Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial.

OBJECTIVE: To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. DESIGN: A prospective, randomized controlled trial. SETTING: A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. INTERVENTION: The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. MAIN MEASURES: The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. RESULTS: Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked (p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed (p = 0.363), lactate levels (p = 0.302), knee extensor strength (p = 0.117), handgrip strength (p = 0.882), global muscle strength (p = 0.104), electromyographic activity (p = 0.179) and Functional Independence Measure (p = 0.059). CONCLUSIONS: Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

Do the commonly used standard questionnaires measure what is of concern to patients with low back pain?

OBJECTIVE: Evaluate whether questionnaires identified all the self-reported patient outcomes raised in focus groups. DESIGN: Mixed methods research combined with qualitative analysis of focus groups. SETTINGS: Physical therapy clinic in a teaching hospital in Brazil. SUBJECTS: A total of 27 patients (aged >18 years, mean age 55.2 years) with chronic non-specific low back pain. INTERVENTIONS: Three focus groups were conducted by the same investigator and analyzed by meaning unit condensation. The results obtained from the focus groups were codified according to the International Classification of Functioning. A similar process was adopted to codify the Roland-Morris Disability Questionnaire, the Quebec Back Pain Disability Scale and the Oswestry Disability Index according to the International Classification of Functioning. The results of both coding processes were compared. RESULTS: In the analysis, seven main concepts were identified, comprising 77 meaning units. Only three meaning units were not linked to the International Classification of Functioning. Most of the codes present in the questionnaires and focus groups represent limitations to activities. Some codes were identified in the questionnaires that were not mentioned by the focus group participants. No questionnaire assessed environmental factors or problems related to specific parts of the body, and very few assessed body function, all of which were issues raised in the focus groups. CONCLUSION: This study shows that not all fields considered important by patients to their function are being evaluated, and emotional and contextual factors should be included in clinical assessments in order to fully understand patient need.

Neuromuscular Electrical Stimulation on Hemodynamic and Respiratory Response in Patients Submitted to Cardiac Surgery: Pilot Randomized Clinical Trial

Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery

Ambulation capacity and functional outcome in patients undergoing neuromuscular electrical stimulation after cardiac valve surgery: A randomised clinical trial.

BACKGROUND: Early mobilization and physical exercise are considered fundamental components in cardiovascular surgery rehabilitation; however, occasionally they are inadequate for inhibiting functional decline. Neuromuscular electrical stimulation (NMES) is a promising tool in cardiovascular rehabilitation; however, to date, no randomized clinical trial has measured the effects of NMES on functional capacity and quality of life in patients who undergo routine cardiac surgery with a short intensive care unit (ICU) stay. Therefore, we aimed to investigate the effects of NMES on walking ability, muscle strength, functional independence, and quality of life in cardiac valve surgery patients in the immediate postoperative period. METHODS: A randomized, parallel, controlled, 2-arm clinical trial with assessor blinding was conducted. Fifty-nine adult patients in the preoperative period after cardiac valve reconstruction and/or replacement were randomly assigned to a control or intervention group. The intervention group underwent NMES in the quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10 sessions. The primary outcome was ambulation ability, assessed through the Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO). Secondary outcomes were muscular strength (assessed through the Medical Research Council scale), functional independence measure (assessed through the Functional Independence Measurement Questionnaire), and quality of life (assessed through the Nottingham Health Profile) at baseline (preoperative) and at postoperative days 3 and 5. RESULTS: The baseline characteristics were similar in both groups, except for body mass index. There was no statistically significant difference, with a small effect size, between both groups regarding the distance walked (95% CI, -64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a statistically significant difference in upper-limb muscle strength loss and decline in mobility at postoperative day 3, which had a tendency to recover to initial values at 5PO, in both groups. No significant between-group difference was noted for muscle strength, functional independence, and quality of life. CONCLUSIONS: The use of NMES had no effect on walking ability, strength, quality of life, or functional outcome in the postoperative period for patients that underwent regular valve replacement.

Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial.

OBJECTIVE: During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD: The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3. RESULTS: Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION: Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial

OBJECTIVE: During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD: The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3. RESULTS: Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION: Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

Determinants of distance walked during the six-minute walk test in patients undergoing cardiac surgery at hospital discharge.

INTRODUCTION: The aim of this study was to identify the determinants of distance walked in six-minute walk test (6MWD) in patients undergoing cardiac surgery at hospital discharge. METHODS: The assessment was performed preoperatively and at discharge. Data from patient records were collected and measurement of the Functional Independence Measure (FIM) and the Nottingham Health Profile (NHP) were performed. The six-minute walk test (6MWT) was performed at discharge. Patients undergoing elective cardiac surgery, coronary artery bypass grafting or valve replacement were eligible. Patients older than 75 years who presented arrhythmia during the protocol, with psychiatric disorders, muscular or neurological disorders were excluded from the study. RESULTS: Sixty patients (44.26% male, mean age 51.53 ± 13 years) were assessed. In multivariate analysis the following variables were selected: type of surgery (P = 0.001), duration of cardiopulmonary bypass (CPB) (P = 0.001), Functional Independence Measure - FIM (0.004) and body mass index - BMI (0.007) with r = 0.91 and r2 = 0.83 with P < 0.001. The equation derived from multivariate analysis: 6MWD = Surgery (89.42) + CPB (1.60) + MIF (2.79 ) - BMI (7.53) - 127.90. CONCLUSION: In this study, the determinants of 6MWD in patients undergoing cardiac surgery were: the type of surgery, CPB time, functional capacity and body mass index.

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery.

INTRODUCTION: Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period. METHODS: Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively. RESULTS: On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.712.3) when compared to CG (35.0612.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.410.5 days vs. 12.2 1 0.9 days, P<0.05), which also had a higher 6MWD (319.9119.3 meters vs. 263.5115.4 meters, P<0.02). CONCLUSION: Adjunctive treatment with virtual reality demonstrated benefits, with better functional performance in patients undergoing cardiac surgery.

The use of the virtual reality as intervention tool in the postoperative of cardiac surgery / O uso da realidade virtual como ferramenta complementar no pós-operatório de cirurgia cardíaca

INTRODUCTION: Cardiac surgery has been the intervention of choice in many cases of cardiovascular diseases. Susceptibility to postoperative complications, cardiac rehabilitation is indicated. Therapeutic resources, such as virtual reality has been helping the rehabilitational process. The aim of the study was to evaluate the use of virtual reality in the functional rehabilitation of patients in the postoperative period. METHODS: Patients were randomized into two groups, Virtual Reality (VRG, n = 30) and Control (CG, n = 30). The response to treatment was assessed through the functional independence measure (FIM), by the 6-minute walk test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were performed preoperatively and postoperatively. RESULTS: On the first day after surgery, patients in both groups showed decreased functional performance. However, the VRG showed lower reduction (45.712.3) when compared to CG (35.0612.09, P<0.05) in first postoperative day, and no significant difference in performance on discharge day (P>0.05). In evaluating the NHP field, we observed a significant decrease in pain score at third assessment (P<0.05). These patients also had a higher energy level in the first evaluation (P<0.05). There were no differences with statistical significance for emotional reactions, physical ability, and social interaction. The length of stay was significantly shorter in patients of VRG (9.410.5 days vs. 12.2 1 0.9 days, P<0.05), which also had a higher 6MWD (319.9119.3 meters vs. 263.5115.4 meters, P<0.02). CONCLUSION: Adjunctive treatment with virtual reality demonstrated benefits, with better functional performance in patients undergoing cardiac surgery.

INTRODUÇÃO: A cirurgia cardíaca tem sido a intervenção de escolha em muitos casos de doenças cardiovasculares. Pela susceptibilidade a complicações pós-operatórias, a reabilitação cardíaca é indicada. Recursos terapêuticos, como a realidade virtual, tem favorecido o processo reabilitacional. O objetivo do estudo foi avaliar o uso da realidade virtual na reabilitação funcional de pacientes pós-cirurgia cardíaca. MÉTODOS: Os pacientes foram randomizados em dois grupos, Realidade Virtual (GRV, n=30) e Grupo Controle (GC, n=30). A resposta ao tratamento foi avaliada por meio do Questionário de Medida de Independência Funcional (MIF), Teste de caminhada de 6 minutos e do Perfil de Saúde de Nottingham (PSN). Os questionários foram aplicados no pré e pós-operatório. RESULTADOS: No primeiro dia de pós-operatório, os pacientes de ambos os grupos demonstraram diminuição do desempenho funcional. No entanto, essa perda foi menor no GRV (45,712,3) em relação ao GC (35,0612,09, P<0,05), sem diferença significativa no momento da alta hospitalar (P>0,05). Na avaliação do PSN, foi observada menor intensidade da dor no terceiro momento de avaliação no GRV (P<0,05). Esses pacientes também apresentaram maior nível de energia na primeira avaliação (P<0,05). Não foram encontradas diferenças com significância estatística para reações emocionais, habilidade física e interação social. O tempo de internação foi significativamente menor nos pacientes do GRV (P<0,05), que também apresentaram maior distância percorrida no TC6 (319,9119,3 metros vs. 263,5115,4 metros, P<0,02). CONCLUSÃO: O tratamento com a realidade virtual foi eficaz em proporcionar melhor desempenho funcional pós-operatório.