A pragmatic community-based intervention of multimodal physiotherapy plus deep water running (DWR) for fibromyalgia syndrome: a pilot study Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: a randomized controlled trial. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report Modellvorhaben Akupunktur – a Summary of the Art, Arc and Gerac Trials A systematic review of nonrandomized controlled trials on the curative effects of aquatic exercise An exercise program in the treatment of fibromyalgia. A multimodal physiotherapy programme plus deep water running for improving cancer-related fatigue and quality of life in breast cancer survivors. High intensity physical group training in water--an effective training modality for patients with COPD. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Alpe d’HuZes Cancer Rehabilitation (A-CaRe) Research: Four Randomized Controlled Exercise Trials and Economic Evaluations in Cancer Patients and Survivors Effectiveness of manual therapies: the UK evidence report Non-pharmacological care for patients with generalized osteoarthritis: design of a randomized clinical trial Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: a randomized controlled trial. Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity.
Evidence -based recommendations support the use of multimodal therapy and hydrotherapy for fibromyalgia syndrome ; however , there is little st and ardisation of such programmes . The aim of the study was to assess the effectiveness of a pool-based exercise using deep water running ( DWR ) as part of a multimodal physiotherapy programme for patients with fibromyalgia syndrome . For a non-r and omised clinical study , 44 patients diagnosed with fibromyalgia were recruited from primary care . Patients in the experimental group received a multimodal programme incorporating pool-based exercise using DWR three times a week for an 8-week period . The control group received a leaflet containing advice and continued with normal activities . Patients were evaluated for physical function ( Fibromyalgia Impact Question naire , FIQ ) , pain , general health ( Short Form-12 Health Survey ) and quality of life ( European Quality of Life Scale-5D ) pre- and post intervention . Statistically significant results were found for the experimental group for FIQ total score , incorporating physical function , pain , fatigue , stiffness and psychological variables ( p < 0.05 ) . Statistically significant differences between the experimental group and control were also found for general health ( p < 0.05 ) and quality of life ( p < 0.05 ) . The results of this pilot study and the high level of compliance and adherence and low level of attrition suggest that this multimodal programme incorporating DWR is a safe and effective intervention for fibromyalgia syndrome that is acceptable to patients Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 UNLABELLED Knee pain is a common health problem in the elderly population , for which non-invasive treatments are recommended as a first line treatment in the management of knee pain . A r and omized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain . Women over 75 years of age with knee pain ( n=150 ) were r and omly assigned into four groups ; exercise ( Ex ) and heat/steam generating sheet ( HSGS ) ( n=38 ) , Ex ( n=37 ) , HSGS ( n=38 ) , or health education ( HE ) ( n=37 ) . The Ex group attended a 60-min comprehensive training program twice a week for 3-months . The HSGS group placed two sheets on the knee for five hours per day . Functional fitness , visual analog scale ( VAS ) , and Japanese knee osteoarthritis measure ( JKOM ) were assessed at baseline and post-intervention . The results showed VAS improvements in the Ex+HSGS and HSGS groups . Total JKOM score , muscle strength , and functional mobility significantly improved in the Ex+HSGS group compared with the HE group . The odds ratio ( OR ) for VAS and functional mobility improvement was more than eight times as great in the Ex+HSGS group ( OR=8.60 , 95 % confidence interval (CI)=2.82 - 32.73 ) compared with the education group . Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life . The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain , improving physical function and increasing quality of life . TRIAL REGISTRATION NUMBER JMA-IIA00110 Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that special Model Projects on Acupuncture ( “ Modellvorhaben Akupunktur ” ) be developed in order to determine the evidence -based role of acupuncture in the treatment of certain illnesses . This paper presents a summary of the main r and omised controlled trials performed as part of these projects , and the associated economic analyses . Overall the results show that acupuncture  is effective in practice for a range of chronic conditions , and it seems likely to have acceptable cost utility ( at least at a rate of ¢35 per session ) . Sham acupuncture , in the form of minimal off-point needling in a therapeutic context , also appears to be effective , being no different to prophylactic medication in migraine , and superior to guideline -based st and ard care in chronic low back pain . In patients recruited to  acupuncture  trials , the response to treatment does not differ between those that agree to be r and omised and those that do not . This suggests that the results of the pragmatic Acupuncture in Routine Care studies are applicable to patients from the general population who express a preference for  acupuncture . In conclusion ,  acupuncture  appears to be effective in a range of chronic conditions and it seems to have acceptable cost-effectiveness in Western health economic terms . These programmes of research do not confirm the hypothesis that needling at specific points is essential to achieve satisfactory clinical effects of acupuncture . Sham acupuncture , in the form of minimal off-point needling in a therapeutic context , is unlikely to be an inactive placebo . In April 2006 , the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee Background : The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonr and omized controlled trials ( n RCTs ) . Methods : Study design was a systematic review of nonr and omized controlled trials . Trials were eligible if they were nonr and omized clinical trials . Studies included one treatment group in which aquatic exercise was applied .  We search ed the following data bases from 2000 up to July 20 , 2009 : MEDLINE via PubMed , CINAHL , and Ichushi-Web . Results : Twenty-one trials met all inclusion criteria . Language s included were English ( N = 9 ) , Japanese ( N = 11 ) , and Korean ( N = 1 ) . Target diseases were knee and /or hip osteoarthritis , poliomyelitis , chronic kidney disease , discomforts of pregnancy , cardiovascular diseases , and rotator cuff tears . Many studies on nonspecific disease ( healthy participants ) were included . All studies reported significant effectiveness in at least one or more outcomes . However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies . Furthermore , there was the problem of heterogeneity , and we were therefore not able to perform a meta- analysis . Conclusion : Because there was insufficient evidence on aquatic exercise due to poor method ological and reporting quality and heterogeneity of n RCTs , we were unable to offer any conclusions about the effects of this intervention . However , we were able to identify problems with current n RCTs of aquatic exercise , and propose a strategy of strengthening study quality , stressing the importance of study feasibility as a future research agenda objective OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors . A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres . Patients in the experimental group received a MMPP incorporating DWR , 3 times a week , for an 8-week period . The control group received a leaflet containing instructions to continue with normal activities . Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale-Revised total score ( d = 0.7 , P = 0.001 ) , as well as behavioural/severity ( d = 0.6 , P = 0.05 ) , affective/meaning ( d = 1.0 , P = 0.001 ) and sensory ( d = 0.3 , P = 0.03 ) domains . Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5 , P < 0.05 ) and quality of life ( d = 1.3 , P < 0.05 ) . All participants attended over 80 % of sessions , with no major adverse events reported . The results of this study suggest MMPP incorporating  DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors . Further , the high level of adherence and lack of adverse events indicate such a programme is safe and feasible The aim of this study was to examine the effect of high intensity physical group training in water and on l and for patients with COPD with regard to physical capacity and health related quality of life ( HRQoL ) . A controlled , semi-r and omised study was conducted where 30 patients were r and omised to training either in water or on l and . Thirteen patients constituted a control group . Forty-three out patients , with moderate to severe COPD ( 27w/16 m ) , from two local hospitals in northern Sweden , were included in the study . High intensity physical group training in water ( water group ) or on l and ( l and group ) was performed for 12weeks , three times per week , 45min per session . The control group received no intervention . Pre- and post-intervention , all patients performed incremental and endurance shuttle walking tests ( ISWT and ESWT ) ,  cycle ergometer tests  and  responded question naires about HRQoL ( St. Georges Respiratory Question naire -- SGRQ and SF-36 ) . The patients trained with a mean heart rate of 80 - 90 % of peak heart rate . Both training groups increased the distance walked , i.e. l and group in ISWT ( 25 m ) and water group in ESWT ( 179 m ) . The water group increased the distance in ESWT significantly more that both the l and and the control groups . Both training groups increased the time cycled ( 40 - 85s ) and work load ( 10 - 20W ) in the cycle ergometer test . The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant . The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the l and and the control groups . In conclusion , high intensity physical group training in water is of benefit for patients with COPD . It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on l and OBJECTIVE To examine the benefits of modified constraint-induced movement therapy ( mCIMT ) on motor function , daily function , and health-related quality of life ( HRQOL ) in elderly stroke survivors . DESIGN Two-group r and omized controlled trial , with pretreatment and posttreatment measures . SETTING Rehabilitation clinics . PARTICIPANTS Twenty-six elderly stroke patients ( mean age , 72 y ) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident . INTERVENTIONS Twenty-six patients received either mCIMT ( restraint of the unaffected limb combined with intensive training of the affected limb ) or traditional rehabilitation for a period of 3 weeks . MAIN OUTCOME MEASURES Outcome measures included the Fugl-Meyer Assessment ( FMA ) , FIM instrument , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The FMA evaluated the severity of motor impairment ; the FIM instrument and MAL reported daily function ; and the SIS detected HRQOL . RESULTS The mCIMT group exhibited significantly greater improvements in motor function , daily function , and the physical domain of HRQOL than the traditional rehabilitation group . Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group . CONCLUSIONS These findings suggest mCIMT is a promising intervention for improving motor function , daily function , and physical aspects of HRQOL in elderly patients with stroke . The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program Background Previous studies showed that exercise in cancer patients is feasible and may reduce fatigue and improve physical fitness and quality of life . However , many previous studies had method ological weaknesses related to trial design , sample size , comparison group , outcome measures , short follow-up duration s and programme content . Purpose This paper aims to present the rationale and design of the clinical research subprogramme of the Alpe d’HuZes Cancer Rehabilitation ( A-CaRe ) programme . Method A-CaRe Clinical Research includes four r and omized controlled trials in patients : ( a ) after chemotherapy , ( b ) during chemotherapy , ( c ) after stem cell transplantation and ( d ) during childhood cancer . These trials compare high-intensity resistance and endurance exercise interventions with usual care or a waiting list control group . In two studies , a second intervention arm consisting of low-to-moderate intensity exercise is included . All four A-CaRe trials use similar methods . Results Outcome measures are carefully chosen based on the International Classification of Functioning Disability and Health model . Measurements will be performed prior to r and omization ( T0 ) , after completion of the intervention ( T1 ) and at follow-up ( T2 ) . The primary outcome measures are cardiorespiratory fitness , muscle strength and fatigue . Secondary outcome measures include health-related quality of life and psychosocial functioning . Furthermore , cost-effectiveness and cost-utility analyses are performed from a societal perspective . Conclusion We hypothesize that exercise is more effective at improving physical fitness and thereby reducing fatigue and more cost-effective compared with usual care or a waiting list control group . If so , the programmes will be implemented in the Dutch clinical practice Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions . Methods The conclusions are based on the results of systematic review s of r and omized clinical trials ( RCTs ) , widely accepted and primarily UK and United States evidence -based clinical guidelines , plus the results of all RCTs not yet included in the first three categories . The strength/ quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs . Results By September 2009 , 26 categories of conditions were located containing RCT evidence for the use of manual therapy :  13 musculoskeletal conditions , four types of chronic headache and nine non-musculoskeletal conditions . We identified 49 recent relevant systematic review s and 16 evidence -based clinical guidelines plus an additional 46 RCTs not yet included in systematic review s and guidelines .Additionally , brief references are made to other effective non-pharmacological , non-invasive physical treatments . Conclusions Spinal manipulation/mobilization is effective in adults for : acute , subacute , and chronic low back pain ; migraine and cervicogenic headache ; cervicogenic dizziness ;  manipulation/mobilization is effective for several extremity joint conditions ; and thoracic manipulation/mobilization is effective for acute/subacute neck pain . The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration , and for manipulation/mobilization for mid back pain , sciatica , tension-type headache , coccydynia , temporom and ibular joint disorders , fibromyalgia , premenstrual syndrome , and pneumonia in older adults . Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation , or for Stage 1 hypertension when added to an antihypertensive diet . In children , the evidence is inconclusive regarding the effectiveness for otitis media and enuresis , and it is not effective for infantile colic and asthma when compared to sham manipulation . Massage is effective in adults for  chronic low back pain and chronic neck pain . The evidence is inconclusive for knee osteoarthritis , fibromyalgia , myofascial pain syndrome , migraine headache , and premenstrual syndrome . In children , the evidence is inconclusive for asthma and infantile colic Background Non-pharmacological treatment ( NPT ) is a useful treatment option in the management of hip or knee osteoarthritis . To our knowledge however , no studies have investigated the effect of NPT in patients with generalized osteoarthritis ( GOA ) . The primary aim of this study is to compare the effectiveness of two currently existing health care programs with different intensity and mode of delivery on daily functioning in patients with GOA . The secondary objective is to compare the cost-effectiveness of both interventions . Methods / Design In this r and omized , single blind , clinical trial with active controls , we aim to include 170 patients with GOA . The experimental intervention consist of six self-management group sessions provided by a multi-disciplinary team ( occupational therapist , physiotherapist , dietician and specialized nurse ) . The active control group consists of two group sessions and four sessions by telephone , provided by a specialized nurse and physiotherapist . Both therapies last six weeks . Main study outcome is daily functioning during the first year after the treatment , assessed on the Health Assessment Question naire . Secondary outcomes are health related quality of life , specific complaints , fatigue , and costs . Illness cognitions , global perceived effect and self-efficacy , will also be assessed for a responder analysis . Outcome assessment s are performed directly after the intervention , after 26 weeks and after 52 weeks . Discussion This article describes the design of a r and omized , single blind , clinical trial with a one year follow up to compare the costs and effectiveness of two non-pharmacological interventions with different modes of delivery for patients with GOA.Trial registration Dutch Trial Register OBJECTIVE To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation ( rTMS ) for decreasing upper-limb muscle tone after chronic stroke . DESIGN A r and omized sham-controlled trial with a 4-week follow-up . SETTING Research hospital . PARTICIPANTS Patients with stroke ( N=20 ) with poststroke upper limb spasticity . INTERVENTIONS The experimental group received rTMS to the primary motor cortex of the unaffected side ( 1500 pulses ; 1Hz ; 90 % of resting motor threshold for the first dorsal interosseous muscle ) in 10 sessions , 3d/wk , and physical therapy ( PT ) . The control group received sham stimulation and PT . MAIN OUTCOME MEASURES Modified Ashworth scale ( MAS ) , upper-extremity Fugl-Meyer assessment , FIM , range of motion , and stroke-specific quality -of-life scale . All outcomes were measured at baseline , after treatment ( postintervention ) , and at a 4-week follow-up . A clinical ly important difference was defined as a reduction of ≥1 in the MAS score . RESULTS Friedman test revealed that PT is efficient for significantly reducing the upper limb spasticity of patients only when it is associated with rTMS . In the experimental group , 90 % of the patients at postintervention and 55.5 % at follow-up showed a decrease of ≥1 in the MAS score , representing clinical ly important differences . In the control group , 30 % of the patients at postintervention and 22.2 % at follow-up experienced clinical ly meaningful changes . There were no differences between the groups at any time for any of the other outcome measures , indicating that both groups demonstrated similar behaviors over time for all variables . CONCLUSIONS rTMS associated with PT can be beneficial in reducing poststroke spasticity . However , more studies are needed to clarify the clinical changes underlying the reduction in spasticity induced by noninvasive brain stimulations OBJECTIVE This study was design ed to compare the initial efficacy of Motivational Interviewing ( MI ) , Online Transtheoretical Model (TTM)-tailored communications and a brief Health Risk Intervention ( HRI ) on four health risk factors ( inactivity , BMI , stress and smoking ) in a worksite sample . METHOD A r and omized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments . The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months . At the initial post-treatment assessment at 6 months , groups were compared on the percentage who had progressed from at risk to taking effective action on each of the four risks . RESULTS Compared to the HRI only group , the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months . MI and TTM group outcomes were not different . CONCLUSION This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes . Future research will examine the long-term impacts of each treatment , their cost effectiveness , effects on productivity and quality of life and process variables mediating outcomes Objectives To support return to work ( RTW ) among cancer patients , a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy . The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes . Design Longitudinal prospect i ve intervention study using a one-group design . Setting Two hospitals in the Netherl and s. Participants Of the eligible patients , 56 % participated ; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included . Patients completed question naires on RTW , the importance of work , work ability ( WAI ) , RTW self-efficacy , fatigue ( MFI ) , and quality of life ( EORTC QLQ C-30 ) at baseline and 6 , 12 and 18 months follow-up . Before and after the exercise programme 1-repetition maximum ( 1RM ) muscle strength and cardiorespiratory fitness ( VO2 peak ) were assessed . Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme , 59 % of the cancer patients returned to work , 86 % at 12 months and 83 % at 18 months . In addition , significant improvements ( p<0.05 ) in the importance of work , work ability , RTW self-efficacy , and quality of life were observed , whereas fatigue levels were significantly reduced . After completing the exercise programme , 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level . Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme . A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW , reduced fatigue and increased importance of work , work ability , and quality of life OBJECTIVES To compare the effect of high-intensity aerobic interval exercise ( HIA ) with home-based exercise ( HB ) in older adults with chronic disease soon after discharge from the hospital . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Community-dwelling older adults aged 70 to 92 ( N = 115 ) were recruited while in the hospital . After discharge , they were r and omized to HIA group ( n = 59 ) or HB ( n = 56 ) . INTERVENTION High-intensity aerobic interval exercise ( HIA ) consisted of endurance , strength , and balance exercises . The HB consisted of low-intensity exercises and telephone follow-up from a physical therapist . MEASUREMENTS Health-related quality of life ( HRQOL ) was assessed using the Medical Outcomes Study 36-item Short Form Survey , physical fitness was measured using the Senior Fitness Test , and physical activity was assessed using the Physical Activity Scale for the Elderly . RESULTS Intention-to-treat analysis showed that both groups improved their HRQOL and physical activity after 3 months . Improvements on the Senior Fitness Test ( chair st and , arm curl and 6-minute walk ( 6MWT ) ) were significantly greater in the HIA group than the HB group . The mean difference was 25.9 m on the 6MWT ( P = .001 , effect size d = 0.2 ) , 1.3 per 30 seconds on the chair st and s mean ( P = .001 , effect size d = 0.3 ) , and 1.6 per 30 seconds on the arm curl ( P = .001 , effect size d = 0.4 ) . CONCLUSION High-intensity aerobic interval exercise ( HIA ) participants significantly improved their physical fitness . Both groups increased their HRQOL and physical activity . The findings suggest that exercise therapy should be incorporated as a part of the treatment for older people at risk for functional decline
HRM  treatment is associated with clinical improvement in diseases of the skin , respiratory , circulatory , digestive and nervous system among others .
The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of  HRM .
Health resort medicine ( HRM ; in German : Kurortmedizin ) is a field of medicine with long-lasting tradition in several European countries .
A number of systematic review s have shown the effectiveness of HRM  in musculoskeletal conditions .
Review s focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare .
This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions , to summarize evidence for its effectiveness and to assess the quality of published studies .