Pub Date : 2022-03-22DOI: 10.1097/CPT.0000000000000200
Amy Toonstra, K. Lefebvre, Jessica Denn, Matthew Goecke, Lucas Grossoehme, E. Jarocki, Charlie Leslie, Rachel Peckumn, Peter J. Rundquist, Spencer Warfield
Purpose: The purpose of this study is to determine effects of cuff overinflation on blood pressure (BP) measurements compared with the standardized 20 mm Hg above the loss of Korotkoff sounds when taking manual BP in adults. Methods: One hundred twelve participants were recruited. American Heart Association standard procedure guidelines were referenced. Baseline BP was measured using standard cuff inflation of 20 mm Hg above loss of systolic Korotkoff sounds, followed by BP measurements with cuff inflations of 40, 60, and 80 mm Hg above the loss of Korotkoff sounds. Results: Friedman's analysis of variance found statistically significant differences in systolic measurements between standard and all 3 over-inflation methods (P = .015). Post-hoc Wilcoxon signed-rank tests demonstrated significant difference in systolic measurements between standard cuff inflation and 60 and 80 mm Hg above the loss of Korotkoff sounds (P = .005, .003). Conclusions: This study reveals blood pressure cuff inflation 60 mm Hg past the loss of Korotkoff sounds creates statistically significant differences in systolic BP measurements as compared with recommended procedures. Higher cuff inflation levels may significantly change BP measurements and decrease accuracy of clinical decision-making and medical management.
目的:本研究的目的是确定袖带过度膨胀对血压(BP)测量的影响，并将其与成人手动测量血压时Korotkoff音丧失后标准化20毫米汞柱的血压(BP)测量值进行比较。方法:招募了112名受试者。参考了美国心脏协会的标准程序指南。基线血压测量采用标准袖带膨胀20毫米汞柱高于收缩期Korotkoff音丧失，随后测量血压，袖带膨胀40、60和80毫米汞柱高于Korotkoff音丧失。结果:Friedman的方差分析发现，标准方法和所有3种过度膨胀方法在收缩期测量上存在统计学上的显著差异(P = 0.015)。事后Wilcoxon sign -rank检验显示，标准袖带膨胀与Korotkoff音丧失后60和80 mm Hg之间的收缩期测量存在显著差异(P = 0.005, 0.003)。结论:本研究表明，与推荐的方法相比，丧失Korotkoff音后的袖带血压升高60毫米汞柱在收缩压测量中产生统计学上的显著差异。较高的袖带膨胀水平可能显著改变血压测量，降低临床决策和医疗管理的准确性。
{"title":"Impact of Blood Pressure Cuff Overinflation on Blood Pressure Measurements in Adults","authors":"Amy Toonstra, K. Lefebvre, Jessica Denn, Matthew Goecke, Lucas Grossoehme, E. Jarocki, Charlie Leslie, Rachel Peckumn, Peter J. Rundquist, Spencer Warfield","doi":"10.1097/CPT.0000000000000200","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000200","url":null,"abstract":"Purpose: The purpose of this study is to determine effects of cuff overinflation on blood pressure (BP) measurements compared with the standardized 20 mm Hg above the loss of Korotkoff sounds when taking manual BP in adults. Methods: One hundred twelve participants were recruited. American Heart Association standard procedure guidelines were referenced. Baseline BP was measured using standard cuff inflation of 20 mm Hg above loss of systolic Korotkoff sounds, followed by BP measurements with cuff inflations of 40, 60, and 80 mm Hg above the loss of Korotkoff sounds. Results: Friedman's analysis of variance found statistically significant differences in systolic measurements between standard and all 3 over-inflation methods (P = .015). Post-hoc Wilcoxon signed-rank tests demonstrated significant difference in systolic measurements between standard cuff inflation and 60 and 80 mm Hg above the loss of Korotkoff sounds (P = .005, .003). Conclusions: This study reveals blood pressure cuff inflation 60 mm Hg past the loss of Korotkoff sounds creates statistically significant differences in systolic BP measurements as compared with recommended procedures. Higher cuff inflation levels may significantly change BP measurements and decrease accuracy of clinical decision-making and medical management.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"171 - 176"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48994855","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 : 2022-03-22DOI: 10.1097/CPT.0000000000000194
H. McKenna, Jennifer Jones, Erin Y. Harmon
Purpose: To assess the admitting characteristics, adverse events, and rehabilitation outcomes of patients adhering to move in the tube (MIT) or standard sternal precautions in an inpatient rehabilitation facility (IRF). Methods: This study is a retrospective analysis of 273 patients admitted to a single IRF. Patients followed the sternal precautions recommended by their admitting acute care hospitals. One hundred ninety patients' assigned standard and 83 patients' assigned MIT sternal precautions were evaluated. Admitting characteristics, including comorbidities and functional status, were compared between cohorts. Hospital readmissions, sternal disruptions, length of stay, functional independence at discharge, and discharge destination were also assessed. Results: Patients adhering to MIT precautions had higher levels of functional independence at admission despite a higher frequency of combined coronary artery bypass grafts/valve surgeries, comorbidities, and prior functional limitations. There was no difference in sternal wound disruptions, return to hospital rates, length of IRF stay, or functional independence levels at discharge between cohorts. Conclusions: Patients on MIT precautions were admitted to an IRF with more medical complications but higher functional independence. Both groups had minimal sternal complications, providing evidence that modified sternal precautions are safe and can benefit patients in an IRF setting.
{"title":"Move in the Tube Sternal Precautions: A Retrospective Analysis of a Single Inpatient Rehabilitation Facility","authors":"H. McKenna, Jennifer Jones, Erin Y. Harmon","doi":"10.1097/CPT.0000000000000194","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000194","url":null,"abstract":"Purpose: To assess the admitting characteristics, adverse events, and rehabilitation outcomes of patients adhering to move in the tube (MIT) or standard sternal precautions in an inpatient rehabilitation facility (IRF). Methods: This study is a retrospective analysis of 273 patients admitted to a single IRF. Patients followed the sternal precautions recommended by their admitting acute care hospitals. One hundred ninety patients' assigned standard and 83 patients' assigned MIT sternal precautions were evaluated. Admitting characteristics, including comorbidities and functional status, were compared between cohorts. Hospital readmissions, sternal disruptions, length of stay, functional independence at discharge, and discharge destination were also assessed. Results: Patients adhering to MIT precautions had higher levels of functional independence at admission despite a higher frequency of combined coronary artery bypass grafts/valve surgeries, comorbidities, and prior functional limitations. There was no difference in sternal wound disruptions, return to hospital rates, length of IRF stay, or functional independence levels at discharge between cohorts. Conclusions: Patients on MIT precautions were admitted to an IRF with more medical complications but higher functional independence. Both groups had minimal sternal complications, providing evidence that modified sternal precautions are safe and can benefit patients in an IRF setting.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"108 - 115"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49084940","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 : 2022-03-22DOI: 10.1097/CPT.0000000000000202
Colleen G. Hergott, Lori A. Bolgla, J. Waller, Aaron Dowling, Kennedy Ezzell, Corley Graves, William Peed
Purpose: Cardiorespiratory fitness tests are important for older adults to determine baseline cardiovascular fitness and appropriate aerobic exercise intensity. The Timed Up and Go (TUG) is a test that can be modified to challenge the aerobic system by performing 10 continuous repetitions (TUG-10). The TUG-10 advantages include less space and time requirements and incorporation of functional tasks with balance challenges. The purpose of this study was to relate the performance and physiologic responses of the TUG-10 to other common aerobic capacity tests. Methods: Fourteen independent community-dwelling adults performed the 6-minute-walk test (6MWT), 2-minute-step test (2MST), and TUG-10. Heart rate (HR), diastolic and systolic blood pressure, and rate of perceived exertion (RPE) were recorded before and after each test. Bland–Altman plots were used to determine the agreement between test performances. Repeated measures mixed models compared differences in the physiologic changes between the tests. Results: Participants had a clinically greater increase in the adjusted mean change in HR during the 2MST (22.5 bpm) than the 6MWT (17.0 bpm) and TUG-10 (12.3 bpm). Diastolic blood pressure response was similar across all 3 tests with no significant change. Systolic blood pressure increased less during the 6MWT (15.4 mm Hg) compared with the 2MST (33.3 mm Hg) and TUG-10 (28.7 mm Hg). Participants reported a higher RPE during the 2MST (7.9) than the 6MWT (6.1) and TUG-10 (5.2). The Bland–Altman plots indicated that participants' performance on the 3 tests was comparable. Conclusions: The TUG-10, 6MWT, and 2MST demonstrated comparable performances and clinically similar physiologic changes. Heart rate and RPE changes were greater during the 2MST than the other tests, suggesting that the 2MST was more demanding. Findings support the TUG-10 as a potential functional outcome measure to estimate cardiorespiratory fitness. Moreover, the TUG-10 required minimal space and time and may facilitate the gap in aerobic testing in physical therapy practice.
目的：心肺功能测试对老年人确定基线心血管功能和适当的有氧运动强度很重要。Timed Up and Go（TUG）是一种可以通过进行10次连续重复来挑战有氧系统的测试（TUG-10）。TUG-10的优势包括更少的空间和时间要求，以及结合了具有平衡挑战的功能任务。本研究的目的是将TUG-10的性能和生理反应与其他常见的有氧能力测试联系起来。方法：14名独立居住在社区的成年人进行6分钟步行测试（6MWT）、2分钟步进测试（2MST）和TUG-10。在每次测试前后记录心率（HR）、舒张压和收缩压以及感知用力率（RPE）。Bland–Altman图用于确定测试性能之间的一致性。重复测量混合模型比较了测试之间生理变化的差异。结果：与6MWT（17.0bpm）和TUG-10（12.3 bpm）相比，参与者在2MST（22.5bpm）期间的HR调整平均变化在临床上增加更大。在所有3项测试中，舒张压反应相似，没有显著变化。与2MST（33.3 mm Hg）和TUG-10（28.7 mm Hg）相比，6MWT（15.4 mm Hg。参与者在2MST（7.9）期间报告的RPE高于6MWT（6.1）和TUG-10（5.2）。Bland–Altman图表明，参与者在3项测试中的表现具有可比性。结论：TUG-10、6MWT和2MST表现出相似的性能和临床相似的生理变化。2MST期间的心率和RPE变化比其他测试更大，这表明2MST的要求更高。研究结果支持TUG-10作为一种潜在的功能结果指标来评估心肺功能。此外，TUG-10需要最少的空间和时间，可能有助于物理治疗实践中有氧测试的差距。
{"title":"TUG-10: A Modification of the Timed Up and Go Test for Aerobic Assessment in Older Adults","authors":"Colleen G. Hergott, Lori A. Bolgla, J. Waller, Aaron Dowling, Kennedy Ezzell, Corley Graves, William Peed","doi":"10.1097/CPT.0000000000000202","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000202","url":null,"abstract":"Purpose: Cardiorespiratory fitness tests are important for older adults to determine baseline cardiovascular fitness and appropriate aerobic exercise intensity. The Timed Up and Go (TUG) is a test that can be modified to challenge the aerobic system by performing 10 continuous repetitions (TUG-10). The TUG-10 advantages include less space and time requirements and incorporation of functional tasks with balance challenges. The purpose of this study was to relate the performance and physiologic responses of the TUG-10 to other common aerobic capacity tests. Methods: Fourteen independent community-dwelling adults performed the 6-minute-walk test (6MWT), 2-minute-step test (2MST), and TUG-10. Heart rate (HR), diastolic and systolic blood pressure, and rate of perceived exertion (RPE) were recorded before and after each test. Bland–Altman plots were used to determine the agreement between test performances. Repeated measures mixed models compared differences in the physiologic changes between the tests. Results: Participants had a clinically greater increase in the adjusted mean change in HR during the 2MST (22.5 bpm) than the 6MWT (17.0 bpm) and TUG-10 (12.3 bpm). Diastolic blood pressure response was similar across all 3 tests with no significant change. Systolic blood pressure increased less during the 6MWT (15.4 mm Hg) compared with the 2MST (33.3 mm Hg) and TUG-10 (28.7 mm Hg). Participants reported a higher RPE during the 2MST (7.9) than the 6MWT (6.1) and TUG-10 (5.2). The Bland–Altman plots indicated that participants' performance on the 3 tests was comparable. Conclusions: The TUG-10, 6MWT, and 2MST demonstrated comparable performances and clinically similar physiologic changes. Heart rate and RPE changes were greater during the 2MST than the other tests, suggesting that the 2MST was more demanding. Findings support the TUG-10 as a potential functional outcome measure to estimate cardiorespiratory fitness. Moreover, the TUG-10 required minimal space and time and may facilitate the gap in aerobic testing in physical therapy practice.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"157 - 165"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43085420","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 : 2022-03-22DOI: 10.1097/CPT.0000000000000193
A. Fick, H. Tymkew, Morgan Deters, Kelsey Martin, Jordan Ratermann, Abigail Reilly, Brad Lohbeck, Yuan-ling Liu
Purpose: Left ventricular assist devices (LVAD) are an alternative treatment for patients with heart failure. The purposes of this study were to describe patients immediately post-LVAD surgery, determine differences between functional outcome measures and discharge location, and the potential for initial Functional Status Score of the Intensive Care Unit (FSS-ICU) to assist in discharge recommendations. Methods: A retrospective study (n = 100) was conducted with the following data obtained: general demographics, FSS-ICU, ICU Mobility Scale (IMS), maximal ambulation distance, and discharge location. Patients were divided into 2 groups based on discharge location (home vs facility). Results: The mean age was 52.8 years, with 64% male. A significant improvement in all functional outcomes was observed from evaluation to discharge. Patients discharged home (76%) exhibited significantly higher FSS-ICU and IMS scores and tolerated out-of-bed activity and ambulation earlier. A score of 14 or higher on the initial FSS-ICU was predictive for discharge to home recommendation. Conclusion: Patients post-LVAD implantation exhibited low levels of functional mobility initially, yet were able to tolerate early activity. Patients discharged home had higher functional scores during the initial evaluation. Using the results of the FSS-ICU may assist in discharge recommendations; further research is needed.
{"title":"Functional Status and Discharge Location of Patients Post–Left Ventricular Assist Devices Surgery in the Acute Care Setting","authors":"A. Fick, H. Tymkew, Morgan Deters, Kelsey Martin, Jordan Ratermann, Abigail Reilly, Brad Lohbeck, Yuan-ling Liu","doi":"10.1097/CPT.0000000000000193","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000193","url":null,"abstract":"Purpose: Left ventricular assist devices (LVAD) are an alternative treatment for patients with heart failure. The purposes of this study were to describe patients immediately post-LVAD surgery, determine differences between functional outcome measures and discharge location, and the potential for initial Functional Status Score of the Intensive Care Unit (FSS-ICU) to assist in discharge recommendations. Methods: A retrospective study (n = 100) was conducted with the following data obtained: general demographics, FSS-ICU, ICU Mobility Scale (IMS), maximal ambulation distance, and discharge location. Patients were divided into 2 groups based on discharge location (home vs facility). Results: The mean age was 52.8 years, with 64% male. A significant improvement in all functional outcomes was observed from evaluation to discharge. Patients discharged home (76%) exhibited significantly higher FSS-ICU and IMS scores and tolerated out-of-bed activity and ambulation earlier. A score of 14 or higher on the initial FSS-ICU was predictive for discharge to home recommendation. Conclusion: Patients post-LVAD implantation exhibited low levels of functional mobility initially, yet were able to tolerate early activity. Patients discharged home had higher functional scores during the initial evaluation. Using the results of the FSS-ICU may assist in discharge recommendations; further research is needed.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"116 - 122"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46272428","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 : 2022-03-22DOI: 10.1097/CPT.0000000000000199
K. Dias, G. Ferreira, Keith J. Martin, R. Pignataro
The use of electronic or e-cigarettes, commonly referred to as vaping, has markedly increased in recent years. Vaping devices were initially introduced to promote smoking cessation in the chronic adult smoker as a less harmful substitute for combustible cigarettes. However, they have significantly expanded in popularity with youth, creating a global health crisis. Broadly, 2 populations of individuals are noted to vape: the chronic smoker attempting to quit and young teenagers who are lured into using these devices. Recent evidence indicates an outbreak of vaping-associated lung injury and other physiological disturbances that may be particularly harmful to patients and clients. Many physical therapists are currently unaware of the physiological effects of e-cigarettes and lack the knowledge and confidence needed to provide cessation recommendations at the individual and community levels. This lack of awareness also hampers the assessment of physiological responses, appropriate modifications to the plan of care, and referral for interprofessional consultation when indicated. The purpose of this perspective article is to provide recent updates to educate physical therapists and physical therapist assistants about e-cigarettes and relevant implications for patient care. The article reports the growing prevalence of e-cigarette use as a public health crisis, the pathophysiological impact of vaping on various body systems, and the unique role physical therapists and physical therapist assistants can play in successfully engaging in e-cigarette cessation interventions. The authors suggest a targeted 5-step Verify, Assess, Plan, Educate, and Refer approach that can be utilized by physical therapists in addressing vaping and smoking cessation. Finally, the article discusses opportunities for incorporating these strategies into physical therapist education and offers avenues for future research and practice.
{"title":"Defining the Role of the Physical Therapist in Addressing Vaping and Smoking Cessation","authors":"K. Dias, G. Ferreira, Keith J. Martin, R. Pignataro","doi":"10.1097/CPT.0000000000000199","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000199","url":null,"abstract":"The use of electronic or e-cigarettes, commonly referred to as vaping, has markedly increased in recent years. Vaping devices were initially introduced to promote smoking cessation in the chronic adult smoker as a less harmful substitute for combustible cigarettes. However, they have significantly expanded in popularity with youth, creating a global health crisis. Broadly, 2 populations of individuals are noted to vape: the chronic smoker attempting to quit and young teenagers who are lured into using these devices. Recent evidence indicates an outbreak of vaping-associated lung injury and other physiological disturbances that may be particularly harmful to patients and clients. Many physical therapists are currently unaware of the physiological effects of e-cigarettes and lack the knowledge and confidence needed to provide cessation recommendations at the individual and community levels. This lack of awareness also hampers the assessment of physiological responses, appropriate modifications to the plan of care, and referral for interprofessional consultation when indicated. The purpose of this perspective article is to provide recent updates to educate physical therapists and physical therapist assistants about e-cigarettes and relevant implications for patient care. The article reports the growing prevalence of e-cigarette use as a public health crisis, the pathophysiological impact of vaping on various body systems, and the unique role physical therapists and physical therapist assistants can play in successfully engaging in e-cigarette cessation interventions. The authors suggest a targeted 5-step Verify, Assess, Plan, Educate, and Refer approach that can be utilized by physical therapists in addressing vaping and smoking cessation. Finally, the article discusses opportunities for incorporating these strategies into physical therapist education and offers avenues for future research and practice.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"140 - 150"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47777917","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 : 2022-03-16DOI: 10.1097/CPT.0000000000000201
Bini Thomas, J. Tabisz, Kelly Collins, O. Kim, Sharmila Gupte
Introduction and Purpose: The 2019 emergence of the coronavirus disease (COVID-19), and associated medical complications of pneumonia and acute respiratory distress syndrome, necessitated the development of safe and effective physical therapy (PT) interventions to treat this new patient population. The acuity of patients with COVID-19 resulted in intensive care unit (ICU)–acquired weakness and deconditioning. The purpose of this case study was to discuss the physical therapy contributions in treating a complex patient with COVID-19 who required venovenous extracorporeal membrane oxygenation (ECMO) support. Case Presentation: This case report discusses a patient who was 34 years old with morbid obesity, in her third trimester of pregnancy, who tested positive for SARS-CoV-2. The deteriorating respiratory status required the patient to have an emergent caesarean section, intubation, and ventilatory support. Methods: Worsening hypoxic respiratory failure and medical deterioration resulted in the initiation of ECMO. After 18 days, the patient was weaned off ECMO and medically cleared to initiate PT. Physical therapy interventions included positioning for airway clearance, bed mobility, transfer training, strengthening, mechanically assisted gait training, and patient education. Results: After 30 days, the patient was transferred back to the referring community hospital where she was subsequently weaned off oxygen support and discharged directly home. Conclusion: This case study outlines how initiating physical therapy interventions in the ICU in collaboration with other disciplines may have contributed to the functional recovery of a medically complex patient with COVID-19. Further research is recommended regarding early and collaborative interventions in the ICU for medically complex patients with COVID-19.
{"title":"Importance of Physical Therapy Interventions for Medically Complex Patient With Severe COVID-19: A Case Report","authors":"Bini Thomas, J. Tabisz, Kelly Collins, O. Kim, Sharmila Gupte","doi":"10.1097/CPT.0000000000000201","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000201","url":null,"abstract":"Introduction and Purpose: The 2019 emergence of the coronavirus disease (COVID-19), and associated medical complications of pneumonia and acute respiratory distress syndrome, necessitated the development of safe and effective physical therapy (PT) interventions to treat this new patient population. The acuity of patients with COVID-19 resulted in intensive care unit (ICU)–acquired weakness and deconditioning. The purpose of this case study was to discuss the physical therapy contributions in treating a complex patient with COVID-19 who required venovenous extracorporeal membrane oxygenation (ECMO) support. Case Presentation: This case report discusses a patient who was 34 years old with morbid obesity, in her third trimester of pregnancy, who tested positive for SARS-CoV-2. The deteriorating respiratory status required the patient to have an emergent caesarean section, intubation, and ventilatory support. Methods: Worsening hypoxic respiratory failure and medical deterioration resulted in the initiation of ECMO. After 18 days, the patient was weaned off ECMO and medically cleared to initiate PT. Physical therapy interventions included positioning for airway clearance, bed mobility, transfer training, strengthening, mechanically assisted gait training, and patient education. Results: After 30 days, the patient was transferred back to the referring community hospital where she was subsequently weaned off oxygen support and discharged directly home. Conclusion: This case study outlines how initiating physical therapy interventions in the ICU in collaboration with other disciplines may have contributed to the functional recovery of a medically complex patient with COVID-19. Further research is recommended regarding early and collaborative interventions in the ICU for medically complex patients with COVID-19.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"151 - 156"},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41838143","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 : 2022-01-19DOI: 10.1097/CPT.0000000000000190
A. Garcia-Araujo, R. Trimer, Cássia da Luz Goulart, F. Caruso, P. A. Ricci, A. Borghi-Silva
Purpose: To evaluate interrater and intrarater reliability of chest wall mobility using cirtometry in individuals with asthma and controls. Methods: Twenty-six controlled individuals with asthma group (AG) and 12 healthy individuals control group (CG) underwent chest wall mobility assessed by cirtometry. The measurements were performed manually by 2 independent evaluators at 3 levels: axillary, xiphoid and abdominal using a tape, in 2 different days. For the analyses, the average of 3 measurements and the highest value were considered. Results: Interrater reliability in AG showed acceptable intraclass correlation coefficient (ICC) for the axillary (0.76 and 0.75), good for the xiphoid (0.91 and 0.93), and abdominal level (0.91 and 0.91) for the average and highest value. In CG, ICC values were acceptable for the 3 levels: axillary (0.64 and 0.71), xiphoid (0.66 and 0.93), and abdominal level (0.61 and 0.91) also for the average and highest value. The analysis with the mean and the highest values found it acceptable for the axillary and good for the xiphoid and abdominal levels. Intrarater ICC was good for all levels in AG, axillary (0.86), xiphoid (0.93), and abdominal (0.96), for both evaluators. In CG, for evaluator 1, it was acceptable for the axillary and good for the xiphoid and abdominal levels. Regarding evaluator 2, it was good for the axillary and xiphoid and acceptable at the abdominal level. Conclusion: Cirtometry is a reliable tool to measure the chest wall mobility in controlled asthma individuals and in healthy individuals. The average of the 3 measurements or the highest value of the evaluations may be considered in clinical assessments. Axillary mobility was lower in the asthma group.
{"title":"Interevaluator and Intraevaluator Reliability of Chest Wall Mobility Assessment in Young Asthmatics Subjects","authors":"A. Garcia-Araujo, R. Trimer, Cássia da Luz Goulart, F. Caruso, P. A. Ricci, A. Borghi-Silva","doi":"10.1097/CPT.0000000000000190","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000190","url":null,"abstract":"Purpose: To evaluate interrater and intrarater reliability of chest wall mobility using cirtometry in individuals with asthma and controls. Methods: Twenty-six controlled individuals with asthma group (AG) and 12 healthy individuals control group (CG) underwent chest wall mobility assessed by cirtometry. The measurements were performed manually by 2 independent evaluators at 3 levels: axillary, xiphoid and abdominal using a tape, in 2 different days. For the analyses, the average of 3 measurements and the highest value were considered. Results: Interrater reliability in AG showed acceptable intraclass correlation coefficient (ICC) for the axillary (0.76 and 0.75), good for the xiphoid (0.91 and 0.93), and abdominal level (0.91 and 0.91) for the average and highest value. In CG, ICC values were acceptable for the 3 levels: axillary (0.64 and 0.71), xiphoid (0.66 and 0.93), and abdominal level (0.61 and 0.91) also for the average and highest value. The analysis with the mean and the highest values found it acceptable for the axillary and good for the xiphoid and abdominal levels. Intrarater ICC was good for all levels in AG, axillary (0.86), xiphoid (0.93), and abdominal (0.96), for both evaluators. In CG, for evaluator 1, it was acceptable for the axillary and good for the xiphoid and abdominal levels. Regarding evaluator 2, it was good for the axillary and xiphoid and acceptable at the abdominal level. Conclusion: Cirtometry is a reliable tool to measure the chest wall mobility in controlled asthma individuals and in healthy individuals. The average of the 3 measurements or the highest value of the evaluations may be considered in clinical assessments. Axillary mobility was lower in the asthma group.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"70 - 76"},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45177615","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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