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Objective Adverse childhood experiences (ACEs), such as emotional and physical maltreatment, are linked to chronic pelvic pain syndrome (CPPS) in adults. Psychological factors are important in understanding CPPS. We aimed to determine the nature and frequency of ACEs in male and female patients with CPPS and to investigate whether somatic symptoms and psychological comorbidities mediate the relationship of ACE severity with pain intensity. Design Cross-sectional study. Setting Interdisciplinary outpatient clinic for CPPS in Hamburg, Germany. Subjects Individuals with CPPS (n = 234) who were 18 to 84 years of age. Methods Using a self-administered questionnaire, we assessed the history of ACEs (ACE Scale), pain intensity (McGill Pain Questionnaire), somatic symptoms (Patient Health Questionnaire–15]), depression (Patient Health Questionnaire–9), and anxiety (Generalized Anxiety Disorder Scale). Parallel mediation analysis was conducted to examine whether the association of ACE severity with pain intensity is mediated by somatic symptoms, depression, and anxiety. Results Emotional abuse and neglect were reported more than twice as often as physical abuse and neglect (37.2% vs 17.1%). Depression partially mediated the association of ACE severity with pain intensity in the whole study population. In sex-stratified analyses, different patterns of associations were observed, but somatic symptoms predicted pain intensity in both sexes. Conclusions Emotional maltreatment was highly prevalent, supporting an increased consideration of psychological factors in CPPS and indicating the need to screen for ACEs in patients with CPPS. Findings further suggest that depression and somatic symptoms may be important targets for therapeutic interventions in patients with CPPS who have a history of childhood adversity.

ObjectiveTo explore feasibility in terms of delivering and evaluating a combination of physiotherapy and psychotherapy for patients with chronic pelvic pain syndrome (CPPS).DesignProspective non-randomised controlled pilot study.SettingTertiary care facility with a specialised interdisciplinary outpatient clinic for patients with CPPS.ParticipantsA total of 311 patients was approached; 60 participated. 36 patients were included in the intervention group (mean age ±SD 48.6 years±14.8; 52.8% female) and 24 in the control group (mean age ±SD 50.6 years±14.5; 58.3% female). Fourteen participants were lost to follow-up.InterventionsParticipants were non-randomly allocated to the intervention group with two consecutive treatment modules (physiotherapy and cognitive behavioural therapy) with a duration of 9 weeks each or to the control group (treatment as usual).Main outcome measuresFeasibility was operationalised in terms of delivering and evaluating the therapeutic combination. Regarding eligibility as the first aspect of feasibility, willingness to participate, dropout and satisfaction were assessed; for the second aspect, standardised self-report questionnaires measuring health-related quality of life, depression severity and pain were applied.ResultsAlthough eligibility and willingness-to-participate rates were low, satisfaction of the participants in the intervention group was high and dropout rates were low. Results indicated a small and non-significant intervention effect in health-related quality of life and significant effects regarding depression severity and pain.ConclusionsThe combination of physiotherapy and psychotherapy for patients with CPPS seems to be feasible and potentially promising with regard to effect. However, a subsequent fully powered randomised controlled trial is needed.Trial registration numberGerman Clinical Trials Register (DRKS00009976) and ISRCTN (ISRCTN43221600).

Zusammenfassung Hintergrund Erworbene neurologische Erkrankungen mit zerebraler Beteiligung führen häufig zu Einschränkungen der Mobilität und damit auch zu einer erschwerten Teilhabe am gesellschaftlichen Leben. Daher ist die Ermöglichung und Verbesserung von Teilhabe eines der wichtigsten Ziele individuell abgestimmter Rehabilitationsmaßnahmen. Die Wiederherstellung der motorischen Funktionen hängt im Rehabilitationsverlauf nicht zuletzt von der vergangenen Zeit seit dem neurologischen Ereignis ab. Ziel Die vorliegende Untersuchung ging der Frage nach, ob die zu Beginn und am Ende einer komplexen interdisziplinären ambulanten neurologischen Rehabilitation routinemäßig eingesetzten Messinstrumente Veränderungen im Verlauf erfassen können und sich diese bei Personen mit akuten/subakuten und chronischen Geschehen unterscheiden. Methode Retrospektiv wurden die Daten im Zeitraum Januar 2004 bis Dezember 2014 aus dem Neuro Reha Team Pasing, München, ausgewertet. Neben demografischen Daten und der Diagnose wurden die Messergebnisse der Instrumente zur Einschätzung der Funktion der unteren Extremität erhoben. Die Berechnung der intra- und intergruppalen Mittelwertunterschiede in den Messergebnissen erfolgten mittels t-Tests für unabhängige Stichproben und Chi2-Tests. Ergebnisse Die Personen mit neurologischen Geschehen wurden im Mittel 82 ± 36 Tage behandelt. Bei allen eingesetzten Messinstrumenten zeigte sich eine signifikante Veränderung von Ausgangs- zu Endbefund. Bis auf den 10-Meter-Gehtest ergaben sich bei allen Messinstrumenten zwischen der akuten/subakuten und der chronischen Gruppe signifikante Unterschiede im Endbefund zugunsten der akuten/subakuten Gruppe. Schlussfolgerung Der routinemäßige Einsatz von Messinstrumenten in einem neurorehabilitativen Setting erlaubt zuverlässig das schnelle Erfassen von Veränderungen im Therapieverlauf sowohl bei Personen mit akutem/subakutem als auch chronischem neurologischen Geschehen.

Background ERAS (Enhanced Recovery After Surgery) is a multidisciplinary and integrative approach with the goal of optimizing the postoperative recovery. We aimed to analyze the economic impact of a newly established ERAS protocol in minimally invasive heart valve surgery at our institution. Methods ERAS protocol was implemented in 61 consecutive patients who were referred for elective minimally-invasive aortic or mitral valve surgery, between February 1, 2018 and March 31, 2019 (ERAS-group). Another 69 patients who underwent elective minimally-invasive heart valve surgery during the same time period were managed according to the hospital standards (Control-group). A detailed cost comparison analysis was carried out from a hospital perspective using a micro-costing approach. Results The total in-hospital stay was significantly shorter in the ERAS-group compared to the Control-group (6.1 ± 2.6 vs 7.7 ± 3.8 days; p = 0.008) resulting in significant cost savings of €1087.2 per patient (p = 0.003). Due to the intensified physiotherapy in the ERAS protocol, the costs for physiotherapy were €94.3 higher compared to the Control-group (p p = 0.006). Conclusion Implementation of an ERAS-protocol in minimally-invasive cardiac surgery can be carried out safely with a fast postoperative recovery of the patient. ERAS results in a financial benefit of up to €1909 per patient and therefore will play a key role in modern cardiac surgery in the near future.

The aim of this prospective study was to evaluate the feasibility and outcome of an activity assessment and intervention on a specialized palliative care ward. All patients admitted between May 2017 and April 2018 were screened for basic assessment (Step 1). Whenever possible the Tinetti-mobility test (TT) was performed by a physiotherapist. A comparison between physician and nurse-led assessment and patient report was performed (Step 2), followed by a low-intensity individually adapted activity intervention (Step 3). Physical function and global quality of life was measured at intervention start and at discharge. Home care training adherence was controlled by phone call. In total, 437 patients were admitted in one year. In 248 patients, a basic assessment was done of which 131 performed a TT. In this group, median age was 63 years. Types of cancer were gastrointestinal (n=39), lung (n=27), urogenital (n=20), non-cancer (n=26) and other (n=26). Median length of stay was 13 days. Correlations between assessment methods were low to moderate, the highest between the TT and the nurse led assessment. Six patients started the intervention. Four patients completed the intervention, of which two continued with the home based training. In all four patients, an improvement in outcomes was measured. In conclusion in around a quarter of patients on a palliative care ward a TT could be performed. The TT correlated to most with nurse led mobility assessment. In the few accrued patients, the activity intervention showed an effect.

Purpose: The study aim was to analyze whether ambulatory therapy of chronic stroke patients contains elements that specifically address "Activity and participation", and to what extent participation as a major goal in rehabilitation is realized in ambulatory care.Method: Qualitative and quantitative content analysis of standard therapy of 71 chronic stroke patients with upper limb impairment. 469 statements on therapy of 34 therapists were analyzed using data-driven and concept-driven coding based on the International Classification of Functioning, Disability and Health framework.Results: Almost half of therapy provided to stroke patients was related to "Upper extremity" (47.5%), as one out of seven identified main categories. Regarding International Classification of Functioning, Disability, and Health framework, 75.1% of therapeutic practices in ambulatory therapy covered "Body functions," but only 13.2% addressed "Activities and participation". Some statements contained specific therapeutic concepts (9.4%) or isolated notes (2.1%) and were not linkable to the International Classification of Functioning, Disability and Health framework.Conclusions: Ambulatory therapy of chronic stroke patients is related, in part, to participation. There is potential for an increase in participation by applying therapeutic approaches, which actively involve the patients in goal-setting and therapeutic exercises to specifically address activities and participation.Implications for rehabilitationTo realize participation as a major goal in the rehabilitation process ambulatory therapy of chronic stroke patients, one should focus on therapeutic approaches and exercises that specifically address activities and participation.Structured goal-setting, which actively involve patients, can be used to identify goals relevant to individual activities and participation.

Das chronische Unterbauchschmerzsyndrom („chronic pelvic pain syndrome“ [CPPS]) kann mit physiotherapeutischen Befunden einhergehen. Ein interdisziplinares Vorgehen bei PatientInnen mit CPPS wird empfohlen. Allerdings existiert keine standardisierte Befunderhebung und -dokumentation der spezifischen physiotherapeutischen Untersuchung, die nicht nur Grundlage fur die Physiotherapie, sondern auch fur die interdisziplinare Kommunikation ist. Ziel war es, ein Instrument fur die standardisierte Dokumentation der physiotherapeutischen Untersuchungsbefunde fur PatientInnen mit CPPS zu entwickeln und damit ein Tool fur Klinik, Forschung und interprofessionelle Kommunikation zu schaffen. Im Rahmen einer Spezialsprechstunde wurde ausgehend von einer explorativen Literatursuche auf Grundlage eines Expertenkonsensus die erste Version des Instruments erstellt. Diese wurde klinisch fur 13 Monate erprobt, uberarbeitet und nach erneutem Expertenkonsens in die finale Version uberfuhrt. Mit dem Physical Therapy Assessment for Chronic Pelvic Pain Syndrome (PTA-CPPS) konnte ein Instrument entwickelt werden, das interne und externe Muskelgruppen im Unterbauch zur systematischen Erfassung der myofaszialen Befunde auflistet und die muskulare Belastbarkeit, die Atembewegungen sowie Narben und Schmerzregionen erhebt. Erganzend zum Instrument wurde ein Manual fur den Untersuchungsablauf entwickelt. Mit dem Instrument steht fur PatientInnen mit CPPS erstmals ein physiotherapeutisches Befundinstrument fur die interdisziplinare klinische und wissenschaftliche Anwendung zur Verfugung.

Chronic pelvic pain (CPP) is a common pain condition. However, treatment remains challenging. Musculoskeletal findings are frequent; therefore physiotherapy might be helpful. The purpose of this review was to evaluate the current evidence on physiotherapy in patients with CPP (PROSPERO registration number CRD42016037516).Six databases were searched and additional hand searches were performed. Two reviewers independently conducted the database search and selected studies using a two-step approach. The methodological quality was assessed applying the Critical Review Form - Quantitative Studies.A total of eight studies were included. Trigger point therapy was examined in four studies; two of which were randomized controlled trials. All studies indicate a significant change in pain measurement. The other four studies evaluated the effect of biofeedback, Thiele massage, Mensendieck somatocognitive therapy and aerobic exercises, whereas the last two were tested in controlled trials. All studies showed significant improvements in pain assessment.The evidence currently available is sparse with methodological flaws, making it difficult to recommend a specific physiotherapy option. There is an urgent need for high-quality randomized controlled trials to identify the most effective physiotherapy management strategy for patients with CPP.

Clinical studies have suggested beneficial effects of exercise on cognitive function in ageing adults and neurodegenerative diseases such as dementia. Recent work indicates the same for progressive multiple sclerosis (MS), an inflammatory and degenerative disease of the central nervous system (CNS). The biological pathways associated with these effects are however not well understood.In this randomized controlled study, we explored serum levels of the myokine Irisin, the neurotrophin brain-derived neurotrophic factor (BDNF) and Interleukin-6 (IL-6) during acute endurance exercise and over the course of a 9-weeks endurance exercise training period in n=42 patients with progressive MS.We detected a significant increase of BDNF levels in progressive MS patients after 30min of bicycling (p0.001). However, there were no significant changes for baseline levels after 22 sessions of training. No significant effects of acute or prolonged exercise could be found for Irisin or Interleukin-6.Our results indicate that BDNF is strongly induced during acute exercise even in patients with progressive MS and advanced physical disability. Long-term effects of exercise programs on biological parameters (Irisin, BDNF, IL-6) were much less pronounced. Given the hypothesis-driven selection of a limited set of biological markers in this pilot study, future studies should use unbiased approaches in larger samples to obtain a comprehensive picture of the networks involved in exercise effects on neurological diseases.

Community ambulation is often affected after a stroke. However, no validated assessment in German to measure community ambulation on a participation level exists.The purpose was to translate and cross-culturally adapt the Functional Walking Categories (FWC) into German and to assess its validity and reliability in patients with stroke.Cross-cultural adaptation guidelines were used for translation. Face and content validity were established with the aid of an expert committee. A pilot study with patients after stroke in a neurological rehabilitation setting checked for concurrent validity using Kendall's tau and reliability using intraclass correlation coefficients.The results indicated that the German version of the FWC has adequate face and content validity. A total of 30 patients (mean age 62 ± 12.315 years, 56.7% female) participated in the study. The FWC correlated well with the Functional Ambulation Categories (tau-b = 0.783), cadence (tau-b = 0.640), gait velocity (tau-b = 0.628), the comfortable 10-m timed walk (tau-b = -0.629), and the fast 10-m timed walk (tau-b = -0.634). Moderate correlations were found between the FWC and step length (tau-b = 0.483) and the Timed Up and Go (tau-b = -0.520), respectively. Intrarater reliability was moderate (ICC = 0.651) while interrater reliability was excellent (ICC = 0.751) (all correlations p 0.001). However, the study was designed as pilot study, thus, full psychometric property testing was not possible.The German FWC offers a reasonable tool for measuring community ambulation on participation level. However, a user manual seems to be helpful.

Objective Chronic pelvic pain syndrome (CPPS) is a common pain condition with psychosocial and somatic symptoms. Myofascial findings and psychiatric comorbidities are frequent. Therefore, the aim of the study was to analyze myofascial and psychosocial aspects. Furthermore, the study focuses on correlations between these aspects and gender differences in this topic. Design Cross-sectional study. Setting Interdisciplinary outpatient clinic for patients with CPPS at the University Medical Centre Hamburg-Eppendorf, Germany. Methods Participants underwent a multimodal diagnostic algorithm including physiotherapeutic assessment and psychotherapeutic evaluation. Those with a positive diagnosis of CPPS were included. Descriptive statistics were used to characterize and analyze the sample. Bivariate correlations were calculated for the association between myofascial findings and psychopathological symptoms. Results A total of 187 patients (56.7% female, mean age ± SD = 49.06 ± 17.05 years) were included. Women had significantly higher numbers of tender (mean ± SD = 17.53 ± 9.58 vs 13.40 ± 8.79, P = 0.003) and trigger points (mean ± SD = 6.23 ± 6.64 vs 4.09 ± 7.15, P = 0.036). They had also significantly higher values in the PHQ-15 (mean ± SD = 11.51 ± 5.24 vs 9.28 ± 5.49, P = 0.009) and the SF-MPQ (mean ± SD = 17.84 ± 8.95 vs 15.11 ± 7.97, P = 0.041). Several significant correlations between myofascial findings and psychosocial factors exist. Conclusions There might be a link between psychosomatic and myofascial aspects in CPPS; thus further studies are needed. Nevertheless, the results stress the urgent need of a multimodal treatment including physiotherapy and psychotherapy in these patients.

Background Chronic pelvic pain syndrome (CPPS) is a pain condition perceived in the pelvic area for at least 6 months. While evidence of the aetiology and maintenance of CPPS is still unclear and therapy options are rare, there is preliminary evidence for the efficacy of cognitive behavioural therapy and physiotherapy. However, an integrated treatment has not yet been studied. The primary aim of this study is therefore to test the feasibility of combined psychotherapy and physiotherapy for female and male patients with CPPS. The secondary aim is to explore changes in patient-relevant and economic outcomes compared to a control group. Methods A feasibility study with a crossover design based on the principles of a ‘cohort multiple randomized controlled trial’ will be conducted to test a combined therapy for patients with CPPS. The study will consist of two consecutive treatment modules (cognitive behavioural group psychotherapy and physiotherapy as individual and group sessions), which will be applied in varying order. The modules will consist of nine weekly sessions with a 4-week break between the modules. The control group will undergo treatment as usual. Study subjects will be recruited from the interdisciplinary outpatient clinic for CPPS at the University Medical Center Hamburg-Eppendorf. Thirty-six patients will be assigned to the intervention, and 18 patients will be assigned to the control group. The treatment groups will be gender homogeneous. Feasibility as the primary outcome will be analysed in terms of the demand, acceptability, and practicality. Secondary study outcomes will be measured using validated self-rating-scales and physical examinations. Discussion To the best of our knowledge, this study is the first to investigate the feasibility of combined psychotherapy and physiotherapy for patients with CPPS. In addition to testing feasibility, the results can be used for the preliminary estimation of therapeutic effects. The results from this study will be used to generate an enhanced therapeutic approach, which might be subject to further testing in a larger study. Trial registration German Clinical Trials Register, DRKS00009976. Registered on 15 March 2016. ISRCTN, ISRCTN43221600. Registered on 10 May 2016. Electronic supplementary material The online version of this article (10.1186/s13063-017-2387-4) contains supplementary material, which is available to authorized users.

Physical exercise (PE) and/or therapy (PT) shows beneficial effects in advanced cancer patients and is increasingly implemented in hospice and palliative care, although systematic data are rare. This retrospective study systematically evaluated the feasibility of PE/PT in terminally ill cancer patients and of different modalities in correspondence to socio-demographic and disease- and care-related aspects.All consecutive terminally ill cancer patients treated in a palliative care inpatient ward during a 3.5-year period were included. The modalities were chosen according to the therapists' and patients' appraisal of current performance status and symptoms.PE/PT were offered to 572 terminally ill cancer patients, whereof 528 patients (92 %) were able to perform at least one PE/PT unit (average 4.2 units/patient). The most frequently feasible modalities were physical exercises in 50 %, relaxation therapy in 22 %, breathing training in 10 %, and positioning and lymph edema treatment in 6 % each. Physical exercise and positioning treatment were performed significantly more often in older patients (p=0.009 and p=0.022, respectively), while relaxation (p=0.05) and lymph edema treatment (p=0.001) were used more frequently in younger. Breathing training was most frequently performed in head and neck cancer (p=0.002) and lung cancer (p=0.026), positioning treatment in brain tumor patients (p=0.021), and lymph edema treatment in sarcoma patients (p=0.012).PE/PT were feasible in90 % of terminally ill cancer patients to whom PE/PT had been offered. Physical exercises, relaxation therapy, and breathing training were the most frequently applicable methods. Prospective trials are needed to evaluate the efficacy of specific PE/PT programs in terminally ill cancer patients.

Hintergrund: Die Zufriedenheit im Beruf spielt nach Studien aus dem angloamerikanischen Raum eine zentrale Rolle bei der Bindung von qualifiziertem Personal. Arbeitszufriedenheit ist ein komplexes Thema, das bislang fur die Gesundheitsfachberufe in Deutschland nur wenig untersucht ist. In der vorliegenden Studie interessierte insbesondere, welche Faktoren die Arbeitszufriedenheit in den therapeutischen Gesundheitsberufen beeinflussen. Ziel: Ziel der berufspolitisch unabhangigen Arbeitsgruppe Physio- und Ergotherapeuten im Beruf ist es, mittels einer deutschlandweiten Befragung eine Standortbestimmung fur die beiden grosten Gruppen der therapeutischen Gesundheitsfachberufe (Physio- und Ergotherapeuten) durchzufuhren. Der vorliegende 4. Teil beschaftigt sich mit dem Thema Zufriedenheit im Beruf. Methode: Querschnitterhebung mittels hypothesenbasiertem Fragebogen bei in Deutschland tatigen Physio- und Ergotherapeuten in der Zeit von Mai bis Dezember 2008. Ergebnisse: 3506 Fragebogen wurden ausgewertet, 1273 von Ergotherapeuten und 2233 von Physiotherapeuten. Ihre Antworten zum Thema Zufriedenheit im Beruf wurden fur die Parameter Berufsgruppe, Geschlecht, Beschaftigungsverhaltnis und Tatigkeitsort analysiert. Die allgemeine Zufriedenheit der Therapeuten liegt im Mittel bei 67 (0 = gar nicht bis 100 = vollkommen zufrieden). Zusatzlich zu dieser Frage wurden mogliche Einflussfaktoren auf die Arbeitszufriedenheit evaluiert. Wertschatzung und Gestaltungsmoglichkeiten beeinflussen die allgemeine Zufriedenheit im Beruf demnach starker als die Berufswahl, die Arbeitszeiten, der finanzielle Nutzen von Fortbildungen und das Stresserleben. Schlussfolgerungen: Nationale und internationale Studien benennen die in dieser Fragebogenerhebung untersuchten Faktoren zur Arbeitszufriedenheit als wichtige Parameter fur „gute Arbeit“. Grose Zufriedenheit im Beruf kann durch Wertschatzung fordernde Masnahmen und selbst bestimmtes Arbeiten erreicht werden.

Die Reflektorische Atemtherapie ist vielfältig einsetzbar, wie Physiotherapeutin Gesche Ketels am Beispiel der Multiplen Sklerose zeigt. Kern der Technik ist das Arbeiten über das Zwerchfell. Außerdem kommen heiße Kompressen, manuelle Techniken und eine propriozeptive und vestibuläre Stimulation zum Einsatz. Lesen Sie hier, welche Ergebnisse man damit bei Patienten mit MS erreichen kann.

Summary Background Constraint-induced movement therapy (CIMT) is recommended for patients with upper limb dysfunction after stroke, yet evidence to support the implementation of CIMT in ambulatory care is insufficient. We assessed the efficacy of home CIMT, a modified form of CIMT that trains arm use in daily activities within the home environment. Methods In this parallel, cluster-randomised controlled trial, we selected 71 therapy practices in northern Germany that treat adult patients with upper limb dysfunction after stroke. Practices were stratified by region and randomly allocated by an external biometrician (1:1, block size of four) using a computer-generated sequence. 37 practices were randomly assigned to provide 4 weeks of home CIMT and 34 practices to provide 4 weeks of standard therapy. Eligible patients had mild to moderate impairment of arm function at least 6 months after stroke and a friend or family member willing to participate as a non-professional coach. Patients of both groups received 5 h of professional therapist contact in 4 weeks. In the home CIMT group, therapists used the contact time to instruct and supervise patients and coaches in home CIMT. Patients in the standard therapy group received conventional physical or occupational therapy, but additional home training was not obligatory. All assessments were done by masked outcome assessors at baseline, after 4 weeks of intervention, and at 6 month follow-up. The primary outcomes were quality of movement, assessed by the Motor Activity Log (MAL-QOM, assessor-assisted self-reported), and performance time, assessed by the Wolf Motor Function Test (WMFT-PT, assessor-reported). Primary outcomes were tested hierarchically after 4 weeks of intervention and analysed by intention to treat, using mixed linear models. This trial is registered with ClinicalTrials.gov, NCT01343602. Findings Between July 11, 2011, and June 4, 2013, 85 of 156 enrolled patients were assigned home CIMT and 71 patients were assigned standard therapy. 82 (96%) patients in the home CIMT group and 71 (100%) patients in the standard therapy group completed treatment and were assessed at 4 weeks. Patients in both groups improved in quality of movement (MAL-QOM; change from baseline 0·56, 95% CI 0·41–0·71, p vs 0·31, 0·15–0·46, p=0·0003 for standard therapy). Patients in the home CIMT group improved more than patients in the standard therapy group (between-group difference 0·26, 95% CI 0·05–0·46; p=0·0156). Both groups also improved in motor function performance time (WMFT-PT; change from baseline −25·60%, 95% CI −36·75 to −12·49, p=0·0006 for home CIMT vs −27·52%, −38·94 to −13·94, p=0·0004 for standard therapy), but the extent of improvement did not differ between groups (2·65%, −17·94 to 28·40; p=0·8152). Nine adverse events (of which six were serious) were reported in the home CIMT group and ten (of which seven were serious) in the standard therapy group; however, none was deemed related to the study intervention. Interpretation Home-based CIMT can enhance the perceived use of the stroke-affected arm in daily activities more effectively than conventional therapy, but was not superior with respect to motor function. Further research is needed to confirm whether home CIMT leads to clinically significant improvements and if so to identify patients that are most likely to benefit. Funding German Federal Ministry of Education and Research.

UNLABELLED Several studies showed that Constraint-Induced Movement Therapy (CIMT) leads to a lasting improvement of upper extremity function in chronic stroke patients. The original technique includes an intensive 2-week program with 6 hours of daily physiotherapy. Due to high expenses it is difficult to implement this concept in outpatient care. PURPOSE The objective of this study was to evaluate the effects of a 4-week homebased CIMT program among chronic stroke patients and to compare them with a 2-week CIMT program, based on the original technique. METHODS Seven adults with chronic stroke completed a newly developed variant of CIMT, performed at patients' homes (group1, CIMThome), supervised by an instructed family member, constraint of unaffected hand for a target of 60% of waking hours. The intervention was analysed with pre-, post-treatment and 6-month follow-up measurements. Effects on improvement in upper extremity function were compared with patients treated according to the original protocol (group2, CIMTclassic), supervised by a physiotherapist, constraint of unaffected hand for a target of 90% of waking hours. RESULTS Patients from both groups showed almost identical improvement of their motor function according to scores on the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) immediately after the treatment period as well as at follow-up after 6 months. CONCLUSIONS Our study suggests that CIMThome is not only feasible but also as effective as CIMTclassic. This finding should be replicated in a larger prospective randomized trial to perform a non-inferiority analysis.

Objectives. Constraint-induced movement therapy (CIMT) has been shown to be effective in chronic stroke patients. It is worthwhile to investigate the influence of individual factors for two reasons: to find out whether they influence outcome and to see whether they support the theory underlying CIMT. Methods. Agroupof26 patients were treated with CIMT and followed over 6 months. In total, 14 individual factors were identified. Patients were assessed with 6 tests, including 2 commonly used after stroke (Frenchay Arm Test, 9 Hole Peg Test). Results. There were individual differences, but as a group, patients improved after therapy. There were no individual factors that influenced improvement in more than one test. Conclusions. CIMT is an effective therapy in patients with moderate impairment after stroke, also in tests commonly used in stroke rehabilitation. Factors that could have expected to make a difference on the basis of the theory behind CIMT (e.g., time since stroke, previous therapy, sensory deficit) did not influence results. Patients with hemorrhagic lesions and those with a high level of performance (Motor Activity Log > 2.5) profit as well. Pairwise therapy is as effective as individual therapy.