Cardiopulmonary physical therapy journal最新文献

Background and purpose: A less-restrictive clamshell precaution (CP) protocol for postsurgical upper extremity (UE) movement was implemented after lung transplantation (LTx) instead of traditional sternal precaution (SP) protocols. The purpose of this pilot study is to assess the safety of transitioning from the SP protocol to the CP protocol.

Methods: This pilot study was a single-site, observational, cohort study at an academic medical center from March 1, 2021, to February 28, 2023. The CP protocol was implemented on March 1, 2022. Cohorts were determined by the protocol in place at the date of LTx. Safety is described by the frequency of adverse events (AEs), defined as sternal instability or chronic surgical wound infection within 6 months. Summary statistics were reported. Adverse event rates are reported with 95% Wilson score confidence intervals (CIs).

Results: Demographics and clinical characteristics were similar between the cohorts. AEs occurred in 4 patients (10%), including 3 patients (18.8%, 95% CI: 6.6%-43.0%) in the SP cohort (n = 16) and 1 patient (4.2%, 95% CI: 0.7%-20.2%) in the CP cohort (n = 24). Those with AEs were older with a higher body mass index and comorbidity index score compared with those who did not have AEs.

Discussion: In this pilot study of reducing UE movement restrictions after LTx, there was preliminary evidence of lower AEs, suggesting that reducing restrictions may be a safe alternative to the current standard of care.

Conclusions: The results of this pilot study provide preliminary support for the safety CP protocol. However, because of the small sample sizes, further studies are needed to confirm this.

Long COVID is an infection-associated chronic condition that can cause a wide variety of symptoms and long-term functional impairments. While investigation into curative treatment is ongoing, current standard management of Long COVID relies heavily on rehabilitative care by physical, occupational, and speech therapists. Unfortunately, many persons with Long COVID encounter financial barriers to receiving rehabilitative care, especially because some state Medicaid programs and safety net health insurance plans do not cover one-on-one rehabilitation visits. Shared Medical Appointments (SMAs) are group visits which can deliver multidisciplinary care, and they are widely reimbursed by health insurance plans. SMAs also offer the added benefit of peer support and camaraderie, and they are an efficient method for clinicians to deliver care to many patients at once. SMAs can serve as an innovative method of delivering rehabilitative care for persons with Long COVID who cannot access individual appointments with a physical, occupational, and/or speech therapist. The purpose of this clinical perspective is to present the rationale, development, and organization and content of a six-session curriculum of SMAs that was created to deliver rehabilitation principles for Long COVID management. The curriculum covers physical activity, daily living activities, and thinking and speaking. It includes identification of functional concerns and goals, instruction in rehabilitative strategies and tools, and troubleshooting challenges that are encountered as patients implement strategies. The content in this clinical perspective is intended to be easily adapted and delivered by other clinicians in order to facilitate more equitable access to Long COVID rehabilitative care.

Purpose: Physical frailty is prevalent in lung transplant (LTx) candidates and is linked to adverse outcomes preoperatively and postoperatively. Exercise is beneficial in optimizing exercise capacity and quality of life in candidates, but its impact on physical frailty is unknown.

Methods: We prospectively registered and published a protocol (PROSPERO CRD42022363730) before undertaking a systematic review. We searched 4 databases plus trial registries from 1980 to February 2024 for studies of exercise interventions in adults awaiting LTx. Outcomes were measures or surrogate markers of physical frailty. An NIH assessment tool was used to assess study quality, and certainty of evidence was assessed using GRADE.

Results: Fifteen studies (664 patients) were included. Interventions were in-person pulmonary rehabilitation, home exercise, and telerehabilitation. Studies included aerobic, resistance, balance, and breathing training. Only 2 studies assessed frailty using a phenotypic measure. Studies demonstrated improvement in some surrogate frailty outcomes including the Short Physical Performance Battery, 5 times sit-to-stand test, and handgrip or muscle strength measures. The study quality was fair or poor; evidence was low or very low certainty for all outcomes due to imprecision and high risk of bias. Uncontrolled study designs and heterogeneity of interventions and outcomes limit conclusions on effectiveness.

Conclusions: Exercise training appears beneficial in modifying surrogate markers of physical frailty before LTx, but conclusions are limited by low or very low certainty evidence. High quality randomized trials are needed to determine the impact of exercise interventions on physical frailty and to develop guidelines for LTx prehabilitation.

Purpose: Long COVID is a debilitating condition that is estimated to affect over 65M individuals across the world after a Coronavirus Disease 2019 (COVID-19) infection and has no broadly effective treatments. People with Long COVID have reported that pacing helps manage their symptoms, but it is difficult to implement. Based on experiences in the Long COVID community, we hypothesized that wearable devices can help individuals pace and reduce their Long COVID symptom severity.

Methods: To inform the design of a larger study, we performed user testing by distributing Garmin® devices, the study surveys and pacing educational materials to 11 individuals with Long COVID, and conducting interviews to learn about their experience.

Results: Eight of the 9 (89%) individuals reported that the information provided was helpful for their symptom management, and 2 testers did not complete the final survey. Four (44%) users had not used a wearable device before and none had trouble setting up their device. Due to the limited sample size and lack of control group, generalizability is unknown.

Conclusions: The most user testers reported that the study materials were helpful for their symptom management. These results are a promising indication of the potential for wearable devices and educational materials to help individuals with Long COVID, and potentially other chronic conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), decrease symptom severity.

Purpose: Despite the dramatic improvement in pulmonary function after lung transplantation, lung transplant recipients often have reduced physical function. The purpose of this study was to investigate the associations between physical function and a wide range of patient-level factors among lung transplant recipients to allow researchers and healthcare providers to identify and better understand contributors to poor physical function.

Methods: A cross-sectional study of lung transplant recipients enrolled in Lung Transplant Go (LTGO), a randomized, controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention on physical function. Data were collected at the time of study enrollment for physical function using 30-second sit-to-stand test (STS-30), and patient-level factors: discharge destination, time since transplant, hospital length of stay, participation in exercise program outside the study, comorbidities, psychological distress, and symptoms. Regression analysis was performed to identify the association between physical function and patient-level factors.

Results: A total of 72 lung transplant recipients with a mean age of 56 (13), 58% male, and 88% white, completed the STS-30. The bivariate analysis identified factors associated with STS-30, which are age, marital status, time since transplant, Questionnaire for Lung Transplant Patients' activity intolerance subscale, and psychological distress. Factors significantly predicted STS-30 using the regression analysis were age, time since transplant, and psychological distress (p< 0.05).

Conclusion: Age, time since lung transplantation, and psychological distress significantly predicted poor physical function. Interventions to prevent poor physical function post-lung transplantation should consider these factors. Research is needed to better understand patient-level factors on other physical function measures.

Background and purpose: Among individuals with diagnosed heart failure (HF), the impact of physical activity on systemic inflammation and risk of hospital admissions remains unclear. This study examines the associations between physical activity and 1) systemic inflammation measured through C-reactive protein (CRP) levels and 2) frequency of hospital admissions in those with HF.

Methods: We utilized data from the National Health and Nutrition Evaluation Survey in this observational cross-sectional study to include 377 community-dwelling adults with HF. Demographic, clinical, and functional variables were extracted from the data and included in the regression models as covariates during analysis. Associations between activity and hospital admissions were examined using Poisson regression. Multivariable logistic regression analysis was used for association between CRP and physical activity.

Results: We found a direct linear relationship between CRP levels and hospital admissions with higher levels of CRP significantly associated with greater number oof hospital admissions in HF (IRR = 1.18, p < 0.001). Similarly, participating in vigorous activity was significantly associated with decreased expected rate of hospital admissions (IRR = 0.38, p = 0.013 (C.I. = 0.18-0.80) and with a significant decrease in the CRP levels (B = -0.44, p = 0.018 (C.I. = -0.80 - -0.83).

Discussion: To our knowledge, this is the first study using population-level data to examine the association between physical activity level, systemic inflammation, and hospitalizations in individuals with HF.

Conclusions: The findings of this study demonstrate that irrespective of sex, engagement in physical activity at higher intensity levels is strongly associated with favorable health outcomes in older adults with HF.