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Amirkhosravi F, Allenson KC, Moore LW, Kolman JM, Foster M, Hsu E, Sasangohar F, Dhala A. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis. Sci Rep 2024; 14:16012. [PMID: 38992072 PMCID: PMC11239889 DOI: 10.1038/s41598-024-66633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
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Affiliation(s)
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - Jacob M Kolman
- Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA
| | - Margaret Foster
- School of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USA
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Center for Critical Care, Houston Methodist, Houston, TX, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, Houston, TX, USA.
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Ma W, Liu Y, Liu J, Qiu Y, Zuo Y. Prehabilitation of surgical patients: a bibliometric analysis from 2005 to 2023. Perioper Med (Lond) 2024; 13:48. [PMID: 38822436 PMCID: PMC11140917 DOI: 10.1186/s13741-024-00410-x] [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: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Good preoperative conditions help patients to counteract surgical injury. Prehabilitation is a multimodal preoperative management strategy, including physical, nutritional, psychological, and other interventions, which can improve the functional reserve of patients and enhance postoperative recovery. The purpose of this study is to show the evolution trend and future directions of research related to the prehabilitation of surgical patients. METHODS The global literature regarding prehabilitation was identified from The Web of Science Core Collection database. Bibliometric methods of the Bibliometrix package of R (version 4.2.1) and VOSviewer were used to analyze publication trends, cooperative networks, study themes, and co-citation relationships in the field. RESULTS A total of 638 publications were included and the number of publications increased rapidly since 2016, with an average annual growth rate of 41.0%. "Annals of Surgery", "British Journal of Surgery" and "British Journal of Anesthesia" were the most cited journals. Experts from the USA, Canada, the UK, and the Netherlands contributed the most in this field, and an initial cooperative network among different countries and clinical teams was formed. Malnutrition, older patients, frailty, and high-risk patients were the hotspots of recent studies. However, among the top 10 cited articles, the clinical effects of prehabilitation were conflicting. CONCLUSION This bibliometric review summarized the most influential publications as well as the publication trends and clarified the progress and future directions of prehabilitation, which could serve as a guide for developing evidence-based practices.
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Affiliation(s)
- Wei Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yijun Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yanhua Qiu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Oda K, Matsumoto K, Shoji K, Shigemi A, Kawamura H, Takahashi Y, Katanoda T, Hashiguchi Y, Jono H, Saito H, Takesue Y, Kimura T. Validation and development of population pharmacokinetic model of vancomycin using a real-world database from a nationwide free web application. J Infect Chemother 2024:S1341-321X(24)00146-6. [PMID: 38825002 DOI: 10.1016/j.jiac.2024.05.014] [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: 03/28/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Vancomycin requires a population pharmacokinetic (popPK) model to estimate the area under the concentration-time curve (AUC), and an AUC-guided dosing strategy is necessary. This study aimed to develop a popPK model for vancomycin using a real-world database pooled from a nationwide web application (PAT). METHODS In this retrospective study, the PAT database between December 14, 2022 and April 6, 2023 was used to develop a popPK model. The model was validated and compared with six existing models based on the predictive performance of datasets from another PAT database and the Kumamoto University Hospital. The developed model determined the dosing strategy for achieving the target AUC. RESULTS The modeling populations consisted of 7146 (13,372 concentrations from the PAT database), 3805 (7540 concentrations from the PAT database), and 783 (1775 concentrations from Kumamoto University Hospital) individuals. A two-compartment popPK model was developed that incorporated creatinine clearance as a covariate for clearance and body weight for central and peripheral volumes of distribution. The validation demonstrated that the popPK model exhibited the smallest mean absolute prediction error of 5.07, outperforming others (ranging from 5.10 to 5.83). The dosing strategies suggested a first dose of 30 mg/kg and maintenance doses adjusted for kidney function and age. CONCLUSIONS This study demonstrated the updating of PAT through the validation and development of a popPK model using a vast amount of data collected from anonymous PAT users.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan; Department of Infection Control, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akari Shigemi
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Tomomi Katanoda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Yumi Hashiguchi
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Hideyuki Saito
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3 Hika-dai 3-chome, Tokoname City, Aichi, 479-8510, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
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Licker M, El Manser D, Bonnardel E, Massias S, Soualhi IM, Saint-Leger C, Koeltz A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. J Clin Med 2024; 13:2765. [PMID: 38792307 PMCID: PMC11121931 DOI: 10.3390/jcm13102765] [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: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.
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Affiliation(s)
- Marc Licker
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Diae El Manser
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Eline Bonnardel
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Sylvain Massias
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Islem Mohamed Soualhi
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Charlotte Saint-Leger
- Department of Cardiovascular & Thoracic Surgery, University Hospital of Martinique, F-97200 Fort-de-France, France;
| | - Adrien Koeltz
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
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Yang L, Alice A, Friedenreich CM. Physical activity for cancer prehabilitation: A scoping review. Crit Rev Oncol Hematol 2024; 196:104319. [PMID: 38460927 DOI: 10.1016/j.critrevonc.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Azam Alice
- Adapted Physical Activity and Health, University Rennes 2, Rennes, France
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
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Hamdan PNF, Hamzaid NA, Hasnan N, Abd Razak NA, Razman R, Usman J. Effects of releasing ankle joint during electrically evoked cycling in persons with motor complete spinal cord injury. Sci Rep 2024; 14:6451. [PMID: 38499594 PMCID: PMC10948841 DOI: 10.1038/s41598-024-56955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Literature has shown that simulated power production during conventional functional electrical stimulation (FES) cycling was improved by 14% by releasing the ankle joint from a fixed ankle setup and with the stimulation of the tibialis anterior and triceps surae. This study aims to investigate the effect of releasing the ankle joint on the pedal power production during FES cycling in persons with spinal cord injury (SCI). Seven persons with motor complete SCI participated in this study. All participants performed 1 min of fixed-ankle and 1 min of free-ankle FES cycling with two stimulation modes. In mode 1 participants performed FES-evoked cycling with the stimulation of quadriceps and hamstring muscles only (QH stimulation), while Mode 2 had stimulation of quadriceps, hamstring, tibialis anterior, and triceps surae muscles (QHT stimulation). The order of each trial was randomized in each participant. Free-ankle FES cycling offered greater ankle plantar- and dorsiflexion movement at specific slices of 20° crank angle intervals compared to fixed-ankle. There were significant differences in the mean and peak normalized pedal power outputs (POs) [F(1,500) = 14.03, p < 0.01 and F(1,500) = 7.111, p = 0.008, respectively] between fixed- and free-ankle QH stimulation, and fixed- and free-ankle QHT stimulation. Fixed-ankle QHT stimulation elevated the peak normalized pedal PO by 14.5% more than free-ankle QH stimulation. Releasing the ankle joint while providing no stimulation to the triceps surae and tibialis anterior reduces power output. The findings of this study suggest that QHT stimulation is necessary during free-ankle FES cycling to maintain power production as fixed-ankle.
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Affiliation(s)
- Puteri Nur Farhana Hamdan
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
- Department of Biomedical Engineering, Faculty of Engineering, Centre of Applied Biomechanics, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rizal Razman
- Centre for Sport & Exercise Sciences, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Biomedical Engineering, Faculty of Engineering, Centre of Applied Biomechanics, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Takara H, Suzuki S, Satoh S, Abe Y, Miyazato S, Kohatsu Y, Minakata S, Moriya M. Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study. Neurocrit Care 2024:10.1007/s12028-024-01946-y. [PMID: 38429610 DOI: 10.1007/s12028-024-01946-y] [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: 06/21/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Early mobilization has been shown to promote functional recovery and prevent complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy of early mobilization in patients with aSAH remains unclear. This study aimed to investigate the association between early mobilization and functional outcomes in patients with aSAH. METHODS This multicenter retrospective study was conducted in Japan and included patients with aSAH who received physical therapy with or without occupational therapy from April 2014 to March 2019. The primary outcome was the modified Rankin Scale (mRS) score, with a favorable functional outcome defined as an mRS score of 0-2 and an unfavorable outcome with an mRS score of 3-5. Patients initiating walking training within 14 days of aSAH onset were classified into the early mobilization group, whereas those initiating training after 14 days were classified into the delayed mobilization group. Propensity score matching analysis was performed to assess the association between early mobilization and favorable outcomes. RESULTS A total of 718 patients were screened, and 450 eligible patients were identified. Before matching, 229 patients (50.9%) were in the early mobilization group and 221 (49.1%) were in the delayed mobilization group. After matching, each group consisted of 122 patients, and the early mobilization group exhibited a higher proportion of favorable outcomes than did the delayed mobilization group (81.1% vs. 52.5%, risk difference 28.7%, 95% confidence interval 17.4-39.9, p < 0.001). CONCLUSIONS This multicenter retrospective study suggests that initiating walking training within 14 days of aSAH onset is associated with favorable outcomes.
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Affiliation(s)
- Hikaru Takara
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan.
| | - Shota Suzuki
- Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shuhei Satoh
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Yoko Abe
- Department of Rehabilitation, Sapporo Shiroishi Memorial Hospital, Hokkaido, Japan
| | - Shohei Miyazato
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan
| | - Yoshiki Kohatsu
- Department of Rehabilitation, Naha City Hospital, 2-31-1, Furujima, Naha City, Okinawa, 902-8511, Japan
| | - Shin Minakata
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Masamichi Moriya
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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An KR, Seijas V, Xu MS, Grüßer L, Humar S, Moreno AA, Turk M, Kasanagottu K, Alzghari T, Dimagli A, Ko MA, Villena-Vargas J, Papatheodorou S, Gaudino MFL. Does prehabilitation before esophagectomy improve postoperative outcomes? A systematic review and meta-analysis. Dis Esophagus 2024; 37:doad066. [PMID: 38018252 DOI: 10.1093/dote/doad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
Esophagectomy for esophageal cancer is associated with high morbidity. It remains unclear whether prehabilitation, a strategy aimed at optimizing patients' physical and mental functioning prior to surgery, improves postoperative outcomes. A systematic review and meta-analysis was conducted to evaluate the effect of prehabilitation on post-operative outcomes after esophagectomy. Data sources included Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PEDro, with information from 1 January 2000 to 5 August 2023. The analysis included randomized controlled trials and observational studies that compared prehabilitation interventions to standard care prior to esophagectomy. A random effects model was used to generate a pooled estimate for pairwise meta-analysis, meta-analysis of proportions, and meta-analysis of means. A total of 1803 patients were included with 584 in randomized controlled trials (RCTs) and 1219 in observational studies. In the randomized evidence, there were no significant differences between prehabilitation and control in the odds of postoperative pneumonia (15.0 vs. 18.9%, odds ratio (OR) 1.06 [95% confidence interval (CI): 0.66;1.72]) or pulmonary complications (14 vs. 25.6%, OR 0.68 [95% CI: 0.32;1.45]). In the observational data, there was a reduction in both postoperative pneumonia (22.5 vs. 32.9%, OR 0.48 [95% CI: 0.28;0.83]) and pulmonary complications (26.1 vs. 52.3%, OR 0.35 [95% CI: 0.17;0.75]) with prehabilitation. Hospital and intensive care unit length of stay (days), operative mortality, and severe complications (Clavien-Dindo ≥ 3) did not differ between groups in both the randomized data and observational data. Prehabilitation demonstrated reductions in postoperative pneumonia and pulmonary complications in observational studies, but not RCTs. The overall certainty of these findings is limited by the low quality of the available evidence.
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Affiliation(s)
- Kevin R An
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Vanessa Seijas
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Division of Rehabilitation, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Ageing, Functioning Epidemiology, and Implementation, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Physical and Rehabilitation Medicine, Rehabilitation in Health Research Group, University of Antioquia, Medellin, Colombia
| | - Michael S Xu
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Linda Grüßer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sapna Humar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Amabelle A Moreno
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Division of Pediatric Surgery, Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Marvee Turk
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Koushik Kasanagottu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michael A Ko
- Division of Thoracic Surgery, Department of Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, ON, Canada
| | | | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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Burnett C, Bestall J, Boland A, Burke S, Callister M, Greenwood-Wilson S, Hewison J, Morgan E, Murray RL, Pompili C, Sloss A, Williams G, Franks K. The Prehabilitation Radiotherapy Exercise, smoking Habit cessation and Balanced diet Study (PREHABS) protocol to explore the feasibility of embedding behavioural modifications into the clinical pathway for patients undergoing radical radiotherapy for lung cancer. BMJ Open 2024; 14:e081365. [PMID: 38272548 PMCID: PMC10824008 DOI: 10.1136/bmjopen-2023-081365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Patients with curable non-surgical lung cancer are often current smokers, have co-existing medical comorbidities and are treated with curative radiotherapy. To maximise the benefits of modern radiotherapy, there is an urgent need to optimise the patient's health to improve survival and quality of life. METHODS AND ANALYSIS The Yorkshire Cancer Research-funded Prehabilitation Radiotherapy Exercise, smoking Habit cessation and Balanced diet Study (PREHABS) (L426) is a single-centre prospective feasibility study to assess embedding behavioural changes into the radical radiotherapy pathway of patients with lung cancer. Feasibility will be assessed by measuring acceptability, demand and implementation. The duration of the study is 24 months. PREHABS has two workstreams: the intervention study and the theory of change (ToC) study.Intervention study: PREHABS will commence at the R-IDEAL phase 2 trial (exploratory) based on existing evidence and includes support for smoking cessation, increasing activity and dietary well-being. Patients undergoing radical radiotherapy for lung cancer will be recruited from the oncology department at Leeds Teaching Hospitals NHS Trust (LTHT). ToC study: to maximise the acceptability and adherence to the PREHABS, we will use a ToC approach to qualitatively explore the key barriers and enablers of implementing a tailored programme of 'prehabilitation'. The PREHABS ToC study participants will be recruited from patients with lung cancer undergoing radical radiotherapy and staff from the LTHT oncology department. ANALYSIS The primary endpoint analysis will report the number of participants and adherence to the study interventions. Secondary endpoints include continued engagement with study interventions post-treatment. The analysis will focus on descriptive statistics. Thematic analysis of the qualitative data from the ToC study will identify consensus on intervention optimisation and delivery. ETHICS AND DISSEMINATION On 12 May 2021, the Cambridge East Ethics Committee granted ethical approval (21/EE/0048). The study is registered in the National Institute for Health and Care Research (NIHR) portfolio. The results will be disseminated through publication in peer-reviewed scientific journals and presented at conferences. TRIAL REGISTRATION NUMBER NIHR portfolio 48420.
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Affiliation(s)
- Carole Burnett
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison Boland
- Leeds Centre for Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Shaunna Burke
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Matthew Callister
- Leeds Centre for Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Samuel Greenwood-Wilson
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Psychiatry and Behavioural Sciences School of Medicine, University of Leeds, Leeds, UK
| | - Emma Morgan
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rachael L Murray
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | | | - Andy Sloss
- Patient Representative, Patient Representative, Leeds, UK
| | - Gillian Williams
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
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10
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She KY, Huang L, Zhang HT, Gao Y, Yao KR, Luo Q, Tang X, Li L, Zhao L, Wang ZH, Yang XJ, Yin XH. Effect of prehabilitation on postoperative outcomes in the frail older people: A systematic review and meta-analysis. Geriatr Nurs 2024; 55:79-88. [PMID: 37976559 DOI: 10.1016/j.gerinurse.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The study investigates the impact of preoperative rehabilitation on the surgical prognosis of frail older patients. METHOD The effect sizes of all studies retrieved and included by the nine databases were analyzed and expressed as RR and WMD. RESULTS 8 studies with 902 participants met the criteria for inclusion. A significant reduction in total complications (RR = 0.84, 95 % CI = 0.73 to 0.97, P = 0.021) and the 6MWT after surgery (WMD = 74.76, 95 % CI = 44.75 to 104.77, P = 0.000) was observed in the prehabilitation group. But it had no differences in mortality(RR = 1.89, 95 % CI = 0.75 to 4.72, P = 0.176), readmission rates(RR = 1.04, 95 % CI = 0.56 to 1.91, P = 0.906) and LOS(WMD = -0.24, 95 % CI = -1.00 to 0.52, P = 0.540). CONCLUSIONS Prehabilitation had positive effect on postoperative complications and functional recovery in frail older patients.
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Affiliation(s)
- Ke-Yi She
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Li Huang
- The Second Hospital, University of South China, Hengyang, Hunan, China
| | - Hong-Tao Zhang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Yue Gao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Ke-Ru Yao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Qin Luo
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xi Tang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Lu Li
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Lu Zhao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Zhi-Han Wang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xin-Jun Yang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xin-Hong Yin
- School of Nursing, University of South China, Hengyang, Hunan, China.
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11
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Yanase L, Clark D, Baraban E, Stuchiner T. A Retrospective Analysis of Ischemic Stroke Patients Supports That Very Early Mobilization Within 24 Hours After Intravenous Alteplase Is Safe and Possibly Beneficial. J Neurosci Nurs 2023; 55:188-193. [PMID: 37815279 DOI: 10.1097/jnn.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT BACKGROUND: Stroke care guidelines recommend early mobilization of acute ischemic stroke patients, but there are sparse data regarding early mobilization of stroke patients receiving thrombolytic therapy. We developed the Providence Early Mobility for Stroke (PEMS) protocol to mobilize patients to their highest individual tolerance within 24 hours of stroke admission in 2010, and it has been in continuous use at our primary and comprehensive stroke centers for over a decade. In this study, we evaluated the PEMS protocol in all patients treated with intravenous alteplase without endovascular treatment. METHODS : This retrospective study includes 318 acute ischemic stroke patients treated with alteplase who were admitted to 2 urban stroke centers between January 2013 and December of 2017 and were mobilized with the PEMS protocol within 24 hours of receiving alteplase. Safety of PEMS was assessed by change in National Institutes of Health Stroke Scale at 24 hours by time first mobilized. Using multivariate and logistic regression models, we analyzed time first mobilized and 90-day modified Rankin scale (mRS). RESULTS : Median time first mobilized was 9 hours from administration of alteplase. For every hour delay in mobilization, the odds of being slightly or moderately disabled (mRS, 2-3) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .004), and the odds of being severely disabled or dead (mRS, 4-6) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .02). In addition, for every hour delay in mobilization, 24-hour National Institutes of Health Stroke Scale increased by 1.8%. DISCUSSION: Our results support that the PEMS protocol is safe, and possibly beneficial, for acute ischemic stroke patients treated with intravenous alteplase. Our protocol differs from other very early mobility protocols because it does not prescribe a "dose" of activity. Instead, each patient was mobilized to his/her individual highest degree as soon as it was safe to do so.
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12
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Cambriel A, Choisy B, Hedou J, Bonnet MP, Fellous S, Lefevre JH, Voron T, Gaudillière D, Kin C, Gaudillière B, Verdonk F. Impact of preoperative uni- or multimodal prehabilitation on postoperative morbidity: meta-analysis. BJS Open 2023; 7:zrad129. [PMID: 38108466 PMCID: PMC10726416 DOI: 10.1093/bjsopen/zrad129] [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: 07/16/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to increase patients' preoperative health status and thereby improve postoperative outcomes. However, reported results of prehabilitation are contradictory. The objective of this systematic review is to evaluate the effects of prehabilitation on postoperative outcomes (postoperative complications, hospital length of stay, pain at postoperative day 1) in patients undergoing elective surgery. METHODS The authors performed a systematic review and meta-analysis of RCTs published between January 2006 and June 2023 comparing prehabilitation programmes lasting ≥14 days to 'standard of care' (SOC) and reporting postoperative complications according to the Clavien-Dindo classification. Database searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO. The primary outcome examined was the effect of uni- or multimodal prehabilitation on 30-day complications. Secondary outcomes were length of ICU and hospital stay (LOS) and reported pain scores. RESULTS Twenty-five studies (including 2090 patients randomized in a 1:1 ratio) met the inclusion criteria. Average methodological study quality was moderate. There was no difference between prehabilitation and SOC groups in regard to occurrence of postoperative complications (OR = 1.02, 95% c.i. 0.93 to 1.13; P = 0.10; I2 = 34%), total hospital LOS (-0.13 days; 95% c.i. -0.56 to 0.28; P = 0.53; I2 = 21%) or reported postoperative pain. The ICU LOS was significantly shorter in the prehabilitation group (-0.57 days; 95% c.i. -1.10 to -0.04; P = 0.03; I2 = 46%). Separate comparison of uni- and multimodal prehabilitation showed no difference for either intervention. CONCLUSION Prehabilitation reduces ICU LOS compared with SOC in elective surgery patients but has no effect on overall complication rates or total LOS, regardless of modality. Prehabilitation programs need standardization and specific targeting of those patients most likely to benefit.
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Affiliation(s)
- Amélie Cambriel
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin Choisy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Julien Hedou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Marie-Pierre Bonnet
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université Paris Cité, CRESS, EPOPé, INSERM, INRA, Paris, France
| | - Souad Fellous
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie H Lefevre
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Voron
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dyani Gaudillière
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Cindy Kin
- Division of General Surgery, Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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13
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Zak M, Wasik M, Sikorski T, Aleksandrowicz K, Miszczuk R, Courteix D, Dutheil F, Januszko-Szakiel A, Brola W. Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review. J Clin Med 2023; 12:5675. [PMID: 37685741 PMCID: PMC10488935 DOI: 10.3390/jcm12175675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Krzysztof Aleksandrowicz
- Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, T. Chałubińskiego 3, 50-368 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Renata Miszczuk
- Institute of Pedagogy, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, 63000 Clermont-Ferrand, France
| | - Aneta Januszko-Szakiel
- Institute of Information Studies, Faculty of Managment and Social Communication, Jagiellonian University, ul. Lojasiewicza 4, 30-348 Krakow, Poland;
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
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14
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Alomari S, Theodore J, Ahmed AK, Azad TD, Lubelski D, Sciubba DM, Theodore N. Development and External Validation of the Spinal Tumor Surgery Risk Index. Neurosurgery 2023; 93:462-472. [PMID: 36921234 DOI: 10.1227/neu.0000000000002441] [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: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Patients undergoing surgical procedures for spinal tumors are vulnerable to major adverse events (AEs) and death in the postoperative period. Shared decision making and preoperative optimization of outcomes require accurate risk estimation. OBJECTIVE To develop and validate a risk index to predict short-term major AEs after spinal tumor surgery. METHODS Prospectively collected data from multiple medical centers affiliated with the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2020 were reviewed. Multiple logistic regression was used to assess sociodemographic, tumor-related, and surgery-related factors in the derivation cohort. The spinal tumor surgery risk index (STSRI) was built based on the resulting scores. The STSRI was internally validated using a subgroup of patients from the American College of Surgeons National Surgical Quality Improvement Program database and externally validated using a cohort from a single tertiary center. RESULTS In total, 14 982 operations were reviewed and 4556 (16.5%) major AEs occurred within 30 days after surgery, including 209 (4.5%) deaths. 22 factors were independently associated with major AEs or death and were included in the STSRI. Using the internal and external validation cohorts, the STSRI produced an area under the curve of 0.86 and 0.82, sensitivity of 80.1% and 79.7%, and specificity of 74.3% and 73.7%, respectively. The STSRI, which is freely available, outperformed the modified frailty indices, the American Society of Anesthesiologists classification, and the American College of Surgeons risk calculator. CONCLUSION In patients undergoing surgery for spinal tumors, the STSRI showed the highest predictive accuracy for major postoperative AEs and death compared with other current risk predictors.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The HEPIUS Innovation Lab, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The HEPIUS Innovation Lab, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The HEPIUS Innovation Lab, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The HEPIUS Innovation Lab, Johns Hopkins Hospital, Baltimore, Maryland, USA
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15
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Gao B, Zhao W, Su W, Qiu J, Xi H, Li N, Zhang Y. Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project. JBI Evid Implement 2023; 21:128-137. [PMID: 37158603 DOI: 10.1097/xeb.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. INTRODUCTION End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. METHODS Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. RESULTS In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0-22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation ( P < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P < 0.05). CONCLUSIONS This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future.
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Affiliation(s)
- Bingxin Gao
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Geriatric Department, Zhongshan Hospital, Fudan University, Faculty of Nursing, Shanghai, China
| | - Wenwen Zhao
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Department of Medical, Zhongshan Hospital, Fudan University, Faculty of Nursing
| | - Wei Su
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Department of Nursing, Zhongshan Hospital, Fudan University, Faculty of Nursing
| | - Jie Qiu
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Hepatic Surgical Department, Zhongshan Hospital, Fudan University, Faculty of Nursing, Shanghai, China
| | - Huan Xi
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Hepatic Surgical Department, Zhongshan Hospital, Fudan University, Faculty of Nursing, Shanghai, China
| | - Na Li
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Hepatic Surgical Department, Zhongshan Hospital, Fudan University, Faculty of Nursing, Shanghai, China
| | - Yuxia Zhang
- Fudan University Centre for Evidence-based Nursing: a JBI Centre of Excellence
- Department of Nursing, Zhongshan Hospital, Fudan University, Faculty of Nursing
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16
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Lehmkuhl L, Olsen HT, Brønd JC, Rothmann MJ, Dreyer P, Jespersen E. Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit. Acta Anaesthesiol Scand 2023; 67:462-469. [PMID: 36636823 DOI: 10.1111/aas.14195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU. METHOD In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh- and chest-worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in-bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA. RESULTS We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non-lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00. CONCLUSION ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse- and/or physiotherapy-initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU.
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Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, Odense University Hospital Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
- Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Section of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
- Bergen University, Bergen, Norway
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Gregory AJ, Noss CD, Chun R, Gysel M, Prusinkiewicz C, Webb N, Raymond M, Cogan J, Rousseau-Saine N, Lam W, van Rensburg G, Alli A, de Vasconcelos Papa F. Perioperative Optimization of the Cardiac Surgical Patient. Can J Cardiol 2023; 39:497-514. [PMID: 36746372 DOI: 10.1016/j.cjca.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/06/2023] Open
Abstract
Perioperative optimization of cardiac surgical patients is imperative to reduce complications, utilize health care resources efficiently, and improve patient recovery and quality of life. Standardized application of evidence-based best practices can lead to better outcomes. Although many practices should be applied universally to all patients, there are also opportunities along the surgical journey to identify patients who will benefit from additional interventions that will further ameliorate their recovery. Enhanced recovery programs aim to bundle several process elements in a standardized fashion to optimize outcomes after cardiac surgery. A foundational concept of enhanced recovery is attaining a better postsurgical end point for patients, in less time, through achievement and maintenance in their greatest possible physiologic, functional, and psychological state. Perioperative optimization is a broad topic, spanning multiple phases of care and involving a variety of medical specialties and nonphysician health care providers. In this review we highlight a variety of perioperative care topics, in which a comprehensive approach to patient care can lead to improved results for patients, providers, and the health care system. A particular focus on patient-centred care is included. Although existing evidence supports all of the elements reviewed, most require further improvements in implementation, as well as additional research, before their full potential and usefulness can be determined.
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Affiliation(s)
- Alexander J Gregory
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Christopher D Noss
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rosaleen Chun
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Gysel
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Prusinkiewicz
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Webb
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Meggie Raymond
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | | | - Wing Lam
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gerry van Rensburg
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ahmad Alli
- Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Andersson M, Egenvall M, Danielsson J, Thorell A, Sturesson C, Soop M, Nygren-Bonnier M, Rydwik E. CANOPTIPHYS study protocol: Optimising PHYSical function before CANcer surgery: effects of pre-operative optimisation on complications and physical function after gastrointestinal cancer surgery in older people at risk-a multicentre, randomised, parallel-group study. Trials 2023; 24:41. [PMID: 36658653 PMCID: PMC9850586 DOI: 10.1186/s13063-022-07026-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This multicentre study explores the effects of pre-operative exercise on physical fitness, post-operative complications, recovery, and health-related quality of life in older individuals with low pre-operative physical capacity scheduled to undergo surgery for colorectal cancer. We hypothesise that this group of patients benefit from pre-operative exercise in terms of improved pre-operative physical function and lower rates of post-operative complications after surgery compared to usual care. Standardised cancer pathways in Sweden dictate a timeframe of 14-28 days from suspicion of cancer to surgery for colorectal cancer. Therefore, an exercise programme aimed to enhance physical function in the limited timeframe requires a high-intensity and high-frequency approach. METHODS Participants will be included from four sites in Stockholm, Sweden. A total of 160 participants will be randomly assigned to intervention or control conditions. Simple randomisation (permuted block randomisation) is applied with a 1:1 allocation ratio. The intervention group will perform home-based exercises (inspiratory muscle training, aerobic exercises, and strength exercises) supervised by a physiotherapist (PT) for a minimum of 6 sessions in the pre-operative period, complemented with unsupervised exercise sessions in between PT visits. The control group will receive usual care with the addition of advice on health-enhancing physical activity. The physical activity behaviour in both groups will be monitored using an activity monitor. The primary outcomes are (1) change in physical performance (6-min walking distance) in the pre-operative period and (2) post-operative complications 30 days after surgery (based on Clavien-Dindo surgical score). DISCUSSION If patients achieve functional benefits by exercise in the short period before surgery, this supports the implementation of exercise training as a clinical routine. If such benefits translate into lower complication rates and better post-operative recovery or health-related quality of life is not known but would further strengthen the case for pre-operative optimisation in colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04878185. Registered on 7 May 2021. https://clinicaltrials.gov/ct2/home.
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Affiliation(s)
- Mikael Andersson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Monika Egenvall
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Danielsson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Christian Sturesson
- grid.24381.3c0000 0000 9241 5705Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Soop
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Rydwik
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden ,Stockholm Region Council, FOU nu, Research and Development Unit for the Elderly, Järfälla, Sweden
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Gendia A, Rehman M, Cota A, Gilbert J, Clark J. Can virtual reality technology be considered as a part of the surgical care pathway? Ann R Coll Surg Engl 2023; 105:2-6. [PMID: 36374265 PMCID: PMC9773243 DOI: 10.1308/rcsann.2022.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery. METHODS A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed. RESULTS Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia. CONCLUSIONS The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.
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Affiliation(s)
- A Gendia
- Royal Cornwall Hospitals NHS Trust, UK
| | - M Rehman
- Northampton General Hospital NHS Trust, UK
| | - A Cota
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Gilbert
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Clark
- Royal Cornwall Hospitals NHS Trust, UK
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Garant RC, Tobalske BW, Ben Sassi N, van Staaveren N, Tulpan D, Widowski T, Powers DR, Harlander-Matauschek A. Does wing use and disuse cause behavioural and musculoskeletal changes in domestic fowl ( Gallus gallus domesticus)? ROYAL SOCIETY OPEN SCIENCE 2023; 10:220809. [PMID: 36704252 PMCID: PMC9874265 DOI: 10.1098/rsos.220809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
Domestic chickens may live in environments which restrict wing muscle usage. Notably, reduced wing activity and accompanying muscle weakness are hypothesized risk factors for keel bone fractures and deviations. We used radio-frequency identification (RFID) to measure duration spent at elevated resources (feeders, nest-boxes), ultrasonography to measure muscle thickness (breast and lower leg) changes, radiography and palpation to determine fractures and deviations, respectively, following no, partial (one-sided wing sling) and full (cage) immobilization in white- and brown-feathered birds. We hypothesized partially immobilized hens would reduce elevated resource usage and that both immobilization groups would show decreased pectoralis thickness (disuse) and increased prevalence of fractures and deviations. Elevated nest-box usage was 42% lower following five weeks of partial immobilization for brown-feathered hens but no change in resource usage in white-feathered birds was observed. Fully immobilized, white-feathered hens showed a 17% reduction in pectoralis thickness, while the brown-feathered counterparts showed no change. Lastly, fractures and deviations were not affected in either strain or form of wing immobilization; however, overall low numbers of birds presented with these issues. Altogether, this study shows a profound difference between white- and brown-feathered hens in response to wing immobilization and associated muscle physiology.
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Affiliation(s)
- Renée C. Garant
- Department of Animal Biosciences, University of Guelph, 50 Stone Road E, Guelph, ON, Canada N1G 2W1
| | - Bret W. Tobalske
- Division of Biological Sciences, University of Montana, 32 Campus Drive, Missoula, MT 59812, USA
| | - Neila Ben Sassi
- Department of Animal Biosciences, University of Guelph, 50 Stone Road E, Guelph, ON, Canada N1G 2W1
| | - Nienke van Staaveren
- Department of Animal Biosciences, University of Guelph, 50 Stone Road E, Guelph, ON, Canada N1G 2W1
| | - Dan Tulpan
- Department of Animal Biosciences, University of Guelph, 50 Stone Road E, Guelph, ON, Canada N1G 2W1
| | - Tina Widowski
- Department of Animal Biosciences, University of Guelph, 50 Stone Road E, Guelph, ON, Canada N1G 2W1
| | - Donald R. Powers
- Department of Biology, George Fox University, 414 N Meridian Street, Newberg, OR 97132, USA
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Cho ST, Kim SJ, Nam BJ, Kim KW, Lee GH, Kim JH. Absolute Bed Rest Duration of 3 Days for Osteoporotic Vertebral Fractures: A Retrospective Study. Asian Spine J 2022; 16:898-905. [PMID: 35527538 PMCID: PMC9827199 DOI: 10.31616/asj.2021.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/06/2022] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. PURPOSE To reduce unnecessary absolute bed rest (ABR), this study sought to determine the optimal aimed length of ABR in older patients getting conservative treatment for osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE OVFs are quite common in elderly patients. ABR is a vital part of conservative treatment for OVFs, although the length of ABR may increase patient. No recommendations regarding how long ABR should last. METHODS This study was conducted in 134 patients with OVFs initially treated conservatively. The patients were split into two groups: 3-day and 7-day ABR. From the time of injury to 1, 4, and 12 weeks after injury, compression rate (CR) and local kyphotic angle (LKA) were assessed and compared between the two groups. Any complications such as pneumonia, deep vein thrombosis, delirium, and urinary tract infection known to be related to ABR were examined based on the electronic medical record. RESULTS Forty-four patients underwent ABR for 3 days and 90 underwent ABR for 7 days. There was no significant difference in CR and LKA between the two groups at the time of injury versus 1, 4, and 12 weeks after injury. The patients were divided into two groups: those who received a 3-day ABR and those who received a 7-day ABR. CR and LKA were measured and compared between the two groups from the time of damage to 1, 4, and 12 weeks after injury. The ABR-related complication rate was 43.4% in the 7-day ABR group and 22.7% in 3-day ABR group (p=0.02). The duration of hospital stay was significantly shorter in the 3-day ABR group (12.8 days) than in the 7-day group (16 days) (p=0.01). CONCLUSIONS Considering radiological outcomes, prognosis, complications, patient convenience, and economic impact, a 3-day ABR period is appropriate for the conservative treatment of OVFs.
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Affiliation(s)
- Sung Tan Cho
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung Joo Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bum Joon Nam
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kun Woo Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Gyu Hyeon Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jin Hwan Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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Hamdan PNF, Hamzaid NA, Abd Razak NA, Hasnan N. Contributions of the Cybathlon championship to the literature on functional electrical stimulation cycling among individuals with spinal cord injury: A bibliometric review. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:671-680. [PMID: 33068748 PMCID: PMC9729926 DOI: 10.1016/j.jshs.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016. METHODS Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist. RESULTS A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than that in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship. CONCLUSION The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.
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Affiliation(s)
- Puteri Nur Farhana Hamdan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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Grove K, Edgar DW, Chih H, Harrold M, Natarajan V, Mohd S, Hurn E, Cavalheri V. Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19. J Clin Med 2022; 11:jcm11133602. [PMID: 35806891 PMCID: PMC9267535 DOI: 10.3390/jcm11133602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022] Open
Abstract
↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected COVID-19 was recruited. Participants were grouped according to their polymerase chain reaction (PCR) test result into COVID-19 positive (COVID+) and COVID-19 negative (COVID−) groups. Between-group comparisons of characteristics of the participants and hospital admission data were performed. Sixty-five participants were included (38 COVID+ and 27 COVID−; 36 females [55%]). Participants in the COVID+ group had greater acute hospital length of stay (LOS) (median [25−75th percentile] 10 [5−21] vs. 3 [2−5] days; p < 0.05] and only those with COVID+ required mechanical ventilation (8 [21%] participants). Twenty-one percent of the COVID+ participants were discharged to inpatient rehabilitation (7% of the COVID− participants). Of note, pre-existing pulmonary disease was more prevalent in the COVID− group (59% vs. 13%; p < 0.05). Within the COVID+ group, when compared to participants discharged home, those who required inpatient rehabilitation had worse peripheral oxygen saturation (SpO2) on admission (86 ± 5.7% vs. 93 ± 3.8%; p < 0.05) and longer median LOS (30 [23−37] vs. 7 [4−13] days; p < 0.05). Despite having less people with pre-existing pulmonary disease, the COVID+ group required more care and rehabilitation than the COVID− group. In the COVID+ group, SpO2 on hospital presentation was associated with LOS, critical care needs, mechanical ventilation duration and the need for inpatient rehabilitation.
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Affiliation(s)
- Kristen Grove
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
| | - Dale W. Edgar
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
- Burn Injury Research Node, University of Notre Dame Australia, Fremantle, WA 6160, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Meg Harrold
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
| | - Varsha Natarajan
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
| | - Sheeraz Mohd
- Department of Cardiology, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia;
| | - Elizabeth Hurn
- Department of Physiotherapy, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA 6009, Australia;
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- Allied Health, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Correspondence:
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Marchand AA, Houle M, O'Shaughnessy J, Châtillon CÉ, Descarreaux M. Physical Predictors of Favorable Postoperative Outcomes in Patients Undergoing Laminectomy or Laminotomy for Central Lumbar Spinal Stenosis: Secondary Analysis of a Randomized Controlled Trial. Front Neurol 2022; 13:848665. [PMID: 35493839 PMCID: PMC9051316 DOI: 10.3389/fneur.2022.848665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design Secondary analysis of a randomized controlled trial. Objective To identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis. Summary of Background Data Clinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis. Methods Patients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression. Results Sixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02–27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95–1.24)] total ambulation time [OR = 1.00 95%CI (0.99–1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95–1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98–1.06)]. Conclusion Results show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery.
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Affiliation(s)
- Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Andrée-Anne Marchand
| | - Mariève Houle
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Julie O'Shaughnessy
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Claude-Édouard Châtillon
- Department of Neurosurgery, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
- Division of Neurosurgery, Faculty of Medicine, University of Montreal, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Noronha J, Samuel S, Singh VP, Prabhu HS. Effects of exercise-based prehabilitation in children undergoing elective surgeries: a systematic review. F1000Res 2022; 10:1262. [PMID: 35251598 PMCID: PMC8861468 DOI: 10.12688/f1000research.74493.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Prehabilitation is a therapeutic strategy involving preoperative physical exercises, nutritional support, and stress and anxiety reduction. This approach has been gaining popularity and has been seeing effective results in adults in terms of improving pre and postoperative outcomes. The purpose of this review was to summarise the evidence about the effects of exercise-based prehabilitation programs on various outcome measures in children post elective surgeries. Methods: PubMed, Scopus, Web of Science, PEDro, CINAHL/EBSCO and EMBASE electronic databases were searched from inception to June 2021. Based on the inclusion criteria, titles and abstracts were independently screened by the authors. After that, a data extraction table of the selected studies which included the participants, type, and details of exercise intervention, outcome measures and results were analysed after which the quality assessment of the studies was done. Results: The search yielded 2219 articles of which three articles fulfilled the inclusion criteria with two studies being randomized controlled trials and one being a quasi-experimental pre-post type of study. One randomized controlled trial was on the effects of exercise-based prehabilitation in reducing pulmonary complications post cardiac surgeries in children and the other two studies were on the effects of prehabilitation on functional capacity & pulmonary function. All the three articles found that exercise-based prehabilitation had a positive effect on children’s post-surgery. Conclusion: Although there is a paucity of evidence-based literature, we conclude based on the existing literature retrieved by our review that exercise-based prehabilitation improves postoperative outcomes and helps in reducing postoperative complications in children undergoing various surgeries.
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Affiliation(s)
- Jean Noronha
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Stephen Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore,, Manipal Academy of Higher Education, Manipal, India
| | - Vijay Pratap Singh
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - H Shivananda Prabhu
- Department of Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Sarcopenia in Children with Solid Organ Tumors: An Instrumental Era. Cells 2022; 11:cells11081278. [PMID: 35455957 PMCID: PMC9024674 DOI: 10.3390/cells11081278] [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: 02/04/2022] [Revised: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia has recently been studied in both adults and children and was found to be a prognostic marker for adverse outcome in a variety of patient groups. Our research showed that sarcopenia is a relevant marker in predicting outcome in children with solid organ tumors, such as hepatoblastoma and neuroblastoma. This was especially true in very ill, high-risk groups. Children with cancer have a higher likelihood of ongoing loss of skeletal muscle mass due to a mismatch in energy intake and expenditure. Additionally, the effects of cancer therapy, hormonal alterations, chronic inflammation, multi-organ dysfunction, and a hypermetabolic state all contribute to a loss of skeletal muscle mass. Sarcopenia seems to be able to pinpoint this waste to a high degree in a new and objective way, making it an additional tool in predicting and improving outcome in children. This article focuses on the current state of sarcopenia in children with solid organ tumors. It details the pathophysiological mechanisms behind sarcopenia, highlighting the technical features of the available methods for measuring muscle mass, strength, and function, including artificial intelligence (AI)-based techniques. It also reviews the latest research on sarcopenia in children, focusing on children with solid organ tumors.
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Hao S, Reis HL, Wercholuk AN, Snyder RA, Parikh AA. Prehabilitation for Older Adults Undergoing Liver Resection: Getting Patients and Surgeons Up to Speed. J Am Med Dir Assoc 2022; 23:547-554. [PMID: 35247359 DOI: 10.1016/j.jamda.2022.01.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Morbidity rates following liver resection are high, especially among older adult patients. This review aims to evaluate the evidence surrounding prehabilitation in older patients anticipating liver resection and to describe how prehabilitation may be implemented. DESIGN Problem-based narrative review with case-based discussion. SETTING AND PARTICIPANTS All older adults anticipating liver resection inclusive of benign and malignant etiologies in the United States. METHODS Literature search was performed using MeSH terms and keywords in MEDLINE via PubMed, followed by a manual second search for relevant references within selected articles. Articles were excluded if not available in the English language or did not include patients undergoing hepatectomy. RESULTS Prehabilitation includes a range of activities including exercise, nutrition/dietary changes, and psychosocial interventions that may occur from several weeks to days preceding a surgical operation. Older adult patients who participate in prehabilitation may experience improvement in preoperative candidacy as well as improved postoperative quality of life and faster return to baseline; however, evidence supporting a reduction in postoperative length of stay and perioperative morbidity and mortality is conflicting. A variety of modalities are available for prehabilitation but lack consensus and standardization. For a provider desiring to prescribe prehabilitation, multidisciplinary assessments including geriatric, cardiopulmonary, and future remnant liver function can help determine individual patient needs and select appropriate interventions. CONCLUSIONS AND IMPLICATIONS In the older adult patient undergoing liver resection, the current body of literature suggests promising benefits of prehabilitation programs inclusive of functional assessment as well as multimodal interventions. Additional research is needed to determine best practices.
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Affiliation(s)
- Scarlett Hao
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Heidi L Reis
- Health Sciences Library, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Ashley N Wercholuk
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA; Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
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Aglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022; 26:314-318. [PMID: 35519935 PMCID: PMC9015935 DOI: 10.5005/jp-journals-10071-24144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Impaired physical activity and functional ability is a significant problem in critical illness survivors. Measurement of physical functioning through intensive care unit (ICU) stay determines patients at risk of poor physical outcomes, monitors efficacy of intervention, and informs recovery trajectories. Objectives Study objective was to assess physical function trajectory and identify residual functional limitations in critically ill patients admitted to ICU at the point of discharge from the hospital using robust clinical measures. Materials and methods Following ethical approval, 100 patients (78 males and 22 females) admitted to medical and surgical ICUs were recruited. Scores on Functional Status Score in ICU (FSS-ICU), Physical Function ICU Test (PFIT), and Functional Independence Measure (FIM) were recorded. Day of physiotherapy reference in the ICU was considered as day of ICU admission. Data were collected at three points, namely ICU admission, ICU discharge, and hospital discharge. Results Scores on all outcome measures increased linearly, and an upward functional trajectory was observed in patients from the point of ICU admission till hospital discharge (p >0.001). Conclusion Deficits in functional recovery exist until hospital discharge, substantiating the need to implement home-based rehabilitation to recover optimum physical function and independence in activities of daily living. How to cite this article Aglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022;26(3):314–318.
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Affiliation(s)
- Damini R Aglawe
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
- Bela M Agarwal, Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India, Phone: +91 9819000674, e-mail:
| | - Bela M Agarwal
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Bhoomika D Sawant
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Adel TZVD, van Dijk M, de Heer M, Hoekstra S, Steenhorst J, van Rosmalen J, Verbruggen S, Toussaint-Duyster L, Ista E. Quality improvement intervention to stimulate early mobilization of critically ill children. Nurs Crit Care 2022. [PMID: 35191161 DOI: 10.1111/nicc.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immobility during hospital stay is associated with muscle weakness, delirium, and delayed neurocognitive recovery. Early mobilization of critically ill adults improves their physical functioning and shortens the duration of mechanical ventilation. However, comparable research in children is lacking. AIMS To determine the effects of the implementation of an early mobilization (EM) program on mobility activities for critically ill children and to explore barriers and facilitators and clinical outcomes before and after implementation. STUDY DESIGN A prospective single-centre before-and-after study. METHODS This study was conducted in a PICU of a large tertiary hospital. Children aged from 3 months to 18 years, with an expected stay of ≥3 days were eligible to participate. In the "before" phase, participants received usual care; in the "after" phase we implemented a multicomponent, multidisciplinary EM protocol. The primary outcome was a change in the process outcome "mobilization activities". Secondary outcomes were PICU staff opinions on mobilization (survey), safety, process measures, involvement of parents and physical therapist, and clinical outcomes (sedative use and prevalence of delirium). RESULTS A total of 113 children were included; 55 before and 58 after, with a median age of 31 months (IQR: 10-103) and 35 months (IQR: 7-152), respectively. The number of mobilization activities (per patient per day) had significantly increased from 5 (IQR: 2-7) to 6 (IQR: 4-8) (U = 272185.0; p < .001). PT consultations for mobilization had significantly increased from 23.6% (13/55) to 46.5% (27/58) (X2 = 6.48; p = .011). In both phases, no mobilization-related adverse events were documented. The survey showed that PICU staff found EM of critically ill children useful and feasible. In the after phase, PICU staff rated the perceived benefit of the support of the physical therapist during mobilization activities significantly higher than in the before phase (X2 = 34.80; p < .001). CONCLUSIONS Implementation of a structured EM program for critically ill children is feasible and safe. RELEVANCE TO CLINICAL PRACTICE It is suggested to start the implementation of a structed EM program with the idendentification of local barriers and facilitators by an interdisciplinary PICU team. Further, an increased presence of physiotherapists on the PICU would improve mobilisation levels, and facilitate mobilisation in critically ill children. Also, they can support and advice PICU nurses and parents in mobilising children.
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Affiliation(s)
- Tabitha Zanen-van den Adel
- Department of Orthopedics, Section Physical Therapy, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariska de Heer
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoukje Hoekstra
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith Steenhorst
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sascha Verbruggen
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leontien Toussaint-Duyster
- Department of Orthopedics, Section Physical Therapy, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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30
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Elkbuli A, Fanfan D, Sutherland M, Newsome K, Morse J, Babcock J, McKenney M. The Association Between Early Versus Late Physical Therapy Initiation and Outcomes of Trauma Patients With and Without Traumatic Brain Injuries. J Surg Res 2022; 273:34-43. [PMID: 35026443 DOI: 10.1016/j.jss.2021.11.011] [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: 06/03/2021] [Revised: 10/15/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a lack of literature regarding the most effective timing to initiate physical therapy (PT) among traumatically injured patients. We aim to evaluate the association between early PT/mobilization versus delayed or late PT/mobilization and clinical outcomes of trauma patients. METHODS A retrospective cohort analysis of an urban level-I trauma center from 2014 to 2019 was performed. Univariate analyses and multivariable logistic regression were performed with significance defined as P < 0.05. RESULTS A total of 11,937 patients were analyzed. Among patients without a traumatic brain injury (TBI), late PT initiation times were associated with 60% lower odds of being discharged home without services (P < 0.05), significantly increased hospital and ICU length of stay (H-LOS, ICU-LOS) (P < 0.05), and significantly higher odds of complications (VTE, pneumonia, pressure ulcers, ARDS) (P < 0.001). Among patients with a TBI, late PT initiation time had 76% lower odds of being discharged home without services (P < 0.05) and significantly longer H-LOS and ICU-LOS (P < 0.05) however did not experience significantly higher odds of complications (P > 0.05). CONCLUSIONS Among traumatically injured patients, early PT is associated with decreased odds of complications, shorter H-LOS and ICU-LOS, and a favorable discharge disposition to home without services. Adoption of early PT initiation/mobilization protocols and establishment of prophylactic measures against complications associated with delayed PT is critical to maximize quality of care and trauma patient outcomes. Multi-center prospective studies are needed to ascertain the impact of PT initiation times in greater detail and to minimize trauma patient morbidity.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA.
| | - Dino Fanfan
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Jennifer Morse
- Center for Trauma and Acute Care Surgery Research HCA, Clinical Operations Group, Nashville, TN, USA
| | - Jessica Babcock
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA; University of South Florida, Tampa, Florida, USA
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31
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Ueno K, Kaneko H, Itoh H, Takeda N, Morita H, Fujiu K, Kamiya K, Komuro I. Effectiveness and Approach of Rehabilitation in Patients With Acute Heart Failure: A Review. Korean Circ J 2022; 52:576-592. [PMID: 35929052 PMCID: PMC9353252 DOI: 10.4070/kcj.2022.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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32
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Bhattacharyay S, Rattray J, Wang M, Dziedzic PH, Calvillo E, Kim HB, Joshi E, Kudela P, Etienne-Cummings R, Stevens RD. Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury. Sci Rep 2021; 11:23654. [PMID: 34880296 PMCID: PMC8654973 DOI: 10.1038/s41598-021-02974-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Our goal is to explore quantitative motor features in critically ill patients with severe brain injury (SBI). We hypothesized that computational decoding of these features would yield information on underlying neurological states and outcomes. Using wearable microsensors placed on all extremities, we recorded a median 24.1 (IQR: 22.8-25.1) hours of high-frequency accelerometry data per patient from a prospective cohort (n = 69) admitted to the ICU with SBI. Models were trained using time-, frequency-, and wavelet-domain features and levels of responsiveness and outcome as labels. The two primary tasks were detection of levels of responsiveness, assessed by motor sub-score of the Glasgow Coma Scale (GCSm), and prediction of functional outcome at discharge, measured with the Glasgow Outcome Scale-Extended (GOSE). Detection models achieved significant (AUC: 0.70 [95% CI: 0.53-0.85]) and consistent (observation windows: 12 min-9 h) discrimination of SBI patients capable of purposeful movement (GCSm > 4). Prediction models accurately discriminated patients of upper moderate disability or better (GOSE > 5) with 2-6 h of observation (AUC: 0.82 [95% CI: 0.75-0.90]). Results suggest that time series analysis of motor activity yields clinically relevant insights on underlying functional states and short-term outcomes in patients with SBI.
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Affiliation(s)
- Shubhayu Bhattacharyay
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA.
| | - John Rattray
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter H Dziedzic
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Eusebia Calvillo
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Han B Kim
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan Joshi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Pawel Kudela
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Etienne-Cummings
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Robert D Stevens
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
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33
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Leser JM, Harriot A, Buck HV, Ward CW, Stains JP. Aging, Osteo-Sarcopenia, and Musculoskeletal Mechano-Transduction. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:782848. [PMID: 36004321 PMCID: PMC9396756 DOI: 10.3389/fresc.2021.782848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
The decline in the mass and function of bone and muscle is an inevitable consequence of healthy aging with early onset and accelerated decline in those with chronic disease. Termed osteo-sarcopenia, this condition predisposes the decreased activity, falls, low-energy fractures, and increased risk of co-morbid disease that leads to musculoskeletal frailty. The biology of osteo-sarcopenia is most understood in the context of systemic neuro-endocrine and immune/inflammatory alterations that drive inflammation, oxidative stress, reduced autophagy, and cellular senescence in the bone and muscle. Here we integrate these concepts to our growing understanding of how bone and muscle senses, responds and adapts to mechanical load. We propose that age-related alterations in cytoskeletal mechanics alter load-sensing and mechano-transduction in bone osteocytes and muscle fibers which underscores osteo-sarcopenia. Lastly, we examine the evidence for exercise as an effective countermeasure to osteo-sarcopenia.
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Affiliation(s)
| | | | | | | | - Joseph P. Stains
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States
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34
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Martin D, Besson C, Pache B, Michel A, Geinoz S, Gremeaux-Bader V, Larcinese A, Benaim C, Kayser B, Demartines N, Hübner M. Feasibility of a prehabilitation program before major abdominal surgery: a pilot prospective study. J Int Med Res 2021; 49:3000605211060196. [PMID: 34851778 PMCID: PMC8649915 DOI: 10.1177/03000605211060196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the feasibility of a prehabilitation program and its effects on physical performance and outcomes after major abdominal surgery. METHODS In this prospective pilot study, patients underwent prehabilitation involving three training sessions per week for 3 weeks preoperatively. The feasibility of delivering the intervention was assessed based on recruitment and adherence to the program. Its impacts on fitness (oxygen uptake (VO2)) and physical performance (Timed Up and Go Test, 6-Minute Walk Test) were evaluated. RESULTS From May 2017 to January 2020, 980 patients were identified and 44 (4.5%) were invited to participate. The main obstacles to patient recruitment were insufficient time (<3 weeks) prior to scheduled surgery (n = 276, 28%) and screening failure (n = 312, 32%). Of the 44 patients, 24 (55%) declined to participate, and 20 (23%) were included. Of these, six (30%) were not adherent to the program. Among the remaining 14 patients, VO2 at ventilatory threshold significantly increased from 9.7 to 10.9 mL/min/kg. No significant difference in physical performance was observed before and after prehabilitation. CONCLUSION Although prehabilitation seemed to have positive effects on exercise capacity, logistic and patient-related difficulties were encountered. The program is not feasible in its current form for all-comers.
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Affiliation(s)
- David Martin
- Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Cyril Besson
- Department of Sports Medicine, Swiss Olympic Medical Center, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Basile Pache
- Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anna Michel
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sandrine Geinoz
- Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vincent Gremeaux-Bader
- Department of Sports Medicine, Swiss Olympic Medical Center, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anna Larcinese
- Department of Physiotherapy, University Hospital CHUV, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
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35
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Alonso AC, Silva-Santos PR, Quintana MSL, da Silva VC, Brech GC, Barbosa LG, Pompeu JE, Silva ECGE, da Silva EM, de Godoy CG, Greve JMD. Physical and pulmonary capacities of individuals with severe coronavirus disease after hospital discharge: A preliminary cross-sectional study based on cluster analysis. Clinics (Sao Paulo) 2021; 76:e3540. [PMID: 34852146 PMCID: PMC8595570 DOI: 10.6061/clinics/2021/e3540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=-0.28, p=0.04), Short Physical Performance Battery score (r=-0.28, p=0.03), and forced vital capacity (r=-0.29, p=0.03). CONCLUSION Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities.
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Affiliation(s)
- Angelica Castilho Alonso
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Graduacao em Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Paulo Roberto Silva-Santos
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marília Simões Lopes Quintana
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vanderlei Carneiro da Silva
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Guilherme Carlos Brech
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Graduacao em Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Lorena Gonçalves Barbosa
- Programa de Graduacao em Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - José Eduardo Pompeu
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Erika Christina Gouveia e Silva
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Elizabeth Mendes da Silva
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Caroline Gil de Godoy
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Julia Maria D’Andréa Greve
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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36
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Anesthesia preoperative clinics: redefining the value proposition. Int Anesthesiol Clin 2021; 59:59-72. [PMID: 34433183 DOI: 10.1097/aia.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Reis NFD, Biscaro RRM, Figueiredo FCXS, Lunardelli ECB, Silva RMD. Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:353-361. [PMID: 35107546 PMCID: PMC8555403 DOI: 10.5935/0103-507x.20210051] [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: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Traduzir, adaptar transculturalmente para o português do Brasil o
instrumento Early Rehabilitation Index e validar para uso
na unidade de terapia intensiva o instrumento Early Rehabilitation
Barthel Index, para avaliação do estado
funcional. Métodos Foram executadas as seguintes etapas: preparação,
tradução, reconciliação, tradução
reversa, revisão, harmonização, pré-teste e
avaliação psicométrica. Após esse processo
inicial, a versão em português foi aplicada por dois
avaliadores em pacientes que permaneciam pelo menos 48 horas internados na
unidade de terapia intensiva. Verificou-se a confiabilidade da escala por
meio da consistência interna, da confiabilidade entre avaliadores e
do efeito piso e teto. Para a validade de constructo, correlacionou-se o
Early Rehabilitation Barthel Index com instrumentos que
usualmente são utilizados para avaliação do estado
funcional na unidade de terapia intensiva. Resultados Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O
Early Rehabilitation Barthel Index teve confiabilidade
adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre
avaliadores foi excelente, com coeficiente de correlação
intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com
índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso
e teto foram mínimos. Observou-se a validade do Early
Rehabilitation Barthel Index por meio das
correlações com o escore total do Perme Escore (rô =
0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do
Physical Function in Intensive Care Test-score
(rô = 0,69), do Medical Research Council sum score
(rô = 0,58), além das dinamometrias de preensão palmar
(rô = 0,58) e manual de coxa (rô = 0,55), todos com p <
0,001. Conclusão A versão adaptada do Early Rehabilitation Index para
o português brasileiro e na sua totalidade, Early
Rehabilitation Barthel Index é confiável e
válida para avaliação do estado funcional dos pacientes
na alta da unidade de terapia intensiva.
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Affiliation(s)
- Nair Fritzen Dos Reis
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Fernanda Cabral Xavier Sarmento Figueiredo
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Elizabeth Cristiane Buss Lunardelli
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Rosemeri Maurici da Silva
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
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Cooper D, Gasperini M, Parkosewich JA. Nurses' Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation. Am J Crit Care 2021; 30:266-274. [PMID: 34195779 DOI: 10.4037/ajcc2021801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delays in early patient mobility are common in critical care areas. Oral intubation with mechanical ventilation is negatively associated with out-of-bed activities. OBJECTIVES To explore nurses' mobility practices for patients with oral intubation and mechanical ventilation and identify barriers related to patient, nurse, and environment-of-care factors specific to this population. METHODS In this cross-sectional, descriptive study in a medical intensive care unit, mobility was defined as standing, sitting in a chair, or walking. A total of 105 patients who met predefined mobility criteria and their 48 nurses were enrolled. Nurses were interviewed about mobility practices at the ends of shifts. Descriptive statistics summarized nurse and patient characteristics and mobility barriers. RESULTS Patients were deemed ready to begin mobility within a mean (SD) of 41.5 (34.8) hours after oral endotracheal intubation. Two-thirds of nurses reported that they never or rarely got these patients out of bed. Only 12.4% of patients had a clinician's activity order. Common patient-related barriers were uncooperative behavior (21.9%) and active medical issues (15%), even in patients who met mobility criteria. Nurse-related barriers were concerns for patient safety, specifically falls (14.3% of patients) and harm (9.5%). The environment of care posed very few barriers; nurses rarely mentioned that lack of help (13.3% of patients) or lack of clinician's activity order (5.7%) impeded mobility. CONCLUSIONS Mobility practices were nonexistent in these patients despite patients' being deemed ready to begin out-of-bed activities. Nurses must be attentive to their unit's mobility culture to overcome these barriers.
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Affiliation(s)
- Dawn Cooper
- Dawn Cooper is a clinical nurse specialist in the medical intensive care unit, York Street Campus, New Haven, Connecticut
| | - Monica Gasperini
- Monica Gasperini is a clinical nurse III in the medical intensive care unit and a clinical instructor at the Center for Professional Practice, New Haven, Connecticut
| | - Janet A. Parkosewich
- Janet A. Parkosewich is the nurse researcher for the Division of Nursing, Yale New Haven Hospital, New Haven, Connecticut
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Vincze A, Gaál J, Griger Z. Bone Health in Idiopathic Inflammatory Myopathies: Diagnosis and Management. Curr Rheumatol Rep 2021; 23:55. [PMID: 34196873 PMCID: PMC8249248 DOI: 10.1007/s11926-021-01016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW This article provides an update on the most recent advances in epidemiology, pathogenesis, diagnostic procedures, and therapeutic approaches for myositis-associated bone diseases, such as osteoporosis and bone fractures. RECENT FINDINGS In the recent years, several studies showed that osteoporosis and consequent fractures are a common and frequently underestimated complication in patients with idiopathic inflammatory myopathies (IIM). In younger patients, asymptomatic fractures might present in the early phase of the disease which could increase the risk of development of further fractures. High-risk patients could be selected with early application of combined diagnostic procedures, such as fracture risk scores with steroid dose adjustments and imaging. Recent advances might help clinicians from different fields of medicine in the early recognition and management of myositis-associated osteoporosis, which will potentially improve the quality of life of patients with IIM.
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Affiliation(s)
- Anett Vincze
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - János Gaál
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
- Department of Medicine, Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
| | - Zoltán Griger
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary.
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary.
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Waldauf P, Hrušková N, Blahutova B, Gojda J, Urban T, Krajčová A, Fric M, Jiroutková K, Řasová K, Duška F. Functional electrical stimulation-assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up. Thorax 2021; 76:664-671. [PMID: 33931570 PMCID: PMC8223653 DOI: 10.1136/thoraxjnl-2020-215755] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Functional electrical stimulation-assisted cycle ergometry (FESCE) enables in-bed leg exercise independently of patients' volition. We hypothesised that early use of FESCE-based progressive mobility programme improves physical function in survivors of critical care after 6 months. METHODS We enrolled mechanically ventilated adults estimated to need >7 days of intensive care unit (ICU) stay into an assessor-blinded single centre randomised controlled trial to receive either FESCE-based protocolised or standard rehabilitation that continued up to day 28 or ICU discharge. RESULTS We randomised in 1:1 ratio 150 patients (age 61±15 years, Acute Physiology and Chronic Health Evaluation II 21±7) at a median of 21 (IQR 19-43) hours after admission to ICU. Mean rehabilitation duration of rehabilitation delivered to intervention versus control group was 82 (IQR 66-97) versus 53 (IQR 50-57) min per treatment day, p<0.001. At 6 months 42 (56%) and 46 (61%) patients in interventional and control groups, respectively, were alive and available to follow-up (81.5% of prespecified sample size). Their Physical Component Summary of SF-36 (primary outcome) was not different at 6 months (50 (IQR 21-69) vs 49 (IQR 26-77); p=0.26). At ICU discharge, there were no differences in the ICU length of stay, functional performance, rectus femoris cross-sectional diameter or muscle power despite the daily nitrogen balance was being 0.6 (95% CI 0.2 to 1.0; p=0.004) gN/m2 less negative in the intervention group. CONCLUSION Early delivery of FESCE-based protocolised rehabilitation to ICU patients does not improve physical functioning at 6 months in survivors. TRIAL REGISTRATION NUMBER NCT02864745.
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Affiliation(s)
- Petr Waldauf
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Natália Hrušková
- Department of Rehabilitation, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Barbora Blahutova
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Jan Gojda
- Department of Internal Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Tomáš Urban
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Adéla Krajčová
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Michal Fric
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Kateřina Jiroutková
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - Kamila Řasová
- Department of Rehabilitation, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesiology and Intensive Care Medicine, 3rd Faculty of Medicine and FNKV University Hospital, Charles University, Prague, Czech Republic
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Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. What matters to you? An investigation of patients' perspectives on and acceptability of prehabilitation in major cancer surgery. Eur J Cancer Care (Engl) 2021; 30:e13475. [PMID: 34106493 DOI: 10.1111/ecc.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy). METHODS Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations. RESULTS Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support. CONCLUSION Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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Marchand AA, Houle M, O'Shaughnessy J, Châtillon CÉ, Cantin V, Descarreaux M. Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Sci Rep 2021; 11:11080. [PMID: 34040109 PMCID: PMC8155114 DOI: 10.1038/s41598-021-90537-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/12/2021] [Indexed: 02/08/2023] Open
Abstract
Lumbar spinal stenosis is the most common reason for spine surgery in older adults, but the effects of prehabilitation on perioperative outcomes among these patients have not been investigated. This study aims to evaluate the effectiveness of a preoperative exercise-based intervention program compared with usual care on the improvement of clinical status, physical capacities and postoperative recovery of patients awaiting surgery for lumbar spinal stenosis. Sixty-eight participants were randomised to receive either a 6-week supervised exercise-based prehabilitation program or hospital usual care. The outcomes included both clinical and physical measures. Data collection occurred at post-intervention, and 6 weeks, 3- and 6-months post-surgery. Significant but small improvements were found in favour of the experimental group at the post-intervention assessment for pain intensity, lumbar spinal stenosis-related disability, lumbar strength in flexion, low back extensor muscles endurance, total ambulation time, and sit to stand performance. A significant difference in favor of the intervention group was found starting at the 3-month postoperative follow-up for low back-related disability. No adverse events were reported. Exercise-based prehabilitation did not improve short-term postoperative recovery in patients with lumbar spinal stenosis.
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Affiliation(s)
- Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Mariève Houle
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Julie O'Shaughnessy
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G9A 5H7, Canada
| | - Claude-Édouard Châtillon
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada.,Division of Neurosurgery, Faculty of Medicine, University of Montreal, Montréal, Canada
| | - Vincent Cantin
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Roche M, Ravot C, Malapert A, Paget-Bailly S, Garandeau C, Pitiot V, Tomatis M, Riche B, Galamand B, Granger M, Barbavara C, Bourgeois C, Genest E, Stefani L, Haïne M, Castel-Kremer E, Morel-Soldner I, Collange V, Le Saux O, Dayde D, Falandry C. Feasibility of a prehabilitation programme dedicated to older patients with cancer before complex medical-surgical procedures: the PROADAPT pilot study protocol. BMJ Open 2021; 11:e042960. [PMID: 33811052 PMCID: PMC8023742 DOI: 10.1136/bmjopen-2020-042960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ageing is associated with an increased prevalence of comorbidities and sarcopenia as well as a decline of functional reserve of multiple organ systems, which may lead, in the context of the disease-related and/or treatment-related stress, to functional deconditioning. The multicomponent 'Prehabilitation & Rehabilitation in Oncogeriatrics: Adaptation to Deconditioning risk and Accompaniment of Patients' Trajectories (PROADAPT)' intervention was developed multiprofessionally to implement prehabilitation in older patients with cancer. METHODS The PROADAPT pilot study is an interventional, non-comparative, prospective, multicentre study. It will include 122 patients oriented to complex medical-surgical curative procedures (major surgery or radiation therapy with or without chemotherapy). After informed consent, patients will undergo a comprehensive geriatric assessment and will be offered a prehabilitation kit that includes an advice booklet with personalised objectives and respiratory rehabilitation devices. Patients will then be called weekly and monitored for physical and respiratory rehabilitation, preoperative renutrition, motivational counselling and iatrogenic prevention. Six outpatient visits will be planned: at inclusion, a few days before the procedure and at 1, 3, 6 and 12 months after the end of the procedure. The main outcome of the study is the feasibility of the intervention, defined as the ability to perform at least one of the components of the programme. Clinical data collected will include patient-specific and cancer-specific characteristics. ETHICS AND DISSEMINATION The study protocol was approved by the Ile de France 8 ethics committee on 5 June 2018. The results of the primary and secondary objectives will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03659123. Pre-results of the trial.
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Affiliation(s)
- Mélanie Roche
- Plateforme Transversale de Recherche de l'IC-HCL, Hospices Civils de Lyon, Lyon, France
| | - Christine Ravot
- Geriatrics Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Amélie Malapert
- Plateforme Transversale de Recherche de l'IC-HCL, Hospices Civils de Lyon, Lyon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life Unit in Oncology, University Hospital Centre Besancon, Besancon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Université Bourgogne Franche-Comté, Besancon, France
| | - Charlène Garandeau
- Direction à la Recherche Clinique et à l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Virginie Pitiot
- Plateforme Transversale de Recherche de l'IC-HCL, Hospices Civils de Lyon, Lyon, France
| | - Mélanie Tomatis
- Geriatrics Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Riche
- Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive CNRS UMR 5558, Équipe Biostatistiques Santé, Université de Lyon, Lyon, France
| | - Béatrice Galamand
- Geriatrics Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Marion Granger
- Geriatrics Unit, Hospices Civils de Lyon, Lyon, France
- Centre Hospitalier de Chambery, Chambery, France
| | | | - Chrystelle Bourgeois
- Department of Medical Oncology, Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Laetitia Stefani
- Department of Medical Oncology, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Max Haïne
- Pôle de gérontologie et Médecine de Réadaptation, Hôpital Nord-Ouest, Villefranche-sur-Saone, France
| | | | - Isabelle Morel-Soldner
- Geriatrics Unit, Centre Hospitalier de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Vincent Collange
- Département anesthésie réanimation, Medipole Lyon-Villeurbanne, Villeurbanne, France
| | - Olivia Le Saux
- Therapeutic targeting of the tumor cell and its immune microenvironment, Centre de Recherche en Cancerologie de Lyon, Lyon, France
| | - David Dayde
- Plateforme Transversale de Recherche de l'IC-HCL, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Geriatrics Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, Oullins, France
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Bensoussan C, Champclou A, Galarraga O, Letellier G, Rahmani A, Riochet D, De-Sèze M. Assessing the contribution of lower limb mobilization, in the supine position, on shoulder-pelvis girdles dissociation. Gait Posture 2021; 85:224-231. [PMID: 33618166 DOI: 10.1016/j.gaitpost.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several articular, muscular and neurological diseases generate mobility loss in the shoulder and pelvis girdles. Joint mobilization contributes to improving shoulder-pelvis girdles dissociation, but current mobilization techniques are not always successful and standardized. A robotic medical device, DPA Med®, by inducing trunk mobilization through lower limb oscillation has been developed for producing such a shoulder-pelvis girdles dissociation and is already used worldwide in rehabilitation hospitals. RESEARCH QUESTION To determine the optimal lower limb oscillation frequency that generated the best shoulder-pelvis girdles dissociation using the DPA Med® device. METHODS Thirty healthy adult volunteers (mean age: 38.6 [SD 15.2] years, mean height: 174 [SD 11.9] cm, mean body mass: 70.3 [SD 14.7] kg) participated in this prospective study. A kinematic analysis quantified pelvic and shoulder girdle mobility (rotation and lateral tilt) at different DPA Med® frequencies, from 0.5 Hz to 1 Hz. A visual analysis of the lower limb movement was also performed, using video sensors, to better understand the kinematics involved. RESULTS All DPA Med® frequencies have shown significant shoulder-pelvis girdles dissociation (p < 0.05). This study established an optimal oscillation frequency with the minimal interindividual variability at 0.808 Hz. It induced pelvic mobility similar to that of normal gait, in the transverse and frontal planes (10.3°, SD 2.9°, and 12.0°, SD 2.2°, respectively). This trunk mobility was achieved by producing a lemniscate-shaped motion in the lower limbs (an eight-shaped motion in the transverse plane). SIGNIFICANCE This study has shown that the DPA Med® device is able to induce shoulder-pelvis girdles dissociation similar to that of normal gait and allowed to establish the existence of an optimal DPA Med® oscillation frequency for lower limb mobility at 0.808 Hz. Further studies are required to evaluate its potentially benefits on gait disorders.
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Affiliation(s)
| | | | - Omar Galarraga
- Movement Analysis Laboratory, Rehabilitation Center of Coubert, France
| | - Guy Letellier
- Pediatric Rehabilitation Center (ESEAN-APF), Nantes, France
| | | | - David Riochet
- Pediatric Rehabilitation Center (ESEAN-APF), Nantes, France; Movement Analysis Laboratory, Le Mans University, France; Nantes University Hospital, France
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Salik E, Donat A, Ağaoğlu MH. Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report. J Chiropr Med 2021; 19:249-259. [PMID: 33536862 DOI: 10.1016/j.jcm.2020.01.002] [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: 11/06/2018] [Revised: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature. Clinical Features A 44-year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain. Intervention and Outcome After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient's symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care. Conclusion As far as the authors are aware, there is currently no published case of ASD care in chiropractic literature. Our rehabilitative management received a favorable response. It can be hypothesized that it offers a perspective that informs improved patient care.
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Affiliation(s)
- Emsal Salik
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Ali Donat
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Mustafa Hulisi Ağaoğlu
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
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Yong SY, Siop S, Kho WM. A cross-sectional study of early mobility practice in intensive care units in Sarawak Hospitals, Malaysia. Nurs Open 2021; 8:200-209. [PMID: 33318828 PMCID: PMC7729545 DOI: 10.1002/nop2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/02/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
Aims To determine the prevalence, characteristics of EM activities, the relationship between level of activity and mode of ventilation and adherence rate of EM protocol. Background Mobilizing ICU patients remains a challenge, despite its safety, feasibility and positive short-term outcomes. Design A cross-sectional point prevalence study. Methods All patients who were eligible and admitted to the adult ICUs during March 2018 were recruited. Data were analysed by using the Statistical Package for Social Sciences version 24 for Windows. Results The prevalence of EM practice was 65.6%. The most frequently reported avoidable and unavoidable factors inhibit mobility were deep sedation and vasopressor infusion, respectively. Level II of activity was the most common level of activity performed in ICU patients. The invasive ventilated patient had 12.53 the odds to stay in bed as compared to non-invasive ventilated patient. An average adherence rate of EM protocol was 52.5%.
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Affiliation(s)
- Siew Yieng Yong
- Advanced Diploma in Intensive Care NursingMinistry of Health Malaysia Training InstitutionKuchingMalaysia
| | - Sidiah Siop
- Nursing DepartmentFaculty of Medicine and Health SciencesUniversiti Malaysia Sarawak (UNIMAS)KuchingMalaysia
| | - Wee Meng Kho
- Internal Medicine and DermatologyTimberland Medical CentreKuchingMalaysia
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Abstract
PURPOSE The purpose of this report is to demonstrate the successful application of virtual reality to improve physical therapy in the pediatric cardiovascular intensive care unit. Early mobilization and cognitive stimulation improve morbidity of critically ill children. However, maintaining child engagement with these therapies can be challenging, especially during extended intensive care stays. SUMMARY OF KEY POINTS While virtual reality has been successfully used as an analgesic and anxiolytic in the cardiovascular intensive care unit, this report demonstrates its novel use as a tool to augment physical therapy for a child who had been debilitated after heart transplantation. Virtual reality encouraged the child to engage in physical therapy sessions, participate for greater durations, and directly address barriers to discharge. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE While further studies are needed to define best practice, this report demonstrates that virtual reality can be safely used for carefully selected and monitored children in critical care.
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Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:7840743. [PMID: 33294221 PMCID: PMC7714600 DOI: 10.1155/2020/7840743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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Lyashenko EA, Ivanova LG, Chimagomedova AS. [Postoperative cognitive disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:39-45. [PMID: 33205929 DOI: 10.17116/jnevro202012010239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive impairment or delirium occurs in about 40% of elderly patients after surgery. The increasing number of elderly people has led to a significant increase in the number of cases of postoperative cognitive dysfunction (POCD). This is one of the most important medical and social problems, the analysis of which is especially difficult, since it requires the coordination of a large number of specialties: anesthesiology, surgery, neurology, psychiatry, neuropsychology, as well as fundamental neurosciences. Thus, a systematic multidisciplinary approach that takes into account all possible factors affecting the condition of patients should be considered. The article is devoted to the main aspects of the pathogenesis, prevention and treatment of POCD.
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Affiliation(s)
- E A Lyashenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - L G Ivanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Sh Chimagomedova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Cao J, Li S, Ma Y, Li Z, Liu G, Liu Y, Jiao J, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X, Wu X. Risk factors associated with deep venous thrombosis in patients with different bed-rest durations: A multi-institutional case-control study. Int J Nurs Stud 2020; 114:103825. [PMID: 33352438 DOI: 10.1016/j.ijnurstu.2020.103825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/16/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Deep vein thrombosis represents a threat to public health and a heavy economic burden to society, and often occurs as a complication or cause of death in bedridden patients. How to prevent deep vein thrombosis is a general concern in clinical practice. However, it remains uncertain whether the risk factors for deep vein thrombosis would be affected by different bed-rest durations. Solving this issue will be invaluable for the provision of more rational medical care to prevent deep vein thrombosis. OBJECTIVE To explore whether risk factors for deep vein thrombosis are affected by bed-rest durations and to identify different risk factors in groups with different bed-rest durations. DESIGN A retrospective multicenter case-control study. SETTINGS AND PARTICIPANTS This multicenter study was conducted in wards with high rates of bed rest in 25 general hospitals in China. Participants were bedridden patients from these wards. METHODS Bedridden patients were identified from the research database of bedridden patients' major immobility complications. These data were collected from prospective descriptive studies by a standardized web-based online case report form. Cases were defined as bedridden patients who suffered deep vein thrombosis during hospitalization (n=186). Each case was matched with three controls, bedridden patients who did not suffer deep vein thrombosis in the same center with the same bed-rest duration (n=558). Descriptive statistics, univariate analysis, and multivariate conditional logistic regression models were employed. RESULTS Among 23,985 patients, the overall incidence of deep vein thrombosis during hospitalization was 1.0%. Multivariate analysis showed that for patients with bed-rest duration of 4 weeks or less, older age (odds ratio [OR] =1.027, 95% confidence interval [CI] 1.013-1.041) and being in a surgical department (OR=2.527, 95% CI 1.541-4.144) were significantly associated with increased risk of deep vein thrombosis. Female sex (OR=4.270, 95% CI 1.227-14.862), smoking (OR=10.860, 95% CI 2.130-55.370), and special treatment (OR=3.455, 95% CI 1.006-11.869) were independent factors predicting deep vein thrombosis for patients with bed-rest durations from 5 to 8 weeks. For those with bed-rest durations from 9 to 13 weeks, Charlson Comorbidity Index (OR=1.612, 95% CI 1.090-2.385) was the only independent risk factor for deep vein thrombosis. CONCLUSIONS Risk factors for deep vein thrombosis varied among patients with different bed-rest durations. This finding is helpful for nurses to increase their awareness of prevention of deep vein thrombosis in patients with different bed-rest durations, and lays a more solid foundation for clinical decision making.
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Affiliation(s)
- Jing Cao
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shuya Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Yufen Ma
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhen Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Ge Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Ying Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jing Jiao
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Chen Zhu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
| | - Xinjuan Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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