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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2016; 26(06): 309-318
DOI: 10.1055/s-0042-120047
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

Prozessmodulierte Mikrostromtherapie (ZYTOENERGESE®) im Rahmen der stationären Frührehabilitation nach Knie- bzw. Hüftoperationen

Eine doppelblind randomisierte Plazebo-kontrollierte PilotstudieProcess Modulated Microcurrent Therapy (ZYTOENERGESE®) during Early Inpatient Rehabilitation after Knee- and Hip OperationsA Double-blind, Randomized, Plazebo-controlled Pilot Trial
T. Bochdansky
1   Physikalische Medizin und Rehabilitation Physikalische Sportheilkunde, Feldkirch, Österreich
,
K. Ammer
2   Medical Imaging Research Unit, University of South Wales, UK
› Author Affiliations
Further Information

Publication History

13 June 2016

24 October 2016

Publication Date:
12 December 2016 (online)

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Zusammenfassung

Obwohl die positiven Effekte der Elektrotherapie empirisch schon seit mehreren Jahrhunderten bekannt sind, gibt es trotz neuester Forschungsergebnisse (inkl. Nobelpreis) noch immer viele offene physiologische Fragen über die Wirkmechanismen, vor allem im molekular- und membranphysiologischen Bereich. Unklar ist auch, welche elektrischen Parameter für welche therapeutischen Ziele am optimalsten sind.

In einer pragmatischen, randomisierten und plazebokontrollierten Studie wurde die zusätzliche Effektivität einer neuen Form der Elektrotherapie, die prozessmodulierte Mikrostromtherapie (PMMST, Zytoenergese®), klinisch im Rahmen einer 14-tägigen stationären Frühmobilisation nach Knie- und Hüftgelenksoperationen (Totalendoprothesen) getestet.

Die Ergebnisse von 114 der 120 teilnehmenden Patienten wurden ausgewertet. Ungefähr 1 Woche postoperativ wurden bei Aufnahme, bei Entlassung und bei einer Kontrolle nach 1 Monat (=ca. 50 Tage post OP) neben klinischen Tests auch die Balancefähigkeit apparativ getestet. Sämtliche klinische Parameter zeigten eine deutliche Verbesserung am Ende des stationären Aufenthaltes, deren Zunahme bei der Nachkontrolle geringer ausgeprägt war als nach der Phase der Frühmobilisation.

Nach Anwendung tatsächlicher Mikroströme konnte bei Patienten nach Hüftoperationen eine deutlichere Verbesserung der symmetrischen Beinbelastung als bei Patienten nach Knieoperationen festgestellt werden.

Die Mechanismen, über die PMMST zur Wiederherstellung der Mobilität von Patienten nach Hüft- oder Kniegelenksoperationen beitragen kann, bleiben vorerst unklar. Denkbar sind eine Verbesserung der Muskelfunktion und die Förderung der Integration in den Alltagsgebrauch. Weitere Untersuchungen dazu sind gerechtfertigt, ebenso weitere Studien zur Anwendung bei der Schmerzbehandlung und Wundheilung.

Abstract

Although the positive effects of electrotherapy are known empirically for several centuries, there are still many physiological questions about the mechanisms of action, especially in the field of molecular and membrane physiology despite of latest research results (including Nobel Prize). It is also unclear what electrical parameters for which therapeutic goals are most optimal.

In a pragmatic, randomized, Plazebo-controlled study, we investigated the additional clinical effectiveness of a new form of electrotherapy, the process-modulated micro current therapy (PMMST, Zytoenergese®, during a 14-day stationary early mobilization after knee and hip operations (endoprosthesis).

The results of 114 of the 120 participating patients were evaluated. In addition to clinical tests the balance ability was recorded with a test equipment at admission approximately 1 week after surgery, at dismissal and at a follow-up 1 month after surgery (approx. 50 days). All clinical parameters showed a significant improvement at the end of the inpatient stay, which was more pronounced in the phase of early mobilization than in the follow-up period.

A better improvement in symmetrical weight distribution of the feet was observed after application of real micro-currents in patients after hip surgery than in patients after knee surgery.

The mechanisms, by which PMMST can contribute to restore the mobility of patients after hip or knee surgery, remain for the moment unclear. Improving the muscular function and the promotion of integration in everyday use are possible explanations. Further investigations to this topic and to pain therapy and wound management are warranted.

Schlüsselwörter

Elektrotherapie - Plazebo kontrolliert - Rehabilitation - Gelenksersatzoperation

Key words

electrotherapy - placebo controlled - rehabilitation - arthroplasty
 

  • Literatur

  • 1 Günther R, Jantsch H. Physikalische Medizin. Berlin Heidelberg: Springer; 1986
    CrossrefGoogle Scholar
  • 2 Bossert F, Vogedes K. Elektrotherapie, Licht und Strahlentherapie. München: Urban & Fischer; 2014
    Google Scholar
  • 3 Galvani A. De viribus electricitatis in motu muscularii. De Bononiensi Scientiarum et Artium Instituto atque Academia Commentarii. vol. VII. Bononiae: Ex Typographia Instituti Scientiarum; 1792
    Google Scholar
  • 4 Du Bois-Reymond E. Gesammelte Abhandlungen zur Nerven- und Muskelphysik. Leipzig: Verlag v.Veit & Comp; 1875
    Google Scholar
  • 5 Goldman DE. Potential, impedance and rectification in membranes. J Gen Physiol 1943; 20: 37-60
    PubMedGoogle Scholar
  • 6 MacKinnon R. Potassium channels and the atomic basis of selective ion conduction (Nobel Lecture). Angewandte Chemie International Edition 2004; 43: 4265-4277
    CrossrefPubMedGoogle Scholar
  • 7 Long SB, Tao X, Campbell EB et al. Atomic structure of a voltage-dependent K+ channel in a lipid membrane-like environment. Nature 2007; 450: 376-382
    CrossrefPubMedGoogle Scholar
  • 8 Uemura M, Maeshige N, Koga Y. Monophasic pulsed 200-μa current promotes galvanotaxis with polarization of actin filament and integrin α2β1 in human dermal fibroblasts. Eplasty 2016; 16: e6 eCollection 2016
    PubMedGoogle Scholar
  • 9 Curtis D, Fallows S, Morris M et al. The efficacy of frequency specific microcurrent therapy on delayed onset muscle soreness. J Bodyw Mov Ther 2010; 14: 272-279
    CrossrefPubMedGoogle Scholar
  • 10 McMakin CR, Oschman JL. Visceral and somatic disorders: tissue softening with frequency-specific microcurrent. J Altern Complement Med. 2013; 19: 170-177
    CrossrefPubMedGoogle Scholar
  • 11 Poltawski L, Johnson M, Watson T. Microcurrent therapy in the management of chronic tennis elbow: pilot studies to optimize parameters. Physiother Res Int 2012; 17: 157-166
    CrossrefPubMedGoogle Scholar
  • 12 Naeser M, Hahn KA, Liebermann BE et al. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil 2002; 83: 978-988
    CrossrefPubMedGoogle Scholar
  • 13 Ohno Y, Fujiya H, Goto A et al. Microcurrent electrical nerve stimulation facilitates regrowth of mouse soleus muscle. Int J Med Sci 2013; 10: 1286-1294
    CrossrefPubMedGoogle Scholar
  • 14 Mayer St K. Die Arndt-Schulzsche Regel. Klinische Wochenschrift 1925; 4: 1649-1649
    CrossrefPubMedGoogle Scholar
  • 15 Brock N. Experimentelle Beiträge zum „Arndt-Schulzschen Gesetz“. Naumyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie 1938; 190: 191-194
    PubMedGoogle Scholar
  • 16 Funk JO, Kruse A, Kirchner H. Cytokine production after helium neon laser irradiation in cultures of human peripheral blood mononuclear cells. J Photochemistry Photobiology B: Biology 1992; 16: 347-355
    PubMedGoogle Scholar
  • 17 Sommer AP, Pinheiro AL, Mester AR et al. Biostimulatory windows in low-intensity laser activation: lasers, scanners and NASA’s light-emitting diode array system. J Clin Laser Med Surg 2001; 19: 29-33
    CrossrefPubMedGoogle Scholar
  • 18 Poltawski L, Johnson M, Watson T. Microcurrent therapy in the management of chronic tennis elbow: pilot studies to optimize parameters. Physiother Res Int 2012; 17: 157-166
    CrossrefPubMedGoogle Scholar
  • 19 Cheng Cheng N, Van Hoof H, Bockx E et.al. The effects of electric currents on ATP generation, protein synthesis, and membrane transport of rat skin. Clin Orthop Relat Res 1982; 264-272
    PubMedGoogle Scholar
  • 20 Puhar I, Amalija Kapudija A, Adrian Kasaj A et al. Efficacy of electrical neuromuscular stimulation in the treatment of chronic periodontitis. J Periodontal Implant Sci 2011; 41: 117-122
    CrossrefPubMedGoogle Scholar
  • 21 Nessler JP, Mass DP. Direct-current electrical stimulation of tendon healing in vitro. Clin Orthop Relat Res 1987; 303-312
    PubMedGoogle Scholar
  • 22 Carley PJ, Wainapel SF. Electrotherapy for acceleration of wound healing: low intensity direct current. Arch Phys Med Rehabil 1985; 66: 443-446
    PubMedGoogle Scholar
  • 23 Ciombor DM, Aaron RK. The role of electrical stimulation in bone repair. Foot Ankle Clin 2005; 10: 579-593 vii
    CrossrefPubMedGoogle Scholar
  • 24 Zuzzi DC, Ciccone Cde C, Neves LM et al. Evaluation of the effects of electrical stimulation on cartilage repair in adult male rats. Tissue Cell. 2013; 45: 275-281
    CrossrefPubMedGoogle Scholar
  • 25 Farahani RM, Kloth LC. The hypothesis of ‘biophysical matrix contraction’: wound contraction revisited. Int Wound J 2008; 5: 477-482
    CrossrefPubMedGoogle Scholar
  • 26 Bassett CA, Becker RO. Generation of electric potentials by bone in response to mechanical stress. Science 1962; 137: 1063-1064
    CrossrefPubMedGoogle Scholar
  • 27 Korelo RI, Kryczyk M, Garcia C et al. Wound healing treatment by high frequency ultrasound, microcurrent, and combined therapy modifies the immune response in rats. Braz J Phys Ther 2016. pii: S1413-35552016005000141. [Epub ahead of print]
    PubMed
  • 28 Asadi MR, Torkaman G, Hedayati M et al. Role of sensory and motor intensity of electrical stimulation on fibroblastic growth factor-2 expression, inflammation, vascularization, and mechanical strength. J Rehab Res 2013; 50: 489-498
    PubMedGoogle Scholar
  • 29 Talebi G, Torkaman G, Firouzabadi M et al. Effect of micro-amperage direct current stimulation on injury potential and ist realtion to wound surface area in guinea pig. Cont Proc IEEE Eng Med Biol Soc 2007; 35: 16-19
    PubMedGoogle Scholar
  • 30 Foulds IS, Barker AT. Human skin battery potentials and their possible role in wound healing. Br J Dermatol 1983; 109: 515-522
    CrossrefPubMedGoogle Scholar
  • 31 Kloth LC. Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments and clinical trials. Int J Low Extrem Wounds 2005; 4: 23-44
    CrossrefPubMedGoogle Scholar
  • 32 Kim JH, Choi H, Suh MJ et al. Effect of biphasic electrical current stimulation on IL-1β-stimulated annulus fibrosus cells using in vitro microcurrent generating chamber system. Spine 2013; 38: 1368-1376
    CrossrefPubMedGoogle Scholar
  • 33 Gossrau G, Wähner M, Kuschke M et al. Microcurrent transcutaneous electric nerve stimulation in painful diabetic neuropathy: a randomized Plazebo-controlled study. Pain Med 2011; 12: 953-960
    CrossrefPubMedGoogle Scholar
  • 34 Bannuru RR, McAlindon TE, Sullivan MC et al. Effectiveness and implications of alternative plazebo treatments: a systematic review and network meta-analysis of osteoarthritis trials. Ann Intern Med. 2015; 163: 365-372
    CrossrefPubMedGoogle Scholar
  • 35 McCrory P. The power of Plazebo. Br J Sports Med 2005; 39: 125
    PubMedGoogle Scholar
  • 36 Jakovljevic M. The Plazebo-nocebo response: controversies and challenges from clinical and research perspective. Eur Neuropsychopharmacol 2014; 24: 333-341
    CrossrefPubMedGoogle Scholar
  • 37 Benedetti F, Carlino E, Piedimonte A. Increasing uncertainty in CNS clinical trials: the role of Plazebo, nocebo, and Hawthorne effects. Lancet Neurol 2016. pii: S1474-4422(16)00066-1. [Epub ahead of print]
    PubMed
  • 38 White P, Lewith G, Hopwood V et al. The Plazebo needle, is it a valid and convincing Plazebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial. Pain 2003; 106: 401-409
    CrossrefPubMedGoogle Scholar
  • 39 Bochdansky Th, Böckelberger M, Laube W et al Evaluation zweier interdisziplinärer Nachsorgestationen. Phys Med Rehab Kuror 2009; 19: 256-265
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Folstein MF, Folstein SE, McHugh PR. Mini-Mental State (a practical method for grading the state of patients for the clinician). Journal of Psychiatric Research 1975; 12: 189-198
    CrossrefPubMedGoogle Scholar
  • 41 Bohannon RW. Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age Ageing 1997; 26: 15-19
    PubMedGoogle Scholar
  • 42 Duncan PW, Weiner DK, Chandler J et al. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45: M192-M197
    CrossrefPubMedGoogle Scholar
  • 43 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148
    CrossrefPubMedGoogle Scholar
  • 44 Guralnik JM, Simonsick EM, Ferrucci L et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49: M85-M94
    CrossrefPubMedGoogle Scholar
  • 45 Perera S, Mody S, Woodman R et al. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006; 54: 743-749
    CrossrefPubMedGoogle Scholar
  • 46 Wright AA, Cook CE, Baxter GD et al. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther 2011; 41: 319-327
    CrossrefPubMedGoogle Scholar
  • 47 Andersson EI, Lin CC, Smeets RJ. Performance tests in people with chronic low back pain: responsiveness and minimal clinically important change. Spine 2010; 35: E1559-E1563
    CrossrefPubMedGoogle Scholar
  • 48 Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008; 88: 733-746
    CrossrefPubMedGoogle Scholar
  • 49 Tubach F, Ravaud P, Baron G et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 2005; 64: 34-37
    CrossrefPubMedGoogle Scholar
  • 50 Hsieh YW, Wang CH, Wu SC et al. Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabil Neural Repair 2007; 21: 233-238
    CrossrefPubMedGoogle Scholar
  • 51 Kohen-Raz R. Application of tetra-ataxiametric posturography in clinical and developmental diagnosis. Percept Mot Skills 1991; 73: 635-656
    CrossrefPubMedGoogle Scholar
  • 52 Schwesig R. Das posturale System in der Lebensspanne. Schriften zur Sportwissenschaft. Hamburg: Verlag Dr Kovac; 2006
    Google Scholar
  • 53 Schwesig R, Fischer D, Lauenroth A et al. Can falls be predicted with gait analytical and posturographic measurement systems? A prospective follow-up study in a nursing home population. Clin Rehabil 2013; 27: 183-190
    CrossrefPubMedGoogle Scholar
  • 54 Kollmitzer J, Ebenbichler GR, Sabo A et al. Effects of back extensor strength training versus balance training on postural control. Med Sci Sports Exerc 2000; 32: 1770-1776
    CrossrefPubMedGoogle Scholar
  • 55 Schwesig R, Becker S, Fischer D. Intraobserver reliability of posturography in healthy subjects. Somatosensory & motor research 2014; 31: 16-22
    CrossrefPubMedGoogle Scholar
  • 56 Kim HS, Yun DH, Yoo SD et al. Balance control and knee osteoarthritis severity. Ann Rehabil Med 2011; 35: 701-709
    CrossrefPubMedGoogle Scholar
  • 57 Rockstroh G, Schleicher W, Krummenauer F. Der Nutzen der während einer stationären Anschlussheilbehandlung applizierten Mikrostromtherapie bei Patienten nach Implantation einer Knie-Totalendoprothese – eine randomisierte, klinische Studie. Rehabilitation 2010; 3: 173-179
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Kirkpatrick DR, McEntire DM, Hambsch ZJ et al. Therapeutic basis of clinical pain modulation. Clin Transl Sci 2015; 8: 848-856
    CrossrefPubMedGoogle Scholar
  • 59 Poltawski L, Watson T. Bioelectricity and microcurrent therapy for tissue healing – a narrative review. Physical therapy rev 2009; 14: 104-114
    PubMedGoogle Scholar