Physiospot CardioRespiratory

COPD as a Systemic Disease: Impact on Physical Functional Limitations

Mark D. Eisner MD, Blanc PD, Yelin EH,Sidney S, Katz PP, Ackerson L, Lathon P, Tolstykh I, Omachi T, Byl N, Iribarren C

The authors of this study aimed to establish the physical functional limitations that are directly attributable to COPD compared to a matched referent group without COPD.
Subjects were matched for age, sex, and race and measures used to study the impact of COPD on the risk of a broad array of functional limitations included: lower extremity function (Short Physical Performance Battery), submaximal exercise performance (Six Minute Walk Test), standing balance (Functional Reach Test), skeletal muscle strength (manual muscle testing with dynamometry), and self-reported functional limitation (standardized item battery).

COPD was associated with poorer lower extremity function, less distance walked during the SMWT, weaker muscle strength in every muscle group tested, including both the upper and lower extremities and carried a greater risk of self-reported functional limitation.
Conclusions

The American Journal of Medicine 2008; 121: 789 – 796

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Functional Residual Capacity Changes After Different Endotracheal Suctioning Methods

Heinze H, Sedemund-Adib B, Heringlake M, Gosch UW, Eichler W

This study set out to investigate the effects of three different endotracheal suctioning procedures on functional residual capacity (FRC). In a crossover design study, twenty postoperative cardiac surgery patients received three different suctioning methods in randomized order: closed suctioning during pressure-controlled ventilation, closed suctioning during volume-controlled ventilation, and open suctioning. FRC was measured before and 20 min after the intervention.

The results showed that FRC is reduced in post cardiac surgery patients after suctioning, regardless of which method is used.

Anesthesia and Analgesia 2008; 107: 941 - 944

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Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial.

Herdy AH, Marcchi PL, Vila A, Tavares C, Collaço J, Niebauer J, Ribeiro JP.

This study of 56 patients awaiting coronary artery bypass graft (CABG) surgery while still in hospital makes interesting reading. The patients were randomised into two groups. Rehab group received cardiopulmonary rehabilitation which lasted at least 5 days preoperatively and consisted of phase I cardiac rehabilitation associated with respiratory physical therapy, while the other group (usual care) received the standard care usually available to these patients.

By discharge (post CABG), Rehab patients presented a shorter time to endotracheal extubation, a reduction in the incidence of pleural effusion, atelectasis, pneumonia and atrial fibrillation or flutter. Length of in-hospital stay after surgery was also significantly reduced in the Rehab group.

American Journal of Physical Medicine and Rehabilitation 2008; 87: 714 - 9

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ICF: Clinical relevance for physiotherapy? A critical review

Lara Allet; Elisabeth Burge; Dominique Monnin

The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines with a universal language. However, the ICF is still highly complex and questions remain about its practicability. The aims of this review were to (i) identify how the ICF is integrated in the clinical activity of physiotherapists, (ii) discuss advantages and limits of the use of the ICF, and (iii) suggest further possibilities for implementing the ICF by physiotherapists. Of 155 identified articles, 22 were specific to physiotherapy. These articles described the utility of the ICF to facilitate decision-making for physiotherapists; to classify the evaluation of therapy outcomes; to ensure that all aspects of human functioning are represented while testing the effectiveness and the reliability of these outcomes; to structure the documentation of assessments and interventions, as well as to ameliorate the communication.

ICF has a clinical relevance for physiotherapists, although the limited reliability of the qualifier system for the feasibility of its implementation was shown. The authors emphasize that the ICF is a tool that facilitates the decision of what to measure but not how to measure.

Advances in Physiotherapy, 2008, 10(3), 127-137

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The immediate effect of musculoskeletal physiotherapy techniques and massage on pain and ease of breathing in adults with cystic fibrosis.

 

Lee A, Holdsworth M, Holland A, Button B

The optimal treatment approach to musculoskeletal pain in cystic fibrosis remains unclear. This study aimed to examine the effect of a combination of musculoskeletal physiotherapy techniques and massage therapy on musculoskeletal pain and ease of breathing.

A single treatment session was associated with reduction in pain and improvement in ease of breathing in adults with cystic fibrosis.

Journal of Cystic Fibrosis, 2008 Aug, online article ahead of print

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Group-based Aerobic Training in Patients With Chronic Heart Failure: Norwegian Ullevaal Model

Nilsson BB, Hellesnes B, Westheim A, Risberg MA

This case report describes the responses of four patients with chronic heart failure (NYHA III), to a group-based, high-intensity, interval training rehabilitation programme that included aerobic, resistance, flexibility and balance actvities. The four patients each experienced improvements in physical capacity and quality of life with no adverse events. This study adds support to the growing body of evidence that high-intensity interval training should be included into programmes for people with chronic heart failure.

Physical Therapy 2008; 88: 523 – 535

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Predictive Utility of the 6-Minute Walk Distance on Survival in Patients Awaiting Lung Transplantation

Tuppin MP, Paratz JD, Chang AT, Seale HE, Walsh JR, Kermeeen FD, McNeil KD, Hopkins PM

This study aimed to determine the hazard function associated with the 6MWD, and its utility relative to other prognostic variables in all patients on the lung transplant list. A retrospective chart review was conducted on 163 patients who were listed for single or double LT, and either survived to transplant or died while on the waiting list. Patients included had either a diagnosis of COPD, Cystic Fibrosis or Interstitial Lung Disease.

The 6MWD proved to be the most predictive variable of outcome (survival), demonstrating that those with a greater 6MWD have a lower risk of death. A protective effect for each unit increase in the 6MWD was also demonstrated. This research demonstrates that the 6MWD is useful for stratifying patients on the lung transplant waiting list by identifying those patients with a significantly higher risk of mortality.

The Journal of Heart and Lung Transplantation 2008; 27: 729 – 734

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Noninvasive ventilation in acute cardiogenic pulmonary edema.

Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J

This large multicenter, randomized, controlled trial set out to establish whether; noninvasive ventilation (continuous positive airway pressure (CPAP) or noninvasive intermittent positive-pressure ventilation (NIPPV)) reduces mortality and if there are important differences in outcome associated with the method of treatment, in a group of patients with acute cardiogenic pulmonary oedema.

Their findings included no significant difference in; 7-day mortality between patients receiving standard oxygen therapy and those undergoing noninvasive ventilation, or in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation. Noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea, heart rate, acidosis and hypercapnia. There were no treatment-related adverse events.

New England Journal of Medicine 2008; 359: 142-51.

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Whole body vibration: a new therapeutic approach to improve muscle function in cystic fibrosis?

Rietschel E, Koningsbruggen S, Fricke O, Semlar O, Schoenau E

This study aimed to evaluate the effects of Whole Body Vibration (WBV) on muscle function in patients with Cystic Fibrosis (CF). The theory behind WBV is that it stimulates muscle contractions via stretch reflexes, thereby improving muscle activity.

During treatment with WBV the following tests were carried out; Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV), BMI, chair rising test, one and two leg jump test and grip strength.

The most significant improvements were noted in BMI and weight. FVC and FEV showed improvements but these were not significant. The authors state that the outcomes of the study support the use of WBV to improve muscle function in patients with CF.

International Journal of Rehabilitation Research, 2008, 31(3), 253-256

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During exercise non-invasive ventilation in chronic restrictive respiratory failure.

Borel JC, Wuyam B, Chouri-Pontarollo N, Deschaux C, Levy P, Pépin JL

The objective of this study was to investigate exercise endurance and associated physiological responses with non-invasive ventilation (NIV) during exercise in restrictive CRF patients. Eighteen patients performed maximal exercise in spontaneous breathing conditions (MWLE) and during two constant workload exercise (CWLE) tests at 75% Pmax, with or without NIV in random order.  For the whole group, CWLE duration when using NIV increased which correlated with reduction in heart rate and oxygen desaturation, and dyspnea relief during exercise. NIV responders showed more severe lung restriction.  At the end of MWLE, responders had a lower Vt, a higher dead-space ratio and lower oxygen pulse.

In severely restrictive patients, NIV during exercise significantly improved exercise duration and tolerance and increased alveolar ventilation.

Respiratory Medicine, 2008, 102(5), 711-9

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