## 3 Results
### Assessment of Treatment Effectiveness  
The predominant therapy length was 2-3 months (33.3%). Furthermore, it lasted 4-5 months (nine patients) in the case of 23.1% of patients. The shortest therapy, which was 1-1.5 months, happened in the case of 17.9% of patients (seven patients), while the longest therapy of 6 months or longer than 6 months was the case for 10.3% (four patients) and 15.4% (six patients), respectively. In patients with the therapy length over six months, the duration was 10.50 \(\pm\) 1.64 months on average (ranging from 8.00 to 12.00 months). The most common number of buckles used in the therapy was two (39.4%). One in five patients used one buckle (21.2%, seven patients) and similarly, one in five patients used more than three buckles (21.2%, seven patients). Three buckles were employed in the treatment of 18.2% of patients (six people). In all patients treated with more than three buckles, the number of buckles ranged from 4.00 to 6.00 buckles. Pain level during installation of the buckle was assessed with a 1 to 4 scale with the outcome of 1.51 \(\pm\) 0.50 on average. None of the patients considered the therapy disturbing to their everyday lives. Almost all patients declared the desire to repeat the treatment in case the problem appeared again (94.9%). The patients assessed the therapy's effectiveness on a scale from 1 to 10. The average outcome in the analyzed group was 9.08 \(\pm\) 0.93, ranging from 7.00 to 10.00. Patients evaluated how the treatment influenced the clinical picture of their nails using a scale from 1 to 4, with 1 meaning no improvement and 4 meaning full recovery. The average outcome was 3.54 \(\pm\) 0.64, and the replies ranged from 2 to 4, meaning that the patients claimed considerable improvement/full improvement on average, while their replies ranged from minimal improvement to full improvement. No patient indicated a lack of any improvement, (Table 6). \begin{table}
\begin{tabular}{l l l l l} \hline \hline
**Variable** & **Scale Definition** & **Before** & **After** & **\(\boldsymbol{p}\)** \\ \hline Worries about the appearance of the nails [1; 2; 3; 4] & 1—lowest, 4—highest & 3.13 \(\pm\) 0.80 & 1.15 \(\pm\) 0.37 & \textless{0.001} \\ \hline Feeling of discomfort [1; 2; 3; 4] & 1—lowest, 4—highest & 3.46 \(\pm\) 0.55 & 1.10 \(\pm\) 0.31 & \textless{0.001} \\ \hline Nail pain level [1; 2; 3; 4] & 1—highest, 4—lowest & 2.00 (1.00;3.00) & 4.00 (4.00;4.00) & \textless{0.001} 1 \\ \hline Nail pain level according to the VAS scale level [1; 2; 3; 4] & 1—VAS of 0, 2—VAS of 1–3, 3—VAS of 4–7, 4—VAS of 8–10 & 3.31 \(\pm\) 0.69 & 1.18 \(\pm\) 0.39 & \textless{0.001} \\ \hline Pain intensity—Latinen scale [0–4] & 0—no pain, 4—not sustainable & 2.38 \(\pm\) 1.04 & 0.23 \(\pm\) 0.43 & \textless{0.001} \\ \hline Pain frequency & 0—not occurring, 4—continuous & 2.18 \(\pm\) 0.97 & 0.15 \(\pm\) 0.37 & \textless{0.001} \\ \hline Intake of painkillers—Latinen scale [0–4] & 0—no medication, 4—permanently, very high doses & 0.00 (0.00;1.00) & 0.00 (0.00;0.00) & 0.001 1 \\ \hline Motor activity limitation—Latinen scale [0–4] & 0—no limitation, 4—preventing self sufficiency & 2.00 (1.00;2.00) & 0.00 (0.00;0.00) & \textless{0.001} 1 \\ \hline Pain restricting patient from wearing full shoes [1; 2; 3; 4] & 1—highly, 4—no restriction & 2.03 \(\pm\) 0.71 & 3.85 \(\pm\) 0.37 & \textless{0.001} \\ \hline General health condition [1; 2; 3; 4; 5; 6; 7] & 1—very poor, 7—excellent & 2.05 \(\pm\) 1.10 & 6.31 \(\pm\) 0.69 & \textless{0.001} \\ \hline Life quality [1; 2; 3; 4; 5; 6; 7] & 1—very poor, 7—excellent & 1.82 \(\pm\) 1.02 & 6.41 \(\pm\) 0.72 & \textless{0.001} \\ \hline \hline \end{tabular}  
* Data presented with the mean and standard deviation or the median and interquartile range. Comparisons of before and after treatment were performed with a paired \(t\)-test or the Wilcoxon test 1, as appropriate.  
\end{table} 
Table 5: Comparison of life quality assessment before and after VHO-Osthold® Perfect buckle treatment.