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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Improvement in walking abilities in transfemoral amputees with a distal weight bearing implant.

BACKGROUND: The ability to walk with a prosthesis is the main objective of rehabilitation following amputation, and distance and speed of walking achieved are considered determining factors in amputees' perception of quality-of-life. OBJECTIVES: To assess walking abilities and improvement in gait distance and speed parameters in patients undergoing transfemoral amputation with a femoral implant that allows distal support of the residuum. STUDY DESIGN: Experimental before-and-after study. METHODS: Ten transfemoral amputation patients received a titanium implant that allowed distal weight bearing of the residuum within the socket. The post-intervention follow-up period was 14 months. We evaluated the functionality using a 2-min walk test and the physiological cost index. RESULTS: The etiology of amputation was traumatic in six patients (60%). The mean 2-min walk test score was 98.4 ± 19.5 m prior to the femoral implant and 122.5 ± 26.1 m at 14 months ( p < 0.008), representing an improvement of 24.5%. The mean gait speed prior to the femoral implant was 0.82 ± 0.16 and 1.02 ± 0.21 m/s at 14 months ( p < 0.008). The physiological cost index showed no differences ( p < 0.55). CONCLUSION: The results of this study show an improvement in the distance walked and gait speed in amputees 14 months after having received a femoral implant. Clinical relevance This article provides additional insight into the use of a femoral implant that allows distal support of the residuum to improve walking abilities and gait distance and speed parameters in patients undergoing transfemoral amputation, mainly those of vascular origin.

Muscular Dysfunction in COPD: Systemic Effect or Deconditioning?

BACKGROUND: Muscular dysfunction has been described as one of the systemic manifestations of chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to evaluate muscular strength of the different anatomical compartments in patients with severe COPD compared with healthy controls. METHOD: We performed a cross-sectional study in patients with severe COPD. We evaluated the muscular strength of the respiratory muscles, flexors and extensors of the cervical spine and knee, as well as handgrip force. The 6-min walking test (6MWT) and serum inflammatory markers were also analysed. RESULTS: Twenty-eight male patients with COPD (mean age 67.8 years, mean FEV1 (%) 39 %) and 24 male healthy controls (mean age 70.2 years) were studied. The strength of the flexors and extensors of the knee was significantly reduced in patients with COPD (p < 0.001 and p = 0.003). No differences were observed in the flexors and extensors of the cervical spine and handgrip force between groups. No correlation was observed between the muscular strength in the different anatomic compartments and the concentrations of blood inflammatory biomarkers or the metres walked in the 6MWT in COPD patients. However, a significant negative linear correlation was observed between the 6MWT and IL-6 and IL-8 levels (rho = -0.67, p = 0.001; rho = -0.57, p = 0.008). In addition, we found a negative correlation between the 6MWT and inspiratory capacity (rho = -0.755, p = 0.031). CONCLUSIONS: Our results suggest that muscular dysfunction in patients with COPD differs in different muscular compartments. The main factor for a reduced exercise capacity was a reduction in inspiratory capacity.

The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees.

BACKGROUND: Lower limb amputation leads to impaired balance, ambulation, and transfers. Proper fit of the prosthesis is a determining factor for successful ambulation. Vacuum-assisted socket systems extract air from the socket, which decreases pistoning and probability of soft-tissue injuries and increases proprioception and socket comfort. OBJECTIVES: To investigate the effect of vacuum-assisted socket system on transtibial amputees' performance-based and perceived balance, transfers, and gait. STUDY DESIGN: Quasi-experimental before-and-after study. METHODS: Subjects were initially assessed using their prosthesis with the regular socket and re-evaluated 4 weeks after fitting including the vacuum-assisted socket system. We evaluated the mobility grade using Medicare Functional Classification Level, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, the 6-Min Walk Test, the Locomotor Capabilities Index, Satisfaction with Prosthesis (SAT-PRO questionnaire), and Houghton Scale. RESULTS: A total of 16 unilateral transtibial dysvascular amputees, mean age 65.12 (standard deviation = 10.15) years. Using the vacuum-assisted socket system, the patients significantly improved in balance, gait, and transfers: scores of the Berg Balance Scale increased from 45.75 (standard deviation = 6.91) to 49.06 (standard deviation = 5.62) (p < 0.01), Four Square Step Test decreased from 18.18 (standard deviation = 3.84) s to 14.97 (3.9) s (p < 0.01), Timed Up and Go Test decreased from 14.3 (standard deviation = 3.29) s to 11.56 (2.46) s (p < 0.01). The distance walked in the 6-Min Walk Test increased from 288.53 (standard deviation = 59.57) m to 321.38 (standard deviation = 72.81) m (p < 0.01). CONCLUSION: Vacuum-assisted socket systems are useful for improving balance, gait, and transfers in over-50-year-old dysvascular transtibial amputees. CLINICAL RELEVANCE: This study gives more insight into the use of vacuum-assisted socket systems to improve elderly transtibial dysvascular amputees' functionality and decrease their risk of falls. The use of an additional distal valve in the socket should be considered in patients with a lower activity level.

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.

Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

[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