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Brit Long Alex Koyfman Katharine L. Modisett Christian J. Woods 《The Journal of emergency medicine》2017,52(4):472-483
Background
Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment.Objective
This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment.Discussion
Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, ≤ 65 mm Hg, lactate ≥ 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario.Conclusions
The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes. 相似文献3.
Osnat Wittmann Ayelet Rimon Dennis Scolnik Miguel Glatstein 《The Journal of emergency medicine》2018,54(3):315-319
Background
Neutropenia may alarm clinicians and prompt extensive evaluation in children with fever, even in immunocompetent patients.Objective
Our aim was to determine outcomes in previously healthy febrile children presenting to the emergency department with severe neutropenia.Methods
We reviewed data from infants and children aged 3–36 months with fever and severe neutropenia, defined as a peripheral neutrophil count <500 × 103/μL, at our institution between January 1, 2012 and December 31, 2015. We compared our results to those from a similar study of children with a peripheral neutrophil count of 500–1000 × 103/μL.Results
Severe neutropenia was recorded in 52 patients; severe bacterial infection (SBI) was found in 1 (1.9%), but none had a positive blood culture. Incidence of SBI was not different from that found in a study of similar patients with moderate neutropenia.Conclusions
Immunocompetent patients with fever and severe neutropenia do not carry a higher risk for SBI compared to patients with fever and moderate neutropenia. Such patients could potentially be followed closely with serial blood counts to ensure bone marrow recovery, without the use of antibiotics. 相似文献4.
Moriah J. Brier Rhonda M. Williams Aaron P. Turner Alison W. Henderson Ann Marie Roepke Daniel C. Norvell Helene Henson Joseph M. Czerniecki 《Archives of physical medicine and rehabilitation》2018,99(3):452-458
Objective
To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA).Design
Cross-sectional cohort study using self-report surveys.Setting
Department of Veterans Affairs, academic medical center, and level I trauma center.Participants
Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men).Interventions
Not applicable.Main Outcome Measures
The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction.Results
In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms.Conclusions
The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict. 相似文献5.
Takahiro Shoji Takehiko Tarui Takashi Igarashi Yuki Mochida Hiroyuki Morinaga Yasuhiko Miyakuni Yoshitaka Inoue Yasuhiko Kaita Hiroshi Miyauchi Yoshihiro Yamaguchi 《The Journal of emergency medicine》2018,54(4):410-418
Background
Bleeding from hemorrhagic shock can be immediately controlled by blocking the proximal part of the hemorrhagic point using either resuscitative thoracotomy for aortic cross-clamping or insertion of a large-caliber (10–14Fr) resuscitative endovascular balloon occlusion of the aorta (REBOA) device via the femoral artery. However, such methods are very invasive and have various complications. With recent progress in endovascular treatment, a low-profile REBOA device (7Fr) has been developed.Objective
The objective of this study was to report our experience of this low-profile REBOA device and to evaluate the usefulness of emergency physician?operated REBOA in life-threatening hemorrhagic shock.Methods
Ten patients with refractory hemorrhagic shock underwent REBOA using this device via the femoral artery. All REBOA procedures were performed by emergency physicians. The success rate of the insertion, vital signs, and REBOA-related complications were evaluated.Results
Median age was 54 years (interquartile range 33–78 years). The causes of hemorrhagic shock were trauma (n = 4; 1 blunt and 3 penetrating), ruptured abdominal aortic aneurysm (n = 3), and obstetric hemorrhage (n = 3). Two patients had cardiopulmonary arrest upon arrival. REBOA procedure was successful in all patients, and all became hemodynamically stable to undergo definitive interventions after REBOA. There were no REBOA-related complications. The mortality rate within 24 h and 30 days was 40%.Conclusions
This REBOA device was useful for emergency physicians in life-threatening hemorrhagic shock because of its ease in handling and low invasiveness. 相似文献6.
Katy Meeker Susan K. Brown Michele Lamping Michael R. Moyer M. Joyce Dienger 《Nursing for Women's Health》2018,22(6):454-462
Objective
To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies.Design
Quality improvement initiative.Setting/Local Problem
The labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork.Participants
Approximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians.Intervention/Measurements
During each simulation, there were two scenarios with a debriefing session at the end of each. Teamwork and communication were evaluated using participant surveys.Results
Participants reported improved communication (p = .031) and teamwork (p = .041) after simulation. Additionally, 81% of respondents believed that their ability to perform clinical skills improved.Conclusion
Use of high-fidelity human patient simulation was associated with improved teamwork and communication for a maternity care team. Simulation has been incorporated into standard education. We hope to sustain successful outcomes by providing ongoing simulation experiences for labor and delivery staff annually. 相似文献7.
Arasi Thangavelu Steven Rosenbaum Devi Thangavelu 《The Journal of emergency medicine》2018,54(6):892-897
Background
Cholecystitis is an inflammation of the gallbladder that most commonly occurs as a result of obstruction of the cystic duct by gallstones. The current standard of treatment for acute cholecystitis is cholecystectomy.Objective
Our goal was to discuss the benefits of and compare early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis.Materials and Methods
A Medline literature search was performed dating from January 1982 to July 2015. We limited the search to human studies written in English and using the keywords “Acute Cholecystitis,” early vs. delayed laparoscopic cholecystectomy, surgical management, and surgical complications.Results
There were 225 articles reviewed, of which 25 met criteria for selection. Our recommendations are based on these 25 articles.Conclusion
Early laparoscopic cholecystectomy is preferred over delayed, due to overall better quality of life, lower morbidity rates, and lower hospital cost. Ultimately, management of acute cholecystitis by emergency physicians should be made based on patient's clinical status and available resources in their particular hospital. 相似文献8.
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Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献10.
Cynthia Gagnon Isabelle Lessard Bernard Brais Isabelle Côté Caroline Lavoie Matthis Synofzik Jean Mathieu 《Archives of physical medicine and rehabilitation》2018,99(9):1747-1754
Objective
To document in adults affected by autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) the intra- and interrater reliability, standard error of measurement, agreement, minimal detectable change, and construct validity of the 9-Hole Peg Test (NHPT), the Standardized Finger-to-Nose Test (SFNT), and grip strength.Design
Metrologic study.Setting
Neuromuscular rehabilitation clinic.Participants
Genetically confirmed adult patients with ARSACS (N=42; 21 women; mean age, 38.6y).Interventions
Not applicable.Main Outcome Measures
Intra- and interrater reliability was determined using the intraclass correlation coefficient (ICC). Construct validity was determined by assessing the capacity of the NHPT, the SFNT, and grip strength to distinguish between participants based on sex, mobility stages, and age groups, and on performance on the Archimedes spiral and fast alternating hand movements tests.Results
All 3 tests have shown excellent reliability (ICC=.90–.98). However, the limit of agreement was influenced by the participant’s performance on the NHPT, and the minimal detectable change was very different for both hands (right=9.7 vs left=28.0). Construct validity was confirmed for the SFNT and NHPT, but it was not demonstrated for grip strength.Conclusions
Given the metrologic properties assessed in this study, the SFNT is an excellent measure to assess upper limb coordination, whereas the NHPT must be used with caution. The grip strength is reliable but does not seem to reflect disease severity. 相似文献11.
Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Bassem T. Elhassan Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2017,9(10):1006-1012
Background
Theoretically, patients with only one functional arm secondary to contralateral amputation or paralysis will subject their only functional upper extremity to increased loads. This could become an issue after reverse shoulder arthroplasty (RSA). However, there are no reported data on the implant survival or function for patients with a nonfunctional contralateral upper extremity.Objective
To report the outcomes of RSA in patients with contralateral upper extremity amputation or paralysis.Design
Retrospective case series.Setting
Tertiary university hospital.Patients
All patients who underwent RSA between January 2004 and December 2013.Methods
Of 1335 RSA procedures performed, 5 patients had a minimum 2-year follow-up and nonfunctional contralateral upper extremity. There were 3 men and 2 women, with a mean (standard deviation) age and length of follow-up of 72.4 (7.5) years and 56.4 (24-132) months. Two of the patients had a contralateral upper extremity amputation, and the other 3 had contralateral upper extremity paralysis as a result of stroke, traumatic brain injury, and traumatic brachial plexus injury at birth.Main Outcomes
Pain, range of motion, functional scores (Simple Shoulder Test, American Shoulder and Elbow Society and Quick-Disability of the Arm, Shoulder and Hand), satisfaction, complications/reoperations, and radiographic loosening.Results
RSA resulted in substantial improvement in pain (P = .008), forward flexion (P = .02), and external range of motion (P = .01). The mean (standard deviation) Simple Shoulder Test, American Shoulder and Elbow Society, and Quick-Disability of the Arm, Shoulder, and Hand scores were 9.8 (1.3), 82 (13), and 17.8 (13.4), respectively. The results were excellent in 3, satisfactory in 1, and unsatisfactory in 1 patient (due only to external rotation limited to 10°). Subjectively, all 5 patients felt greatly improved and stated they would undergo RSA again. There were no complications or reoperations. There were no shoulders with component loosening.Conclusions
RSA seems to be a safe, effective, and successful surgical procedure for patients with a nonfunctional contralateral upper extremity. Studies with larger sample sizes and longer follow-up will hopefully validate the present findings.Level of Evidence
IV 相似文献12.
Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2018,10(6):607-615
Background
Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff–related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.Objective
To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears.Design
Retrospective case series/cross-sectional study.Setting
Tertiary university hospital.Patient (participants)
All wheelchair-dependent patients undergoing RSA between 2004 and 2013.Methods/Interventions
Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data.Outcomes
Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity.Results
RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively.Conclusions
RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result.Level of Evidence
III 相似文献13.
Kelly L.D. Pham Kristie F. Bjornson Marisa Osorio Kathryn B. Whitlock Teresa L. Massagli 《PM & R》2018,10(6):594-600
Background
The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.Objective
To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.Design
This is a retrospective noninferiority study.Setting
One academically affiliated pediatric inpatient rehabilitation unit located in a children’s hospital.Patients
All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014.Methods or Interventions
We compared functional outcomes for 2 groups of children.Main Outcome Measurements
Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used.Results
There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI –0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference –0.05, 95% CI –0.058 to 0.003).Conclusions
The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever-increasing need for contact isolation.Level of Evidence
III 相似文献14.
Marcos Eduardo Scheicher Ligia Cristiane Santos Fonseca Tiago Buso Bortolloto Isabela Feitosa de Carvalho 《Journal of bodywork and movement therapies》2018,22(2):482-486
Background
The deterioration in the somatosensory and motor systems observed with increasing age can cause balance problems. Studies have shown that the use of infrapatellar bandages can enhance proprioception and improve postural balance.Aims
To evaluate the effect of an infrapatellar bandage on static balance and mobility in elderly female fallers and non-fallers.Methods
Forty older women (20 fallers and 20 non-fallers) were evaluated. Mobility (Timed Up and Go test) and balance (force platform) were measured in the presence and absence of additional sensory information (elastic infrapatellar bandage).Results
Mobility differed in fallers (p = 0.0001), but not in non-fallers (p = 0.27), when the patellar bandage was applied. Additional sensory information did not improve static balance in either group (p > 0.05), but a trend towards improvement was observed in fallers.Conclusion
Additional sensory input from an infrapatellar bandage improves mobility but not bipedal stance in elderly fallers. 相似文献15.
Xue-Cheng Liu David Embrey Channing Tassone Kim Zvara Brenna Brandsma Roger Lyon Karin Goodfriend Sergey Tarima John Thometz 《PM & R》2018,10(3):269-275
Background
Orthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long-term kinematic effects are lacking clinical evidence.Objective
To determine changes in 3-dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow-up visits (18-month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait.Design
A prospective cohort study.Setting
Children’s Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin.Patients
A total of 23 children with CP, mean age 10.5 years (6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic.Methods
Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6-foot segment model was used.Outcome Measurements
Kinematic and kinetic data were recorded for each patient’s initial and follow-up visit (18-month follow-up average, 15-20 months range).Results
For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups between the barefoot and AFO groups.Conclusion
The use of AFOs long term either maintained or improved foot deformities or dysfunction.Level of Evidence
Level II. 相似文献16.
Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study
Louise M. Crowe Stephen Hearps Vicki Anderson Meredith L. Borland Natalie Phillips Amit Kochar Sarah Dalton John A. Cheek Yuri Gilhotra Jeremy Furyk Jocelyn Neutze Mark D. Lyttle Silvia Bressan Susan Donath Charlotte Molesworth Ed Oakley Stuart R. Dalziel Franz E. Babl 《Archives of physical medicine and rehabilitation》2018,99(7):1360-1369
Objective
To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as mild by applying different published definitions of mild TBI to a large prospectively collected dataset, and to examine the variability in the proportions included by various definitions.Design
Prospective observational study.Setting
Hospital emergency departments.Participants
Children (N=11,907) aged 3 to 16 years (mean age, 8.2±3.9y). Of the participants, 3868 (32.5%) were girls, and 7374 (61.9%) of the TBIs were the result of a fall. Median Glasgow Coma Scale score was 15.Main Outcome Measures
We applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3 to 16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented.Results
Adjustments had to be made to the 17 definitions to apply to the dataset: none in 7, minor to substantial in 10. The percentage classified as mild TBI across definitions varied from 7.1% (n=841) to 98.7% (n=11,756) and varied by age group.Conclusions
When applying the 17 definitions of mild TBI to a large prospective multicenter dataset of TBI, there was wide variability in the number of cases classified. Clinicians and researchers need to be aware of this variability when examining literature concerning children with mild TBI. 相似文献17.
Molly E. Marino Emily C. Dore Pengsheng Ni Colleen M. Ryan Jeffrey C. Schneider Amy Acton Alan M. Jette Lewis E. Kazis 《Archives of physical medicine and rehabilitation》2018,99(3):521-528
Objective
To develop self-reported short forms for the Life Impact Burn Recovery Evaluation (LIBRE) Profile.Design
Short forms based on the item parameters of discrimination and average difficulty.Setting
A support network for burn survivors, peer support networks, social media, and mailings.Participants
Burn survivors (N=601) older than 18 years.Interventions
Not applicable.Main Outcome Measures
The LIBRE Profile.Results
Ten-item short forms were developed to cover the 6 LIBRE Profile scales: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. Ceiling effects were ≤15% for all scales; floor effects were <1% for all scales. The marginal reliability of the short forms ranged from .85 to .89.Conclusions
The LIBRE Profile-Short Forms demonstrated credible psychometric properties. The short form version provides a viable alternative to administering the LIBRE Profile when resources do not allow computer or Internet access. The full item bank, computerized adaptive test, and short forms are all scored along the same metric, and therefore scores are comparable regardless of the mode of administration. 相似文献18.
Arsalan Ghourbanpour Ghadam Ali Talebi Somayeh Hosseinzadeh Naser Janmohammadi Mohammad Taghipour 《Journal of bodywork and movement therapies》2018,22(2):493-497
Question
What are the effects of patellar taping on pain, functional disability and patellar alignments in Patellofemoral Pain Syndrome (PFPS)?Design
Double-blind randomized clinical trial.Participants
Thirty PFPS Patients were randomly divided into two groups, intervention and control.Intervention: Patients in control group received only the routine physiotherapy. In addition to routine physiotherapy, patellar taping was used in the intervention group. Each patient was treated for 12 sessions over a period of 4 weeks.Outcome measures
The KOOS and VAS questionnaires were used to assess the quality of life (QOL) and pain intensity, respectively. Three components of patellar alignment including Patellofemoral Congruence Angle (PFCA), Lateral Patellofemoral Angle (LPFA) and Lateral Patellar Displacement (LPD) were evaluated using the skyline radiography method.Results
The results indicated that there was no significant difference between the control and intervention groups for LPD (P = 0.586), PFCA (P = 0.704) and LPFA (P = 0.176) variables. No significant difference was found between the two groups in all items of the KOOS questionnaire. The knee pain intensity was significantly reduced in both the intervention (P < 0.001) and control (P = 0.001) groups at the end of the 4th week.Conclusion
The results of the present study indicated that patellar taping compared to routine physiotherapy treatments had no beneficial effects on pain reduction, QOL improvement and correction of patellar alignment in PSPS patients.Trial registration
IRCT201111012851N2. 相似文献19.
Débora Fortes Marizeiro Ana Carolina Lins Florêncio Ana Carla Lima Nunes Nataly Gurgel Campos Pedro Olavo de Paula Lima 《Journal of bodywork and movement therapies》2018,22(4):924-929
Background
Although diaphragmatic myofascial release techniques are widely used in clinical practice, few studies have evaluated the simultaneous acute effects of these techniques on the respiratory and musculoskeletal systems.Objective
To evaluate the immediate effects of diaphragmatic myofascial release in sedentary women on the posterior chain muscle flexibility; lumbar spine range of motion; respiratory muscle strength; and chest wall mobility.Design
A randomized placebo-controlled trial with concealed allocation, intention-to-treat analysis, and blinding of assessors and participants.Participants
Seventy-five sedentary women aged between 18 and 35 years.Intervention
The sample was randomly allocated into one of two groups; the experimental group received two diaphragmatic myofascial release techniques in a single session, and the control group received two placebo techniques following the same regimen.Outcomes measures
The primary outcome was chest wall mobility, which was analyzed using cirtometry. The secondary outcomes were flexibility, lumbar spine range of motion, and respiratory muscle strength. Outcomes were measured before and immediately after treatment.Results
The manual diaphragm release techniques significantly improved chest wall mobility immediately after intervention, with a between-group difference of 0.61 cm (95% CI, 0.12–1.1) for the axillary region, 0.49 cm (95% CI, 0.03–0.94) for the xiphoid region, and 1.44 (95% CI, 0.88–2.00) for the basal region. The techniques also significantly improved the posterior chain muscle flexibility, with a between-group difference of 5.80 cm (95% CI, 1.69–9.90). All movements except flexion of the lumbar spine significantly increased. The effects on respiratory muscle strength were non-significant.Conclusion
The diaphragmatic myofascial release techniques improve chest wall mobility, posterior chain muscle flexibility, and some movements of the lumbar spine in sedentary women. These techniques could be considered in the management of people with reduced chest wall and lumbar mobility.Trial registration
NCT03065283. 相似文献20.
Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14