Evaluating the reliability and validity of the Icelandic translation of the Mini-BESTest in rehabilitation patients: an international implication for balance assessment.

BACKGROUND: The Mini-BESTest (Balance Evaluation Systems Test) is a standardized balance evaluation tool. The psychometric properties of the Mini-BESTest are being established around the world. PURPOSE: This study aimed to evaluate the reliability and validity of the Icelandic translation of the Mini-BESTest. METHODS: Thirty rehabilitation inpatients (16/14 women/men), with mixed diagnoses and a range of self-assessed balance, were assessed with the: Mini-BESTest on two occasions; Activities-specific Balance Confidence Scale; Berg Balance Scale; Timed Up and Go test; and 10 Meter Walk Test. Statistical analyses included the Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha (α), Pearson's r, and the independent t-test. RESULTS: Relative reliability demonstrated good test-retest (ICC3.1 = 0.84), intra-rater reliability (ICC3.1 = 0.86), and excellent inter-rater reliability (ICC2.1 = 0.96). Absolute reliability (SEM) was 1.607, and internal consistency (α) was 0.80. Construct validity was supported by a high correlation between the Mini-BESTest and other standardized measures (r = ±0.6-0.73). The Mini-BESTest discriminated between patients with poor versus good self-rated balance (p ˂ 0.001), with no floor or ceiling effects. CONCLUSION: The psychometric properties of the Icelandic translation of the Mini-BESTest are comparable with the original version and other translations. These results for this mixed patient group should be relevant to clinicians and researchers internationally.

Evaluating the Benefits of Exercise Training in HFrEF or COPD Patients: ISO-LEVEL COMPARISON CAN ADD VALUABLE INFORMATION TO V˙o2peak.

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) are relatively common conditions with similar symptoms of exercise intolerance and dyspnea. The aim of this study was to compare exercise capacity, ventilatory response, and breathing pattern in patient groups with either advanced HFrEF or COPD before and after exercise training. METHODS: An observational study was conducted with parallel groups of 25 HFrEF and 25 COPD patients who took part in 6 wk of inpatient rehabilitation with exercise training. All patients underwent cardiopulmonary exercise tests at the start and end of the training, with resting arterial blood gas measurements. RESULTS: The average peak oxygen uptake (V˙o2) was low at the start of the study but increased significantly after training in both groups, or by 2.2 ± 2.1 mL/kg/min in HFrEF patients and 1.2 ± 2.2 mL/kg/min in COPD patients. At ISO-V˙o2 (ie, same level of V˙o2 in pre- and post-exercise tests), carbon dioxide production (V˙co2) decreased after exercise training in both groups. Similarly, at ISO-V˙E (ie, same level of ventilation), breathing frequency (f) decreased and tidal volume (VT) increased, resulting in an improved breathing pattern (lower f/VT ratio) after training. CONCLUSION: The findings of this study show that exercise training in severely affected patient groups with HFrEF or COPD led to an increase in maximal exercise capacity, a more favorable breathing pattern, and a diminished V˙co2 during exercise. Therefore, comparisons of V˙co2 and breathing pattern at ISO-levels of V˙o2 or V˙E before and after training are valuable and underutilized outcome measures in treatment studies.

[Effects of rehabilitation on functional capacity, obesity and health behavior, among cardiac patients with DM2]. / Áhrif endurhæfingar á threk, holdafar og heilsueflandi hegðun hjartasjúklinga með sykursýki af tegund 2.

OBJECTIVE: Present study examines the prevalence of type 2 diabetes (DM2) in patients attending cardiac rehabilitation (CR) compared to the general population utilising data from the Icelandic Heart Association population study. The study also examined the efficacy of CR for promoting health behaviors. MATERIAL AND METHODS: A prospective study among DM2 patients attending CR at Reykjalundur Rehabilitation centre. The DM2 group was compared to other cardiac patients, with respect to obesity and exercise capacity at the beginning and end of 4-6 weeks of CR. Additionally, in the DM2 group, weight, smoking cessation, physical activity and walking capacity were assessed at 3 and 6 months follow-ups. RESULTS: The prevalence of DM2 was 2-4 times higher in CR participants than in the general population. Compared to other CR participants, the DM2 group was heavier, with increased waist circumference and less exercise capacity. During the CR both groups lost weight and waist circumference decreased to similar extent, but the exercise capacity increased less in the DM2 group. In follow up after 6 months the DM2 group´s weight and glucose values were back to same level as before CR, but waist circumference was still decreased and they retained increased physical activity and walking capacity. CONCLUSION: DM2 is more prevalent among patients in cardiac rehabilitation than in the general population. The DM2 group was more obese, had lower exercise capacity and responded somewhat less to CR than other cardiac patients. Follow up after 6 months did however show that they continued their regular exercise and walking capacity was still retained.

[Lung volume reduction surgery for severe pulmonary emphysema in Iceland]. / Arangur lungnasmaekkunaradgerda vid langvinnri lungnathembu a Islandi.

INTRODUCTION: Lung volume reduction surgery (LVRS) can benefit patients with severe emphysema. The aim of this study was to evaluate the outcome of LVRS performed in Iceland. MATERIALS AND METHODS: A prospective study of 16 consecutive patients who underwent bilateral LVRS through median sternotomy between January 1996 and December 2008. All patients had disabling dyspnea, lung hyperinflation, and emphysema with upper lobe predominance. Preoperatively all patients underwent pulmonary rehabilitation. Spirometry, lung volumes, arterial blood gases and exercise capacity were measured before and after surgery. Mean follow-up time was 8.7 years. RESULTS: Mean age was 59.2 ± 5.9 years. All patients had a history of heavy smoking. There was no perioperative mortality and survival was 100%, 93%, and 63% at 1, 5, and 10 years, respectively. The forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC) improved significantly after surgery by 35% (p<0.001) and 14% (p<0.05), respectively. The total lung capacity, residual volume and partial pressure of CO2 also showed statistically significant improvements but exercise capacity, O2 consumption and diffusing capacity of the lung for CO did not change. Prolonged air leak (≥ 7 days) was the most common complication (n=7). Five patients required reoperation, most commonly for sternal dehiscence (n=4). CONCLUSION: In this small prospective study, FEV1 and FVC increased and lung volumes and PaCO2 improved after LVRS. Long term survival was satisfactory although complications such as reoperations for sternal dehiscence were common and hospital stay therefore often prolonged.