Hong Kong Physiotherapy Journal最新文献

Background: Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery.

Objective: This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital.

Methods: All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman's rho analysis.

Results: From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5-17) days, and mortality rate was 15.2% ( $n=10$ ). The cohort had a median of 20.5 (IQR 2-25) VFDs to day 28. Community-acquired pneumonia (66.7%, $n=44$ ) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8-21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0-1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, $n=612$ ). Airway suctioning (92.4%, $n=61$ ), patient positioning (72.7%, $n=48$ ) or positioning advice to nurses (77.3%, $n=51$ ), and hyperinflation techniques (63.6%, $n=42$ ) were among the respiratory techniques most delivered.

Conclusion: This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.

Background: Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored.

Objective: This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF.

Methods: A cross-sectional study including individuals with CF aged 6-18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test - MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated.

Results: 30 individuals (20 females) aged $11.2\pm 3.7$ years, mean FEV ${}_{1}62.8\pm 27.6$ %, were included. A sympathovagal balance (LF/HF) increase ( $p<0.001$ ) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV₁ ( $r=0.45$ , $p=0.01$ and $r=0.46$ , $p=0.01$ ; respectively). MST distance also correlated positively and significantly with SDNN ( $r=0.43$ , $p=0.01$ ), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50 ms - RMSSD ( $r=0.53$ , $p<0.01$ ), low frequency - LF ( $r=0.48$ , $p<0.01$ ), HF ( $r=0.64$ , $p<0.01$ ), dispersion of points perpendicular to the short-term identity line - SD1 ( $r=0.40$ , $p=0.02$ ) and negatively with LF/HF ( $r=-0.57$ ,

Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients.

Objective: This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation.

Methods: A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4 h provided between interventions.

Results: The MHI treatment increased the tidal volume [ $V_t$ ; 1.2 mL/kg (95% CI, 0.8-1.5)] and static lung compliance [ $C_{\text{stat}}$ ; 3.7 mL/cmH₂O (95% CI, 2.6-4.8)] immediately post-intervention compared with the baseline ( $p<0.05$ ). Moreover, the MHI with suction induced higher $V_t$ [1.4 mL/kg (95% CI, 0.8-2.1)] and $C_{\text{stat}}$ [3.4 mL/cmH₂O (95% CI, 2.1-4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7 g (95% CI, 0.6-0.8)] was greater in MHI with suction compared with suction alone ( $p<0.05$ ). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ( $p>0.05$ ) between interventions.

Conclusions: MHI can improve $V_t$ , $C_{\text{stat}}$ and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

Background: Trunk stability is key in controlling body balance and movements. Trunk Stabilization Exercises (TSE) and Conventional Trunk Exercises (CTE) are performed to improve dynamic balance. The authors have previously reported that dynamic balance was improved by a 12-week and 6-week TSE program. However, there is a dearth of research on its immediate effect on dynamic balance in trained soccer players.

Objective: To compare the immediate effect of TSE with that of CTE on dynamic balance in trained soccer players.

Methods: Forty-eight male soccer players (24.60 ± 1.38 years) participated in this crossover study, wherein each participant took part in three exercise sessions: TSE, CTE, and No Exercise control (NE), each consisting of three steps: pre-test, intervention and post-test, with an interval of one week between each exercise condition. To assess dynamic balance, the Y Balance Test-Lower Quarter (YBT-LQ) score in the anterior, posteromedial, and posterolateral directions was measured before and 5 minutes after each intervention.

Results: The YBT-LQ composite score was significantly improved after TSE (0.51) as compared to CTE (0.22) and NE (0.04) (p<0.05). Furthermore, in TSE and CTE conditions, YBT-LQ scores of the posterolateral and posteromedial directions significantly improved at the post-test (p<0.05).

Conclusion: Both TSE and CTE are effective in immediately improving dynamic balance; however, TSE showed greater improvement as compared to the latter. Immediate improvements in the posteromedial and posterolateral directions of the YBT-LQ were demonstrated after performing the TSE and CTE.

Background: Various factors, inherited and acquired, are associated with habitual spinal postures.

Objective: The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.

Methods: In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2-22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.

Results: LC and SS angles correlated significantly ( $r=0.80$ , $p<0.001$ ). Statistically significant differences for both LC ( $p=0.023$ ) and SS ( $p=0.013$ ) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ( $r=-0.27$ , $p=0.004$ ); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ( $r=-0.17$ , $p=0.08$ ). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC-SS) in standing and the participants' body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.

Conclusion: The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.

Background: The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi).

Objective: This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines.

Methods: Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India.

Results: The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach's alpha $>$ 0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient $>$ 0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions.

Conclusion: The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.

Objective: The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis.

Methods: Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15.

Results: There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); $p$ -value $=0.005$ , in the control and intervention groups, respectively], with a mean difference (95% CI) of $-0.9$ ( $-1.6$ to $-0.3$ ).

Conclusion: Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04260919.