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Ahmad AM, Abusarea SA, Fouad BZ, Guirguis SA, Shafie WA. Impact of Adding Early Bedside Cycling to Inpatient Cardiac Rehabilitation on Physical Function and Length of Stay after Heart Valve Surgery. A Randomized Controlled Trial. Arch Phys Med Rehabil 2024:S0003-9993(24)00811-6. [PMID: 38367831 DOI: 10.1016/j.apmr.2024.02.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/16/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To assess whether adding bedside cycling to inpatient cardiac rehabilitation (CR) early after heart valve surgery could lead to better physical function and shorter length of hospital stays. DESIGN This is a single-centered, randomized, controlled, parallel-group intervention study. SETTINGS This study was conducted at the National Heart Institute from December 2022 to June 2023. PARTICIPANTS Thirty-one heart valve surgery patients completed this study after being randomized into two groups: an intervention group (n1=16) and an active control group (n2=15). Eligibility criteria were heart valve surgery with median sternotomy, clinical stability, and age from 20 to 40. INTERVENTIONS the intervention group received early bedside cycling for the lower limbs, using a mini bike, in addition to an inpatient CR program, and the control group received the CR program alone. MAIN OUTCOME MEASURE The primary outcome was six-minute walk distance (6MWD). The secondary outcomes comprised forced vital capacity (FVC), Barthel Index (BI), the length of ICU stay, the total length of hospital stay, and the physical component summary (PCS) of the 12-item Short Form (SF-12) Health Survey. RESULTS Compared to the control group, the intervention group showed more improvements in 6MWD (p<0.001), BI score (p<0.001), and FVC (p=0.006) at hospital discharge, and shorter ICU stay (p=0.002) and total hospital stay (0.015). At 1-month follow-up, the intervention group showed a non-significantly better improvement in the PCS of the SF-12 compared to the control group (p=0.057). CONCLUSION Adding early bedside cycling to a usual inpatient CR program after heart valve surgery could induce significantly better short-term physical function as assessed by 6MWD and BI, higher pulmonary function as measured by FVC, and shorter lengths of ICU and total hospital stays than the usual CR program alone. TRIAL REGISTRATION ClinicalTrial.gov (NCT05893433).
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Affiliation(s)
- Ahmad Mahdi Ahmad
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
| | - Salwa Asem Abusarea
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Sandra Aziz Guirguis
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Shen H, Xu Y, Zhang Y, Ren L, Chen R. Correlation Between Diaphragmatic Excursion and Exercise Tolerance Improvement Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease-Obstructive Sleep Apnea Overlap Syndrome. Int J Chron Obstruct Pulmon Dis 2024; 19:63-75. [PMID: 38222322 PMCID: PMC10787556 DOI: 10.2147/copd.s437698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose We assess the predictive value of diaphragm excursion (DE) in enhancing exercise tolerance following pulmonary rehabilitation (PR) among patients with COPD-OSA overlap syndrome. Material and Methods This prospective cohort study enrolled 63 patients diagnosed with COPD-OSA overlap syndrome who actively participated in a PR program from January 2021 to May 2023. Among these, 58 patients successfully completed the 20-week PR program, with exercise tolerance assessed through the measurement of six-minute walk distance (6MWD), and DE evaluated by ultrasonography. The responder to PR in terms of exercise ability was defined as a patient who showed an increase of >30m in 6MWD. The cutoff value for predicting PR response based on DE was determined using receiver operating characteristic (ROC) curves. Results Following the PR program, significant improvements were observed in mMRC, 6MWD, DE during deep breathing, and diaphragm thickness fraction (DTF). Of the participants, 33 patients (57%) were classified as responders, while 25 patients (43%) were considered non-responders. Baseline values of FEV1% predicted, 6MWD, DE during deep breathing, DTF, and PaO2 exhibited a significant elevation in responders as compared to non-responders. The changes of 6MWD were positively associated with the baseline values of DTF and DE during deep breathing, FEV1% predicted and PaO2, while negatively correlated with baseline value of mMRC. The predictive performance in terms of the area under the ROC curve for determining responder's DTF was found to be 0.769, accompanied by a sensitivity of 85% and specificity of 68%, using a cutoff value at 17.26%. Moreover, it was observed that DE during deep breathing could predict the area under the ROC curve for responders to be 0.753, with a sensitivity of 91% and specificity of 56% at a cutoff value of 3.61cm. Conclusion Diaphragm excursion serves as a valuable predictor for determining the enhancement of exercise tolerance following PR in patients with COPD-OSA overlap syndrome. Trial Registration ChiCTR1800020257, www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Honghua Shen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yiming Xu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yin Zhang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Lei Ren
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Rui Chen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
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Agarwal B, Shah M, Sawant B, Bagwe H, Murkudkar P, Mullerpatan R. Predictive equation for six-minute walk test in Indian children, adolescents, and adults. Lung India 2023; 40:143-148. [PMID: 37006098 PMCID: PMC10174647 DOI: 10.4103/lungindia.lungindia_680_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 11/13/2022] [Accepted: 01/07/2023] [Indexed: 03/05/2023] Open
Abstract
Background Post-COVID residual dysfunction has been observed in a majority of people, with reduction in cardiopulmonary endurance emerging as a primary symptom. The Six-Minute Walk Test is a simple, reliable, and valid test that is used routinely on people with chronic respiratory dysfunction. In the current COVID-19 pandemic situation, reference values and a predictive equation developed from a large sample across a large age group, from 6 to 75 years, will enable one to establish goals of treatment for post-COVID rehabilitation. Methods Following institutional ethical clearance, we recruited 1369 participants for the study (685 females and 684 males). Participants were classified according to biological age into group 1 (6-12 years), group 2 (13-17 years), group 3 (18-40 years), group 4 (41-65 years), and group 5 (>65 years). Informed consent was sought and participants were screened using a health history questionnaire. Demographic features, namely, age, height, weight, and body mass index (BMI) were noted. The Six-Minute Walk Test was administered as per ATS guidelines. Clinical parameters, namely, pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and rate of perceived exertion were recorded. Results The Six-Minute Walk Test (6MWT) was significantly influenced by age and gender (r = 0.257, P = 0.00 and r = 0.501, P = 0.00, respectively). Walking distance was longest in 13-17-year-old males, whereas females demonstrated a linear decline after 12 years. In each age group, males walked a greater distance than females. Stepwise linear regression analysis was used to derive the following predictive equation: 6MWT = 491.93 - (2.148 × age) + (107.07 × gender) (females = 0, males = 1). Conclusion The study confirmed variability of the Six-Minute Walk Test, with age and gender being predominant predictors. Reference values, equations, and percentile charts generated from the study can be utilised to guide clinical decision-making while exercise prescription for patients with post COVID dysfunction.
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Affiliation(s)
- Bela Agarwal
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Monal Shah
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Bhoomika Sawant
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Hiranmayee Bagwe
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Payal Murkudkar
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Nakao Y, Kawamura K, Iwase T, Osawa A, Maeshima S, Arai H. Decrease in 6-min walk distance among frail older people. Geriatr Gerontol Int 2023; 23:248-249. [PMID: 36746432 DOI: 10.1111/ggi.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Yuto Nakao
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Koki Kawamura
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taku Iwase
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Aiko Osawa
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shinichiro Maeshima
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
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Atalay OT, Yılmaz A, Bahtiyar BC, Altınışık G. Whole-Body Vibration or Aerobic Exercise in Patients with Bronchiectasis? A Randomized Controlled Study. Medicina (Kaunas) 2022; 58. [PMID: 36556991 DOI: 10.3390/medicina58121790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Background and Objectives: The whole-body vibration (WBV) technique is an exercise training method. It has been reported to improve muscle strength, exercise capacity, and the quality of life. However, there is no study on the use of the WBV technique in bronchiectasis. The aim of the present study is to compare the effect of aerobic exercise with whole-body vibration on exercise capacity, respiratory function, dyspnea, and quality of life (QoL) in bronchiectasis patients. Materials and Methods: Clinically stable bronchiectasis patients aged 18−74 years participated in this study. A pulmonary function test, 6 minute walk test (6MWT), five times sit-to-stand test (FTSST), Modified Medical Research Council (mMRC) Scale, an, St. Georges Respiratory Questionnaire (SGRQ) were used in the evaluation. In total, 41 patients (WBV group: 20, aerobic group: 21) completed the study. The patients were treated for eight weeks. Results: When the two groups were compared after the treatment, there was a significant difference between the mMRC scores in favor of the WBV group (p < 0.05). When the results of the WBV group were examined before and after treatment, a significant difference was found between the 5SST and 6MWT (p < 0.05). When the aerobic group was compared before and after the treatment, it was observed that there was a significant difference in FVC, FVC%, 5SST, 6MWT, and SGRQ total score, and activity and impact scores, which are the sub-parameters (p < 0.05). Conclusions: Eight weeks of WBV exercise can lead to significant improvements in patients with bronchiectasis, exercise capacity, and dyspnea. Larger studies are needed to define the optimal intensity and duration of WBV, as well as to investigate its possible long-term effects.
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Lin CH, Lee CW, Huang CH. Inspiratory Muscle Training Improves Aerobic Fitness in Active Children. Int J Environ Res Public Health 2022; 19:14722. [PMID: 36429439 PMCID: PMC9690705 DOI: 10.3390/ijerph192214722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Research on the effect of inspiratory muscle training (IMT) on exercise performance is inconsistent. IMT has not been applied to fit child athletes, who are more likely to develop inspiratory muscle fatigue, and, consequently, to benefit from IMT. Methods: Thirty children (mean age: 10.7 ± 1.2 years) were recruited and randomly assigned to a high-intensity (HG), a low-intensity (LG), or a control group (CG). For both training groups, a double-blind procedure was applied. In the HG, 80% of maximal inspiratory pressure (MIP) was used as the level of training intensity. The LG used 30% MIP. Training groups were trained at 6 breaths a set, 4 sets a day, totaling 24 breaths a day for 6 weeks. Exercise capacity outcomes include maximal and submaximal aerobic capacity, as measured as VO2max and distance from six-minute walk test (6MWD). Results show improvement in MIP, VO2max, and 6MWD only in the HG. MIP in the HG significantly increases from 108.7 (100.8-143.3) to 144.4 (130.0-175.6) cmH2O. VO2max in the HG increases from 43.0 (40.5-45) to 53.0 (46-63) mL·kg-1·min-1. The 6MWD increases from 792.0 (737.5-818.0) to 862.0 (798.5-953.5) m. Data are presented as median (interquartile range). No difference is found in the LG or CG. Conclusion: high-intensity IMT increases MIP, maximal, and submaximal exercise capacity in the HG, but no difference is found in the LG or CG. Therefore, high-intensity type of IMT improves aerobic fitness in fit children by appropriately applying inspiratory muscle strength training.
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Affiliation(s)
- Ching-Hsin Lin
- Division of Rehabilitation Technology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Chih-Wei Lee
- Department of Physical Therapy, Tzu Chi University, Hualien 970374, Taiwan
| | - Chien-Hui Huang
- Department of Physical Therapy, Tzu Chi University, Hualien 970374, Taiwan
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LaPatra T, Baird GL, Goodman R, Pinder D, Gaffney M, Klinger JR, Palevsky HI, Fritz J, Mullin CJ, Mazurek JA, Kawut SM, Ventetuolo CE. Remote Six-Minute Walk Testing in Patients with Pulmonary Hypertension: A Pilot Study. Am J Respir Crit Care Med 2022; 205:851-854. [PMID: 35015981 DOI: 10.1164/rccm.202110-2421le] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tess LaPatra
- University of Pennsylvania Perelman School of Medicine, 14640, Department of Medicine, Philadelphia, Pennsylvania, United States
| | - Grayson L Baird
- Lifespan Hospital System, Biostatistics Core, Providence, Rhode Island, United States
| | - Randi Goodman
- University of Pennsylvania, 6572, Pulmonary, Allergy, Critical Care, Philadelphia, Pennsylvania, United States
| | - Diane Pinder
- University of Pennsylvania, 6572, Philadelphia, Pennsylvania, United States
| | - Maeve Gaffney
- Columbia University, 5798, New York, New York, United States
| | - James R Klinger
- Rhode Island Hospital, Pulm/CC, Providence, Rhode Island, United States.,Brown Univeristy, Providence, Rhode Island, United States
| | - Harold I Palevsky
- Perelman School of Medicine, Medicine, Philadelphia, Pennsylvania, United States
| | - Jason Fritz
- University of Pennsylvania, Pulmonary, Allergy and Critical Care, 19104, Pennsylvania, United States
| | - Christopher J Mullin
- Brown University Warren Alpert Medical School, 12321, Pulmonary, Critical Care, and Sleep Medicine, Providence, Rhode Island, United States
| | - Jeremy A Mazurek
- University of Pennsylvania, 6572, Philadelphia, Pennsylvania, United States
| | - Steven M Kawut
- University of Pennsylvania Perelman School of Medicine, 14640, Medicine , Philadelphia, Pennsylvania, United States
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Tilea I, Petra DN, Serban RC, Gabor MR, Tilinca MC, Azamfirei L, Varga A. Short-Term Impact of Iron Deficiency in Different Subsets of Patients with Precapillary Pulmonary Hypertension from an Eastern European Pulmonary Hypertension Referral Center. Int J Gen Med 2021; 14:3355-3366. [PMID: 34285560 PMCID: PMC8285229 DOI: 10.2147/ijgm.s318343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Over the last few decades, interest in the role of iron status in pulmonary hypertension (PH) has grown considerably due to its potential impact on symptoms, exercise capacity (as assessed by the 6-minute walk distance [6MWD]), prognosis, and mortality. The aim of the present study was to identify iron deficiency (ID) prevalence in specific precapillary PH subgroups of Romanian patients and its short-term impact on 6MWD. Patients and Methods Complete datasets from 25 precapillary PH adults were examined and included in the analysis. Data were collected at baseline and after continuous follow-up of an average of 13.5 months. Enrolled patients were assigned to group 1 (pulmonary arterial hypertension) or subgroup 4.1 (chronic thromboembolic pulmonary hypertension), and individualized targeted therapy was prescribed. General characteristics, World Health Organization functional class, 6MWD, pulse oximetry, laboratory parameters, and echocardiographic and hemodynamic parameters were recorded. Ferritin values and transferrin saturation were used to assess ID. Results At baseline, 16 out of 25 patients were iron deficient. The univariate linear regression analysis did not show a statistically significant impact of ID on 6MWD (p=0.428). In multivariate regression analysis, possible predictors of 6MWD, including ID, were not statistically significant at baseline or after an average of 13.5 months follow-up (p=0.438, 0.361, respectively) and ID indicates a negative impact on 6MWD independent of applied corrections. Conclusion The results of this study demonstrate that 1.4.1 subgroup PAH patients have an increased prevalence of ID compared with other etiologies. ID has a negative impact on the functional status (assessed by 6MWD), in specific groups and subgroups of patients with precapillary PH, albeit not independently nor significant to other known predictors such as age, gender, oxygen saturation, and hemoglobin value. These data can be integrated with global research and are consistent with phenotypes of patients diagnosed with PH of different etiologies.
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Affiliation(s)
- Ioan Tilea
- Department of Internal Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania.,Department of Cardiology II, County Emergency Clinical Hospital, Targu Mures, 540042, Romania
| | - Dorina Nastasia Petra
- Department of Family Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania.,Department of Internal Medicine II, County Emergency Clinical Hospital, Targu Mures, 540042, Romania
| | - Razvan Constantin Serban
- Cardiac Catheterization Laboratory, The Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, 540136, Romania
| | - Manuela Rozalia Gabor
- Department of Economics and Law, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania
| | - Mariana Cornelia Tilinca
- Department of Internal Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania
| | - Leonard Azamfirei
- Department of Anesthesiology and Intensive Care, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania.,Department of Anesthesiology and Intensive Care, County Emergency Clinical Hospital, Targu Mures, 540042, Romania
| | - Andreea Varga
- Department of Cardiology II, County Emergency Clinical Hospital, Targu Mures, 540042, Romania.,Department of Family Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania
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Sivakumar K, Rohitraj GR, Rajendran M, Thivianathan N. Study of the effect of Occlutech Atrial Flow Regulator on symptoms, hemodynamics, and echocardiographic parameters in advanced pulmonary arterial hypertension. Pulm Circ 2021; 11:2045894021989966. [PMID: 33614019 PMCID: PMC7869179 DOI: 10.1177/2045894021989966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Optimal sized balloon atrial septostomy improves hemodynamics in advanced pulmonary arterial hypertension. Occlutech Atrial Flow Regulator is designed to provide an atrial septal fenestration diameter titrated according to the age and right atrial pressures. This observational study analyzed symptoms, exercise distance, oxygen saturations, hemodynamics and echocardiographic parameters after Atrial Flow Regulator implantation in patients with syncope or right-heart failure. Patients with high-risk predictors of mortality during septostomy were scrutinized. Thirty-nine patients (9 children) with syncope (34/39) or right-heart failure (27/39) underwent Atrial Flow Regulator implantation without procedural complications. Six-minute walk distance increased from 310 ± 158.2 to 376.4 ± 182.6 m, none developed syncope. Oxygen saturations reduced from 96.4 ± 6.4% to 92 ± 4.9% at rest and further to 80.3 ± 5.9% on exercise. Right atrial pressures reduced from 9.4 ± 5 (2-27) mmHg to 6.9 ± 2.6 (1-12) mmHg, while cardiac index increased from 2.4 ± 0.8 (0.98-4.3) to 3 ± 1 (1.1-5.3) L/min/m2 and systemic oxygen transport increased from 546.1 ± 157.9 (256.2-910.5) to 637.2 ± 191.1 (301.3-1020.2) ml/min. Echocardiographic improvement included significant reduction of pericardial effusion and inferior caval congestion at a median follow-up of 37 months. Overall survival improved except two early and one late deaths in high-risk patients. Five of seven patients with advanced disease and key hemodynamic predictors of mortality survived. Acute hemodynamic benefits in pulmonary arterial hypertension after Atrial Flow Regulator were improved cardiac output, systemic oxygen transport, and reduced right atrial pressures. Improvement of symptoms especially syncope, exercise duration, and right ventricular systolic function as well as device patency were sustained on mid-term follow-up. Implantation was safe in all including young children without procedural complications. Mortality was noted only in patients who had high-risk predictors and patients at advanced stage of the disease.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Gopalavilasam R Rohitraj
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Monica Rajendran
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Nithya Thivianathan
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
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Ramani G, Cassady S, Shen E, Broderick M, Wasik A, Sui Q, Nelsen A. Novel dose-response analyses of treprostinil in pulmonary arterial hypertension and its effects on six-minute walk distance and hospitalizations. Pulm Circ 2020; 10:2045894020923956. [PMID: 35154662 PMCID: PMC8826281 DOI: 10.1177/2045894020923956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/12/2020] [Indexed: 12/03/2022] Open
Abstract
Treprostinil is a prostacyclin analogue approved for the treatment of pulmonary
arterial hypertension. Apart from the inhaled formulation, there is neither a
target dose nor a ceiling dose to guide clinicians using treprostinil; doses are
individualized for each patient based upon tolerability and clinical
improvement. Using combined data from the pivotal subcutaneous and oral
treprostinil studies, we evaluated the effect of treprostinil dose on
hospitalization and exercise capacity to better define the treprostinil
dose–response relationship. Data from the pivotal subcutaneous and oral
treprostinil studies were combined by converting oral doses to weight-based
continuous doses (ng/kg/min) accounting for patient weight and bioavailability.
Patients were divided into dose tertiles (lowest, middle, highest 33%) and
retrospectively analyzed. Analysis 1 assessed the effect of dose on pulmonary
arterial hypertension-related and all-cause hospitalizations. Analysis 2
evaluated the effects of dose on six-minute walk distance, Borg dyspnea score,
and World Health Organization functional class. Results showed that, in Analysis
1, higher doses of treprostinil were associated with significantly longer times
to first pulmonary arterial hypertension-related and all-cause hospitalization.
In Analysis 2, there was a trend toward improvements in six-minute walk distance
with higher doses. In patients with pulmonary arterial hypertension on systemic
treprostinil therapy, higher doses were associated with significantly longer
time to first pulmonary arterial hypertension-related and all-cause
hospitalization. There was a trend toward improvements in six-minute walk
distance. Collectively, these results underscore the importance of managing
prostacyclin adverse events in order to achieve appropriate dose titration.
Further studies are required to confirm these findings and to better
characterize the dose–response relationship of treprostinil.
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Affiliation(s)
- Gautam Ramani
- University of Maryland School of Medicine, Department of Cardiovascular Medicine, Baltimore MD, USA
| | - Steven Cassady
- University of Maryand School of Medicine, Department of Pulmonary Medicine, Baltimore MD, USA
| | - Eric Shen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | | | - Allie Wasik
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - Qun Sui
- North Carolina State University, Raleigh, NC, USA
| | - Andrew Nelsen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
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11
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Dhoot S, Mittal S, Singh SP, Patel V, Kasliwal RR, Mehta V. Effect of ferric-carboxy maltose on oxygen kinetics and functional status in heart failure patients with iron deficiency. Future Sci OA 2020; 6:FSO467. [PMID: 32518682 PMCID: PMC7273388 DOI: 10.2144/fsoa-2019-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
There is a very high prevalence of iron deficiency anemia in patients with systolic heart failure. The present study is a prospective, parallel, 1:1 randomized controlled trial of intravenous ferric-carboxy maltose compared with standard of care in patients with heart failure. A total of 70 patients who presented to us with symptomatic chronic heart failure were included and randomly assigned to either groups (35 per group). Post 12 weeks, there were improvements noticed in peak VO2, New York Heart Association functional classification, 6-min walk test distance covered and reduction in Minnesota Living with Heart Failure Questionnaire score in the ferric-carboxy maltose as compared with standard of care group. However, no improvement in ejection fraction was noticed. Iron deficiency is commonly seen in patients with heart failure. This study was performed to observe the effect of intravenous iron therapy (ferric-carboxy maltose) in this population. The outcome showed significant benefit in symptoms and improvement in quality of life. These results are in concordance with other similar trials. Therefore, simple intravenous iron replacement along with other heart failure measures can make life easier for patients with heart failure.
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Affiliation(s)
- Sandip Dhoot
- Department of Cardiology, Dedanta, The Medicity Hospital, Gurgaon, India
| | - Sanjay Mittal
- Department of Cardiology, Dedanta, The Medicity Hospital, Gurgaon, India
| | - Simar Pal Singh
- Department of Cardiology, Dedanta, The Medicity Hospital, Gurgaon, India.,Chelsea & Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital Site, Isleworth, UK
| | - Vishal Patel
- Chelsea & Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital Site, Isleworth, UK
| | - Ravi R Kasliwal
- Department of Cardiology, Dedanta, The Medicity Hospital, Gurgaon, India
| | - Varshil Mehta
- Chelsea & Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital Site, Isleworth, UK
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12
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Liwsrisakun C, Pothirat C, Chaiwong W, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A, Tajarernmuang P, Phetsuk N. Exercise Performance as a Predictor for Balance Impairment in COPD Patients. ACTA ACUST UNITED AC 2019; 55:E171. [PMID: 31137581 DOI: 10.3390/medicina55050171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022]
Abstract
Background and objective: Six-minute walk test (6-MWT) is a widely used test for assessing exercise performance in chronic obstructive pulmonary (COPD). However, the association between reduced walking distance and balance impairment in COPD has not been directly investigated. Therefore, the aim of this study was to identify exercise performance as a predictor for balance impairment in COPD. Materials and Methods: The cross-sectional study was conducted at a single visit involving stable COPD patients in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. The 6-MWT was measured for in all subjects. The prognostic confounding factors were also collected for all subjects. Balance test was measured using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. A cut-off score of BBS < 46 and/or the TUG ≥ 13.5 s was classified as balance impairment. Multivariable logistic regressions were performed to identify the six-minute walk distance (6-MWD) as a predictor for balance impairment in COPD. Results: Of the 176 COPD subjects assessed for eligibility, 118 COPD patients were enrolled including 86 males (72.9%) with a mean age of 73.5 ± 8.1 years. Thirty-three (28.0%) cases were classified with a balance impairment. The 6-MWD < 300 m was the predictor of balance impairment in COPD with an adjusted risk ratio of 10.10 (95%CI; 2.87, 35.61, p-value < 0.001). Conclusions: The 6-MWT is not only useful for evaluation of exercise performance, but also for prediction of balance impairment in patients with COPD. Our study suggests that the 6-MWD < 300 m is an important risk factor for balance impairment in COPD.
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Byrd R, Smith P, Mohamedaly O, Snyder LD, Pastva AM. A 1-Month Physical Therapy-Based Outpatient Program for Adults Awaiting Lung Transplantation: A Retrospective Analysis of Exercise Capacity, Symptoms, and Quality of Life. Cardiopulm Phys Ther J 2019; 30:61-9. [PMID: 30983916 DOI: 10.1097/CPT.0000000000000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose Rehabilitation can improve health outcomes in candidates for lung transplantation. The purpose of this study was to retrospectively evaluate the effect of a one-month physical therapy (PT)-based outpatient program on exercise capacity, symptoms, quality of life and examine predictors of functional outcome changes in adults awaiting lung transplantation. Methods Participants (n=141) completed a 23-session exercise and educational program over one month. Outcomes included 6-minute walk distance (6MWD), San Diego Shortness of Breath Questionnaire (SOBQ), Center for Epidemiological Studies-Depression Scale (CESD), and Ferrans and Powers Quality of Life Index Pulmonary Version III (QOL). Results Participants were older (median age 63) with restrictive (59%) or obstructive (24%) disease. Moderate-to-large improvements in 6MWD were observed (69 m, p < 0.001, d = 0.72), independent of demographics, symptoms, and QOL. Lower initial 6MWD and lower oxygen utilization were associated with greater 6MWD improvements, with largest gains occurring in initial 6MWD < 305 m. Small-to-moderate improvements were observed on CESD (p < 0.001, d = 0.26) and in overall QOL (p < 0.001, d = 0.27), with a non-significant improvement observed on SOBQ (p = 0.248, d = 0.13). Conclusions Completion of a one-month PT-based outpatient rehabilitation program was associated with improved exercise capacity, depressive symptoms and QOL.
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Singh SK, Naaraayan A, Acharya P, Menon B, Bansal V, Jesmajian S. Pulmonary Rehabilitation in Patients with Chronic Lung Impairment from Pulmonary Tuberculosis. Cureus 2018; 10:e3664. [PMID: 30755839 PMCID: PMC6364956 DOI: 10.7759/cureus.3664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Setting Our study was conducted at a tertiary care center for respiratory illnesses (Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India). Patients were enrolled in the study from the outpatient clinic. Objective To assess the effects of pulmonary rehabilitation (PR) in patients with chronic lung impairment from previously treated tuberculosis (CLIPTB), on exercise capacity (six-minute walk distance), pulmonary function tests, quality of life and markers of systemic inflammation. Design Prospective cohort study including 29 patients who had finished anti-tubercular therapy and currently had symptoms of dyspnea with or without cough secondary to CLIPTB. Result Significant improvement in six-minute walk distance (488 meters at baseline vs 526 meters post PR intervention, p-value 0.033) and chronic respiratory questionnaire score (17.21 at baseline vs 18.96 post PR intervention, p-value 0.025) with pulmonary rehabilitation was noted. Pulmonary function tests, inflammatory markers and mid-thigh muscle mass trended towards improvement with pulmonary rehabilitation but were not statistically significant. Conclusion Our study shows that pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and should be recommended.
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Affiliation(s)
- Seema K Singh
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Ashutossh Naaraayan
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Prakash Acharya
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Balakrishnan Menon
- Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, IND
| | - Vishal Bansal
- Physiology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, IND
| | - Stephen Jesmajian
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
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15
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Stewart RAH, Szalewska D, Stebbins A, Al-Khalidi HR, Cleland JGH, Rynkiewicz A, Drazner MH, White HD, Mark DB, Roy A, Kosevic D, Rajda M, Jasinski M, Leng CY, Tungsubutra W, Desvigne-Nickens P, Velazquez EJ, Petrie MC. Six-minute walk distance after coronary artery bypass grafting compared with medical therapy in ischaemic cardiomyopathy. Open Heart 2018. [PMID: 29531766 PMCID: PMC5845417 DOI: 10.1136/openhrt-2017-000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background In patients with ischaemic left ventricular dysfunction, coronary artery bypass surgery (CABG) may decrease mortality, but it is not known whether CABG improves functional capacity. Objective To determine whether CABG compared with medical therapy alone (MED) increases 6 min walk distance in patients with ischaemic left ventricular dysfunction and coronary artery disease amenable to revascularisation. Methods The Surgical Treatment in Ischemic Heart disease trial randomised 1212 patients with ischaemic left ventricular dysfunction to CABG or MED. A 6 min walk distance test was performed both at baseline and at least one follow-up assessment at 4, 12, 24 and/or 36 months in 409 patients randomised to CABG and 466 to MED. Change in 6 min walk distance between baseline and follow-up were compared by treatment allocation. Results 6 min walk distance at baseline for CABG was mean 340±117 m and for MED 339±118 m. Change in walk distance from baseline was similar for CABG and MED groups at 4 months (mean +38 vs +28 m), 12 months (+47 vs +36 m), 24 months (+31 vs +34 m) and 36 months (-7 vs +7 m), P>0.10 for all. Change in walk distance between CABG and MED groups over all assessments was also similar after adjusting for covariates and imputation for missing values (+8 m, 95% CI -7 to 23 m, P=0.29). Results were consistent for subgroups defined by angina, New York Heart Association class ≥3, left ventricular ejection fraction, baseline walk distance and geographic region. Conclusion In patients with ischaemic left ventricular dysfunction CABG compared with MED alone is known to reduce mortality but is unlikely to result in a clinically significant improvement in functional capacity. Trial registration number NCT00023595.
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Affiliation(s)
- Ralph A H Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | | | - Amanda Stebbins
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - John G H Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - Mark H Drazner
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Daniel B Mark
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dragana Kosevic
- Department of Cardiology, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miroslaw Rajda
- Nova Scotia Health Authority, Queen Elizabeth II Health Science Centre, Halifax, Canada
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Chua Yeow Leng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Eric J Velazquez
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark C Petrie
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
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Banerjee D, Kamuren J, Baird GL, Palmisciano A, Krishnan I, Whittenhall M, Klinger JR, Ventetuolo CE. The Modified Borg Dyspnea Scale does not predict hospitalization in pulmonary arterial hypertension. Pulm Circ 2017; 7:384-390. [PMID: 28597751 PMCID: PMC5467923 DOI: 10.1177/2045893217695568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Breathlessness is the most common symptom reported by patients with pulmonary arterial hypertension (PAH). The Modified Borg Dyspnea Scale (MBS) is routinely obtained during the six-minute walk test in the assessment of PAH patients, but it is not known whether the MBS predicts clinical outcomes such as hospitalizations in PAH. Methods We performed a retrospective study of World Health Organization (WHO) Group 1 PAH patients followed at our center. The dates of the first three MBS and hospitalizations that occurred within three months of a documented MBS were collected. Marginal Cox hazard regression modeling was used to assess for a relationship between MBS and all-cause as well as PAH-related hospitalization. Results A total of 50 patients were included; most (92%) were functional class III/IV, 44% and 65% were treatment-naïve prior to their first MBS and hospitalization, respectively. The first recorded MBS was inversely correlated with the first recorded six-minute walk distance (6MWD) (r = –0.41, P < 0.01) but did not track with WHO functional class (r = 0.07, P = 0.63). MBS did not predict all-cause (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.76–1.08; P = 0.28) or PAH-related hospitalization (HR, 1.04; 95% CI, 0.89–1.23; P = 0.61), though there was a strong relationship between 6MWD and PAH-related hospitalization (P = 0.01). These findings persisted after multivariable adjustment. Conclusions Breathlessness as assessed by MBS does not predict all-cause or PAH-related hospitalization. Robust and validated patient-reported outcomes are needed in pulmonary vascular disease.
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Affiliation(s)
- Debasree Banerjee
- 1 Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane Kamuren
- 1 Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Mary Whittenhall
- 1 Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - James R Klinger
- 1 Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Corey E Ventetuolo
- 1 Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,3 Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA
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Hayashi K, Fukumoto K, Yokoi K, Nagaya M, Inoue T, Ito S, Nakajima H, Hattori K, Kadono I, Nishida Y. Post-operative delayed ambulation after thymectomy is associated withpre-operative six-minute walk distance. Disabil Rehabil 2017; 40:1900-1905. [PMID: 28415886 DOI: 10.1080/09638288.2017.1315182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Delayed post-operative ambulation is a risk of post-operative complications and increases overall healthcare costs. We investigated pre-operative and intraoperative variables associated with delayed ambulation in patients who underwent thymectomy. METHODS A total of 57 consecutive patients undergoing thymectomy were included in this study. Pre-operative functional exercise capacity was evaluated by six-minute walk distance. Ambulation was considered to be delayed if the patient could not walk the ward on post-operative day 1. Binary logistic regression analysis was performed to clarify the factors associated with delayed ambulation. RESULTS Pre-operative six-minute walk distance was the only significant variable that was associated with delayed ambulation. The area under the receiver operating characteristic curve for predicting delayed ambulation was 0.684 (95% confidential interval: 0.546-0.823, p = 0.017), and the optimal discriminatory pre-operative six-minute walk distance value was 498 m. Post-operative hospital stay was significantly longer in patients with low six-minute walk distance (<498 m) than those with high six-minute walk distance (≥498 m). In contrast, the presence of myasthenia gravis or adjuvant chemoradiotherapy was not associated with delayed ambulation. CONCLUSIONS Our results suggest that low pre-operative six-minute walk distance is associated with delayed post-operative ambulation and longer post-operative hospital stay in patients who underwent thymectomy. Implications for rehabilitation The predictors for delayed ambulation after thymectomy are not fully investigated. The presence of myasthenia gravis was not associated with delayed ambulation. Low pre-operative six-minute walk distance was associated with delayed ambulation.
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Affiliation(s)
- Kazuhiro Hayashi
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan
| | - Koichi Fukumoto
- b Department of Thoracic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kohei Yokoi
- b Department of Thoracic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Motoki Nagaya
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan
| | - Takayuki Inoue
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan
| | - Satoru Ito
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan.,c Department of Respiratory Medicine , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Hiroki Nakajima
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan
| | - Keiko Hattori
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan
| | - Izumi Kadono
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan.,d Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yoshihiro Nishida
- a Department of Rehabilitation , Nagoya University Hospital , Nagoya , Japan.,d Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Japan
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18
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Moura LM, Quintão MMP, de Carvalho KSR, Carrapatoso BC, Malfacini SLL, da Silva AC, Orsini M, Nascimento OJM, Chermont SSMC. Controlled Study of Correlation of Biomechanical Profile of Hemiparetic Patients with Distance Travelled in Six Minutes. Neurol Int 2015; 7:5417. [PMID: 26487924 PMCID: PMC4591490 DOI: 10.4081/ni.2015.5417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/18/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Abstract
The six-minute walking test (6MWT) is used to assess exercise tolerance that is associated with motor function of the lower limbs in hemiparetic patients. It is suggested that, for post-stroke subjects, performance in the 6MWT may be limited by biomechanical and cardiovascular factors. Our aim is to determine the correlation between the six-minute walk distance (6MWD) and the biomechanical profile of hemiparetic patients. During this cross-sectional controlled study, 10 hemiparetic patients with heart failure underwent 6MWT (ATS protocol). Tonus (Ashworth Scale) and goniometry of the lower limbs were measured. The average of 6MWD in two tests was 279±8 m. There was a negative correlation between the degree of spasticity for both the sural triceps (r=-0.57, P<0.05), quadriceps (r=-0.58, P<0.05) and the limitation in ankle dorsiflexion and the 6MWD (r=-0.76, P<0.05). Also, there was correlation between hip extension and ankle dorsiflexion limitations with 6MWD (r=0.66, P<0.05), (r=0.77, P<0.05). The negative correlation between the highest spasticity in paretic limb and the 6MWD and the correlation between the lower movement range of paretic hip and ankle suggest association with these factors and gait velocity in 6MWT. Loss percentage represents the percentage calculation between distance traveled and the distance predicted achieved by patients. In this study, the negative correlation between the percentage of loss of 6MWD and the limitation in the ankle dorsiflexion movement suggests that for a minor motion arch of the ankle, there is a higher percentage of walking distance loss foretold.
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Affiliation(s)
- Laís Moreira Moura
- The Heart Failure Clinic, School Clinic of Physiotherapy, Serra dos Órgãos University Center , Teresópolis, Brazil
| | - Mônica Maria Pena Quintão
- The Heart Failure Clinic, School Clinic of Physiotherapy, Serra dos Órgãos University Center , Teresópolis, Brazil ; Post Graduate Program in Cardiovascular Sciences, Fluminense Federal University , Niterói, Brazil
| | - Karen Santos R de Carvalho
- The Heart Failure Clinic, School Clinic of Physiotherapy, Serra dos Órgãos University Center , Teresópolis, Brazil
| | | | | | - André Custódio da Silva
- The Heart Failure Clinic, School Clinic of Physiotherapy, Serra dos Órgãos University Center , Teresópolis, Brazil
| | - Marco Orsini
- Fluminense Federal University , Niterói, Brazil ; Masters Program in Science Rehabilitation, Centro Universitário Augusto Motta, Bonsucesso , Rio de Janeiro, Brazil
| | | | - Sergio S M C Chermont
- The Heart Failure Clinic, School Clinic of Physiotherapy, Serra dos Órgãos University Center , Teresópolis, Brazil ; Post Graduate Program in Cardiovascular Sciences, Fluminense Federal University , Niterói, Brazil
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Granger CL, Denehy L, Parry SM, Martin J, Dimitriadis T, Sorohan M, Irving L. Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study. BMC Pulm Med 2015; 15:89. [PMID: 26264470 PMCID: PMC4534028 DOI: 10.1186/s12890-015-0075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer (NSCLC). Cardiopulmonary exercise testing (CPET) is the gold standard measure of exercise capacity; however this laboratory test has limitations for use in research and clinical practice. Alternative field walking tests are the six-minute walk test (6MWT), incremental-shuttle walk test (ISWT) and endurance-shuttle walk test (ESWT); however there is limited information about their clinimetric properties in NSCLC. AIMS In NSCLC to determine the 1) criterion validity of the 6MWT, ISWT and ESWT against CPET; 2) construct validity of the 6MWT, ISWT and ESWT against measures of function, strength, respiratory function and health-related quality of life (HRQoL); and 3) clinical applicability of the tests. METHODS Twenty participants (40 % male, mean ± SD age 66.1 ± 6.5 years) with stage I-IIIb NSCLC completed the 6MWT, ISWT, ESWT and CPET within six months of treatment. Testing order was randomised. Additional measures included Eastern Cooperative Oncology Group Performance-Status (ECOG-PS, function), respiratory function, hand-grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships. RESULTS The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption (r = 0.61, p = 0.007). Relationships between CPET and six minute walk distance (6MWD) (r = 0.24, p = 0.329) or ESWT time (r = 0.02, p = 0.942) were poor. Moderate construct validity existed for the 6MWD and respiratory function (forced vital capacity % predicted r = 0.53, p = 0.019; forced expiratory volume in the first second % predicted r = 0.55, p = 0.015). There were no relationships between the walking tests and measures of function, strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time. No floor effects were seen in the tests. The mean ± SD time required to perform the individual 6MWT, ISWT and ESWT was 12.8 ± 2.5, 14.7 ± 3.7 and 16.3 ± 5.0 min respectively; in comparison to CPET which was 51.2 ± 12.7 min. Only one assessor was required to perform all field walking tests and no adverse events occurred. CONCLUSIONS The ISWT is a promising measure of functional exercise capacity in lung cancer. Findings need to be confirmed in a larger sample prior to translation into practice.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
- Institute for Breathing and Sleep, Heidelberg Road, Heidelberg, VIC, Australia.
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, Australia.
| | - Joel Martin
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Tim Dimitriadis
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Maeve Sorohan
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
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Abstract
Exercise intolerance is the main characteristic of pulmonary arterial hypertension (PAH). The six-minute walk test (6MWT) and cardiopulmonary exercise test are widely used in assessing exercise capacity of PAH patients. Six-minute walk distance (6MWD) has been specified as the main clinical outcome in PAH and has been used as the primary end-point in many studies conducted for new PAH treatments. Using 6MWD as the end-point in clinical studies has many advantages. 6MWT is an inexpensive, easily applicable, and repeatable standardized test that is well-tolerated by PAH patients. Moreover, it is a valid measure of symptomatic improvement. It is correlated with variables of maximal cardiopulmonary exercise test as a measure of submaximal exercise capacity and disease severity markers such as functional class and pulmonary hemodynamics. It is widely used in clinical practice together with other invasive and non-invasive disease markers in assessing disease progression and response to treatment. In addition, it has prognostic importance and is a good prognostic marker. On the other hand, there are limitations to the use of 6MWD as the primary end-point in PAH treatment. It has decreased sensitivity in individuals with less severe disease and high 6MWD at baseline and decreased adequacy in assessing the effects of treatment in patients who are still under PAH treatment. Despite the limitations, 6MWD plays a key role in the evaluation and management of PAH patients.
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Affiliation(s)
- Rengin Demir
- Department of Cardiology, Cardiology Institute, İstanbul University; İstanbul-Turkey.
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Abstract
BACKGROUND: Recent trials involving pirfenidone suggest a beneficial effect in the treatment of idiopathic pulmonary fibrosis (IPF). OBJECTIVE: To report on the efficacy and safety of pirfenidone in the treatment of patients with IPF, at a tertiary care hospital in Saudi Arabia. METHODS: The study included 58 patients with IPF who were evaluated from March 2012 to March 2013. During the study period, 33 patients received pirfenidone, and the remaining patients (n = 25) served as a control group. Baseline clinical characteristics, physiological parameters and the results of a 36-Item Short Form Health Survey (SF-36) were compared between the groups. Furthermore, we compared changes in forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLco), six-minute walk distance (6MWD) and SF-36 for both groups during follow-up. The last follow-up period ended in January 2014. RESULTS: There were no significant differences in baseline clinical characteristics between the groups. Furthermore, we found no differences in FVC, DLco and SF-36 during follow-up (median, 12 months). However, patients receiving pirfenidone treatment were less likely to experience reductions in 6MWD compared with the control group (13% vs. 52%, respectively; P = 0.001). Although adverse events were more frequently reported by the pirfenidone group compared with the control group (85 vs. 56%, respectively; P = 0.015), these patients did not require discontinuation of treatment. CONCLUSION: Pirfenidone treatment preserves functional capacity, as reflected by the 6MWD. Adverse events associated with pirfenidone treatment were generally well tolerated by the patients.
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Affiliation(s)
- Esam H Alhamad
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ijiri N, Kanazawa H, Yoshikawa T, Hirata K. Application of a new parameter in the 6-minute walk test for manifold analysis of exercise capacity in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:1235-40. [PMID: 25395845 PMCID: PMC4224096 DOI: 10.2147/copd.s71383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND New parameters in the 6-minute walk test (6 MWT) are required for comprehensive analysis of exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to apply a novel index, the desaturation distance ratio (DDR), to clinical research on COPD as an estimate of exercise capacity and to examine whether DDR is a potential parameter for manifold analysis of exercise capacity in patients with COPD. METHODS A total of 41 patients with COPD (median age [interquartile range] =75 [68-79] years; and body mass index [BMI] =22.3 [19.4-23.8] kg/m(2)) participated in the study. The 6 MWT was performed along with anthropometric measurements and a pulmonary function test. The "desaturation area" was measured as the total area above the curve created using peripheral oxygen saturation (SpO2) values observed at each minute during the 6 MWT. Then the DDR was calculated as the ratio of the desaturation area to the 6-minute walk distance (6 MWD). RESULTS The 6 MWD was 370 (328-445) m, and the decline in SpO2 values (ΔSpO2) was -5.0% (-8.0% to -1.5%). The DDR correlated modestly with baseline pulmonary function in patients with COPD (forced expiratory volume in 1 second [% of predicted value]: r=-0.658, P<0.001; and diffusing capacity of the lung for carbon monoxide [DL(CO)]: r=-0.470, P=0.002), comparable with the findings of the 6 MWD. The DDR correlated well with ΔSpO2 (r=-0.656, P<0.001) and with the increase in subjective sense of dyspnea during the 6 MWT, as assessed by Borg scale scores (ΔBorg) (r=0.486, P=0.001), in contrast with the 6 MWD, which was not significantly correlated with ΔSpO2 and ΔBorg scale scores. CONCLUSION The DDR is more informative for manifold analysis of exercise capacity associated with oxygen desaturation and subsequent sense of dyspnea by exercise in patients with COPD.
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Affiliation(s)
- Naoki Ijiri
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahiro Yoshikawa
- Department of Sports Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Datta D, ZuWallack RL. Measuring unsupported arm lifts as an outcome in pulmonary rehabilitation of chronic obstructive pulmonary disease patients. Chron Respir Dis 2014; 10:159-63. [PMID: 23897931 DOI: 10.1177/1479972313497371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation includes upper and lower extremity exercise training. While validated tests such as the six-minute walk distance (6MWD) and shuttle walk tests are available to evaluate the effectiveness of lower extremity training, the optimal method of evaluating the effectiveness of upper extremity training has not been determined. This study evaluates the potential utility of unsupported arm lifts (UALs) testing as an outcome measurement for pulmonary rehabilitation. Records of chronic obstructive pulmonary disease (COPD) patients who underwent outpatient pulmonary rehabilitation at our institution were reviewed. Outcomes assessed before and immediately after the intervention included 6MWD, the self-administered Chronic Respiratory Questionnaire (CRQ-SA), and UALs. For the latter, the patient repeatedly raises a wooden dowel from thigh to arm level, with the number of repetitions per minute used as the outcome. Changes in variables from pre- to post-pulmonary rehabilitation were analyzed using paired t test. Pearson correlation coefficients were used to evaluate associations. Of the 241 patients, 51% were male. Mean age was 69 ± 9 years, body mass index was 28 ± 7 kg/m(2), and forced expiratory volume in 1 second was 50 ± 20 percent-predicted. All studied variables increased significantly post-pulmonary rehabilitation: the 6MWD by 45 ± 50 m (effect size 0.49), the CRQ-SA total score by 0.84 ± 0.86 units (effect size 0.89), and UAL by 12 ± 13 lifts/minute (effect size 0.75; p < 0.0001 for all). As a measure of upper extremity exercise capacity, UAL appears to be responsive to the comprehensive pulmonary rehabilitation intervention. Using effect sizes, the degree of improvement appears to be between that of 6MWD and CRQ-SA. UAL may be a useful outcome assessment for pulmonary rehabilitation in COPD patients.
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Affiliation(s)
- Debapriya Datta
- Department of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, Farmington, CT, USA
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