Effects of home-based neuromuscular electrical stimulation in severe chronic obstructive pulmonary disease patients: a randomized controlled clinical trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients experience a sustained deterioration of several capacities. Those with severe COPD undergo a considerable decline in their physical and functional capacities, but pulmonary rehabilitation (PR) is used to reduce the weakness of such patients. To date, neuromuscular electrical stimulation (NMES) has been used in acute COPD patients but NMES superimposed onto voluntary muscular contraction has not been tested in COPD patients.

AIM

The aim of this study was to evaluate the effects of superimposed NMES on the cardiorespiratory performance and functionality of severe COPD patients undergoing a home-based rehabilitation program.

DESIGN

This was a randomized controlled clinical trial.

POPULATION

A total of 36 stable severe COPD patients were included in this study and were randomly divided into two groups: an intervention group and a control group.

SETTING

The study was conducted as a home-based program.

METHODS

The control group received standard medical treatment. The intervention group additionally underwent an individualized physical therapy program. The intervention consisted of a pulmonary rehabilitation (PR) protocol for 8 weeks (2 h/week). The protocol was carried out as follows: 10 minutes of controlled breathing training; 30 minutes of NMES superimposed onto voluntary muscular contraction; and 5 minutes of relaxation/cool-down. The outcome measures were cardiorespiratory performance measured using the 6-Minute Walk Test in the treadmill and functionality assessed with the functional independence measure.

RESULTS

In the intervention group, significant improvements were observed after the treatment in cardiorespiratory performance and functionality (P<0.05), while the control group did not show any significant changes (P>0.05). The between-group analysis showed significant differences in cardiorespiratory performance and functionality (P<0.05).

CONCLUSIONS

An 8-week individualized home-based PR program including controlled breathing training, aerobic exercise with elastic bands, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.

CLINICAL REHABILITATION IMPACT

A home-based pulmonary rehabilitation program including controlled breathing training, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.

[Effects of a dance therapy programme on quality of life, sleep and blood pressure in middle-aged women: A randomised controlled trial]

BACKGROUND AND OBJECTIVE

Evidence suggests that dance therapy may have positive effects in areas such as cardiovascular parameters and sleep. The aim of the present study is to explore whether a dance therapy programme improves sleep and blood pressure in a population of middle-aged pre-hypertensive and hypertensive women.

METHODS

A randomised controlled trial was conducted, in which participants were assigned to one of 2 groups: standard care (with usual activities and medication) or dance therapy (in which the participants followed a dance therapy programme, in addition to their medication). The intervention was an 8-week, 3-times-per-week, progressive and specific group dance-training programme. The dance steps were specifically designed to improve balance by shifting the body and relocating the centre of gravity. The main measures obtained were blood pressure, sleep quality and quality of life, measured by the Pittsburgh Sleep Quality Index and the European Quality of Life Questionnaire.

RESULTS

Sixty-seven pre-hypertensive and hypertensive middle-aged women were randomised to either an intervention group (n=35) or a control group (n=32) after baseline testing. The intervention group reported a significant improvement in blood pressure values (P<.01), as well as in sleep quality (P<.05) and quality of life (P<.001), compared to the control group.

CONCLUSION

The dance therapy programme improved blood pressure, sleep and quality of life in pre-hypertensive and hypertensive middle-aged women, and constitutes an interesting basis for larger-scale research.

Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3-5 years old

AIM

The objective of the study was to assess posture, muscle flexibility and balance in children aged 3-5 years old with a history of nonsynostotic plagiocephaly.

METHODS

Fifty-two children with previous history of plagiocephaly were evaluated, along with 52 control subjects matched for age, sex, height, weight and physical activity. The outcome measures included static posture, assessed through the measurement of angles and distances between anatomical landmarks; muscle flexibility, evaluated with the Stibor, Shober and finger-to-floor distance tests and balance, assessed by the Pediatric Balance Scale.

RESULTS

One-way analysis of variance afforded statistically significant differences (P < 0.05) in head position, muscle flexibility (thoracic mobility and trunk and lower limbs muscle shortening) and balance.

CONCLUSION

Children with previous history of non-synostotic plagiocephaly present changes in head position, muscle shortening and a poor balance when compared to control children at 3-5 years old.

Factors Influencing Performance-Oriented Mobility After Hip Fracture

Objective: To identify the patient- and fracture-related determinants that influence performance-oriented mobility in hip fracture patients as measured by the Performance-Oriented Mobility Assessment (POMA) score. Method: A prospective study was conducted. Patients aged 65 or older ( n = 186) were prospectively recruited. Patients were assessed for mobility (Tinetti POMA), level of independence (Modified Barthel Index), emotional distress (Goldberg General Health Questionnaire), comorbidities (Charlson Comorbidity Index), and Perceived Health (categorical scale). Results: The study revealed that patient age, type of fracture, length of hospital stay, level of emotional distress, and level of independence were significant predictors of performance-oriented mobility. When combined, these factors explained 44.3% of the variance in performance-oriented mobility ( r2 = .443; r2 adjusted = .414; F = 15.46; p < .001). Discussion: Patients who are older, spend more days in hospital, have worse pre-fracture independence level or higher emotional distress levels at discharge, and sustain subtrochanteric or intertrochanteric fractures seem to have poorer performance-oriented mobility after hip fracture.

The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial

Objective:

To investigate the effects of a physiotherapy protocol on patients with pleural effusion.

Design:

Randomized controlled trial.

Setting:

University hospital.

Participants:

A total of 104 consecutive inpatients with a medical diagnosis of pleural effusion.

Intervention:

Patients were randomly allocated to a control group receiving standard treatment (medical treatment and drainage) or an intervention group treated with physiotherapy added to standard treatment. The physiotherapy programme included deep breathing exercises, mobilizations and incentive spirometry.

Main outcome measures:

Spirometric predicted values and chest radiographs were measured before treatment and at discharge and the length of hospital stay was recorded. Assessors were blinded to the intervention.

Results:

A comparative analysis showed a significant improvement of spirometric parameters in the intervention group; pre-to-post hospitalization predicted values showed significant changes in vital capacity (73.1 ± 12.6% to 72.13 ± 13.7 %, P<0.001 ), forced expiratory volume in first second (72.13 ± 13.7% to 78.98 ± 16.9%, P<0.001) and forced expiratory flow at 25-75 % (64.8 ± 35.1% to 76.78 ± 35.3%, P=0.198) compared to the control group that showed no significant changes across treatment. The radiographic findings showed better scores on the affected side of the thorax at discharge in the physiotherapy group. Length of hospital stay was also significantly ( P=0.014) shorter in the intervention group (26.7 ± 8.8 days) compared to the control group (38.6 ± 10.7 days).

Conclusions:

A physiotherapy programme added to standard treatment improves the spirometric parameters and the radiological findings and reduces the hospital stay in patients with a pleural effusion.

Prevalence of risk factors for atrial fibrillation and stroke among 1210 patients with sleep disordered breathing

AIMS

This study sought to identify the prevalence of risk factors for atrial fibrillation and stroke in a sleep apnea population.

METHODS

Study participants included 1210 consecutive adults who were referred with suspicion of sleep apnea. Statistical analysis was used to determine the relationship between sleep apnea syndrome and risk factors for atrial fibrillation and stroke.

RESULTS

Among 1210 enrolled patients, 65.8% had severe sleep apnea (Apnea/hypopnea Index--AHI>30), 25.2% had mild to moderate sleep apnea (AHI 5 to 30), and 8.8% had no sleep apnea (AHI<5). At baseline, the mean apnea-hypopnea index in patients with sleep apnea syndrome was 35. Compared to patients with an AHI<5, those with an AHI>30 were older (47.3±11.4 vs. 52.74±12.4, p<0.001) and had a higher body mass index (BMI) (30.7±7.3 vs. 33.83±10.1, p<0.001), a higher prevalence of hypertension (38 vs. 16%, p<0.001), and a higher CHADS2 (congestive heart failure, hypertension, age, diabetes and prior stroke) score (0.59±0.8 vs. 0.28±0.64, p<0.001).

CONCLUSIONS

Patients with severe sleep apnea have a higher prevalence of risk factors for atrial fibrillation and stroke when compared with subjects without sleep apnea.

Effectiveness of an occupational therapy intervention in reducing emotional distress in informal caregivers of hip fracture patients: a randomized controlled trial

OBJECTIVE

To examine the effectiveness of an occupational therapy intervention program in reducing emotional distress in informal caregivers of hip fracture patients.

DESIGN

Single-blind randomized controlled trial.

SETTING

A public Trauma and Rehabilitation Hospital in Granada, Spain.

PARTICIPANTS

A total of 186 caregivers and their care recipients with hip fracture (93 in each group) were allocated to an intervention group or a control group using a block system.

INTERVENTION

An occupational therapy intervention during patient hospitalization focused on patient handling by caregivers and ergonomic treatment for both.

MAIN MEASURES

The Goldberg General Health Questionnaire was used to measure emotional distress and psychological well-being. The Goldberg Anxiety and Depression Scale was used to measure caregiver affective illness.

RESULTS

Among informal caregivers, emotional distress decreased to a greater extent in the intervention group than in the control group from the first assessment to the six-month follow-up (intervention group: 4.16 (SD 4.57) to 2.81 (SD 2.93); control group: 4.61 (SD 4.57) to 4.24 (SD 4.30)), showing significant differences at the first, third and sixth month. As regards anxiety levels, significant differences were only found at the third month (1.54 (SD 2.09) vs. 2.35 (SD 2.53) in the intervention and control groups, respectively (p < 0.05)), although the intervention group always showed lower levels from the first month. Although depression levels decreased in both groups, the decrease was also greater in the intervention group.

CONCLUSION

Occupational therapy training for caregivers of hip fracture patients helps to significantly reduce emotional distress, anxiety and depression in caregivers.

Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial

OBJECTIVE

To explore whether an occupational therapy intervention combined with physiotherapy rehabilitation improved hip fracture patient outcomes regarding emotional distress, fatigue, independence and function.

DESIGN

Randomized controlled trial.

SETTING

Inpatient trauma ward in a rehabilitation and trauma hospital.

PARTICIPANTS

One hundred and twenty-two patients admitted into hospital for hip fracture.

INTERVENTION

Patients were randomly assigned to a standard care group (SC, n = 61) or a combined treatment group (CT, n = 61). The SC group received conventional hospital care for hip fracture patients and the CT group underwent occupational therapy as well.

MAIN MEASURES

Patients' emotional distress (GHQ-28), perceived fatigue (the first item of the BASDAI using a 0-100 visual analogue scale scale), level of independence (Modified Barthel Index) and function (Harris Hip Score) were measured at baseline and one, three and six months after the intervention.

RESULTS

Patients in the CT group experienced a considerable decrease of emotional distress at three and six months (p = 0.005 and p < 0.001, respectively). A between-group analysis showed significant differences in emotional distress at one, three and six months (p < 0.001). Although fatigue levels decreased in the SC group, the most significant decline was reported by the CT group at six months (p < 0.001, mean difference = 14 points). Regarding independence level, significant differences were found within groups at each stage, but also between groups at one month in favor of the CT group. Function improved in both groups compared with baseline (p < 0.001), but no significant differences were found in functionality between groups.

CONCLUSION

Although both groups reported significant improvements, patients in the CT group had better scores in emotional distress and dependence throughout follow-up and better scores in all measures at six months.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program

PURPOSE

The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile.

METHODS

Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development.

RESULTS

Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly.

CONCLUSION

The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.

[Endocrinometabolic disorders in chronic obstructive pulmonary disease]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is characterized by the presence of chronic airflow obstruction and associated endocrinometabolic disorders, which usually worsen the clinic and prognostic of the patients. Therefore, in-depth knowledge of these prevalent disorders in patients with COPD is relevant to develop preventive measures and early detection.

PURPOSE

To analyze the prevalence of endocrinometabolic diseases that occur in COPD subjects and their related risk factors.

METHODS

We carried out a bibliographic search of the bibliographic resources of the last 10 years, including PubMed, Scopus and ScienceDirect databases. Words used were: "endocrine metabolic disorders AND COPD", "endocrine disorders AND COPD" and "metabolic disorders AND COPD". The bibliographical analysis was made in two steps. During the first phase, we excluded those articles in which the title or their content did not correspond with the objective settled; during the second phase, we deleted all the references duplicated in both databases. Finally, 17 articles after full-text critical appraisal were maintained.

RESULTS

After reviewing the articles, we found a significant relationship between diabetes mellitus, metabolic syndrome, obesity, osteoporosis, hypogonadism and COPD. Different authors have reported a higher prevalence of these comorbidities, influencing the development of COPD.

CONCLUSIONS

Due to the high prevalence and association with COPD, these comorbidities have to be considered by the health professionals related to the COPD patients. Better understanding of the endocrinometabolic disorders related to COPD can influence the treatment and the outcome of patients.