Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study.

INTRODUCTION: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. METHODS: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. RESULTS: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4-6) vs. 7 days (IQR, 5-9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23-25) vs. 35 days (IQR, 28-45) in the control cohort, p = 0.03). CONCLUSIONS: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.

Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol.

BACKGROUND: The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN: The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. DISCUSSION: The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. TRIAL REGISTRATION: ISRCTN12051706.

Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension.

RATIONALE: Sildenafil, a phosphodiesterase-5 inhibitor, could be useful for treating pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD). However, vasodilators may inhibit hypoxic pulmonary vasoconstriction and impair gas exchange in this condition. OBJECTIVES: To assess the acute hemodynamic and gas exchange effects of sildenafil in patients with COPD-associated PH. METHODS: We conducted a randomized, dose comparison trial in 20 patients with COPD-associated PH. Eleven patients were assigned to 20 mg, and 9 patients to 40 mg, of sildenafil. Pulmonary hemodynamics and gas exchange, including ventilation-perfusion (V(A)/Q) relationships, were assessed at rest and during constant-work rate exercise, before and 1 hour after sildenafil administration. MEASUREMENTS AND MAIN RESULTS: Both sildenafil doses reduced the mean pulmonary arterial pressure (PAP) at rest and during exercise, without differences between them. Overall, PAP decreased -6 mm Hg (95% confidence interval [95% CI], -7 to -4) at rest and -11 mm Hg (95% CI, -14 to -8) during exercise. After sildenafil, Pa(O(2)) decreased -6 mm Hg (95% CI, -8 to -4) at rest because of increased perfusion in units with low V(A)/Q ratio, without differences between doses. No change in Pa(O(2)) (95% CI, -3 to 0.2 mm Hg) or V(A)/Q relationships occurred during exercise after sildenafil. Changes induced by sildenafil in Pa(O(2)) and V(A)/Q distributions at rest correlated with their respective values at baseline. CONCLUSIONS: In patients with COPD-associated PH, sildenafil improves pulmonary hemodynamics at rest and during exercise. This effect is accompanied by the inhibition of hypoxic vasoconstriction, which impairs arterial oxygenation at rest. The use of sildenafil in COPD should be done cautiously and under close monitoring of blood gases. Clinical trial registered with www.clinicaltrials.gov (NCT00491803).

Prehabilitation in thoracic surgery.

Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer (NSCLC). However, it may be responsible of postoperative complication and mortality, especially in patients with impaired pulmonary function. Enhanced recovery after surgery (ERAS) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery. Preoperative exercise-based intervention (prehabilitation) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion. Cardio-pulmonary exercise test (CPET) is the gold standard technique to predict postoperative morbi-mortality. The implementation of a preoperative respiratory rehabilitation could optimize patient's physical capacity before surgery and improve outcomes and enhance recovery. The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery, the type of exercise and its duration, and the group of patients with best benefit. Prehabilitation is a safe intervention without side effects in patients. High-intensity interval training (HIT) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration. Prehabilitation increase exercise capacity and significantly enhances pulmonary function. But the reduction of postoperative complication and mortality has not been clearly demonstrated. Different criteria selection, type of intervention and small sample size, in addition to no randomization, could justify disparate results. It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function. Further randomized clinical trials with enough patients, correct duration of HIT (2 to 6 weeks) and focused in COPD patients are needed to clarify the suitability of prehabilitation. Meanwhile, safety of prehabilitation and good results of some studies support this intervention in high-risk patients.

[Daily living activity in chronic obstructive pulmonary disease: validation of the Spanish version and comparative analysis of 2 questionnaires]. / Actividades de la vida diaria en pacientes con enfermedad pulmonar obstructiva crónica: validación de la traducción española y análisis comparativo de 2 cuestionarios.

BACKGROUND AND OBJECTIVE: Exercise limitation is a common finding in chronic obstructive pulmonary disease (COPD) patients and has an important role in disease prognosis and the use of health care services. There are no questionnaires in Spanish language that evaluate the impact of the disease in the activities of daily living in these patients. Our objective was to adapt and validate the Spanish versions of 2 standard questionnaires for assessment of physical activity: the London Chest Activity of Daily Living scale (LCADL) and the Modified Baecke Physical Activity Questionnaire (modified Baecke). PATIENTS AND METHOD: After carrying out the translation and back-translation, the 2 questionnaires were administered to 55 patients with COPD (mean age [standard deviation]: 66 [8] years; forced expiratory volume in 1 s: 1.2 [0.5] l, 38 [15]%) in 2 occasions and a conventional exercise test was performed. RESULTS: Cronbach's alpha coefficient was very high (0.98 and 0.97 for LCADL and modified Baecke, respectively; p < 0.0001 each). Intraclass correlation coefficients of the test re-test reliability was also very high (0.97 and 0.96, respectively). Mean values of the questionnaires in the 2 administrations were 20 (11) vs 19 (11) for LCADL (p = 0.26), and 15 (9) vs 14 (9) for modified Baecke (p = 0.51). The 2 questionnaires showed a significant correlation with quality of life (St. George's Respiratory Questionnaire), dyspnea score (Medical Research Council scale) and 6 min walk test. CONCLUSIONS: The Spanish versions of these 2 questionnaires to assess physical activity are relibale and they display the expected association with health related quality of life, dyspnea score, and the 6 min walk test, confirming their validity. Therefore, we propose its use to complement the assessment of physical activity in those patients with COPD in whom direct measurements of this variable are not available.

Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations.

UNLABELLED: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with several modifiable (sedentary life-style, smoking, malnutrition, hypoxemia) and non-modifiable (age, co-morbidities, severity of pulmonary function, respiratory infections) risk factors. We hypothesise that most of these risk factors may have a converging and deleterious effects on both respiratory and peripheral muscle function in COPD patients. METHODS: A multicentre study was carried out in 121 COPD patients (92% males, 63 ± 11 yr, FEV(1), 49 ± 17%pred). Assessments included anthropometrics, lung function, body composition using bioelectrical impedance analysis (BIA), and global muscle function (peripheral muscle (dominant and non-dominant hand grip strength, HGS), inspiratory (PI(max)), and expiratory (PE(max)) muscle strength). GOLD stage, clinical status (stable vs. non-stable) and both current and past hospital admissions due to COPD exacerbations were included as covariates in the analyses. RESULTS: Respiratory and peripheral muscle weakness were observed in all subsets of patients. Muscle weakness, was significantly associated with both current and past hospitalisations. Patients with history of multiple admissions showed increased global muscle weakness after adjusting by FEV(1) (PE(max), OR = 6.8, p < 0.01; PI(max), OR = 2.9, p < 0.05; HGSd, OR = 2.4, and HGSnd, OR = 2.6, p = 0.05). Moreover, a significant increase in both respiratory and peripheral muscle weakness, after adjusting by FEV(1), was associated with current acute exacerbations. CONCLUSIONS: Muscle dysfunction, adjusted by GOLD stage, is associated with an increased risk of hospital admissions due to acute episodes of exacerbation of the disease. Current exacerbations further deteriorate muscle dysfunction.

Physical activity and clinical and functional status in COPD.

BACKGROUND: The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD. METHODS: Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation. RESULTS: The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV(1) was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (Dlco) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [Pemax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (Vo(2)peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor alpha (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression. CONCLUSIONS: More physically active COPD patients show better functional status in terms of Dlco, Pemax, 6MWD, Vo(2)peak, and systemic inflammation.

Noves propostes terapèutiques en fisioteràpia de les malalties respiratòries infantils / No disponible

Fonament. La fisioteràpia respiratòria infantil és unaespecialitat fonamentada en evidències científiques, àmpliament desenvolupada a la resta de països europeus ique comença a incorporar-se en el nostre país.Objectiu. Donar a conèixer un nou model de fisioteràpiarespiratòria infantil, científicament validat i complementari al tractament mèdic, que té com a objectiu el drenatge de secrecions de les vies aèries intra i extratoràciques en nadons i infants.Mètode. S'ha fet una revisió bibliogràfica dels darrersquinze anys de les malalties respiratòries infantils, la seva incidència, el tractament mèdic i fisioterapèutic i dels nous abordatges terapèutics.Resultats. Els darrers deu anys ha tingut lloc un canvien les avaluacions, els diagnòstics i les tècniques de tractament que utilitzen els fisioterapeutes per tractar les malalties respiratòries infantils. Aquests tractaments basats en evidències científiques han demostrat que les tècniques convencionals, com el drenatge postural, el repic (clapping), etc. no aconsegueixen eliminar secrecions bronquials;per contra, les tècniques basades en les modificacionsdel flux espiratori obtenen millors resultats i generenmenys complicacions secundàries.Conclusions. L'evolució de les professions sanitàriespassa per la incorporació de tractaments fonamentats enevidències científiques que validen les teràpies aplicades als pacients. Els fisioterapeutes respiratoris han fet un esforç molt important en investigació científica els darrers anys que cal considerar i incorporar en pediatria

No disponible

Actividades de la vida diaria en pacientes con enfermedad pulmonar obstructiva crónica: validación de la traducción española y análisis comparativo de 2 cuestionarios / Daily living activity in chronic obstructive pulmonary disease: validation of the Spanish version and comparative analysis of 2 questionnaires

Fundamento y objetivo: La limitación de la capacidad de ejercicio es una característica de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), con un papel relevante en el pronóstico de la enfermedad y la utilización de servicios sanitarios. La inexistencia de cuestionarios que permitan evaluar el grado de actividad física diaria limita la evaluación clínica de estos pacientes. Nuestro objetivo ha sido adaptar al español y evaluar la fiabilidad y validez de 2 cuestionarios de actividad física formados por varias subescalas: la escala London Chest Activity of Daily Living (LCADL) y el Modified Baecke Physical Activity Questionnaire (Baecke modificado). Pacientes y método: Después de efectuar la traducción directa e inversa de ambos cuestionarios, éstos se aplicaron en 2 ocasiones a 55 pacientes con EPOC ­media (desviación estándar) de edad de 66 (8) años y de volumen espiratorio forzado en el primer segundo de 1,2 (0,5) l, con un 38 (15)% del valor de referencia­ y se realizaron pruebas convencionales de tolerancia al ejercicio. Resultados: El coeficiente alfa de Cronbach fue muy elevado en ambos casos (0,98 y 0,97 para LCADL y Baecke modificado, respectivamente; p < 0,0001 ambos). La reproducibilidad test-retest fue también muy alta para ambos cuestionarios (0,97 y 0,96, respectivamente). Para la LCADL, los valores medios obtenidos en las 2 administraciones fueron de 20 (11) frente a 19 (11) (p = 0,26), y para el Baecke modificado de 15 (9) frente a 14 (9) (p = 0,51). Ambos cuestionarios presentaron una correlación moderada con la calidad de vida (determinada por el St. George's Respiratory Questionnaire), con el índice de disnea (medida por la escala del Medical Research Council) y con la prueba de la marcha de 6 min. Conclusiones: Las versiones españolas de los cuestionarios de actividad física evaluados son fiables y ambas presentan la asociación esperada con la calidad de vida, el índice de disnea y la tolerancia al ejercicio, lo que refleja su validez. Aconsejamos la utilización complementaria de estos cuestionarios para la evaluación de la actividad física en pacientes con EPOC en ausencia de mediciones objetivas de esta variable

Background and objective: Exercise limitation is a common finding in chronic obstructive pulmonary disease (COPD) patients and has an important role in disease prognosis and the use of health care services. There are no questionnaires in Spanish language that evaluate the impact of the disease in the activities of daily living in these patients. Our objective was to adapt and validate the Spanish versions of 2 standard questionnaires for assessment of physical activity: the London Chest Activity of Daily Living scale (LCADL) and the Modified Baecke Physical Activity Questionnaire (modified Baecke). Patients and method: After carrying out the translation and back-translation, the 2 questionnaires were administered to 55 patients with COPD (mean age [standard deviation]: 66 [8] years; forced expiratory volume in 1 s: 1.2 [0.5] l, 38 [15]%) in 2 occasions and a conventional exercise test was performed. Results: Cronbach's alpha coefficient was very high (0.98 and 0.97 for LCADL and modified Baecke, respectively; p < 0.0001 each). Intraclass correlation coefficients of the test re-test reliability was also very high (0.97 and 0.96, respectively). Mean values of the questionnaires in the 2 administrations were 20 (11) vs 19 (11) for LCADL (p = 0.26), and 15 (9) vs 14 (9) for modified Baecke (p = 0.51). The 2 questionnaires showed a significant correlation with quality of life (St. George's Respiratory Questionnaire), dyspnea score (Medical Research Council scale) and 6 min walk test. Conclusions: The Spanish versions of these 2 questionnaires to assess physical activity are relibale and they display the expected association with health related quality of life, dyspnea score, and the 6 min walk test, confirming their validity. Therefore, we propose its use to complement the assessment of physical activity in those patients with COPD in whom direct measurements of this variable are not available