Respiratory physiotherapy in patients with cystic fibrosis and upper limb deep vein thrombosis.

We report physiotherapy management of two patients with severe cystic fibrosis (CF) lung disease and upper limb deep vein thrombosis (DVT). These patients were admitted due to a pulmonary exacerbation. Following peripherally inserted central catheters, they were diagnosed with an upper limb DVT. Due to their underlying lung disease, physiotherapy was mandatory for improvement. However, the DVT and anticoagulation treatment raised concerns for pulmonary emboli and hemoptysis. A framework for physiotherapy management in these patients, using a set of precautions and restrictions to maintain airway clearance while minimizing the risk for pulmonary emboli and hemoptysis, was established. Using this set of instructions, the patients experienced no major adverse events while maintaining sufficient airway clearance to allow respiratory improvement. These precautions were continued until the upper limb DVTs were resolved. To our knowledge, there are currently no guidelines or expert opinions available. Therefore, this framework can help guide physiotherapy management.

How abnormal is the normal? Clinical characteristics of CF patients with normal FEV1.

BACKGROUND: Normal values (>80%) of Forced Expiratory Volume in one second (FEV1 ) in patients with cystic fibrosis (CF) may lead to the interpretation that there is no lung disease. This study is a comprehensive analysis of lung involvement in CF patients having normal FEV1 . METHODS: Patients were recruited from two CF centers: Hadassah Medical Center, Jerusalem and Vall d' Hebron Hospital, Barcelona. Lung disease was assessed by lung clearance index (LCI), chest CT-Brody score, respiratory cultures, number of pulmonary exacerbations (PEx), and days of antibiotic treatment in the year before the assessment. RESULTS: Of the 247 patients, 89 (36%) had FEV1 ≥80% and were included in the study (mean age, 17.6; range, 4.25-49 years). Chronic Pseudomonas aeruginosa infection was found in 21%, and 31% had at least one major PEx in the year before the study. Abnormally elevated LCI was found in 86% of patients, ranging between 7.52 and 18.97, and total Brody score (TBS) was abnormal in 92% (range, 5.0-96.5). Patients with chronic P. aeruginosa had significantly higher LCI (p = .01) and TBS (p = .02) which were associated with more major PEx (p < .01 and p = .01, respectively) and more days of intravenous (IV) antibiotic treatment in the preceding year (p = .03 and p = .001, respectively). CONCLUSIONS: Most CF patients with normal FEV1 have already physiological and structural lung abnormalities which were associated with more PEx and IV antibiotic treatment. Further studies are needed to determine if better adherence to the currently used therapies and the new cystic fibrosis transmembrane modulators will prevent the progression of lung disease.

Physiotherapy Management of People Diagnosed with de Quervain's Disease: A Case Series.

Purpose : To report the outcomes of a physiotherapy management approach for de Quervain's disease (DQD), a common hand disorder for which evidence for physiotherapy management is lacking, in 4 consecutive patients with DQD. Methods : Participants underwent a median of eight treatment sessions, consisting of mobilizations with movement, eccentric muscle training, and high-voltage electrical stimulation. Outcomes were assessed with an 11-point numeric pain rating scale (NPRS; range 1-10) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH; range 0%-100%). Result s: Median NPRS and DASH scores decreased from a baseline of 5 and 48, respectively, to 2.8 and 19 after treatment; at 6-month follow-up, all participants reported minimal pain and disability, but one participant required a corticosteroid injection shortly after discharge from physiotherapy. Conclusions : Overall outcome was considered successful for three of four patients, comparable to the success rate previously reported for corticosteroid injections. A randomized clinical trial evaluating the efficacy of this intervention seems warranted.

Objectif: Présenter les résultats d'une approche de traitement par la physiothérapie de la maladie de De Quervain, une affection de la main courante pour laquelle il y a peu de données probantes quant au traitement par la physiothérapie, chez quatre patients consécutifs ayant la maladie de De Quervain. Méthodes: Les participants ont subi une médiane de huit séances de traitement comportant des activités de mobilisation avec mouvements, de contraction musculaire excentrique et de simulation électrique à haute tension. Les résultats ont été évalués à l'aide d'une échelle numérique de cotation de la douleur à 11 points (1 à 10) et d'un questionnaire sur les déficiences du bras, de l'épaule et de la main (0 à 100%). Résultats: Les notes médianes de l'échelle numérique de cotation de la douleur et du questionnaire sur les déficiences du bras, de l'épaule et de la main ont diminué, passant de la note médiane de base de 5/10 et 48/100, respectivement, à 2,8/10 et 19/100 après le traitement; au suivi du 6e mois, les participants ont déclaré avoir une douleur et une déficience minimales, mais un participant a eu besoin d'une injection de corticostéroïdes peu de temps après la fin du traitement par la physiothérapie. Conclusions: Dans l'ensemble, le traitement est considéré comme réussi pour 3 des 4 patients, ce qui est semblable au taux de succès rapporté antérieurement pour les injections de corticostéroïdes. La tenue d'un essai clinique randomisé évaluant l'efficacité de cette intervention semble justifiée.