Effects of physical training on functional status in patients with prolonged mechanical ventilation.
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BACKGROUND AND PURPOSE: Patients requiring prolonged mechanical ventilation (PMV) are frequently deconditioned because of respiratory failure precipitated by the underlying disease, the adverse effects of medications, and a period of prolonged immobilization. The effects of 6 weeks of physical training on the strength of respiratory and limb muscles, on ventilator-free time, and on functional status in patients requiring PMV were examined. SUBJECTS: Thirty-nine patients with PMV were initially enrolled in the study and were assigned to either a treatment group (n=20) or a control group (n=19). Three subjects in the treatment group and 4 subjects in the control group died during the 6-week intervention period and thus their data were excluded from the final analysis. METHODS: Subjects in the treatment group received physical training 5 days a week for 6 weeks. Strength of respiratory and limb muscles, ventilator-free time, and functional status, which was measured by the Barthel Index of Activities of Daily Living (BI) and Functional Independence Measure (FIM), were examined at baseline and at the third and sixth weeks of the study period. RESULTS: Respiratory and limb muscle strength improved significantly at the third and sixth weeks in the treatment group compared with baseline measurements. Total BI and FIM scores increased significantly in the treatment group and remained unchanged in the control group. Effect sizes of the BI and FIM scores were 2.02 and 1.93, respectively, at the sixth week. DISCUSSION AND CONCLUSION: The results show that a 6-week physical training program may improve limb muscle strength and ventilator-free time and thus improve functional outcomes in patients requiring PMV. (+info)
A randomised controlled cross-over trial of aerobic training versus Qigong in advanced Parkinson's disease.
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AIM: To investigate the effects of an aerobic training in subjects with Parkinson's disease (PD) as compared to a medical Chinese exercise (Qigong). METHODS: DESIGN: randomized controlled trial with a cross over design. SETTING: PD out-patients referred to a Neurorehabilitation facility for the management of motor disability. SUBJECTS: 26 PD patients in Hoehn and Yahr stage II to III under stable medication were randomly allocated to either Group AT1+QG2 (receiving 20 aerobic training sessions followed by 20 ''Qigong'' group sessions with 2 month interval between the interventions), or Group QG1+AT2 (performing the same treatments with an inverted sequence). MAIN OUTCOME MEASURES: clinical effects of treatment were sought through the Unified Parkinson's Disease Rating Scale (UPDRS), Brown's Disability Scale (B'DS), six-Minute Walking Test (6MWT), Borg scale for breathlessness, Beck Depression Inventory (BDI) and Parkinson's Disease Questionnaire-39 items (PDQ-39). A spirometry test and maximum cardiopulmonary exercise test (CPET) were also performed to determine the pulmonary function, the metabolic and cardio-respiratory requests at rest and under exercise. All measures were taken immediately before and at the completion of each treatment phase. RESULTS: The statistical analysis focusing on the evolution of motor disability and quality of life revealed a significant interaction effect between group and time for the 6MWT (time x group effect: F: 5.4 P=0.002) and the Borg scale (time x group effect: F: 4.2 P=0.009). Post hoc analysis showed a significant increase in 6MWT and a larger decrease in Borg score after aerobic training within each subgroup, whereas no significant changes were observed during Qigong. No significant changes over time were detected through the analysis of UPDRS, B'DS, BDI and PDQ-39 scores. The analysis of cardiorespiratory parameters showed significant interaction effects between group and time for the Double Productpeak (time x group effect: F: 7.7 P=0.0003), the VO(2peak) (time x group effect: F: 4.8 P=0.007), and the VO(2)/kg ratio (time x group effect: F: 4.3 P=0.009), owing to their decrease after aerobic training to an extent that was never observed after Qigong treatment. CONCLUSIONS: Aerobic training exerts a significant impact on the ability of moderately disabled PD patients to cope with exercise, although it does not improve their self-sufficiency and quality of life. (+info)
Optimal intensity for respiratory muscle endurance training in patients with spinal cord injury.
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OBJECTIVE: Respiratory muscle endurance of able-bodied persons, assessed by normocapnic hyperpnoea at 70% of their maximal voluntary ventilation, usually ranges from 10 to 20 minutes. The aim of this study was to determine the level of ventilation that patients with paraplegia and tetraplegia can sustain for 10-20 minutes to later be used as the guideline for respiratory muscle endurance training. DESIGN: Pilot study; cross-over setting. SUBJECTS: Two groups, 8 patients with paraplegia and 6 with tetraplegia. METHODS: Respiratory muscle endurance tests were performed at 3 different intensities of normocapnic hyperpnoea, i.e. 20%, 40% and 60% maximal voluntary ventilation. Subjects performed partial re-breathing from a bag to assure normocapnia. Respiratory endurance was separately analysed for patients with paraplegia and tetraplegia. RESULTS: Mean respiratory endurance times were 46.0, 18.9 and 4.2 minutes at 20%, 40% and 60% maximal voluntary ventilation in patients with tetraplegia and 51.8, 38.8 and 12.2 minutes in patients with paraplegia. The duration differed significantly at 60% maximal voluntary ventilation between the groups. CONCLUSION: Minute ventilation to perform respiratory muscle endurance training can be set at around 40% of maximal voluntary ventilation for patients with tetraplegia and around 60% of maximal voluntary ventilation for patients with paraplegia, as these levels can be sustained for 10-20 minutes. (+info)
Dyspnea and quality of life in patients with pulmonary fibrosis after six weeks of respiratory rehabilitation.
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The aim of the study was to estimate the level of dyspnea and quality of life in patients with pulmonary fibrosis after 6 weeks' respiratory rehabilitation. The study comprised of 31 patients (F/M-12/19) with interstitial lung diseases (21 with idiopathic interstitial pneumonia, 4 with lung fibrosis due to allergic alveolitis, 4 with lung fibrosis due to collagenosis, 2 with lung fibrosis due to silicosis) who successfully finished the rehabilitation program. Each patient underwent an intensive (every day for 30 min) inpatient pulmonary rehabilitation program of an average length of 4 wk, continued later at home for up to 12 wk. The program consisted of respiratory muscle training and bicycle riding to the limits of the patient's tolerance. Dyspnea (MRC, OCD, BDI and Borg scale) and the quality of live (SF-36, St. George's Respiratory Questionnaire) were assessed at the time of admission and discharge. Rehabilitation caused dyspnea sensation to diminish (Borg scale: 2.97 before vs. 2.19 after). Some domains of the quality of life in SF-36 questionnaire (Role-Physical 40.6 vs. 60.2) and St. George's Respiratory Questionnaire (activity: 52 vs. 45, impact 47 vs. 40 and total 47 vs. 42) also were improved compared with the pre-rehabilitation results. We conclude that 12 weeks of combined inpatient and home-based rehabilitation programme improves the quality of live and sensation of dyspnea in patients with interstitial lung disease, despite changes in pulmonary function tests. (+info)
Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial.
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BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5-18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with < or = 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of < or = 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP. (+info)
Nursing students' willingness to use complementary and alternative therapies for cancer patients: Istanbul survey.
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It is important for student nurses to be knowledgeable of the complementary and alternative therapies and to provide accurate information to both cancer patients and other health care professionals. This study examined the nursing students' willingness to use these therapies, availability of sources of information, use of the therapies for self care, opinions about the integration of these therapies into nursing curriculum, and analyzed the differences among the responses. A self-administered questionnaire was offered to 640 nursing students in Istanbul, descriptive statistics were used, and comparisons among responses were made with chi-square test. Willingness to use for cancer patients was highest for nutritional therapy (76.1%), breathing therapies (74.5%), and massage and manipulation-Tui Na, in which pressure and touch are applied to the body (71.9%). Use of information sources was highest for nutritional therapy (75.6%), breathing therapies (71.9%), and massage and manipulation-Tui Na (62.3%). Over half of the nursing students used music therapy (54.2%), and massage and manipulation-Tui Na (53.6%) for self-care. Breathing therapies (87.2%) were the most desired therapy chosen to be included in nursing curriculum. The statistically significant differences were found among the responses related to use five therapies for care and related to desired three therapies to be included in nursing curriculum. Although students had not previously been exposed to these therapies use with oncology patients, many of students expressed a desire to integrate therapies learning into nursing curriculum. The more student nurses document high risk patients, the more effective strategies will be developed by other health care professionals. (+info)
Influence of the technique of re-educating thoracic and abdominal muscles on respiratory muscle strength in patients with cystic fibrosis.
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OBJECTIVE: To determine the effect that re-education of the thoracic and abdominal muscles has on the respiratory muscle strength of patients with cystic fibrosis evaluated over time at the Cystic Fibrosis Outpatient Clinic of the Universidade Catolica de Brasilia (Catholic University of Brasilia). METHODS: The sample consisted of 29 cystic fibrosis patients, characterized based on anthropometric, genetic and bacterial colonization data. The patients were submitted to physical therapy sessions, involving re-education of the respiratory muscles, twice a week for four months. Spirometry, pressure manometry and anthropometry were performed before and after each session. RESULTS: Comparing baselines values to those obtained after physical therapy, increases in maximum inspiratory pressure and maximum expiratory pressure were observed in all patients, those without any obstructive respiratory disease and those with mild obstructive respiratory disease (p < 0.05). A positive correlation between age and maximum expiratory pressure was observed for most of the patients. Maximum inspiratory pressure correlated positively with age only in the group with mild obstructive respiratory disease (p = 0.012; r = 0.817). In female patients and in the group of patients without obstructive respiratory disease, a negative correlation was observed between maximum expiratory pressure and colonization with Pseudomonas aeruginosa (p = 0.036; r = -0.585). CONCLUSION: Use of the thoracic and abdominal muscle re-education technique increased respiratory muscle strength in the cystic fibrosis patients studied, a finding that underscores the importance of including physical therapy in the treatment of these patients. (+info)
Mounier-Kuhn syndrome.
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Mounier-Kuhn syndrome, or tracheobronchomegaly, is a rare clinical entity characterized by abnormal dilation of the trachea and main bronchi. The diagnosis can usually be made by measuring the tracheal diameter. We report the case of a 40-year-old black man with refractory lower respiratory tract infection. Tracheobronchomegaly was confirmed through computed tomography. (+info)