1
|
Liou YG, Chang SL, Hu S, Chen MZ, Yeh JT. Effect of adding neuromuscular electrical stimulation for patients with moderate to severe chronic obstructive pulmonary disease: Systematic review and meta-analysis. Complement Ther Clin Pract 2024; 57:101867. [PMID: 38901395 DOI: 10.1016/j.ctcp.2024.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Healthcare providers have faced challenges for patients with moderate and severe chronic obstructive pulmonary disease (COPD) in conducting their pulmonary rehabilitation due to dyspnea and exercise intolerance. Neuromuscular electrical stimulation (NMES) has been used to improve the muscle group's power and endurance without adding pulmonary workload, which might be used as a potential adjuvant rehabilitation method and thus to improve patients' pulmonary functions. METHODS This was a systematic review and meta-analysis of randomized controlled trials. Data were retrieved from PubMed, CINAHL, Academic Search Complete, Cochrane Library, and Airiti Library databases from the inception of the database to December 2022. The Cochrane Collaboration tool was used to assess the risk of bias. Two reviewers independently assessed, extracted, and appraised the included studies. Then, the grading of recommendations, assessment, development, and evaluation (GRADE) methodology was used for assessing the certainty of evidence. The pooled estimates were calculated using a random-effects model. RESULTS In total, 19 studies involving 589 moderate to severe COPD patients were analyzed. Compared with controls, adding NMES to pulmonary rehabilitation could significantly increase exercise capacity, physical activity function, and health-related quality of life (HRQoL) (all p < 0.05). The GRADE results showed low to very low certainty of evidence levels. CONCLUSION NMES could improve exercise capacity and reduce the perceived sensation of dyspnea during exercise and is recommended as an effective adjuvant training modality in the rehabilitation for moderate to severe COPD patients.
Collapse
Affiliation(s)
- Yueh-Guo Liou
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Lo-Sheng Sanatorium and Hospital, New Taipei City, Taiwan.
| | - Shin Lin Chang
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Internal Medicine, Koo Foundation Sun Yat-Sen Cancer Center Hospital, Taipei City, Taiwan.
| | - Sophia Hu
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ming-Zing Chen
- Department of Chest Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
| | - Jiunn-Tyng Yeh
- Department of Internal Medicine, Koo Foundation Sun Yat-Sen Cancer Center Hospital, Taipei City, Taiwan.
| |
Collapse
|
2
|
Yoshioka Y, Oshima Y, Sato S, Tamaki A, Hamada R, Miyasaka J, Hata K, Ito T, Ikeguchi R, Hatano E, Matsuda S. Neuromuscular electrical stimulation, muscle mass, and physical function decline in the early phase after living donor liver transplantation. Liver Transpl 2024:01445473-990000000-00390. [PMID: 38937941 DOI: 10.1097/lvt.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/19/2024] [Indexed: 06/29/2024]
Abstract
This study aims to investigate the effects of neuromuscular electrical stimulation (NMES) in addition to conventional early mobilization in the early postoperative period after living donor liver transplantation (LTx) on body composition and physical function. This was a retrospective single-center cohort study. Adult subjects who were admitted for living donor LTx from 2018 to 2023 were included in the analysis. After April 2020, patients underwent 4 weeks of NMES in addition to conventional rehabilitation. The skeletal muscle mass index, body cell mass, and physical function, including the 6-minute walking distance, were assessed before surgery and at discharge, and changes in these outcomes were compared before and after the introduction of NMES. Sixty-one patients were in the NMES group, and 53 patients before the introduction of NMES were in the control group. ANCOVA with etiology, obstructive ventilatory impairment, Child-Pugh classification, and initial body composition value as covariates demonstrated that there was a significantly smaller decline of body cell mass (-2.9±2.7 kg vs. -4.4±2.7 kg, p = 0.01), as well as of the skeletal muscle mass index (-0.78±0.73 kg/m2 vs. -1.29±1.21 kg/m2, p = 0.04), from baseline to discharge in the NMES group than in the control group; thus, the decline after surgery was suppressed in the NMES group. Four weeks of NMES, in addition to conventional rehabilitation in the early period after LTx, may attenuate the deterioration of muscle mass. It is suggested that NMES is an option for developing optimized rehabilitation programs in the acute postoperative period after LTx.
Collapse
Affiliation(s)
- Yuji Yoshioka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Susumu Sato
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Hyogo, Japan
| | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | | | - Koichiro Hata
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
3
|
Anderson LJ, Paulsen L, Miranda G, Syrjala KL, Graf SA, Chauncey TR, Garcia JM. Neuromuscular electrical stimulation for physical function maintenance during hematopoietic stem cell transplantation: Study protocol. PLoS One 2024; 19:e0302970. [PMID: 38728244 PMCID: PMC11086915 DOI: 10.1371/journal.pone.0302970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Hematopoietic stem cell transplantation is a common life-saving treatment for hematologic malignancies, though can lead to long-term functional impairment, fatigue, muscle atrophy, with decreased quality of life. Although traditional exercise has helped reduce these effects, it is inconsistently recommended and infrequently maintained, and most patients remain sedentary during and after treatment. There is need for alternative rehabilitation strategies, like neuromuscular electrical stimulation, that may be more amenable to the capabilities of hematopoietic stem cell transplant recipients. Patients receiving autologous HCT are being enroled in a randomized controlled trial with 1:1 (neuromuscular electrical stimulation:sham) design stratified by diagnosis and sex. Physical function, body composition, quality of life, and fatigue are assessed prior to hematopoietic stem cell transplant (prior to initiating preparatory treatment) and 24±5 days post hematopoietic stem cell transplant (Follow-up 1); physical function and quality of life are also assessed 6-months post hematopoietic stem cell transplant (Follow-up 2). The primary outcome is between-group difference in the 6-minute walk test change scores (Follow-up 1-Pre-transplant; final enrolment goal N = 23/group). We hypothesize that 1) neuromuscular electrical stimulation will attenuate hematopoietic stem cell transplant-induced adverse effects on physical function, muscle mass, quality of life, and fatigue compared to sham at Follow-up 1, and 2) Pre-transplant physical function will significantly predict fatigue and quality of life at Follow-up 2. We will also describe feasibility and acceptability of neuromuscular electrical stimulation during hematopoietic stem cell transplant. This proposal will improve rehabilitative patient care and quality of life by determining efficacy and feasibility of a currently underutilized therapeutic strategy aimed at maintaining daily function and reducing the impact of a potent and widely used cancer treatment. This trial is registered with clinicaltrials.gov (NCT04364256).
Collapse
Affiliation(s)
- Lindsey J. Anderson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, Washington, United States of America
| | - Lauren Paulsen
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Gary Miranda
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, Unites States of America
| | - Solomon A. Graf
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Medical Oncology, Seattle, Washington, Unites States of America
| | - Thomas R. Chauncey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Medical Oncology, Seattle, Washington, Unites States of America
| | - Jose M. Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, Washington, United States of America
| |
Collapse
|
4
|
LoMauro A, Gervasoni F. 20 years of neuromuscular electrical stimulation in COPD. Eur Respir Rev 2024; 33:220247. [PMID: 38508667 PMCID: PMC10951858 DOI: 10.1183/16000617.0247-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
Although a lung disease, COPD is also associated with extrapulmonary manifestations including, among others, limb muscle dysfunction. Limb muscle dysfunction is a key systemic consequence of COPD that impacts patients' physical activity, exercise tolerance, quality of life and survival. Deconditioning is the main mechanism underlying the development of limb muscle dysfunction in COPD, which can be partially improved with exercise. However, some patients may not be able to tolerate exercise because of incapacitating breathlessness or unwillingness to undertake whole-body exercise. Alternative training modalities that do not give rise to dyspnoea, such as neuromuscular electrical stimulation (NMES), are urged. Over the past 20 years, NMES in COPD has presented conflicting conclusions in meta-analysis. In this review, we try to understand the reason for this result by analysing possible biases and factors that brought conflicting conclusions. We discuss the population (the intervention group, but also the control group), the outcome measures, the frequency of stimulation, the rehabilitation protocol (i.e. NMES alone versus standard care/rehabilitation or NMES plus conventional exercise training versus conventional exercise training alone or NMES versus sham treatment) and the trial design. The main reason for this discrepancy is the lack of dedicated guidelines for NMES. Further research is urged to determine the optimal parameters for an NMES programme. Despite this, NMES appears to be an effective means of enhancing quadriceps strength and exercise capacity in COPD with the potential to break the vicious circle induced by the disease and COPD patients' lifestyle.
Collapse
Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | | |
Collapse
|
5
|
Jenkins AR, Gaynor-Sodeifi K, Lewthwaite H, Triandafilou J, Belo LF, de Oliveira MF, Jensen D. Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis. ERJ Open Res 2023; 9:00102-2023. [PMID: 37529637 PMCID: PMC10388177 DOI: 10.1183/23120541.00102-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/08/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Low fat-free mass (FFM) is linked to poor health outcomes in COPD, including impaired exercise tolerance and premature death. The aim of this systematic review was to synthesise evidence on the effectiveness of interventions for increasing FFM in COPD. Methods Searches of electronic databases (MEDLINE, Cochrane Library, Embase, Web of Science, Scopus) and trial registers (ClinicalTrials.gov) were undertaken from inception to August 2022 for randomised studies of interventions assessing measures of FFM in COPD. The primary outcome was change in FFM (including derivatives). Secondary outcomes were adverse events, compliance and attrition. Results 99 studies (n=5138 people with COPD) of 11 intervention components, used alone or in combination, were included. Exercise training increased mid-thigh cross-sectional area (k=3, standardised mean difference (SMD) 1.04, 95% CI 0.02-2.06; p=0.04), but not FFM (k=4, SMD 0.03, 95% CI -0.18-0.24; p=0.75). Nutritional supplementation significantly increased FFM index (k=11, SMD 0.31, 95% CI 0.13-0.50; p<0.001), but not FFM (k=19, SMD 0.16, 95% CI -0.06-0.39; p=0.16). Combined exercise training and nutritional supplementation increased measures related to FFM in 67% of studies. Anabolic steroids increased FFM (k=4, SMD 0.98, 95% CI 0.24-1.72; p=0.009). Neuromuscular electrical stimulation increased measures related to FFM in 50% of studies. No interventions were more at risk of serious adverse events, low compliance or attrition. Discussion Exercise training and nutritional supplementation were not effective in isolation to increase FFM, but were for localised muscle and index measures, respectively. Combined, exercise and nutritional supplementation shows promise as a strategy to increase FFM in COPD. Anabolic steroids are efficacious for increasing FFM in COPD.
Collapse
Affiliation(s)
- Alex R. Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Kaveh Gaynor-Sodeifi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Centre of Research Excellence in Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jaycie Triandafilou
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Letícia F. Belo
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, State University of Londrina, Londrina, Brazil
| | - Mayron Faria de Oliveira
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| |
Collapse
|
6
|
Murray MA, Mulryan K, Ní Chléirigh M, Redmond KC, Kelly E. Caring for patients with advanced COPD: beyond the inhalers…. Breathe (Sheff) 2023; 19:220229. [PMID: 37378065 PMCID: PMC10292785 DOI: 10.1183/20734735.0229-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
COPD affects millions of people worldwide. Patients with advanced COPD have a high symptom burden. Breathlessness, cough and fatigue are frequent daily symptoms. Guidelines often focus on pharmacological treatment, especially inhaler therapy, but other approaches in combination with medications offer symptomatic benefit. In this review, we take a multidisciplinary approach with contributions from pulmonary physicians, cardiothoracic surgeons and a physiotherapist. The following areas are addressed: oxygen therapy and noninvasive ventilation (NIV), dyspnoea management, surgical and bronchoscopic options, lung transplantation and palliative care. Oxygen therapy prescribed within guidelines improves mortality in patients with COPD. NIV guidelines offer only low-certainty instruction on the use of this therapy on the basis of the limited available evidence. Dyspnoea management can take place through pulmonary rehabilitation. Specific criteria aid decisions on referral for lung volume reduction treatments through surgical or bronchoscopic approaches. Lung transplantation requires precise disease severity assessment to determine which patients have the most urgent need for lung transplantation and are likely to have the longest survival. The palliative approach runs in parallel with these other treatments, focusing on symptoms and aiming to improve the quality of life of patients and their families facing the problems associated with life-threatening illness. In combination with appropriate medication and an individual approach to symptom management, patients' experiences can be optimised. Educational aims To understand the multidisciplinary approach to management of patients with advanced COPD.To recognise the parallel approaches to oxygen, NIV and dyspnoea management with consideration of more interventional options with lung volume reduction therapy or lung transplantation.To understand the high level of symptomatology present in advanced COPD and the relevance of palliative care alongside optimal medical management.
Collapse
Affiliation(s)
- Michelle A. Murray
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | | | - Emer Kelly
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Verceles AC, Serra M, Davis D, Alon G, Wells CL, Parker E, Sorkin J, Bhatti W, Terrin ML. Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study. Heart Lung 2023; 58:229-235. [PMID: 36473808 PMCID: PMC9992240 DOI: 10.1016/j.hrtlng.2022.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care. OBJECTIVES To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation. METHODS Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation. RESULTS The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days. CONCLUSIONS The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.
Collapse
Affiliation(s)
- Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Monica Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies at University of Texas Health Science, San Antonio, TX, USA
| | - Derik Davis
- Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Chris L Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Elizabeth Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - John Sorkin
- Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore MD, USA; Department of Veterans Affairs, Baltimore VA Maryland Health Care System, Geriatric Research, Education and Clinical Center, Baltimore, MD, USA
| | - Waqas Bhatti
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Pyszora A, Lewko A. Non-pharmacological Management in Palliative Care for Patients With Advanced COPD. Front Cardiovasc Med 2022; 9:907664. [PMID: 35924211 PMCID: PMC9339631 DOI: 10.3389/fcvm.2022.907664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.
Collapse
Affiliation(s)
- Anna Pyszora
- Palliative Care Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
- *Correspondence: Anna Pyszora
| | - Agnieszka Lewko
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| |
Collapse
|
9
|
Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
Collapse
Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
10
|
Alves IGN, da Silva E Silva CM, Martinez BP, de Queiroz RS, Gomes-Neto M. Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis. Clin Rehabil 2022; 36:449-471. [PMID: 35014892 DOI: 10.1177/02692155211067983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. DATA SOURCES MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. REVIEW METHODS Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. RESULTS 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. CONCLUSIONS Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.
Collapse
Affiliation(s)
| | | | - Bruno Prata Martinez
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Mansueto Gomes-Neto
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
11
|
Effects of neuromuscular electrical stimulation on exercise capacity and quality of life in COPD patients: a systematic review and meta-analysis. Biosci Rep 2021; 40:223800. [PMID: 32368783 PMCID: PMC7253403 DOI: 10.1042/bsr20191912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/30/2022] Open
Abstract
Neuromuscular electrical stimulation (NMES) has been shown to produce benefits in the muscle function of chronic obstructive pulmonary disease (COPD) patients. The definite effectiveness of NMES, applied in isolation or concurrently with conventional pulmonary rehabilitation (PR) or exercise training, remains unclear. This review was to determine the effects of NMES on exercise capacity, functional performance, symptoms, and health-related quality of life (HRQoL) in COPD patients. Electronic databases (PubMed, Embase, Web of Science, the Cochrane Library) were searched for relevant randomized controlled trials (RCTs). Two investigators independently screened the eligible studies up to February 2020 that used NMES as the intervention group. The outcome measures were 6-min walking distance (6MWD), peak rate of oxygen uptake (VO2 peak), St George’s Respiratory Questionnaire (SGRQ), and symptoms of dyspnoea and fatigue. Data were extracted using a predefined table and papers were appraised using Downs and Black tool. We analyzed 13 RCTs with 447 COPD patients. In the analysis of 6MWD, pooled estimates showed a significant increase in the NMES group, compared with the control group (mean difference (MD) = 27.05, 95% confidence interval (CI): 8.46–45.63, P<0.001). There were also improvements in symptoms of dyspnea or leg fatigue, and reduction in London Chest Activity of Daily Living (LCADL) scores. No statistically significant difference was observed in VO2 peak, peak power, and SGRQ. NMES could improve exercise capacity and reduce perceived sensation of dyspnea during exercise in patients with COPD, but not to be recommended as an effective alternative training modality in the rehabilitation of stable COPD patients.
Collapse
|
12
|
Benavides-Córdoba V, Guerrero-Jaramillo D, Betancourt-Peña J. Pulmonary Rehabilitation in COVID-19: The Contribution of other Chronic Lung Syndromes for the Intervention of a Novel Disease. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210129124433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract::
COVID-19 has spread throughout the world causing a significant number of cases of
pneumonia and SARS. Patients with COVID-19 may also have other cardiovascular, respiratory,
and neuromuscular disorders. These multisystemic complications present the need for comprehensive
interventions focused on improving symptoms, functional capacity, and quality of life. Pulmonary
rehabilitation has the potential to offer some of these benefits. However, the evidence related
to specific aspects of pulmonary rehabilitation evaluation and intervention in COVID19 is limited.
We have learned from experiences with other types of chronic lung diseases that have used pulmonary
rehabilitation successfully. While the evidence of rehabilitation emerges in COVID-19, it is
necessary to establish some initial recommendations, prepared according to the sequelae found until
now.
Collapse
Affiliation(s)
- Vicente Benavides-Córdoba
- Facultad de Salud Universidad del Valle, Facultad de Salud y Rehabilitación Institucion Universitaria Escuela Nacional del Deporte, Cali, Colombia
| | - Diana Guerrero-Jaramillo
- Secretaría de Salud Publica Municipal, Facultad de Salud, Universidad Santiago de Cali, Colombia
| | - Jhonatan Betancourt-Peña
- Facultad de Salud y Rehabilitacion Institucion Universitaria Escuela Nacional del Deporte, Facultad de Salud Universidad del Valle, Cali, Colombia
| |
Collapse
|
13
|
TRĂILĂ D, PESCARU C, SUPPINI POROJAN N, MIHUTA C, HOGEA P, CRIŞAN A, CIUMARNEAN L, MARC Monica. Neuromuscular electrostimulation as an adjuvant therapy to pulmonary rehabilitation programs in chronic obstructive pulmonary disease. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Chronic obstructive pulmonary disease (COPD) is commonly associated with a vicious circle of sedentary lifestyle - deconditioning - muscular dysfunction. High-frequency neuromuscular electrostimulation has demonstrated beneficial effects among subjects with muscle weakness. This study aimed to evaluate the benefits of merging pulmonary rehabilitation program (PRP) with neuromuscular electrostimulation in patients with very severe COPD. Material and methods. The study included 38 males with clinically stable COPD, who were divided in 2 groups: group A-19 patients that underwent a PRP of 5 sessions/week for 4 weeks and group B-19 patients that underwent intercostal and lower extremity muscle electrostimulation (5 sessions/week for 4 weeks, 60 min /session) in association with the same type of PRP. Saint Georges’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) dyspnea scale, spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), six minutes walking test (6MWT) and bio-electrical impedance were examined before and after the intervention. Results. Electrostimulation applied in group B increased muscle mass (50.15 ± 0.61kg vs 53.97 ± 0.87kg, p<0.001)., PEmax (5.41 ± 0.25 vs post 6.79 ± 0.22, p<0.0003) and improved mMRC score (2.68 ± 0.15 vs 2.10 ± 0.15, p<0.0109), 6MWT (369.6 ± 10.77m vs post: 445.6 ± 6.03 m) and SGRQ (61.32 ± 1.83 vs. 44.95 ± 1.94, p<0.0001). In group B only SGRQ score (55.05 ± 1.32 vs. 50.05 ± 1.51, p=0.018) was improved after PRP. Conclusion. A protocol which combines PRP with neuromuscular electrical stimulation in patients with very severe forms of COPD, has grater beneficial effect on dyspnoea, exercise tolerance, muscle mass toning and quality of life, compared with PRP alone.
Collapse
Affiliation(s)
- Daniel TRĂILĂ
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Camelia PESCARU
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | | | - Camil MIHUTA
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Patricia HOGEA
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alexandru CRIŞAN
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Lorena CIUMARNEAN
- ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - MARC Monica
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| |
Collapse
|
14
|
López-López L, Torres-Sánchez I, Rodríguez-Torres J, Cabrera-Martos I, Ortiz-Rubio A, Valenza MC. Does adding an integrated physical therapy and neuromuscular electrical stimulation therapy to standard rehabilitation improve functional outcome in elderly patients with pneumonia? A randomised controlled trial. Clin Rehabil 2019; 33:1757-1766. [PMID: 31244327 DOI: 10.1177/0269215519859930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the effects of an integrated programme of physical and electrical therapy to standard rehabilitation to improve physical and functional performance in elderly patients with pneumonia. DESIGN Randomized clinical trial. The study was registered in the ClinicalTrial.gov website (identifier: NCT02515565). SETTING University Hospital. SUBJECTS In total, 185 elderly patients with pneumonia were eligible for the study, of which 95 were finally randomized. INTERVENTIONS Patients were randomized to a control group which received the standard treatment or to an intervention group which received additionally an integrated programme of physical and electrical therapy. MAIN MEASURES Demographic and clinical information was acquired. Pulmonary function, length of hospital stay, handgrip strength, independence levels and comorbidities were assessed as descriptive outcomes. The main outcome measure was functional and physical performance, evaluated with the short physical performance battery. Secondary outcome measures were respiratory symptoms including dyspnoea, fatigue and cough. RESULTS Mean age of patients was 74.92 (11.03) years in the intervention group and 72.53 (9.24) years in the control group. Significant between groups differences (P < 0.05) were found in short physical performance battery chair stand test (2.17 (0.97) vs. 0.58 (0.61)) and total score (5.91 (3.61) vs. 4.15 (3.15)). The intervention group showed better performance than the control group in both cases. Fatigue (32.04 (18.58) vs. 46.22 (8.90)) and cough (18.84 (2.47) vs. 17.40 (3.67)) showed higher improvement in the intervention group, and significant differences were observed between the groups. CONCLUSION An integrated programme of physical and electrical therapy during hospitalization improves physical and functional performance in patients with pneumonia.
Collapse
Affiliation(s)
- Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| |
Collapse
|
15
|
Dolmage TE, Dubois-Webster J, Goldstein RS. Could scooting be a useful option for aerobic exercise in chronic obstructive pulmonary disease? RESPIRATORY MEDICINE: X 2019. [DOI: 10.1016/j.yrmex.2019.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
16
|
TSEH WAYLAND, CHAMPION HOLLIEM, EK SUSANNA, FRAZIER WILLR, KINSLOW ANNAE, MCCLAIN CAROLINEW, BARREIRA TIAGOV. Ergogenic Effect of Neuromuscular Electrical Stimulation During Rest and Submaximal Exercise. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2019; 12:203-313. [PMID: 30761202 PMCID: PMC6355132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The primary aim of this investigation was to determine the ergogenic effect of neuromuscular electrical stimulation (NMES) amongst twenty apparently healthy males during submaximal exercise. In Session 1, 20 participants (Age = 35.0 ± 15.0 yrs; Height = 179.9 ± 8.5 cm; Body Mass = 85.4 ± 12.0 kg) were familiarized with all equipment. Sessions 2-4 included the following randomized 5-min trials a) Rest and Rest+NMES, b) Rest, Arms-Only, Arms+NMES, and c) Rest, Arms+Legs, Arms+Legs+NMES. Physiological variables collected during rest and submaximal exercise were volume of oxygen (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), respiratory exchange ratio (RER), and rate pressure product (RPP). Paired sample t-test was used to determine significant mean differences between the NMES and non-NMES trials. Bonferroni post-hoc analysis established alpha at 0.008. From the 18 paired t-tests, the only observed significant mean difference (t(19) = -6.4, p < 0.001) was RER values between the Arms-Only trial compared to the Arms+NMES trial (0.94 and 1.00, respectively). While RER displayed a significant difference, from a practical perspective, however, these differences were deemed non-physiologically significant. Viewed in concert, findings from this study suggests that NMES utilization does not evoke an acute ergogenic effect amongst an apparently healthy male population.
Collapse
Affiliation(s)
- WAYLAND TSEH
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - HOLLIE M. CHAMPION
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - SUSANNA EK
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - WILL R. FRAZIER
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - ANNA E. KINSLOW
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - CAROLINE W. MCCLAIN
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | | |
Collapse
|
17
|
de Mello CL, da Conceição TMA, Dal Pont T, Peruzzolo CC, Lúcio MN, Paulin E. The Benefits of Neuromuscular Electrical Stimulation in the Muscular and Functional Capacity of Patients With Liver Cirrhosis: Protocol for a Randomized Clinical Trial. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2018; 11:1179552218811834. [PMID: 30505152 PMCID: PMC6256309 DOI: 10.1177/1179552218811834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022]
Abstract
Cirrhosis causes systemic and metabolic changes that culminate in various complications, such as compromised pulmonary function, ascites, hepatic encephalopathy, weight loss, and muscle weakness with significant physical function limitations. Our aim is to evaluate the effects of training with neuromuscular electrical stimulation (NMES) on the muscular and functional capacity of patients with cirrhosis classified as Child-Pugh B and C. A total of 72 patients diagnosed with cirrhosis will be recruited and randomized to perform an NMES protocol for 50 minutes, 3 times a week, for 4 weeks. The evaluations will be performed at the beginning and after 12 sessions, and patients will be submitted to a pulmonary function test, an ultrasound evaluation of the rectus femoris, an evaluation of peripheral muscle strength, a submaximal exercise capacity test associated with an evaluation of peripheral tissue oxygenation, a quality of life evaluation, and orientation about monitoring daily physical activities. The evaluators and patients will be blinded to the allocation of the groups. Training Group will be treated with the following parameters: frequency of 50 Hz, pulse width of 400 μs, rise and fall times of 2 s, and on:off 1:1; Sham Group: 5 Hz, 100 μs, on:off 1:3. The data will be analyzed using the principles of the intention to treat. This study provides health professionals with information on the benefits of this intervention. In this way, we believe that the results of this study could stimulate the use of NMES as a way of rehabilitating patients with more severe cirrhosis, with the objective of improving these patients' functional independence.
Collapse
Affiliation(s)
| | | | - Tarcila Dal Pont
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | | | | | - Elaine Paulin
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Universidade de São Paulo, São Paulo, Brazil.,Centro de Ciências da Saúde e do Esporte-CEFID, Laboratório de Fisioterapia Respiratória-LAFIR, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| |
Collapse
|
18
|
Gong H, Jiang Q, Shen D, Gao J. Neuromuscular electrical stimulation improves exercise capacity in adult patients with chronic lung disease: a meta-analysis of English studies. J Thorac Dis 2018; 10:6722-6732. [PMID: 30746217 DOI: 10.21037/jtd.2018.11.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Neuromuscular electrical stimulation (NMES) has been suggested as an alternative rehabilitative therapy to enhance exercise performance and skeletal muscle function in adult patients with chronic lung disease. However, the results of individual studies have been inconsistent. We performed a meta-analysis to evaluate the effectiveness of NMES with regard to increasing exercise capacity, quadriceps strength, muscle mass, cross-sectional area, and quality of life and decreasing dyspnea in adult patients with chronic lung disease. Methods A systematic search was conducted of the PubMed, Cochrane Library and EMBASE databases for randomized controlled trials (RCTs) published in English-language journals before January 2018. Data were extracted using standardized forms, and the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated. Results Eleven RCTs involving 368 patients were included in this meta-analysis. The pooled results showed that NMES significantly improved the 6-min walk distance (WMD: 37.93 m, 95% CI: 19.53-56.33 m; P<0.0001; P for heterogeneity =0.11; I2=47%) but not the incremental shuttle walk test (WMD: 18.18 m, 95% CI: -79.41 to 115.77 m, P=0.72; P for heterogeneity <0.0001, I2=94%) or endurance shuttle walk test (ESWT) (WMD: 96.73 m, 95% CI: -45.58 to 239.03 m, P=0.18; P heterogeneity =0.22, I2=34%). Moreover, NMES was associated with a significant improvement in quadriceps strength (SMD: 1.14, 95% CI: 0.86-1.43, P<0.00001; P heterogeneity =0.02, I2=58%). Conclusions This systemic review and meta-analysis provided evidence supporting the beneficial role of NMES in improving exercise capacity in patients with chronic respiratory disease.
Collapse
Affiliation(s)
- Haihong Gong
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qinghe Jiang
- Department of Respiratory Disease, Liaocheng People's Hospital, Liaocheng 252000, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jinming Gao
- Department of Respiratory Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
19
|
Gad* A. Functional Electrical Stimulation (FES): Clinical successes and failures to date. ACTA ACUST UNITED AC 2018. [DOI: 10.29328/journal.jnpr.1001022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Hill K, Cavalheri V, Mathur S, Roig M, Janaudis‐Ferreira T, Robles P, Dolmage TE, Goldstein R. Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2018; 5:CD010821. [PMID: 29845600 PMCID: PMC6494594 DOI: 10.1002/14651858.cd010821.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In people with chronic obstructive pulmonary disease (COPD), the use of neuromuscular electrostimulation (NMES) either alone, or together with conventional exercise training, might improve the condition of the peripheral muscles, increase exercise capacity and functional performance, reduce symptoms and improve health-related quality of life (HRQoL). OBJECTIVES To determine the effects of NMES, applied in isolation or concurrently with conventional exercise training to one or more peripheral muscles, on peripheral muscle force and endurance, muscle size, exercise capacity, functional performance, symptoms, HRQoL and adverse events in people with COPD. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register, the Physiotherapy Evidence Database, clinical trial registries and conference abstracts on 14 March 2018. SELECTION CRITERIA Randomised controlled trials that recruited adults with COPD if they had compared outcomes between a group that received NMES and a group that received usual care or compared outcomes between a group that received NMES plus conventional exercise training and a group that participated in conventional exercise training alone. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias using the Cochrane 'Risk of bias' tool. We expressed continuous data as either the standardised mean difference (SMD) or mean difference (MD) with the corresponding 95% confidence interval (CI). We assessed the quality of evidence using the GRADE approach. MAIN RESULTS Nineteen studies met the inclusion criteria of which 16 contributed data on 267 participants with COPD (mean age 56 to 76 years and 67% were men). Of these 16 studies, seven explored the effect of NMES versus usual care and nine explored the effect of NMES plus conventional exercise training versus conventional exercise training alone. Six studies utilised sham stimulation in the control group. When applied in isolation, NMES produced an increase in peripheral muscle force (SMD 0.34, 95% CI 0.02 to 0.65; low-quality evidence) and quadriceps endurance (SMD 1.36, 95% CI 0.59 to 2.12; low-quality evidence) but the effect on thigh muscle size was unclear (MD 0.25, 95% CI -0.11 to 0.61; low-quality evidence). There were increases in six-minute walk distance (6MWD) (MD 39.26 m, 95% CI 16.31 to 62.22; low-quality evidence) and time to symptom limitation exercising at a submaximal intensity (MD 3.62 minutes, 95% CI 2.33 to 4.91). There was a reduction in the severity of leg fatigue on completion of an exercise test (MD -1.12 units, 95% CI -1.81 to -0.43). The increase in peak rate of oxygen uptake (VO2peak) was of borderline significance (MD 0.10 L/minute, 95% CI 0.00 to 0.19).For NMES with conventional exercise training, there was an uncertain effect on peripheral muscle force (SMD 0.47, 95% CI -0.10 to 1.04; very low-quality evidence) and there were insufficient studies to undertake a meta-analysis on the effect on quadriceps endurance or thigh muscle size. However, there was an increase in 6MWD in favour of NMES combined with conventional exercise training (MD 25.87 m, 95% CI 1.06 to 50.69; very low-quality evidence). In people admitted to either in an intensive care unit or a respiratory high dependency centre, NMES combined with conventional exercise reduced the time taken for participants to first sit out of bed by 4.98 days (95% CI -8.55 to -1.41; very low-quality evidence), although the statistical heterogeneity for this analysis was high (I2 = 60%). For both types of studies (i.e. NMES versus usual care and NMES with conventional exercise training versus conventional exercise training alone), there was no risk difference for mortality or minor adverse events in participants who received NMES. AUTHORS' CONCLUSIONS NMES, when applied in isolation, increased quadriceps force and endurance, 6MWD and time to symptom limitation exercising at a submaximal intensity, and reduced the severity of leg fatigue on completion of exercise testing. It may increase VO2peak, but the true effect on this outcome measure could be trivial. However, the quality of evidence was low or very low due to risk of bias within the studies, imprecision of the estimates, small number of studies and inconsistency between the studies. Although there were no additional gains in quadriceps force with NMES plus conventional exercise training, there was evidence of an increase in 6MWD. Further, in people who were the most debilitated, the addition of NMES may have accelerated the achievement of a functional milestone, that is, the first time someone sits out of bed.
Collapse
Affiliation(s)
- Kylie Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustraliaWA 6845
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
| | - Vinicius Cavalheri
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustraliaWA 6845
- Sir Charles Gairdner HospitalInstitute for Respiratory HealthPerthWestern AustraliaAustralia
| | - Sunita Mathur
- University of TorontoDepartment of Physical TherapyTorontoONCanada
| | - Marc Roig
- McGill UniversitySchool of Physical and Occupational TherapyMontrealQCCanada
| | - Tania Janaudis‐Ferreira
- McGill UniversitySchool of Physical and Occupational TherapyMontrealQCCanada
- Research Institute of the McGill University Health CentreTranslational Research in Respiratory Diseases ProgramMontrealCanada
| | - Priscila Robles
- Toronto General Research Institute, University Health NetworkPMB 11‐127, 585 University AvenueTorontoONCanadaM5G2N2
| | - Thomas E Dolmage
- West Park Healthcare CentreRespiratory Diagnostic & Evaluation ServicesTorontoONCanada
| | - Roger Goldstein
- West Park Healthcare Centre, University of TorontoDivision of Respiratory Medicine82 Buttonwood AvenueTorontoONCanadaM6M 2J5
| | | |
Collapse
|
21
|
Wolpat A, Lima FV, Silva FM, Tochetto M, de Freitas A, Grandi T, Rodrigues L, Paiva V, Cipriano G, Chiappa AM, Zago J, Chiappa GR. Association between inspiratory muscle weakness and slowed oxygen uptake kinetics in patients with chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2017; 42:1239-1246. [DOI: 10.1139/apnm-2016-0568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may have poor inspiratory muscle function, which reduces minute and alveolar ventilation, leading to increased hypoxemia and slow pulmonary oxygen uptake kinetics. However, little is known about the effect of inspiratory muscle weakness (IMW) on oxygen uptake kinetics in patients with COPD. Thus, we tested the hypothesis that COPD patients with IMW have slowed oxygen uptake kinetics. An observational study was conducted that included COPD patients with moderate to severe airflow limitation and a history of intolerance to exercise. Participants were divided into 2 groups: (IMW+; n = 22) (IMW–; n = 23) of muscle weakness. The maximal inspiratory, expiratory, and sustained inspiratory strength as well as the maximal endurance of the inspiratory muscles were lower in IMW+ patients (36 ± 9.5 cm H2O; 52 ± 14 cm H2O; 20 ± 6.5 cm H2O; 94 ± 84 s, respectively) than in IMW– patients (88 ± 12 cm H2O; 97 ± 28 cm H2O; 82.5 ± 54 cm H2O; 559 ± 92 s, respectively; p < 0.05). Moreover, the 6-min walk test and peak oxygen uptake were reduced in the IMW+ patients. During the constant work test, oxygen uptake kinetics were slowed in the IMW+ compared with IMW– patients (88 ± 29 vs 61 ± 18 s, p < 0.05). Our findings demonstrate that inspiratory muscle weakness in COPD is associated with slowed oxygen uptake kinetics, and thus, reduced functional capacity.
Collapse
Affiliation(s)
- Andiara Wolpat
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Francisco V. Lima
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Fabiola M. Silva
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Micheli Tochetto
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | | | - Tatiane Grandi
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Leonardo Rodrigues
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Verônica Paiva
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Adriana M. Chiappa
- Intensive Medicine Service, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio Zago
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Gaspar R. Chiappa
- Anhanguera Faculty of Porto Alegre, Avenida Cavalhada 4890, 91740-000
| |
Collapse
|
22
|
Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens AM. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can 2017; 69:1-76. [PMID: 29162949 PMCID: PMC5683854 DOI: 10.3138/ptc.2015-88] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice.
Collapse
Affiliation(s)
- Ethne L. Nussbaum
- Department of Physical Therapy, University of Toronto
- Toronto Rehab, University Health Network, Toronto, Ontario
| | - Pamela Houghton
- School of Physical Therapy, University of Western Ontario, London
| | - Joseph Anthony
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Sandy Rennie
- Department of Physical Therapy, University of Toronto
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia
| | - Barbara L. Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba
| | - Alison M. Hoens
- School of Physical Therapy, University of Western Ontario, London
| |
Collapse
|
23
|
Bolzani A, Rolser SM, Kalies H, Maddocks M, Rehfuess E, Gysels M, Higginson IJ, Booth S, Bausewein C. Physical interventions for breathlessness in adults with advanced diseases. Hippokratia 2017. [DOI: 10.1002/14651858.cd012684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Bolzani
- LMU Munich; Department of Palliative Medicine, Munich University Hospital; Marchioninistr. 15 Munich Germany
| | - Stefanie M Rolser
- LMU Munich; Department of Palliative Medicine, Munich University Hospital; Marchioninistr. 15 Munich Germany
| | - Helen Kalies
- LMU Munich; Department of Palliative Medicine, Munich University Hospital; Marchioninistr. 15 Munich Germany
| | - Matthew Maddocks
- Cicely Saunders Institute, King's College London; Department of Palliative Care, Policy and Rehabilitation; Denmark Hill London UK SE5 9PJ
| | - Eva Rehfuess
- LMU Munich; Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health; Marchioninistr. 15 Munich Germany 81377
| | - Marjolein Gysels
- University of Amsterdam; Amsterdam Institute of Social Science Research; Amsterdam Netherlands
| | - Irene J Higginson
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; Bessemer Road Denmark Hill London UK SE5 9PJ
| | - Sara Booth
- Cambridge University Hospitals; Department of Palliative Care; Cambridge UK
| | - Claudia Bausewein
- LMU Munich; Department of Palliative Medicine, Munich University Hospital; Marchioninistr. 15 Munich Germany
| |
Collapse
|
24
|
De Brandt J, Spruit MA, Hansen D, Franssen FM, Derave W, Sillen MJ, Burtin C. Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease: A review of the English-language literature. Chron Respir Dis 2017; 15:182-219. [PMID: 28580854 PMCID: PMC5958462 DOI: 10.1177/1479972317709642] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients often experience lower limb muscle dysfunction and wasting. Exercise-based training has potential to improve muscle function and mass, but literature on this topic is extensive and heterogeneous including numerous interventions and outcome measures. This review uses a detailed systematic approach to investigate the effect of this wide range of exercise-based interventions on muscle function and mass. PUBMED and PEDro databases were searched. In all, 70 studies (n = 2504 COPD patients) that implemented an exercise-based intervention and reported muscle strength, endurance, or mass in clinically stable COPD patients were critically appraised. Aerobic and/or resistance training, high-intensity interval training, electrical or magnetic muscle stimulation, whole-body vibration, and water-based training were investigated. Muscle strength increased in 78%, muscle endurance in 92%, and muscle mass in 88% of the cases where that specific outcome was measured. Despite large heterogeneity in exercise-based interventions and outcome measures used, most exercise-based trials showed improvements in muscle strength, endurance, and mass in COPD patients. Which intervention(s) is (are) best for which subgroup of patients remains currently unknown. Furthermore, this literature review identifies gaps in the current knowledge and generates recommendations for future research to enhance our knowledge on exercise-based interventions in COPD patients.
Collapse
Affiliation(s)
- Jana De Brandt
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Martijn A Spruit
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands.,3 Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Dominique Hansen
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits Me Franssen
- 2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Wim Derave
- 4 Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Maurice Jh Sillen
- 2 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Chris Burtin
- 1 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
25
|
Brüggemann AK, Mello CL, Dal Pont T, Hizume Kunzler D, Martins DF, Bobinski F, Pereira Yamaguti W, Paulin E. Effects of Neuromuscular Electrical Stimulation During Hemodialysis on Peripheral Muscle Strength and Exercise Capacity: A Randomized Clinical Trial. Arch Phys Med Rehabil 2017; 98:822-831.e1. [PMID: 28093194 DOI: 10.1016/j.apmr.2016.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effects of neuromuscular electrical stimulation of high and low frequency and intensity, performed during hemodialysis, on physical function and inflammation markers in patients with chronic kidney disease (CKD). DESIGN Randomized clinical trial. SETTING Hemodialysis clinic. PARTICIPANTS Patients with CKD (N=51) were randomized into blocks of 4 using opaque sealed envelopes. They were divided into a group of high frequency and intensity neuromuscular electrical stimulation and a group of low frequency and intensity neuromuscular electrical stimulation. INTERVENTIONS The high frequency and intensity neuromuscular electrical stimulation group was submitted to neuromuscular electrical stimulation at a frequency of 50Hz and a medium intensity of 72.90mA, and the low frequency and intensity neuromuscular electrical stimulation group used a frequency of 5Hz and a medium intensity of 13.85mA, 3 times per week for 1 hour, during 12 sessions. MAIN OUTCOME MEASURES Peripheral muscle strength, exercise capacity, levels of muscle trophism marker (insulin growth factor 1) and levels of proinflammatory (tumor necrosis factor α) and anti-inflammatory (interleukin 10) cytokines. RESULTS The high frequency and intensity neuromuscular electrical stimulation group showed a significant increase in right peripheral muscle strength (155.35±65.32Nm initial vs 161.60±68.73Nm final; P=.01) and left peripheral muscle strength (156.60±66.51Nm initial vs 164.10±69.76Nm final; P=.02) after the training, which did not occur in the low frequency and intensity neuromuscular electrical stimulation group for both right muscle strength (109.40±32.08Nm initial vs 112.65±38.44Nm final; P=.50) and left muscle strength (113.65±37.79Nm initial vs 116.15±43.01Nm final; P=.61). The 6-minute walk test distance (6MWTD) increased in both groups: high frequency and intensity neuromuscular electrical stimulation group (435.55±95.81m initial vs 457.25±90.64m final; P=.02) and low frequency and intensity neuromuscular electrical stimulation group (403.80±90.56m initial vs 428.90±87.42m final; P=.007). The groups did not differ in peripheral muscle strength and 6MWTD after the training protocol. In the high frequency and intensity neuromuscular electrical stimulation group, a correlation was observed between the initial and final values of 6MWTD and muscle strength. In the low frequency and intensity neuromuscular electrical stimulation group, correlations occurred only between the 6MWTD and the initial muscle strength. Only the low frequency and intensity neuromuscular electrical stimulation group increased levels of insulin growth factor 1 (252.38±156.35pg/mL initial vs 336.97±207.34pg/mL final; P=.03), and only the high frequency and intensity neuromuscular electrical stimulation group reduced levels of interleukin 10 (7.26±1.81pg/mL vs 6.32±1.54pg/mL; P=.03). The groups showed no differences in tumor necrosis factor α levels. CONCLUSIONS Patients with CKD on hemodialysis improve exercise capacity after peripheral neuromuscular electrical stimulation of high and low frequency and intensity. However, the benefits on muscle and inflammatory outcomes seem to be specific for the adopted electrical stimulation strategy.
Collapse
Affiliation(s)
| | | | - Tarcila Dal Pont
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil
| | - Deborah Hizume Kunzler
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Fernandes Martins
- Federal University of Santa Catarina, Florianopolis, SC, Brazil; University of Southern Santa Catarina - UNISUL, Florianopolis, SC, Brazil
| | - Franciane Bobinski
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | | | - Elaine Paulin
- Santa Catarina State University - UDESC, Florianopolis, SC, Brazil; University of São Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
26
|
Chen RC, Li XY, Guan LL, Guo BP, Wu WL, Zhou ZQ, Huo YT, Chen X, Zhou LQ. Effectiveness of neuromuscular electrical stimulation for the rehabilitation of moderate-to-severe COPD: a meta-analysis. Int J Chron Obstruct Pulmon Dis 2016; 11:2965-2975. [PMID: 27932876 PMCID: PMC5135061 DOI: 10.2147/copd.s120555] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Patients with COPD often experience skeletal muscle dysfunction. For those who are unable or unwilling to undertake physical training, neuromuscular electrical stimulation (NMES) may provide an alternative method of rehabilitation. The purpose of this meta-analysis was to investigate the controversial topic of whether this therapy is effective in patients with moderate-to-severe COPD. PATIENTS AND METHODS We pooled data from nine trials published between January 9, 2002 and January 4, 2016 across PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, and relevant websites for randomized controlled trials. In these trials, patients with moderate-to-severe COPD were randomly allocated to receive NMES. Primary outcomes were quadricep strength and exercise capacity. The secondary outcome was health-related quality of life. RESULTS We extracted data from 276 patients. NMES contributed to statistically improved quadricep strength (standardized mean difference 1.12, 95% confidence interval [CI] 0.64-1.59, I2=54%; P<0.00001) and exercise capacity, including longer exercise distance (weighted mean difference 51.53, 95% CI 20.13-82.93, I2=90%; P=0.001), and longer exercise endurance (standardized mean difference 1.11, 95% CI 0.14-2.08, I2=85%; P=0.02). There was no significant difference in St George's Respiratory Questionnaire scores (weighted mean difference -0.07, 95% CI -2.44 to 2.30, I2=56%; P=0.95). CONCLUSION NMES appears an effectual means of enhancing quadricep strength and exercise capacity in moderate-to-severe COPD patients. Further research is demanded to clarify its effect on other outcomes and determine the optimal parameters for an NMES program.
Collapse
Affiliation(s)
- Rong-Chang Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Xiao-Ying Li
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Li-Li Guan
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Bing-Peng Guo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Wei-Liang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Zi-Qing Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Ya-Ting Huo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| | - Xin Chen
- Zhujiang Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Lu-Qian Zhou
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University
| |
Collapse
|
27
|
Jones S, Man WD, Gao W, Higginson IJ, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 2016; 10:CD009419. [PMID: 27748503 PMCID: PMC6464134 DOI: 10.1002/14651858.cd009419.pub3] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This review is an update of a previously published review in the Cochrane Database of Systematic Reviews Issue 1, 2013 on Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease.Patients with advanced progressive disease often experience muscle weakness, which can impact adversely on their ability to be independent and their quality of life. In those patients who are unable or unwilling to undertake whole-body exercise, neuromuscular electrical stimulation (NMES) may be an alternative treatment to enhance lower limb muscle strength. Programmes of NMES appear to be acceptable to patients and have led to improvements in muscle function, exercise capacity, and quality of life. However, estimates regarding the effectiveness of NMES based on individual studies lack power and precision. OBJECTIVES Primary objective: to evaluate the effectiveness of NMES on quadriceps muscle strength in adults with advanced disease. Secondary objectives: to examine the safety and acceptability of NMES, and its effect on peripheral muscle function (strength or endurance), muscle mass, exercise capacity, breathlessness, and health-related quality of life. SEARCH METHODS We identified studies from searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), and Database of Abstracts of Reviews of Effects (DARE) (the Cochrane Library), MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and PsycINFO (OVID) databases to January 2016; citation searches, conference proceedings, and previous systematic reviews. SELECTION CRITERIA We included randomised controlled trials in adults with advanced chronic respiratory disease, chronic heart failure, cancer, or HIV/AIDS comparing a programme of NMES as a sole or adjunct intervention to no treatment, placebo NMES, or an active control. We imposed no language restriction. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study design, participants, interventions, and outcomes. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We calculated mean differences (MD) or standardised mean differences (SMD) between intervention and control groups for outcomes with sufficient data; for other outcomes we described findings from individual studies. We assessed the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS Eighteen studies (20 reports) involving a total of 933 participants with COPD, chronic respiratory disease, chronic heart failure, and/or thoracic cancer met the inclusion criteria for this update, an additional seven studies since the previous version of this review. All but one study that compared NMES to resistance training compared a programme of NMES to no treatment or placebo NMES. Most studies were conducted in a single centre and had a risk of bias arising from a lack of participant or assessor blinding and small study size. The quality of the evidence using GRADE comparing NMES to control was low for quadriceps muscle strength, moderate for occurrence of adverse events, and very low to low for all other secondary outcomes. We downgraded the quality of evidence ratings predominantly due to inconsistency among study findings and imprecision regarding estimates of effect. The included studies reported no serious adverse events and a low incidence of muscle soreness following NMES.NMES led to a statistically significant improvement in quadriceps muscle strength as compared to the control (12 studies; 781 participants; SMD 0.53, 95% confidence interval (CI) 0.19 to 0.87), equating to a difference of approximately 1.1 kg. An increase in muscle mass was also observed following NMES, though the observable effect appeared dependent on the assessment modality used (eight studies, 314 participants). Across tests of exercise performance, mean differences compared to control were statistically significant for the 6-minute walk test (seven studies; 317 participants; 35 m, 95% CI 14 to 56), but not for the incremental shuttle walk test (three studies; 434 participants; 9 m, 95% CI -35 to 52), endurance shuttle walk test (four studies; 452 participants; 64 m, 95% CI -18 to 146), or for cardiopulmonary exercise testing with cycle ergometry (six studies; 141 participants; 45 mL/minute, 95% CI -7 to 97). Limited data were available for other secondary outcomes, and we could not determine the most beneficial type of NMES programme. AUTHORS' CONCLUSIONS The overall conclusions have not changed from the last publication of this review, although we have included more data, new analyses, and an assessment of the quality of the evidence using the GRADE approach. NMES may be an effective treatment for muscle weakness in adults with advanced progressive disease, and could be considered as an exercise treatment for use within rehabilitation programmes. Further research is very likely to have an important impact on our confidence in the estimate of effect and may change the estimate. We recommend further research to understand the role of NMES as a component of, and in relation to, existing rehabilitation approaches. For example, studies may consider examining NMES as an adjuvant treatment to enhance the strengthening effect of programmes, or support patients with muscle weakness who have difficulty engaging with existing services.
Collapse
Affiliation(s)
- Sarah Jones
- Royal Brompton & Harefield NHS Foundation Trust and Imperial CollegeNIHR Respiratory Biomedical Research UnitLondonUK
- Harefield HospitalHarefield Pulmonary Rehabilitation UnitMiddlesexUK
| | - William D‐C Man
- Royal Brompton & Harefield NHS Foundation Trust and Imperial CollegeNIHR Respiratory Biomedical Research UnitLondonUK
- Harefield HospitalHarefield Pulmonary Rehabilitation UnitMiddlesexUK
| | - Wei Gao
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Irene J Higginson
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Andrew Wilcock
- University of NottinghamHayward House Macmillan Specialist Palliative Care UnitNottingham City Hospital NHS TrustNottinghamUKNG5 1PB
| | - Matthew Maddocks
- Cicely Saunders Institute, King's College LondonDepartment of Palliative Care, Policy and RehabilitationDenmark HillLondonUKSE5 9PJ
| | | |
Collapse
|
28
|
Emerging therapies for the treatment of skeletal muscle wasting in chronic obstructive pulmonary disease. Pharmacol Ther 2016; 166:56-70. [DOI: 10.1016/j.pharmthera.2016.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/18/2022]
|
29
|
Coquart JB, Grosbois JM, Olivier C, Bart F, Castres I, Wallaert B. Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1189-97. [PMID: 27350745 PMCID: PMC4902151 DOI: 10.2147/copd.s105049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD. Methods Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home. Results The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and −18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05). Conclusion Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance.
Collapse
Affiliation(s)
- Jérémy B Coquart
- Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, Beuvry, France
| | - Jean-Marie Grosbois
- Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, France; Formaction Santé, Perenchies, France
| | - Cecile Olivier
- Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France
| | - Frederic Bart
- Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, France
| | - Ingrid Castres
- Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, Beuvry, France
| | - Benoit Wallaert
- Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France
| |
Collapse
|
30
|
Triest FJ, Singh SJ, Vanfleteren LE. Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation: Can we learn from cardiac rehabilitation? Chron Respir Dis 2016; 13:286-94. [PMID: 27081189 DOI: 10.1177/1479972316642367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) who participate in pulmonary rehabilitation (PR) often have concomitant cardiovascular disease (CVD), which is a frequently undiagnosed and undertreated comorbidity. CVD contributes to the burden of the disease and is associated with an increased risk for hospitalizations and mortality. Optimizing the diagnosis and management of cardiovascular risk and disease should be considered as part of the holistic approach of PR. In addition, we need to consider similarities and differences in cardiac and PR programs, in order to improve personalized care in patients with both diseases. The current review addresses the burden of CVD in COPD patients who participate in PR, how CVD and its risk factors affect PR and should be managed during PR, and extends on what we can learn of the organization of cardiac rehabilitation programs.
Collapse
Affiliation(s)
- Filip Jj Triest
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| |
Collapse
|
31
|
Abstract
This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants). This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
| |
Collapse
|
32
|
Akar O, Günay E, Sarinc Ulasli S, Ulasli AM, Kacar E, Sariaydin M, Solak Ö, Celik S, Ünlü M. Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit. CLINICAL RESPIRATORY JOURNAL 2015; 11:743-750. [PMID: 26597394 DOI: 10.1111/crj.12411] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/27/2015] [Accepted: 11/14/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Serious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation. METHODS Thirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated. RESULTS Lower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P = 0.014) and 2 (from 4.00 to 5.00, P = 0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P = 0.038, P = 0.046 and P = 0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation. CONCLUSION This study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated.
Collapse
Affiliation(s)
- Olcay Akar
- Department of Chest Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Ersin Günay
- Department of Chest Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Sevinc Sarinc Ulasli
- Department of Chest Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Alper Murat Ulasli
- Department of Physical Treatment and Rehabilitation, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Emre Kacar
- Department of Radiology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Muzaffer Sariaydin
- Department of Chest Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Özlem Solak
- Department of Physical Treatment and Rehabilitation, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Sefa Celik
- Department of Medical Biochemistry, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mehmet Ünlü
- Department of Chest Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| |
Collapse
|
33
|
Abstract
Dyspnea is the most prevalent symptom among patients with cardiac and respiratory diseases. It is an independent predictor of mortality in patients with heart disease, COPD, and the elderly. Studies using naloxone to block opioid-receptor signaling demonstrate that endogenous opioids modulate dyspnea in patients with COPD. Neuroimaging studies support a cortical-limbic network for dyspnea perception. A 2012 American Thoracic Society statement recommended that dyspnea be considered across three different constructs: sensory (intensity), affective (distress), and impact on daily activities. The 2013 GOLD (Global Initiative for Chronic Obstructive Lung Disease) executive summary recommended a treatment paradigm for patients with COPD based on the modified Medical Research Council dyspnea score. The intensity and quality of dyspnea during exercise in patients with COPD is influenced by the time to onset of critical mechanical volume constraints that are ultimately dictated by the magnitude of resting inspiratory capacity. Long-acting bronchodilators, either singly or in combination, provide sustained bronchodilation and lung deflation that contribute to relief of dyspnea in those with COPD. Opioid medications reduce breathing discomfort by decreasing respiratory drive (and associated corollary discharge), altering central perception, and/or decreasing anxiety. For individuals suffering from refractory dyspnea, a low dose of an opioid is recommended initially, and then titrated to achieve the lowest effective dose based on patient ratings. Acupuncture, bronchoscopic volume reduction, and noninvasive open ventilation are experimental approaches shown to ameliorate dyspnea in patients with COPD, but require confirmatory evidence before clinical use.
Collapse
Affiliation(s)
- Donald A Mahler
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | | |
Collapse
|
34
|
Sheng S, Zhenzhong S, Weimin J, Yimeng W, Qudong Y, Jinhui S. Improvement in Pulmonary Function of Chronic Obstructive Pulmonary Disease (COPD) Patients With Osteoporotic Vertebral Compression Fractures (OVCFs) After Kyphoplasty Under Local Anesthesia. Int Surg 2015; 100:503-9. [PMID: 25785335 PMCID: PMC4370543 DOI: 10.9738/intsurg-d-14-00173.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To investigate the changes in respiratory function of COPD patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty (KP). Pain scores, pulmonary function parameters (PFT), and local kyphotic angle (LKA) were measured in 31 older patients (25 women, 6 men) with OVCFs before, 3 days after and 3 months after kyphoplasty. The preoperative and postoperative (3 days, 3 months) PFT parameters were as follows: % pred FVC, 74.33 ± 12.35, 85.23.8 ± 13.23, and 84.86 ± 14.01; % pred FEV1, 60.23 ± 11.2, 60.02 ± 11.90, and 60.78 ± 12.70; FEV1/FVC ratio (%), 68.22 ± 16.74, 59.56 ± 13.23, and 60.77 ± 12.28, % pred MVV 52.46 ± 14.37, 55.23 ± 15.68, and 62.12 ± 14.48, respectively. The preoperative mean VAS score was 8.01 ± 1.41 and significantly decreased to 2.52 ± 0.89 and 2.34 ± 0.78 at 3 days, 3 months after kyphoplasty, respectively. The preoperative local kyphotic angle degree was 21.96 ± 5.75°, significantly decreased to 13.48 ± 6.12° 3 days after KP, and maintained 3 month after KP. The decrease in the VAS scores correlated with the PFT parameters; however, there were no significant correlations between the PFT parameters and the LKA, the VAS scores and the LKA. Kyphoplasty under local anesthesia is a safety treatment for the COPD patients with OVCFS, and is able to improve the lung function impaired by OVCFs.
Collapse
Affiliation(s)
- Song Sheng
- The Ninth People's Hospital of Wuxi City, Jiangsu Province, China
| | - Sun Zhenzhong
- The Ninth People's Hospital of Wuxi City, Jiangsu Province, China
| | - Jiang Weimin
- The First People's Hospital of Suzhou City, Jiangsu Province, China
| | - Wang Yimeng
- The First People's Hospital of Suzhou City, Jiangsu Province, China
| | - Yin Qudong
- The Ninth People's Hospital of Wuxi City, Jiangsu Province, China
| | - Shi Jinhui
- The First People's Hospital of Suzhou City, Jiangsu Province, China
| |
Collapse
|
35
|
Ryan R, Spathis A, Booth S. Correlates between basic science and therapeutic interventions. Curr Opin Support Palliat Care 2014; 8:200-7. [DOI: 10.1097/spc.0000000000000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|