Shuttle walk tests as outcome measures: Are two incremental shuttle walk tests and two endurance shuttle walk tests necessary?

This study was undertaken in people with chronic obstructive pulmonary disease to determine differences in incremental shuttle walk test distance and endurance shuttle walk test time when two of each shuttle test were performed before (n = 53 participants) and after an exercise training program (n = 31 participants) and whether the results altered program outcomes. There was a significant increase in incremental shuttle walk test distance between the two incremental shuttle walk tests before (P < 0.001) and after training (P < 0.01). There was no significant difference in the endurance shuttle walk test time between the two endurance shuttle walk tests before (P = 0.95) or after training (P = 0.07). There was a significant increase in both incremental shuttle walk test distance and endurance shuttle walk test time after training (all P < 0.01); however, the increase was greater if the better of the two tests was reported at both time points. The incremental shuttle walk test should be performed twice before and after an exercise training program. This does not seem to be necessary for the endurance shuttle walk test; however, improvement after training was greater if the better of two endurance shuttle walk tests were used to evaluate program outcomes.     

Are cardiovascular and metabolic responses to field walking tests interchangeable and obesity-dependent?

Purpose: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals.

Method: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20–45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland–Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables.

Results: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO₂ mL?kg^?1?min^?1)?=?6.9 (CI: 5.7–8.1), and heart rate (bpm)?=?37.0 (CI: 33.3–40.7)] and ISWT [VO₂ (mL?kg^?1?min^?1)?=?6.1 (CI: 4.9–7.3), and heart rate (bpm)?=?36.2 (CI: 32.1–40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO₂ ( r?=?0.70); dyspnoea (r?=?0.80); and leg fatigue (r?=?0.70).

Conclusions: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited.

• Implications for Rehabilitation

• Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk.

• Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing.

• Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

     

Are high-sensitivity cardiac troponin I values stable between preoperative visit and day of non-cardiac surgery?

BackgroundIt is unclear if cardiac troponin values are stable in patients prior to undergoing non-cardiac surgery, or if they tend to rise towards the day of surgery.MethodsIn this small pilot study (n = 18) among patients with cardiac risk undergoing non-cardiac surgery, we determined if high-sensitivity cardiac troponin I (hscTnI) changes between the preoperative clinic visit and the day of surgery. HscTnI was measured on an Abbott Architect STAT (Abbott Laboratories, USA) platform.ResultsThe mean duration between preoperative clinic visit and day of surgery was 8.7 ± 2.8 (SD) days. Median hscTnI was 3.4 ng/L [2.0–4.8, IQR] at the preoperative visit and 2.8 ng/L [2.3–4.4] on the day of surgery (mean difference − 0.24 ng/L, 95% CI - 0.73 to 0.24 ng/L, p = 0.30). Only one patient had a large change (> 50%) along with symptoms.DiscussionEvidence from this small study suggests that cardiac troponin values are stable in most high-risk patients, absent clinical events, within 10 days prior to non-cardiac surgery.     

Are nurses able to assess fatigue,exertion fatigue and types of fatigue in residential home patients?

Are nurses able to assess fatigue, exertion fatigue and types of fatigue in residential home patients? Although fatigue is recognized as a subjective, generalized, extensive and disabling health care problem with a relatively high prevalence among the chronically ill, there have been no studies to show whether nurses caring for fatigued subjects are able to accurately assess the level of fatigue that exists in these patients. The aim of the present study is to investigate this issue. The following research questions are formulated: (1) To what degree do the assessments of fatigue and exertion fatigue given by nurses and patients agree? and (2) To what degree do the assessments of types of fatigue given by nurses and patients agree? The method adopted employed a correlational design approach applied to residential home patients and nurses. Data were gathered by questionnaire. Data collected from 44 selected patients and two assessors (nurses) for each patient are used in the analyses. Measurement instruments used are the Dutch fatigue scale (DUFS), the Dutch exertion fatigue scale (DEFS), types of fatigue and sociodemographic variables. Measurement correlations between the patients and the nurses, both for the DUFS and DEFS, showed fair agreement (fatigue and exertion fatigue) and slight agreement (types of fatigue). The main conclusion of this study is that nurses working in residential home care are unable, in comparison with the patients themselves, to accurately assess patient's fatigue (fair agreement), exertion fatigue (fair agreement) and types of fatigue (slight agreement).     

Are Contents of Physical Therapy in Nine Japanese Hospitals for Inpatients with Stroke Related to Inpatients’ and Physical Therapists’ Characteristics?

[Purpose] This study investigated the factors that influence activities provided during physical therapy for stroke. [Subjects] Data were collected from 85 physical therapists and 216 inpatients with stroke. [Methods] Time spent on specific functional activities provided to inpatients with stroke was recorded at nine rehabilitation facilities. These were used as dependent variables. Physical therapists’ characteristics, including years since acquiring a license, gender, and treatment concepts influencing physical therapy for stroke, were recorded. Inpatients’ characteristics, including age, gender, affected side, days post stroke, score on the Modified Rankin Scale (mRS), and gait ability measured by the Functional Independence Measure (FIM gait), were also recorded. Physical therapists’ and inpatients’ characteristics were used as independent variables. The t-test, correlation coefficients, and analysis of covariance were used to investigate which independent variables correlated with which dependent variables. [Results] Pre-gait, advanced gait, and community mobility were significantly correlated with mRS and FIM gait (|r_s| = 0.32–0.62). Time spent on other functional activities had a weak correlation with inpatients’ characteristics. Time spent on functional activities had no or few correlations with physical therapists’ characteristics. [Conclusion] Relationships between time spent on specific functional activities and physical therapists’ characteristics were weaker than those for inpatients’ characteristics. Physical therapy for stroke includes many factors.Key words: Physical therapy, Rehabilitation, Stroke     

Effects of Nordic walking on physical functions and depression in frail people aged 70?years and above

[Purpose] This study investigated the effects of Nordic walking on physical functions and depression in frail people aged 70 years and above. [Subjects] Twenty frail elderly individuals ≥70 years old were assigned to either a Nordic walking group (n=8) or general exercise group (n=10). [Methods] The duration of intervention was equal in both groups (3 sessions/week for 12 weeks, 60 min/session). Physical function (balance, upper extremity strength, lower extremity strength, weakness) and depression were examined before and after the interventions. [Results] With the exception of upper extremity muscle strength, lower extremity strength, weakness, balance, and depression after Nordic walking demonstrated statistically significant improvement. However, in the general exercise group, only balance demonstrated a statistically significant improvement after the intervention. There were significant differences in the changes in lower extremity muscle strength, weakness and depression between the groups. [Conclusion] In conclusion, Nordic walking was more effective than general exercise. Therefore, we suggest that Nordic walking may be an attractive option for significant functional improvement in frail people over 70 years old.Key words: Nordic walking, General exercise, Frail people     

On the Functional Capacity and Quality of Life of Patients with Acromegaly: Are They Candidates for Rehabilitation Programs?

[Purpose] This study compared patients having active acromegaly with those having controlled acromegaly in terms of peripheral muscle strength, body composition, and functional capacity. We also examined the associations between these measures. [Methods] A total of 14 patients with active acromegaly, 12 patients with controlled acromegaly, and 12 healthy controls were subjected to isometric dynamometry, surface electromyography, electrical bioimpedance, and a six-minute walk test. [Results] The active acromegaly group exhibited significantly more fat-free mass than the control group. With respect to the peripheral muscle performance, the controlled acromegaly group presented a significantly lower electromyographic median frequency than the control group. The quadriceps maximum strength was significantly lower in the controlled acromegaly group than in the control group. The fat-free mass was significantly correlated with the quadriceps maximum strength. The global scores of the Acromegaly Quality of Life Questionnaire were significantly correlated with the six-minute walk distance. [Conclusion] Patients with acromegaly have more fat-free mass, less peripheral muscle strength, and greater fatigability than healthy control subjects. These findings depend on the degree of hormonal control. In acromegalic patients, peripheral muscle strength is related to body composition, and functional capacity is correlated with quality of life.Key words: Acromegaly, Muscle strength, Exercise tolerance     

Assessment of muscular strength with the modified sphygmomanometer test: what is the best method and source of outcome values?

Background

Tests that are usually employed for the clinical assessment of muscular strength have notable disadvantages. The Modified Sphygmomanometer Test (MST) is a promising method because it is low-cost and provides objective measures.

Objectives

To investigate the most adequate method and sources of outcome values for the assessment of strength with the MST.

Method

Methodological study with 40 healthy adults (22.98±2.26 years), who did not practice physical activity regularly. The strength of the flexors and extensors of the elbow and knee, the handgrip of the dominant side and anterior trunk flexors were randomly assessed with portable dynamometers and the MST (bag and cuff adaptations, and sphygmomanometer without adaptation) by a single examiner. An independent examiner read and recorded the values. The sources of the investigated outcome values were the first trial and the means of two and three trials. One-way ANOVAs and Pearson Correlation Coefficients were used for the analyses (α=0.05).

Results

For the MST methods applied to assess all muscular groups, similar values were found for all sources of outcome values (0.01<F<0.26; 0.77<p<1.00) with significant and positive correlations between the measures obtained with the dynamometers (0.51<r<0.94; p<0.003).

Conclusions

All MST methods showed adequate results for the assessment of strength in healthy individuals, and after familiarization, only one trial was sufficient to provide reliable measures. The sphygmomanometer without adaptation is not time consuming, compared to the other adaptations, and showed the capability of measuring higher values of strength. The bag method was easily trained to be used and stabilized.     

Are infrequent episodic,frequent episodic and chronic tension-type headache inherited? A population-based study of 11 199 twin pairs

The objective was to investigate the importance of genetic and environmental factors for infrequent episodic, frequent episodic and chronic tension-type headache. Twin pairs recruited from the population-based Danish Twin Registry received a posted questionnaire. Only twin pairs where both twins replied were included. A total of 3523 monozygotic (MZ), 4150 dizygotic (DZ) same-gender and 3526 DZ opposite-gender twin pairs were included. The prevalence of frequent episodic and chronic tension-type headache was significantly more frequent in women than men, and significantly higher in those with co-occurrence of migraine. The concordance rates were significantly higher in MZ than same-gender DZ twin pairs with no or frequent episodic tension-type headache, while the difference was not significant in chronic tension-type headache. The concordance rates of infrequent episodic tension-type headache in MZ and same-gender DZ twin pairs was significantly different in women but not in men, although the difference was small in both genders. We conclude that genetic factors play a role in no and frequent episodic tension-type headache, while infrequent episodic tension-type headache is caused primarily by environmental factors. The data regarding chronic tensiontype headache were limited, so no firm conclusion could be drawn. Greppi-Sicuteri Commitee: Giorgio Zanchin, Miguel J.A. Lainez, Marcello Fanciullacci, Paolo Martelletti, Arne May, Lorenzo Pinessi     

Are there two forms of isometric muscle action? Results of the experimental study support a distinction between a holding and a pushing isometric muscle function

Background

In isometric muscle function, there are subjectively two different modes of performance: one can either hold isometrically – thus resist an impacting force – or push isometrically – therefore work against a stable resistance. The purpose of this study is to investigate whether or not two different isometric muscle actions – the holding vs. pushing one (HIMA vs PIMA) – can be distinguished by objective parameters.

Methods

Ten subjects performed two different measuring modes at 80% of MVC realized by a special pneumatic system. During HIMA the subject had to resist the defined impacting force of the pneumatic system in an isometric position, whereby the force of the cylinder works in direction of elbow flexion against the subject. During PIMA the subject worked isometrically in direction of elbow extension against a stable position of the system. The signals of pressure, force, acceleration and mechanomyography/-tendography (MMG/MTG) of the elbow extensor (MMGtri/MTGtri) and the abdominal muscle (MMGobl) were recorded and evaluated concerning the duration of maintaining the force level (force endurance) and the characteristics of MMG-/MTG-signals. Statistical group differences comparing HIMA vs. PIMA were estimated using SPSS.

Results

Significant differences between HIMA and PIMA were especially apparent regarding the force endurance: During HIMA the subjects showed a decisively shorter time of stable isometric position (19?±?8 s) in comparison with PIMA (41?±?24 s; p?=?.005). In addition, during PIMA the longest isometric plateau amounted to 59.4% of the overall duration time of isometric measuring, during HIMA it lasted 31.6% (p?=?.000). The frequency of MMG/MTG did not show significant differences. The power in the frequency ranges of 8–15 Hz and 10–29 Hz was significantly higher in the MTGtri performing HIMA compared to PIMA (but not for the MMGs). The amplitude of MMG/MTG did not show any significant difference considering the whole measurement. However, looking only at the last 10% of duration time (exhaustion), the MMGtri showed significantly higher amplitudes during PIMA.

Conclusion

The results suggest that under holding isometric conditions muscles exhaust earlier. That means that there are probably two forms of isometric muscle action. We hypothesize two potential reasons for faster yielding during HIMA: (1) earlier metabolic fatigue of the muscle fibers and (2) the complexity of neural control strategies.

     

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

ObjectiveTo examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome.MethodsThis retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded.ResultsA total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA.ConclusionSonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.