Physical functioning post-COVID-19 and the recovery process: a mixed methods study

PURPOSE

To describe physical functioning after severe COVID-19-infection.

MATERIALS AND METHOD

An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation.

RESULTS

At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms.

CONCLUSION

Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.

Introducing Mechanically Assisted Cough for Patients with Progressive Neurological Disease: Patient-Physical Therapist Interaction and Physical Therapist Perspective

OBJECTIVE

The goal of this study was to explore patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (MI-E) device treatment for patients with progressive neurological disease.

METHODS

Qualitative content analysis of participant-observation of interaction between patients and physical therapists during 9 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists.

RESULTS

The introduction of MI-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life-situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home-use in an inclusive dialogue with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support.

CONCLUSION

Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing MI-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing MI-E to patients. Further research is needed to explore this from the patient's perspective.

IMPACT

This study added to the body of knowledge regarding MI-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care.

Predictors of Disability Attributed to Symptoms of Increased Interrecti Distance in Women after Childbirth: An Observational Study

OBJECTIVE

The purpose of this study was to investigate how various physical and psychological factors are linked to disability attributed to symptoms from increased interrecti distance (IRD) in women after childbirth.

METHODS

In this cross-sectional observational study, 141 women with an IRD of at least 2 finger-widths and whose youngest child was between the ages of 1 and 8 years participated. A multiple linear regression model was performed, with disability as the outcome variable and fear-avoidance beliefs, emotional distress, body mass index, lumbopelvic pain, IRD, and physical activity level as predictor variables.

RESULTS

The regression model accounted for 60% (R2 = 0.604, adjusted R2 = 0.586) of the variance in disability (F6,132 = 33.5). The 2 strongest predictors were lumbopelvic pain, with a regression coefficient of 1.4 (95% CI = 1.017 to 1.877), and fear avoidance, with a regression coefficient of 0.421 (95% CI = 0.287 to 0.555). The actual IRD, with a regression coefficient of -0.133 (95% CI = -1.154 to 0.888), did not contribute significantly to the variation in disability.

CONCLUSION

Disability attributed to symptoms from an increased IRD is explained primarily by the level of lumbopelvic pain but also by the degree of fear-avoidance beliefs and emotional distress.

IMPACT

This study highlights pain intensity and psychological factors as crucial factors for understanding disability attributed to increased IRD.

Abdominal Muscle Activation During Common Modifications of the Trunk Curl-up Exercise

ABSTRACT

Crommert, ME, Bjerkefors, A, Tarassova, O, and Ekblom, MM. Abdominal muscle activation during common modifications of the trunk curl-up exercise. J Strength Cond Res 35(2): 428-435, 2021-The purpose of this study was to investigate effects of common modifications of trunk curl-up exercise on the involvement of the abdominal muscles, particularly the deepest muscle layer, transversus abdominis (TrA). Ten healthy females performed 5 different variations of the trunk curl-up at a standardized speed, varying the exercise by assuming 3 different arm positions and applying left and right twist. Indwelling fine-wire electromyography (EMG) electrodes were used to record from TrA, obliquus internus (OI), obliquus externus (OE), and rectus abdominis (RA) unilaterally on the right side. Increasing the load by changing the arm position during a straight trunk curl-up increased the EMG of all abdominal muscles. Obliquus internus and TrA showed higher activation during right twist compared with left twist, whereas OE displayed the opposite pattern. Rectus abdominis did not show any change in activation level between twisting directions. The apparent load dependency on the activation level of all muscles, and the twisting direction dependency of all muscles except RA, are in keeping with the fiber orientation of the muscles. Notably, also TrA, with a less obvious mechanical role with regards to fiber orientation, increased activation with load during the straight trunk curl-up. However, the highest activation level of TrA during the trunk curl-up was only 40% of a maximum contraction; thus, it might not be the most suitable strength training exercise for this muscle.

Women's experiences of living with increased inter-recti distance after childbirth: an interview study

Background

Although an increased inter-recti distance, also known as diastasis recti, is common after pregnancy, evidence-based knowledge about the condition is relatively limited. In particular, little is known about the consequences as perceived by the women. The objective of the present study was to describe how postpartum women with increased inter-recti distance experience the condition as well as the contacts they have had with healthcare providers regarding their symptoms.

Methods

A purposeful sampling approach was used to recruit 19 participants from an existing study cohort of 144 women. All participants had an inter-recti distance of at least two finger widths and at least one child, with the youngest child between the ages of 1 and 6 years. Individual interviews based on a semi-structured interview guide were performed and subsequently analysed using qualitative content analysis.

Results

Four categories emerged from the interviews: the body’s function and ability has changed; the body does not look like it used to; uncomprehending attitudes and treatment in their surroundings; and trying to acquire an understanding of and strategies to cope with the diastasis. The findings reveal that women with increased inter-recti distance might experience fear of movement and engage in avoidance behaviour. In combination with feelings of physical instability in the midsection of their bodies and body dissatisfaction, many of the women restrict their everyday lives and physical activities.

Conclusions

The findings indicate that increased inter-recti distance is a complex phenomenon that affects the women in a multitude of ways, highlighting the importance of considering the condition for each individual in her own context from a biopsychosocial perspective.

Can Sonography Be Used to Estimate Deep Abdominal Muscle Activation in Different Static Arm Positions While Standing?

OBJECTIVES

The aim of this study was to investigate whether sonography is a reliable tool for measuring deep abdominal muscle activation in different static arm positions while standing.

METHODS

Sonographic recordings were made of the transversus abdominis and obliquus internus abdominis in 4 different static arm positions that varied with regard to the postural demand and loading direction posed on the trunk. Ten nonconsecutive repetitions of each arm position were performed, and thickness measurements were made at 2 locations within each muscle. Reliability was analyzed by the generalizability theory; comparisons regarding thickness measurements were made by repeated-measures analyses of variance; and fascial sliding was analyzed by a 1-sample t test.

RESULTS

Averaged over all repetitions, arm positions, and the 2 measurement locations, the thickness measurements were highly reliable for both the obliquus internus abdominis and transversus abdominis. The transversus abdominis was thicker with shoulders flexed than with shoulders extended or arms above the head (P < .021) and with arms alongside the body compared with shoulders extended (P < .005). There was no thickness difference between arm positions for the obliquus internus abdominis (P = .059).

CONCLUSIONS

The results indicate that sonographic recordings of the obliquus internus abdominis and transversus abdominis in different static arm positions while standing provide reliable measurements of muscle thickness. However, in light of previously reported electromyographic data, the results raise some concerns regarding the validity of using thickness measurements as proxies for muscle activation in positions that may induce passive muscle deformation.