How whole-body vibration can help our COPD patients. Physiological changes at different vibration frequencies.

OBJECTIVE: Evaluate cardiac, metabolic, and ventilatory changes during a training session with whole-body vibration training (WBVT) with 3 different frequencies in patients with chronic obstructive pulmonary disease (COPD). METHODS: This was a prospective, interventional trial in outpatients with severe COPD. Participants performed 3 vertical WBVT sessions once a week using frequencies of 35, 25 Hz and no vibration in squatting position (isometric). Cardiac, metabolic, and ventilator parameters were monitored during the sessions using an ergospirometer. Changes in oxygen pulse response (VO2/HR) at the different frequencies were the primary outcome of the study. RESULTS: Thirty-two male patients with a mean forced expiratory volume in 1 second of 39.7% completed the study. Compared to the reference of 35 Hz, VO2/HR at no vibration was 10.7% lower (P=0.005); however, no statistically significant differences were observed on comparing the frequencies of 35 and 25 Hz. The median oxygen uptake (VO2) at 25 Hz and no vibration was 9.43% and 13.9% lower, respectively, compared to that obtained at 35 Hz (both comparisons P<0.0001). The median expiratory volume without vibration was 9.43% lower than the VO2 at the end of the assessment at 35 Hz vibration (P=0.002). CONCLUSION: Vertical WBVT training sessions show greater cardiac, metabolic, and respiratory responses compared with the squat position. On comparing the 2 frequencies used, we observed that the frequency of 35 Hz provides higher cardiorespiratory adaptation.

Ischiocrural Strength May Be a Better Prognostic Marker Than Quadriceps Strength in COPD.

It is well known that chronic obstructive pulmonary disease (COPD) patients present with muscle dysfunction that may not correlate with the degree of severity of airflow obstruction. Historically, the strength deficit of the knee extensor musculature (quadriceps) has been described as an independent factor of mortality in COPD. We present the results of a retrospective study with longitudinal follow-up of 60 patients with severe COPD followed for 7 years. During follow-up 22 patients died, mainly of respiratory cause. We have observed that the strength of knee flexor muscles (ischiocrural) and dominant handgrip were independent predictors of mortality in severe COPD patients. However, knee extensor strength (quadriceps) was not an independent predictor of mortality. This is the first study which highlights the importance of knee flexor musculature as a prognostic factor in COPD.

Distance and speed of walking in individuals with trans-femoral amputation fitted with a distal weight-bearing implant.

INTRODUCTION: Preservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to trans-femoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs. HYPOTHESIS: The hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve. MATERIAL AND METHODS: Twenty-three TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT). RESULTS: The amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001). DISCUSSION: After implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading. TYPE OF STUDY: An experimental prospective study. LEVEL OF PROOF: III, case-control study.

Safety of Rehabilitation Program for COPD Patients / Seguridad de un programa de rehabilitación para pacientes con EPOC

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Improving physical activity in patients with COPD with urban walking circuits.

BACKGROUND: Even after a rehabilitation program, levels of physical activity in COPD progressively decrease unless strategies to encourage activity are implemented. We analyzed the effects of the implementation of urban walking circuits on levels of physical activity and exercise capacity of patients with severe and very severe COPD after a rehabilitation program. METHOD: A total of 83 patients were randomized to either urban circuits group (UCG) or usual care in the non-circuit group (NCG), after completing a 2-week rehabilitation program. Results were evaluated 9 months after completion of the rehabilitation program and were compared with a control group of 54 patients not enrolled in the rehabilitation program. RESULTS: At the end of follow-up, UCG patients increased their physical activity by a mean of 32.4 (SE = 5.9) min per day and 1.09 (SE = 0.22) days walked per week; 33.9 (SE = 5.6) min per day and 1.12 (SE = 0.24) days per week more compared to the NCG (p < 0.001). There was a significant positive correlation between the results of the 6-min walking test and minutes walked per day in the UCG (r(2) = 0.52, p < 0.05) but not in the NCG (r(2) = 0.094, p > 0.05). Controls showed a significant decrease in exercise capacity and physical activity over the follow-up. CONCLUSIONS: Urban circuits are an easy, inexpensive strategy, which demonstrated to be useful to stimulate physical activity in our population of severe and very severe COPD patients and resulted in increased exercise capacity even 9 months after completion of a rehabilitation program.

Effects of whole body vibration training in patients with severe chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: To determine if whole body vibration training (WBVT) improves muscular force and modifies functional capacity parameters in patients with severe chronic obstructive pulmonary disease (COPD). METHODS: We performed a randomized controlled trial in the outpatient Physical Medicine and Rehabilitation Department of a general hospital. Sixty stable male patients with COPD and mean forced expiratory volume in 1 s (FEV1) 34.3% (predicted) were enrolled with 51 patients completing the study. Participants were randomized into two groups: Whole Body Vibration Training Group (WBVTG), (n = 26) undergoing three sessions per week for a total of 6 weeks and a Control Group (CG) (n = 25) without intervention. The main outcome measures were isokinetic knee flexor and extensor testing in a concentric-concentric regime and exercise capacity measured by the 6-min walking test (6MWT). Secondary outcomes were pulmonary muscular assessment with maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). RESULTS: No significant differences were observed between groups in maximum moment of isokinetic knee flexor/extensor testing force in a concentric-concentric regime. In contrast, WBVTG patients showed a significant increase in the 6MWT (81.2 ± 9.2) meters; mean ± SD; P < 0.001). There was also a significant decrease in maximum oxygen desaturation in the 6MWT after 6 weeks of training (3.1 ± 1.1; P = 0.01). There were significant differences between groups in MIP and MEP at the end of the study in favour of the WBVTG. CONCLUSIONS: WBVT provided significant improvements in functional capacity in severe COPD patients without changes in muscular force.

[Factors related with clinical evolution in whiplash]. / Factores relacionados con la evolución clínica del síndrome del latigazo cervical.

BACKGROUND AND OBJECTIVE: Factors of poor clinical recovery in acute whiplash are not conclusive. The goal of this prospective longitudinal study was to identify factors with influence in clinical evolution allowing us to identify patients with risk for developing chronic symptoms and disabilities after an acute whiplash. PATIENTS AND METHOD: We included 226 patients who suffered acute whiplash after road traffic accident and met the Department of Physical Medicine and Rehabilitation for medical evaluation and physiotherapy treatment. We collected variables following a protocol designed for the study. All patients were assessed through the visual analogue scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality, at initial evaluation and at discharge of treatment. RESULTS: Factors related with poor recovery of NPH at discharge were: number of days of cervical column immobilization with collar, presence of headache, dizziness, and dorsal pain at initial evaluation and initial evaluation of VAS score and Goldberg Depression and Anxiety Scale. In the multivaried analysis we found that variables with influence on NPH at discharge were statistically significant for VAS, Goldberg depression subscale and NPH scores at initial evaluation. CONCLUSIONS: The most important factors that determine the evolution of patients with acute whiplash are the initial evaluation of the neck pain with the Visual Analogue Scale, the cervical column functionality with NPH and Goldberg Depression subscale.

Factores relacionados con la evolución clínica del síndrome del latigazo cervical / Factors related with clinical evolution in whiplash

FUNDAMENTO Y OBJETIVO: Los factores de mala evolución clínica en el síndrome del latigazo cervical (SLC) no son concluyentes. El objetivo de este estudio longitudinal y prospectivo ha sido identificar aquellos que permitan seleccionar a pacientes con riesgo de desarrollar síntomas crónicos y discapacidad en la fase aguda del SLC.PACIENTES Y MÉTODO: Se incluyó a 226 pacientes con SLC secundario a accidente de tráfico, que habían sido remitidos al Servicio de Medicina Física y Rehabilitación para tratamiento médico rehabilitador. Además de recoger las variables del protocolo diseñado para el estudio, se cumplimentaron la escala visual analógica (EVA) para valorar la intensidad del dolor, la Escala de Depresión y Ansiedad de Goldberg y el Northwick Park Hospital Neck Pain Questionnaire (NPH)para valorar la funcionalidad de la columna cervical en la valoración inicial y al alta del tratamientofisioterápico.RESULTADOS: Los factores relacionados con una mala recuperación del NPH en el momento delalta eran el número de días de inmovilización cervical con ortesis cervical, presencia inicial decefalea, vértigo y/o dolor dorsal, valor inicial de la EVA y la Escala de Depresión y Ansiedadde Goldberg. En el análisis multivariado, las variables con influencia estadísticamente significativasobre el NPH al alta eran la EVA, la subescala de depresión de Goldberg y el NPH de lavaloración inicial.CONCLUSIONES: Los factores que influyen en la evolución clínica tras un SLC son la valoracióninicial de la intensidad del dolor cervical mediante la EVA, la funcionalidad de la columna cervicalmediante el NPH y la subescala de depresión de Goldberg

BACKGROUND AND OBJECTIVE: Factors of poor clinical recovery in acute whiplash are not conclusive.The goal of this prospective longitudinal study was to identify factors with influence in clinicalevolution allowing us to identify patients with risk for developing chronic symptoms and disabilities after an acute whiplash.PATIENTS AND METHOD: We included 226 patients who suffered acute whiplash after road traffic accident and met the Department of Physical Medicine and Rehabilitation for medical evaluation and physiotherapy treatment. We collected variables following a protocol designed for the study. All patients were assessed through the visual analogue scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality, at initial evaluation and at discharge of treatment.RESULTS: Factors related with poor recovery of NPH at discharge were: number of days of cervicalcolumn immobilization with collar, presence of headache, dizziness, and dorsal pain at initial evaluation and initial evaluation of VAS score and Goldberg Depression and Anxiety Scale. In the multivaried analysis we found that variables with influence on NPH at discharge werestatistically significant for VAS, Goldberg depression subscale and NPH scores at initial evaluation.CONCLUSIONS: The most important factors that determine the evolution of patients with acute whiplash are the initial evaluation of the neck pain with the Visual Analogue Scale, the cervical column functionality with NPH and Goldberg Depression subscale

Cross-validation of a model for predicting functional status and length of stay in patients with stroke.

OBJECTIVE: In a study published in 2002, it was observed that a variable composed by the Functional Independence Measure (FIM) and the trunk control test at admission predicted 66.5% of the FIM at discharge in stroke patients. The objective was to confirm the reproducibility of this predictive model. METHODS: Retrospective study of 245 hemiparetic stroke inpatients of the rehabilitation department. The main variables studied were: trunk control test FIM at admission and compound variable (FIM+trunk control test) as independent variables and FIM at discharge and inpatient rehabilitation length of stay as dependent variables. RESULTS: Correlation between the compound variable and the length of stay was statistically significant (r=0.59), as was its correlation with the total FIM at discharge (r=0.82). The regression analysis predicted 34.3% of the length of stay variability and 66.4% of the total FIM at discharge variability. CONCLUSION: The compound variable is a reliable tool because of its reproducibility in predicting the functional level at hospital discharge in hemiparetic patients.