Pub Date : 2024-04-17DOI: 10.1097/cpt.0000000000000245
R. Manske, J. Heick, Brian A. Young
Venous thromboembolism can present as either a deep vein thrombosis (DVT) or a pulmonary embolism. The purpose of this study was to determine if there was a difference in physical therapists' estimation of the probability of a patient having a DVT in patient vignettes as compared with the modified Wells criteria prediction. Members of the American Academy of Orthopaedics, Academy of Orthopaedic Physical Therapists (AOPT), and American Academy of Sports Physical Therapy (AASPT) completed patient vignettes. Descriptive statistics were calculated, and sign tests assessed for differences between responses of the presence of DVT (likely or unlikely) and whether referral was necessary. Six hundred and seventy consented, and 521 completed the survey of 24,028 members from the AOPT and AASPT. In total, 7.2% did not feel competent to screen for DVT. Descriptive statistics revealed difficulty in determining whether a DVT was likely or unlikely in 4/5 vignettes as compared with the modified Wells criteria, with only vignette 2 having 95.9% correctly answering as DVT being unlikely. In the other 4 vignettes, approximately 60% to 70% of respondents estimated DVT to be likely, despite 2 of these being unlikely. Across the vignettes, between 2.3% and 19.2% more respondents chose to refer when they determined if a DVT was likely. Across vignettes, statistically significant differences between DVT being likely or unlikely and decision to refer were present. Respondents consistently chose to refer even when a DVT was unlikely (P < .001 for vignettes 1, 3–5. P = .038 for vignette 2). Venous thromboembolisms are potentially life-threatening conditions seen by physical therapists. Members of the AOPT and AASPT have difficulty in determining the presence or absence of DVT in clinical case vignettes, with some demonstrating a conservative management decision to refer despite low probability of DVT. Efforts to educate members should be considered to improve the understanding of DVT assessment. Members of the AOPT and AASPT appear to have difficulty in determining the presence of a DVT in clinical patient vignettes. Respondents chose to refer patients perhaps with conservative caution. Efforts to educate therapists should be considered to improve the understanding of DVT assessment.
{"title":"Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopaedic and Sports Academies","authors":"R. Manske, J. Heick, Brian A. Young","doi":"10.1097/cpt.0000000000000245","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000245","url":null,"abstract":"\u0000 \u0000 Venous thromboembolism can present as either a deep vein thrombosis (DVT) or a pulmonary embolism. The purpose of this study was to determine if there was a difference in physical therapists' estimation of the probability of a patient having a DVT in patient vignettes as compared with the modified Wells criteria prediction.\u0000 \u0000 \u0000 \u0000 Members of the American Academy of Orthopaedics, Academy of Orthopaedic Physical Therapists (AOPT), and American Academy of Sports Physical Therapy (AASPT) completed patient vignettes. Descriptive statistics were calculated, and sign tests assessed for differences between responses of the presence of DVT (likely or unlikely) and whether referral was necessary.\u0000 \u0000 \u0000 \u0000 Six hundred and seventy consented, and 521 completed the survey of 24,028 members from the AOPT and AASPT. In total, 7.2% did not feel competent to screen for DVT. Descriptive statistics revealed difficulty in determining whether a DVT was likely or unlikely in 4/5 vignettes as compared with the modified Wells criteria, with only vignette 2 having 95.9% correctly answering as DVT being unlikely. In the other 4 vignettes, approximately 60% to 70% of respondents estimated DVT to be likely, despite 2 of these being unlikely. Across the vignettes, between 2.3% and 19.2% more respondents chose to refer when they determined if a DVT was likely. Across vignettes, statistically significant differences between DVT being likely or unlikely and decision to refer were present. Respondents consistently chose to refer even when a DVT was unlikely (P < .001 for vignettes 1, 3–5. P = .038 for vignette 2).\u0000 \u0000 \u0000 \u0000 Venous thromboembolisms are potentially life-threatening conditions seen by physical therapists. Members of the AOPT and AASPT have difficulty in determining the presence or absence of DVT in clinical case vignettes, with some demonstrating a conservative management decision to refer despite low probability of DVT. Efforts to educate members should be considered to improve the understanding of DVT assessment.\u0000 \u0000 \u0000 \u0000 Members of the AOPT and AASPT appear to have difficulty in determining the presence of a DVT in clinical patient vignettes. Respondents chose to refer patients perhaps with conservative caution. Efforts to educate therapists should be considered to improve the understanding of DVT assessment.\u0000","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1097/cpt.0000000000000250
N. Pathare, Helen Harrod Clark, Kara Marks
Guidelines advocate the use of pulmonary rehabilitation (PR) in individuals with COVID-19. However, there is a lack of concrete information on inpatient PR. Therefore, we synthesized literature on the efficacy of inpatient PR on pulmonary outcomes in individuals with COVID-19. Using PubMed, Web of Science, Cochrane Library and Embase, three researchers screened 474 articles for eligibility with the search terms: (covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19 *) AND (respiratory or pulmonary) AND (physical therapy or physiotherapy or rehabilitation). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. Nine articles were finalized using the inclusion criteria: diagnosis of COVID-19, age >18 years and inpatient PR. Reviewers extracted relevant information and appraised using the Robins-I tool and the Newcastle Ottawa Scale. The pooled sample consisted of 718 participants (F = 35.2%, age = 36-71 y). Study quality for non-randomized trial was moderate, while cohort studies had a mean score of 7/9. The pooled estimate showed that inpatient PR could improve the exercise capacity with clinical importance for individuals with COVID-19. Within group changes were noted in FEV1 and FVC values (n = 4) and HR-QoL (n = 3). Inpatient PR was reported to be safe (n = 4). Current review suggests that inpatient PR was safe, feasible and induced large improvements in exercise capacity in individuals with COVID-19. Given the high heterogeneity, sample sizes and quality of designs of the included studies, findings should be interpreted with caution. Our study provides valuable evidence that inpatient PR is safe and may accelerate improvement in exercise capacity in individuals with COVID-19.
{"title":"Effect of Inpatient Pulmonary Rehabilitation on Pulmonary Outcomes in Individuals With COVID-19: A Systematic Review and Meta-Analysis","authors":"N. Pathare, Helen Harrod Clark, Kara Marks","doi":"10.1097/cpt.0000000000000250","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000250","url":null,"abstract":"\u0000 \u0000 Guidelines advocate the use of pulmonary rehabilitation (PR) in individuals with COVID-19. However, there is a lack of concrete information on inpatient PR. Therefore, we synthesized literature on the efficacy of inpatient PR on pulmonary outcomes in individuals with COVID-19.\u0000 \u0000 \u0000 \u0000 Using PubMed, Web of Science, Cochrane Library and Embase, three researchers screened 474 articles for eligibility with the search terms: (covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19 *) AND (respiratory or pulmonary) AND (physical therapy or physiotherapy or rehabilitation). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used. Nine articles were finalized using the inclusion criteria: diagnosis of COVID-19, age >18 years and inpatient PR. Reviewers extracted relevant information and appraised using the Robins-I tool and the Newcastle Ottawa Scale.\u0000 \u0000 \u0000 \u0000 The pooled sample consisted of 718 participants (F = 35.2%, age = 36-71 y). Study quality for non-randomized trial was moderate, while cohort studies had a mean score of 7/9. The pooled estimate showed that inpatient PR could improve the exercise capacity with clinical importance for individuals with COVID-19. Within group changes were noted in FEV1 and FVC values (n = 4) and HR-QoL (n = 3). Inpatient PR was reported to be safe (n = 4).\u0000 \u0000 \u0000 \u0000 Current review suggests that inpatient PR was safe, feasible and induced large improvements in exercise capacity in individuals with COVID-19. Given the high heterogeneity, sample sizes and quality of designs of the included studies, findings should be interpreted with caution. Our study provides valuable evidence that inpatient PR is safe and may accelerate improvement in exercise capacity in individuals with COVID-19.\u0000","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"97 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140695075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/cpt.0000000000000244
Bini Thomas, Sandra P. Morgan, James M. Smith
Coronary artery bypass grafting (CABG) surgery treats complications from coronary artery diseases, and its recovery traditionally consisted of bedrest. Recent research emphasizes the benefits of early mobilization for hospitalized patients. However, the functional outcomes and effectiveness of early mobilization for persons within the intensive care units after CABG has not been investigated thus far. The objective of this review was to determine the effectiveness of early mobilization in reducing hospital and intensive care unit length of stay (LoS) and improving functional outcomes of persons after CABG. This study was registered with PROSPERO and followed PRISMA guidelines. PubMed, Embase, CINAHL, and PEDro databases were searched using MeSH terms. Studies with early mobilization interventions for adults in the intensive care unit after CABG that recorded outcomes of LoS or functioning were included. Methodological quality was measured using the PEDro scale and Oxford Level of Evidence. This systematic review collectively addressed 2280 participants through 14 studies in 7 countries. The initiation time frames for early mobilization varied, with the majority beginning within 24 to 48 hours after surgery and interventions were heterogenous. Early mobility was found to be effective in reducing atelectasis, improving oxygen saturation, and decreasing time spent on mechanical ventilation. Among early mobilization participants, the LoS was reduced in all studies; intensive care unit LoS decreased by one day or greater in 6 of 14 studies, and hospital LoS decreased by one day or greater in 5 of 7 studies. Data analysis found that early mobilization achieved better functional outcomes. It was found that implementing early mobilization led to decreased intensive care and hospital lengths of stay, reduced atelectasis and pleural effusion, and improved functional and respiratory outcomes in persons who underwent CABG surgery.
冠状动脉旁路移植术（CABG）是治疗冠状动脉疾病并发症的手术，其恢复过程传统上需要卧床休息。最近的研究强调了住院患者早期康复的益处。然而，迄今为止，尚未对 CABG 术后重症监护病房患者的功能结果和早期康复的有效性进行调查。本综述旨在确定早期动员在缩短住院时间和重症监护病房住院时间（LoS）以及改善心血管手术后患者功能预后方面的有效性。 本研究已在 PROSPERO 注册，并遵循了 PRISMA 指南。使用 MeSH 术语对 PubMed、Embase、CINAHL 和 PEDro 数据库进行了检索。纳入的研究包括对 CABG 术后重症监护室中的成人进行早期动员干预，并记录了 LoS 或功能的结果。方法学质量采用 PEDro 量表和牛津证据等级进行衡量。 该系统性综述共涉及 7 个国家的 14 项研究的 2280 名参与者。早期移动的启动时间各不相同，大多数在术后24至48小时内开始，干预措施也不尽相同。研究发现，早期动员能有效减少肺不张、提高血氧饱和度并缩短机械通气时间。在所有研究中，早期移动参与者的LoS都有所减少；在14项研究中，有6项研究的重症监护室LoS减少了一天或更多，在7项研究中，有5项研究的住院LoS减少了一天或更多。 数据分析发现，早期动员可获得更好的功能性结果。研究发现，实施早期动员可缩短重症监护和住院时间，减少肺不张和胸腔积液，改善接受 CABG 手术患者的功能和呼吸预后。
{"title":"Impact of Early Mobilization Within the Intensive Care Unit After Coronary Artery Bypass Grafting: A Systematic Review","authors":"Bini Thomas, Sandra P. Morgan, James M. Smith","doi":"10.1097/cpt.0000000000000244","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000244","url":null,"abstract":"\u0000 \u0000 Coronary artery bypass grafting (CABG) surgery treats complications from coronary artery diseases, and its recovery traditionally consisted of bedrest. Recent research emphasizes the benefits of early mobilization for hospitalized patients. However, the functional outcomes and effectiveness of early mobilization for persons within the intensive care units after CABG has not been investigated thus far. The objective of this review was to determine the effectiveness of early mobilization in reducing hospital and intensive care unit length of stay (LoS) and improving functional outcomes of persons after CABG.\u0000 \u0000 \u0000 \u0000 This study was registered with PROSPERO and followed PRISMA guidelines. PubMed, Embase, CINAHL, and PEDro databases were searched using MeSH terms. Studies with early mobilization interventions for adults in the intensive care unit after CABG that recorded outcomes of LoS or functioning were included. Methodological quality was measured using the PEDro scale and Oxford Level of Evidence.\u0000 \u0000 \u0000 \u0000 This systematic review collectively addressed 2280 participants through 14 studies in 7 countries. The initiation time frames for early mobilization varied, with the majority beginning within 24 to 48 hours after surgery and interventions were heterogenous. Early mobility was found to be effective in reducing atelectasis, improving oxygen saturation, and decreasing time spent on mechanical ventilation. Among early mobilization participants, the LoS was reduced in all studies; intensive care unit LoS decreased by one day or greater in 6 of 14 studies, and hospital LoS decreased by one day or greater in 5 of 7 studies.\u0000 \u0000 \u0000 \u0000 Data analysis found that early mobilization achieved better functional outcomes. It was found that implementing early mobilization led to decreased intensive care and hospital lengths of stay, reduced atelectasis and pleural effusion, and improved functional and respiratory outcomes in persons who underwent CABG surgery.\u0000","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"104 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1097/cpt.0000000000000246
Sara Bills, Julie Skrzat, M. Tevald
The 4-Element Movement Model (4EMM) has been proposed as framework to guide clinical decision making in the physical therapy management of individuals with movement disorders. The model is centered on the primary elements of movement, including motion, force, control, and energy. Clinical application of the model begins with the selection of a movement task, followed by systematic observation of the performance of the task, including control, amount, speed, symmetry, and symptoms provoked during the movement. Testable hypotheses about the impairments contributing to movement problems are then generated, which inform the examination and intervention. A major advantage of the model is its broad applicability to a range of patient populations and settings. In this clinical perspective, we describe the application of the 4EMM to patients with cardiac, vascular, and pulmonary impairments.
{"title":"Application of the 4-Element Movement Model to Cardiovascular and Pulmonary Physical Therapy Practice","authors":"Sara Bills, Julie Skrzat, M. Tevald","doi":"10.1097/cpt.0000000000000246","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000246","url":null,"abstract":"The 4-Element Movement Model (4EMM) has been proposed as framework to guide clinical decision making in the physical therapy management of individuals with movement disorders. The model is centered on the primary elements of movement, including motion, force, control, and energy. Clinical application of the model begins with the selection of a movement task, followed by systematic observation of the performance of the task, including control, amount, speed, symmetry, and symptoms provoked during the movement. Testable hypotheses about the impairments contributing to movement problems are then generated, which inform the examination and intervention. A major advantage of the model is its broad applicability to a range of patient populations and settings. In this clinical perspective, we describe the application of the 4EMM to patients with cardiac, vascular, and pulmonary impairments.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"46 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-03DOI: 10.1097/cpt.0000000000000240
Emily Anne Gray, Margot Alison Skinner, Leigh Anne Hale
Following coronary artery bypass graft (CABG) surgery, people are required to navigate the majority of their physical recovery, including progressive engagement in physical activity, after they leave hospital. However, there are many physical and psychological challenges to physical activity during the early recovery period. The aim of this study was to identify facilitating factors that help overcome such challenges to physical activity following CABG surgery. A qualitative descriptive study using semistructured interviews (n = 22) was undertaken. Data analysis was informed by the COM-B model and Theoretical Domains Framework (TDF) and performed using the Framework Method. Interview data were first inductively coded to identify factors that facilitated physical activity followed by a deductive analysis to group these facilitators under the relevant COM-B and TDF headings. Facilitators relevant to all 6 COM-B elements and 13 of 14 TDF domains were identified. Although having physical capability and physical opportunity were important, the most prevalent facilitators identified by participants as being helpful related to psychological capability (for example, knowledge, having a plan, identifying barriers and coming up with solutions, and listening to their body), reflective motivation (for example, goals, experiencing positive benefits from activity, and being optimistic and determined), and social opportunity (for example, support from family, health professionals, and peers). Psychosocial facilitators play a large role in overcoming barriers to physical activity following CABG surgery. The findings provide insight for clinicians regarding potential factors to address when preparing and supporting people to engage in physical activity.
{"title":"Perceived Facilitators of Physical Activity Following Coronary Artery Bypass Graft Surgery: A Qualitative Study","authors":"Emily Anne Gray, Margot Alison Skinner, Leigh Anne Hale","doi":"10.1097/cpt.0000000000000240","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000240","url":null,"abstract":"\u0000 \u0000 Following coronary artery bypass graft (CABG) surgery, people are required to navigate the majority of their physical recovery, including progressive engagement in physical activity, after they leave hospital. However, there are many physical and psychological challenges to physical activity during the early recovery period. The aim of this study was to identify facilitating factors that help overcome such challenges to physical activity following CABG surgery.\u0000 \u0000 \u0000 \u0000 A qualitative descriptive study using semistructured interviews (n = 22) was undertaken. Data analysis was informed by the COM-B model and Theoretical Domains Framework (TDF) and performed using the Framework Method. Interview data were first inductively coded to identify factors that facilitated physical activity followed by a deductive analysis to group these facilitators under the relevant COM-B and TDF headings.\u0000 \u0000 \u0000 \u0000 Facilitators relevant to all 6 COM-B elements and 13 of 14 TDF domains were identified. Although having physical capability and physical opportunity were important, the most prevalent facilitators identified by participants as being helpful related to psychological capability (for example, knowledge, having a plan, identifying barriers and coming up with solutions, and listening to their body), reflective motivation (for example, goals, experiencing positive benefits from activity, and being optimistic and determined), and social opportunity (for example, support from family, health professionals, and peers).\u0000 \u0000 \u0000 \u0000 Psychosocial facilitators play a large role in overcoming barriers to physical activity following CABG surgery. The findings provide insight for clinicians regarding potential factors to address when preparing and supporting people to engage in physical activity.\u0000","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"53 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139389079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1097/cpt.0000000000000233
Rebecca Byrd, Rachel Breslin, Peijin Wang, Sarah Peskoe, Shein-Chung Chow, Sean Lowers, Laurie D Snyder, Amy M Pastva
Purpose: Pulmonary rehabilitation both before and after lung transplant is associated with improved functional exercise capacity and physical quality of life. There is wide variation in rehabilitation program provision. This study's aim was to compare the effects of group versus individual rehabilitation.
Methods: Individuals who completed pre- and/or posttransplant outpatient rehabilitation at a single, academic, medical center between March 2019 and March 2021 were included in this study. Noninferiority analysis was used to assess differences in change in 6-minute walk distance (6MWD) between group and individual rehabilitation. Multivariable linear regression models examined 6MWD, Short Physical Performance Battery (SPPB), Ferrans and Powers Quality of Life Index Pulmonary Version (QLI), Center for Epidemiological Studies-Depression Scale (CESD), and San Diego Shortness of Breath Questionnaire (SOBQ).
Results: Preoperatively, 93 patients completed group and 81 completed individual rehabilitation. Postoperatively, 110 completed group and 105 completed individual rehabilitation. Individual rehabilitation was noninferior to group rehabilitation (a 5 0.05). In addition, there was no significant difference in changes in 6MWD, SPPB, QLI, CESD, or SOBQ, between cohorts pre- and postoperatively (all P > .25).
Conclusions: Individual rehabilitation seems to be an acceptable alternative to group rehabilitation for lung transplant candidates and recipients.
肺移植前后的肺康复与功能运动能力和身体生活质量的改善有关。康复计划的规定有很大的差异。这项研究的目的是比较团体康复和个人康复的效果。2019年3月至2021年3月期间在单一学术医疗中心完成移植前和/或移植后门诊康复的个体被纳入本研究。采用非劣效性分析评估组间和个体间6分钟步行距离(6MWD)变化的差异。多变量线性回归模型检验了6MWD、短体力表现电池(SPPB)、ferans and Powers生活质量指数肺版(QLI)、流行病学研究中心抑郁量表(CESD)和圣地亚哥呼吸急促问卷(SOBQ)。术前93例患者完成群体康复，81例患者完成个体康复。术后组康复110例，个体康复105例。个体康复效果不低于组康复效果(α = 0.05)。此外，患者术前和术后6MWD、SPPB、QLI、CESD或SOBQ的变化无显著差异(P均为0.25)。对于肺移植候选人和受者而言，个体康复似乎是一种可接受的替代方案。
{"title":"Group Versus Individual Rehabilitation in Lung Transplantation: A Retrospective Noninferiority Assessment.","authors":"Rebecca Byrd, Rachel Breslin, Peijin Wang, Sarah Peskoe, Shein-Chung Chow, Sean Lowers, Laurie D Snyder, Amy M Pastva","doi":"10.1097/cpt.0000000000000233","DOIUrl":"10.1097/cpt.0000000000000233","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary rehabilitation both before and after lung transplant is associated with improved functional exercise capacity and physical quality of life. There is wide variation in rehabilitation program provision. This study's aim was to compare the effects of group versus individual rehabilitation.</p><p><strong>Methods: </strong>Individuals who completed pre- and/or posttransplant outpatient rehabilitation at a single, academic, medical center between March 2019 and March 2021 were included in this study. Noninferiority analysis was used to assess differences in change in 6-minute walk distance (6MWD) between group and individual rehabilitation. Multivariable linear regression models examined 6MWD, Short Physical Performance Battery (SPPB), Ferrans and Powers Quality of Life Index Pulmonary Version (QLI), Center for Epidemiological Studies-Depression Scale (CESD), and San Diego Shortness of Breath Questionnaire (SOBQ).</p><p><strong>Results: </strong>Preoperatively, 93 patients completed group and 81 completed individual rehabilitation. Postoperatively, 110 completed group and 105 completed individual rehabilitation. Individual rehabilitation was noninferior to group rehabilitation (a 5 0.05). In addition, there was no significant difference in changes in 6MWD, SPPB, QLI, CESD, or SOBQ, between cohorts pre- and postoperatively (all <i>P ></i> .25).</p><p><strong>Conclusions: </strong>Individual rehabilitation seems to be an acceptable alternative to group rehabilitation for lung transplant candidates and recipients.</p>","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" ","pages":"28-36"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44521522","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 : 2023-11-22DOI: 10.1097/cpt.0000000000000237
A. Gustavson, Alana Rasmussen, Melissa Ludescher, Brionn Tonkin, Amy Toonstra
The persistent postacute effects of the coronavirus 2019 (COVID-19) illness are and will continue to negatively impact the growing numbers of people recovering from acute viral illness. Rehabilitation providers are critical members of the interdisciplinary care team that screen for, evaluate, treat, and manage Long COVID sequalae. However, current models of outpatient rehabilitation may lack the organizational capacity to effectively treat a large volume of patients at a higher frequency and longer duration currently indicated under emerging clinical consensus. Thus, the purpose of this special communication is to outline challenges in organizational capacity to scaling Long COVID care through illustrative examples.
{"title":"Building and Sustaining Organizational Capacity for the Rehabilitation Profession to Support Long COVID Care","authors":"A. Gustavson, Alana Rasmussen, Melissa Ludescher, Brionn Tonkin, Amy Toonstra","doi":"10.1097/cpt.0000000000000237","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000237","url":null,"abstract":"The persistent postacute effects of the coronavirus 2019 (COVID-19) illness are and will continue to negatively impact the growing numbers of people recovering from acute viral illness. Rehabilitation providers are critical members of the interdisciplinary care team that screen for, evaluate, treat, and manage Long COVID sequalae. However, current models of outpatient rehabilitation may lack the organizational capacity to effectively treat a large volume of patients at a higher frequency and longer duration currently indicated under emerging clinical consensus. Thus, the purpose of this special communication is to outline challenges in organizational capacity to scaling Long COVID care through illustrative examples.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"21 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139249530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1097/cpt.0000000000000239
Alvaro N. Gurovich
The physical therapy profession is amazing. This statement could come from a close (maybe too close) source, but high job satisfaction rates do not lie.1 The intellectual capacity that physical therapists have is incredible because clinicians need to juggle patient's needs and goals, with normal and abnormal physiology, and design a successful plan of care. All that within the constraints of a Machiavellian heath care system that prioritizes profits over care. On top of that, most of the cardiopulmonary physical therapy specialists deal with life-or-death situations on a daily basis. Their decision-making skills are second to none because hemodynamics, end-organ perfusion, or alveolar ventilation can change in any second during interventions emphasizing the premise that not all patients are the same. The only way to support our profession is with relevant work that will enhance evidence-based practice and novel discoveries to improve the human experience. In this issue, we present you with 2 clinical perspectives, 1 case report, and 2 original research articles. First, Drs. Brockway, Ayres, and Shoemaker2 bring us their 2022 CSM educational session on high-intensity interval training in patients with complex comorbidities. Their lecture was one of the highlights in CSM 2022 and I am very happy that we are able to bring it in written form to our readers. Then, and still under the lessons learned because of the COVID-19 pandemic, DiVitto et al3 propose a 3-phase protocol for patients under extracorporeal membrane oxygenation (ECMO), which has enhanced mobility and decreased hospitalization stay. Continuing with the APTA Academy of Cardiovascular and Pulmonary Physical Therapy's “Vitals are Vital” campaign, Smith et al4 bring us a case report on the impact of in-service education to improve blood pressure measurement in outpatient rehabilitation. In addition, Connors et al5 performed a quality improvement project to standardize physical therapy in patients with single or bilateral lung transplant. Their preliminary results showed that their standardized intervention could improve exercise capacity in these patients. Finally, the Cardiopulmonary Physical Therapy Journal is proud to present the updated version of the Academy's cardiovascular and pulmonary entry-level physical therapy competencies by Johanson et al.6 This updated version followed a modified Delphi process to shape competent physical therapy education in our field. This is CPTJ Volume 34's last issue, and I am extremely proud of the editorial board, associated editors, reviewers, and authors who have brought in 2023 their relevant work to help clinicians perform their even more relevant work and take good care of the human experience.
{"title":"Relevant Work","authors":"Alvaro N. Gurovich","doi":"10.1097/cpt.0000000000000239","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000239","url":null,"abstract":"The physical therapy profession is amazing. This statement could come from a close (maybe too close) source, but high job satisfaction rates do not lie.1 The intellectual capacity that physical therapists have is incredible because clinicians need to juggle patient's needs and goals, with normal and abnormal physiology, and design a successful plan of care. All that within the constraints of a Machiavellian heath care system that prioritizes profits over care. On top of that, most of the cardiopulmonary physical therapy specialists deal with life-or-death situations on a daily basis. Their decision-making skills are second to none because hemodynamics, end-organ perfusion, or alveolar ventilation can change in any second during interventions emphasizing the premise that not all patients are the same. The only way to support our profession is with relevant work that will enhance evidence-based practice and novel discoveries to improve the human experience. In this issue, we present you with 2 clinical perspectives, 1 case report, and 2 original research articles. First, Drs. Brockway, Ayres, and Shoemaker2 bring us their 2022 CSM educational session on high-intensity interval training in patients with complex comorbidities. Their lecture was one of the highlights in CSM 2022 and I am very happy that we are able to bring it in written form to our readers. Then, and still under the lessons learned because of the COVID-19 pandemic, DiVitto et al3 propose a 3-phase protocol for patients under extracorporeal membrane oxygenation (ECMO), which has enhanced mobility and decreased hospitalization stay. Continuing with the APTA Academy of Cardiovascular and Pulmonary Physical Therapy's “Vitals are Vital” campaign, Smith et al4 bring us a case report on the impact of in-service education to improve blood pressure measurement in outpatient rehabilitation. In addition, Connors et al5 performed a quality improvement project to standardize physical therapy in patients with single or bilateral lung transplant. Their preliminary results showed that their standardized intervention could improve exercise capacity in these patients. Finally, the Cardiopulmonary Physical Therapy Journal is proud to present the updated version of the Academy's cardiovascular and pulmonary entry-level physical therapy competencies by Johanson et al.6 This updated version followed a modified Delphi process to shape competent physical therapy education in our field. This is CPTJ Volume 34's last issue, and I am extremely proud of the editorial board, associated editors, reviewers, and authors who have brought in 2023 their relevant work to help clinicians perform their even more relevant work and take good care of the human experience.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135866616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.1097/cpt.0000000000000238
Diane M. Wrisley, Eder A. Garavito, Brittany Jones, Tamara Klintworth-Kirk, Ashley K. Poole
Background and Purpose: Individuals with cardiorespiratory dysfunction demonstrate postural instability and increased risk of falls. Given that coronavirus disease (COVID-19) is commonly defined as a respiratory condition, it could be presumed that these patients may demonstrate similar balance deficits. This study aimed to determine deficits and characterize balance dysfunction (sensory or motor) in hospitalized patients classified as “COVID-19 recovered.” Methods: Twenty-five participants consented for this study. Participants completed the Activity-Specific Balance Confidence Scale (ABC), a questionnaire about dizziness, the Timed “Up & Go” (TUG), and the modified Clinical Test of Sensory Interaction and Balance in a single session. The percentage of subjects who scored abnormal on the outcome measures was calculated. Correlations between demographics, respiratory function, and clinical outcome measures were determined using Spearman correlation coefficient. Results: All participants had abnormal scores on the TUG, 88% had abnormal scores on the ABC, and 48% of the subjects had abnormal scores on standing on foam eyes closed indicating difficulty using vestibular information. No correlation coefficient above 0.50 was found between the demographic information, respiratory function, and clinical outcome measures. Discussion: Clinical outcome measure scores did not correlate with respiratory function indicating that the deficits may be due to the extrapulmonary components of COVID-19. Conclusion: Both young and older adults presented with motor and sensory balance deficits acutely after COVID-19 infection. It is recommended that individuals acutely post–COVID-19 receive education and interventions to increase mobility, improve balance, decrease fall risk, and specifically receive activities that stimulate the vestibular system.
{"title":"Motor and Sensory Balance Deficits in Individuals Immediately After COVID-19, a Cohort Study","authors":"Diane M. Wrisley, Eder A. Garavito, Brittany Jones, Tamara Klintworth-Kirk, Ashley K. Poole","doi":"10.1097/cpt.0000000000000238","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000238","url":null,"abstract":"Background and Purpose: Individuals with cardiorespiratory dysfunction demonstrate postural instability and increased risk of falls. Given that coronavirus disease (COVID-19) is commonly defined as a respiratory condition, it could be presumed that these patients may demonstrate similar balance deficits. This study aimed to determine deficits and characterize balance dysfunction (sensory or motor) in hospitalized patients classified as “COVID-19 recovered.” Methods: Twenty-five participants consented for this study. Participants completed the Activity-Specific Balance Confidence Scale (ABC), a questionnaire about dizziness, the Timed “Up & Go” (TUG), and the modified Clinical Test of Sensory Interaction and Balance in a single session. The percentage of subjects who scored abnormal on the outcome measures was calculated. Correlations between demographics, respiratory function, and clinical outcome measures were determined using Spearman correlation coefficient. Results: All participants had abnormal scores on the TUG, 88% had abnormal scores on the ABC, and 48% of the subjects had abnormal scores on standing on foam eyes closed indicating difficulty using vestibular information. No correlation coefficient above 0.50 was found between the demographic information, respiratory function, and clinical outcome measures. Discussion: Clinical outcome measure scores did not correlate with respiratory function indicating that the deficits may be due to the extrapulmonary components of COVID-19. Conclusion: Both young and older adults presented with motor and sensory balance deficits acutely after COVID-19 infection. It is recommended that individuals acutely post–COVID-19 receive education and interventions to increase mobility, improve balance, decrease fall risk, and specifically receive activities that stimulate the vestibular system.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136264755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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