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Mucha FC, Gonçalves Wamosy RM, Scalco JC, Almeida ACDS, Itaborahy BDH, Cardoso J, Mayer AF, Santos Schivinski CI. Comparison of the modified shuttle walk test in children with cystic fibrosis and healthy controls. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2052. [PMID: 37818756 DOI: 10.1002/pri.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To evaluate and compare performance in the modified shuttle walk test (MSWT) with cardiorespiratory parameters and respiratory muscle strength in children with cystic fibrosis (CF) and healthy controls. METHODS A cross-sectional study with children divided into the CF group (CFG) and healthy control group (HCG). Two MSWTs were performed and the data from the test with the longest distance walked and its cardiorespiratory parameters (blood pressure, respiratory rate, heart rate (HR), oxygen saturation, and dyspnea sensation) were considered, the last three every 4 levels. Respiratory muscle strength was evaluated using a manometer. The Wilcoxon test was used to compare the parameters before and after the MSWT, and the Mann-Whitney and independent t-tests were applied to compare the data between the groups. The distance walked and its association with the variation in cardiorespiratory parameters and respiratory muscle strength were analyzed by Spearman's correlation. RESULTS Sixty-two children (31 in each group) participated, with an average age of 10.2 (2.1) years. Children with CF had poorer performance in the average distance walked (CFG 716.7 (274.3)) when compared to the HCG (948.0 (202.8)). Both groups exhibited an increase in all the cardiorespiratory parameters at the end of the test, but the CFG displayed less variation in some parameters. Children with CF presented a positive correlation between distance walked and respiratory muscle strength, HR variation, and systolic blood pressure. CONCLUSIONS There was no difference in respiratory muscle strength between the groups. In the CFG, the greater the respiratory muscle strength, the better the performance in the MSWT. The CFG exhibited less variation in cardiorespiratory parameters than the HCG.
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Affiliation(s)
- Francieli Camila Mucha
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Renata Maba Gonçalves Wamosy
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Janaina Cristina Scalco
- Human Movement Sciences, State University of Santa Catarina, Rua Pascoal Simone, Florianópolis, Santa Catarina, Brazil
| | - Ana Carolina da Silva Almeida
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Juliana Cardoso
- Physiotherapy, Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Undergraduate and Graduate Program in Human Movement Sciences, Center for Health and Sports Sciences, University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Camila Isabel Santos Schivinski
- Undergraduate and Graduate Physiotherapy Programs, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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MacRae JM, Harasemiw O, Lightfoot CJ, Thompson S, Wytsma-Fisher K, Koufaki P, Bohm C, Wilkinson TJ. Measurement properties of performance-based measures to assess physical function in chronic kidney disease: recommendations from a COSMIN systematic review. Clin Kidney J 2023; 16:2108-2128. [PMID: 37915888 PMCID: PMC10616478 DOI: 10.1093/ckj/sfad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background There is wide heterogeneity in physical function tests available for clinical and research use, hindering our ability to synthesize evidence. The aim of this review was to identify and evaluate physical function measures that could be recommended for standardized use in chronic kidney disease (CKD). Methods MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, Scopus and Web of Science were searched from inception to March 2022, identifying studies that evaluated a clinimetric property (validity, reliability, measurement error and/or responsiveness) of an objectively measured performance-based physical function outcomes using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) based recommendations. Studies with individuals of all ages and of any stage of CKD were included. Results In total, 50 studies with 21 315 participants were included. Clinimetric properties were reported for 22 different physical function tests. The short physical performance battery (SPPB), Timed-up-and-go (TUG) test and Sit-to-stand tests (STS-5 and STS-60) had favorable properties to support their use in CKD and should be integrated into routine use. However, the majority of studies were conducted in the hemodialysis population, and very few provided information regarding validity or reliability. Conclusion The SPPB demonstrated the highest quality of evidence for reliability, measurement error and construct validity amongst transplant, CKD and dialysis patients. This review is an important step towards standardizing a core outcome set of tools to measure physical function in research and clinical settings for the CKD population.
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Affiliation(s)
- Jennifer M MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oksana Harasemiw
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | | | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Pelagia Koufaki
- School of Health Sciences, Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Clara Bohm
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
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3
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Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS. Guidance and standard operating procedures for functional exercise testing in cystic fibrosis. Eur Respir Rev 2023; 32:230029. [PMID: 37558263 PMCID: PMC10410399 DOI: 10.1183/16000617.0029-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.
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Affiliation(s)
- Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mathieu Gruet
- Laboratory of the Impact of Physical Activity on Health (IAPS), University of Toulon, Toulon, France
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK
| | - Brenda Button
- Department of Physiotherapy, Melbourne School of Health Science, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marlies Wagner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Abbey Sawyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helge Hebestreit
- Paediatric Department, University Hospitals Würzburg, Würzburg, Germany
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Don S Urquhart
- Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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4
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Effects of Exercise Training on Peripheral Muscle Strength in Children and Adolescents with Cystic Fibrosis: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10122520. [PMID: 36554044 PMCID: PMC9778003 DOI: 10.3390/healthcare10122520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.
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Boonjindasup W, Chang AB, Marchant JM, Irons JY, McElrea MS. How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis. Lung 2021; 199:213-222. [PMID: 33590270 DOI: 10.1007/s00408-021-00422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. METHODS We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. RESULTS All children achieved repeatable MIP/MEP values within 10-11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6-11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. CONCLUSION It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia. .,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cough, Asthma & Airways Research Group, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - J Yoon Irons
- Health and Social Care Research Centre, University of Derby, Derby, UK
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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Combret Y, Boujibar F, Gennari C, Medrinal C, Sicinski S, Bonnevie T, Gravier FE, Laurans M, Marguet C, Le Roux P, Lamia B, Prieur G, Reychler G. Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial. PLoS One 2021; 16:e0246781. [PMID: 33577586 PMCID: PMC7880481 DOI: 10.1371/journal.pone.0246781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background Functional exercise capacity assessment is recommended in children with cystic fibrosis (CF). The six-minute walk test (6MWT) is a valid evaluation of exercise capacity but can be technically complex. Inversely, the sit-to-stand test (STST) is a simple method to evaluate exercise capacity, and is validated in healthy children and adults with CF. This study aimed to evaluate STST measurement properties in children and adolescents with CF. Methods In this multicenter study, children with CF (6 to 18 years) performed two iterations of both the STST and the 6MWT in a randomized order. Criterion validity was determined by assessing correlations between STST repetitions and 6MWT distance (6MWD). Intra-rater reliability, test-retest repeatability, mean bias and limits of agreement were also assessed. Relationships with other outcomes (i.e. respiratory and quadriceps muscle strength) and cardio-respiratory responses were analysed for both tests. Results Thirty-six children with CF were included (mean age 12.0 ±3.5 years and FEV1 95.8 ±25.0%). On average, 39.6 ±10.5 repetitions were performed during the STST and mean 6MWD was 596.0 ±102.6 meters. STST number of repetitions was significantly correlated with 6MWD (r = 0.48; p<0.01). Both tests had very good intra-rater reliability (ICCSTST = 0.91 (95%CI 0.76–0.96) and ICC6MWT = 0.94 (95%CI 0.85–0.97)), and a significant test-retest learning effect. The number of STST repetitions was not correlated with quadriceps or respiratory muscle strength test, and the STST induced fewer cardio-respiratory responses than the 6MWT. Conclusions The STST is an easy-to-use functional test with moderate criterion validity when compared to the 6MWT in children with CF, probably because both tests measure different components of functional exercise capacity. The STST is useful when the 6MWT is unfeasible, however further investigations are required to explore the clinical implications of STST results in children with CF. Clinical trial registration NCT03069625.
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Affiliation(s)
- Yann Combret
- Pediatric Department, Le Havre Hospital, Le Havre, Normandie, France
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Brussels Capital Region, Belgium
- Pulmonology Department, Le Havre Hospital, Le Havre, Normandie, France
- * E-mail:
| | - Fairuz Boujibar
- INSERM U1096, UNIROUEN, Normandie Univ, Rouen University Hospital, Rouen, Normandie, France
| | - Charlotte Gennari
- Cystic Fibrosis Department, Pediatric Section, Caen University Hospital, Caen, Normandie, France
| | - Clément Medrinal
- Pulmonology Department, Le Havre Hospital, Le Havre, Normandie, France
- Erphan Department, UVSQ, Paris-Saclay University, Versailles, Île-de-France, France
- Saint Michel School of Physiotherapy, Paris-Saclay University, Paris, Île-de-France, France
| | - Sophie Sicinski
- Pediatric Cystic Fibrosis Department, Pediatric Section, Rouen University Hospital, Rouen, Normandie, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, Normandie, France
- UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Rouen University Hospital, Rouen, Normandie, France
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, Normandie, France
- UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Rouen University Hospital, Rouen, Normandie, France
| | - Muriel Laurans
- Cystic Fibrosis Department, Pediatric Section, Caen University Hospital, Caen, Normandie, France
| | - Christophe Marguet
- Pediatric Cystic Fibrosis Department, Pediatric Section, Rouen University Hospital, Rouen, Normandie, France
- Pediatric Respiratory Disease and Allergy Unit, UNIROUEN, Inserm EA 2656, Rouen University Hospital, Rouen, Normandie, France
| | - Pascal Le Roux
- Pediatric Department, Le Havre Hospital, Le Havre, Normandie, France
| | - Bouchra Lamia
- Pulmonology Department, Le Havre Hospital, Le Havre, Normandie, France
- UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Rouen University Hospital, Rouen, Normandie, France
- Intensive Care Unit, Respiratory Section, Rouen University Hospital, Rouen, Normandie, France
| | - Guillaume Prieur
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Brussels Capital Region, Belgium
- Pulmonology Department, Le Havre Hospital, Le Havre, Normandie, France
- UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Rouen University Hospital, Rouen, Normandie, France
| | - Grégory Reychler
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Brussels Capital Region, Belgium
- Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinics, Brussels, Brussels Capital Region, Belgium
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Poncin W, Evrard S, Mareschal A, Gohy S, Reychler G. Effects of rehabilitation methods on lower-limb muscle function and functional performance in patients with cystic fibrosis: A systematic review. Clin Rehabil 2020; 35:534-545. [PMID: 33222526 DOI: 10.1177/0269215520972941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effects of rehabilitation methods on leg muscle function and functional performance in cystic fibrosis. DATA SOURCES A literature search was conducted in PubMed (MEDLINE), Scopus and the Cochrane Library from inception to October 12, 2020. A secondary hand search through reference lists from identified articles was conducted. REVIEW METHODS Three authors independently checked the full-text copies for eligibility of relevant articles. Randomized controlled trials were included. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The PRISMA guidelines were followed. Results suggestive of leg muscle function (e.g. strength, power, endurance, and fatigue) and functional performance were reported. RESULTS The search identified 8 studies (233 patients). The overall quality of these articles was good. Rehabilitation modalities investigated were physical exercises (aerobic, anaerobic and resistance training) (n = 7) and neuromuscular electrical stimulation (n = 1). Most studies (n = 4) reported on the effects of combined aerobic and resistance training and showed improvement on leg strength when exercises were supervised. Aerobic training alone or the use of neuromuscular electrical stimulation also enhanced leg strength, whereas anaerobic training did not. Two studies evaluated leg fatigue and found no improvement compared to standard care. One study assessed the effect of exercises on functional performance and found no improvement when compared to standard care. No studies emphasized the impact of rehabilitation methods on leg muscle endurance or power. CONCLUSION Combined aerobic and resistance training enhances leg muscle strength in cystic fibrosis. There is insufficient data on other leg muscle outcomes, nor on alternative rehabilitation strategies.
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Affiliation(s)
- William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Sarah Evrard
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Alice Mareschal
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Sophie Gohy
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Centre de référence pour la mucoviscidose, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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