The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies.

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.

Effect of structured training programme on arm dysfunction, lymphoedema and quality of life after breast cancer surgery.

OBJECTIVE: To evaluate the effect of education given according to daily living activities model on arm dysfunction, lymphoedema and quality of life in patients undergoing breast cancer surgery. METHODS: The randomised controlled study was done at a tertiary hospital and comprised patients undergoing breast cancer surgery who underwent breast cancer surgery from November 2017 to October 2018. After randomisation, the intervention group received education through specifically-designed tools, while the control group received routine care. Data was collected using a patient information form, the subjective perception of post-operative functional impairment of the arm scale, Katz index of daily living activities, the disabilities of the arm, shoulder and hand scale and the short form of the quality of life scale. Three interviews were conducted at post-surgery 1st week, 1st month and 3rd month. Data was analysed using SPSS 23. RESULTS: Of the 58 subjects, 29(50%) each were cases and controls. The overall mean age was 48.9±9 years. In the intervention group, the measurements of the upper arm circumference were significantly better than the control group (p<0.05). Also there were significant differences between the groups in terms of scales and indices used (p<0.05). CONCLUSIONS: The intervention group recovered earlies than the control group.

Unemployment risk among individuals undergoing medical treatment for chronic diseases.

BACKGROUND: Chronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases. AIMS: To examine the association between chronic disease and the risk of unemployment in a disaster area. METHODS: This cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered. RESULTS: Among the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P < 0.05]. In participants with a lower degree of psychological distress and better levels of daily life activity (n = 1967), no significant associations were observed (OR = 1.1, 95% CI 0.6-2.1). Conversely, in 536 participants with a higher degree of psychological distress and/or poorer levels of daily life activity, statistically significant associations were found (OR = 2.6, 95% CI 1.01-6.6, P < 0.05). CONCLUSIONS: The association between undergoing medical treatment for chronic disease and unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity.

The effect of motor learning-based telerehabilitation on quality of life of children with cerebral palsy during the COVID-19 pandemic.

BACKGROUND: During the pandemic, the access of children with cerebral palsy (CP) to rehabilitation services was adversely affected due to the significant risk of infection. AIMS: We assessed whether the effect of a motor learning-based treatment provided via a telerehabilitation method on the quality of life of children with cerebral palsy during the COVID-19 period was equivalent to face-to-face treatment. METHODS: Distance exercises were explained by a physiotherapist to the patients in the telerehabilitation group, and motor learning-based treatment was applied by their families; the physiotherapist followed the sessions with video conferencing. Motor learning-based treatment was offered to the face-to-face group by a physiotherapist in the clinic. RESULTS: In the comparison between the groups, there was a significant difference in the parameters of play activities, pain-hurt, fatigue, eating activities, and speech communication activities after treatment (p<0.05). However, in the test performed by considering the nonhomogeneous parameters before the treatment, no time-dependent difference was found in the repeated measurements before and after the treatment in all parameters (p>0.05). CONCLUSION: Motor learning-based treatment provided using the telerehabilitation method has a positive effect on the quality of life of children with CP, but the results are similar to face-to-face treatment.

Independent relationships of daily life activity and leisure-time exercise with metabolic syndrome and its traits in the general Japanese population.

PURPOSE: This study aimed to investigate independent relationships of daily non-exercise life activity and leisure-time exercise volume and intensity with the prevalence of metabolic syndrome and its traits in Japanese adults. METHODS: Data of 24,625 eligible subjects (12,709 men, 11,916 women) who participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study were analyzed. Information about lifestyle characteristics was obtained from a questionnaire. Logistic regression analyses were performed to evaluate the independent associations of daily life activity as well as leisure-time exercise volume and intensity with the prevalence of metabolic syndrome and its traits by sex. RESULTS: Male subjects with higher daily life activity as well as with higher leisure-time exercise volume had a lower prevalence of metabolic syndrome, independently with each other. Female subjects with higher daily life activity also had a lower prevalence of metabolic syndrome. Particularly, male and female subjects with the highest daily life activity quartile showed considerably low odds ratios of 0.66 (95% CI, 0.53-0.81) and 0.64 (0.52-0.79), respectively, for low HDL-cholesterol even after the adjustment for BMI compared with the first quartile. Meanwhile, male subjects with the higher leisure-time exercise showed a quite lower prevalence of elevated triglycerides. Higher moderate-intensity exercise was more intensely associated with a lower prevalence of metabolic syndrome and some of its traits in both sexes. CONCLUSIONS: Our results suggest that higher daily life activity and higher moderate-intensity exercise may be independently associated with a lower risk of metabolic syndrome in Japanese adults.

Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD.

Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages). Conclusion: The two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO.

Índice de independencia de paciente con Accidente Vascular Encefálico / Independence rate of patient presenting with strokes

Las discapacidades o secuelas permanentes más frecuentes en los pacientes que presentan Accidentes Vasculares Encefálicos, son las hemiparesias, la incapacidad para caminar o la dependencia parcial en actividades de la vida diaria. La determinación por parte del equipo de salud de si existen secuelas o no, en un paciente que ha sufrido esta enfermedad, es un elemento importante para darle seguridad y optimismo realista. Se realizó un estudio descriptivo, prospectivo y de corte transversal, con el objetivo de evaluar el índice de independencia en pacientes con Accidente Vascular Encefálico que fueron egresados del Servicio de Cerebro Vascular del Hospital Provincial Docente Saturnino Lora, Municipio Santiago Cuba, en noviembre de 2008. El universo estuvo constituido por 102 pacientes que residían en las áreas de salud de dicho Municipio, se tomó una muestra de 22 pacientes a través del método aleatorio simple, a los que se les aplicó la evaluación de las necesidades básicas de la vida diaria, según la Escala de Índice de Katz, que evalúa seis funciones: bañarse, vestirse, uso del servicio sanitario, movilidad, continencia y alimentación. Se exploraron otras variables como: edad, sexo, estadía hospitalaria, toma motora. Se obtuvo como resultado que predominó la edad entre los 70 y 90 años, el sexo femenino, la estadía hospitalaria estuvo entre 7 y 10 días. Se arribó a la conclusión que un mínimo de paciente sufrió toma motora, siendo directamente proporcional al grado de independencia en una u otra de las seis necesidades básicas y solamente un caso tenía dependencia total en todas las actividades de la vida diaria(AU)

The more frequent disabilities or permanent sequelae in patients presenting with strokes are the hemiparesis, inability to walk or the partial dependence in daily life activities. The determination according to the health team if there are or not sequelae in a patient, who has suffered this disease, is an important element to give him safety and a realistic optimism. A cross-sectional, prospective and descriptive study was conducted to assess the independence rate in patients presenting with strokes discharged from the Cerebrovascular Service of the Saturnino Lora Teaching Provincial Hospital, Santiago de Cuba municipality in November, 2008. The universe included 102 patient residents of such municipality; the sample included 22 patients by simple randomized method assessing the basic needs of the daily life, according to Katz Rate Scale evaluating six functions: to take a bath, to dress, use of bathrooms, mobility, continence and feeding. Other variables were explored including: age, sex, hospital stay, motor affection. The result was a predominance of ages between 70 and 90 years, female sex, the hospital stay was between 7 and 10 days. We concluded that a minimum of patients undergoes motor affection, which is directly proportional to the independence degree in one or in another of the six basic needs and only one case had a total dependence in all activities of daily life(AU)