Pub Date : 2009-01-01DOI: 10.1016/S0004-9514(09)70047-9
Sarah E. Lamb
Question
Does assessment by a multidisciplinary team, or assessment by a community nurse with the ability to refer to other professionals, reduce further falls in recurrent fallers?
Design
Cluster-randomised, controlled trial.
Setting
18 general practices in the UK.
Participants
Adults aged at least 65 years, living in the community, who had experienced 2 or more falls in the past year, and who did not present to an emergency department for their most recent fall. Inability to participate for one year, abbreviated mental test score less than 7, and nursing home placement were exclusion criteria. Randomisation of 516 participants allotted 213 to care by the multidisciplinary team (secondary care), 141 to care by the community nurse (primary care), and 162 to usual care.
Interventions
Participants allocated to secondary care attended a multidisciplinary clinic (comprising a doctor, nurse, physiotherapist, and occupational therapist) with referral for investigations, interventions (including Homecheck), and follow-up if necessary. Participants allocated to primary care were assessed by a community nurse who identified risk factors for falls and could refer to other professionals. Participants in the usual care group were assessed by their usual primary care physicians, who provided management at their own discretion.
Outcome measures
The primary outcome was the proportion of participants in each group who had at least one fall during the follow-up period of 12 months. Other outcomes were death, move to institutional care, change in Barthel score, change in the timed Get Up and Go score, fall-related fractures, and hospitalisations. Participants lost to follow-up were assumed to have had an adverse outcome.
Results
466 participants contributed data to the primary outcome, with an adverse outcome assumed for a further 39 participants on falls and other dichotomous outcomes. At 12 months, 75% of the secondary care group, 87% of the primary care group, and 84% of the usual care group had fallen. Secondary care prevented significantly more falls than usual care (adjusted odds ratio 0.52, 95% CI 0.35 to 0.79). The secondary care group also had a significantly more positive Barthel index than the usual care group. The groups did not significantly differ on the other outcomes. The data were also analysed without imputing adverse outcomes for participants who were lost to follow-up. Compared to the usual care group, the secondary care group had significantly fewer falls, fractures, hospitalisations, and deaths.
Conclusion
Multidisciplinary assessment of elderly, recurrent fallers reduces the risk of further falls compared to usual care. Assessment of risk factors for falls by a community nurse with the potential to refer to other professionals did not have the same benef
由多学科小组进行评估，或由有能力转诊其他专业人员的社区护士进行评估，是否能减少复发性跌倒者的进一步跌倒?设计群-随机对照试验。在英国设置18个一般做法。参与者年龄至少65岁，居住在社区，在过去一年中经历过2次或2次以上跌倒，并且最近一次跌倒没有出现在急诊室。排除标准为1年无参与能力、简略智力测验得分低于7分、安置在养老院。516名参与者随机分配213名由多学科团队护理(二级护理)，141名由社区护士护理(初级护理)，162名接受常规护理。干预措施被分配到二级保健的参与者前往多学科诊所(由医生、护士、物理治疗师和职业治疗师组成)进行调查、干预(包括家庭检查)和必要时的随访。被分配到初级保健的参与者由一名社区护士进行评估，该护士确定了跌倒的危险因素，并可以参考其他专业人员。常规护理组的参与者由他们的常规初级保健医生进行评估，他们根据自己的判断提供管理。主要结果是每组参与者在12个月的随访期间至少有一次跌倒的比例。其他结果包括死亡、转到机构护理、Barthel评分改变、Get Up and Go计时评分改变、跌倒相关骨折和住院。失去随访的参与者被认为有不良结果。结果466名参与者为主要结局提供了数据，另外39名参与者在跌倒和其他二分结局方面假设有不良结局。在12个月时，75%的二级护理组、87%的初级护理组和84%的常规护理组下降了。二级护理比常规护理更能预防跌倒(校正优势比0.52,95% CI 0.35 ~ 0.79)。二级护理组Barthel指数明显高于常规护理组。两组在其他结果上没有显著差异。对数据进行了分析，但没有对失去随访的参与者的不良结果进行归因。与常规护理组相比，二级护理组的跌倒、骨折、住院和死亡明显减少。结论与常规护理相比，多学科评估老年人复发性跌倒可降低进一步跌倒的风险。由社区护士对跌倒风险因素进行评估，并有可能转诊给其他专业人员，却没有同样的好处。
{"title":"Multidisciplinary assessment of elderly people with a history of multiple falls reduces the risk of further falls","authors":"Sarah E. Lamb","doi":"10.1016/S0004-9514(09)70047-9","DOIUrl":"10.1016/S0004-9514(09)70047-9","url":null,"abstract":"<div><h3>Question</h3><p>Does assessment by a multidisciplinary team, or assessment by a community nurse with the ability to refer to other professionals, reduce further falls in recurrent fallers?</p></div><div><h3>Design</h3><p>Cluster-randomised, controlled trial.</p></div><div><h3>Setting</h3><p>18 general practices in the UK.</p></div><div><h3>Participants</h3><p>Adults aged at least 65 years, living in the community, who had experienced 2 or more falls in the past year, and who did not present to an emergency department for their most recent fall. Inability to participate for one year, abbreviated mental test score less than 7, and nursing home placement were exclusion criteria. Randomisation of 516 participants allotted 213 to care by the multidisciplinary team (secondary care), 141 to care by the community nurse (primary care), and 162 to usual care.</p></div><div><h3>Interventions</h3><p>Participants allocated to secondary care attended a multidisciplinary clinic (comprising a doctor, nurse, physiotherapist, and occupational therapist) with referral for investigations, interventions (including Homecheck), and follow-up if necessary. Participants allocated to primary care were assessed by a community nurse who identified risk factors for falls and could refer to other professionals. Participants in the usual care group were assessed by their usual primary care physicians, who provided management at their own discretion.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was the proportion of participants in each group who had at least one fall during the follow-up period of 12 months. Other outcomes were death, move to institutional care, change in Barthel score, change in the timed Get Up and Go score, fall-related fractures, and hospitalisations. Participants lost to follow-up were assumed to have had an adverse outcome.</p></div><div><h3>Results</h3><p>466 participants contributed data to the primary outcome, with an adverse outcome assumed for a further 39 participants on falls and other dichotomous outcomes. At 12 months, 75% of the secondary care group, 87% of the primary care group, and 84% of the usual care group had fallen. Secondary care prevented significantly more falls than usual care (adjusted odds ratio 0.52, 95% CI 0.35 to 0.79). The secondary care group also had a significantly more positive Barthel index than the usual care group. The groups did not significantly differ on the other outcomes. The data were also analysed without imputing adverse outcomes for participants who were lost to follow-up. Compared to the usual care group, the secondary care group had significantly fewer falls, fractures, hospitalisations, and deaths.</p></div><div><h3>Conclusion</h3><p>Multidisciplinary assessment of elderly, recurrent fallers reduces the risk of further falls compared to usual care. Assessment of risk factors for falls by a community nurse with the potential to refer to other professionals did not have the same benef","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 2","pages":"Page 139"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70047-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28249610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-01-01DOI: 10.1016/S0004-9514(09)70082-0
Kotaro Tamari
Question
What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program?
Design
A prospective cohort observational study.
Participants
63 Japanese men and women over 65 years with mild disability.
Outcome measures
Health-related quality of life was measured using the Short Form 36. Predictors included age, sex, body mass index, presence of chronic diseases, frequency of exercise, number of falls, and activity limitations measured before undertaking the exercise program.
Results
The presence of diabetes negatively predicted a good outcome (OR 0.20, 95% CI 0.05 to 0.88) and positively predicted a poor outcome (OR 4.40, 95% CI 1.21 to 18.86) when adjusted for age, sex and body mass index. The accuracy of the prediction of a good outcome was 1.25 (LR+) and 0.44 (LR−). The accuracy of the prediction of a poor outcome was 7.15 (LR+) and 0.87 (LR−).
Conclusion
The quality of life improved in a community-dwelling elderly population with mild disability who undertook a three-month group-based progressive resistance exercise program. However, those with diabetes mellitus were more likely to experience decreased quality of life. Therefore, health care providers need to monitor carefully participants with this disease who are undertaking progressive resistance exercise.
问题:在社区居住的老年人中，进行三个月的渐进式阻力运动项目，哪些基线特征预示着生活质量的好坏?设计一项前瞻性队列观察研究。参与者:63名65岁以上轻度残疾的日本男性和女性。结果测量健康相关的生活质量使用短表36进行测量。预测因素包括年龄、性别、体重指数、慢性病的存在、运动频率、跌倒次数和运动前测量的活动限制。当调整年龄、性别和体重指数时，糖尿病的存在负向预测预后良好(OR 0.20, 95% CI 0.05 ~ 0.88)，正向预测预后不良(OR 4.40, 95% CI 1.21 ~ 18.86)。预测良好预后的准确度分别为1.25 (LR+)和0.44 (LR -)。预测不良预后的准确率分别为7.15 (LR+)和0.87 (LR -)。结论:在社区居住的轻度残疾老年人群中，进行为期三个月的渐进式阻力运动后，生活质量得到改善。然而，那些患有糖尿病的人更有可能经历生活质量下降。因此，卫生保健提供者需要仔细监测正在进行进行性抵抗运动的这种疾病的参与者。
{"title":"Diabetes predicts decreased quality of life among community-dwelling seniors undertaking progressive resistance exercise: an observational study","authors":"Kotaro Tamari","doi":"10.1016/S0004-9514(09)70082-0","DOIUrl":"10.1016/S0004-9514(09)70082-0","url":null,"abstract":"<div><h3>Question</h3><p>What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program?</p></div><div><h3>Design</h3><p>A prospective cohort observational study.</p></div><div><h3>Participants</h3><p>63 Japanese men and women over 65 years with mild disability.</p></div><div><h3>Outcome measures</h3><p>Health-related quality of life was measured using the Short Form 36. Predictors included age, sex, body mass index, presence of chronic diseases, frequency of exercise, number of falls, and activity limitations measured before undertaking the exercise program.</p></div><div><h3>Results</h3><p>The presence of diabetes negatively predicted a good outcome (OR 0.20, 95% CI 0.05 to 0.88) and positively predicted a poor outcome (OR 4.40, 95% CI 1.21 to 18.86) when adjusted for age, sex and body mass index. The accuracy of the prediction of a good outcome was 1.25 (LR+) and 0.44 (LR−). The accuracy of the prediction of a poor outcome was 7.15 (LR+) and 0.87 (LR−).</p></div><div><h3>Conclusion</h3><p>The quality of life improved in a community-dwelling elderly population with mild disability who undertook a three-month group-based progressive resistance exercise program. However, those with diabetes mellitus were more likely to experience decreased quality of life. Therefore, health care providers need to monitor carefully participants with this disease who are undertaking progressive resistance exercise.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 3","pages":"Pages 201-205"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70082-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28340603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-01-01DOI: 10.1016/S0004-9514(09)70012-1
Colleen G. Canning
Question
Does injection of Botulinum toxin followed by constraint-induced movement therapy improve spasticity and upper limb motor function more than the same injection followed by rehabilitation based on neurodevelopmental techniques?
Design
Randomised trial with concealed allocation and blinded outcome assessment.
Setting
Rehabilitation department of a tertiary hospital in Taiwan.
Participants
Adults at least one year after a stroke with a Modified Ashworth Scale (MAS) score of 3 or more in the elbow, wrist, or finger flexors, and with at least 10 degrees of active interphalangeal and metacarpophalangeal extension and 20 degrees of wrist extension. Fixed contractures, major co-morbidities, and previous Botulinum toxin injection or surgery for spasticity were exclusion criteria. Randomisation of 32 participants allotted 16 to each group.
Interventions
Both groups received a total dose of 1000 units of Botulinum toxin type A, injected at standard muscular sites in the affected upper limb, and commenced their 3-month rehabilitation regimen the following day. The intervention group underwent intensive training of the affected upper limb for 2 hours, 3 times per week, while the non-affected upper limb was restrained for at least 5 hours per day. Selected tasks were progressed in complexity, with some assistance with movements and verbal feedback and encouragement. The control group received 1 hour each of physiotherapy and occupational therapy, 3 times per week. Therapy was based on neurodevelopmental techniques, focusing on normalising tone, and movement patterns.
Outcome measures
The primary outcome was the MAS (0 = no spasticity, 4 = rigid in flexion or extension). Secondary outcomes included the Motor Activity Log (MAL), comprising two 6-point scales of amount of use and quality of movement, and the Action Research Arm Test (ARAT), which rates 19 tasks from 0 (no movement possible) to 3 (normal movement), to give a total score out of 57.
Results
29 participants completed the study. At 6 months, the treatment group had significantly greater reduction in MAS scores for the elbow (0.7, 95% CI 0.1 to 1.3), wrist (0.7, 95% CI 0.2 to 1.2), and fingers (1.2, 95% CI 0.9 to 1.5). Also at 6 months, the treatment group had significantly greater improvement in amount of use (1.1, 95% CI 0.8 to 1.4), quality of movement (0.9, 95% CI 0.6 to 1.2), and ARAT scores (7, 95% CI 4 to 10).
Conclusion
Injection of Botulinum toxin followed by constraint-induced movement therapy improves spasticity and upper limb motor function more than the same injection followed by rehabilitation based on neurodevelopmental techniques.
问题:注射肉毒毒素后进行限制性运动治疗是否比同样注射肉毒毒素后进行基于神经发育技术的康复治疗更能改善痉挛和上肢运动功能?随机试验，隐匿分配和盲法结局评估。设置:台湾某三级医院康复科。参与者:中风后至少一年，肘关节、腕关节或手指屈肌的改良Ashworth量表(MAS)得分为3分或以上，指间和掌指关节活动至少10度，腕关节活动至少20度的成年人。排除标准为固定挛缩、主要合并症和既往注射肉毒杆菌毒素或痉挛手术。32名参与者随机分配，每组16名。干预措施两组患者均接受总剂量为1000单位的a型肉毒杆菌毒素，注射于受影响上肢的标准肌肉部位，并于次日开始为期3个月的康复治疗。干预组对患肢进行强化训练，每周3次，每次2小时，而对非患肢进行每天至少5小时的约束。在动作、口头反馈和鼓励的帮助下，选定的任务在复杂程度上取得进展。对照组患者接受物理治疗和职业治疗各1小时，每周3次。治疗以神经发育技术为基础，重点是使音调和运动模式正常化。主要终点是MAS(0 =无痉挛，4 =屈伸僵硬)。次要结果包括运动活动日志(MAL)，包括使用数量和运动质量的两个6分制量表，以及行动研究臂测试(ARAT)，该测试对19项任务进行评分，从0(不可能运动)到3(正常运动)，总分为57分。结果29名参与者完成了研究。6个月时，治疗组肘关节(0.7,95% CI 0.1至1.3)、手腕(0.7,95% CI 0.2至1.2)和手指(1.2,95% CI 0.9至1.5)的MAS评分显著降低。同样在6个月时，治疗组在使用量(1.1,95% CI 0.8至1.4)、运动质量(0.9,95% CI 0.6至1.2)和ARAT评分(7,95% CI 4至10)方面有显著更大的改善。结论注射肉毒毒素后进行限制性运动治疗对痉挛和上肢运动功能的改善效果优于注射肉毒毒素后进行基于神经发育技术的康复治疗。
{"title":"Constraint-induced movement therapy after injection of Botulinum toxin improves spasticity and motor function in chronic stroke patients","authors":"Colleen G. Canning","doi":"10.1016/S0004-9514(09)70012-1","DOIUrl":"10.1016/S0004-9514(09)70012-1","url":null,"abstract":"<div><h3>Question</h3><p>Does injection of Botulinum toxin followed by constraint-induced movement therapy improve spasticity and upper limb motor function more than the same injection followed by rehabilitation based on neurodevelopmental techniques?</p></div><div><h3>Design</h3><p>Randomised trial with concealed allocation and blinded outcome assessment.</p></div><div><h3>Setting</h3><p>Rehabilitation department of a tertiary hospital in Taiwan.</p></div><div><h3>Participants</h3><p>Adults at least one year after a stroke with a Modified Ashworth Scale (MAS) score of 3 or more in the elbow, wrist, or finger flexors, and with at least 10 degrees of active interphalangeal and metacarpophalangeal extension and 20 degrees of wrist extension. Fixed contractures, major co-morbidities, and previous Botulinum toxin injection or surgery for spasticity were exclusion criteria. Randomisation of 32 participants allotted 16 to each group.</p></div><div><h3>Interventions</h3><p>Both groups received a total dose of 1000 units of Botulinum toxin type A, injected at standard muscular sites in the affected upper limb, and commenced their 3-month rehabilitation regimen the following day. The intervention group underwent intensive training of the affected upper limb for 2 hours, 3 times per week, while the non-affected upper limb was restrained for at least 5 hours per day. Selected tasks were progressed in complexity, with some assistance with movements and verbal feedback and encouragement. The control group received 1 hour each of physiotherapy and occupational therapy, 3 times per week. Therapy was based on neurodevelopmental techniques, focusing on normalising tone, and movement patterns.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was the MAS (0 = no spasticity, 4 = rigid in flexion or extension). Secondary outcomes included the Motor Activity Log (MAL), comprising two 6-point scales of amount of use and quality of movement, and the Action Research Arm Test (ARAT), which rates 19 tasks from 0 (no movement possible) to 3 (normal movement), to give a total score out of 57.</p></div><div><h3>Results</h3><p>29 participants completed the study. At 6 months, the treatment group had significantly greater reduction in MAS scores for the elbow (0.7, 95% CI 0.1 to 1.3), wrist (0.7, 95% CI 0.2 to 1.2), and fingers (1.2, 95% CI 0.9 to 1.5). Also at 6 months, the treatment group had significantly greater improvement in amount of use (1.1, 95% CI 0.8 to 1.4), quality of movement (0.9, 95% CI 0.6 to 1.2), and ARAT scores (7, 95% CI 4 to 10).</p></div><div><h3>Conclusion</h3><p>Injection of Botulinum toxin followed by constraint-induced movement therapy improves spasticity and upper limb motor function more than the same injection followed by rehabilitation based on neurodevelopmental techniques.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 4","pages":"Page 286"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70012-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28522541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70050-3
Shylie Mackintosh
Question
For people with osteoarthritis of the hip or knee, do hydrotherapy or Tai Chi give worthwhile improvements in pain and physical function?
Design
Randomised, 3-arm, parallel, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
Setting
Tertiary hospital, Sydney, Australia.
Participants
Adults aged 59–85 years, with osteoarthritis of the hip or knee meeting American College of Rheumatology criteria, recruited through advertisements, social clubs for older people, and referral from local general practitioners and rheumatologists. 55 participants were randomised to hydrotherapy, 56 to Tai Chi, and 41 to a control group.
Interventions
Participants in either of the two treatments groups were required to attend classes (max 15 participants) for one hour, twice per week for 12 weeks. Hydrotherapy involved lower limb exercise in waist-deep water, including walking, free-standing and bar work, running, and stairs. Tai Chi included a 10-minute warm-up followed by a modification of 24 forms of Sun style Tai Chi. Participants were allowed to purchase, if they desired, a Tai Chi video to assist with home practice. The control group were waitlisted for 12 weeks and then randomly allocated to one of the two treatments.
Outcomes
The primary outcomes were pain and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included the SF-12 general health status questionnaire; the Depression, Anxiety and Stress Scale of psychological well being; the participant's global assessment of treatment effectiveness and current status of the joint that had originally been the most painful; and physical performance measures (50-foot walk test, stair climb test, and Up and Go test). Outcomes were assessed at the end of the 12-week treatment period, and 12 weeks later.
Results
At the end of treatment, pain had improved by 6 points (95% CI 0 to 13) more in the hydrotherapy group than the control group. Similarly, physical function had improved by 10 points (95% CI 4 to 14) more in the hydrotherapy group and by 10 points (95%CI 3 to 17) more in the Tai Chi group. The hydrotherapy group also showed significant treatment benefits in the physical component summary of the SF-12 and the three physical performance measures. Twelve weeks later, comparisons with a no-treatment control group were not possible, but the outcomes that had improved significantly during treatment had mostly been maintained.
Conclusion
Older people with osteoarthritis of the hip or knee can obtain clinically worthwhile improvements in physical function from hydrotherapy or Tai Chi.
对于患有髋关节或膝关节骨关节炎的人来说，水疗或太极能有效改善疼痛和身体机能吗?设计随机、三臂、平行、对照试验，采用隐蔽分配、评估者盲法和意向治疗分析。第三医院，悉尼，澳大利亚。参与者年龄在59-85岁之间，患有髋关节或膝关节骨关节炎，符合美国风湿病学会的标准，通过广告、老年人社交俱乐部和当地全科医生和风湿病学家的推荐招募。55名参与者被随机分配到水疗组，56人被分配到太极拳组，41人被分配到对照组。干预措施两个治疗组的参与者都被要求参加课程(最多15人)，每周两次，每次一小时，持续12周。水疗法包括在齐腰深的水中进行下肢运动，包括散步、独立行走、酒吧工作、跑步和爬楼梯。太极拳包括10分钟的热身，然后是24种太阳式太极拳的修改。参与者可以购买，如果他们愿意，太极视频，以协助家庭练习。对照组等待12周，然后随机分配到两种治疗中的一种。主要结果是疼痛和身体功能，由安大略省西部和麦克马斯特大学骨关节炎指数(WOMAC)测量。次要结局包括SF-12一般健康状况问卷;心理健康抑郁、焦虑、压力量表;参与者对治疗效果和最初最疼痛关节现状的总体评估;以及体能测试(50英尺步行测试、爬楼梯测试和Up and Go测试)。在12周治疗期结束和12周后评估结果。结果治疗结束时，水疗法组疼痛改善程度较对照组高6点(95% CI 0 ~ 13)。同样，水疗组的身体机能改善了10个点(95%CI 4至14)，太极拳组的身体机能改善了10个点(95%CI 3至17)。在SF-12的物理成分总结和三项物理性能测量中，水疗组也显示出显著的治疗益处。12周后，无法与未治疗对照组进行比较，但治疗期间显著改善的结果大部分得到了维持。结论老年髋关节或膝关节骨性关节炎患者通过水疗或太极治疗可获得临床有价值的身体功能改善。
{"title":"Hydrotherapy and Tai Chi each provide clinical improvements for older people with osteoarthritis","authors":"Shylie Mackintosh","doi":"10.1016/S0004-9514(08)70050-3","DOIUrl":"10.1016/S0004-9514(08)70050-3","url":null,"abstract":"<div><h3>Question</h3><p>For people with osteoarthritis of the hip or knee, do hydrotherapy or Tai Chi give worthwhile improvements in pain and physical function?</p></div><div><h3>Design</h3><p>Randomised, 3-arm, parallel, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.</p></div><div><h3>Setting</h3><p>Tertiary hospital, Sydney, Australia.</p></div><div><h3>Participants</h3><p>Adults aged 59–85 years, with osteoarthritis of the hip or knee meeting American College of Rheumatology criteria, recruited through advertisements, social clubs for older people, and referral from local general practitioners and rheumatologists. 55 participants were randomised to hydrotherapy, 56 to Tai Chi, and 41 to a control group.</p></div><div><h3>Interventions</h3><p>Participants in either of the two treatments groups were required to attend classes (max 15 participants) for one hour, twice per week for 12 weeks. Hydrotherapy involved lower limb exercise in waist-deep water, including walking, free-standing and bar work, running, and stairs. Tai Chi included a 10-minute warm-up followed by a modification of 24 forms of Sun style Tai Chi. Participants were allowed to purchase, if they desired, a Tai Chi video to assist with home practice. The control group were waitlisted for 12 weeks and then randomly allocated to one of the two treatments.</p></div><div><h3>Outcomes</h3><p>The primary outcomes were pain and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included the SF-12 general health status questionnaire; the Depression, Anxiety and Stress Scale of psychological well being; the participant's global assessment of treatment effectiveness and current status of the joint that had originally been the most painful; and physical performance measures (50-foot walk test, stair climb test, and Up and Go test). Outcomes were assessed at the end of the 12-week treatment period, and 12 weeks later.</p></div><div><h3>Results</h3><p>At the end of treatment, pain had improved by 6 points (95% CI 0 to 13) more in the hydrotherapy group than the control group. Similarly, physical function had improved by 10 points (95% CI 4 to 14) more in the hydrotherapy group and by 10 points (95%CI 3 to 17) more in the Tai Chi group. The hydrotherapy group also showed significant treatment benefits in the physical component summary of the SF-12 and the three physical performance measures. Twelve weeks later, comparisons with a no-treatment control group were not possible, but the outcomes that had improved significantly during treatment had mostly been maintained.</p></div><div><h3>Conclusion</h3><p>Older people with osteoarthritis of the hip or knee can obtain clinically worthwhile improvements in physical function from hydrotherapy or Tai Chi.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 2","pages":"Page 143"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70050-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27451799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70028-X
Paul Smith , Mary Galea , Michael Woodward , Catherine Said , Michael Dorevitch
Question
Are there differences in physical activity between older adults undergoing inpatient rehabilitation and those living in the community? Are there differences in physical activity within and between these two groups on weekdays compared to weekends? Are there differences in physical activity within and between these two groups over the day?
Design
An observational study.
Participants
Twenty-five elderly patients (aged 81 years) undergoing rehabilitation and 25 age- and gender-matched community-dwelling people (aged 80 years).
Outcome measures
The Positional Activity Logger was used to measure the frequency and duration of time spent upright (uptime), over three consecutive days, including a weekend day.
Results
The inpatient group achieved a median daily uptime of 1.3 hours which was significantly less than the community group's median of 5.5 hours (p < 0.001). Uptime for inpatients was significantly greater on weekdays (1.6 hours) when therapy was available than on weekend days (1.1 hours) when therapy was generally not available (p < 0.001), whereas uptime for community participants was no different on weekdays (5.9 hours) than on weekend days (4.8 hours) (p = 0.05). Median uptime was significantly less for the inpatient group than for the community group at all times of day (p < 0.001).
Conclusion
Elderly patients undergoing rehabilitation spend much of the day less physically active than their community peers.
{"title":"Physical activity by elderly patients undergoing inpatient rehabilitation is low: an observational study","authors":"Paul Smith , Mary Galea , Michael Woodward , Catherine Said , Michael Dorevitch","doi":"10.1016/S0004-9514(08)70028-X","DOIUrl":"10.1016/S0004-9514(08)70028-X","url":null,"abstract":"<div><h3>Question</h3><p>Are there differences in physical activity between older adults undergoing inpatient rehabilitation and those living in the community? Are there differences in physical activity within and between these two groups on weekdays compared to weekends? Are there differences in physical activity within and between these two groups over the day?</p></div><div><h3>Design</h3><p>An observational study.</p></div><div><h3>Participants</h3><p>Twenty-five elderly patients (aged 81 years) undergoing rehabilitation and 25 age- and gender-matched community-dwelling people (aged 80 years).</p></div><div><h3>Outcome measures</h3><p>The Positional Activity Logger was used to measure the frequency and duration of time spent upright (uptime), over three consecutive days, including a weekend day.</p></div><div><h3>Results</h3><p>The inpatient group achieved a median daily uptime of 1.3 hours which was significantly less than the community group's median of 5.5 hours (<em>p</em> < 0.001). Uptime for inpatients was significantly greater on weekdays (1.6 hours) when therapy was available than on weekend days (1.1 hours) when therapy was generally not available (<em>p</em> < 0.001), whereas uptime for community participants was no different on weekdays (5.9 hours) than on weekend days (4.8 hours) (<em>p</em> = 0.05). Median uptime was significantly less for the inpatient group than for the community group at all times of day (<em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Elderly patients undergoing rehabilitation spend much of the day less physically active than their community peers.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 3","pages":"Pages 209-213"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70028-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27612133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70062-X
Chris C. Harts , Pieter H. Helmhout , Rob A. de Bie , J. Bart Staal
Question
Is eight weeks of high-intensity strengthening of the isolated lumbar extensors more effective than low-intensity strengthening or no strengthening? Are any gains maintained 16 weeks later?
Design
Randomised, three-arm trial with concealed allocation, assessor blinding, and intention-to-treat-analysis. Participants in the waiting list control group were randomised again, after the first 8 weeks, to either the high-intensity or the low-intensity strengthening program.
Participants
Sixty-five army personnel with non-specific chronic low back pain.
Intervention
The high-intensity training group received 10 sessions of 15 to 20 repetitions for the isolated lumbar extensor muscles. The low-intensity training group received a nonprogressive, low-intensity resistance protocol.
Outcome measures
Primary outcomes were global perceived effect and disability. Secondary outcomes were health-related quality of life, fear of movement/(re-)injury, and isometric lumbar extensor muscle strength. Measures were taken before and after the training and 16 weeks later.
Results
At eight weeks, SF-36 overall score was on average 7% (95% CI 1 to 13) greater in the high-intensity training group compared with the low-intensity training group and the waiting list control group, and self-assessed decrease of back symptoms was on average 39% (95% CI 14 to 64) greater in the high-intensity training group compared with the waiting list control group. There was no difference in improvement between the groups for any other outcome at 8 weeks or 24 weeks.
Conclusions
Although some beneficial effects were found, the results of this high-intensity strengthening program of the isolated lumbar extensor muscles do not clearly support the generally-claimed beneficial influence of exercise for chronic non-specific low back pain.
8周的高强度孤立腰伸肌强化比低强度强化或不强化更有效吗?16周后是否仍有增长?设计:采用隐藏分配、评估者盲法和意向治疗分析的随机三组试验。等待名单对照组的参与者在前8周后再次被随机分配到高强度或低强度的强化计划中。参与者:65名患有非特异性慢性腰痛的军人。干预:高强度训练组对孤立的腰伸肌进行10次15 - 20次的重复训练。低强度训练组接受非进行性低强度阻力方案。主要结果是整体感知效应和残疾。次要结局是健康相关的生活质量、对运动/(再)损伤的恐惧和腰伸肌力量。在训练前后和16周后分别采取措施。结果8周后，高强度训练组的SF-36总分比低强度训练组和等候名单对照组平均高7% (95% CI 1 ~ 13)，高强度训练组自我评估的背部症状减轻程度比等候名单对照组平均高39% (95% CI 14 ~ 64)。在8周或24周时，两组之间的任何其他结果的改善没有差异。结论:尽管发现了一些有益的效果，但这种高强度的孤立腰伸肌强化计划的结果并不清楚地支持通常声称的运动对慢性非特异性腰痛的有益影响。
{"title":"A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial","authors":"Chris C. Harts , Pieter H. Helmhout , Rob A. de Bie , J. Bart Staal","doi":"10.1016/S0004-9514(08)70062-X","DOIUrl":"10.1016/S0004-9514(08)70062-X","url":null,"abstract":"<div><h3>Question</h3><p>Is eight weeks of high-intensity strengthening of the isolated lumbar extensors more effective than low-intensity strengthening or no strengthening? Are any gains maintained 16 weeks later?</p></div><div><h3>Design</h3><p>Randomised, three-arm trial with concealed allocation, assessor blinding, and intention-to-treat-analysis. Participants in the waiting list control group were randomised again, after the first 8 weeks, to either the high-intensity or the low-intensity strengthening program.</p></div><div><h3>Participants</h3><p>Sixty-five army personnel with non-specific chronic low back pain.</p></div><div><h3>Intervention</h3><p>The high-intensity training group received 10 sessions of 15 to 20 repetitions for the isolated lumbar extensor muscles. The low-intensity training group received a nonprogressive, low-intensity resistance protocol.</p></div><div><h3>Outcome measures</h3><p>Primary outcomes were global perceived effect and disability. Secondary outcomes were health-related quality of life, fear of movement/(re-)injury, and isometric lumbar extensor muscle strength. Measures were taken before and after the training and 16 weeks later.</p></div><div><h3>Results</h3><p>At eight weeks, SF-36 overall score was on average 7% (95% CI 1 to 13) greater in the high-intensity training group compared with the low-intensity training group and the waiting list control group, and self-assessed decrease of back symptoms was on average 39% (95% CI 14 to 64) greater in the high-intensity training group compared with the waiting list control group. There was no difference in improvement between the groups for any other outcome at 8 weeks or 24 weeks.</p></div><div><h3>Conclusions</h3><p>Although some beneficial effects were found, the results of this high-intensity strengthening program of the isolated lumbar extensor muscles do not clearly support the generally-claimed beneficial influence of exercise for chronic non-specific low back pain.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 1","pages":"Pages 23-31"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70062-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27285444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70066-7
Suzanne S. Kuys , Sandra G. Brauer , Louise Ada , Trevor G. Russell
Question
Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability?
Design
A within-participant, repeated measures experimental study.
Participants
18 individuals with a first stroke who were undergoing inpatient rehabilitation.
Intervention
Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session.
Outcome measures
During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale.
Results
Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity.
Conclusion
Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.
在跑步机上增加步行强度是否会对步行模式产生负面影响或降低步行质量?是否有任何变化受到行走能力的影响?设计一项参与者内、重复测量的实验研究。参与者为18名首次中风且正在接受住院康复治疗的患者。干预:在跑步机上以30%、40%、50%和60%的心率储备强度行走。结果测量:在跑步机步行练习中，步行模式用线性和角运动学来测量，步行质量用Rivermead步态分析量表和视觉模拟量表来测量。结果60%心率储备时在跑步机上行走，麻痹肢体的步长比30%心率储备时增加0.05 m (95% CI 0.01 ~ 0.10)，非麻痹肢体的步长增加0.09 m (95% CI 0.05 ~ 0.12)，摇摆中髋屈度增加4度(95% CI 1 ~ 6)。在60%心率储备时，髋部和膝关节在中位时的屈曲度分别比在30%心率储备时多3度和4度。行走能力不影响行走方式的改变。步行质量不随跑步机强度的增加而改变。结论在跑步机上增加步行强度不会对新卒中患者的步行方式产生不利影响，也不会降低步行质量。这项研究增加了一些支持，包括在跑步机上行走在高强度的康复为新行走的中风患者。
{"title":"Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study","authors":"Suzanne S. Kuys , Sandra G. Brauer , Louise Ada , Trevor G. Russell","doi":"10.1016/S0004-9514(08)70066-7","DOIUrl":"10.1016/S0004-9514(08)70066-7","url":null,"abstract":"<div><h3>Question</h3><p>Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability?</p></div><div><h3>Design</h3><p>A within-participant, repeated measures experimental study.</p></div><div><h3>Participants</h3><p>18 individuals with a first stroke who were undergoing inpatient rehabilitation.</p></div><div><h3>Intervention</h3><p>Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session.</p></div><div><h3>Outcome measures</h3><p>During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale.</p></div><div><h3>Results</h3><p>Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity.</p></div><div><h3>Conclusion</h3><p>Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 1","pages":"Pages 49-54"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70066-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27285447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70049-7
Josep Masip
Question
Acute cardiogenic pulmonary oedema (ACPO) can be managed with either non-invasive pressure support ventilation (NIPSV) or non-invasive continuous positive airway pressure (CPAP). Does management with NIPSV increase the risk of myocardial infarction compared to management with CPAP?
Design
Randomised controlled trial with concealed allocation.
Setting
High-dependency unit of a hospital emergency department in Turin, Italy.
Patients
52 adults with severe ACPO, defined as acute dyspnoea, > 30 breaths per minute, use of accessory respiratory muscles, oxygen saturation (SpO2) < 90% with FiO2 60%, and radiological signs of ACPO. Patients with signs of acute coronary syndrome (ACS) on hospital admission were excluded from the study.
Interventions
All patients received standard medications (diuretic, nitroglycerin, morphine) and oxygen. NIPSV was applied by a Pulmonetics Systems LTV 1000 ventilator. CPAP was administered by means of a flow generator (Whisper-Flow) with an expiratory (PEEP) valve. Patients randomised to NIPSV (n = 25) received sufficient inspiratory pressure (IPAP) to generate a tidal volume of ∼7 mL/kg, and oxygen to maintain SpO2 at ∼93%, via an oronasal mask. Expiratory pressure (EPAP) was gradually increased until SpO2 ≥ 96% (maximum of 12 cmH2O). Those randomised to CPAP (n = 27) commenced at 5 cmH2O via an oronasal mask with oxygen to maintain SpO2 at ∼93%. The CPAP was gradually increased until SpO2 ≥ 96% (maximum of 12 cmH2O). Treatment failure was defined as cardiac arrest, respiratory distress and arterial blood gas deterioration for > 60 min, PaO2/FiO2 < 100 mmHg, coma or psychomotor agitation, haemodynamic instability, or life-threatening arrhythmias. Otherwise, treatment continued until the participant met objective criteria of recovery.
Outcomes
The primary outcome was the rate of acute myocardial infarction (AMI). Secondary outcomes included rate of endotracheal intubation, death, duration of ventilatory assistance, and lengths of stay in the hospital and high-dependency unit.
Results
In the NIPSV group, the average EPAP and IPAP applied were 7 ± 1 and 15 ± 3 cm H2O, respectively. In the CPAP group, the mean pressure applied was 9 ± 2 cm H2O. AMI occurred in four patients on NIPSV and eight patients on CPAP, which was not significantly different, absolute risk reduction (ARR) 0.14, 95% CI –0.10 to 0.34. Also not significantly different were the number of intubations with only one in the NIPSV group, ARR –0.04, 95% CI –0.20 to 0.09, and the number of deaths with three in the NIPSV group and two in the CPAP group, ARR –0.05, 95% CI –0.23 to 0.13. The lengths of stay in hospital an
急性心源性肺水肿(ACPO)可以通过无创压力支持通气(NIPSV)或无创持续气道正压通气(CPAP)进行治疗。与CPAP治疗相比，NIPSV治疗是否会增加心肌梗死的风险?设计隐蔽分配随机对照试验。意大利都灵一家医院急诊科的高依赖性病房。52例成人严重ACPO患者，定义为急性呼吸困难;每分钟30次呼吸，使用副呼吸肌，氧饱和度(SpO2) <90%， FiO2 60%， ACPO影像学征象。入院时有急性冠脉综合征(ACS)体征的患者被排除在研究之外。所有患者均接受标准药物治疗(利尿剂、硝酸甘油、吗啡)和吸氧。NIPSV应用于Pulmonetics Systems LTV 1000呼吸机。CPAP通过带呼气(PEEP)阀的流量发生器(Whisper-Flow)进行管理。随机分配到NIPSV组的患者(n = 25)通过口鼻面罩接受足够的吸气压力(IPAP)，以产生约7 mL/kg的潮气量，并通过氧气将SpO2维持在约93%。呼气压(EPAP)逐渐升高，直至SpO2≥96%(最高12 cmH2O)。随机分配到CPAP组的患者(n = 27)在5 cmH2O时开始，通过含氧口鼻面罩将SpO2维持在93%。CPAP逐渐升高，直至SpO2≥96%(最大值为12 cmH2O)。治疗失败定义为心脏骤停、呼吸窘迫和动脉血气恶化;60 min, PaO2/FiO2 <100mmhg，昏迷或精神运动性躁动，血流动力学不稳定，或危及生命的心律失常。否则，继续治疗，直到参与者达到康复的客观标准。主要观察指标为急性心肌梗死(AMI)发生率。次要结局包括气管插管率、死亡率、呼吸辅助持续时间、在医院和高依赖病房的住院时间。结果NIPSV组平均EPAP为7±1 cm H2O, IPAP为15±3 cm H2O。CPAP组平均施加压力为9±2 cm H2O。4例使用NIPSV的患者发生AMI, 8例使用CPAP的患者发生AMI，两者无显著性差异，绝对风险降低(ARR) 0.14, 95% CI -0.10 ~ 0.34。NIPSV组插管次数只有1次，ARR为-0.04,95% CI为-0.20 ~ 0.09;NIPSV组死亡3次，CPAP组死亡2次，ARR为-0.05,95% CI为-0.23 ~ 0.13。在医院和高依赖性病房的住院时间在两组之间也没有显著差异。结论本研究表明，与CPAP相比，NIPSV治疗ACPO患者AMI发生率无显著差异。
{"title":"NIPSV for acute cardiogenic pulmonary oedema does not increase the risk of myocardial infarction compared to CPAP","authors":"Josep Masip","doi":"10.1016/S0004-9514(08)70049-7","DOIUrl":"10.1016/S0004-9514(08)70049-7","url":null,"abstract":"<div><h3>Question</h3><p>Acute cardiogenic pulmonary oedema (ACPO) can be managed with either non-invasive pressure support ventilation (NIPSV) or non-invasive continuous positive airway pressure (CPAP). Does management with NIPSV increase the risk of myocardial infarction compared to management with CPAP?</p></div><div><h3>Design</h3><p>Randomised controlled trial with concealed allocation.</p></div><div><h3>Setting</h3><p>High-dependency unit of a hospital emergency department in Turin, Italy.</p></div><div><h3>Patients</h3><p>52 adults with severe ACPO, defined as acute dyspnoea, > 30 breaths per minute, use of accessory respiratory muscles, oxygen saturation (SpO<sub>2</sub>) < 90% with F<sub>i</sub>O<sub>2</sub> 60%, and radiological signs of ACPO. Patients with signs of acute coronary syndrome (ACS) on hospital admission were excluded from the study.</p></div><div><h3>Interventions</h3><p>All patients received standard medications (diuretic, nitroglycerin, morphine) and oxygen. NIPSV was applied by a Pulmonetics Systems LTV 1000 ventilator. CPAP was administered by means of a flow generator (Whisper-Flow) with an expiratory (PEEP) valve. Patients randomised to NIPSV (n = 25) received sufficient inspiratory pressure (IPAP) to generate a tidal volume of ∼7 mL/kg, and oxygen to maintain SpO<sub>2</sub> at ∼93%, via an oronasal mask. Expiratory pressure (EPAP) was gradually increased until SpO<sub>2</sub> ≥ 96% (maximum of 12 cmH<sub>2</sub>O). Those randomised to CPAP (n = 27) commenced at 5 cmH<sub>2</sub>O via an oronasal mask with oxygen to maintain SpO<sub>2</sub> at ∼93%. The CPAP was gradually increased until SpO<sub>2</sub> ≥ 96% (maximum of 12 cmH<sub>2</sub>O). Treatment failure was defined as cardiac arrest, respiratory distress and arterial blood gas deterioration for > 60 min, PaO<sub>2</sub>/F<sub>i</sub>O<sub>2</sub> < 100 mmHg, coma or psychomotor agitation, haemodynamic instability, or life-threatening arrhythmias. Otherwise, treatment continued until the participant met objective criteria of recovery.</p></div><div><h3>Outcomes</h3><p>The primary outcome was the rate of acute myocardial infarction (AMI). Secondary outcomes included rate of endotracheal intubation, death, duration of ventilatory assistance, and lengths of stay in the hospital and high-dependency unit.</p></div><div><h3>Results</h3><p>In the NIPSV group, the average EPAP and IPAP applied were 7 ± 1 and 15 ± 3 cm H<sub>2</sub>O, respectively. In the CPAP group, the mean pressure applied was 9 ± 2 cm H<sub>2</sub>O. AMI occurred in four patients on NIPSV and eight patients on CPAP, which was not significantly different, absolute risk reduction (ARR) 0.14, 95% CI –0.10 to 0.34. Also not significantly different were the number of intubations with only one in the NIPSV group, ARR –0.04, 95% CI –0.20 to 0.09, and the number of deaths with three in the NIPSV group and two in the CPAP group, ARR –0.05, 95% CI –0.23 to 0.13. The lengths of stay in hospital an","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 2","pages":"Page 142"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70049-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27451798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-01-01DOI: 10.1016/S0004-9514(08)70043-6
Joanne Glinsky , Lisa Harvey , Monique Korten , Craig Drury , Shane Chee , Simon C. Gandevia
Questions
Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants’ perceptions about use of their hands for activities of daily living?
Design
Randomised controlled trial with concealed allocation, assessor blinding, and intentionto-treat analysis.
Participants
Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles.
Intervention
The wrist muscles of one randomly-chosen hand were trained 3 times a week for 8 weeks. The control group received no intervention.
Outcome measures
The primary outcome was strength measured as maximal voluntary isometric torque in Nm. The secondary outcomes were muscle endurance measured as fatigue resistance and participants’ perceptions about use of their hands using the Canadian Occupational Performance Measure.
Results
The mean effect on maximal voluntary isometric torque was 0.2 Nm (95% CI –0.5 to 0.8). This represents an 8% increase of mean initial strength; less than the 20% deemed clinically worthwhile at the commencement of the study. The mean effect on fatigue resistance was 0.1 (95% CI 0.0 to 0.2). The mean effect on participants’ perceptions of performance was –0.3 (95% CI –1.9 to 1.2) and satisfaction was –0.3 (95% CI –1.6 to 1.0).
Conclusion
The results indicate that progressive resistance exercise has no effect on participants’ perceptions about hand function. However, it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia.
8周渐进式阻力训练计划对四肢瘫痪患者增加手腕肌肉力量有效吗?它对提高肌肉耐力和参与者对日常生活活动中使用双手的认知有效吗?设计随机对照试验，采用隐蔽分配、评估盲法和意向治疗分析。参与者32名四肢瘫痪且手腕屈肌或伸肌神经无力的患者。干预:随机选择一只手，每周训练3次，持续8周。对照组不进行干预。主要终点是以Nm的最大自主等距扭矩测量的强度。次要结果是肌肉耐力测量疲劳阻力和参与者的感知使用他们的手使用加拿大职业绩效测量。结果对最大自主等距扭矩的平均影响为0.2 Nm (95% CI -0.5 ~ 0.8)。这表示平均初始强度增加了8%;少于20%的人在研究开始时认为有临床价值。对疲劳抗力的平均影响为0.1 (95% CI 0.0 ~ 0.2)。对参与者表现感知的平均影响为-0.3 (95% CI -1.9至1.2)，满意度为-0.3 (95% CI -1.6至1.0)。结论渐进式阻力运动对被试手功能知觉无明显影响。然而，目前尚不清楚渐进式阻力运动项目是否能改善四肢瘫痪后神经系统引起的肌肉无力的力量和耐力。
{"title":"Short-term progressive resistance exercise may not be effective at increasing wrist strength in people with tetraplegia: a randomised controlled trial","authors":"Joanne Glinsky , Lisa Harvey , Monique Korten , Craig Drury , Shane Chee , Simon C. Gandevia","doi":"10.1016/S0004-9514(08)70043-6","DOIUrl":"10.1016/S0004-9514(08)70043-6","url":null,"abstract":"<div><h3>Questions</h3><p>Is an 8-week progressive resistance exercise program effective for increasing strength in the wrist muscles of people with tetraplegia? Is it effective for improving muscle endurance and participants’ perceptions about use of their hands for activities of daily living?</p></div><div><h3>Design</h3><p>Randomised controlled trial with concealed allocation, assessor blinding, and intentionto-treat analysis.</p></div><div><h3>Participants</h3><p>Thirty-two people with tetraplegia and neurological weakness of their wrist flexor or extensor muscles.</p></div><div><h3>Intervention</h3><p>The wrist muscles of one randomly-chosen hand were trained 3 times a week for 8 weeks. The control group received no intervention.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was strength measured as maximal voluntary isometric torque in Nm. The secondary outcomes were muscle endurance measured as fatigue resistance and participants’ perceptions about use of their hands using the Canadian Occupational Performance Measure.</p></div><div><h3>Results</h3><p>The mean effect on maximal voluntary isometric torque was 0.2 Nm (95% CI –0.5 to 0.8). This represents an 8% increase of mean initial strength; less than the 20% deemed clinically worthwhile at the commencement of the study. The mean effect on fatigue resistance was 0.1 (95% CI 0.0 to 0.2). The mean effect on participants’ perceptions of performance was –0.3 (95% CI –1.9 to 1.2) and satisfaction was –0.3 (95% CI –1.6 to 1.0).</p></div><div><h3>Conclusion</h3><p>The results indicate that progressive resistance exercise has no effect on participants’ perceptions about hand function. However, it is not yet clear whether progressive resistance exercise programs improve strength and endurance in muscles with neurologically-induced weakness following tetraplegia.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"54 2","pages":"Pages 103-108"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(08)70043-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27451883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号