Trends and Outcomes of Early Rehabilitation in the Intensive Care Unit for Patients With Cardiovascular Disease: A Cohort Study With Propensity Score-Matched Analysis.

BACKGROUND: The effectiveness of acute-phase cardiovascular rehabilitation (CR) in intensive care settings remains unclear in patients with cardiovascular disease (CVD). This study aimed to investigate the trends and outcomes of acute-phase CR in the intensive care unit (ICU) for patients with CVD, including in-hospital and long-term clinical outcomes. METHOD: This retrospective cohort study reviewed a total of 1,948 consecutive patients who were admitted to a tertiary academic ICU for CVD treatment and underwent CR during hospitalisation. The endpoints of this study were the following: in-hospital outcomes: probabilities of walking independence and returning home; and long-term outcomes: clinical events 5 years following hospital discharge, including all-cause readmission or cardiovascular events. It evaluated the associations of CR implementation during ICU treatment (ICU-CR) with in-hospital and long-term outcomes using propensity score-matched analysis. RESULTS: Among the participants, 1,092 received ICU-CR, the rate of which tended to increase with year trend (p for trend <0.001). After propensity score matching, 758 patients were included for analysis (pairs of n=379 ICU-CR and non-ICU-CR). ICU-CR was significantly associated with higher probabilities of walking independence (rate ratio, 2.04; 95% CI 1.77-2.36) and returning home (rate ratio, 1.22; 95% CI 1.05-1.41). These associations were consistently observed in subgroups aged >65 years, after surgery, emergency, and prolonged ICU stay. ICU-CR showed significantly lower incidences of all-cause (HR 0.71; 95% CI 0.56-0.89) and cardiovascular events (HR 0.69; 95% CI 0.50-0.95) than non-ICU-CR. CONCLUSIONS: The implementation of acute-phase CR in ICU increased with year trend, and is considered beneficial to improving in-hospital and long-term outcomes in patients with CVD and various subgroups.

Medial elbow joint space gapping associated with repetitive baseball pitching in preadolescent baseball players.

BACKGROUND: The baseball pitching motion creates valgus stress to the medial elbow, which contributes to increased medial elbow joint space gapping. The musculoskeletal systems of preadolescent baseball players are immature compared with those of adults, but it is unclear whether the repetitive pitching action causes an increase in medial elbow joint space gapping. This study aimed to examine differences in medial elbow joint space gapping based on the pitch count of preadolescent baseball players compared with those of adult players. METHODS: The participants were 11 healthy preadolescent baseball players and 12 college students with baseball experience. They threw 60 maximal-effort pitches arranged into 4 sets of 15 pitches. The medial elbow joint space was measured ultrasonographically with the forearm weight before pitching and following every set of 15 pitches. Repeated-measures analysis of variance and the Bonferroni post hoc test were used to compare the medial elbow joint space among the 5 pitching sets (before pitching and after 15, 30, 45, and 60 pitches) and between the groups of preadolescent baseball players and college students. RESULTS: There was no significant change in the medial elbow joint space gapping of the dominant elbow based on age/pitch count (F = 0.42, P = .796). There was a significant effect of pitch count (F = 30.28, P < .001) and between-group effects (F = 4.56, P = .045). The medial elbow joint space gapping increased significantly after 60 pitches in preadolescent baseball players (P = .023) and college students (P = .021). The medial elbow joint space gapping in preadolescent baseball players was significantly wider than that in college students (P = .007 before pitching, P = .027 at 15 pitches). CONCLUSION: Sixty repetitive pitches contributed to an increase in the medial elbow joint space gapping, regardless of age. The results of this study provide further evidence when considering pitching limitations.

Safety of neuromuscular electrical stimulation in patients implanted with cardioverter defibrillators.

Neuromuscular electrical stimulation (NMES) is one of the few exercise modes that have been confirmed to be effective for advanced heart failure patients. Previous clinical trials that verified the effects of NMES excluded patients with implantable cardioverter defibrillators (ICDs). We investigated whether NMES to leg muscles could be applied in heart failure patients implanted with ICDs. As a result, we found that NMES could be conducted without any instances of electromagnetic interference. NMES to leg muscles could be applied safely to ICD patients if the aforementioned common stimulation methods were used with sufficient monitoring during NMES.

Evaluation of flexor digitorum superficialis function in adolescent baseball players.

Hypothesis and/or Background: Increased flexor digitorum superficialis (FDS) tendon activity can be a therapeutic target for elbow disorders in adolescent baseball players. The proportion of adolescent baseball players who can use FDS independently is unknown, and which finger is most often used remains unclear. This study investigated whether adolescent baseball players intentionally used FDS on each finger. Methods: Adolescent baseball players were recruited and assessed for FDS function for each finger using the standard technique. Results: Sixty-nine participants (mean age: 10.4 years) were recruited. Participants numbered 33, 56, 59, and 25 on the throwing side and those numbered 28, 46, 54, and 33 on the nonthrowing side could independently flex the proximal interphalangeal joint while holding their palms in the index, middle, ring, and small fingers, respectively. When assessing both throwing and nonthrowing participants, a significant number of participants could independently flex the proximal interphalangeals of the ring and middle fingers but had difficulty with the index and small fingers (P < .001). No significant difference was noted between the throwing and nonthrowing participants in any finger (P > .05). Discussion and/or Conclusion: One study reported that participating baseball players with elbow pain have more medial elbow joint space than those without pain symptoms. In another study on finger movements during pitching motion, the force of the thumb, index, middle, and ring fingers was greatest immediately before maximum external rotation. According to both reports, FDS function, especially in the index finger, can be a therapeutic target for medial-sided elbow injuries in adolescent baseball players.

Walking speed in patients with first acute myocardial infarction who participated in a supervised cardiac rehabilitation program after coronary intervention.

This study aimed to evaluate the degree of reduction in walking speed in patients with acute myocardial infarction (AMI) compared to age-matched community-dwelling people and identify factors associated with walking speed. The subjects were 210 middle-aged and 188 elderly patients with a first AMI (AMI group) and 198 age-matched community-dwelling people with no medical events (non-AMI group). We measured maximum walking speed in all subjects and collected clinical data, including that related to motor function, at the end of a supervised cardiac rehabilitation program in the AMI group. Data were analyzed based on age and sex. Walking speed in men and women in the middle-aged AMI subgroup decreased to 77.9% and 75.7% relative to that of the non-AMI subgroup matched by sex, respectively; walking speed in men and women in the elderly AMI subgroup decreased to 78.7% and 74.2% relative to that of the non-AMI subgroup matched by sex, respectively. Moreover, 6.4% of men and 23.8% of women in the middle-aged AMI subgroup, and 28.8% of men and 43.5% of women in the elderly AMI subgroup, had a slower walking speed compared to their respective non-AMI groups, which may contribute to an increased risk for cardiovascular mortality. Stepwise multiple regression analysis for motor function revealed that only leg strength in the middle-aged AMI subgroup, and both leg strength and standing balance in the elderly AMI subgroup, were associated with walking speed, regardless of sex after adjusting for clinical characteristics. These results suggest that evaluation and management of walking speed are necessary in implementing effective disease management for patients with first AMI.

Detailed Changes in Oxygenation following Awake Prone Positioning for Non-Intubated Patients with COVID-19 and Hypoxemic Respiratory Failure-A Historical Cohort Study.

Few studies have reported on the effectiveness of awake prone therapy in the clinical course of coronavirus disease (COVID-19) patients. This study aimed to investigate the effects of awake prone therapy during spontaneous breathing on the improvement of oxygenation over 3 weeks for COVID-19 acute respiratory failure. Data of consecutive COVID-19 patients with lung disorder with a fraction of inspired oxygen (FIO2) ≥ 0.4 and without tracheal intubation were analyzed. We examined changes in SpO2/FIO2, ROX index ((SpO2/FIO2)/respiratory rate) and the seven-category ordinal scale after the initiation of FIO2 ≥ 0.4 and compared these changes between patients who did and did not receive prone therapy. Of 58 patients, 27 received awake prone therapy, while 31 did not. Trend relationships between time course and change in SpO2/FIO2 and ROX index were observed in both groups, although a significant interaction in the relationship was noted between prone therapy and change in SpO2/FIO2 and ROX index. The seven-category ordinal scale also revealed a trend relationship with time course in the prone therapy group. The awake prone therapy was significantly associated with a lower rate of tracheal intubation. In patients with COVID-19 pneumonia treated with FIO2 ≥ 0.4, awake prone therapy may improve oxygenation within two weeks.

Reduction in the soles of graduated compression stockings prevents falls without reducing the preventive effect for venous stasis.

INTRODUCTION: Graduated compression stockings (GCS) are widely used to prevent venous thromboembolism; however, GCS are slippery and a fall hazard owing to the synthetic fibers. Therefore, we investigated whether changing the sole's shape decreased slipping. MATERIALS AND METHODS: We designed four GCS types with varying sole shapes and normal slipperiness to compare with normal GCS and a barefoot model without GCS (control). A mannequin foot with a GCS type or the control was placed on a ramp at 0°, and the angle was slowly increased. When the mannequin foot had moved ≥100% from the original position, the angle of slide-out (AS) was measured, and the forward and backward AS values were compared. Next, we investigated whether sole modification influenced the effectiveness of the normal GCS for preventing venous stasis. The same GCS type (Torenka) was given to 30 healthy volunteers. Peak systolic velocities (PSV) of the popliteal vein prior to wearing GCS and 20 and 40min after wearing GCS were measured using Doppler ultrasound, and the changes were compared with those of the normal GCS. RESULTS: Only the AS of the GCS type with the smallest sole area (Torenka) was not significantly different from the control's AS, which was significantly larger than the normal GCS' AS. Normal and Torenka GCS resulted in significantly increased PSV after 20 and 40min compared with no GCS, with no significant difference between the two groups. CONCLUSION: Torenka-type GCS were the least slippery but were as effective as normal GCS for venous stasis.