisabeth Christensen
- Department of Radiology Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Musculoskeletal Rehabilitation Research Unit, Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
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Bieler T, Siersma V, Magnusson SP, Kjaer M, Christensen HE, Beyer N. In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function. Scand J Med Sci Sports 2016; 27:873-886. [DOI: 10.1111/sms.12694] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/21/2022]
Affiliation(s)
- T. Bieler
- Institute of Sports Medicine Copenhagen; Bispebjerg and Frederiksberg Hospitals; University of Copenhagen and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Musculoskeletal Rehabilitation Research Unit; Department of Physical & Occupational Therapy Bispebjerg and Frederiksberg Hospitals; University of Copenhagen; Copenhagen Denmark
| | - V. Siersma
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - S. P. Magnusson
- Institute of Sports Medicine Copenhagen; Bispebjerg and Frederiksberg Hospitals; University of Copenhagen and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Musculoskeletal Rehabilitation Research Unit; Department of Physical & Occupational Therapy Bispebjerg and Frederiksberg Hospitals; University of Copenhagen; Copenhagen Denmark
| | - M. Kjaer
- Musculoskeletal Rehabilitation Research Unit; Department of Physical & Occupational Therapy Bispebjerg and Frederiksberg Hospitals; University of Copenhagen; Copenhagen Denmark
| | - H. E. Christensen
- Department of Radiology Bispebjerg and Frederiksberg Hospitals; University of Copenhagen; Copenhagen Denmark
| | - N. Beyer
- Institute of Sports Medicine Copenhagen; Bispebjerg and Frederiksberg Hospitals; University of Copenhagen and Center for Healthy Aging; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Hammer NM, Bieler T, Beyer N, Midtgaard J. The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis - a mixed methods study. Disabil Rehabil 2015; 38:1691-704. [PMID: 26677724 DOI: 10.3109/09638288.2015.1107642] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. METHOD An SE-theory based mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n = 52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10-100) were analysed (Mann-Whitney test) for differences in characteristics of maintainers and non-maintainers. Semi-structured individual interviews (n = 15; at 12-months follow-up) were analysed using directed content analysis. RESULTS Compared to non-maintainers (n = 9; 17%) maintainers (n = 31; 60%) had improved (p < 0.01) in median scores of ASES (Pain: +12 versus -32 points; Function: +7 versus -9 points; Other Symptoms: +11 versus -26 points) from baseline to 12 months. Experiences of possessing required skills, inspiration by other participants, encouragement from physical therapists and altered interpretations of PA-induced physiological conditions contributed to increased SE and PA maintenance. Moreover, experienced symptoms, exercise outcome expectations and obligation towards the study influenced maintenance. CONCLUSION SE contributes to understanding of post-intervention PA maintenance in patients with hip osteoarthritis. However, disease-related factors and clinical trial participation appears significant too. Implications for Rehabilitation Patients' perceived self-efficacy for physical activity contributes to the understanding of post-intervention physical activity maintenance in patients with hip osteoarthritis. Practitioners may benefit from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits. Post-intervention physical activity maintenance may be increased by focussing on the patients' exercise self-efficacy through verbal persuasion and support, disease-specific information and information on normal physiological responses to exercise combined with an individualised training progression to support experiences of success and achievement of desired outcomes.
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Affiliation(s)
- Nanna Maria Hammer
- a The University Hospitals Centre for Health Research, Copenhagen University Hospital , Copenhagen , Denmark
| | - Theresa Bieler
- b Musculoskeletal Rehabilitation Research Unit, Department Physical and Occupational Therapy & Institute of Sports Medicine Copenhagen , Bispebjerg & Frederiksberg Hospitals, University of Copenhagen , Copenhagen , Denmark
| | - Nina Beyer
- b Musculoskeletal Rehabilitation Research Unit, Department Physical and Occupational Therapy & Institute of Sports Medicine Copenhagen , Bispebjerg & Frederiksberg Hospitals, University of Copenhagen , Copenhagen , Denmark
| | - Julie Midtgaard
- a The University Hospitals Centre for Health Research, Copenhagen University Hospital , Copenhagen , Denmark ;,c Department of Public Health , Section of Social Medicine, University of Copenhagen , Copenhagen , Denmark
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Bieler T, Magnusson S, Kjaer M, Beyer N. SAT0451 Supervised Strength Training, NORDIC Walking or Unsupervised Home Based Exercise in Older People with Hip Osteoarthritis? A Randomized Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bieler T, Magnusson S, Kjaer M, Beyer N. Intra-rater reliability and agreement of muscle strength, power and functional performance measures in patients with hip osteoarthritis. J Rehabil Med 2014; 46:997-1005. [DOI: 10.2340/16501977-1864] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
AIM Prognosis and treatment of Achilles tendon pain (achillodynia) has been insufficiently studied. The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia. METHODS Patients with achillodynia for at least 3 months were randomly allocated to one of two exercise regimens. Exercise was performed daily for a 3-month period. Symptom severity was evaluated by tendon tenderness, ultrasonography, a questionnaire on pain and other symptoms, and a global assessment of improvement. Follow-up was performed at time points 3, 6, 9, 12 weeks and 1 year. RESULTS Of 53 patients with achillodynia 45 patients were randomized to either eccentric exercises or stretching exercises. Symptoms gradually improved during the 1-year follow-up period and were significantly better assessed by pain and symptoms after 3 weeks and all later visits. However, no significant differences could be observed between the two groups. Women and patients with symptoms from the distal part of the tendon had significantly less improvement. CONCLUSIONS Marked improvement in symptoms and findings could be gradually observed in both groups during the 1-year follow-up period. To that extent this is due to effect of both regimens or the spontaneous improvement is unsettled.
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Affiliation(s)
- J Nørregaard
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
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Barkler EH, Magnusson SP, Becher K, Bieler T, Aagaard P, Kjaer M, Saugbjerg PA. [The effect of supervised rehabilitation on ankle joint function and the risk of recurrence after acute ankle distortion]. Ugeskr Laeger 2001; 163:3223-6. [PMID: 11421189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
INTRODUCTION The effect of an early rehabilitation programme, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. METHODS Ninety-two subjects, matched for age, sex, and level of sports activity, were randomised to a control or training group. All subjects received the same standard information about early ankle mobilisation. In addition, the training group participated in supervised physical therapy rehabilitation (one hour, twice weekly) with emphasis on balance training. Postural sway, position sense, and isometric ankle strength were measured six weeks and four months after the injury, and at 12 months data on re-injury were collected. RESULTS In both the training group and the control group, there were a significant difference between the injured and the uninjured side for all variables except for position sense at six weeks. The side-to-side differences in per cent were similar for both groups for all variables (p > 0.05) at six weeks, and there were no such differences at four months. Re-injury occurred in 11/38 (29%) is the control group, but in only 2/29 (7%) in the training group (p < 0.05). CONCLUSION These data showed that an ankle injury led to reduced ankle strength and postural control at six weeks, but that these variables had become normal at four months, irrespective of supervised rehabilitation. However, the findings also showed that supervised rehabilitation may reduce the number of re-injuries, and may therefore play a role in injury prevention.
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Affiliation(s)
- E H Barkler
- H:S Bispebjerg Hospital, idraetsmedicinsk forskningscenter
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Holme E, Magnusson SP, Becher K, Bieler T, Aagaard P, Kjaer M. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports 1999; 9:104-9. [PMID: 10220845 DOI: 10.1111/j.1600-0838.1999.tb00217.x] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.
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Affiliation(s)
- E Holme
- Dept. of Rheumatology H, Bispebjerg Hospital, Copenhagen, Denmark
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Abstract
Low energy laser (LEL) is a widely used treatment for a variety of musculoskeletal disorders although convincing documentation of the effect is missing. We have examined the LEL effect on Rheumatoid Arthritis (RA) in a double blind placebo controlled study. Twenty-two patients completed the study (10 receiving LEL treatment) according to the protocol. A significant effect on pain score was found due to LEL treatment, but when data were corrected for disease variation the effect disappeared. No effect of LEL could be demonstrated on the other assessed variables: grip strength, morning stiffness, flexibility, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). In conclusion, we did not find that LEL had any clinically relevant effects on RA.
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Affiliation(s)
- F Johannsen
- Department of Rheumatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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