Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis

OBJECTIVE:

To systematically review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke. The specific questions were: Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke? Is this type of intervention more effective in increasing walking speed, than non-virtual reality-based walking interventions?

METHOD:

A systematic review with meta-analysis of randomized clinical trials was conducted. Participants were adults with chronic stroke and the experimental intervention was walking training associated with virtual reality-based training to increase walking speed. The outcome data regarding walking speed were extracted from the eligible trials and were combined using a meta-analysis approach.

RESULTS:

Seven trials representing eight comparisons were included in this systematic review. Overall, the virtual reality-based training increased walking speed by 0.17 m/s (IC 95% 0.08 to 0.26), compared with placebo/nothing or non-walking interventions. In addition, the virtual reality-based training increased walking speed by 0.15 m/s (IC 95% 0.05 to 0.24), compared with non-virtual reality walking interventions.

CONCLUSIONS:

This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke, and resulted in better results than non-virtual reality interventions.     

THE EFFECTS OF CONVENTIONAL PHYSICAL THERAPY AND ECCENTRIC STRENGTHENING FOR INSERTIONAL ACHILLES TENDINOPATHY

Study Design:

Single‐blind, randomized, clinical trial.

Background:

The effect of eccentric training for mid‐portion Achilles tendinopathy is well documented; however, its effect on insertional Achilles tendinopathy is inconclusive. The primary purpose of this study was to investigate the effect of eccentric training on pain and function for individuals with insertional Achilles tendinopathy.

Methods:

All patients received a 12‐week conventional strengthening protocol. Patients who were randomly assigned to the experimental group received additional eccentric exercises. Patients completed the Short Form‐36 Health and Bodily Pain Surveys, the Foot and Ankle Outcomes Questionnaire, and the Visual Analog Scale at initial evaluation, after 6 weeks of therapy, and at 12 weeks after therapy.

Results:

Thirty‐six patients (20 control and 16 experimental; average age 54 years; 72% women) completed the study. Both groups experienced statistically significant decreases in pain and improvements in function. No statistically significant differences were noted between the groups for any of the outcome measures.

Conclusion:

Conventional physical therapy consisting of gastrocnemius, soleus and hamstring stretches, ice massage on the Achilles tendon, and use of heel lifts and night splints with or without eccentric training is effective for treating insertional Achilles tendinopathy.

Level of Evidence:

Level 2     

Identification and agreement of first turn point by mathematical analysis applied to heart rate,carbon dioxide output and electromyography

Background

The second heart rate (HR) turn point has been extensively studied, however there are few studies determining the first HR turn point. Also, the use of mathematical and statistical models for determining changes in dynamic characteristics of physiological variables during an incremental cardiopulmonary test has been suggested.

Objectives

To determine the first turn point by analysis of HR, surface electromyography (sEMG), and carbon dioxide output () using two mathematical models and to compare the results to those of the visual method.

Method

Ten sedentary middle-aged men (53.9±3.2 years old) were submitted to cardiopulmonary exercise testing on an electromagnetic cycle ergometer until exhaustion. Ventilatory variables, HR, and sEMG of the vastus lateralis were obtained in real time. Three methods were used to determine the first turn point: 1) visual analysis based on loss of parallelism between and oxygen uptake (); 2) the linear-linear model, based on fitting the curves to the set of data (Lin-Lin ); 3) a bi-segmental linear regression of Hinkley'' s algorithm applied to HR (HMM-HR), (HMM- ), and sEMG data (HMM-RMS).

Results

There were no differences between workload, HR, and ventilatory variable values at the first ventilatory turn point as determined by the five studied parameters (p>0.05). The Bland-Altman plot showed an even distribution of the visual analysis method with Lin-Lin , HMM-HR, HMM-CO_2, and HMM-RMS.

Conclusion

The proposed mathematical models were effective in determining the first turn point since they detected the linear pattern change and the deflection point of , HR responses, and sEMG.     

Attitudes of medical clerks toward persons with intellectual disabilities

Objective

To assess the attitudes of upper-year undergraduate medical students (ie, clerks) toward the philosophy of community inclusion of persons with intellectual disabilities (ID) according to demographic, personal contact, and training variables.

Design

Cross-sectional self-administered survey.

Setting

Clerkship rotations at Queen’s University in Kingston, Ont, and the University of Toronto in Ontario in 2006.

Participants

A total of 258 clerks.

Main outcome measures

Scores on the Community Living Attitudes Scale—Short Form.

Results

There were no differences in the Community Living Attitudes Scale—Short Form subscale scores across categories of demographic characteristics, personal contact, or having received didactic training about ID. Clerks who had seen patients with ID during their medical school training had higher mean sheltering subscale scores than those who had not (3.27 vs 3.07, P = .02). Additional analysis revealed that 88.5% of clerks who had seen patients with ID reported seeing 5 or fewer such patients, and that those who rated the quality of their supervision more positively had higher mean scores on the empowerment subscale and lower mean scores on the sheltering subscale.

Conclusion

Although specific training has the potential to promote more socially progressive attitudes regarding persons with ID, lower-quality supervision is associated with higher endorsement of items expressing the need to shelter individuals with ID from harm and lower endorsement of items promoting empowerment.     

Comparing the effects of minimal handling protocols on the physiological parameters of preterm infants receiving exogenous surfactant therapy

Background

The practice of minimal handling is recommended for preterm infants (PTIs). However, few studies have investigated the effects of this practice among these infants or the time needed to ensure greater physiological stability, especially after exogenous surfactant treatments.

Objective

The current study compared the effects of two protocols of minimal handling on the physiological variables of PTIs after surfactant therapy.

Method

An exploratory prospective observational study was performed with 40 PTIs weighing less than 1,500 g. The infants were divided into two groups and monitored for 72 hours. One group received the standard minimal handling procedure during the first 12 hours after surfactant therapy; the other group (i.e., the modified group) received minimal handling within 72 hours after surfactant therapy. Infant heart rate (HR), oxygen saturation, body temperature, and the adverse events associated with changes to these variables were monitored every 10 minutes.

Results

Significant between-group differences were not found with regard to the occurrence of the adverse events associated with physiological changes (p>0.05).

Conclusion

The practice of minimal handling among very low birth weight infants did not alter their physiological stability when performed either 12 or 72 hours after surfactant therapy.     

Ground reaction forces during level ground walking with body weight unloading

Background:

Partial body weight support (BWS) systems have been broadly used with treadmills as a strategy for gait training of individuals with gait impairments. Considering that we usually walk on level ground and that BWS is achieved by altering the load on the plantar surface of the foot, it would be important to investigate some ground reaction force (GRF) parameters in healthy individuals walking on level ground with BWS to better implement rehabilitation protocols for individuals with gait impairments.

Objective:

To describe the effects of body weight unloading on GRF parameters as healthy young adults walked with BWS on level ground.

Method:

Eighteen healthy young adults (27±4 years old) walked on a walkway, with two force plates embedded in the middle of it, wearing a harness connected to a BWS system, with 0%, 15%, and 30% BWS. Vertical and horizontal peaks and vertical valley of GRF, weight acceptance and push-off rates, and impulse were calculated and compared across the three experimental conditions.

Results:

Overall, participants walked more slowly with the BWS system on level ground compared to their normal walking speed. As body weight unloading increased, the magnitude of the GRF forces decreased. Conversely, weight acceptance rate was similar among conditions.

Conclusions:

Different amounts of body weight unloading promote different outputs of GRF parameters, even with the same mean walk speed. The only parameter that was similar among the three experimental conditions was the weight acceptance rate.     

Associations between low back pain,urinary incontinence,and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Background:

Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability.

Objective:

To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging.

Method:

Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant.

Results:

The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R²=0.02; F=0.47; p=0.628), 10.6% (R²=0.106; F=3.03; p=0.057), and 10.1% (R²=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment.

Conclusion:

These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly.     

The influence of resistance exercise with emphasis on specific contractions (concentric vs. eccentric) on muscle strength and post-exercise autonomic modulation: a randomized clinical trial

Background

Compared to eccentric contractions, concentric contractions result in higher cardiovascular stress. However, we do not know how these two types of contractions influence cardiac autonomic modulation during the post-exercise recovery period.

Objective

to compare the effect of resistance training that is performed with concentric vs. eccentric emphasis on muscle strength and on post-exercise recovery which was assessed by examining heart rate variability (HRV), for the knee extensor muscle group in young healthy adults.

Methods

For this study, 105 men between 18 and 30 years of age were randomized into 4 groups: concentric control (CONCC), eccentric control (ECCC), concentric training (CONCT) and eccentric training (ECCT). The CONCC and ECCC groups underwent one session of resistance exercise (RE) using the knee extensor muscle group (3 sets of 1 repetition at 100% of the maximal repetition [1MR]) and the CONCT and ECCT groups performed 10 training sessions. The HRV was analyzed at baseline and across four recovery periods (T1, T2, T3 and T4).

Results

The ECCT group exhibited increased muscle strength at the end of the study. Regarding cardiac autonomic modulation, the CONCC and ECCC groups exhibited increases in overall variability (SDNN and SD2) at T1 compared to baseline, and the ECCT group demonstrated increases in variables reflecting vagal modulation and the recovery process (RMSSD, SD1 and HF [ms²]) at T1, T2 and T4 compared to baseline.

Conclusions

Resistance training with emphasis on eccentric contractions promoted strength gain and an increase in cardiac vagal modulation during recovery compared to baseline.     

REAL‐TIME TEST‐RETEST AND INTERRATER RELIABILITY OF SELECT PHYSICAL PERFORMANCE MEASURES IN PHYSICALLY ACTIVE COLLEGE‐AGED STUDENTS

Background:

A new 16‐item physical performance measure screening battery (16‐PPM) was developed in order to expand on established movement based qualitatively scored functional screening batteries to encompass a broader spectrum of quantitatively scored functional constructs such as strength, endurance, and power.

Purpose/Hypothesis:

The purpose of this study was quantify the real‐time tests‐retest and expert versus novice interrater reliability of the 16‐PPM screen on a group of physically active college‐aged individuals. The authors'' hypothesized that the test‐retest and interrater reliability of quantitatively‐scored performance measures would be highly correlated (ICC ≥ 0.75) and that qualitatively‐scored movement screening tests would be moderately correlated (K_w = 0.41‐0.60).

Study Design:

Cohort reliability study

Methods:

Nineteen (8 males, 11 females) healthy physically active college‐aged students completed the 16‐PPM on two days, one week apart.

Results:

The majority of the quantitatively scored components of the 16‐PPMs demonstrated good expert‐novice interrater reliability (ICC > 0.75), while qualitatively scored tests had moderate (K_w = 0.41‐0.60) to substantial (K_w = 0.61‐0.80) agreement. Test‐retest reliability was consistent between raters, with most quantitatively scored PPMs exhibiting superior reliability to the qualitatively scored PPMs.

Conclusions:

The 16‐PPM test items showed good test‐retest and interrater reliability. However, results indicate that expert raters may be more reliable than novice raters for qualitatively scored tests. The validity of this 16‐PPM needs to be determined in future studies.

Clinical Relevance:

Physical performance screening batteries may be used to help identify individuals at risk for future athletic injury; however, current PPMs that rely on qualitatively scored movement screens have exhibited inconsistent and questionable injury prediction validity. The addition of reliable quantitatively scored PPMs may complement qualitatively scored PPMs to improve the battery''s predictive ability.

Level of Evidence:

Level III     

THE EFFECT OF AXIOSCAPULAR AND ROTATOR CUFF EXERCISE TRAINING SEQUENCE IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME: A RANDOMIZED CROSSOVER TRIAL

Background

While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of exercise training interventions has not been defined.

Hypothesis/Purpose

The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises.

Study Design

Level I randomized crossover trial

Methods

This was a prospective study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome (SAIS). They were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation.

Results

The results showed significant improvements in pain (p < 0.001), function (p < 0.001), and patient satisfaction (p < 0.001) at all follow-up times for both groups. There was not a statistically significant difference in pain or function at any follow-up period for initiating one group of exercise before the other (p > 0.05). There was a statistically significant interaction between the patient''s global rating of change at the 4 week follow-up as compared to 8 weeks (p = 0.04) or 16 (p < 0.001).

Conclusion

Patients with SAIS demonstrate improvement in pain and function with a standardized program of physical therapy regardless of group exercise sequencing.

Level of Evidence

1b     

Skinfold thickness affects the isometric knee extension torque evoked by Neuromuscular Electrical Stimulation

BACKGROUND:

Subcutaneous adipose tissue may influence the transmission of electrical stimuli through to the skin, thus affecting both evoked torque and comfort perception associated with neuromuscular electrical stimulation (NMES). This could seriously affect the effectiveness of NMES for either rehabilitation or sports purposes.

OBJECTIVE:

To investigate the effects of skinfold thickness (SFT) on maximal NMES current intensity, NMES-evoked torque, and NMES-induced discomfort.

METHOD:

First, we compared NMES current intensity, NMES-induced discomfort, and NMES-evoked torque between two subgroups of subjects with thicker (n=10; 20.7 mm) vs. thinner (n=10; 29.4 mm) SFT. Second, we correlated SFT to NMES current intensity, NMES-induced discomfort, and NMES-evoked knee extension torque in 20 healthy women. The NMES-evoked torque was normalized to the maximal voluntary contraction (MVC) torque. The discomfort induced by NMES was assessed with a visual analog scale (VAS).

RESULTS:

NMES-evoked torque was 27.5% lower in subjects with thicker SFT (p=0.01) while maximal current intensity was 24.2% lower in subjects with thinner SFT (p=0.01). A positive correlation was found between current intensity and SFT (r=0.540, p=0.017). A negative correlation was found between NMES-evoked torque and SFT (r=-0.563, p=0.012). No significant correlation was observed between discomfort scores and SFT (r_s=0.15, p=0.53).

CONCLUSION:

These results suggest that the amount of subcutaneous adipose tissue (as reflected by skinfold thickness) affected NMES current intensity and NMES-evoked torque, but had no effect on discomfort perception. Our findings may help physical therapists to better understand the impact of SFT on NMES and to design more rational stimulation strategies.     

The addition of functional task-oriented mental practice to conventional physical therapy improves motor skills in daily functions after stroke

Background

Mental practice (MP) is a cognitive strategy which may improve the acquisition of motor skills and functional performance of athletes and individuals with neurological injuries.

Objective

To determine whether an individualized, specific functional task-oriented MP, when added to conventional physical therapy (PT), promoted better learning of motor skills in daily functions in individuals with chronic stroke (13±6.5 months post-stroke).

Method

Nine individuals with stable mild and moderate upper limb impairments participated, by employing an A₁-B-A₂ single-case design. Phases A₁ and A₂ included one month of conventional PT, and phase B the addition of MP training to PT. The motor activity log (MAL-Brazil) was used to assess the amount of use (AOU) and quality of movement (QOM) of the paretic upper limb; the revised motor imagery questionnaire (MIQ-RS) to assess the abilities in kinesthetic and visual motor imagery; the Minnesota manual dexterity test to assess manual dexterity; and gait speed to assess mobility.

Results

After phase A₁, no significant changes were observed for any of the outcome measures. However, after phase B, significant improvements were observed for the MAL, AOU and QOM scores (p<0.0001), and MIQ-RS kinesthetic and visual scores (p=0.003; p=0.007, respectively). The significant gains in manual dexterity (p=0.002) and gait speed (p=0.019) were maintained after phase A₂.

Conclusions

Specific functional task-oriented MP, when added to conventional PT, led to improvements in motor imagery abilities combined with increases in the AOU and QOM in daily functions, manual dexterity, and gait speed.     

Early surgery for native valve infective endocarditis

Expanded abstract

Citation

Kang DH, Kim YJ, Kim SH, Sun BJ, Kim DH, Yun SC, Song JM, Choo SJ, Chung CH, Song JK, Lee JW, Sohn DW: Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012, 366: 2466-2473.

Background

The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis (IE) remain controversial. This trial compares clinical outcomes of early surgery and conventional treatment in patients with IE.

Methods

Objective

To determine the effect of early surgery (<48 hours) to decrease the rate of death or embolic events as compared with conventional treatment for IE.

Design

Prospective randomized trial.

Setting

Two academic medical centers in Korea.

Subjects

Adult patients with left-sided, native-valve IE and a high risk of embolism.

Intervention

Valve repair or replacement with removal of vegetation within 48 hours of random assignment versus no early surgery.

Outcomes

Composite primary endpoint of in-hospital death and embolic events occurring within 6 weeks after random assignment. Secondary endpoints, at 6 months, included death from any cause, embolic events, recurrence of IE, and repeat hospitalization due to the development of congestive heart failure.

Results

Thirty-seven patients were assigned to the early-surgery group (<48 hours), whereas 39 were assigned to conventional therapy. Of the 39 randomly assigned to conventional therapy, 27 patients (77%) underwent surgery during the initial hospitalization and three during follow-up. One patient (3%) in the early-surgery group and nine (23%) in the conventional-treatment group reached the primary endpoint (hazard ratio (HR) 0.10, 95% confidence interval (CI) 0.01 to 0.82; P = 0.03). There was no significant difference in all-cause mortality at 6 months in the early-surgery and conventional-treatment groups (3% and 5%, respectively; HR 0.51, 95% CI 0.05 to 5.66; P = 0.59). The rates of the composite endpoint of death from any cause, embolic events, or recurrence of IE at 6 months were 3% in the early-surgery group and 28% in the conventional-treatment group (HR 0.08, 95% CI 0.01 to 0.65; P = 0.02).

Conclusions

Early surgery in patients with IE and large vegetations significantly reduced the composite endpoint of death from any cause and embolic events by effectively decreasing the risk of systemic embolism.     

Effect of upper extremity proprioceptive neuromuscular facilitation combined with elastic resistance bands on respiratory muscle strength: a randomized controlled trial

Background

Elastic resistance bands (ERB) combined with proprioceptive neuromuscular facilitation (PNF) are often used in resistance muscle training programs, which have potential effects on peripheral muscle strength. However, the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation.

Objectives

The assessment of the effects of PNF combined with ERB on respiratory muscle strength.

Method

Twenty healthy, right-handed females were included. Subjects were randomized to either the resistance training program group (TG, n=10) or the control group (CG, n=10). Maximal expiratory pressure (MEP) and inspiratory pressure (MIP) were measured before and after four weeks of an upper extremity resistance training program. The training protocol consisted of upper extremity PNF combined with ERB, with resistance selected from 1 repetition maximum protocol.

Results

PNF combined with ERB showed significant increases in MIP and MEP (p<0.05). In addition, there were significant differences between the TG and CG regarding ∆MIP (p=0.01) and ∆MEP (p=0.04).

Conclusions

PNF combined with ERB can have a positive impact on respiratory muscle strength. These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength.     

Effect of low-level laser therapy (808 nm) on skeletal muscle after endurance exercise training in rats

BACKGROUND:

Low-level laser therapy (LLLT) has been demonstrated to be effective in optimizing skeletal muscle performance in animal experiments and in clinical trials. However, little is known about the effects of LLLT on muscle recovery after endurance training.

OBJECTIVE:

This study evaluates the effects of low-level laser therapy (LLLT) applied after an endurance training protocol on biochemical markers and morphology of skeletal muscle in rats.

METHOD:

Wistar rats were divided into control group (CG), trained group (TG), and trained and laser irradiated group (TLG). The endurance training was performed on a treadmill, 1 h/day, 5 days/wk, for 8 wk at 60% of the maximal speed reached during the maximal effort test (Tmax) and laser irradiation was applied after training.

RESULTS:

Both trained groups showed significant increase in speed compared to the CG. The TLG demonstrated a significantly reduced lactate level, increased tibialis anterior (TA) fiber cross-section area, and decreased TA fiber density. Myogenin expression was higher in soleus and TA muscles in both trained groups. In addition, LLLT produced myogenin downregulation in the TA muscle of trained animals.

CONCLUSION:

These results suggest that LLLT could be an effective therapeutic approach for stimulating recovery during an endurance exercise protocol.     

Thorax,pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis

Background:

Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability.

Objectives:

The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA).

Method:

The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon^(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane.

Results:

The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01).

Conclusions:

The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking.     

BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT

Study Design:

Experimental design

Background:

Normal breathing mechanics play a key role in posture and spinal stabilization. Breathing Pattern Disorders (BPD) have been shown to contribute to pain and motor control deficits, which can result in dysfunctional movement patterns. The Functional Movement Screen™ (FMS™) has been shown to accurately predict injury in individuals who demonstrate poor movement patterns. The role BPD play on functional movement is not well established. Furthermore, there is currently no single test to clinically diagnose BPD. A variety of methods are used, but correlations between them are poor.

Purpose:

To examine the relationship between BPD and functional movement and identify correlations between different measures of BPD.

Methods:

Breathing was assessed in 34 healthy individuals using a multi‐dimensional approach that included biomechanical, biochemical, breathing related symptoms, and breathing functionality measures. Movement was assessed using the FMS™. Analysis, involving independent t‐tests and Pearson correlation were performed to identify associations between measures.

Results:

Individuals who exhibited biochemical and biomechanical signs of BPD were significantly more likely to score poorly on the FMS™. These studied measures of BPD correlated highly with each other.

Conclusion:

These results demonstrate the importance of diaphragmatic breathing on functional movement. Inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that are capable of modifying movement. These findings provide evidence for improved breathing evaluations by clinicians.

Level of Evidence:

2B     

The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study

♦ Objectives:

There is a lack of consensus on the risk factors for hernia formation, and the impact on peritoneal dialysis (PD) survival has seldom been studied.

♦ Methods:

This was a population-based study and all collected data were retrieved from the National Health Insurance Research Database of Taiwan. Patients who commenced PD between January 1998 and December 2006 were screened for inclusion. Multiple logistic regression and Cox proportional hazards models were applied to estimate the predictors for hernia formation and determine the predictors of PD withdrawal.

♦ Results:

A total of 6,928 PD patients were enrolled and followed until December 2009, with 631 hernia events and 391 hernioplasties being registered in 530 patients (7.7%). The incidence rate was 0.04 hernias/patient/year. Longer PD duration (per 1 month increase, hazard ratio (HR) 1.019) and history of mitral valve prolapse (MVP) (HR 1.584) were independent risk factors for hernia formation during PD, and female gender (HR 0.617) was a protective factor. On the other hand, there were 4,468 PD withdrawals, with cumulative incidence rates of 41% at 1 year, 66% at 3 years, and 82% at 5 years. Independent determinants for cumulative PD withdrawal included hernia formation during PD (HR 1.154), age (per 1 year increase, HR 1.014), larger dialysate volume (per 1 liter increase, HR 0.496), female gender (HR 0.763), heart failure (HR 1.092), hypertension (HR 1.207), myocardial infarction (HR 1.292), chronic obstructive pulmonary disease (COPD) (HR 1.227), cerebrovascular accident (CVA) (HR 1.364), and history of MVP (HR 0.712)

♦ Conclusions:

Prolonged PD duration was a risk factor for hernia formation, and female gender was protective. Hernia formation during PD therapy may increase the risk of PD withdrawal.