Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial.

BACKGROUND: There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR). RESEARCH QUESTION: To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR. STUDY DESIGN AND METHODS: A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care). RESULTS: Ninety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI -4.1/+43.8)] and Chronic Respiratory Disease Questionnaire - Emotion score [0.4 points (0-0.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.0-15.4)] and Chronic Respiratory Disease Questionnaire - Emotion [0.5, (0.2-0.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (-32.3/0.8) in linear models. CONCLUSIONS: The TelePR maintenance strategy was both feasible and safe but failed to show superiority over usual care, despite improvements in some HRQoL domains. Acute exacerbations may have an important negative influence on long-term physical function. CLINICALTRIALS. GOV IDENTIFIER: NCT03247933.

Slackline Training in Children with Spastic Cerebral Palsy: A Randomized Clinical Trial.

OBJECTIVE: To assess whether a slackline intervention program improves postural control in children/adolescents with spastic cerebral palsy (CP). DESIGN: Randomized controlled trial. SETTING: Patients' association. PARTICIPANTS: Twenty-seven children/adolescents with spastic CP (9-16 years) were randomly assigned to a slackline intervention (n = 14, 13 ± 3 years) or control group (n = 13, 12 ± 2 years). INTERVENTION: Three slackline sessions per week (30 min/session) for 6 weeks. MAIN OUTCOME MEASURES: The primary outcome was static posturography (center of pressure-CoP-parameters). The secondary outcomes were surface myoelectrical activity of the lower-limb muscles during the posturography test and jump performance (countermovement jump test and Abalakov test). Overall (RPE, >6-20 scale) rating of perceived exertion was recorded at the end of each intervention session. RESULTS: The intervention was perceived as "very light" (RPE = 7.6 ± 0.6). The intervention yielded significant benefits on static posturography (a significant group by time interaction on Xspeed, p = 0.006) and jump performance (a significant group by time interaction on Abalakov test, p = 0.015). CONCLUSIONS: Slackline training improved static postural control and motor skills and was perceived as non-fatiguing in children/adolescents with spastic CP.

Impact of environmental air pollutants on disease control in asmathic patients.

PURPOSE: Asthmatics are adversely affected by the presence of air pollutants, the concentrations of which can nowadays be measured. However, the utility of this information in clinical practice has not been defined in a group of asthmatics in stable condition. Our objective was to determine what impact the level of air pollutants had on the control of their asthma and the degree of airway inflammation. METHODS: We performed a cross-sectional study of adult asthmatics in stable condition. From the regional environmental authority, we obtained the concentrations of ambient nitric oxide (NO2), ozone (O3), suspended particulate matter up to 10 micrometers in diameter (PM10) and sulphur dioxide (SO2) at fixed geographical points. Disease control was assessed using asthma control test (ACT) scores, and airway inflammation using fraction of exhaled nitric oxide (FeNO) values. Correlation and linear regression studies were performed using ACT scores as the dependent variable. RESULTS: The study included 99 asthmatics, aged 39 years (SD 8), 55% women. Mean ACT value was 17.2 (SD 6.5), and FeNO 33.7 (SD 16). Of the pollutants studied, only NO2 was correlated with ACT scores (CC = 0.45, p < 0.001). We found no relationship between pollutants and airway inflammation. Multivariate analysis showed that ACT score was predicted by ambient air NO2 concentration and, to a lesser extent, mean FeNO. CONCLUSIONS: Information on the concentration of ambient NO2 in our environment can help the clinician to interpret the evolution of asthmatic patients.

Retesting the validity of a specific field test for judo training.

The main goal of this research project was to retest the validity of a specifically designed judo field test (Santos Test) in a different group of judokas. Eight (n=8) national-level male judokas underwent laboratory and field testing. The mean data (mean +/- SD) obtained in the laboratory tests was: HRmax: 200 ± 4.0 beats × min(-1), VO2 max: 52.8 ± 7.9 ± ml × kg(-1) × min(-1), lactate max: 12 ± 2.5 mmol × l(-1), HR at the anaerobic threshold: 174.2 ± 9.4 beats × min(-1), percentage of maximum heart rate at which the anaerobic threshold appears: 87 ± 3.6 %, lactate threshold: 4.0 ± 0.2 mmol × l(-1), and RPE: 17.2 ± 1.0. The mean data obtained in the field test (Santos) was: HRmax: 201.3 ± 4.1 beats × min(-1), VO2 max: 55.6 ± 5.8 ml × kg(-1) × min(-1), lactate max: 15.6 ± 2.8 mmol × l(-1), HR at the anaerobic threshold: 173.2 ± 4.3 beats × min(-1), percentage of maximum heart rate at which the anaerobic threshold appears: 86 ± 2.5 %, lactate threshold: 4.0 ± 0.2 mmol × l(-1), and RPE: 16.7 ± 1.0. There were no significant differences between the data obtained on both tests in any of the parameters, except for maximum lactate concentration. Therefore, the Santos test can be considered a valid tool specific for judo training.

A new individual and specific test to determine the aerobic-anaerobic transition zone (Santos Test) in competitive judokas.

The main goal of this research project was to design a specific, simple, and noninvasive field test to determine the individual aerobic-anaerobic transition zone in judokas. Our aim was to develop a field test as close as possible to real judo combat. Eight state- and national-level judokas participated in the study. To find the reliability of our test, all subjects repeated the same test under the same conditions within a 7-day period. Because the results were positive, we tested the validity of our proposal using a laboratory test that possessed the same characteristics. On both tests, the same parameters were studied. The mean data obtained in the laboratory test were as follows: maximum heart rate (HRmax): 198.2 +/- 3.9 bxmin-1, HR at the anaerobic threshold: 170.3 +/- 5.7 bxmin-1, percentage of HRmax at which the anaerobic threshold appears: 85.9 +/- 2.9%, lactate max: 14.6 +/- 1.4 mmolxL-1, lactate threshold: 4 +/- 0.3 mmolxL-1, and VO2max: 58.3 +/- 4.4 mlxkgxmin-1. The mean data obtained in the field test were as follows: HRmax: 199.7 +/- 1.8 bxmin-1, HR at the anaerobic threshold: 169.7 +/- 2.7 bxmin-1, percentage of HRmax at which the anaerobic threshold appears: 85.0 +/- 1.8%, lactate max: 17.0 +/- 2 mmolxL-1, lactate threshold: 4.0 +/- 0.3 mmolxL-1, and VO2max: 59.8 +/- 3.6 mlxkgxmin-1. There were no significant differences between the data obtained on both tests in any of the parameters evaluated, except for the lactate maximum. Therefore, we can conclude that our field test is a useful tool for judo training.

The utility of a specific measure for heart transplant patients: reliability and validity of the Kansas City Cardiomyopathy Questionnaire.

BACKGROUND: Health-Related Quality of Life of patients with heart transplantation is an important variable; however, it has received little attention so far, and only two Spanish validated measurement instruments are available. The aim of our study was to validate the Spanish version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in heart transplant patients. METHODS: A prospective study was performed in 186 patients awaiting heart transplantation in nine transplant hospitals. Hundred transplant recipients filled out the KCCQ, the Euroqol 5-D (EQ5D), and the Short Form-36 (SF-36) Health Survey at pretransplant, after 3 months, 6 months, and 1 year of follow-up. A complete set of sociodemographic and clinical data were also collected. The validity, reliability, sensitivity to change, and effect size were studied. Two questionnaires, the SF-36 and EQ5D, were used to evaluate the validity. RESULTS: Mean age of patients was 56.0 years, and 80.5% were men. Twenty-six percent had acute rejection. A five-dimensional factorial structure could be discerned. The questionnaire presented a Cronbach's alpha coefficient of more than 0.7. Correlations between the KCCQ and the other questionnaires and clinical variables were satisfactory. CONCLUSIONS: The KCCQ features adequate psychometric properties. The KCCQ offers several advantages over other questionnaires because it quantifies symptoms (frequency, severity, and stability) and it is much more sensitive to change, even when compared with the SF-36. The specific questionnaire for heart transplant patients is a useful and user-friendly instrument for measuring the Health-Related Quality of Life related to functional status, quality of life, and social limitation more accurately.

Linfangioleiomiomatosis: estudio de 15 pacientes / Lymphangioleiomyomatosis: study of 15 patients

Fundamento: Descripción y seguimiento de las pacientes diagnosticadas de linfangioleiomiomatosis en un hospital con programa de trasplante pulmonar. Pacientes y métodos: Se efectuó un estudio retrospectivo de 15 mujeres (edad media en el momento del diagnóstico, 43; rango, 36-52 años) diagnosticadas en el Hospital Vall d'Hebron de linfangioleiomiomatosis (9 pacientes) o remitidas de otros hospitales (6 pacientes) para evaluación preoperatoria de trasplante pulmonar. Resultados: La disnea apareció en todos los casos y fue el síntoma más constante. También fueron muy frecuentes los problemas pleurales en fases tempranas de la evolución de la enfermedad (12 de 15 pacientes). Por ello, se efectuó una pleurodesis química en 7 pacientes y una pleurectomía en dos (una bilateral). La tomografía computarizada (TC) torácica puso de manifiesto imágenes quísticas muy características, y la TC abdominal demostró la presencia de angiomiolipomas asociados en un caso. En 2 pacientes no se llegó al diagnóstico de linfangioleiomiomatosis hasta estudiar el pulmón explantado. El diagnóstico previo en estas 2 pacientes fue de enfisema y hemosiderosis pulmonar. La supervivencia actuarial desde el inicio de los síntomas fue del 82 y del 49 por ciento a los 5 y 10 años, respectivamente. Seis de las 8 pacientes en las que se realizó un trasplante pulmonar consiguieron una supervivencia postoperatoria prolongada. Conclusiones: Aunque podrían existir algunos casos con diagnósticos alternativos, la linfangioleiomiomatosis parece que es poco frecuente en nuestro ámbito. El trasplante pulmonar es útil en fases avanzadas de la enfermedad, y en nuestros pacientes ha mejorado de forma prolongada la insuficiencia respiratoria en la mitad de los casos (AU)