Técnicas complementarias de relajación y analgesia no farmacológicas durante el parto: revisión sistemática / Complementary techniques of relaxation and non-pharmacological analgesia during childbirth: systematic review

Introducción: Existe la necesidad de proporcionar estrategias de analgesia que alienten y promuevan la participación de la mujer en la toma de decisiones en el momento del parto y las técnicas de relajación podrían ser un método analgésico no far-macológico complementario y/o alternativo a la anestesia epidural ampliamente utilizado. en la estándar atención del trabajo de parto. Objetivo: El objetivode este estudio es analizar los efectos obstétricos de las técnicas de relajación en el manejo del dolor durante el parto. Método: Se realiza una revisión sistemática con lectura crítica de los estudios incluidos. La búsqueda de estudios se realizó en las principales bases de datos MEDLINE, Cochrane Library, Cuiden, LILACS y SciELO. Se incluyen estudios publicados en inglés o español entre 2015 y febrero de 2021. Se incluyen una vez estudios, seis de los cuales son revisados sistemáticamente y cinco son ensayos clínicos aleatorios. Las intervenciones analizadas fueron técnicas de relajación como hipnosis, inyección intradérmica de agua estéril, inmersión en agua tibia, masaje, acu-puntura, musicoterapia, aromaterapia, apoyo continuo y prácticas mente-cuerpo como respiración relajante, yoga y meditación, entre otras. Conclusión: La principal conclusión de este estudio es que las técnicas de relajación pueden disminuir el nivel de dolor durante el trabajo, aunque la evidencia científica actual es limitada y la calidad metodológica varía de baja a moderada. Se necesitan más ensayos controlados aleatorios para apoyar esta investigación (AU)

Introduction:There is a need to provide analgesia strategies that encourage and promote women's participation in decision-making at the time of delivery and relaxation techniques could be a complementary and/or alternative non-pharmacological analgesic method to the widely used epidural anaesthesia in standard labour care. Objective: Theobjective of this study is to analyze the obstetric effects of relaxation techniques on pain management during labour. Method: A systematic review is performed with critical reading of included studies. The search for studies was carried out in the main databases MEDLINE, Cochrane Library, Cuiden, LILACS and SciELO. Studies published in English or Spanish between 2015 and February 2021 were included. Eleven studies were included, six of which are systematic reviews and five are randomised clinical trials. The interventions analysed were relaxation techniques such as hypnosis, intradermal injection of sterile water, warm water immersion, massage, acupuncture, music therapy, aromatherapy, continuous support and mind-body practices like relaxing breathing, yoga and meditation, among others. Conclusion: The main conclusion of this study is that relaxation techniques may decrease the level of pain during labour, although the current scientific evidence is limited and the methodological quality varies from low to moderate. More randomised controlled trials are needed to support this research (AU)

The 5-STS is a prognostic factor of sub-acute stroke patients who will not become community walkers at discharge from rehabilitation.

BACKGROUND: The recovery of community ambulation is a common concern among individuals after stroke. OBJECTIVES: (1) To develop a potential readily applicable prognostic model able to correctly discriminate stroke patients who will not become independent community walkers at discharge; (2) To investigate the effects of early reassessment during the first month of treatment on the prediction accuracy of this model. METHODS: This was a prospective cohort study. A consecutive sample of 80 patients at ≤60 days poststroke were assessed at baseline of outpatient physical rehabilitation and reassessed one month later. Non-functional community ambulation was measured. RESULTS: Seventy-four patients were followed until discharge. Of these, 47 patients were non-functional community walkers at discharge. A prediction model based on baseline performance in the five repetition sit-to-stand [5-STS] test was able to discriminate those patients of the sample (Area-under-curve = 0.956), and again with data from reassessment (AUC = 0.952). A time of 21 s at baseline was a highly prognostic cut-off point for discrimination (sensitivity = 87.2% and 85.1%). The combined use of baseline and reassessment data improved sensitivity (98.1%)CONCLUSION:Early findings of the 5-STS among stroke patients is an independent prognostic factor associated with independent community walking at discharge. It could discriminate individuals who will not become community walkers at discharge.

Development of the ESEx index: a tool for predicting risk of recurrent severe COPD exacerbations.

Background: In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other clinical complications. Objectives: We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years. Design: Prospective cohort. Methods: The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration. Results: Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination [areas under the receiver operating characteristic curve (AUCs): 0.913]. Conclusions: The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.

In vitro bacteriological effect of tri-beveled needle electrolysis against Staphylococcus aureus.

Percutaneous needle electrolysis using tri-beveled needles with a specific protocol (5 mA applied for 25 s) has demonstrated to provoke a clinical reduction of recurrent bacterial infections in mammary fistulas. However, the bactericidal effect of needle electrolysis in this pathology remains theoretical. This in vitro study evaluated the bactericidal effect of this protocol and whether it changed when introducing small variations. Staphylococcus aureus were generated in saline solution (9 Log10 CFU/mL) and treated in three different experiments including the main protocol and introducing variations in needle gauge, intensity, and total dosage, respectively. After 24 h, the viable cell count showed that the protocol had an average reduction of 5 log10 CFU/ml compared to the control group. While variations in needle gauge did not modify this effect, variations in current intensity or dosage did. This study demonstrated that the bacterial effect was greater by increasing either current intensity or total dosage, and it decreased with substantial reductions of these parameters.

Galvanic current activates the NLRP3 inflammasome to promote Type I collagen production in tendon.

The NLRP3 inflammasome coordinates inflammation in response to different pathogen- and damage-associated molecular patterns, being implicated in different infectious, chronic inflammatory, metabolic and degenerative diseases. In chronic tendinopathic lesions, different non-resolving mechanisms produce a degenerative condition that impairs tissue healing and which therefore complicates their clinical management. Percutaneous needle electrolysis consists of the application of a galvanic current and is an emerging treatment for tendinopathies. In the present study, we found that galvanic current activates the NLRP3 inflammasome and induces an inflammatory response that promotes a collagen-mediated regeneration of the tendon in mice. This study establishes the molecular mechanism of percutaneous electrolysis that can be used to treat chronic lesions and describes the beneficial effects of an induced inflammasome-related response.

Galvanic current dosage and bacterial concentration are determinants of the bactericidal effect of percutaneous needle electrolysis: an in vitro study.

Percutaneous needle electrolysis (PNE) is a physiotherapy technique that has been shown to be effective in different pathologies such as tendinopathies or mammary fistula. For many years, theoretical bactericidal and germicidal effects have been attributed to this type of galvanic currents, partly explained by the changes in pH that it generates. However, these effects have not yet been demonstrated. The aim of this study was to evaluate the bactericidal effect and the changes in pH caused by PNE. S. aureus were prepared in two different solutions (TSB and saline solution) and in different concentrations (from 9 to 6 Log10 CFU/mL). Bacteria were treated with three experimental PNE doses to assess bacterial death levels and the changes caused to the pH of the medium. The viable cell count showed that all experimental PNE doses had a bactericidal effect against a high concentration (9 Log10 CFU/mL) of S. aureus in saline solution (p < 0.001). Furthermore, we found that when the concentration of bacteria decreased, a lower dose of galvanic current generated the same effect as a higher dose. Changes in pH were registered only in experiments performed with saline solution. PNE had a bactericidal effect against S. aureus and the level of this effect was mainly modulated by the solution, the bacterial concentration and the dose. Changes affecting pH were modulated by the type of solution and there was no relationship between this and bacterial death.

Influence of Acromial Morphologic Characteristics and Acromioclavicular Arthrosis on the Effect of Platelet-Rich Plasma on Partial Tears of the Supraspinatus Tendon.

OBJECTIVE. The purposes of this study were to determine the medium-term effect of ultrasound-guided infiltration of platelet-rich plasma (PRP) on partial tears of the supraspinatus tendon (SST) and to identify prognostic indicators of an unfavorable outcome. SUBJECTS AND METHODS. Over a period of 4 years, patients with a partial SST tear smaller than 1.5 cm referred for ultrasound-guided PRP infiltration (1 mL) for shoulder pain lasting more than 3 months were recruited consecutively. MRI was used to analyze the type of acromion and presence of acromioclavicular (AC) arthrosis. Primary (size of the tear and associated bursitis) and secondary (mobility and pain) results were collected at 3 months. RESULTS. The study included 128 patients (66 men, 62 women; mean age, 48.3 years; range, 20-59 years). At 3 months, favorable evolution of the tear repair was recorded in 71.1% (91/128) of patients and resolution of bursitis in 66.7% (42/63). Changes in tear size had large effect sizes (Cohen d ≥ 1.16), as did pain and shoulder mobility (Cohen d ≥ 0.95). The strongest predictors of unfavorable evolution of tear and bursitis were type 3 acromion and types 1 and 2 acromion with AC arthrosis (p < 0.001; ß = 20.412). CONCLUSION. Ultrasound-guided PRP infiltration of partial tears of the SST relieves pain and improves shoulder mobility, but its effect on the size of the tear is influenced by the morphologic characteristics of the acromion and the presence of AC arthrosis. The effect of PRP is insufficient in patients with a type 3 acromion or severe AC arthrosis.

Therapeutic pulmonary telerehabilitation protocol for patients affected by COVID-19, confined to their homes: study protocol for a randomized controlled trial.

BACKGROUND: In December 2019, 27 cases of pneumonia, of unknown cause, were identified in the province of Hubei (China). The WHO declared the situation as a Public Health Emergency of International Concern, and it was finally declared a global pandemic on March 11, 2020. The Spanish Government obliges the entire population to remain confined to their homes, with the exception of essential basic services, to stop the spread of COVID-19. Home isolation implies a notable physical deconditioning. Telerehabilitation methods have reported positive experiences, and we propose to study in affected patients of COVID-19, due to the general house confinement of the entire Spanish population. METHODS: Patients will be recruited in the regions of Andalusia, Murcia, and Valencia (Spain). Patients will remain confined to their homes, and there, they will carry out their assigned exercise program, which will be controlled telematically. Evaluators will attend to carry out all measurements at the beginning, during, and end of the study, telematically controlled. The patients will be randomly divided into three groups, two of them will perform a home exercise program (breathing exercises or non-specific exercises for muscle toning) and the third group will perform sedentary activities, using mental activation techniques, and will act as a sham group. We will evaluate respiratory variables and other variables of the physical state through physical tests, effort, and perceived fatigue. The data will be statistically analyzed, and the hypotheses will be tested between the groups, using the SPSS software, v.24, considering a 95% confidence interval. DISCUSSION: We will analyze the results, in terms of the level of fatigue and perceived exertion, physical health, and maintenance of respiratory activity of two types of exercise programs, toning and respiratory, applied in patients affected by COVID-19 during the period of home confinement. We intend to investigate a field not previously studied, such as the repercussion of carrying out a toning and respiratory exercise program in these patients, in historical circumstances that no one had previously observed in Spain, since the general population has never been forced to remain confined in their homes, due to a pandemic infection, by a coronavirus (COVID-19). Observing the effects that these two home exercise programs could produce in patients infected with COVID-19, we will try to better analyze and understand the mechanisms that are associated with the worsening of breathing in this type of patient. TRIAL REGISTRATION: Brazilian Clinical Trial Registry RBR-6m69fc . Registered on March 31, 2020.

Patterns and predictors of low physical activity in patients with stable COPD: a longitudinal study.

BACKGROUND: Despite the frequency and negative impact of low physical activity among patients with chronic obstructive pulmonary disease (COPD), little is known about how it persists and remits over time or the factors predicting new states of low physical activity. The aim of the study was to determine the probability of a transition between states of low and nonlow physical activity in a cohort of patients with stable COPD followed for 2 years. We also investigated different potentially modifiable factors to determine whether they can predict new states of low physical activity. METHODS: We prospectively included 137 patients with stable COPD (mean age 66.9 ± 8.3 years). Physical activity was measured at baseline and at 1 and 2 years of follow up. Low physical activity was defined according to energy expenditure by cut-off points from the Fried frailty model. The likelihood of annual transition towards new states and recovery was calculated. We evaluated demographic, frailty, nonrespiratory, and respiratory variables as potential predictors, using generalized estimating equations. RESULTS: At baseline, 37 patients (27%) presented with low physical activity. During the study period, a total of 179 annual transitions were identified with nonlow physical activity at the beginning of the year; 17.5% transitioned to low physical activity. In contrast, 34.3% of the 67 transitions that started with low physical activity recovered. Predictors of transition to new states of low physical activity were dyspnea ⩾2 (odds ratio = 3.21; 95% confidence interval: 1.20-8.61) and poor performance on the five sit-to-stand test (odds ratio = 4.75; 95% confidence interval: 1.30-17.47). CONCLUSIONS: The change between levels of low and nonlow physical activity is dynamic, especially for recovery. Annual transitions toward new states of low physical activity are likely among patients with dyspnea or poor performance on the five sit-to-stand test. The reviews of this paper are available via the supplemental material section.

Frailty transitions and associated clinical outcomes in patients with stable COPD: A longitudinal study.

BACKGROUND: Although frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce. AIMS: The present study aimed to describe the frailty status transition rates over a 2-year period and their associated clinical outcomes in stable COPD patients, and to determine predictors of improvement in frailty status. METHODS: We prospectively included 119 patients with stable COPD (mean age ± SD, 66.9 ± 7.9 years) over a follow-up period of 2 years. Frailty was assessed using the Fried criteria (unintentional weight loss, weakness, exhaustion, low activity level, and slow walking speed). Several demographic, clinical, and health-related variables were measured. We calculated the rates for each of the frailty transitions (no change, improvement, or worsening) between baseline and 2 years. Outcomes were compared using one-way analysis of variance and predictors of improvement were identified in multivariate logistic regression. RESULTS: After 2 years of follow-up, 21 (17.6%) patients had an improved frailty status, 14 (11.7%) had worsened, and 84 (70.5%) had maintained the same frailty status. The worsening group (vs no change group) had greater dyspnea (p = 0.013) and disability (p = 0.036) and lower handgrip strength (p = 0.001). In contrast, the improved group (vs no change group) had greater handgrip (p<0.001) and quadriceps strength (p = 0.032). Furthermore, the improved group had greater handgrip strength (p<0.001), quadriceps strength (p = 0.003), physical activity (p = 0.008), and lower disability (p = 0.019) than the worsening group. Additionally, we determined that the 5STS test (≤ 13.6s) and exacerbations (≥ 2) were independent predictors for improvement in frailty status [adjusted OR 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively]. CONCLUSIONS: Frailty is a dynamic process for approximately one-third of patients with stable COPD and transitions in frailty status are associated with significant changes in clinical outcomes. The 5STS and exacerbations were independent predictors of improvement in frailty status.

Relación entre el sexo, edad e índice de masa corporal y el Foot Function Index en pacientes con fascitis plantar / Relationship between sex, age and body mass index and the Foot Function Index in patients with plantar fasciitis

La fascitis plantar es una de las patologías de miembro inferior que más impacto causan en la persona produciendo dolor, discapacidad y limitación funcional. Una serie de factores incrementan el riesgo de sufrir fascitis plantar tales como predominio del sexo femenino, edad avanzada y un índice de masa corporal (IMC) elevado. El impacto que produce la fascitis plantar en la persona ser cuantificado por escalas para darnos información en la clínica acerca del estado de nuestros pacientes. Métodos y objetivos: Se realizó un estudio observacional transversal con 28 participantes que sufrían fascitis plantar y se les administra la encuesta FFI-sp con el propósito de determinar la relación entre las subescalas incluidas en el FFI-sp con el sexo, edad e IMC en pacientes con fascitis plantar. Resultados: No se han obtenido resultados significativos que indiquen relación del sexo, edad e IMC con las subescalas incluidas en el FFI-sp. Conclusión: No se ha encontrado relación entre FFI-sp y las variables sexo, edad e IMC

Background: Plantar fasciitis is one of the lower limb pathologies that causes more impact on the person and it produces pain, disability and functional limitation. Some factors which increase the risk of plantar fasciitis such as female predominance, advanced age, and high body mass index (BMI). The impact of plantar fasciitis on people is quantified by scales to give us information in the clinic about the state of our patients. Methods and Objetives: A cross-sectional observational study was performed with 28 participants who are suffering plantar fasciitis and administered the FFI-sp in order to determine the relationship between the subcategories included in the FFI-sp with gender, age and BMI in patients with plantar fasciitis. Results: There have not been significant results indicating a relationship between gender, age and BMI with the subscales included in the FFI-sp. Conclusion: There's no relationship between gender, age and body mass index with the Foot Function Index in patients with plantar fasciitis

Valor del Test de Silfverskiöld para el diagnóstico de la fascitis plantar / Value of the Silfverskiöld Test for the diagnosis of plantar fasciitis

La fascitis plantar (FP) está descrita como la causa más común de dolor en el talón. Aunque se considera una patología multifactorial, la limitación de la dorsiflexión del tobillo es uno de los factores más determinantes, predisponiendo al desarrollo de patologías en el miembro inferior. Objetivo: Determinar la exactitud del test de Silfverskiöld como herramienta diagnóstica de la FP a partir del análisis de varios indicadores (sensibilidad, especifidad, valor predictivo positivo y negativo, y razones de verosimilitud positiva y negativa). Método: Se realizó un estudio de validez transversal en 16 sujetos (9 mujeres y 7 hombres) diagnosticados de fascitis plantar unilateral de al menos 3 meses de evolución. Un fisioterapeuta se encargó de evaluar el déficit de dorsiflexión en ambos tobillos mediante el Test de Silfverskiöld. Resultados: Fueron descartados aquellos pies sin problemas de movilidad en dorsiflexión de tobillo, por lo que finalmente fueron analizados 14 pies afectos y 8 sanos. los indicadores de eficacia diagnóstica del test de Silfverskiöld en la FP. Al determinar la eficacia del test de Silfverskiöld como predictor de FP encontramos una sensibilidad de 93,7%, especificidad del 75%, valor predictivo positivo (VPP) de 86,6% y valor predictivo negativo (VPN) de 85,7%. La razón de verosimilitud positiva (RV+) fue de 3,74, mientras que la negativa (RV-) resultó 12,5. Conclusión: El test de Silfverskiöld puede ser considerado una prueba eficaz para el diagnóstico de la FP. Existe una importante asociación entre la limitación en la dorsiflexión de tobillo por restricción de gemelos y la probabilidad de padecer FP

Background: Plantar fasciitis (PF) is described as the most common cause of heel pain. Although it is considered a multifactorial pathology, the limitation of dorsiflexion of the ankle is one of the most determining factors, predisposing to the development of pathologies in the lower limb. Objective: To determine the accuracy of the Silfverskiöld test as a diagnostic tool for PF, based on the analysis of several indicators (sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios). Method: A cross-sectional validity study was conducted in 16 subjects (9 women and 7 men) diagnosed with unilateral plantar fasciitis of at least 3 months evolution. A physiotherapist was responsible for assessing the deficit of dorsiflexion in both ankles by the Silfverskiöld test. Outcome: Those feet without mobility problems in ankle dorsiflexion were discarded, so finally 14 affected feet and 8 healthy ones were analyzed. the indicators of diagnostic efficacy of the Silfverskiöld test in PF. When determining the efficacy of the Silfverskiöld test as a predictor of PF, we found a sensitivity of 93.7%, specificity of 75%, positive predictive value (PPV) of 86.6% and negative predictive value (NPV) of 85.7%. The positive likelihood ratio (LR+) was 3.74, while the negative (LR-) ratio was 12.5. Conclusion: The Silfverskiöld test can be considered an effective test for the diagnosis of PF. There is an important association between limitation in dorsiflexion of the ankle due to restriction of twins and the probability of suffering PF

Patterns and predictors of exhaustion episodes in patients with stable COPD: A longitudinal study.

BACKGROUND AND OBJECTIVE: Exhaustion is the perception of low energy. Little is known about how exhaustion persists, remits or reappears over time in patients with chronic obstructive pulmonary disease (COPD) or how to predict these events. We determined the likelihood of transitions between states of exhaustion and no exhaustion among patients with stable COPD followed up for 2 years. We investigated combinations of potential factors for their abilities to predict new-onset exhaustion episodes. METHODS: We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Exhaustion states were measured at baseline and 1 and 2 years later. Exhaustion was defined as an answer of "most of the time" or "a moderate amount of time" to 1 of 2 questions: "How often have you found it hard to get going?" and "How often does everything seem to require effort?" We evaluated demographic, non-respiratory and respiratory variables as potential predictors. The likelihoods of new episodes and recovery were calculated. Predictors were evaluated with generalised estimating equations. RESULTS: At baseline, 27 patients (19.7%) displayed exhaustion. Of the 110 patients without exhaustion at baseline, 17 (15.5%) displayed exhaustion at least once during the follow-up period. During the study period, a total of 204 annual transitions displaying no exhaustion at the beginning were identified. Of them, 10.3% transitioned to exhaustion in the next year. The likelihood of recovery after exhaustion was 50%. Independent predictors of new-onset exhaustion episodes within the following year were: the COPD assessment test score (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.01-1.21), depression (OR = 6.89; 95% CI: 1.00-47.41) and female gender (OR = 6.88; 95% CI: 1.83-25.73). CONCLUSIONS: Patients in stable COPD with high CAT scores and depression were most likely to experience new-onset exhaustion episodes Thus, exhaustion might be predicted by a combination of psychological factors and respiratory health status. Nevertheless, exhaustion is dynamic in COPD; half of patients recover from exhaustion.

Ansiedad entre cuidadores de pacientes con Enfermedad Pulmonar Obstructiva Crónica tras el alta hospitalaria / Anxiety among caregivers of patients with Chronic Obstructive Pulmonary Disease after hospital discharge

Objetivo: Identificar los factores que influyen en cambios en la ansiedad de los cuidadores tres meses después del alta hospitalaria por exacerbación aguda de la Enfermedad Pulmonar Obstructiva Crónica (EPOC). Metodología: Estudio longitudinal. Participaron 87 cuidadores de pacientes hospitalizados por exacerbación aguda de EPOC. Se midió la ansiedad en el momento de la hospitalización y tres meses después del alta. Además, se midieron potenciales factores asociados a su cambio en cuatro dominios: Contexto del cuidado, demandas del cuidado, recursos y características del paciente. Utilizamos regresiones logísticas múltiples univariadas y multivariadas para determinar los cambios en la ansiedad tres meses después. Resultados: Presentaron ansiedad en el momento de la hospitalización el 57,5% de los cuidadores. De ellos, el 44% había remitido su ansiedad tres meses después del alta hospitalaria. Sin embargo, el 22% de los cuidadores quienes no habían presentado ansiedad en el momento de la hospitalización se mostraron ansiosos a los 3 meses. La gravedad de la EPOC y no recibir apoyo de otro cuidador disminuyó las probabilidades de remisión de la ansiedad. La sobrecarga moderadamente alta incrementa las probabilidades de presentar nuevos síntomas de ansiedad. Conclusiones: La percepción de los síntomas de la ansiedad es dinámica. Los cuidadores pueden recuperarse si reciben ayuda de otro cuidador o si el paciente al que cuidan no está en un estado severo de EPOC (AU)

Objective: To identify the factors that influence changes in caregivers anxiety status three months after discharge for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methodology: Longitudinal study. Participants included 87 caregivers of patients hospitalized for acute exacerbation of COPD. Anxiety was measured at the time of hospitalization and three months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. We used multiple univariate and multivariate logistic regressions to determine changes in anxiety three months later. Univariate and multivariate multiple logistic regressions were used to determine changes in anxiety three months later. Results: A total of 57.5% of caregivers reported anxiety at the time of hospitalization. Of these, 44% had a remission of their anxiety three months after discharge. However, 22% of caregivers who had not experienced anxiety at the hospitalization became anxious at 3 months. The severity of COPD and not receiving help from another caregiver decreased the likelihood of remission of anxiety. Moderately high overload increases the likelihood of experiencing anxiety symptoms. Conclusions: The perception of anxious symptoms is dynamic. Caregivers are likely to recover from anxiety when they receive help from another caregiver and if the patient they are caring for does not have severe COPD (AU)

Determinants of each domain of the Short Physical Performance Battery in COPD.

BACKGROUND: The Short Physical Performance Battery (SPPB) is an assessment tool with good prognostic value in COPD. It includes the following: standing balance, 4 m gait speed test (4MGS), and the timed five-repetition sit-to-stand test (5STS). The specific differences in determinants between these three tasks have not been adequately characterized in COPD patients. We aimed to identify health-related, functional, and psychological determinants of each SPPB test. METHODS: We conducted a cross-sectional analysis of 137 patients with stable COPD. Patients performed the SPPB, quadriceps muscle strength (QMS), exercise tolerance test (6-min walk test [6MWT]), and pulmonary function; and health-related and psychological factors, physical activity, the COPD assessment test (CAT), body mass index, age, and depression were assessed. RESULTS: Separate multivariable regression models predicting the 4MGS, 5STS, and balance test results described 31%, 39.1%, and 12.1% of the variance for each test, respectively. QMS was negatively associated with all three tests. The 6MWT was negatively associated with the 4MGS and 5STS. Depression and age were positively associated with 4MGS scores, whereas CAT and age were positively associated with 5STS scores. CONCLUSION: The three SPPB tests did not provide equivalent information regarding a COPD patient's status. The 5STS was associated with health status factors, while the 4MGS was associated with psychological factors.

Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study.

BACKGROUND: Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. OBJECTIVE: The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. MATERIALS AND METHODS: This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. RESULTS: A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed. CONCLUSION: Depressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.

Patterns, Trajectories, and Predictors of Functional Decline after Hospitalization for Acute Exacerbations in Men with Moderate to Severe Chronic Obstructive Pulmonary Disease: A Longitudinal Study.

BACKGROUND: Hospitalization for acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) is common, but little is known about the impact of hospitalization on the development of disability. The purpose of this study was to determine the rate and time course of functional changes 3 months after hospital discharge for AE-COPD compared with baseline levels 2 weeks before admission, and to identify predictors of functional decline. METHODS: This was a prospective study including 103 patients (age mean, 71 years; standard deviation, 9.1 years) who were hospitalized with AE-COPD. Number of dependencies in Activities of Daily Living (ADLs) was measured at the preadmission baseline and at weeks 6 and 12 after discharge. Patterns of improvement, no change, and decline were defined over 3 consecutive intervals (baseline and weeks 6 and 12). Trajectories grouped patients with similar time courses of disability. Recovery was defined as returning to baseline function after functional decline. Univariate and multivariate multiple logistic regression was used to determine predictors of functional decline after week 12. RESULTS: Six trajectories of functional changes were found. From baseline to 12 weeks, 50% of patients continued to have the same function whereas 31% experienced functional decline after 6 weeks; 16.7% recovered over subsequent weeks. At week 12, as a consequence of all trajectories, 38% of patients showed functional declines compared with baseline function, 57% had not declined, and 6 improved. Length of stay (odds ratio [OR] = 1.12;95% [confidence interval] CI 1.03-1.22), dyspnea (OR = 1.85; 95% CI 1.05-3.26), and frailty (OR = 3.97; 95% CI 1.13-13.92) were independent predictors of functional decline after 12 weeks. CONCLUSIONS: Hospitalization for AE-COPD is a risk factor for the progression of disability. More than one third of patients hospitalized for AE-COPD declined during the 12 weeks following discharge, with most of this decline occurring by week 6.

Interobserver Reliability of Peripheral Muscle Strength Tests and Short Physical Performance Battery in Patients With Chronic Obstructive Pulmonary Disease: A Prospective Observational Study.

OBJECTIVE: To evaluate the interobserver reliability of the Short Physical Performance Battery (SPPB) and hand dynamometry when measuring isometric muscle strength in people with chronic obstructive pulmonary disease (COPD). DESIGN: Reliability study. Each patient was assessed by a pulmonology physician and a physical therapist in 2 separate sessions 7 to 14 days apart (mean, 9.8±0.8d). Each rater was blinded to the other's results. SETTING: Pneumology unit of a public hospital. PARTICIPANTS: Random sample of outpatients with stable COPD (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SPPB and muscle strength (kg) using electronic handgrip and handheld dynamometers. Reliability was assessed with intraclass correlation coefficients (ICCs), standard error of measurement values, and Bland-Altman plots. ICCs were calculated for the SPPB summary score and for its 3 subscales. RESULTS: The ICCs for the overall reliability of the SPPB summary score and for grip and quadriceps strength were .82 (95% confidence interval [CI], .62-.91), .97 (95% CI, .93-.98), and .76 (95% CI, .49-.88), respectively. The standard error of measurement values were .55 points, 1.30kg, and 1.22kg, respectively. The mean differences between the rater's scores were near zero for grip strength and SPPB summary score measures. The ICCs for the SPPB subscales were .84 (95% CI, .66-.92) for the chair subscale, .75 (95% CI, .48-.88) for gait, and .33 (95% CI, -.42 to .68) for balance. CONCLUSIONS: Interobserver reliability was good for quadriceps and handgrip dynamometry and for the SPPB summary score and its chair stand and gait speed subscales. Both pulmonary physicians and physical therapists can obtain and exchange the scores. Because the reliability of the balance subscale was questionable, it is better to use the SPPB summary score.