Short-Term Effect of Different Physical Exercises and Physiotherapy Combinations on Sputum Expectoration, Oxygen Saturation, and Lung Function in Young Patients with Cystic Fibrosis.

PURPOSE: Exercise and chest physiotherapy are integral components of cystic fibrosis (CF) care. We aimed to determine short-term effects of a combined exercise-physiotherapy intervention, using either trampoline or cycle exercises compared to billiard (sham training) on sputum production, oxygen saturation (SaO2) and short-term lung function in participants with CF. METHODS: Twelve 16- to 29-year-old individuals with CF were randomly allocated to all 3 interventions on non-consecutive days of a week with exercise and physiotherapy parts lasting 30 min and breaks of 30 min after each procedure. Sputum weight (g) and lung function were measured before and after the exercise + rest and physiotherapy + rest interventions and SaO2 was measured before and after the combined interventions. Differences in outcome measures between the different exercises and combined exercise/physiotherapy regimens were analyzed by univariate multilevel linear regression. RESULTS: Sputum expectoration during and after trampoline exercise was significantly higher than with and after billiard (P = 0.021), and tended to be higher than with and after cycling of similar cardiovascular intensity (P = 0.074). Sputum weights during and after physiotherapy were comparable among sessions, irrespective of the prior exercise or sham procedure. The increase in SaO2 was significantly higher after the combined trampoline/physiotherapy (1.7 ± 0.9%) and cycling/physiotherapy (1.8 ± 0.8%) sessions compared to billiard/physiotherapy (0.5 ± 1.8%, P = 0.011 and P = 0.007). No effects were observed on lung function. CONCLUSIONS: Exercise followed by physiotherapy has an additive effect on sputum production in participants with CF and leads to improved oxygen saturation. Exercises with increased ventilation combined with mechanical vibration seem to be most efficient.

The use of the comprehensive International Classification of Functioning, Disability and Health Core Set for low back pain in clinical practice: a reliability study.

BACKGROUND AND PURPOSE: The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain (LBP) can be used to describe functioning and the influence of the environment of patients with LBP with a selection of 78 categories, from the ICF components 'body functions', 'body structures', 'activities and participation' and 'environmental factors'. The reliability of the qualifiers' scale of the ICF Core Set for LBP has not yet been studied. METHODS: Reliability study was conducted in three study centres in the German-speaking part of Switzerland. In the first step, two physiotherapists independently assessed 31 patients with LBP with the original qualifier scale of the 78 ICF categories from the comprehensive ICF Core Set for LBP. After the first 31 patients, inter-rater reliability was assessed and the response options were reduced based on a Rasch analysis. The second sample (n = 30) was assessed by the physiotherapists with the modified qualifier scale and inter-rater reliability was calculated again. RESULTS: The percentage agreement for the ICF categories ranged from 19% to 87%, mean 44% (nominal kappa from -0.73 to 0.54, median 0.22; weighted kappa -0.2 to 0.69, median 0.38) in the first round with the original qualifier scale. In the second round with the reduced response options, the percentage agreement ranged from 23% to 90%, mean 49% (nominal kappa from -0.15 to 0.71, median 0.24; weighted kappa -0.16 to 0.81, median 0.25). The overall percentage agreement was 44% in the first round and 49% with the reduced response categories. The overall kappa value in the first round was 0.29 and in the second round 0.32. There was a small but statistically significant improvement in the agreement. CONCLUSION: The low-to-moderate reliability found in this study requires an improved operationalization (e.g. the definition and description of each response category) and improved instructions for the ICF Core Set for LBP.