1
|
Silder A, Zifchock R, Brown L, Sessoms P, Jones D. The Association Between Grip Strength, Upper Body Power, and Limb Dominance in a Military Population. Mil Med 2024; 189:e1846-e1850. [PMID: 38739492 DOI: 10.1093/milmed/usae227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Military service members rely on upper body strength and power to accomplish tasks such as carrying heavy weapons and gear, rappelling, combat grappling, and marksmanship. Early identification of the factors that lead to reduced upper body strength and power would enable leadership to predict and mitigate aspects that decrease military operational readiness and increase injury risk. The purpose of this study was to investigate the relationship between grip strength and upper body power in U.S. Infantry Marines. We hypothesized that dominant arm grip strength would show a strong positive correlation with upper body power and that the dominant arm would be more powerful than the non-dominant arm. MATERIALS AND METHODS A total of 120 U.S. Marines completed 3 maximum effort isometric grip strength trials with their dominant hand and 3 maximum effort ballistic pushups on a ForceDecks force plate system. Force plate data were used to estimate pushup height and peak power. Maximum grip strength, pushup height, and peak power across the 3 trials were used for analysis. Pearson's correlation was used to test for associations between peak power, pushup height, and grip strength. Paired t-tests were used to test for differences in peak power between the dominant and non-dominant arms. RESULTS A very weak correlation was found between grip strength and upper body power, but there was no relationship between grip strength and pushup height. Additionally, there were no significant differences in upper body power between the dominant and non-dominant arms. CONCLUSIONS The results of this study suggest that grip strength is not predictive of upper body power and cannot be used as a stand-alone measure of physical readiness in a military unit. These findings do not, however, degrade the potential of both measures to predict and inform health status and physical readiness. Future prospective research should be conducted to determine if either of these measures can be used as indicators of performance and/or injury susceptibility and if limb dominance plays a role in injury incidence within the upper extremity.
Collapse
Affiliation(s)
- Amy Silder
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Rebecca Zifchock
- Mechanical Engineering, United States Military Academy, West Point, NY 10996, USA
| | - Luke Brown
- Mechanical Engineering, United States Military Academy, West Point, NY 10996, USA
| | - Pinata Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Douglas Jones
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| |
Collapse
|
2
|
Montero-Cámara J, Ferrer-Sargues FJ, Rovira MJS, Cabello AS, Peredo DC, Calabuig JAM, Valtueña-Gimeno N, Sánchez-Sánchez ML. Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial. PLoS One 2024; 19:e0303163. [PMID: 38713654 DOI: 10.1371/journal.pone.0303163] [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: 07/18/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are a group of illnesses that include coronary heart disease, cerebrovascular disease, congenital heart disease and deep vein thrombosis. Major surgery is often chosen as the treatment of choice for CVD. The concept of fast-track rehabilitation after surgery appeared in the 1970s. Participation in these exercise-based prehabilitation programmes may decrease postoperative complications and length of hospital stay. The primary aim of the present study is to evaluate whether the implementation of an additional resistance training (RT) prehabilitation protocol within cardiac exercises based prehabilitation can reduce intensive care unit (ICU) length of stay, postoperative complications and hospital length of stay (LOS). METHODS A protocol of a prospective, parallel, randomised clinical trial includes 96 adult patients diagnosed with valvular pathology and who have been scheduled for surgery. The participants will be randomly assigned to two groups of 48. Control group will be treated with ventilatory and strengthening of respiratory muscles, and aerobic exercise. Experimental group, in addition, will be treated with RT of peripheral muscles. Both hospital stay and ICU stay will be assessed as main variables. Other secondary variables such as exercise capacity, quality of life and respiratory values will also be assessed. Quantitative variables will be analysed with a T-Test or ANOVA, or Mann Witney if the distribution is non-parametric. RESULTS AND CONCLUSION This will be the first controlled clinical study focused on adding strength exercise as an additional treatment during prehabilitation. The results of this study will focus on helping to improve rehabilitation and prehabilitation protocols, considering that it is essential to maintain pulmonary training, as well as the inclusion of peripheral exercises that help people with heart disease to be in a better physical condition in order to increase their participation and sense of quality of life.
Collapse
Affiliation(s)
- Jorge Montero-Cámara
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Francisco José Ferrer-Sargues
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María José Segrera Rovira
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
- Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | | | | | | | - Noemí Valtueña-Gimeno
- Deparment of Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María Luz Sánchez-Sánchez
- Department of Physiotherapy, Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| |
Collapse
|
3
|
Chen Y, Li T, Wang Z, Yan Z, De Vita R, Tan T. A Metamaterial Computational Multi-Sensor of Grip-Strength Properties with Point-of-Care Human-Computer Interaction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2304091. [PMID: 37818760 PMCID: PMC10700692 DOI: 10.1002/advs.202304091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/11/2023] [Indexed: 10/13/2023]
Abstract
Grip strength is a biomarker of frailty and an evaluation indicator of brain health, cardiovascular morbidity, and psychological health. Yet, the development of a reliable, interactive, and point-of-care device for comprehensive multi-sensing of hand grip status is challenging. Here, a relation between soft buckling metamaterial deformations and built piezoelectric voltage signals is uncovered to achieve multiple sensing of maximal grip force, grip speed, grip impulse, and endurance indicators. A metamaterial computational sensor design is established by hyperelastic model that governs the mechanical characterization, machine learning models for computational sensing, and graphical user interface to provide visual cues. A exemplify grip measurement for left and right hands of seven elderly campus workers is conducted. By taking indicators of grip status as input parameters, human-computer interactive games are incorporated into the computational sensor to improve the user compliance with measurement protocols. Two elderly female schizophrenic patients are participated in the real-time interactive point-of-care grip assessment and training for potentially sarcopenia screening. The attractive features of this advanced intelligent metamaterial computational sensing system are crucial to establish a point-of-care biomechanical platform and advancing the human-computer interactive healthcare, ultimately contributing to a global health ecosystem.
Collapse
Affiliation(s)
- Yinghua Chen
- State Key Laboratory of Mechanical System and VibrationSchool of Mechanical EngineeringShanghai Jiao Tong UniversityShanghai200240P. R. China
| | - Tianrun Li
- State Key Laboratory of Mechanical System and VibrationSchool of Mechanical EngineeringShanghai Jiao Tong UniversityShanghai200240P. R. China
| | - Zhemin Wang
- State Key Laboratory of Mechanical System and VibrationSchool of Mechanical EngineeringShanghai Jiao Tong UniversityShanghai200240P. R. China
| | - Zhimiao Yan
- State Key Laboratory of Ocean EngineeringDepartment of MechanicsSchool of Naval ArchitectureOcean & Civil EngineeringShanghai Jiao Tong UniversityShanghai200240P. R. China
| | - Raffaella De Vita
- Department of Biomedical Engineering and MechanicsVirginia TechBlacksburgVA24061USA
| | - Ting Tan
- State Key Laboratory of Mechanical System and VibrationSchool of Mechanical EngineeringShanghai Jiao Tong UniversityShanghai200240P. R. China
| |
Collapse
|
4
|
Silva TK, Perry IDS, Brauner JS, Mancuso ACB, Souza GC, Vieira SRR. Variations in phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study. Nutr Clin Pract 2023; 38:1093-1103. [PMID: 37302020 DOI: 10.1002/ncp.11026] [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: 09/24/2022] [Revised: 04/12/2023] [Accepted: 05/14/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Bioimpedance phase angle (PA) is a measure of cell membrane integrity, whereas handgrip strength (HGS) is an evaluation of functional capacity. Although both are related to the prognosis of patients undergoing cardiac surgery, their changes over time are less known. This study followed variations in PA and HGS for 1 year in these patients, determining associations with clinical outcomes. METHODS This prospective cohort study included 272 cardiac surgery patients. PA and HGS were measured at six predetermined times. The evaluated outcomes were surgery type; bleeding; time of surgery, cardiopulmonary bypass, aortic cross-clamp, and mechanical ventilation; postoperative (PO) length of stay (LOS) in the intensive care unit (ICU) and hospital; and infections, hospital readmission, reoperation, and mortality. RESULTS There were reductions in PA and HGS values after surgery, with total recovery beginning at 6 months for PA and 3 months for HGS. In the PA area under the curve (AUC), age, combined surgery, and sex (β = -9.66, P < 0.001; β = -252.85, P = 0.005; β = -216.56, P < 0.001, respectively) were predictors for PA-AUC reduction. Stratified by sex, age (β = -93.54, P < 0.001) and PO LOS (β = -46.91, P = 0.003) were predictors for HGS-AUC reduction in women, but only age was a predictor in men (β = -77.02, P = 0.010). PA and HGS had an effect in hospital LOS and ICU LOS. CONCLUSION Age, combined surgery, and female sex were predictors of reduced PA-AUC, whereas reduced HGS-AUC was predicted by age in both sexes and PO hospital LOS in women, which suggests that these factors could interfere in prognosis.
Collapse
Affiliation(s)
- Taís K Silva
- Post-Graduation Program on Cardiovascular Sciences, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ingrid D S Perry
- Food and Nutrition Research Center, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Janete S Brauner
- Intensive Medicine Service, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Aline C B Mancuso
- Biostatistics Unit, Graduate Research Group, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Gabriela C Souza
- Postgraduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sílvia R R Vieira
- Internal Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
5
|
Hartog J, Dijkstra S, Dieperink W, Hoekstra T, Fleer J, van der Woude LHV, van der Harst P, Nijsten M, Mariani MA, Blokzijl F. Muscle strength trajectories and their association with postoperative health-related quality of life in patients undergoing coronary artery bypass grafting surgery: a prospective cohort study. BMC Cardiovasc Disord 2023; 23:20. [PMID: 36646994 PMCID: PMC9841699 DOI: 10.1186/s12872-023-03056-7] [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: 08/04/2022] [Accepted: 01/11/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patients with sarcopenia have a higher risk of poor recovery after coronary artery bypass grafting (CABG). Little is known about the impact of changes in muscle strength (the primary indicator for sarcopenia) on health-related quality of life (HR-QoL). This study aimed to (1) identify subgroups with different muscle strength trajectories, (2) identify differences in preoperative risk factors among trajectory group membership, and (3) explore their prognostic value on postoperative HR-QoL in patients undergoing CABG. METHODS In this prospective observational study 131 patients undergoing elective CABG completed grip strength tests and HR-QoL questionnaires. Latent Class Growth Mixture Modelling (LCGMM) was used to identify clinically relevant trajectories (> 5% of study population) for weight-normalised grip strength, measured at admission, 3 days, and 6 months after surgery. Differences between trajectory group membership at baseline were evaluated. The impact of trajectory group membership on postoperative HR-QoL was evaluated with multiple linear regression models. RESULTS Due to low numbers (n = 15), female patients were excluded from LCGMM and subsequent statistical analyses. In males (n = 116), we identified two main weight-normalised grip strength trajectories: a "stable average" trajectory with a slight decline immediately post-surgery and recovery to preoperative levels (n = 85) and a "high" trajectory with a considerable immediate decline after surgery but followed towards a higher level of recovery compared to preoperative level (n = 27). The "stable average" patients were older (68 vs. 57 years; P = 0.003), had more diabetes (27% vs. 4%; P = 0.01) and had a higher BMI (27.8 vs. 24.8; P = 0.005) compared to the "high" group. After correction for age, diabetes, and baseline HR-QoL, group trajectory membership was not associated with postoperative HR-QoL, yet an increase in individual change scores of weight-normalised grip strength was associated with a better postoperative HR-QoL. We also identified one small trajectory group (n = 4, ≤ 5%). CONCLUSIONS This study showed two relevant weight-normalised grip strength trajectories in male patients undergoing CABG, varying in important preoperative risk factors. While change scores of grip strength per weight did predict postoperative HR-QoL, the trajectory subgroups could not predict postoperative HR-QoL. Future research should focus on female patients, reacting potentially different on CABG and/or rehabilitation treatment. Trial registration NCT03774342, 12-12-2018.
Collapse
Affiliation(s)
- Johanneke Hartog
- grid.4830.f0000 0004 0407 1981Department of Cardiothoracic Surgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, AB41, 9713 GZ Groningen, The Netherlands
| | - Sandra Dijkstra
- grid.4830.f0000 0004 0407 1981Department of Cardiothoracic Surgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, AB41, 9713 GZ Groningen, The Netherlands
| | - Willem Dieperink
- grid.4494.d0000 0000 9558 4598Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Trynke Hoekstra
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joke Fleer
- grid.4494.d0000 0000 9558 4598Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lucas H. V. van der Woude
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- grid.4494.d0000 0000 9558 4598Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.7692.a0000000090126352Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten Nijsten
- grid.4494.d0000 0000 9558 4598Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Massimo A. Mariani
- grid.4830.f0000 0004 0407 1981Department of Cardiothoracic Surgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, AB41, 9713 GZ Groningen, The Netherlands
| | - Fredrike Blokzijl
- grid.4830.f0000 0004 0407 1981Department of Cardiothoracic Surgery, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, AB41, 9713 GZ Groningen, The Netherlands ,grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
| |
Collapse
|
6
|
Stavrou G, Tzikos G, Menni AE, Chatziantoniou G, Vouchara A, Fyntanidou B, Grosomanidis V, Kotzampassi K. Endothelial Damage and Muscle Wasting in Cardiac Surgery Patients. Cureus 2022; 14:e30534. [PMID: 36415406 PMCID: PMC9675898 DOI: 10.7759/cureus.30534] [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] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
This is a post-hoc analysis to assess the effect of anesthesia, surgical trauma, and extracorporeal circuit on endothelial integrity, microvascular permeability, and extracellular fluid balance, as well as on skeletal muscle catabolism, in patients undergoing elective cardiac surgery. We included 127 well-nourished patients undergoing “on-pump” elective cardiac surgery. One day prior to surgery (D0) and again on postoperative day 7 (POD7), body mass index, body composition assessment, hand-grip strength (HGS), and mid-upper arm muscle circumference (MAMC) were measured. Patients were assigned to early recovery (ER) and late recovery (LR) groups, depending on the duration of ICU stay (cut-off 48 hours). The magnitude of change (Δ) in all parameters studied was assessed in ER versus LR groups, regarding (i) epithelial tissue dysfunction (Δ-Extra-Cellular Water percentage (Δ-ECW%), Δ-Phase Angle (Δ-PhA)), (ii) skeletal muscle mass catabolism (Δ-Skeletal muscle mass reduction%, Δ-Hand Grip Strength (Δ-HGS) and Δ-Mid Upper-Arm Muscle Circumference (Δ-MAMC)). Baseline measurements were similar in both groups. A significant difference was observed in all Δ-parameters studied (Δ-ECW%, Δ-PhA and muscle catabolism, Δ-HGS, Δ-MAMC), the worse results being correlated to the LR group. The results raise the issue that patients with early recovery may silently have pathological conditions, continuing even on the day of discharge - further research should be planned.
Collapse
|
7
|
Panagidi M, Papazoglou ΑS, Moysidis DV, Vlachopoulou E, Papadakis M, Kouidi E, Galanos A, Tagarakis G, Anastasiadis K. Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery. J Cardiothorac Surg 2022; 17:227. [PMID: 36057619 PMCID: PMC9440499 DOI: 10.1186/s13019-022-01970-z] [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: 03/07/2022] [Accepted: 08/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Phase angle (PA) constitutes a bioelectrical impedance measurement, indicating cell membrane health and integrity, hydration, and nutritional status. Handgrip strength (HS) has been also associated with body composition, nutritional status, inflammation, and functional ability in several chronic diseases. Although their prognostic significance as independent biomarkers has been already investigated regarding the outcomes of a cardiac surgery, our study is the first one to assess the combined predictive value of preoperative PA and HS. DESIGN AND METHODS HS and PA measurements were performed preoperativelyin 195 patients undergoing cardiac surgery. The association ofthe combination of HS and PAwith all-cause mortality rates was the primary study outcome, while its association with the intensive care unit (ICU) length of stay (LOS) was the secondary one. RESULTS PA was positively correlated with HS (r = 0.446, p < 0.005) and negatively with EuroSCORE II (r = - 0.306 p < 0.005). The combination of PA < 5.15 and HS < 25.5 was associated with higher one-year all-cause mortality (OR = 9.28; 95% CI 2.50-34.45; p = 0.001) compared to patients with PA > 5.15 and HS > 25.5, respectively. Patients with combined lower values of PA and HS (PA < 5.15 and HS < 30.7) were at higher risk of prolonged ICU LOS (OR = 4.02; 95% CI 1.53-10.56; p = 0.005) compared to those with higher PA-HS (PA > 5.15-HS > 30.7). The combination of PA-HS was also significantly linked with EuroSCORE II. CONCLUSION The combination of low preoperative PA and HS values was significantly associated with higher risk of all-cause mortality at 12 months and prolonged ICU LOS; thereby it might serve as a clinically useful prognostic biomarker after cardiac surgery procedures.
Collapse
Affiliation(s)
- Mairi Panagidi
- Department of Cardiothoracic Surgery, AHEPA University Hospitalof Thessaloniki, Thessaloniki, Greece
| | - Αndreas S Papazoglou
- First Department of Cardiology, AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elpiniki Vlachopoulou
- Department of Nutritional Sciences, International Hellenic University, Thessaloniki, Greece
| | | | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Galanos
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, AHEPA University Hospitalof Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Anastasiadis
- Department of Cardiothoracic Surgery, AHEPA University Hospitalof Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
8
|
Li L, Yang Q, Guo Q, Liu D, Gao H, Liu Y. Preoperative physical performance predicts pulmonary complications after coronary artery bypass grafting: a prospective study. Sci Rep 2022; 12:11103. [PMID: 35773331 PMCID: PMC9246884 DOI: 10.1038/s41598-022-15145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to evaluate the relationship between preoperative physical performance (grip strength, gait speed, timed up and go) and postoperative pulmonary complications (PPCs) in patients who have undergone coronary artery bypass grafting (CABG). From September 2019 to August 2021, a total of 497 CABG patients who met the inclusion criteria of this study were examined for grip strength, 4-m gait speed, and timed up and go (TUG) before CABG surgery. Among them, 438 were included in the final analysis. PPCs were classified according to the operational definition of Kroenke et al. and patients with clinically significant PPCs were included in the data analysis. Logistic regression was utilised to analyse the relationship between physical performance and clinically significant PPCs. Besides, the receiver operating characteristic (ROC) curve was applied to analyse the predictive effect of grip strength, gait speed, and TUG on clinically significant PPCs after the CABG procedure. In total, 103 (23.5%) patients developed clinically significant PPCs after CABG. After making adjustments for the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and confounding factors, we established that low grip/weight (OR 0.510; 95% CI 0.363–0.715), slow gait speed (OR 0.619; 95% CI 0.517–0.741), and prolonged TUG (OR 1.617; 95% CI 1.379–1.895) were all independently correlated with clinically significant PPCs after CABG. The ROC curve analysis indicated that the area under the ROC curve of the integrated model of the three indicators (AUC 0.792 vs. 0.682, 0.754, 0.765) was larger than that of the model with a single indicator. Besides the predictive effect of the integrated model was superior to the models using grip/weight, gait speed, or TUG alone. Physical performance, including grip/weight, gait speed, and TUG, is a predictive factor for PPCs in CABG patients, and can be used in preoperative evaluations to and help improve the management of high-risk patients.
Collapse
Affiliation(s)
- Lin Li
- Department of Nursing, TEDA International Cardiovascular Hospital, 61, Third Avence, TEDA, Tianjin, 300457, China
| | - Qin Yang
- Center for Basic Medical Research & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Dandan Liu
- Department of Nursing, TEDA International Cardiovascular Hospital, 61, Third Avence, TEDA, Tianjin, 300457, China
| | - Hui Gao
- Department of Nursing, TEDA International Cardiovascular Hospital, 61, Third Avence, TEDA, Tianjin, 300457, China
| | - Yaping Liu
- Department of Nursing, TEDA International Cardiovascular Hospital, 61, Third Avence, TEDA, Tianjin, 300457, China.
| |
Collapse
|
9
|
Mgbemena N, Jones A, Saxena P, Ang N, Senthuran S, Leicht A. Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery. PLoS One 2022; 17:e0263683. [PMID: 35196327 PMCID: PMC8865673 DOI: 10.1371/journal.pone.0263683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Handgrip strength (HGS), lung function and health-related quality of life (HRQoL) are relevant indicators of future cardiovascular risk and mortality. The impact of cardiac surgery on these predictive variables has been under-explored. The aim of this study was to determine the acute (within hospital) changes in HGS, lung function and HRQoL, and their relationships, in adults undergoing elective cardiac surgery. Further, the study examined the relationship between these variables and the predictors for lung function and HRQoL in these patients. Methods The study was a prospective cohort study that involved 101 patients who completed pre-operative (1–2 days before surgery) and physiotherapy discharge (5–7 days after surgery) assessments. Handgrip strength, lung function and HRQoL were assessed using JAMAR dynamometers, Vitalograph-Alpha or EasyOne spirometer, and Short-Form 36 questionnaire, respectively. Changes in these variables and their relationships were analysed using paired t-test and Pearson correlation coefficients, respectively. Prediction of lung function and HRQoL using HGS and other co-variates was conducted using regression analysis. Results At the time of physiotherapy discharge, lung function, HGS and the physical component of HRQoL were significantly (<0.001) reduced compared to their pre-operative values. Significant (<0.001) and moderate correlations were identified between HGS and lung function at pre-operation and physiotherapy discharge. Handgrip strength was a significant predictor of lung function pre-operatively but not at physiotherapy discharge. Pre-operative lung function and HRQoL, as well as other variables, were significant predictors of lung function and HRQoL during physiotherapy discharge. Conclusions Undergoing cardiac surgery acutely and significantly reduced lung function, HGS and physical component of HRQoL in adults with cardiac disease. Assessment of HGS at physiotherapy discharge may be a poor indicator of operative changes in lung function and HRQoL. Clinicians may consider HGS as an inadequate tool in predicting lung function and HRQoL following cardiac surgery.
Collapse
Affiliation(s)
- Nnamdi Mgbemena
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Anne Jones
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, Queensland, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- Department of Surgery, James Cook University, Townsville, Queensland, Australia
| | - Nicholas Ang
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Siva Senthuran
- Department of Intensive Care Medicine, Townsville University Hospital, Townsville, Queensland, Australia
| | - Anthony Leicht
- Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
10
|
Polastri M, Boschi S, Tchantchaleishvili V, Loforte A. Hand grip strength in patients with
LVADs
: A scoping review. Artif Organs 2022; 46:747-754. [DOI: 10.1111/aor.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
| | - Silvia Boschi
- Department of Cardiac‐Thoracic and Vascular Diseases, Cardiac Surgery and Transplantation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
| | | | - Antonio Loforte
- Department of Cardiac‐Thoracic and Vascular Diseases, Cardiac Surgery and Transplantation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
| |
Collapse
|
11
|
Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries. Chin Med J (Engl) 2021; 134:2865-2873. [PMID: 34732661 PMCID: PMC8667982 DOI: 10.1097/cm9.0000000000001709] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored. Methods: A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed. Results: A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050). Conclusions: Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients. Trial Registration: ChiCTR.org.cn, ChiCTR-ONRC-14005096
Collapse
|
12
|
Bubnova MG, Aronov DM, Sprikut AA, Stankevich DI, Poddubskaya EA, Persiyanova-Dubrova AL. Prehabilitation as an important stage before cardiac surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review discusses the preparation of patients for surgery on the heart and other organs. We considered the importance of introducing a new stage of medical and cardiology rehabilitation — prehabilitation. The results of randomized clinical trials, systematic reviews and metaanalyzes evaluating the effectiveness of respiratory techniques and physical training during the prehabilitation are presented. Particular attention is paid to the involvement of patients in prehabilitation programs before the elective coronary artery bypass grafting. Methodological problems arising in the development of prehabilitation programs are discussed.
Collapse
Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - E. A. Poddubskaya
- National Medical Research Center for Therapy and Preventive Medicine
| | | |
Collapse
|
13
|
Fountotos R, Munir H, Goldfarb M, Lauck S, Kim D, Perrault L, Arora R, Moss E, Rudski LG, Bendayan M, Piankova P, Hayman V, Rodighiero J, Ouimet MC, Lantagne S, Piazza N, Afilalo J. Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery. Can J Cardiol 2021; 37:1760-1766. [PMID: 34464690 DOI: 10.1016/j.cjca.2021.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort. METHODS This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay. RESULTS There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance. CONCLUSIONS HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.
Collapse
Affiliation(s)
- Rosie Fountotos
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Haroon Munir
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Sandra Lauck
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dae Kim
- Division of Geriatric Medicine, Beth Israel Deaconess Medical Centre, Harvard University, Boston, Massachusetts, USA
| | - Louis Perrault
- Division of Cardiac Surgery, Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Rakesh Arora
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emmanuel Moss
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Lawrence G Rudski
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Melissa Bendayan
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Palina Piankova
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Victoria Hayman
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Julia Rodighiero
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Marie-Claude Ouimet
- Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | - Sarah Lantagne
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Research Institute, McGill University Health Centre, Montréal, Québec, Canada.
| |
Collapse
|
14
|
Luo C, Shi Y, Lin Y, Ma R, Xia Q, Ding W. Intravenous transfusion of iron sucrose reduces blood transfusions and improves postoperative anaemia after a second thoracotomy: a propensity-score matching study. J Int Med Res 2020; 48:300060520902912. [PMID: 32043401 PMCID: PMC7111040 DOI: 10.1177/0300060520902912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the efficacy of intravenous iron sucrose (IS) in the
perioperative period of a second thoracotomy after open-heart surgery. Methods This study enrolled patients that underwent a second thoracotomy after
previous open-heart surgery. Propensity-score matching was used to match
patients that received oral iron therapy with those that received IS after
admission. The baseline demographic and clinical characteristics,
perioperative data and adverse outcomes were compared between these two
matched groups. Results The study enrolled 447 patients: of these, 148 received oral iron therapy and
effective dietary guidance; and 299 patients received 300 mg IS per week.
After matching the propensity scores, there were no significant differences
between the two groups in terms of age, sex, smoking history, incidence of
major cardiac adverse events, Euro-score, time between the two
thoracotomies, application of recombinant erythropoietin, haemoglobin (Hb)
on admission and red blood cell (RBC) count on admission. The differences
between the two groups after propensity-score matching in terms of the
amount of RBC input and Hb after the operation were significant. Conclusion The administration of IS might be useful for improving postoperative Hb
levels and reducing intraoperative RBC input in patients undergoing a second
thoracotomy.
Collapse
Affiliation(s)
- Chentao Luo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunqing Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Lin
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Runhua Ma
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Xia
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
15
|
Tasbihgou SR, Dijkstra S, Atmosoerodjo SD, Tigchelaar I, Huet R, Mariani MA, Absalom AR. A prospective pilot study assessing levels of preoperative physical activity and postoperative neurocognitive disorder among patients undergoing elective coronary artery bypass graft surgery. PLoS One 2020; 15:e0240128. [PMID: 33048965 PMCID: PMC7553306 DOI: 10.1371/journal.pone.0240128] [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: 07/27/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Physical inactivity and a sedentary lifestyle are associated with a chronic low-level inflammatory state which has been implicated in the pathogenesis of cardiovascular disease. There is growing interest in exercise programs as part of surgical ‘prehabilitation’. We therefore studied preoperative physical activity levels of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery, and performed an exploratory analysis of the influence of physical activity on postoperative outcome. The Short Questionnaire to Assess Health (SQUASH) was used to assess physical activity among 100 patients, of mean (SD) age 65.4 (7.6) years. Additionally, handgrip strength was measured, and the get-up-and-go test was conducted. Anxiety, depression, and quality of life were assessed, and a computerised cognitive test battery was used to assess cognitive performance preoperatively, and three months after surgery. Preoperatively, 76% of patients met the recommended national guidelines for physical activity. The incidence of pre-existing medical conditions, and other pre-operative patient features were similar in active and inactive patients. Preoperative physical activity was significantly inversely related to the logistic EuroSCORE. The level of physical activity was also significantly inversely related with preoperative C-reactive protein (CRP) and peak postoperative CRP, but physical activity did not appear to be associated with any adverse postoperative outcomes or extended length of hospital stay. The incidence of postoperative neurocognitive disorder (PNCD) at 3 months postoperatively was 26%. Cognitive performance was not related with physical activity levels. In summary, this was the first study to assess activity levels of cardiac surgical patients with the SQUASH questionnaire. The majority of patients were physically active. Although physical activity was associated with lower levels of inflammation in this pilot study, it was not associated with an improved clinical or cognitive postoperative outcome.
Collapse
Affiliation(s)
- Setayesh R Tasbihgou
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Dijkstra
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sawal D Atmosoerodjo
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris Tigchelaar
- Laboratory for Experimental Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rolf Huet
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|