Kinematic evaluation of patients with chronic obstructive pulmonary disease during the 6-min walk test.

BACKGROUND: A better understanding of gait kinematics during the 6-min walk test (6MWT) may facilitate the development of rehabilitation strategies for patients with chronic obstructive pulmonary disease (COPD). AIM: To evaluate gait kinematics during the 6MWT in patients with COPD. METHOD: Thirty-six patients with COPD and 19 healthy controls underwent a full-body kinematic analysis during the 6MWT. Data were collected using a system with four infrared cameras to capture the movement of a spherical marker covered with retroreflective tape attached to a helmet worn during the test. RESULTS: The walking distances measured by the assessor and by kinematics analysis were lower in the group of patients (P = 0.036 and P = 0.013, respectively). Moreover, the walking distances measured by kinematics analysis were greater than those measured by the assessor for both groups (P < 0.001). In the kinematics analysis of the complete test, the mean and maximum speeds were higher for the controls than for the patients (P = 0.007 and P = 0.044, respectively). In the half-turn analysis, acceleration, speed, and deceleration peaks (maximal absolute values) were lower for the patients than for the controls (P = 0.002, P = 0.012 and P = 0.006, respectively). CONCLUSIONS: Patients with COPD show worse functional capacity due to lower gait speed and acceleration-deceleration peaks after turnings as compared to healthy individuals during the 6MWT. Assessors can accurately predict the 6MWD measured by kinematics, though they underestimate this distance.

Comparison of neck extensor muscle endurance and cervical proprioception between asymptomatic individuals and patients with chronic neck pain.

INTRODUCTION: Neck extensor endurance (NEE) and cervical proprioception are vital for maintaining cervical spine function and defects in these processes have been associated with chronic neck pain (CNP). The objectives of the study are 1) To investigate the association between NEE and cervical joint position error (JPE) in subjects with CNP; 2) to compare the cervical extensor endurance and cervical JPE of CNP subjects with those of asymptomatic controls; and 3) to determine the relationship between Pain Catastrophizing Scale (PCS) scores, NEE, and cervical JPE in subjects with CNP. METHOD: Sixty-four participants (32 asymptomatic, 32 with CNP) participated in this comparative cross-sectional study. Cervical proprioception was assessed by measuring the absolute JPE in the sagittal and transverse directions. NEE was assessed using a clinical extensor endurance test. NEE capacity and JPE were compared and correlated between asymptomatic and CNP subjects. Pain catastrophic behavior was assessed using the Pain Catastrophizing Scale (PCS) in CNP subjects. RESULTS: CNP subjects showed lower NEE capacity (p < 0.001) and significantly larger JPEs (p < 0.001) than asymptomatic participants. NEE negatively correlated with JPEs in all directions (p < 0.001) in asymptomatic subjects and only neck extension errors showed a correlation in CNP subjects (r = -0.45, p = 0.009). PCS scores were negatively correlated with endurance capacity (r = -0.42, p = 0.017) and positively correlated with JPE (flexion: r = 0.57, p = 0.001). CONCLUSION: CNP subjects showed impaired proprioception and lower endurance capacity compared to asymptomatic participants. Neck extension errors alone correlated with JPE in CNP subjects. PCS scores negatively correlated with NEE in subjects with CNP.

Immediate effects of myofascial release maneuver applied in different lower limb muscle chains on postural sway.

BACKGROUND: There is little evidence about the myofascial release maneuver (MLM) targeting the fascial tissue and its effect on postural balance. This study investigated the immediate effects of the MLM in different lower limb muscle chains on the postural sway of healthy men. METHODS: Sixty-three healthy men (27.2 ± 4.7 years) were randomly assigned to 7 groups (n = 9 each) to receive MLM applied to the lower limb muscle chains (anterior, posterior, medial, lateral, anterior/posterior, and medial/lateral) or placebo intervention. Skin pressure during the 3-min MLM was determined by the visual analog scale between 5 and 7 as previously assessed on participants. Posturography analysis of the elliptical area (Area) and average velocity (Vavg) of the center-of-pressure displacement was performed before and immediately after the MLM in single-leg support and with eyes closed. RESULTS: A two-way repeated measures analysis of variance showed no interaction effect of factors group and time (Area: p = 0.210, ω2 = 0.004; Vavg: p = 0.358, ω2 < 0.001). Within-factor main effect of time was observed for both Area (p < 0.001, ω2 = 0.038) and Vavg (p < 0.001, ω2 = 0.028), with decreased Area and Vavg after all interventions. No between-factor main effect of group was observed for Area or Vavg (MLM or placebo, p = 0.188 or higher). CONCLUSION: MLM applied to the lower limb muscle chains showed no immediate specific effects on postural sway in healthy men. Pre-post effects of MLM were not different from those elicited by a superficial massage. MLM in lower limb muscle chains is not advocated for an immediate improvement of postural balance in this population.

The impact of physical activity level, degree of dyspnoea and pulmonary function on the performance of healthy young adults during exercise.

BACKGROUND: In addition to being simple and requiring minimal technology, the 6-min walk test (6MWT) has been found to be reproducible and well tolerated since its first use. However, the impact of non-anthropometric factors on functional capacity is less clear in healthy young adults because the majority experience no age-related changes in the locomotor system or associated comorbidities. AIM: To identify the effect of physical activity level, degree of dyspnoea and pulmonary function on functional capacity, evaluated through the 6-min walking distance (6MWD) of healthy young adults, in order to prevent clinical abnormalities. METHOD: This is a cross-sectional study including 190 healthy young adults who were subjected to the 6MWT to assess walking distance and degree of dyspnoea using the Borg scale. Furthermore, pulmonary function using spirometry and physical activity level using the International Physical Activity Questionnaire (IPAQ) were assessed. According to the IPAQ, the subjects were categorised as sedentary, irregularly active or active. RESULTS: The 6MWD was positively correlated with pulmonary function parameters (P ≤ 0.002 for all parameters). There was a marginally significant correlation between the 6MWD and the difference between the scores assessed before and after the test using the Borg scale. There was a trend towards significant differences in 6MWD according to the IPAQ categories. Furthermore, forced vital capacity was the only pulmonary function parameter with significant differences between IPAQ categories (P = 0.02). CONCLUSION: In healthy young adults, greater pulmonary function indicates a greater 6MWD. In these subjects, physical activity level based on the IPAQ categories clearly affects pulmonary function. However, the IPAQ category and degree of dyspnoea are poorly related to the 6MWD of these subjects.

Reliability of two pragmatic tools for assessing text neck.

BACKGROUND: There is a hypothesis that the growing use of mobile phones in an inappropriate posture to text and read (text neck) could be a reason for the increasing prevalence of neck pain in the past decade. Before testing if there is an association between text neck and neck pain, it is necessary to develop reliable pragmatic tools appropriate to epidemiological studies. OBJECTIVES: The primary aim of this study was to assess the reliability of the self-perception of text neck, as well as the reliability of physiotherapists' classification of the text neck. METHODS: The convenience sample was composed of 113 high school students between 18 and 21 years old from a cross-sectional study. As their self-perceived posture, participants had to choose in a questionnaire one of four neck postures of a person texting on a mobile phone. The physiotherapists classified lateral photographs taken with the participants texting on a mobile phone in their habitual posture as 1 (normal), 2 (acceptable), 3 (inappropriate), and 4 (excessively inappropriate). RESULTS: The results showed that the test-retest reliability of the self-perception was substantial (kappa = 0.73, 95% CI 0.54 to 0.86). The reliability of the physiotherapists' responses, according to the photographic analysis considering the three raters, was moderate (kappa = 0.5, 95% CI 0.39 to 0.61). Seventy-six percent of the participants with appropriate posture in the photographic analysis self-reported an inappropriate posture. CONCLUSION: This study showed that the self-perception of the neck posture during mobile phone texting is reliable over time and that the physiotherapists' classification based on photographic analysis was acceptable for epidemiological studies. Participants had a tendency to report that the posture was worse than it actually was in the photographic analysis performed by the physiotherapists.

Inter-expert agreement and similarity analysis of traditional diagnoses and acupuncture prescriptions in textbook- and pragmatic-based practices.

This study examined (1) the agreement of acupuncture experts with textbook prescriptions and among themselves, and (2) the association between similar traditional diagnoses and textbook acupuncture prescriptions, examining whether pragmatic practice (i.e., modifying prescriptions according to personal clinical practice) alters such an association. A computational analysis quantified the diagnosis-prescription association from a textbook. Eight acupuncture experts were independently interviewed. Experts modified the textbook prescriptions according to their pragmatic practice. Experts mostly agreed (19-90%) or strongly agreed (0-29%) with the textbook prescriptions, with no-better-than-chance agreement on their ratings (Light's κ = 0.036, CI95% = [0.003; 0.081]). The number of manifestations in traditional diagnoses weakly explains the variability (Spearman's ρ = 0.260, p = 0.038) of the number of acupoints in prescriptions. The association between similar traditional diagnoses and acupuncture prescriptions is strong in the textbook (γ = 0.720, CI95% = [0.658, 0.783]), whereas pragmatic practice had little effect on this association (γ = 0.724-0.769).

Systemic sclerosis: Association between physical function, handgrip strength and pulmonary function.

BACKGROUND: Systemic sclerosis (SSc) is a multisystem disease affecting the skin, respiratory system and skeletal muscles. In SSc patients, hand function disability is the major factor limiting daily activities. AIM: To evaluate the association of physical function with handgrip strength and pulmonary function in SSc patients. A further aim was to assess the relationship between handgrip strength and pulmonary function in patients with SSc. METHOD: A cross-sectional study in which 28 patients with SSc underwent isometric handgrip strength (IHGS) measurement and pulmonary function tests and completed the Health Assessment Questionnaire Disability Index (HAQ-DI) to measure physical function. RESULTS: The HAQ-DI scores were associated with the IHGS (rs = -0.599, P = 0.001) and pulmonary function parameters, particularly the diffusion capacity for carbon monoxide (DLco; rs = -0.642, P = 0.0004). CONCLUSION: In patients with SSc, the degree of physical disability is associated with both hand grip strength and pulmonary function. However, there is no relationship between handgrip strength and pulmonary function in these patients.

Pulse Waveform Analysis of Chinese Pulse Images and Its Association with Disability in Hypertension.

Hypertension affects functional capacity and quality of life. Pulse wave analysis (PWA) quantifies the pulse waveform's propagation and its changes resulting from arterial remodeling. Pulse image analysis (PIA) in traditional Chinese medicine contributes to pattern differentiation and therapeutic intervention. This protocol study evaluates the relationships between the parameters of both PWA and PIA to identify patterns in patients with hypertension and the associations of those patterns with functional capacity. In this observational, cross-sectional study protocol 40 patients were subjected to clinical and laboratorial examinations to assess the risk factors for cardiovascular disease and pattern differentiation. PWA was noninvasively performed at the radial artery to estimate the pulse wave's velocity, arterial compliance, and reflection index. PIA using the "simultaneous pressing" method was performed to assess nine indicators. Handgrip strength and physical activity was assessed as functional outcomes. We hypothesized that interactions between patterns and pulse images affect the PWA parameters and that the functional outcomes are weakly associated with personal, hemodynamic and risk factors for cardiovascular disease. Performing a PIA in patients with hypertension might allow the identification of early target-organ damage, standardization of the PIA based on the PWA, and unification of the pulse diagnosis.

Chinese medicine pattern differentiation and its implications for clinical practice.

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field: general pattern differentiation; genitourinary (recurrent cystitis); cardiovascular (coronary heart disease; arterial hypertension; angina pectoris); neurology (stroke); surgery; metabolic (diabetes mellitus); hepatic (cirrhosis); gastrointestinal (chronic superficial gastritis); orthopedic (low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis); oncology (gastric mucosal dysplasia; lung cancer); gynecologic and obstetric manifestations (nausea and vomiting). The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.