Postoperative Pulmonary Complications in Patients With Transcatheter Tricuspid Valve Implantation-Implications for Physiotherapists.

Objectives: To investigate the incidence of postoperative pulmonary complications (PPCs) and short-term recovery after transcatheter tricuspid valve implantation (TTVI). Methods: A total of 17 patients diagnosed with severe tricuspid regurgitation who received a LuX-valve TTVI were included in this study. Spirometry lung function, maximal inspiratory pressure (MIP), and 6-min walk test distance (6MWD) were recorded. Prior to surgery, patients were stratified into high or low pulmonary risk groups based on published predefined criteria. A physiotherapist provided all patients with education on thoracic expansion exercises, effective cough and an inspiratory muscle training protocol at 50% of MIP for 3 days preoperatively. All patients received standard post-operative physiotherapy intervention including positioning, thoracic expansion exercises, secretion removal techniques and mobilization. Patients were assessed for PPCs as defined by the Melbourne-Group Score-version 2. Clinical characteristics and hospital stay, cost, functional capacity, and Kansas City Cardiomyopathy Questionnaire (KCCQ) heart failure score were recorded at admission, 1-week, and 30-days post-op. Results: The mean (SD) age of the 17 patients was 68.4 (8.0) years and 15 (88%) were female. Pre-surgical assessment identified 8 patients (47%) at high risk of PPCs. A total of 9 patients (53%) developed PPCs between the 1st and 3rd day post-surgery, and 7 of these 9 patients were amongst the 8 predicted as "high risk" prior to surgery. One patient died before the 30 day follow up. Pre-operative pulmonary risk assessment score, diabetes mellitus, a low baseline MIP and 6MWD were associated with a high incidence of PPCs. Compared to those without PPCs, patients with PPCs had longer ICU and hospital stay, and higher hospitalization cost. At 30 days post-surgery, patients without PPCs maintained higher MIP and 6MWD compared to those with PPCs, but there were no significant between-group differences in other lung function parameters nor KCCQ. Conclusion: This is the first study to report the incidence of PPCs post TTVI. Despite a 3-day prehabilitation protocol and standard post-operative physiotherapy, PPCs were common among patients after TTVI and significantly impacted on hospital and short-term recovery and outcomes. In the majority of patients, PPCs could be accurately predicted before surgery. A comprehensive prehabilitation program should be considered for patients prior to TTVI. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [ChiCTR2000039671].

Immuno-modulation with lifestyle behaviour change to reduce SARS-CoV-2 susceptibility and COVID-19 severity: goals consistent with contemporary physiotherapy practice.

Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aimed at reducing SARS-CoV-2 susceptibility and COVID-19 severity, is a goal consistent with contemporary physiotherapy practice. Physiotherapists have a long tradition of managing a , thus, managing CLGSI is a logical extension. Improving patients' lifestyle practices also reduces their NCD risks and increases activity/exercise capacity, health and wellbeing - all principal goals of contemporary physiotherapy. The COVID-19 pandemic lends further support for prioritising health and lifestyle competencies including smoking cessation; whole food plant-based nutrition; healthy weight; healthy sleep practices; and stress management; in conjunction with reducing sedentariness and increasing physical activity/exercise, to augment immunity as well as function and overall health and wellbeing. To support patients' lifestyle change efforts, physiotherapists may refer patients to other health professionals. The authors conclude that immuno-modulation with lifestyle behaviour change to reduce susceptibility to viruses including SARS-CoV-2, is consistent with contemporary physiotherapy practice. Immuno-modulation needs to be reflected in health competencies taught in physiotherapy professional education curricula and taught at standards comparable to other established interventions.

Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension: a randomized-controlled study.

AIM: To explore the effectiveness of acupuncture transcutaneous electrical nerve stimulation (Acu-TENS), a non-invasive modality in reduction of rectal discomfort during barostat-induced rectal distension. METHODS: Forty healthy subjects were randomized to receive 45 min of either Acu-TENS or placebo-TENS (no electrical output) over acupuncture points Hegu (large-intestine 4), Neiguan (pericardium 6) and Zusanli (stomach 36). A balloon catheter attached to a dual-drive barostat machine was then inserted into the subjects' rectum. A step-wise (4 mmHg) increase in balloon pressure was induced until maximal tolerable or 48 mmHg. Visual analogue scale and a 5-point subjective discomfort scale (no perception, first perception of distension, urge to defecate, discomfort/pain and extreme pain) were used to assess rectal discomfort at each distension pressure. Blood beta-endorphin levels were measured before, immediately after intervention, at 24 mmHg and at maximal tolerable distension pressure. RESULTS: There was no difference in the demographic data and baseline plasma beta-endorphin levels between the two groups. Perception threshold levels were higher in the Acu-TENS group when compared to the placebo group, but the difference reached statistical significance only at the sensations "urge to defecate" and "pain". The distension pressures recorded at the "urge to defecate" sensation for the Acu-TENS and placebo-TENS groups were 28.0 ± 4.5 mmHg and 24.6 ± 5.7 mmHg, respectively (P = 0.043); and the pressures recorded for the "pain" sensation for these two groups were 36.0 ± 4.2 mmHg and 30.5 ± 4.3 mmHg respectively (P = 0.002). Compared to the placebo group, a higher number of participants in the Acu-TENS group tolerated higher distension pressures (> 40 mmHg) (65% in Acu-TENS vs 25% in placebo, P = 0.02). The plasma beta-endorphin levels of the Acu-TENS group were significantly higher than that of the placebo group at barostat inflation pressure of 24 mmHg (1.31 ± 0.40 ng/mL vs 1.04 ± 0.43 ng/mL, P = 0.044) and at maximal inflation pressure (1.46 ± 0.53 ng/mL vs 0.95 ± 0.38 ng/mL, P = 0.003). CONCLUSION: Acu-TENS reduced rectal discomfort during barostat-induced rectal distension and concurrently associated with a rise in beta-endorphin level.

An adjunct intervention for management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

OBJECTIVES: Application of transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS) is a noninvasive intervention that has recently been shown to alleviate dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). This case report aims to explore the role of Acu-TENS in patients diagnosed with COPD during the acute exacerbation. STUDY DESIGN: The study design was a case report. SETTING: The study was conducted in an inpatient setting. SUBJECT: The subject was a 74-year-old man admitted to the hospital due to acute exacerbation of COPD (AECOPD). INTERVENTION: Treatment consisted of application of TENS on EX-B1 (Dingchuan) for 45 minutes. OUTCOME MEASURES: Oxygen saturation, heart rate, and dyspnea score were measured before, immediately after, and 45 minutes after Acu-TENS intervention. Other than the physiologic measures, 10 mL of venous blood was taken from the cubital vein for assessment of ß-endorphin level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) level before and immediately postintervention. RESULTS: Postintervention, improved oxygen saturation, and reduction in heart rate and dyspneic sensation were observed accompanied by a raised blood ß-endorphin level but the level of white blood cell count, TNF-α, and CRP remain unchanged. CONCLUSIONS: Application of 45 minutes Acu-TENS appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive Acu-TENS therapy during acute exacerbation warrants further investigation.

The Role of Acu-TENS in Hemodynamic Recovery after Open-Heart Surgery.

Increased heart rate (HR) and reduced blood pressure (BP) are common consequences of cardiac surgery. This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points (Acu-TENS) on HR, BP, rate pressure product (RPP) and nausea and vomiting score after open-heart surgery. After open heart surgery, 40 patients were randomly allocated to either an Acu-TENS group, which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1-5, or a Placebo-TENS group, which received identical electrode placement but with no electrical output from the TENS unit, despite an output indicator light appearing activated. HR, systolic and diastolic BPs (SBP and DBP) were recorded and RPP computed. Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention. Daily HR, BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group. A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days, with all variables returning to preoperative values by Day 4 (P > .2). In the Placebo-TENS and Control groups the HR remained higher (P < .0001), BP lower (P < .05) and RPP higher (P = .01) than respective preoperative values at Day 4. The dose of Maxolon required was lowest in the Acu-TENS group (P = .038). We concluded that Acu-TENS facilitated an earlier return to preoperative BP, HR and RPP values in patients after acute heart surgery.

Electrical stimulation of acupuncture points and blood pressure responses to postural changes: a pilot study.

BACKGROUND: Application of transcutaneous electrical stimulation over acupuncture points (Acu-TENS) facilitates heart rate recovery after exercise and restores hemodynamic stability after open heart surgery. The role of Acu-TENS on cardiovascular parameters in response to postural changes has not been reported. OBJECTIVE: To investigate (1) the effect of Acu-TENS on blood pressure responses to -10º head-down postural change and (2) whether such effects were associated with modulation by the autonomic nervous system. METHOD: Sixteen healthy volunteers, mean age 22.8 (SD, 3.1) years, were subjected to a -10º head-down tilt from the supine position on 3 separate occasions and received in random order the following 3 intervention protocols for 40 minutes before the postural change: Acu-TENS (over bilateral acupuncture points, PC6), sham-TENS (TENS applied to the skin over the patellae), and control (no electrical output from the TENS device applied at PC6). Mean arterial pressure, large artery elasticity index, cardiac output, and heart rate were recorded and compared at different stimulation protocols in the supine and -10º head-down tilt positions. Spectral analysis of heart rate variability was used to determine any modulation by the autonomic nervous system. RESULTS: Change in large artery elasticity index was observed only in the Acu-TENS group (P < .05) and mean arterial pressure appeared most stable during Acu-TENS. Autonomic nervous system modulation was not apparent with spectral analysis, irrespective of intervention. Sympathetic activity predominated in all positions. CONCLUSION: Acu-TENS seems to reduce blood pressure changes with -10º head-down tilt with concomitant changes in arterial vessel tone.

Electroacupuncture in reduction of discomfort associated with barostat-induced rectal distension--a randomized controlled study.

BACKGROUND: This pilot study aims to explore the effectiveness of electroacupuncture in reduction of colorectal discomfort caused by Barostat-induced rectal distension. METHOD: Subjects scheduled for a colonoscopy screening procedure were recruited and randomized to receive either electroacupuncture (EA) or sham acupuncture (SA) (short stud instead of needle) for 45 min to acupuncture points Hegu (LI4), Neiguan (PC6), and Zusanli (ST36). A balloon catheter attached to the Dual Drive Barostat machine was then inserted into the subjects' rectal region. Colorectal discomfort after each incremental pressure (4 mmHg) rise was assessed by visual analog and a four-point subjective discomfort scale. Blood beta-endorphin level was measured before, immediately after acupuncture, at 24 mmHg, and at maximal tolerable inflation pressure. RESULTS: Forty subjects completed the study. Rectal discomfort was reported at a higher inflation pressure in the EA group compared to the SA group (p < 0.05). Twelve subjects in the EA group were able to tolerate the maximal inflation pressure (48 mmHg) compared to only four in the SA group. Beta-endorphin levels increased significantly in the EA group but not in the SA group. CONCLUSION: Electroacupuncture appeared to be effective in reduction of colorectal discomfort during Barostat-induced rectal distension. The role of electroacupuncture during colonoscopy warrants further investigation.

Effect of 4 weeks of Acu-TENS on functional capacity and beta-endorphin level in subjects with chronic obstructive pulmonary disease: a randomized controlled trial.

Our recent studies showed that one session of transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) improved forced expiratory volume in 1s (FEV(1)) in patients with chronic obstructive pulmonary disease (COPD). This study investigated the effect of 4-week Acu-TENS on physical and psychosocial function in these patients. Twenty-eight patients were randomly allocated to receive 4-weeks of 45-min, 5-days/week, of either Acu-TENS (over Dingchuan), Placebo-TENS (same protocol without electrical output), or Sham-TENS (over the patellae). Variables measured before and after intervention included FEV(1), forced vital capacity (FVC), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire score (SGRQ), beta-endorphin and blood inflammatory marker levels. Only the Acu-TENS group attained significant improvement in FEV(1) (p=0.046), physical activity (p=0.007) and total SGRQ score (p=0.028). The increase in beta-endorphin (p=0.012) correlated positively with the improvement in FEV(1) (r=0.526, p=0.008). To conclude, 4 weeks of Acu-TENS improved the functional capacity of patients with COPD, probably due to the bronchodilation induced by beta-endorphin elevation.