Effects and Usefulness of Inspiratory Muscle Training Load in Patients with Advanced Lung Cancer with Dyspnea.

BACKGROUND: Patients with advanced lung cancer tend to experience dyspnea. Pulmonary rehabilitation has been reported as a method for relieving dyspnea. However, exercise therapy imposes a high burden on patients, and it is difficult to sustain in many cases. Inspiratory muscle training (IMT) imposes a relatively low burden on patients with advanced lung cancer; however, its benefits have not been demonstrated. METHODS: We retrospectively analyzed 71 patients who were hospitalized for medical treatment. The participants were divided into an exercise therapy group and an IMT load + exercise therapy group. Changes in maximal inspiratory pressure (MIP) and dyspnea were examined using a two-way repeated measures analysis of variance. RESULTS: MIP variations significantly increase in the IMT load group, with significant differences between baseline and week 1, between week 1 and week 2, and between baseline and week 2. The analysis also showed that the variations in dyspnea decreased in the IMT load + exercise therapy group with significant differences between baseline and week 1 and between baseline and week 2. CONCLUSIONS: The results show that IMT is useful and has a high persistence rate in patients with advanced lung cancer who present dyspnea and cannot perform high-intensity exercise therapy.

Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia.

Persons with mild dementia can effectively maintain and improve their quality of life (QOL) by regularly performing their daily activities. However, research on activities of daily living (ADL) in this population often fails to distinguish between ADL performance and ADL capability, that is, actual independence in daily lives and potential independence in an ideal setting. This study aimed to identify the potential gaps between ADL performance and capability in individuals with mild dementia. A total of 137 community-dwelling older adults (aged ≥ 65 years) who had been diagnosed with dementia and assessed as 0.5 and 1 on a global clinical dementia rating (CDR). Participants were evaluated for basic ADL (BADL) and instrumental ADL (IADL) using the Hyogo Activities of Daily Living Scale (HADLS). Around 35 individuals who met the inclusion criteria were enrolled in the study. BADL performance and BADL capacity were not significantly different (p = 0.128); however, participants rated IADL capacity significantly higher than IADL performance (p < 0.01). Gaps between performance and capability were observed for IADL but not for BADL. This study distinguishes between ADL performance and capability in individuals with mild dementia and is the first to identify the IADL-specific gap between these two components; pertinent targeted interventions are vital in closing this gap. Environmental adjustments are important to improve QOL of persons with mild dementia.

Pulmonary Rehabilitation for Patients After COPD Exacerbation.

BACKGROUND: The aim of this study was to clarify the effectiveness of pulmonary rehabilitation in patients after exacerbations of COPD and to explore the initiation timing of pulmonary rehabilitation. METHODS: Systematic review and meta-analysis were performed to assess the effects of pulmonary rehabilitation in subjects with exacerbations of COPD on mortality and readmission compared with usual care. We searched for studies published up to October 2020 in MEDLINE, Embase, Cochrane Library, and other sources. Risk of bias was assessed for the randomization process, deviations from intended interventions, missing outcome data, outcome measurements, and selection of the reported result using the Risk of Bias 2 tool. We pooled mortality and readmission data and performed comparisons between pulmonary rehabilitation and usual care. The subgroup analysis compared pulmonary rehabilitation at different start times (early: ≤ 1 week from admission; and late: > 1 week from admission). RESULTS: We identified 10 randomized trials (1,056 participants). Our meta-analysis showed a clinically relevant reduction in readmission up to 3-6 months after pulmonary rehabilitation in both early group (4 trials, 190 subjects; risk ratio [RR] 0.58, [95% CI 0.34-0.99]) and late group (3 trials, 281 subjects; RR 0.48, [95% CI 0.32-0.71]). However, pulmonary rehabilitation had no significant effect on mortality 1 y later compared with usual care (4 trials, 765 subjects; RR 1.27, [95% CI 0.91-1.79]). CONCLUSIONS: Pulmonary rehabilitation showed short-term effects for subjects with exacerbations of COPD even if initiated within 1 week; however, further study is required to determine its long-term effects.

Effects of inspiratory muscle training after lung transplantation in children.

Pulmonary rehabilitation is a cornerstone of management for patients after lung transplantation (LT), but the benefits of inspiratory muscle training (IMT) after LT in children are unclear. Therefore, we examined whether IMT can improve respiratory function and dyspnoea in a paediatric patient after LT.The patient was a 13-year-old boy who underwent double LT. However, mild physical activity such as walking triggered dyspnoea for the patient. The patient underwent IMT with the intensity of approximately 30% of his maximal inspiratory pressure (MIP) for 2 months.The patient's MIP was increased by approximately 60% after 2 months, and his forced vital capacity as a percent of the predicted normal value increased from 74.6% to 83.4%, with improvement of dyspnoea.IMT may help improve dyspnoea after LT in children with respiratory muscle weakness and a decline in respiratory function.

Successful occupational therapy at end of life for a patient with prostate sarcoma.

Most previous studies on palliative rehabilitation highlight medical care, with occupational therapy (OT) primarily focused on normal and instrumental activities of daily living. This clinical report describes the case of a 35-year-old patient with prostate sarcoma with a poor prognosis who received OT to help him focus on participating in a meaningful occupation. Initially, the patient was depressed and withdrawn, but with OT, he was able to participate in an occupation, and his life became more active. Although the patient was at the end of his life, he was able to maintain a high quality of life during the limited time period.

The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review.

BACKGROUND: Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. METHODS: We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. DISCUSSION: One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. SYSTEMATIC REVIEW REGISTRATION: Registration number, UMIN000039960.

Effect of Instrumental Activities of Daily Living habituation due to routinising therapy in patients with frontotemporal dementia.

We examined whether Instrumental Activities of Daily Living (IADL) improves with routinising therapy for a patient with frontotemporal dementia (FTD) living in a group home. The patient exhibited symptoms of agitation, apathy, disinhibition, irritability and stereotyped behaviour. The care staff experienced long-term care burden and the patient was spending time idly. An occupational therapist, in collaboration with care staff, evaluated the patient and routinised the household chores included in IADL. Consequently, a routine of household chores was established, reducing behavioural and psychological symptoms of dementia and long-term care burden, and the quality of life (QOL) of the patient improved. The results suggested that routinising IADL of the patient with FTD reduced long-term care burden and improved QOL of the patient.

Impact of physical performance on prognosis among patients with heart failure: Systematic review and meta-analysis.

BACKGROUND: This study aimed to clarify the relationship between physical performance and prognosis of patients with heart failure using a meta-analysis given the inconsistencies in published studies regarding the same. METHODS: A total of 22 studies with 10,368 patients were included in this review. Hazard ratios were used for analysis, while meta-analysis was performed using the inverse-variance method. Among all physical performance tests reported in the literature, the six-minute walk distance (6MD) test was most frequently used. However, short physical performance battery (SPPB) and walking speed were more frequently used as outcomes among studies investigating patients with a higher mean age. RESULTS: The results of our meta-analysis showed that 6MD cut-off values were significantly associated with mortality [hazard ratio (HR), 2.04; 95% confidence interval (CI), 1.48-2.83; p<0.001] and cardiovascular disease (HR, 2.18; 95% CI, 1.68-2.83; p<0.001). Although a number of studies have also reported on the relationship between other physical performance tests and prognosis, meta-analysis could not be performed. Our results revealed that physical performance was strongly correlated with prognosis among patients with heart failure. CONCLUSIONS: Our meta-analysis showed a strong relationship between 6MD and prognosis. However, studies investigating more elderly patients have tended to more frequently utilize walking speed and SPPB as outcomes.

Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure.

BACKGROUND: Ischaemic heart disease including heart failure is the most common cause of death in the world, and the incidence of the condition is rapidly increasing. Heart failure is characterised by symptoms such as fatigue and breathlessness during light activity, as well as disordered breathing during sleep. In particular, sleep disordered breathing (SDB), including central sleep apnoea (CSA) and obstructive sleep apnoea (OSA), is highly prevalent in people with chronic heart failure. A previous meta-analysis demonstrated that positive airway pressure (PAP) therapy dramatically increased the survival rate of people with heart failure who had CSA, and thus could contribute to improving the prognosis of these individuals. However, recent trials found that adaptive servo-ventilation (ASV) including PAP therapy had a higher risk of all-cause mortality and cardiovascular mortality. A meta-analysis that included recent trials was therefore needed. OBJECTIVES: To assess the effects of positive airway pressure therapy for people with heart failure who experience central sleep apnoea. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, and Web of Science Core Collection on 7 February 2019 with no limitations on date, language, or publication status. We also searched two clinical trials registers in July 2019 and checked the reference lists of primary studies. SELECTION CRITERIA: We excluded cross-over trials and included individually randomised controlled trials, reported as full-texts, those published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted outcome data from the included studies. We double-checked that data had been entered correctly by comparing the data presented in the systematic review with study reports. We analysed dichotomous data as risk ratios (RRs) with 95% confidence intervals (CIs) and continuous data as mean difference (MD) or standardised mean difference (SMD) with 95% CIs. Furthermore, we performed subgroup analysis in the ASV group or continuous PAP group separately. We used GRADEpro GDT software to assess the quality of evidence as it relates to those studies that contribute data to the meta-analyses for the prespecified outcomes. MAIN RESULTS: We included 16 randomised controlled trials involving a total of 2125 participants. The trials evaluated PAP therapy consisting of ASV or continuous PAP therapy for 1 to 31 months. Many trials included participants with heart failure with reduced ejection fraction. Only one trial included participants with heart failure with preserved ejection fraction. We are uncertain about the effects of PAP therapy on all-cause mortality (RR 0.81, 95% CI 0.54 to 1.21; participants = 1804; studies = 6; I2 = 47%; very low-quality evidence). We found moderate-quality evidence of no difference between PAP therapy and usual care on cardiac-related mortality (RR 0.97, 95% CI 0.77 to 1.24; participants = 1775; studies = 5; I2 = 11%). We found low-quality evidence of no difference between PAP therapy and usual care on all-cause rehospitalisation (RR 0.95, 95% CI 0.70 to 1.30; participants = 1533; studies = 5; I2 = 40%) and cardiac-related rehospitalisation (RR 0.97, 95% CI 0.70 to 1.35; participants = 1533; studies = 5; I2 = 40%). In contrast, PAP therapy showed some indication of an improvement in quality of life scores assessed by all measurements (SMD -0.32, 95% CI -0.67 to 0.04; participants = 1617; studies = 6; I2 = 76%; low-quality evidence) and by the Minnesota Living with Heart Failure Questionnaire (MD -0.51, 95% CI -0.78 to -0.24; participants = 1458; studies = 4; I2 = 0%; low-quality evidence) compared with usual care. Death due to pneumonia (N = 1, 3% of PAP group); cardiac arrest (N = 18, 3% of PAP group); heart transplantation (N = 8, 1% of PAP group); cardiac worsening (N = 3, 9% of PAP group); deep vein thrombosis/pulmonary embolism (N = 1, 3% of PAP group); and foot ulcer (N = 1, 3% of PAP group) occurred in the PAP therapy group, whereas cardiac arrest (N = 16, 2% of usual care group); heart transplantation (N = 12, 2% of usual care group); cardiac worsening (N = 5, 14% of usual care group); and duodenal ulcer (N = 1, 3% of usual care group) occurred in the usual care group across three trials. AUTHORS' CONCLUSIONS: The effect of PAP therapy on all-cause mortality was uncertain. In addition, although we found evidence that PAP therapy did not reduce the risk of cardiac-related mortality and rehospitalisation, there was some indication of an improvement in quality of life for heart failure patients with CSA. Furthermore, the evidence was insufficient to determine whether adverse events were more common with PAP than with usual care. These findings were limited by low- or very low-quality evidence. PAP therapy may be worth considering for individuals with heart failure to improve quality of life.

Effects of liaison between physiotherapists and occupational therapists for home-visit rehabilitation: preliminary study.

[Purpose] Home-visit rehabilitation is used to restructure patients' home lives and involves comprehensive intervention. In Japan, liaison between physiotherapists and occupational therapists occurs, but impact of this cooperation is unclear. The present study aimed to investigate therapeutic efficacy of this liaison. [Participants and Methods] The study used a cross-sectional design. Participants were community-dwelling older adults who required long-term care and were receiving home-visit rehabilitation provided in the Chubu region. They were divided into a single-intervention group with either physiotherapy or occupational therapy alone, and a liaison-intervention group with therapy coordinated between the 2 professions. In addition to basic information, the Barthel Index, Frenchay Activities Index, Health Utility Index Mark 3, and subjective health assessments were evaluated. [Results] Eighteen participants were recruited. No significant differences were observed between groups for the Barthel Index, whereas the total Frenchay Activities Index score and items of the Frenchay Activities Index (outdoor domestic chores and outdoor activities) were significantly higher in the liaison-intervention group. The emotion item in the Health Utility Index Mark 3 and subjective health assessments were also significantly higher in the liaison-intervention group. [Conclusion] These findings suggest that this liaison is effective for improving activities of daily living and increasing quality of life. This is probably due to each therapist performing a specialized intervention and professional cooperation.

Peripherally acting µ-opioid antagonist for the treatment of opioid-induced constipation: Systematic review and meta-analysis.

BACKGROUND AND AIM: Opioid-induced constipation (OIC) is a frequent adverse event (AE) that impairs patients' quality of life (QOL). Peripherally acting µ-opioid receptor antagonists (PAMORAs) have been recognized as a treatment option for OIC, but the effect consistent across the studies has not been evaluated. METHODS: We conducted a quantitative meta-analysis to explore the efficacy of PAMORA for OIC (registered with PROSPERO: CRD42018085298). We systematically searched randomized controlled trials (RCTs) in Medline, Embase, and Central databases. Change from baseline in spontaneous bowel movements, pooled proportion of responders, QOL, and AEs were calculated and compared with results in placebo cases. RESULTS: We included 31 RCTs with 7849 patients. A meta-analysis revealed that patients under PAMORA therapy had considerably improved spontaneous bowel movement from baseline compared with those given placebo (20 RCTs; mean difference, 1.43; 95% confidence interval [CI], 1.18-1.68; n = 5622) and more responded (21 RCTs; risk ratio [RR], 1.81; 95% CI, 1.55-2.12; n = 4821). Moreover, QOL of patients receiving PAMORA was significantly better (8 RCTs; mean difference, -0.22; 95% CI, -0.28 to -0.17; n = 2884). AEs were increased significantly in the PAMORA group (26 RCTs; RR, 1.10; 95% CI, 1.06-1.15; n = 7715), especially in gastrointestinal disorders, whereas serious AEs were not significant (17 RCTs; RR, 1.04; 95% CI, 0.85-1.28; n = 5890). CONCLUSION: Peripherally acting µ-opioid receptor antagonist has been shown to be effective and durable for patients with OIC and is the only drug with confirmed evidence in meta-analysis. The possibility of publication bias was the limitation of this study.

Association between physical performance and cardiovascular events in patients with coronary artery disease: protocol for a meta-analysis.

BACKGROUND: Physical performance such as muscle strength or walking speed of patients with coronary artery disease (CAD) is lower than that of people who do not have CAD and is related to mortality and re-admission rates. Recent studies have shown that skeletal muscle strength, such as grip strength, was closely associated with cardiac events. Physical performance testing is quick, safe, and inexpensive and provides a reliable assessment tool for routine clinical practice. The aim of this meta-analysis is to clarify the association between physical performance testing and the risk of cardiovascular events and mortality. METHODS/DESIGN: This meta-analysis will include male and female participants of any age in community settings who have a history of the following conditions or procedures: myocardial infarction, or coronary revascularization (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or coronary artery stent), angina pectoris, heart failure, heart transplant, or coronary artery disease defined by angiography. We will search EMBASE and MEDLINE, PubMed, and the Cochrane Library with no limitations on date, language, document type, or publication status. Identified studies will be prospective and retrospective cohort studies. Physical performance will be defined as upper extremity strength, lower extremity strength, walking speed, or other performance scale. Six review authors will independently extract study characteristics from included studies. Participants will be divided into subgroups according to age (middle-aged <65 years and elderly ≥ 65 years), diagnosis (coronary artery disease and heart failure) and follow-up time (up to 12 months and over 12 months). We will pool hazard ratios of Cox proportional hazard models after logarithmic transformation and perform the meta-analysis by using inverse-variance method. DISCUSSION: To our knowledge, this meta-analysis will be the first report to assess the association between physical performance and cardiovascular events in CAD patients. We hope that these findings may help to estimate the prognosis for CAD patients in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015020886.