Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units.

BACKGROUND: Extubation failure can lead to a longer intensive care unit (ICU) stay, higher mortality rate, and higher risk of requiring tracheostomy. Chest physiotherapy (CPT) can help patients in reducing the accumulation of airway secretion, preventing collapsed lung, improving lung compliance, and reducing comorbidities. Much research has investigated the correlation between CPT and respiratory system clearance. However, few studies have investigated the correlation between CPT and failed ventilator extubation. Therefore, this study aimed to investigate the use of CPT for reducing the rate of failed removal from mechanical ventilators. METHODS: This study was an intervention study with mechanical control. Subjects were divided into two groups. The control group, which received routine nursing chest care, was selected from a retrospective chart review. The intervention group was prospectively taken into the chest physiotherapy program. The chest physiotherapy treatment protocol consisted of inspiratory muscle training, manual hyperinflation, chest wall mobilization, secretion removal, cough function training, and early mobilization. RESULTS: A total of 439 subjects were enrolled in the intervention and control groups, with a mean age of 69 years. APACHE II score (P = .09) and GCS scores (P = .54) were similar between the two groups. Compared to the control group, patients in the intervention group had a significantly lower reintubation rate (8% vs 16%; P = .01). CONCLUSIONS: The results indicate that intensive chest physiotherapy could decrease extubation failure in mechanically ventilated patients in the ICU. In addition, chest physiotherapy could also significantly improve the rapid shallow breathing index score.

Quality, language, subdiscipline and promotion were associated with article accesses on Physiotherapy Evidence Database (PEDro).

OBJECTIVE: To quantify the relationship between the number of times articles are accessed on the Physiotherapy Evidence Database (PEDro) and the article characteristics. A secondary aim was to examine the relationship between accesses and the number of citations of articles. METHOD: The study was conducted to derive prediction models for the number of accesses of articles indexed on PEDro from factors that may influence an article's accesses. All articles available on PEDro from August 2014 to January 2015 were included. We extracted variables relating to the algorithm used to present PEDro search results (research design, year of publication, PEDro score, source of systematic review (Cochrane or non-Cochrane)) plus language, subdiscipline of physiotherapy, and whether articles were promoted to PEDro users. Three predictive models were examined using multiple regression analysis. Citation and journal impact factor were downloaded. RESULTS: There were 29,313 articles indexed in this period. We identified seven factors that predicted the number of accesses. More accesses were noted for factors related to the algorithm used to present PEDro search results (synthesis research (i.e., guidelines and reviews), recent articles, Cochrane reviews, and higher PEDro score) plus publication in English and being promoted to PEDro users. The musculoskeletal, neurology, orthopaedics, sports, and paediatrics subdisciplines were associated with more accesses. We also found that there was no association between number of accesses and citations. CONCLUSION: The number of times an article is accessed on PEDro is partly predicted by how condensed and high quality the evidence it contains is.

Aplicación mundial de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud en Fisioterapia: revisión sistemática / Global application of the International Classification of Functioning, Disability and Health in Physiotherapy: a systematic review

Con la creación de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud se busca promover un lenguaje unificado entre las disciplinas de la salud, fundamental para el desarrollo del área clínica e investigativa. El objetivo de este artículo es presentar una revisión del uso y aplicación de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud en el ámbito clínico fisioterapéutico. La búsqueda se focalizó en publicaciones realizadas entre 2001 y 2015 en MEDLINE, EMBASE, PEDro, SciELO y LILACS. Los artículos se categorizaron por ubicación geográfica, tipo de estudio, población y relevancia para la Fisioterapia. Se encontraron 128 artículos sometidos a evaluación por jueces para una selección final de 22, de los cuales el 47,8% fueron estudios cualitativos y el 60,8% fueron escritos en Europa y las áreas de mayor aplicación fueron la neurológica y musculoesquelética. El uso de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud guía del razonamiento clínico en Fisioterapia y permite la toma de decisiones asertivas para el logro de metas propuestas (AU)

The International Classification of Functioning, Disability and Health seeks to promote a unified language among health disciplines, which is essential for the development of clinical practice and research. This article aims to present a review of the use and application of the International Classification of Functioning, Disability and Health in the clinical setting of Physiotherapy. The search focused on publications between 2001 and 2015 in MEDLINE, EMBASE, PEDro, SciELO and LILACS. The articles were categorised by geographic location, type of study, population and relevance for physical therapy. A total of 128 articles were evaluated and 22 were finally selected, of which 47.8% were qualitative studies and 60.8% were conducted in Europe. The areas of greatest application were neurological and musculoskeletal. The International Classification of Functioning, Disability and Health can be used to guide clinical reasoning in Physiotherapy and allows confidence in decision-making to achieve proposed goals (AU)

Medical Devices; Neurological Devices, Classification of the Vibratory Counter-Stimulation Device. Final order.

The Food and Drug Administration (FDA) is classifying the vibratory counter-stimulation device into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the vibratory counter-stimulation device's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

[Efficiency of therapeutically applied physical factors for vibration disease caused by exposure to local vibration (review of literature).]

Important role in treatment and prophylaxis for vibration disease due to local vibration is played by physical factors. If high frequency components prevalent in occupational vibration, treatment with electric therapy, laser, magnetic fields, lymphatic drainage, hydrotherapy provides influence on leading chains of systemic microangiopathies pathogenesis - dysbalance of regulation influences by vegetative nervous system, vasoconstriction and intravascular changes, vascular permeability and microcirculation disorders. If low frequency coomponents prevalent in occupational vibration, treatment of polyneuropathies and locomotory disorders incorporates trophic processes activation: transcranial electroanalgesia, surface application of mineral waters, manual and subwater massage, ozone therapy, local spark discharges, peloids. Complex use of physical methods also increases human adaptational resources.

Treatment-based Classification System for Patients With Low Back Pain: The Movement Control Approach.

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumbar spine requires both local mobility and global stability. Local mobility means that the lumbar spine and its adjacent regions possess adequate nerve and joint(s) mobility and soft tissue compliance (ie, the malleability of tissue to undergo elastic deformation). Global stability means that the muscles of the lumbar spine and its adjacent regions can generate activation that is coordinated with various joint movements and incorporated into activities of daily living. Local mobility and global stability are housed within the bio-behavioral and socio-occupational factors that should be addressed during movement rehabilitation. This schema is converted into a practical physical examination to help the rehabilitation provider to construct a clinical rationale as to why the movement impairment(s) exist. The examination findings are used to guide treatment. We suggest a treatment prioritization that aims to consecutively address neural sensitivity, joint(s) and soft tissue mobility, motor control, and endurance. This prioritization enables rehabilitation providers to better plan the intervention according to each patient's needs. We emphasize that treatment for patients with low back pain is not a static process. Rather, the treatment is a fluid process that changes as the clinical status of the patient changes. This movement control approach is based on clinical experience and indirect evidence; further research is needed to support its clinical utility.

[Usefulness of rehabilitation in inflammatory myopathies]. / Intérêt de la rééducation fonctionnelle au cours des myopathies inflammatoires.

Rehabilitation, for a long time not recommended, seems today to hold a prominent place within the therapeutic arsenal of inflammatory myopathies. The difficulty of its evaluation, apart from the low prevalence of these diseases, lies in a triple heterogeneity: first that distinguishing the different forms of inflammatory myopathies and the phase where they are active; second, that concerning the endpoint considered to assess the efficiency of the intervention; lastly, the diversity of the rehabilitation programs that can be undertaken. Between 1993 and 2016, about 30 studies estimating the rehabilitation of inflammatory myopathies have been published, among which five randomized controlled trials, four controlled trials, 15 open studies, and seven case reports. All these studies evidence the safety of rehabilitation and some show a significant improvement of the criteria estimating the activity of the disease, its functional impact or the impairment of quality of life and the limitation in daily life activities triggered by the disease. The rehabilitation, whether aerobic, anaerobic or mixed, must today systematically be associated with the pharmaceutic treatment proposed to patients affected by inflammatory myopathies. Other studies are necessary to optimize the rehabilitation methods, to understand their effects and action, and to quantify their impact and provide more trustworthy evidence.

[Combined physical therapy: general information, interaction between physical factors]. / Sochetannaya fizioterapiya: obshchie svedeniya, vzaimodeistvie fizicheskikh faktorov.

The present article is devoted to problems pertaining to the combined (simultaneous) medical application of the therapeutic physical factors. The classification of the methods used in combined physical therapy is proposed, their advantages over the traditional therapeutic modalities are discussed, the general principles of simultaneous application of the medical physical factors are considered. The possible variants of interaction between such physical factors in the case of their combined application are theoretically determined, the criteria for their quantitative assessment (coefficients of synergism and effectiveness of combination) are offered, examples of their application for the evaluation of the efficiency of the selected combinations are provided.

ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery.

BACKGROUND: Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. AIM: The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. DESIGN: Observational study. SETTING: In-patients cardiac Rehabilitation Unit in Milan. POPULATION: Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years). METHODS: We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (P<0.001). The environmental code scores significantly decreased in the case of facilitators between T1 and T2 (P=0.0051), but not in the case of barriers. There were significant correlations between the ICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. CONCLUSION: The ICF-based data provided functional information that was consistent with the patients' clinical course. CLINICAL REHABILITATION IMPACT: The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.

Clinical challenges of classification based targeted therapies for non-specific low back pain: What do physiotherapy practitioners and managers think?

BACKGROUND: Classification of non-specific low back pain (NSLBP) was recommended to better target care and so maximise treatment potential. This study investigated physiotherapy practitioners' (PPs) and managers' (PMs) views, experiences and perceptions of barriers and enablers for using classification systems (CSs) to better target treatment for NSLBP in the NHS primary care setting. DESIGN: Qualitative focus group and interviews. METHODS: Data from semi-structured interviews of three PMs and a focus group with five PPs, considered local opinion leaders in physiotherapy, was thematically analysed. RESULTS: Five themes emerged (i) CS knowledge: PPs and PMs were aware of CSs and agreed with its usefulness. PPs were mostly aware of CSs informing specific treatments whilst PMs were aware of prognosis based CSs. (ii) Using CSs: PPs classify by experience and clinical reasoning skills, shifting between multiple CSs. PMs were confident that evidence-based practice takes place but believed CSs may not be always used. (iii) Advantages/disadvantages of CSs: Effective targeting of treatments to patients was perceived as advantageous; but the amount of training required was perceived as disadvantageous. (iv) Barriers: Patients' expectations, clinicians' perceptions, insufficiently complex CSs, lack of training resources. (v) Enablers: Development of sufficiently complex CSs, placed within the clinical reasoning process, mentoring, positive engagement with stakeholders and patients. CONCLUSIONS: PPs and PMs were aware of CSs and agreed with its usefulness. The current classification process was perceived to be largely influenced by individual practitioner knowledge and clinical reasoning skills rather than being based on one CS alone. Barriers and enablers were identified for future research.

Introduction to Special Issue: A Review of the International Classification of Functioning, Disability and Health and Physical Therapy over the Years.

BACKGROUND AND PURPOSE: The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization was developed as a common framework to understand health and to describe the impact of health condition on functioning. The purpose of this paper is to summarize the literature on the use of the ICF in physical therapy practice and research. METHODS: We performed a scoping-narrative review and searched for relevant English language articles from 2001 to 2012 in multiple databases that included MEDLINE, PsycINFO, PubMed and Physiotherapy Evidence Database. Our keywords for the search consisted of ['physical therapy' OR 'physiotherapy'] AND ['ICF']. All types of articles were considered. RESULTS: We found 268 articles; out of which, 79 were reviewed. The years with most publications were 2011 (n = 16), 2008 (n = 15) and 2010 and 2012 (both with n = 13). Publications mostly came from the United States with 27% of the articles. The journal Physical Therapy leads with almost a third of ICF-related physical therapy publications. The ICF has been mostly used in studies of musculoskeletal and neuromuscular conditions. We found a wide array of application of the ICF in research, clinical practice and teaching (classroom and clinical education). Emerging topics included using the ICF in resource allocation and prevention and wellness. CONCLUSION: The use of the ICF in physical therapy practice and research is promising and continues to evolve. With recent developments in ICF-based measurement and integration in assessment tools for use in the clinics, research and teaching, the need to show the added value of using the ICF in practice and research remains.

[Chest physical therapy of the distal lung. Mechanical basis of a new paradigm]. / La kinésithérapie respiratoire du poumon profond. Bases mécaniques d'un nouveau paradigme.

Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.

Perfil epidemiológico de paciente em atendimento fisioterapêutico em Home Care no Estado de São Paulo / Epidemiological profile of patient in physical therapy in Home Care in the State of São Paulo

Objetivo - Traçar um perfil epidemiológico do paciente em atendimento fisioterapêutico em Home Care no Estado de São Paulo. Métodos - Para realização deste trabalho foi realizado levantamento de dados através de análise de prontuários dos pacientes em atendimento de fisioterapia domiciliar no Estado de São Paulo no ano de 2010. Resultados - A amostra foi composta de 412 pacientes, variando a faixa etária entre 1 a 98 anos, a procura pelo serviço de fisioterapia domiciliar é ocasionada principalmente pelas patologias crônicas, sendo que os indivíduos que mais utilizam este tipo de serviço se concentram na faixa etária de 61 a 90 anos, na sua grande maioria composta por mulheres e que o principal objetivo da fisioterapia domiciliar é a reabilitação motora realizados em indivíduos com sequela do AVE, doença que mais acomete os pacientes que se utilizam deste tipo de atendimento. A maior parte dos pacientes atendidos obtiveram uma melhora considerável em um período de tratamento curto demonstrando a eficácia da fisioterapia domiciliar. Conclusão - Com este estudo conclui-se que as principais patologias que requer este tipo de tratamento são as patologias crônicas, em uma faixa etária média de 75 anos, cuja a população se beneficia com o tratamento fisioterapêutico em abordagens precoces.

Objective - To outline an epidemiological profile of the patient in physical therapy in Home Care in the State of São Paulo. Methods - For this study, data collection was conducted through analysis of medical records of patients in home care physical therapy in the State of São Paulo in 2010. Results - The sample consisted of 412 patients, ranging in age from 01 to 98 years, the demand for domiciliary physiotherapy service is mainly caused by chronic diseases, and most individuals who use this type of service are concentrated in the age group 61 to 90 years, mostly composed of women and that the main aim of physiotherapy is the home made motor rehabilitation in patients with sequelae of stroke, a disease that affects most patients who use this type of care. Most patients treated had a considerable improvement in a short period of treatment, demonstrating the effectiveness of physiotherapy at home. Conclusion - This study concludes that the main pathologies that require this type of treatment are chronic diseases, in a mean age of 75 years, whose population benefits from physical therapy treatment approaches in early.