[Remote functional evaluation after reconstruction of the anterior cruciate ligament in amateur sportsmen with sedentary work]

SUMMARY

The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. Currently there are two commonly used surgical procedures: middle third patellar tendon grafts (bone-patellar tendon-bone: BTB) and semitendinosus autografts or semitendinosus combined with gracilis tendon autografts (ST/G). Purpose. The aim of this study is to compare the rehabilitation results over time of amateur sportsmen who have undergone anterior cruciate ligament (ACL) reconstruction surgery by means of one of the two most commonly used procedures: middle third patellar tendon grafts (bone-patellar tendon-bone: BTB) and semitendinosus and gracilis tendon autografts (ST/G). Method. 30 subjects divided into two groups, (15 BTB and 15 ST / G), were evaluated during rehabilitation and at three follow-up periods (16 weeks, 24 weeks, 2 years). Evaluation involved clinical examination, isokinetic tests, and functional rating scales: Lysholm and IKDC. Results. The clinical evaluation resulted in the following mean values: the value of the Lysholm score was 78 in both group at 16 weeks, 91 in group A and 94 in group B at 24 weeks, 98 in group A and 99 in group B at 2 years; the value of the IKDC score was 14 in group A and 15 in group B at 16 weeks, 12 in group A and 14 in group B at 24 weeks, 14 in group A and 15 in group B at 2 years. No major complications occurred during rehabilatation Conclusions. Subjects in both groups showed good neoligament stability up to the 24-week follow up. At the 2-year follow-up the subjects of group B showed poor neoligament stability that prevented the return to the previous level of sporting activity; all the subjects with high intensity sports activity needed a greater muscle strengthening. No statistically significant differences between the two groups are seen.

Functional assessment and rehabilitation protocol in acute patients affected by SARS-CoV-2 infection hospitalized in the Intensive Care Unit and in the Medical Care Unit

BACKGROUND

Coronavirus disease (COVID-19) is characterized by different clinical pictures that may require prolonged hospitalization and produce disabilities challenging the recovery of previous independence.

AIM

The aim is to evaluate the impact of an early assisted rehabilitation program on the functional status of an acutely hospitalized population affected by COVID-19.

DESIGN

Single-institution retrospective longitudinal study.

SETTING

Inpatient intensive care units (ICU) and medical care units (MCU).

POPULATION

Acute COVID-19 patients.

METHODS

General information was collected; age-adjusted Charlson Comorbidity Index was used for comorbidities. Duration of hospital stay, the length of stay in ICU and/or MCU, the length of the rehabilitative treatment, and the destination at the discharge were collected. Evaluation was performed when patients were clinically stable (T0), and at hospital discharge (T1); for subjects enrolled in ICU functional status was assessed at the time of transfer to the MCU. Muscle strength of the four limbs was measured with the Medical Research Council (MRC) sum-score. Functional status was assessed using the 3-item Barthel Index (BI-3) and the General Physical Mobility Score (GPMS). Early assisted-tailored rehabilitation protocol was applied in ICU and in MCU: the aims were the maintenance (or recovery) of the range of motion and of the strength and the recovery of sitting/standing position and gait.

RESULTS

We evaluated 116 patients (mean age 65, SD 11) (65% male), 68 in ICU (mean age 60, SD 10), 48 in MCU (mean age 73, SD 9). At discharge, BI-3 and GPMS significantly improved in both ICU (P<0.001) and MCU (P<0.001) subgroups of patients. MRC sum-score significantly improved in ICU patients (P<0.001). Patients hospitalized in ICU had a significantly longer hospital stay. At discharge, patients admitted to the ICU reach a functional state that is close to that of patients admitted to the MCU.

CONCLUSIONS

The results suggest that an early assisted rehabilitation program may be helpful in improving the short-term functional status of an acutely hospitalized population affected by COVID-19, with discharge at home of 48% CLINICAL REHABILITATION IMPACT: this study focuses on a functional assessment method to be used to identify the rehabilitation needs and verify the results of an early rehabilitation protocol applied to the acute COVID-19 patient admitted to ICU and MCU.

[Evaluation of quality of life and arthropathy in the adult haemophilic patient]

Haemophilia in its most severe clinical form can lead to alterations in the physical and psychosocial state with important repercussions on the quality of life. Purpose. A retrospective study was conducted to highlight the impact of haemophilic arthropathy on quality of life. Materials. We considered 25 patients, with a mean age of 42 years (min 17 - max 71) with haemophilia A, 18 had the severe clinical form (72%). The WFH Physical Examination Score, specific for haemophilia, was used for joint function; the joints examined were: knee, ankle, hip and elbow. To assess the quality of life, two generic self-filling questionnaires were used, SF-36 and the EQ 5D. Results. Significant statistical values have shown that arthropathy affects the SF-36 domain of general health and the subjective well-being EQ-VAS. Conclusions. In the treatment of haemophilic arthropathy, prevention is essential, understood both as a prophylactic medical therapy and as a physiotherapeutic treatment in order to maintain or improve joint function and at the same time play a fundamental role in improving the quality of life of patients.

Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial

OBJECTIVES:

To investigate if focused extracorporeal shock wave therapy (f-ESWT) is an effective treatment in a population affected by greater trochanteric pain syndrome (GTPS).

DESIGN:

Randomized controlled trial, with blind outcome assessors.

SETTING:

Outpatients, University Hospital.

SUBJECTS:

A total of 50 patients affected by GTPS with gluteal tendinopathy.

INTERVENTIONS:

The study group was assigned to receive f-ESWT, the control group received ultrasound therapy (UST).

MAIN MEASURES:

We assessed hip pain and lower limb function by means of a numeric rating scale (p-NRS) and the Lower Extremity Functional Scale (LEFS scale), respectively. The first follow-up evaluation (2M-FUP) was performed two months after the first treatment session, the second (6M-FUP) was carried out six months later.

RESULTS:

The mean age of the population was 61.24 (9.26) years. A marked prevalence of the female sex was recorded (44 subjects, 86%). The statistical analysis showed a significant pain reduction over time for the study group and the control group, the f-ESWT proving to be significantly more effective than UST ( P < 0.05) at the 2M-FUP (2.08 vs 3.36) and at the 6M-FUP (0.79 vs 2.03). A marked improvement of the LEFS total score was observed in both groups as well, but we found no statistical differences in the comparisons between groups.

CONCLUSION:

Our findings support the hypothesis that f-ESWT is effective in reducing pain, both in the short-term and in the mid-term perspective. We also observed a functional improvement in the affected lower limb, but, in this case, f-ESWT showed not to be superior to UST.

Potentiation of muscle strength by focal vibratory stimulation on quadriceps femoris

OBJECTIVES

Several studies have investigated the effects of focal vibration on muscle strength. Non-univocal results have been found. The aim of this study was to evaluate the effect of prolonged focal vibratory stimulation on quadriceps muscle strength at two different frequencies (80 and 300 Hz). The evaluation of muscle strength was performed at different intervals of time after the end of the vibratory stimulation in order to quantify the long-term effects and their trends over time.

METHODS

Twenty-seven healthy volunteers were divided into three groups, a control group (no treatment) and two groups treated with vibratory stimulation (80 or 300 Hz) of relaxed quadriceps femoris bilaterally, once a day (30 min) for 5 consecutive days. The quadriceps' strength was measured through an isokinetic dynamometer, before and at three time intervals after the treatment, with a follow-up period of 4 weeks. The outcome measure was the Peak Torque (PT, Nm) of the quadriceps femoris produced by extension movement at three defined angular velocities and during isometric contraction.

RESULTS

No changes in PT were observed in the control group over time, while PT increased in the treated groups. No significant difference in PT behavior was observed between these two groups. PTs recorded before and after the treatment were markedly different, and the increase in the PT persisted until the follow-up at 4 weeks, for all angular velocities tested.

CONCLUSIONS

Prolonged vibratory stimulation of the quadriceps femoris, both at 80 and at 300 Hz, leads to an increase in muscle strength. The vibration effect does not appear to fade at the end of treatment, but persists at the follow up, suggesting a likely underlying plastic process. The results of the current study suggest that 30-min per day, 5 day focal vibratory treatment can be helpful during the clinical practice to regain muscular strength. It does not require patient's effort during the treatment, requires a little time, its effects are long-lasting, and there are no known adverse effects.

Integrating and monitoring hand burn rehabilitative treatment using Virtual Reality

OBJECTIVES

Hand burn is not a common condition in the clinical practice and needs a long and laboured rehabilitative treatment to restore the lost function.

METHODS

This case report illustrates the achievable improvements in mobility and function by using innovative inertial systems for occupational exercise in a Virtual Reality, in addition to a traditional rehabilitative treatment.

RESULTS

Through these instruments, we could promote and concurrently assess the recovery of a functional grasp and the ability in the execution of Activities of Daily Living.

Early rehabilitation after elective total knee arthroplasty

BACKGROUND AND AIM OF THE WORK

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients.

METHODS

in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment.

RESULTS

length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day.

CONCLUSION

Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

Early rehabilitative treatment after infrainguinal lower limb bypass surgery

Background and aim of the work:

Functional activity may remain limited in patients affected by critical limb ischemia, despite successful infrainguinal lower limb bypass surgery (ILLBS). The aim of the work was to evaluate the impact of a rehabilitative intervention on postoperative ambulatory status and pain.

Methods:

In an observational study, data were collected on 34 patients undergoing ILLBS for critical limb ischemia or end-stage peripheral arterial disease. All patients underwent a postoperative rehabilitation program aimed at recovering gait autonomy. Information was collected on pre-operative comorbidities, ambulatory status (on admission to and discharge from hospital) and pain in the affected lower limb (on the first physiotherapy session and at discharge).

Results:

Before ILLBS, 61.8% of the patients walked independently without aids or assistance. The rehabilitative program started on average 5.7 (SD: 2.1) days after surgery. At discharge, 50% of the patients walked independently, 41.2% walked with aids and/or assistance and 8.8% were not able to walk. Overall, 76.5% of the sample recovered their pre-operative ambulatory status. Although pain tended to decrease, the difference at the first (1.5; SD: 2.6) and at the last treatment session (0.8; SD= 1.3) was not statistically significant.

Conclusion:

Our exercise protocol resulted to be easy to perform during hospital stay, with an overall favourable outcome for ambulatory status. Our results are in line with those reported in literature about the rates of postoperative dependence in walking, but appear to be slightly better in regards to the percentage of patients who recovered pre-operative ambulatory status. (www.actabiomedica.it)

Early rehabilitation after elective total knee arthroplasty

BACKGROUND AND AIM OF THE WORK

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients.

METHODS

in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment.

RESULTS

length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day.

CONCLUSION

Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

Focused extracorporeal shock wave therapy combined with supervised eccentric training for supraspinatus calcific tendinopathy

BACKGROUND

Extracorporeal shockwave therapy (ESWT) is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Eccentric exercise has been introduced as an effective treatment choice for Achilles tendinopathy, but poor evidence exists about its role in the treatment of rotator cuff tendinopathy.

AIM

To investigate if adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome of ESWT.

DESIGN

Pre-post intervention pilot study with matched control-group.

SETTING

Outpatient, University Hospital.

POPULATION

Twenty-two subjects affected by painful supraspinatus calcific tendinopathy.

METHODS

The study-group was assigned to receive focal ESWT (f-ESWT) plus a supervised eccentric training (SET) of the shoulder abductor muscles. The matched control-group received f-ESWT only. The post-treatment assessment at follow-up (T1) was performed nine weeks after the enrollment (T0). We assessed shoulder pain and function by the means of a numeric rating scale (p-NRS) and a DASH scale. As secondary outcome, we measured the isometric strength of the abductor muscles of the affected shoulder using a handheld dynamometer.

RESULTS

At T1, we recorded a significant decrease in pain (P<0.001) and an improvement in upper limb function (P<0.001) in both groups. However, we observed no statistical differences in favor of the study-group, in terms of p-NRS and DASH total score. A mild increase (+13% from baseline) of the maximum isometric abduction strength was noticed in the study group at T1.

CONCLUSIONS

Our findings did not support the hypothesis that adding a supervised eccentric training of the shoulder abductor muscles could improve the outcome (pain and function) of shock wave therapy.

CLINICAL REHABILITATION IMPACT

Our study confirmed that f-ESWT is effective in reducing shoulder pain and improving function in calcific supraspinatus tendinopathy. Adding a supervised eccentric training, focused on the abductor muscles, was useful to improve maximum isometric abduction strength, but appeared to give no advantage in the short-term outcome of shock wave therapy.

Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination

BACKGROUND

Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation.

AIM

To evaluate the outcome of a postoperative assisted rehabilitation program.

DESIGN

Single-institution short-term observational study.

SETTING

Inpatient (Neurosurgery Unit of a University Hospital).

POPULATION

Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma.

METHODS

Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome).

RESULTS

Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation.

CONCLUSIONS

The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor that prevents us to discharge more elderly patients home rather than to assisted settings.

CLINICAL REHABILITATION IMPACT

The results of this descriptive study suggest that an assisted rehabilitation program may be helpful in improving short-term postoperative balance and ambulatory status (more than functional status), but further studies, with a randomized controlled design, are certainly justified to understand the efficacy of rehabilitation in this context.

Early rehabilitation treatment in newborns with congenital muscular torticollis

BACKGROUND

Congenital Muscular Torticollis (CMT) is the most common form of torticollis in infants; on clinical presentation it is classified into 3 types: 1) postural torticollis, with postural deformity only in the neck; 2) muscular torticollis, where neck deformity is associated with muscle tightness and restricted passive range of motion (ROM); and 3) sternomastoid tumor or pseudotumor, with a fibrotic, sternocleido-mastoid muscle mass and passive ROM limitations.

AIM

The aim of this study was to evaluate the physical therapy outcome of infants with CMT treated either by parents using a home exercise program, or by a physical therapist.

DESIGN

Longitudinal study.

SETTING

Outpatients with CMT at our Department of Physical Medicine and Rehabilitation.

POPULATION

Fifty consecutive newborns with CMT, referred by the primary pediatrician:

METHODS

In our study, 50 infants with CMT were evaluated and treated either by a physical therapist or by parents using a home program.

RESULTS

Sixteen females (32%) and 34 males (68%), aged 10.2 weeks (SD 6.66); 23 of the infants (46%) presented with more severe articular limitations than the others (P=0.002) and were therefore prescribed outpatient treatment by a physical therapist; the remaining 27 less severe cases (54%) were prescribed a home therapy program. 49 infants achieved full resolution after an average of 81.06 days (SD 64.05) of rehabilitation treatment. The group of patients who were treated at home achieved resolution more quickly (72.8 vs. 91.1 days), although statistical significance was not reached.

CONCLUSIONS

Infants with CMT who were treated early, either at home or in the outpatient clinic, completely recovered normal neck movement in a short time. It is important not to discharge patients until they have achieved full resolution of CMT symptoms to exclude the minimal risk of relapse.

CLINICAL REHABILITATION IMPACT

This study demonstrates the importance of early treatment in cases of congenital muscular torticollis.

Functional assessment and quality of life before and after pulmonary endoarterectomy

PURPOSE

The study investigates Quality of Life (QOL) and correlation with functional status of patients affected by Chronic Thromboembolic Pulmonary Hypertension who undergo Pulmonary Endoarterectomy.

METHODS

We investigated with an observational design (before surgery, three and twelve months afterwards) the hemodynamic data (NYHA class, mean pulmonary arterial pressure, cardiac output and pulmonary vascular resistance), the functional status (using the 6-Minute Walk Test) and the QOL, using three questionnaires: Medical Outcome Study Short Form-36 (SF-36), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Saint George Respiratory Questionnaire (SGRQ). We report the results of forty-nine patients.

RESULTS

After surgery there was an improvement on functional and hemodynamic parameters and on QOL. The physical domain (PCS) of SF-36 was weakly but significantly associated with all functional parameters. There was no association between functional parameters and mental domain (MCS) of SF-36 or SGRQ. The improvement in 6-Minute Walk Distance was associated with an increase in MLHFQ.

CONCLUSIONS

Both QOL and submaximal exercise tolerance improve after surgery. However only the physical domains of SF-36 appear to be significantly associated to the functional data.

Early rehabilitative treatment for pediatric acute disseminated encephalomyelitis: case report

Although the diagnosis of and therapy for acute disseminated encephalomyelitis (ADEM) have been extensively investigated, the role of rehabilitation in modifying its functional outcome has received little attention in the literature so far. We report a case of pediatric ADEM who showed complete functional recovery following early rehabilitative treatment, started in the Intensive Care Unit.

Monitoring iliopsoas muscle contraction in idiopathic lumbar scoliosis patients

BACKGROUND

Curve evolution in idiopathic scoliosis frequently occurs in lumbar and thoracic-lumbar spine. The spinal and iliopsoas muscles play a major role in maintaining the static and dynamic stability of the spine.

OBJECTIVE

To monitor by video recording, the degree to which asymmetric isometric contractions of the iliopsoas muscle improve the lumbar curve.

DESIGN

10 subjects (9 female, 1 male), mean age of 14.1 years (11-18), who were undergoing rehabilitation for idiopathic scoliosis. 8 subjects wore a brace, 6 had a single lumbar curve, 4 had a thoracic curve; 9 curves were convex to the left and 1 convex to the right. The mean Cobb angle was 20.1 degrees ±8.2523) with a mean degree of rotation of 1.2 (±0.4216).

METHOD

The scoliotic curves were monitored on video whilst the patients performed muscle contraction exercises. Adhesive markers were applied to the skin to be used as reference points of the curve on video. Subjects performed the exercises in a sitting position, facing away from the video camera, with their knees bent at an angle of 90 degrees. The complete exercise procedure was as follows: initial lengthening of the spine and postural control, concentric activation of the iliopsoas, isometric activation for about 3 seconds, then final release. Differences in curvature angle detected on the video recording were analysed and processed using the computer software Dartfish Pro Suite 5.0_Dartfish LTD_Switzerland.

RESULTS

The mean angle of correction through exercise was 6.9 degrees (±3.6) during concentric activation and 4.9 degrees (±3.5) during isometric activation of the iliopsoas.

CONCLUSIONS

Data show the corrective effect that iliopsoas muscle contraction produces on the scoliotic curve.

Early rehabilitative treatment in aortocoronary bypass surgery

AIM

The objective of this retrospective study is to analyze functional recovery and response to rehabilitation treatment during the immediate postoperative phase of aortocoronary bypass (ACB) surgery.

METHODS

We studied 319 patients, who had undergone ACB surgery and who needed post-acute rehabilitation.

RESULTS

All patients presented post-operative respiratory dysfunction, 300 cases presented inability in position changes and needed neuromotor exercises in addition to chest physiotherapy. Rehabilitation treatment began at a mean number of 1.79 +/-1.37 days after surgery and continued for 5.78 +/- 3.59 days. At the discharge, at mean 5.47 +/- 2.25 days after surgery, most of patients (65.61%) walked independently.

CONCLUSIONS

Our study described a protocol of early rehabilitative treatment that appeared to be suitable in promoting patients'functional recovery after aortocoronary bypass surgery.

Identification of risk factors for fatigue and pain when performing surgical interventions

OBJECTIVE

Evaluation of fatigue and pain following surgical activities.

METHODS

Cross-sectional study. We distributed a self-evaluation questionnaire to 180 surgeons to investigate working postures and fatigue and/or pain following working activities.

RESULTS

100 surgeons replied (74 male), mean age 40.1 (SD 10.85; 26-65). Multivariate analysis suggests that the highest risk factor for developing muscle fatigue whilst performing surgical operations is standing compared to sitting (OR: 4.92; 95% CI: 1.32-18.33),followed by the ability to alternate between the two postures (OR: 3.46: 95% CI: 1.26-9.52). Surgeons who complain of intense fatigue when standing have 16 times the risk of developing musculoskeletal pain than surgeons who complain of light fatigue when standing (OR: 15.77; 95% CI: 1.51-164.37). The ability to adjust the height of the operating table before each operation reduces the risk of developing musculoskeletal pain by 83% (OR: 017; 95% CI: 0.03-0.87); 90.9% of surgeons who rest their forearms for less than half the duration of an operation reported pain.

CONCLUSIONS

Fatigue and pain associated with performing surgical interventions could be managed more effectively by: controlling the working posture, being able to rest forearms, being able to regulate the height of the operating table, and possibly by applying the ergonomic guidelines.

Persistent hiccup after surgical resection of a brainstem arteriovenous malformation: a case successfully treated with gabapentin during rehabilitation. Case report

Persistent hiccup rarely occurs during rehabilitation, but its management can prove to be very difficult, particularly in presence of associated dysphagia, requiring longer hospitalization and higher risk of severe clinical complications. We present a case of persistent hiccup after surgical resection of a brainstem arteriovenous malformation successfully treated with gabapentin during rehabilitation.

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: short-term functional assessment in a longitudinal study

AIM

Presently, the surgical treatment choice in chronic thromboembolic pulmonary hypertension (CTEPH) consists in a pulmonary endarterectomy (PEA). The aim of the present study is the functional assessment of patients submitted to PEA both preoperatively and shortly after the intervention. A longitudinal study was developed to study the quality and quantity of functional performance possible in these subjects.

METHODS

Twenty-two subjects were assessed immediately prior to PEA and 3 months later in order to obtain quantitative measurements of short-term functional recovery. The functional assessment included the 6-min walk test (6mWT), the measurement of the oxygen percent saturation (HbS%O(2)) and the degree of dyspnea subjectively perceived by each patient.

RESULTS

Three months after the surgical intervention, there was a definite increase in the number of meters walked during the 6mWT with respect to preintervention; the difference between the distances walked in the 6mWT (6mWD) in the pre and post-PEA was statistically significant (Paired t-test P<0.001).

CONCLUSION

In this study the 6mWT resulted to be a useful tool in the functional evaluation of patients affected by CTEPH and submitted to PEA. The average 6mWD significantly improved already at 3 months after the intervention, thus reaching the minimum limit of the range predicted for the healthy control, but remains lower than the average theoretical value predicted (about 75% of the same).