Helmut Schwann

Ludwig Boltzmann Institute of Rheumatology and Balneology, Wien, Vienna, Austria

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Publications (11)10.75 Total impact

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    ABSTRACT: Practice Guidelines for Exercise Testing. Exercise testing is a standard procedure in cardiology. This has not changed with newer diag-
    Atemwegs- und Lungenkrankheiten 01/2014; 40(06).
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    ABSTRACT: Abstract Background The goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria. Methods Patients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]. Results All MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients. Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time. Conclusion These findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.
    Health and Quality of Life Outcomes 01/2009; · 2.27 Impact Factor
  • W Kullich, N Fagerer, H Schwann
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    ABSTRACT: Osteoarthritis (OA) of the knee is a secondary inflammatory, painful disease of the knee joint with increasing destruction of the articular cartilage. In the inflammatory process the formation of free radicals (reactive oxygen species, ROS) plays a major role in progression of disease and in the subsequent destruction of joint cartilage. The aim of this pilot study was to examine the antioxidative potency of the non-steroidal anti-inflammatory drug (NSAID) nimesulide on glutathione S-transferase (GST), an enzymatic free radical scavenger. In addition, the effects on matrix metalloproteinase MMP-3 and its antagonist tissue inhibitor of matrix-metalloproteinase 3 (TIMP-1) were determined. This was an open-pilot study on 20 patients (aged 41-71 years old) suffering from painful OA of the knee, treated for 3 weeks with nimesulide 100 mg b.i.d. Twenty-three healthy subjects (aged 23-57 years), not age matched, served as a comparison group. GST, MMP-3 and TIMP-1 were measured by enzyme-immunoassays. Clinical symptoms and joint function were measured using the WOMAC Index. During the 3-week treatment period with nimesulide 100 mg b.i.d., both scavenger GST and the TIMP-1/MMP-3 ratio significantly increased. This change was accompanied by significant clinical improvement in terms of pain reduction, stiffness and joint function. Two adverse events occurred possibly related to nimesulide treatment: one case of moderate eyelid swelling, and one case of moderate diarrhea with no abnormality in the endoscopic examination. These results confirm the antioxidative properties of the study drug, indicating that nimesulide, beside its known anti-inflammatory properties, also shows an evident antioxidative activity that adds further supportive evidence to its key role in the treatment of OA patients (thanks to the absence of degenerative effects on cartilage).
    Current Medical Research and Opinion 09/2007; 23(8):1981-6. · 2.37 Impact Factor
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    ABSTRACT: An objective of exercise-based cardiac rehabilitation is improvement in patient-reported outcomes such as health-related quality of life as well as anxiety and depressive symptoms. There are no direct comparisons of the effectiveness of inpatient and outpatient exercise-based cardiac rehabilitation programmes on patient-reported outcomes. In this non-randomized study we collected patient-reported outcomes data with the MacNew Heart Disease health-related quality of life questionnaire and the Hospital Anxiety and Depression Scale at baseline, 1 month and again 3 months after admission to exercise-based cardiac rehabilitation in a cohort of 216 consecutive patients enrolled either in a 4-week inpatient exercise-based cardiac rehabilitation (n=62) or a 3-month outpatient exercise-based cardiac rehabilitation (n=87) and in a usual care group (n=67) to document the natural course in patient-reported outcome variables without exercise-based cardiac rehabilitation. Although MacNew health-related quality of life scores improved more with inpatient than outpatient exercise-based cardiac rehabilitation by month 1, the improvement was still significant in both groups at month 3 and also in the usual care group when compared to baseline. The health-related quality of life scores in the inpatient group, however, decreased between month 1 and 3 whereas they continued to improve in the outpatient group. The significant reduction in both anxiety and depressive symptoms in both exercise-based cardiac rehabilitation groups by month 1 was maintained at month 3 only with outpatient exercise-based cardiac rehabilitation. No significant changes over the 3 months were observed in the usual care group. Significant improvements of 1-month patient-reported outcomes are achieved in patients attending inpatient as well as outpatient exercise-based cardiac rehabilitation when compared with no exercise-based cardiac rehabilitation. In contrast to inpatient exercise-based cardiac rehabilitation, however, outpatient exercise-based cardiac rehabilitation leads to a further improvement of patient-reported outcomes. These results suggest that, if patients have to be admitted for inpatient exercise-based cardiac rehabilitation, this programme should be followed by an outpatient exercise-based cardiac rehabilitation to further improve and stabilize these patient-reported outcome variables.
    European Journal of Cardiovascular Prevention and Rehabilitation 07/2007; 14(3):441-7. · 2.63 Impact Factor
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    ABSTRACT: The goal of cardiac rehabilitation programs is not only to prolong life, but also to improve physical functioning, symptoms, wellbeing and health-related quality of life (HRQL). The aim of the study was to document short-term outcomes of cardiac rehabilitation programs in Austria. Consecutive patients (N = 487, 64.7% male, age 60.9 +/- 12.5 SD years) after myocardial infarction (MI), with or without percutaneous interventions (PCI), coronary artery bypass grafting (CABG) or heart valve surgery (HVS), referred to the six inpatient rehabilitation centers of the Austrian PVA insurance company, were included in the study. Exercise capacity, risk factors and HRQL (MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]) were measured at the beginning and end of the 4-week inpatient cardiac rehabilitation program. Global HRQL (MacNew) improved significantly over time in all patients combined (+0.75 +/- 0.88 SD, T = -16.99, df = 394, p < .001) and exceeded the minimal important difference. Patients with CABG, HVS or MI without PCI showed the greatest improvements in global HRQL after cardiac rehabilitation (p < .02). Blood pressure, cholesterol, triglyceride, body mass index, waist circumference improved significantly (all p < .001). These findings provide evidence that the improvements in HRQL and risk factors following cardiac rehabilitation in Austria are clinically important. HRQL should become a standard outcome parameter in cardiac rehabilitation.
    Wiener klinische Wochenschrift 12/2006; 118(23-24):744-53. · 0.81 Impact Factor
  • European Journal of Cardiovascular Prevention & Rehabilitation - EUR J CARDIOVASC PREV REHABIL. 01/2006; 13.
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    ABSTRACT: In rheumatoid arthritis (RA) the adhesion molecule ICAM-1 mediates the adhesion of leucocytes following subsequent transendothelial migration including interactions and adhesion of several cell types such as fibroblasts, T-lymphocytes and synoviocytes. Significantly increased ICAM-1 levels were measured in the acute phase of RA. The correlation of ICAM-1 levels with the pteridine neopterin (p < or = 0.01) may reflect the role of this adhesion molecule in modulation of immune responses. Despite the significantly higher levels of acute phase reactions parallel to the elevated ICAM-1 levels, no correlations were found between ICAM-1 and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum-Amyloid A (SAA). During an in-patient multidisciplinary rehabilitation programme the levels of ICAM-1 in serum and the majority of all investigated laboratory and clinical parameters such as ESR, CRP, SAA, fibrinogen, pain, swollen and painful joint count, morning stiffness and health assessment questionnaire improved.
    Wiener Medizinische Wochenschrift 02/1999; 149(19-20):550-3.
  • W Kullich, H Schwann
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    ABSTRACT: In the course of a double-blind randomized study lasting 1 year 19 patients suffering from ensured rheumatoid arthritis (ARA criteria) were treated with oral hydrolytic enzymes or oral gold salts. The effects of these therapies were examined in regard to changes in serum concentrations of circulating immune complexes (CIC) and the complement component iC3b. After 12 months treatment with oral enzymes we determined a therapeutically wanted significant decrease of CIC whereas CIC increased up to 6 months. The best but not significant result under therapy with oral gold salts concerning CIC was a decrease in 6 out of 9 patients after 9 months. The complement component iC3b diminished with either therapy during the first 6 months and increased afterwards. As well as the reduction of circulating immune complexes, the intensified inactivation of C3b into iC3b during the second half-year with both treatments indicates that there might be a slight improvement of the pathologically changed immunoreactions after 6 months only. Concerning the examined laboratory parameters, no significant difference was found between both therapies.
    Wiener Medizinische Wochenschrift 02/1992; 142(22):493-7.
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    ABSTRACT: ZusammenfassungHintergrund: Die alarmierende Zunahme chronischer Schmerzen des Stütz- und Bewegungsapparates gibt Anlass zur Suche nach neuen kausalorientierten, präventiven, insbesondere kostenreduzierenden Massnahmen. Hierzu gehören neben der reinen Schmerzbehandlung auch präventive Massnahmen zur Beeinflussung der die Grösse der Infarktareale beeinflussenden Adhäsionsmoleküle (PECAM-1, Platelet-endothelial Cell Adhesion Molecule, und P-Selektin). Zielsetzung: Ausgerichtet auf die Behandlung von Patienten mit chronischem Kreuzschmerz sollte in diesem Zusammenhang untersucht werden, ob und inwieweit eine zu etablierten, standardisierten Rehabilitationsverfahren additive nicht-invasive Intervention mit speziell konzipierten elektromagnetischen Stimulationssignalen grosser spektraler Bandbreite hier hinsichtlich der folgenden Zielparameter zu Verbesserungen führen kann: schmerzende Störungen des Stütz- und Bewegungsapparates, Depression, Angst, Schlafqualität, Infarktareale beeinflussende Adhäsionsmoleküle (PECAM-1 und P-Selektin). Methoden: An der randomisierten, doppelblind placebokontrollierten Duo-Center-Studie (GCP-Standard, Untersuchungszeitraum 3 Wochen) beteiligten sich 44 Patienten mit chronischen Rückenschmerzen (low-back pain). Die elektromagnetische Intervention erfolgte additiv zu einem standardisierten Rehabilitationskonzept über flexible Ganzkörper-Elektromagnetfeldmatten. Zur Bewertung wurden validierte Beweglichkeitsmessungen, Fragebögen und enzymimmunologische Analysen herangezogen. Ergebnisse: In beiden Gruppen zeigten sich signifikante Verbesserungen von Ruhe-, Bewegungs-, Druckschmerz, Angst und Depression. Die elektromagnetische Behandlung führte darüberhinaus zu einer weiteren signifikanten Verbesserung der Beweglichkeit (Finger-Fussbodenabstand) und der Schlafqualität sowie einer signifikanten Verminderung des Adhäsionsmoleküls PECAM-1 in beiden Gruppen, nicht aber des P-Selektins. Schlussfolgerungen: Die erfolgreichen Therapiemassnahmen im Verlauf des 3-wöchigen Rehabilitationsaufenthaltes dürften die Wirkungen der elektromagnetischen Intervention teilweise maskieren. Trotz der gefundenen signifikanten Effekte der elektromagnetischen Behandlung sind diese für eine praxisrelevante Anwendung jedoch noch nicht ausreichend genug. Neben einer verlängerten Anwendungsdauer von mehr als 3 Wochen könnte sich auch auf Grund derzeitiger Forschungs- und Weiterentwicklung der gewählten Signalform eine Optimierung der Therapie einstellen. Insofern erscheint eine derartige Behandlungsform als adjuvante Massnahme zur Verbesserung von Schmerz, Schlaf und schmerzbedingter Angst und Depression bei chronischem Kreuzschmerz geeignet.
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    ABSTRACT: The objective of this study was to establish the non-inferiority of an oral enzyme therapy (Phlogenzym-(PE)) as compared to the non-steroidal anti-inflammatory drug (NSAID) diclofenac (DC) in patients with osteoarthritis (OA) of the hip. Ninety patients presenting with painful episodes of OA of the hip were treated for 6 weeks in one study centre in a phase III, randomised, double blind, parallel group trial. Altogether, 45 patients were treated in the PE group and 45 patients were treated in the DC group. Primary efficacy criteria were: WOMAC dimensions pain, joint stiffness and function, and Lequesne index as multiple endpoint according to O'Brien. The efficacy criteria were analysed applying the test of non-inferiority with regard to mean changes and frequencies, t-test, U test, ANCOVA and descriptive methods. Within the 6 weeks observation period, the adjusted changes from baseline to endpoint of the target parameters worked out as follows (adjusted differences, mean +/- SEM): WOMAC subscale pain (PE -10.3 +/- 1.2, DC -9.5 +/- 1.2), WOMAC subscale joint stiffness (PE -3.9 +/- 0.5, DC -3.6 +/- 0.5), WOMAC subscale physical function (PE -31.7 +/- 3.5, DC -29.7 +/- 3.5), Lequesne's index (PE -2.89 +/- 0.47, DC -2.27 +/- 0.47). Non-inferiority of PE as compared to DC with regard to the O'Brien's global sum of the standardised adjusted changes from baseline to endpoint in pain, stiffness, physical function, and Lequesne's index was established with p = 0.0025. PE was simultaneously non-inferior as compared to DC with regard to the 4 single endpoints: WOMAC subscale pain (p = 0.0033), WOMAC subscale joint stiffness (p = 0.0061), WOMAC subscale physical function (p = 0.0039), Lequesne's index (p = 0.0008) (closed test procedure). The equivalence tests remained insignificant due to comparatively lower effects of DC. For 71.1% of the PE patients and for 61.4% of the DC patients rates of good or very good global investigator assessments of efficacy were calculated (test of non-inferiority: p = 0.0011). In the majority of patients, tolerability was judged in both drug groups as very good or good. This trial showed significant non-inferiority from 6 weeks treatment with PE in patients with OA of the hip with regard to the WOMAC dimensions pain, stiffness and physical function, to Lequesne's index, to the investigator and patients assessments of efficacy, and to the responder rates based on pain, physical function, and patient assessment of efficacy. With regard to drug tolerability some tendencies in favour of PE were detected. However, in this study there was no real difference between PE and DC 100 mg/day, implying an equal benefit-risk relation between the substances. PE may well be recommended for the treatment of patients with osteoarthritis of the hip with signs of inflammation as indicated by a high pain level.
    Clinical and experimental rheumatology 24(1):25-30. · 2.66 Impact Factor
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    ABSTRACT: Kurzfassung: Ziel der Studie: Nachweis der Ef- fizienz kardiologischer rehabilitationsmedizini- scher Maßnahmen im Rahmen eines vierwöchi- gen stationären Anschlussheilverfahrens (AHV) nach einem Akutereignis. Methoden: In den Jahren 2004 und 2005 wur- den in den 6 kardiologischen Rehabilitationszen- tren der Pensionsversicherungsanstalt, über ei- nen Zeitraum von 12 Wochen, prospektiv bei ins- gesamt 650 PatientenInnen nach akutem Koro- narsyndrom bzw. Myokardinfarkt ohne und mit PCI, nach aortokoronarer Bypassoperation und nach Herzklappenoperation im Rahmen eines AHV Leistungsfähigkeit, Blutdruck, Stoffwechselpara- meter und Zigarettenkonsum und subjektive Lebensqualität bei Aufnahme und Entlassung erfasst und der Rehabilitationseffekt evaluiert. Ergebnisse: Der stationäre Rehabilitations- aufenthalt führte bei den angegebenen Pati- entenInnen zu einer signifikanten Verbesserung der körperlichen Leistungsfähigkeit gemessen an der diagnostischen Ergometrie und am Fahr- radergometertraining. Der systolische und dia- stolische Blutdruck konnten in den nahezu opti- malen Bereich nach den ESH/ESC-Richtlinien gesenkt werden. Auch die Stoffwechselparame- ter Gesamt-Cholesterin, LDL-Cholesterin und Tri- glyzeride wurden signifikant verbessert. Schlussfolgerungen: Ein multiprofessionelles Rehabilitationsteam kann während eines statio- nären kardiologischen AHV mit einem struktu- rierten, individuell angepassten Rehabilitations- programm bei dem definierten Patientenkollek- tiv die körperliche Leistungsfähigkeit, die kardi- alen Risikofaktoren und die Lebensqualität deut- lich verbessern. Damit wird die Grundlage für eine möglichst dauerhafte Änderung des Le- bensstils geschaffen. Abstract: Inpatient Cardiac Rehabilitation in Austria: Results of a Prospective Study About Cardiovascular Risk Factors in Sec- ondary Prevention. Objects: Verification of ef- ficiency concerning the cardiac rehabilitation outcome during a four-week inpatient stay sub- sequent to an acute cardiac event. Methods: Prospectively, a total of 650 patients were assessed in the 6 cardiologic rehabilitation centres of the pension insurance company in Austria who joined the study for a period of 12