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Cao Y, He J, Chen X, Jing L, Qiu J, Geng Y, Chen F, Sun G, Ji X. The impact of ankle movements on venous return flow: A comparative study. Phlebology 2024:2683555241264914. [PMID: 39028225 DOI: 10.1177/02683555241264914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity. METHODS 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion. RESULTS In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p < .01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p > .05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow. CONCLUSION The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated.
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Affiliation(s)
- Yun Cao
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - JinFeng He
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xufeng Chen
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Jing
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - JiaWen Qiu
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YuJuan Geng
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - GuoZhen Sun
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - XueLi Ji
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Lin W, Yao B, He J, Lin S, Wang Y, Chen F, Zhang W, Yang J, Ye Z, Qiu J, Wang Y. The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report. J Med Case Rep 2024; 18:207. [PMID: 38610054 PMCID: PMC11015665 DOI: 10.1186/s13256-024-04516-0] [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: 07/15/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. CASE PRESENTATION A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. CONCLUSION Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.
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Affiliation(s)
- Wujian Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Yao
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiahui He
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Therapy Technology, Lvkang Bomei Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Shuangyan Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangting Chen
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weichao Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiashu Yang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital, Jinan University, Heyuan, Guangdong, China
| | - Zhihong Ye
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Shi J, Weng X, Liu C, Ge Y, Chai L, Ru X, Yue Y, Huang X. The effect of the Ankle Pump Exercise (APE) counter system assisted ankle pump motion in patients after femoral neck fracture. BMC Musculoskelet Disord 2023; 24:925. [PMID: 38037009 PMCID: PMC10687785 DOI: 10.1186/s12891-023-06869-x] [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: 03/29/2023] [Accepted: 09/10/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To explore the effect of the Ankle Pump Exercise (APE) counter system on moderate to high-risk Venous thromboembolism (VTE) after femoral neck fracture surgery. METHODS From June 2021 to June 2022, a total of 140 patients with moderate and high-risk VTE after femoral neck fracture surgery treated at the Department of Orthopedics of a tertiary hospital in Zhejiang were included and divided into observation (70 cases) and control (70 cases) groups according to whether APE counter system was used or not. The control group was given routine oral propaganda, and the observation group was given a comprehensive nursing intervention with APE counter system on the basis of the control group's treatment. The compliance rates of the two groups on the postoperative 3st, 5rd, and 7th days were compared. Moreover, the General self-efficacy scale (GSES) was used to evaluate self-efficacy before and after exercise. RESULTS The compliance rates of the control group and the observation group on the postoperative 3st, 5rd, and 7th days were 74.3% vs. 85.7%, 67.1% vs. 85.7%, and 61.4% vs. 82.9%. On the 5rd and 7th days, the compliance of the observation group was obviously higher than that of the control group. Moreover, the mean postoperative GSES score was also significantly higher than that in the control group (23.20 ± 3.516 vs. 25.31 ± 4.583, P < 0.05, values are expressed in mean ± standard). CONCLUSION APE counter system can significantly improve the compliance and self-efficacy of patients with moderate and high-risk VTE after lower limb fracture surgery.
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Affiliation(s)
- Jiaping Shi
- Department of Orthopedics, Zhejiang Hospital, 1229 Gudun Road, Hangzhou, 310030, China
| | - Xia Weng
- Department of Urology, Zhejiang Hospital, Hangzhou, 310030, China
| | - Caixia Liu
- Department of Nursing, Zhejiang Hospital, Hangzhou, 310030, China
| | - Yanzhi Ge
- Department of Orthopedics, Zhejiang Hospital, 1229 Gudun Road, Hangzhou, 310030, China
| | - Lan Chai
- Department of Rheumatology and Immunology, Zhejiang Hospital, Hangzhou, 310030, China
| | - Xuanliang Ru
- Department of Orthopedics, Zhejiang Hospital, 1229 Gudun Road, Hangzhou, 310030, China.
| | - Yingxing Yue
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030, China.
| | - Xiaoqin Huang
- Department of Orthopedics, Zhejiang Hospital, 1229 Gudun Road, Hangzhou, 310030, China.
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Medeiros HPDS, Araújo JNDM, da Silva AB, Dantas RAN, Lopes CT, Vitor AF. Nursing diagnosis proposal "Impaired Peripheral Venous Return": concept formation. Rev Bras Enferm 2023; 76:e20220426. [PMID: 38018610 PMCID: PMC10680394 DOI: 10.1590/0034-7167-2022-0426] [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: 07/28/2022] [Accepted: 06/12/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES to develop a nursing diagnosis proposal focused on venous return. METHODS this is a concept analysis according to the model proposed by Walker and Avant, which is operationalized through an integrative review. The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol recommendations. RESULTS the analysis of the 131 studies allowed identifying attributes, antecedents and consequences. The most common attribute was decreased venous flow. The antecedents most frequently found were structural and/or functional valve deficiency, advanced age and peripheral venous thrombosis. The most common consequences were peripheral edema, venous ulcer and pain in the extremity. CONCLUSIONS the formulated nursing diagnosis was proposed as part of Domain 4, Activity/rest, in Class 4, Cardiovascular/pulmonary responses, with eight defining characteristics, five related factors, six at-risk populations and four associated conditions.
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Affiliation(s)
| | | | | | | | | | - Allyne Fortes Vitor
- Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil
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O'Neil A, Hines D, Wirdzek E, Thornburg C, Murray D, Porter J. Early Mobilization, Early Ambulation, and Burn Therapy in the Acute Hospital Setting. Phys Med Rehabil Clin N Am 2023; 34:733-754. [PMID: 37806694 DOI: 10.1016/j.pmr.2023.06.029] [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] [Indexed: 10/10/2023]
Abstract
Rehabilitation therapies in the burn acute care environment continue to evolve. Immediate access to therapy is considered standard, and therapy is a key component of the transprofessional care team. Early positioning, edema management, and therapy care in the intensive care unit (ICU) environment can limit later complications; mobility in the ICU can be engaged safely using a systems-based approach in the absence of nondirectable agitation. Later in the course of acute care, early ambulation is an appropriate intervention that can improve outcomes.
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Affiliation(s)
- Audrey O'Neil
- Burn Rehabilitation Services; Eskenazi Health, Richard M Fairbanks Burn Center, 720 Eskenazi Avenue, 4th Floor, Indianapolis, IN 46202, USA
| | - Danika Hines
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Emily Wirdzek
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Cody Thornburg
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Derek Murray
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - John Porter
- Physiatry, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Trauma and Burn Services, Department of Surgery, University of Arizona, Creighton University, Phoenix, AZ, USA
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Wang L, Qu Y, Deng Y, Li J, Liu Y, Wu C. Evaluation of a New Method of Sciatic Nerve Block: A Prospective Pilot Study. J Pain Res 2023; 16:2091-2099. [PMID: 37346396 PMCID: PMC10281272 DOI: 10.2147/jpr.s404489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose The location of the sciatic nerve deep within the thigh tissue makes it challenging to locate while the patient is in a supine position. The posterior intermuscular septum of the thigh, which encircles the posterior surface of the adductor magnus muscle (AMM), is where the sciatic nerve is located. Our hypothesis was that administering local anesthetic injections into this area could block the sciatic nerve. Therefore, our aim was to evaluate the effectiveness of sciatic nerve block achieved by injecting local anesthetic into the posterior intermuscular septum of the thigh, named the AMM approach. Methods Twenty-six patients undergoing total knee arthroplasty were included in the study. We performed an ultrasound-guided sciatic nerve block by injecting 20 mL of 0.25% ropivacaine into the posterior surface of the adductor magnus muscle, using the AMM approach. Additionally, we administered a femoral nerve block with 20 mL of 0.4% ropivacaine. We assessed the sensory and motor effects of the blockade in the operated lower limb and recorded postoperative pain scores at 0, 4, 8, 12, 24, and 48 hours after the operation. Results The AMM approach successfully block the sciatic nerve in all 26 patients. The onset of the sensory and motor blockades was achieved within 5.4 ± 1.9 min and 8.7 ± 3.5 min, respectively. We achieved a satisfactory position with the first puncture in 19 of 26 patients (73.1%). The muscle strength of the tibialis anterior immediately after surgery was 4 (ranging from 2 to 5). Additional rescue analgesics were required in 5 of the 26 patients (19.2%) during the first 24 hours postoperatively. Conclusion The AMM approach is an innovative and effective method for sciatic nerve block. When combined with simultaneous femoral nerve block in patients undergoing total knee arthroplasty, it provides a useful analgesic treatment option.
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Affiliation(s)
- Liwei Wang
- Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
| | - Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
| | - Ying Deng
- Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
| | - Jun Li
- Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
| | - Yanqing Liu
- Department of Orthopaedics, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
| | - Changyi Wu
- Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People’s Republic of China
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Liu Y, Wang F, Ma D, Wu X, Hui Z, Zhang H, Zhang L. Views of inpatients on the prevention of venous thrombosis with ankle pump exercise: A cross-sectional survey. Phlebology 2023; 38:28-35. [PMID: 36433701 DOI: 10.1177/02683555221142199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study investigated the current status of patients' knowledge and clinical compliance with ankle pump exercises in order to better enhance patient education and improve patient compliance with ankle pump exercises. METHODS A cross-sectional survey of the current status of ankle pump exercise awareness and compliance was conducted using a self-designed questionnaire. The questionnaire consisted of a general demographic information questionnaire, a questionnaire on patients' perceptions of ankle pump exercise and a compliance questionnaire. RESULTS A total of 2,203 patients from 53 clinical departments participated in this survey. 87.8% of patients considered ankle pump exercise important, 92.1% could grasp the knowledge of ankle pump exercise, 48.5% could self-monitor and exercise daily as instructed, 81.5% of health care workers would often supervise patients to complete ankle pump exercise, poor self-control (34.6%), lack of physical strength (21.1%) and perceived hassle (18.9%) were the top 3 factors contributing to patients' inability to complete the ankle pump exercise. Regression analysis showed that the factors influencing patients' compliance with the ankle pump exercise were literacy, economic level, number of comorbidities and caprini risk class (p < .05). CONCLUSION The patient's cognition of ankle pump exercise is good, but the compliance needs to be improved. It is suggested that the compliance of ankle pump exercise in hospitalized patients should be improved in the future to reduce the incidence of Venous thromboembolism.
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Affiliation(s)
- Yujie Liu
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fang Wang
- Department of Cardiovascular Medicine, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Danfeng Ma
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xuejun Wu
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhen Hui
- Department of Oncology and Radiotherapy, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiyan Zhang
- Department of Extracardiac ICU, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li Zhang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Li H, Zhang W, Lu Q, Wang J, Zhi Y, Zhang L, Zhou L. Which Frequency of Ankle Pump Exercise Should Be Chosen for the Prophylaxis of Deep Vein Thrombosis? INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221105989. [PMID: 35658650 PMCID: PMC9168852 DOI: 10.1177/00469580221105989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Ankle pump exercise (APE) is an effective method to prevent deep vein
thrombosis (DVT) in the lower extremities. However, traditional APE at a
frequency of 3 times/min applied in the clinic lacked high compliance, and
individuals were found to prefer an APE of 30 times/min. This study aimed to
compare the effects of APEs with the above two different frequencies on the
venous hemodynamics and fatigue of lower extremities. Methods The study applied a randomized cross-over design, and 307 healthy adults were
randomly assigned into two groups, whose left feet performed 5 minutes of
traditional APE (3 times/min, after 10 minutes of rest) and 5 minutes of
selected APE (30 times/min, after 10 minutes of rest) in different orders.
The diameters and blood flow velocities of the external iliac vein, femoral
vein, and popliteal vein of the left extremities were recorded with the
color doppler ultrasound when participants were at rest and after 5 minutes
of traditional or selected APE. The fatigue of lower extremities was
assessed with the Rating of Perceived Exertion (RPE) after the participants
performed 5 minutes of different APEs. Results After both traditional APE and selected APE, the diameters and blood flow
(peak systolic) velocities of the external iliac vein, femoral vein, and
popliteal vein increased significantly in the participants (P<.01), and
the effects of the two APEs on venous hemodynamics of the lower extremities
had no significant difference (P>.05). However, participants reported
that traditional APE caused higher fatigue, and 252 (82.1%) participants
preferred APE at 30 times/min. Conclusion Both traditional and selected APE could increase venous blood flow in the
lower extremity. Despite the equivalent effects, the selected APE of 30
times/min may cause less fatigue than the traditional one of 3
times/min.
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Affiliation(s)
- Haiyan Li
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Wei Zhang
- Department of Clinical Nursing, Nursing School, Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Jinping Wang
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Yanru Zhi
- Department of Vascular Surgery, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Lanshu Zhou
- Department of Clinical Nursing, Nursing School, Naval Medical University, Shanghai, China
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