Associação entre postura, função pulmonar e capacidade funcional na fibrose quística

Jaw and neck muscle activity during chewing and craniocervical dysfunction index in children, adolescents, and adults with and without cystic fibrosis: a comparative analysis

OBJECTIVE

To compare masticatory muscle activity between people with cystic fibrosis (pwCF) and healthy controls and to verify whether craniocervical dysfunction is associated with the presence of CF.

METHODS

Fifty-six participants were assessed and divided into pwCF and healthy control (HC) groups, each one composed of 13 children and adolescents at 9 (SD 3) years old and 15 adults at 25 (SD 6) years old. Craniocervical Dysfunction Index assessed symptoms of dysfunction and cervical spine mobility. Electromyography was used to evaluate the jaw and neck muscle activity during chewing.

RESULTS

Muscle activity during chewing was not statistically different between groups. Prevalence of craniocervical dysfunction was 75% for pwCF vs 64% for healthy controls. Individuals with CF are 1.53 [1.260, 1.870] times more likely to have reduced cervical mobility compared to healthy controls (p = 0.000).

CONCLUSION

These results reinforce the need for musculoskeletal disorders treatment in the management of pwCF.

Functional Measures in Non-COPD Chronic Respiratory Diseases: A Systematic Review

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their measurement properties, their minimum clinically important differences, and their associations with CRD course-related events or prognosis in non-COPD CRD. Methods: Studies employing patient-reported or performance-based instruments to assess FP in non-COPD CRD were systematically identified in the PubMed, PEDro, Embase, and Cochrane Library databases. COPD-exclusive studies or those solely reporting exercise capacity tests were excluded. Examination focused on measurement properties and associations with CRD course-related events or prognosis. The risk of bias was evaluated using the COSMIN, Downs and Black, and PEDro checklists based on the study design. Results: A total of 216 studies across seven CRD categories [asthma, bronchiectasis, cystic fibrosis, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), pre-/post-lung-transplantation] from various study types were included. Thirty-three instruments were identified, with the SF-36 questionnaire's physical function domain being the most commonly used patient-reported tool. The 1 min sit-to-stand test was the most extensively studied performance-based measure, with its measurement properties frequently reported in non-COPD CRD studies. Associations with events were infrequently documented, primarily in ILD and PAH studies related to mortality. Conclusions: Despite the prevalent use of FP instruments, limited information exists concerning their measurement properties and clinical implications. This review furnishes a concise summary of available evidence, aiding informed clinical decisions when selecting FP tools for non-COPD CRD.

Visuomotor reaction time and dynamic balance in children with cystic fibrosis and non-cystic fibrosis bronchiectasis: A case-control study

OBJECTIVE

Extrapulmonary involvement such as balance and reaction time is unclear in cystic fibrosis (CF) patients. The aim of this study was to evaluate visuomotor reaction time (VMRT) and dynamic balance in children with CF and non-CF bronchiectasis compared to healthy children.

DESIGN/METHODS

Demographic and clinical characteristics were recorded. All children were evaluated with pulmonary function test (PFT) using a spirometer, incremental shuttle walk test (ISWT) for exercise capacity, Fitlight Trainer for VMRT, and functional reach test (FRT) for dynamic balance.

RESULTS

Fourteen children with CF (10.71 ± 2.94 years, 7 females), 17 children with non-CF bronchiectasis (12.75 ± 2.81 years, 8 females), and 21 healthy children (11.36 ± 3.28 years, 11 females) were included. Children with CF had longer total VMRT (P = .027), poorer FRT performance (P = .001), and shorter ISWT distances (P = .03) compared to the children with non-CF bronchiectasis and controls. Although total VMRT was longest in the CF group, there was no significant difference in mean VMRT among the CF, non-CF bronchiectasis, and control groups (P > .05).

CONCLUSION

Dynamic balance and VMRT show greater impairment in children with CF than in children with non-CF bronchiectasis compared to healthy controls. Our findings suggest that VMRT and dynamic balance should be taken into consideration for assessments and exercise programs in pulmonary rehabilitation.

Deviations of body functions and structure, activity limitations, and participation restrictions of the International Classification of Functioning, Disability, and Health model in children with cystic fibrosis and non-cystic fibrosis bronchiectasis

BACKGROUND

To the best of our knowledge, there is no study in the literature investigating the extrapulmonary outcomes of children with non-cystic fibrosis (CF) bronchiectasis and CF under the framework of the International Classification of Functioning, Disability, and Health (ICF) model. The purpose of the present study is to evaluate the children with CF and non-CF bronchiectasis using the ICF model.

MATERIALS AND METHODS

Children with CF, non-CF bronchiectasis, and healthy counterparts were evaluated (20 participants in each group) according to the ICF items in domain b (body functions), domain s (body structures), and domain d (activities and participation). The pulmonary functions, respiratory and peripheral muscle strength tests, and posture analysis were carried out for domain b. For domain d, however, the Glittre-activities of daily living test and Pediatric Outcome Data Collection were used.

RESULTS

Muscle strength of shoulder abductors and hip extensors in children with CF was significantly lower than healthy children and adolescents (P < .05). The severity of lateral and posterior postural abnormalities in children with CF and non-CF bronchiectasis was higher than those of healthy children (P < .05). Among the patient groups, global function, sports/physical function, expectations, transfers/basic mobility, and pain/comfort were the most affected participation dimensions (P < .05).

CONCLUSIONS

This study highlights the need for comprehensive up-to-date evaluation methods according to the ICF model for understanding rehabilitation requirements in CF and non-CF bronchiectasis in different age groups.

Association between lung function, thoracoabdominal mobility and posture in cystic fibrosis: pilot study

Abstract Introduction: Deterioration of lung function is the main cause of mortality in cystic fibrosis (CF), so it is essential to study different related factors. Objective: To assess the association of pulmonary function with thoracoabdominal mobility and postural alignment in individuals with CF. Method: A cross-sectional study was performed in individuals with CF (8-17 years). Pulmonary function was assessed by spirometry. Thoracoabdominal mobility and postural alignment were evaluated by photogrammetry using the Postural Assessment Software (PAS/Sapo). Pearson correlation coefficient analysis was performed, and p < 0.05 was considered significant. Results: The following spirometric variables showed a decrease compared to predicted values: FEV1, FEV1/FVC, PEF and FEF25-75%. Postural assessment showed alterations in head horizontal alignment (HHA; 2.71 ± 2.23o), acromion horizontal alignment (AHA; 1.33 ± 1.35o), anterior superior iliac spine (ASIS) horizontal alignment (ASISHA; 1.11 ± 0.89o), angle between acromia and ASIS (AAASIS; 0.89 ± 0.39o), scapula horizontal asymmetry - T3 (SHAT3; 16.95 ± 12.03%), and asymmetry of the projection of the center of gravity within the base of support in the frontal (11.45 ± 8.10%) and sagittal (48.98 ± 18.55%) planes. A strong positive correlation was found between pulmonary function and thoracoabdominal mobility in the variables anteroposterior mobility of the upper chest (APMUC) and FVC (r = 0.818, p = 0.024), APMUC and FEV1 (r = 0.874, p = 0.010), and APMUC and FEF25-75% (r = 0.797, p = 0.032). A strong negative correlation was detected between FEV1/FVC and AHA (r = -0.761, p = 0.047). Conclusion: Our study showed in CF a reduction in pulmonary function, strong positive correlation between APMUC and pulmonary function, high prevalence of kyphoscoliosis and strong negative correlation between AHA and pulmonary function.

Systematic Review of Postural Assessment in Individuals With Obstructive Respiratory Conditions: MEASUREMENT AND CLINICAL ASSOCIATIONS

PURPOSE

Changes in posture in individuals with an obstructive respiratory disease have been reported, but the extent of these deviations and their clinical significance is not well understood. This study aimed to systematically review the literature of the skeletal structural alignment in children and adults with an obstructive respiratory disease, describe the measurement techniques used, and determine the clinical relevance of any alternations.

METHODS

Observational cohort or cross-sectional studies of postural assessment were identified, with 2 reviewers independently assessing study quality.

RESULTS

A total of 18 studies were included, 12 in cystic fibrosis (CF), 5 in asthma, and 1 in chronic obstructive pulmonary disease (COPD). The overall quality assessment rating was 12.6 out of 16. Increased thoracic kyphosis or scoliosis was found in both children and adults with CF. Increased shoulder protraction and elevation were evident in asthma and COPD, although changes in spinal curvature were variable. The clinical impact of postural changes was diverse, with an inconsistent influence on lung function. A mix of methods was applied for postural assessment.

CONCLUSIONS

Skeletal structural malalignment appears to be present in some individuals with an obstructive respiratory disease, although the extent of alterations and its clinical impact is variable. Photogrammetry is used to provide a comprehensive assessment of posture in these populations.

Pain and its clinical associations in individuals with cystic fibrosis: A systematic review

Pain is recognized as a clinical complication in cystic fibrosis (CF), but the prevalence, characteristics and clinical associations of this co-morbidity have not been systematically reviewed. Electronic searches of six databases were performed. For inclusion in phase 1, studies reported a pain prevalence rate in CF and/or its clinical associations. For phase 2, included studies reported the measurement properties of validity, reliability and responsiveness of an instrument assessing pain in CF. Two independent reviewers rated the quality of evidence (phase 1) and the measurement properties using the 4-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist (phase 2). Of the 400 studies identified in the literature, 16 met the inclusion criteria for phase 1 and 5 for phase 2. The mean (SD) quality score (of 16) was 11.8 (2.3). The pooled prevalence of pain in adults with CF was 77% (95% confidence interval (CI): 57%-92%) and in children was 42% (95% CI: 0%-91%). Common regions of pain included back, abdomen, chest and limbs. In children and adults, pain was associated with a poorer quality of life (QOL) and significant interference with treatments. Measurement properties of three instruments (Brief Pain Inventory, Multidimensional Pain Inventory, Daily Pain Assessment-CF) were construct validity and criterion-predictive validity, with variable findings based on 'fair' to 'good' quality studies. Pain is a common problem in both children and adults with CF. It has negative clinical associations with QOL and the ability to successfully undertake treatment. Further research exploring the measurement properties of instruments assessing pain is required.

Effect of joint mobilization and stretching on respiratory function and spinal movement in very severe COPD with thoracic kyphosis

[Purpose] The purpose of this study was to analyze the effect of joint mobilization and stretching of the thoracic cage for very severe chronic obstructive pulmonary disease (COPD) on a patient with thoracic kyphosis. [Subject and Methods] The subject is a 73-year-old female COPD patient with thoracic kyphosis. The intervention methods were comprised of joint mobilization and stretching. The program consisted of 30 minute sessions three days per week for eight weeks. Respiratory function, spinal curve, and spinal movement (thoracic and lumbar spine) were measured. [Results] Joint mobilization and stretching did not result in noticeable changes in the respiratory function of the patient; however, positive changes were observed, including decreased thoracic kyphosis curve, increased lumbar lordosis curve, and increased spinal movement. [Conclusion] The results of the analysis show that the patient's age, body mass index, duration of the disease, COPD level, and posture should be considered in the clinical decision to perform pulmonary physical therapy for patients with complicated diseases such as COPD with thoracic kyphosis.

Pulmonary function, functional capacity and quality of life in adults with cystic fibrosis

BACKGROUND

As there are few studies on the impact of respiratory and functional status on the quality of life domains in adults with cystic fibrosis, this study aimed to evaluate the association between respiratory function, functional capacity and quality of life in these subjects.

METHODS

This is a cross-sectional study, where adults with clinical and laboratorial diagnoses of CF fibrosis underwent pulmonary function tests, the six-minute walk distance test (6MWT) and responded to the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Descriptive statistics was used to summarize the findings. The associations were tested by means of Pearson's or Spearman tests, and the significance level was set at 5%.

RESULTS

The 21 patients who completed the study presented with reduced quality of life in all CFQ-R domains, obstructive pulmonary disease and reduced 6MWT distance. The following associations were found between pulmonary function and CFQ-R domains: forced vital capacity - FVC (%) and treatment burden and digestive symptoms (r=-0.433, p<0.05; r=-0.443, p<0.05, respectively), forced expiratory volume in one second - FVC ratio - FEV1/FVC (%) and physical functioning, social and respiratory symptoms (r=0.5, p<0.05; r=0.58, p<0.01; r=0.45, p<0.05, respectively), residual volume (%) and physical functioning (r=0.49, p<0.05), airways' resistance - Raw and physical functioning and emotional functioning (r=-0.44, p<0.05; r=-0,46, p<0.05, respectively), carbon monoxide diffusing capacity (%pred) and physical functioning (r=-0,51; p<0.05).

CONCLUSION

Adults with CF have reduced quality of life, which in part is associated with the severity of their lung function.

Scleroderma: Assessment of posture, balance and pulmonary function in a cross-sectional controlled study

BACKGROUND

Systemic sclerosis leads to significant physical limitations in patients, such as diffuse weakness, skin sclerosis, loss of joint function and lung damage. This study aimed to assess posture and balance in systemic sclerosis patients and secondarily to verify correlations between such measurements and lung function.

METHODS

Thirty-one patients and a similar number of control subjects matched for age, gender, weight, height and body mass index underwent postural assessment using photogrammetry, balance measurement using the Berg Balance Scale and stabilometry, and pulmonary function tests.

FINDINGS

When compared to healthy volunteers, the patients had postural deviations in hip angle (P=0.009 in anterior view and P=0.028 for the right side), horizontal alignment of the pelvis (P=0.002 for the right side and P=0.004 for the left side), vertical alignment of the trunk (P=0.012 for the right side) and ankle angle (P=0.019 for the right side). Postural balance was similar between the two groups as assessed by the Berg Balance Scale and stabilometry. We observed significant correlations between balance measures and posture variables involving the knee and ankle, and between postural control and lung function (ratio between forced vital capacity and diffusing capacity for carbon monoxide).

INTERPRETATION

Our results suggest that posture and balance should be assessed in systemic sclerosis patients in clinical practice, as significant postural changes and compensations are needed to maintain balance. Furthermore, it is important to monitor lung function because vascular injury impacts on postural control in these patients.

Impact of different etiologies of bronchiectasis on the pulmonary function tests

BACKGROUND

Bronchiectasis develops along the natural course of several respiratory and systemic conditions and induces significant changes in the morphofunctional structure of airways. Our objective was to assess the impact of various causes of bronchiectasis on clinical data, pulmonary function tests, and high-resolution computed tomography (HRCT).

METHODS

The present report was a cross-sectional study that was conducted with 112 consecutive patients with bronchiectasis, who were allocated to five groups, as follows: sequelae of tuberculosis, history of non-tuberculosis infection, cystic fibrosis (CF), primary ciliary dyskinesia (PCD), and rheumatoid arthritis. All of the participants underwent spirometry, whole-body plethysmography, measurement of the diffusing capacity for carbon monoxide (DLco), and HRCT.

RESULTS

The highest HRCT score was exhibited in patients with CF (6.03 ± 1.03). The values of forced expiratory volume in 1 second (FEV1) (52.2 ± 17.7%) and DLco (74.1 ± 15.2%) were lower in patients with sequelae of tuberculosis. The increase in the residual volume was more accentuated in the patients with CF (193.5 ± 39.5%) and PCD (189 ± 36.4%). By the multivariate analysis, the cause of FEV1 and bronchiectasis, HRCT score, and degree of dyspnea behaved as independent predictors of DLco.

CONCLUSION

In individuals with bronchiectasis, the pulmonary function abnormalities are associated with the etiology of the underlying disease.

Can walking ability enhance the effectiveness of breathing exercise in children with spastic cerebral palsy?

[Purpose] The purpose of this study was to compare differences in respiratory pressure and pulmonary function and the effectiveness of respiratory feedback training according to walking ability in children with cerebral palsy (CP). [Subjects and Methods] Twenty-three children with spastic CP were enrolled in the final analysis and were divided into an independent walking group (n=12) and non-independent walking group. All children received respiratory feedback training for four weeks. Before and after the training, respiratory muscle strength was measured and a pulmonary function test was performed. [Results] Comparison of respiratory pressure and pulmonary function test results between the two revealed that the independent walking group had significantly higher respiratory function than the other group in all variables except peak expiratory flow. In comparison of changes in respiratory function between the two groups, the independent walking group showed significantly higher improvement of respiratory function in terms of maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity. [Conclusion] These findings showed that children with independent walking ability had better respiratory muscle strength and pulmonary function compared with children without independent walking ability. Understanding respiratory function and the effectiveness of respiratory training according to walking ability will be valuable clinical information for respiratory assessment and therapy in children with CP.

Posture and balance control in patients with acromegaly: results of a cross-sectional study

Acromegaly is a chronic debilitating disease that presents with multiple systemic manifestations, including changes in body composition, joint abnormalities, muscular impairment and visual disturbances. This study aimed to assess posture and body balance in acromegalic patients and to establish the correlation between these measures. Twenty-eight acromegalic patients and a similar number of control subjects matched for sex, age, weight, height and body mass index underwent postural evaluation using the photogrammetry and measurement of balance using the stabilometry in two tasks: feet apart, eyes open and feet together, eyes closed. In comparison with the control group, the acromegalic group presented postural deviations in lateral views in the vertical alignment of the trunk (P=0.001 for the right side and P=0.021 for the left), the hip angle (P=0001 for the right side and P=0.016 for the left side) and horizontal alignment of the pelvis (P=0.017 for the right and P<0.001 for the left side). Compared with healthy subjects, the acromegalic patients presented displacement of the centre of pressure in both the anterior-posterior direction and the medial-lateral direction in both evaluated tasks. We observed significant correlations between balance measures and the following posture evaluation variables: distance between the lower limbs, horizontal alignment of the head and vertical alignment of the head. Our results suggest that posture and balance need to be evaluated for acromegalic patients in clinical practice, as there are significant postural imbalances and deviations in these patients.

Is there an association between postural balance and pulmonary function in adults with asthma?

OBJECTIVE

Asthma may cause systemic repercussions due to its severity and the effects of treatment. Our objective was to compare posture, balance, functional capacity, and quality of life (QOL) according to the severity of disease, as assessed by pulmonary function levels.

METHOD

This cross-sectional study evaluated fifty individuals with asthma. We compared two groups of adult individuals who were divided according to the median of the forced expiratory volume in one second (FEV1) as follows: group A  =  FEV1>74% predicted; group B  =  FEV1<74% predicted. All patients underwent the following tests: spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide (DLco), respiratory muscle strength, posture assessment, stabilometry, six-minute walking distance (6MWD), and QOL.

RESULTS

All pulmonary function variables exhibited statistically significant differences between the two groups, except for the DLco. The maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6MWD were lower in group B. The maximal mediolateral velocity and the mediolateral displacement were significantly different, while the postural changes and QOL were similar between the groups.

CONCLUSIONS

In adult individuals with asthma, the pulmonary function is associated with balance control in the mediolateral direction but does not influence the postural changes or QOL.