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Dr. med. Stefan Bachmann, Rehabilitationszentrum Klinik Valens Costs of long term disability in patients with non-specific low back pain: Three year follow up of a randomized study | ||||
| In Switzerland CHF 5.5 Billion per year are paid for disability allowances. Musculoskeletal and psychiatric disorders constitute the largest subgroups. Disability due to low back pain is one of the important factors for a disability allowance in musculoskeleral disorders. We performed a randomized controlled trial in 174 in-patients with non-acute nonspecific low back pain and work-related disability comparing two treament regimens. Thereby Function Centred Treatment FCT significantly improved the number of days at work after one year (115 days at work), compared with Pain Centred Treatment PCT (75 days at work). At one-year follow-up, 32 of 87 patients in the FCT group and 38 of 87 patients in the PCT group received a disability allowance. Further we found a significant difference in the indirect costs favoring the FCT, but direct cost at one- year follow-up were the same. Results... | ||||
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Dr. Dimitri Ceroni, Hôpital des Enfants, Clinique d'Orthopédie et de Traumatologie, Genève Repercussions of peripheral fractures in children and adolescents | ||||
| Childhood fractures are a major public health problem, 25 % of children consulting in emergency services having a broken bone. Before the end of puberty, half of adolescents reported a fracture and 15 to 25 % of them had more than one lesion. During growth, casting is the treatment of choice for limb fracture and his duration is dependant of callus formation. Immobilization is beneficial for local bone recovery , however it may conduct to general mineral loss. Bone mineral acquisition is high during adolescence and reaches a peak at the end of puberty. Fractures generally happens during this critical phase of growth and may lead to sub-optimal skeletal development and poor resistance to fracture. This has a clinical implication because a 10 to 15 % reduction in bone mineral mass at the end of puberty is associated with a 25 to 50 % increased osteoporosis fracture risk during adulthood. Results... | ||||
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Brigitta Danuser, Institut universitaire romand de Santé au Travail Interdisciplinary intervention strategy for chronic MSDs | ||||
| Work-related musculoskeletal disorders are a persistent and expensive health challenge in all industrial countries including Switzerland. A recent European survey indicates that, among the working population, the three most common work health problems reported are: back pain (30%, increasing), stress (28%), muscular pain in arms or in legs (25%). The cost of work-related MSD in Switzerland has been estimated to about 2-4 Mia CHF per year. A relatively small group of patients causes relatively high health services costs and long absenteeism from work and furthermore show a high risk to loose workability.
Significant progresses have been made these last years in the understanding of the disorder occurrence and chronitisation. Despite of this, the management and successful rehabilitation of MSD suffering workers is still difficult. Recent reviews recommend an intervention strategy based on the bio-psycho-social model. Work hardening and work rehabilitation programs seek to achieve a balance between the physical and mental demands of the job and the individual’s abilities. In a pilot project, we developed and tested the needed instruments and protocols for a multi-disciplinary intervention strategy that takes both aspects into account. This involves the application of clinical and occupation medical skills (rheumatology, occupational medicine, work psychology, ergonomics). Results... | ||||
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Prof. Dr. Annette Draeger, Anatomisches Institut, Universität Bern Myopathy associated with cholesterol-lowering therapy | ||||
| Cardiovascular diseases are the leading cause of death in developed countries and high serum cholesterol has been identified as one principal risk factor. However, muscle pain is a frequent side effect of lipid-lowering therapy. The most severe form is rhabdomyolysis, a potentially life threatening adverse event. Pain and weakness are clinical signs of potentially advanced damage of muscle cells, whose functional and structural integrity is critically dependent upon the stability of their cell membrane.
Our previous work has shown that the skeletal muscle cell membrane has a unique internal structure, rendering it vulnerable to cholesterol depletion. Preliminary experiments in rats demonstrate that the inhibition of an enzyme responsible for cholesterol biosynthesis (HMG CoA reductase) via statin treatment may elicite muscle damage resembling injuries reported in humans. Results... | ||||
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Prof. Dr. Hans Hoppeler, Anatomisches Institut der Universität Bern Chronic eccentric exercise training for the elderly | ||||
| In addition, after falls, elderly people who have led independent lives often require permanent care and experience reduced quality of life. Results... | ||||
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Prof. Dr. Brigitte Jolles, Service d’Orthopédie et de Traumatologie de l’Appareil Moteur, CHUV, Hôpital Orthopédique de la Suisse Romande, Lausanne A new method for treatment outcome evaluation in shoulder pathology | ||||
| Nowadays, physicians have some tools to assess the efficacy of shoulder treatments. Among these tools, they have a lot of questionnaires, that each patient have to fill out, and which contain different items as for example questions on shoulder pain, range of motion or effects of the disease on their daily lives. These subjective data are very important but they lack an objective part in the assessment of the treatment outcome.
As for the doctors, they can assess the range of motion or the muscular power for example. However, they can't make a direct relationship between these data and the limitations patients have or the improvements patients will have with treatment in the activities of the daily lives.
Therefore, physicians currently lack a convenient and simple method to reliably assess the activity and the quality of life of their patients before and after shoulder treatment. Results... | ||||
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PD Dr. Michael Leunig, Orthopädie, spez. Hüfte, Schulthess Klinik Zürich; PD Dr. med. Peter Jüni, Institut für Sozial- und Präventivmedizin der Universität Bern Etiology of primary osteoarthrititis of the hip | ||||
| Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the developed world. Resulting therapeutic interventions and socioeconomic expenditures pose a considerable burden on health and social services. Based on experimental and clinical studies, including in situ inspection in a series of 600 consecutive adolescents and young adults undergoing surgical dislocations of the hip, we propose femoro-acetabular impingement (FAI) to cause early OA in the non-dysplastic hip: morphologic deviations of the proximal femur with a decreased anterior head-neck offset (DAHO) may lead to repetitive trauma of the peripheral articular cartilage during flexion and internal rotation, particularly in individuals taking regular exercises. However, the diagnostic accuracy of clinical tests used to screen for DAHO and FAI is uncertain, reliable estimates of the prevalence of DAHO are lacking, and the prognostic relevance of DAHO for the development of early hip pain and OA is unclear. Results... | ||||
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PD Dr. med. Robert Theiler, Stadtspital Triemli Zürich; Heike A. Bischoff-Ferrari, University Hospital Zurich Early rehabilitation after hip fracture: a randomized controlled trial comparing different vitamin D and physiotherapy programmes | ||||
| Hip fractures are the most common and most severe fractures in the elderly population and the risk increases exponentially with age. A recent meta-analysis on acute management of patients with hip fracture concluded that current research concerning management of falls, geriatric risk factors and fracture prevention in these patients are not adequately addressed. Results... | ||||
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