Physiotherapy practices when treating patients with COVID-19 during a pandemic: A survey study.

Background Specific details pertaining to the clinical and other challenges faced by physiotherapists managing patients with COVID-19 during the pandemic are still largely unknown. Objectives To determine how physiotherapists clinically managed patients with COVID-19 in a hospital-based setting during the pandemic and to identify the personal and professional effects of working as a physiotherapist at this time. Methods Self-administered electronic cross-sectional survey. Participants included physiotherapists from around the world involved in the clinical management of patients with COVID-19. Results Of the 204 participants who returned the questionnaire, 39% worked as senior physiotherapists, 29% as consultant or specialist physiotherapists, 23% as general physiotherapists and 4% as graduate physiotherapists. Seventy-two percent of participants worked in the intensive care unit. The largest barrier to treating patients with COVID-19 was a lack of intensive care trained physiotherapists (70%). Eighty-three percent of participants reported performing activities outside of their typical work duties, including proning patients (55%), tutoring and advising other staff in the intensive care unit (55%) and adjusting or changing ventilator settings (52%). Almost all participants (90%) reported being aware of physiotherapy specific guidelines for treating patients with COVID-19, yet most participants performed techniques that were not recommended. Conclusions The experience of the pandemic highlighted the need for specialist training and availability of experienced cardiorespiratory physiotherapists to manage patients with COVID-19, specifically in intensive care. Furthermore, clear guidelines on the management of patients with COVID-19 should be established to ensure optimal management of patients and ensure the safety of physiotherapy staff.

Physiological response to eccentric and concentric cycling in patients with chronic obstructive pulmonary disease.

We aimed to compare the cardiorespiratory, metabolic, and perceptual responses to high- and moderate-intensity eccentric cycling versus moderate-intensity concentric cycling in chronic obstructive pulmonary disease (COPD) patients. Ten patients with moderate COPD (forced expiratory volume in 1 s (FEV1) = 68.6% ± 20.4% of predicted; 68.3 ± 9.1 years) performed 30 min of moderate-intensity concentric (CONC-M: 50% maximum workload; Wmax), moderate-intensity eccentric (ECC-M: 50% Wmax), and high-intensity eccentric (ECC-H: 100% Wmax) cycling. Average power output, oxygen consumption (V̇O2), minute ventilation (VE), respiratory frequency (fR), oxygen saturation (SpO2), heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), rate of perceived exertion (RPE), and dyspnea were measured during cycling. Compared with CONC-M, lower V̇O2 (-52% ± 14%), VE (-47% ± 16%), fR (-21% ± 14%), HR (-14% ± 16%), SBP (-73% ± 54%), RPE (-36% ± 26%), and dyspnea (-41% ± 37%) were found during ECC-M. During ECC-H, a similar metabolic demand to CONC-M was found. However, average power output was 117% ± 79% higher during ECC-H. Eccentric cycling can be safely performed by COPD patients and induced lower cardiorespiratory, metabolic, and perceptual responses than concentric exercise when performed at the same workload. Novelty Moderate- and high-intensity eccentric cycling can be performed by COPD patients. Moderate-intensity eccentric cycling showed lower cardiorespiratory, metabolic, and perceptual demand than concentric cycling at the same workload in COPD patients. Even at double workload, eccentric cycling induces lower cardiorespiratory, metabolic, and perceptual demand than moderate-intensity concentric cycling.

The use of exercise in burns rehabilitation: A worldwide survey of practice.

INTRODUCTION: Exercise-based interventions have been used to enhance the recovery of burn patients affected by hypermetabolism, muscle wasting and contractures. Although the benefits of exercise in burn population have been previously reported, the extent of exercise prescription in burn patients worldwide remains unknown. Therefore, the purpose of this study is to identify the extent and characteristics of exercise use in specialised and non-specialised burn centres worldwide. METHODS: A web-based survey was developed in English and translated into Spanish and Chinese languages. Distribution of the surveys was made via email using personal contacts of the authors and through six scientific societies related to burn care in 2018. Data were analysed using descriptive statistics and comparisons between frequency distribution on variables of interest using the Chi-Square test and contingency tables. RESULTS: One hundred and fifty-six surveys were completed (103 from the English version, 20 from the Chinese version, and 33 from the Spanish version). The response rate varied from 36.2% (English version) to 9.3% (Chinese version). Fifty eight percent of the surveyed clinicians worked in cities of 1 million inhabitants or more, and 92.3% worked in hospital-based burn centres. Exercise was used by 64.1% of the participants at the intensive care unit level, 75% in burn wards prior to complete wound healing, and 80.1% in rehabilitation units after wound healing. The type of exercise offered, parameters assessed, and characteristics of exercise programs varied notably among burn centres and clinicians consulted. CONCLUSION: The majority of the surveyed clinicians used exercise for rehabilitation of patients following burn injuries. Further investigation is required to elucidate the access to exercise interventions prescribed by health professionals in remote areas, in less developed countries, and the extent of home-based exercise performed by patients.

Exercise training for improving outcomes post-burns: a systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of different modalities of exercise and to evaluate the safety of exercise-based interventions post-burns. DATA SOURCES: Six databases were searched from inception to October 2017 using "burn," "exercise" and synonyms as keywords. Relevant authors, key journals and reference lists of included studies were hand-searched. REVIEW METHODS: Articles reporting on exercise interventions in patients post-burn and considering physical, physiological or psychological outcomes were considered. Two authors independently screened 2253 records and selected 19 articles for inclusion. The quality of the evidence was assessed at the study level and at the outcome level. RESULTS: Unbiased effect size estimators (pooled Hedges' g) with 95% confidence intervals (CIs) were calculated if there were two or more trials with homogeneous outcomes. There were no significant differences post-exercise training in VO2peak ( g = 0.99; 95% CI: -0.4 to 2.4: P = 0.18), resting energy expenditure ( g = -0.51; 95% CI: -1.99 to 0.97: P = 0.5) and muscle strength ( g = 0.51; 95% CI: -0.03 to 1.05: P = 0.07) between groups. Evidence suggested exercise had a beneficial effect on body composition ( g = 0.59; 95% CI: 0.05 to 1.14: P = 0.03), need of surgical release of contractures (risk ratio = 0.34; 95% CI: 0.2 to 0.7; P = 0.004) and health-related quality of life. However, a lack of evidence existed regarding the safety of exercise training post-burns. CONCLUSION: Limited evidence suggests that exercise has a beneficial effect on physical and physiological outcomes in patients post-burn. Further trials using high-quality methodology are required, with focus on reporting of adverse events, health-related quality of life and psychological outcomes.

The efficacy and safety of adrenergic blockade after burn injury: A systematic review and meta-analysis.

BACKGROUND: The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury. METHODS: The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and an appraisal of risk of bias was performed. RESULTS: From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria. Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect favoring propranolol use that significantly decreased resting energy expenditure (g = -0.64; 95% CI, -0.8 to -0.5; p < 0.001) and trunk fat (g = -0.3; 95% CI, -0.4 to -0.1; p < 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3-0.6; p < 0.001) and insulin resistance (g = -1.35; 95% CI, -2.0 to -0.6; p < 0.001). Occurrence of adverse events was not significantly different between the treated patients the and controls. CONCLUSION: Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on adult population with a broader range of outcome measures are warranted. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.

Reduced blood nrf-2 mRNA in local overweight boys at risk of metabolic complications: a study in San Luis City, San Luis, Argentina.

BACKGROUND: Childhood overweight (OW) is a matter of public health concern because of its long-term impact on adulthood health. NF-E2-related factor 2 (Nrf-2) regulates the antioxidant/lipogenic response to a sustained positive energy balance that prevails during weight gain. Here we aimed at studying a possible link between OW and Nrf-2-dependent antioxidant/lipogenic response in a local population of boys at risk of metabolic complications. METHODS: We measured clinical and biochemical parameters related to lipid metabolism, oxidative stress, and metabolic syndrome in a population of OW boys [body mass index (BMI) percentile ≥85(th) and <95(th), n=22] and normal weight boys (NW; BMI percentile<85(th), n=27) from San Luis City, San Luis, Argentina. RESULTS: Compared to NW, OW boys had lower insulin sensitivity, an altered plasma lipid profile, and increased markers of oxidative stress and inflammatory fatty acids. OW boys also had a higher atherogenic index and peripheral insulin resistance than NW boys. We also found that glutathione peroxidase activity and the reduced glutathione to oxidized glutathione ratio were lower in OW boys than NW boys, suggesting that OW boys may have an altered antioxidant response to oxidative stress. Finally, Nrf-2 expression negatively correlated with metabolic syndrome parameters in OW boys. CONCLUSIONS: Our data suggest that OW boys have a reduced antioxidant and lipogenic response to a positive energy balance, resulting in oxidative stress, insulin resistance, and risk of developing metabolic complications. Our data also provide a rationale for nutritional interventions aimed at restoring Nrf-2 expression to reduce the risk of metabolic complications in OW boys.