Urs N. Gamper
Pilotprojekt zum Direktzugang in der Ostschweiz
Physioactive 2014; (6): 21-25
Fit mit 12 Übungen
Sprechstunde Dr. Stutz, Mai 2015
Trippolini MA, Dijkstra PU, Jansen B, Oesch P, Geertzen JH, Reneman MF
Reliability of clinician rated physical effort determination during functional capacity evaluation in patients with chronic musculoskeletal pain.
J Occup Rehabil. 2014 Jun;24(2):361-9.
Oesch P, Meyer K, Jansen B, Kool J
Functional Capacity Evaluation: Performance of Patients with Chronic Nonspecific Low Back Pain Without Waddell Signs
J Occup Rehabil. 2014 Sep 5
Hasselmann V, Oesch P
Are exergames promoting mobility an attractive alternative to conventional self training for elderly people? Study protocol of a randomized controlled trial.
BMC Geriatr. 2014
Wirz M, Köhler B, Marks D, Kool J, Oesch P, Sattelmayer M
Lehrbuch Assessments in der Rehabilitation.
Hans Huber Verlag 2014
Spreitler F, Oesch P
Ist individuelle Klettertherapie bei Patienten mit fortgeschrittener Multiple Sklerose eine mögliche Therapieform zur Verbesserung der posturalen Stabilität, des Sturzrisikos und der Sturzangst?
Abstracts Physiocongress 2014
Bansi J., Luyckx K.
Physio- und Sporttherapie im Wasser
Forte; Schweizerische Multiple Sklerose Gesellschaft
Mai 2014: 10-13
Neuroreha Valens: zurück ins Leben
med & move 2015 Bewustsein, Ars Medici; 26-27
Oesch P, Meyer K, Jansen B, Kool J
Functional Capacity Evaluation: Performance of Patients with Chronic Nonspecific Low Back Pain Without Waddell Signs
J Occup Rehabil. 2014 Sep 5
Work-related evaluation and rehabilitation of patients with low back pain
EULAR HP news 2013; 7 (1): 10-11
Physiopraxis 2013: 13 (3)
Bachmann S, Oesch P
Elektronische Spiele machen Senioren mobil
Bündner Woche; 24. April 2013
There are a lot of symptoms, how can you analyse?
J. Man. Phy. Therapy 2013; 13 (1): 27-32
Bansi J, Block W, Gamper U, Riedel S, Kesselring J
Endurance training in MS: short-term immune responses and their relation to cariorespiratory fitness, health-related quality of life and fatigue
J Neurol 2013; 260 (12): 2993-3001
Effects of Three Weeks Aquatic Cycling on Growth Factor BDNF and Cardiorespiratory Fitness and health-related quality of life
Turk J Physio Rehab 2013: 24 (2): 83
Daniel H, Oesch P, Stuck AE, Born S, Bachmann S, Schönenberger AW
Evaluation of a novel photography-based home assessment protocol for identification of environmental risk factors for falls in eldery persons
Swiss medical weekly, 143, w13884, doi:10.4414/smw.2013.13884
Schnurr B, Oesch P. Sind Nintendo Wii®-Balancespiele eine machbare Alternative zum herkömmlichen Selbsttraining des Gleichgewichts nach Schlaganfall? ergoscience 2012. 2012;7(4)
BACKGROUND: Low back pain (LBP) is one of the major concerns in health care. In Switzerland, musculoskeletal problems represent the third largest illness group with 9.4 million consultations per year. The return to work rate is increased by an active treatment program and saves societal costs. However, results after rehabilitation are generally poorer in patients with a Southeast European cultural background than in other patients. This qualitative research about the rehabilitation of patients with LBP and a Southeast European cultural background, therefore, explores possible barriers to successful rehabilitation. METHODS: We used a triangulation of methods combining three qualitative methods of data collection: 13 semi-structured in-depth interviews with patients who have a Southeast European cultural background and live in Switzerland, five semi-structured in-depth interviews and two focus groups with health professionals, and a literature review. Between June and December 2008, we recruited participants at a Rehabilitation Centre in the German-speaking part of Switzerland. RESULTS: To cope with pain, patients prefer passive strategies, which are not in line with recommended coping strategies. Moreover, the families of patients tend to support passive behaviour and reduce the autonomy of patients. Health professionals and researchers propagate active strategies including activity in the presence of pain, yet patients do not consider psychological factors contributing to LBP. The views of physicians and health professionals are in line with research evidence demonstrating the importance of psychosocial factors for LBP. Treatment goals focusing on increasing daily activities and return to work are not well understood by patients partly due to communication problems, which is something that patients and health professionals are aware of. Additional barriers to returning to work are caused by poor job satisfaction and other work-related factors. CONCLUSIONS: LBP rehabilitation can be improved by addressing the following points. Early management of LBP should be activity-centred instead of pain-centred. It is mandatory to implement return to work management early, including return to adapted work, to improve rehabilitation for patients. Rehabilitation has to start when patients have been off work for three months. Using interpreters more frequently would improve communication between health professionals and patients, and reduce misunderstandings about treatment procedures. Special emphasis must be put on the process of goal-formulation by spending more time with patients in order to identify barriers to goal attainment. Information on the return to work process should also include the financial aspects of unemployment and disability.
Schädler S, Kool J, Lüthi H, Marks D, Oesch P, Pfeffer A, Wirz M. Assessments in der Neurorehabilitation. 3 ed. Bern: Hans Huber Verlag; 2012.
STUDY DESIGN: Analytical cross-sectional study. OBJECTIVE: To assess the association of "nonorganic somatic components" together with physical and other psychosocial factors on functional capacity evaluation (FCE) in patients with chronic nonspecific low back pain (NSLBP) undergoing fitness-for-work evaluation. SUMMARY OF BACKGROUND DATA: Functional capacity evaluation is increasingly used for physical fitness-for-work evaluation in patients with chronic NSLBP, but results seem to be influenced by physical as well as psychosocial factors. The influence of nonorganic somatic components together with physical and other psychosocial factors on FCE performance has not yet been investigated. METHODS: One hundred twenty-six patients with chronic NSLBP referred for physical fitness-for-work evaluation were included. The 4 FCE tests were lifting from floor to waist, forward bend standing, grip strength, and 6-minute walking. Nonorganic somatic components were assessed with the 8 nonorganic somatic signs as defined by Waddell and were adjusted for age, sex, days off work, salary in the previous occupation, pain intensity, fear avoidance belief, and perceived functional ability in multivariate regression analyses. RESULTS: Between 42% and 58% of the variation in the FCE tests was explained in the final multivariate regression models. Nonorganic somatic components were consistent independent predictors for all tests. Their influence was most important on forward bend standing and walking distance, and less on grip strength and lifting performance. The physical factors of age and/or sex were strongly associated with grip strength and lifting, less with walking distance, and not at all with forward bend standing. The influence of at least 1 other psychosocial factor was observed in all FCE tests, having the highest proportion in the 6-minute walking test. CONCLUSION: Nonorganic somatic components seem to be consistent independent predictors in FCE testing and should be considered for interpretation of test results.
BACKGROUND: Functional capacity evaluation (FCE) requires determination of effort by observation of effort indexes for performance interpretation. Waddell signs have been shown to be associated with decreased functional performance. Whether determination of effort by observational criteria and Waddell sign testing can be used interchangeably to interpret lifting performance is unknown. OBJECTIVE: The purposes of this study were to assess the concurrent validity of submaximal effort and Waddell signs and to determine whether these contribute independently to lifting performance. DESIGN: This investigation was an analytical cross-sectional study. METHODS: A total of 130 people who had chronic nonspecific low back pain and were referred for fitness-for-work evaluation were included. Physical effort was determined on the basis of observational criteria for lifting from floor to waist, lifting from waist to shoulder, and horizontal lifting during FCE. A second assessor conducted Waddell sign testing. The concurrent validity of Waddell signs and submaximal effort was assessed by calculating sensitivity and specificity. Hierarchical regression analysis was used to determine the contributions of Waddell signs and submaximal effort to lifting performance. Age and sex were covariates. RESULTS: The FCE assessor found a low sensitivity of Waddell signs for submaximal effort determination. Between 53% and 63% of the participants who were classified as showing submaximal effort had Waddell signs. Waddell signs and submaximal effort were independent contributors to lifting performance. The contribution of submaximal effort was larger than that of Waddell signs, as shown by 20% to 29% higher explained variance in lifting performance when submaximal effort was added to the model first versus 3% to 6% higher explained variance when Waddell signs were added first. LIMITATIONS: Assessor variability could have influenced the study results. CONCLUSIONS: In people with chronic nonspecific low back pain, Waddell sign testing and determination of physical effort by observational criteria should not be used interchangeably to interpret lifting performance during FCE.
Daniel H, Oesch P, Stuck A, Born S, Bachman S. Sind virtuelle Hausbesuche durch Bezugspersonen von älteren Menschen eine praktikable, reliable und valide Alternative zu Wohnraumabklärungen vor Ort durch Ergotherapeutinnen? Swiss Med Wkly. 2012;142(Suppl 195)
Training in MS: influence of two different endurance training protocols
(aquatic versus overland) on cytokine and neurotrophin concentrations during
three week randomized controlled trial
Background: The influences of exercising on cytokine response, fatigue and cardiorespiratory values are important aspects of rehabilitation in persons with multiple sclerosis (PwMS). Exercise performed within these programs is often practised in water but the effects of immersion on PwMS have not been systematically investigated.
Objective: The objective of this study is to determine differences in cytokine and neurotrophin concentrations, fatigue and cardiorespiratory values in response to 3 week endurance training conducted on a cycle ergometer or an aquatic bike.
Methods: A randomized controlled clinical trial was conducted in 60 MS patients (Expanded Disability Status Scale range 1.0–6.5). Resting serum levels of brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), Interleukin-6, soluble receptor of IL-6 and tumor necrosis factor alpha, and concentrations in response to cardiopulmonary exercise test (CPET), fatigue and cardiorespiratory values were determined at entry and discharge. Subjects performed daily 30 minute training at 60% of VO2max.
Results: Cytokines and neurotrophins showed no significant differences between groups over the training intervention. Within the water group BDNF resting and post-CPET concentrations (p<0.05) showed a significant increase and NGF tended to increase after the training intervention. Short-term effects on BDNF (CEPT) tended to increase at the start and significantly thereafter (p<0.05). No changes occurred in the land group. Other cytokines and fatigue scores remained unchanged over the training period. Cardiorespiratory values improved significantly over time within both groups.
Conclusion: This study indicates that aquatic training activates BDNF regulation and can be an effective training method during rehabilitation in PwMS.
Gait impairment and fatigue are common and disabling problems in multiple sclerosis (MS). Characterisation of abnormal gait in MS patients has been done mainly using observational studies and simple walking tests providing only limited quantitative and no qualitative data, or using intricate and time-consuming assessment procedures. In addition, the correlation of gait impairments with fatigue is largely unknown. The aim of this study was to characterise spatio-temporal gait parameters by a simple and easy-to-use gait analysis system (GAITRite(R)) in MS patients compared with healthy controls, and to analyse changes and correlation with fatigue during inpatient rehabilitation. Twenty-four MS patients (EDSS <6.5) admitted for inpatient rehabilitation and 19 healthy subjects were evaluated using the GAITRite(R) Functional Ambulation System. Between-group differences and changes of gait parameters during inpatient rehabilitation were analysed, and correlation with fatigue, using the Wurzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS), was determined. Compared to healthy controls MS patients showed significant impairments in different spatio-temporal gait parameters, which showed a significant improvement during inpatient rehabilitation. Different gait parameters were correlated with fatigue physical score, and change of gait parameters was correlated with improvement of fatigue. Spatio-temporal gait analysis is helpful to assess specific walking impairments in MS patients and subtle changes during rehabilitation. Correlation with fatigue may indicate a possible negative impact of fatigue on rehabilitation outcome.
Oesch P, Hilfiker R, Keller S, Kool J, Schädler S, Tal-Akabi A, Verra M, Widmer-Leu C. Assessments in der muskuloskelettalen Rehabilitation. 2 ed. Bern: Hans Huber Verlag; 2011.
OBJECTIVE: To test a study design and explore the feasibility and potential effects of conventional neurological therapy, constraint induced therapy and therapeutic climbing to improve minimal to moderate arm and hand function in patients after a stroke. METHOD: A pilot study with six-month follow-up in patients after stroke with minimal to moderate arm and hand function admitted for inpatient rehabilitation was performed. Participants were randomly allocated to one of three treatment approaches. Main outcomes were improvement of arm and hand function and adverse effects. RESULTS: 283 patients with stroke were screened for inclusion over a two-year period, out of which fourtyfour were included. All patients could be treated according to the protocol. Improvement of arm and hand function was significantly higher in conventional neurological therapy and constraint induced therapy compared with therapeutic climbing at discharge, and at six months follow-up (P < 0.05, effect size = 0.56-0.76). No significant differences in arm and hand function were observed between constraint induced therapy and conventional neurological therapy. Constraint induced therapy participants were significantly less at risk of developing shoulder pain at six months follow-up compared with the other participants (P < 0.05, effect size = 0.82 and 1.79, respectively). CONCLUSIONS: The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.
To systematically and comprehensively describe functioning and disability in Multiple sclerosis (MS), practical tools based on the International Classification of Functioning, Disability and Health (ICF), such as ICF Core Sets, are needed. OBJECTIVE: To report on the results of an evidence-based International Consensus Conference to develop the Comprehensive and Brief ICF Core Set for MS. A formal and iterative decision-making and consensus process was undertaken, involving the integration of evidence from preparatory studies (expert survey, systematic literature review, qualitative study, empirical cross-sectional study) and expert opinion. The decision-making and consensus process included discussions and voting in working groups and plenary sessions involving selected international experts from different health professions. Twenty-one experts from 16 countries selected 138 ICF categories for the Comprehensive ICF Core for MS (40 Body functions, 7 Body structures, 53 Activities and Participation categories and 38 Environmental factors) and 19 categories for the Brief ICF Core Set for MS (8 Body functions, 2 Body structures, 5 Activities and Participation categories, 4 Environmental factors). An evidence-based and formal decision-making consensus process led to the approval of ICF Core Sets for MS which should be further validated.
The aim of this study involving 170 patients suffering from non-specific low back pain was to test the validity of the spinal function sort (SFS) in a European rehabilitation setting. The SFS, a picture-based questionnaire, assesses perceived functional ability of work tasks involving the spine. All measurements were taken by a blinded research assistant; work status was assessed with questionnaires. Our study demonstrated a high internal consistency shown by a Cronbach's alpha of 0.98, reasonable evidence for unidimensionality, spearman correlations of >0.6 with work activities, and discriminating power for work status at 3 and 12 months by ROC curve analysis (area under curve = 0.760 (95% CI 0.689-0.822), respectively, 0.801 (95% CI 0.731-0.859). The standardised response mean within the two treatment groups was 0.18 and -0.31. As a result, we conclude that the perceived functional ability for work tasks can be validly assessed with the SFS in a European rehabilitation setting in patients with non-specific low back pain, and is predictive for future work status.
OBJECTIVES: To determine whether exercise is more effective than usual care to reduce work disability in patients with non-acute non-specific low back pain, and if so, to explore which type of exercise is most effective. METHODS: Systematic review and meta-analysis of randomized controlled trials investigating the effectiveness of exercise in non-acute non-specific low back pain, and reporting on work disability. Data sources: MEDLINE, EMBASE, PEDro, Cochrane Library databases, NIOSHTIC-2, and PsycINFO until August 2008. Work disability data were converted to odds ratios. Random effects meta-analyses were conducted. RESULTS: A total of 23 trials met the inclusion criteria, 20 of which were suitable for inclusion in meta-analysis allowing 17 comparisons of exercise interventions with usual care and 11 comparisons of 2 different exercise interventions. A statistically significant effect in favour of exercise on work disability was found in the long term (odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48-0.92) but not in the short (OR = 0.80, 95% CI 0.51-1.25) and intermediate term (OR = 0.78, 95% CI 0.45-1.34). Meta-regression indicated no significant effect of specific exercise characteristics. CONCLUSION: Exercise interventions have a significant effect on work disability in patients with non-acute non-specific low back pain in the long term. No conclusions can be made regarding exercise types.
Oesch P, Bachmann S. Physical Medicine and Rehabilitation. In: Firestein G, Budd R, Harris E, McInnes I, Ruddy S, Sergent J, editors. Kelley's Textbook of Rheumatology. 8 ed. Philadelphia: Elsevier; 2009.
Oesch P. The management of work disability of persons with arthritis and rheumatism. Ann Rheum Dis. 2009;68(Suppl3):19
Lambeck J, Gamper U. The Bad Ragaz Ringmethod. In: Brody L, Geigle P, editors. Aquatic Exercise for Rehabilitation and Training2009. p. 79-100.
Lambeck J, Gamper U. The Halliwick Concept. In: Brody L, Geigle P, editors. Aquatic Exercise for Rehabilitation and Training2009. p. 45 – 71.
Cantieni M, Leensen T, Knüsel O, Oesch P. Ist die ILOAS ein geeignetes Messinstrument zur Erfassung des funktionellen Status von Patienten mit Kniegelenkersatz während der stationären Rehabilitation? Reproduzierbarkeit, Validität und Responsivität der Iowa Level of Assistance Scale. physioscience 2009;5(4):165-72
Brodbeck D, Degen M, Stanimirov M, Kool J, Scheermesser M, Oesch P, Neuhaus M, editors. Computer-aided therapy system with augmented feedback for the lower back. Proceedings of the Second International Conference on Health Informatics; 2009 January 14-17; Porto, Portugal.
OBJECTIVE: To compare costs of function- and pain-centred inpatient treatment in patients with chronic low back pain over 3 years of follow-up. DESIGN: Cost analysis of a randomized controlled trial. PATIENTS: A total of 174 patients with chronic low back pain were randomized to function- or pain-centred inpatient treatment. METHODS: Data on direct and indirect costs were gathered by questionnaires sent to patients, health insurance providers, employers, and the Swiss Disability Insurance Company. RESULTS: There was a non-significant difference in total medical costs after 3 years' follow-up. Total costs were 77,305 Euros in the function-centred inpatient treatment group and 83,085 Euros in the pain-centred inpatient treatment group. Likewise, indirect costs after 3 years from lost work days were non-significantly lower in the function-centred in-patient treatment group (6354 Euros; 95% confidence interval -20,892, 8392) and direct medical costs were non-significantly higher in the function-centred inpatient treatment group (574 Euros; 95% confidence interval -862, 2011). CONCLUSION: The total costs of function-centred and pain-centred inpatient treatment were similar over the whole 3-year follow-up.
Overberg J, Oesch P, Perrot G. Wie standardisiert sind Nachbehandlungsschemata für Knieendoprothesen in der Schweiz? physioscience. 2007;3:9-15
Oesch P. Patient centred rehabilitation after total knee replacement. Ann Rheum Dis. 2007;66(Suppl II):33
Oesch P. Assessment: Umfangmessungen - Gekonnter Umgang mit dem Maßband. physiopraxis. 2007;1:34-5
OBJECTIVE: To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Patients (N=174; 79% male; mean age, 42 y) with previous sick leave of 6 weeks or more. INTERVENTIONS: FCT (4 h/d for 3 wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3 wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat. MAIN OUTCOME MEASURES: Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2-0.5), moderate (0.5-0.8), and large (>0.8). RESULTS: After 1 year, the FCT group had significantly more work days (mean, 118; median, 39.5; interquartile range [IQR], 0-198) than the PCT group (mean, 74; median, 0; IQR, 0-160; Mann-Whitney U test, P=.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval, 1.1-3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant. CONCLUSIONS: FCT is more effective than PCT for increasing work days.
Gamper U. Konservative Therapie bei peripheren Nervenläsionen und radikulären Syndromen. In: Mumenthaler M, Stöhr M, Müller-Vahl H, editors. Läsionen Peripherer Nerven und Radikuläre Syndrome. 9 ed. Stuttgart: Georg Thieme Verlag; 2007.