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1.
Michael J. Shoemaker Amy B. Curtis Eric Vangsnes Michael G. Dickinson 《Cardiopulmonary Physical Therapy Journal》2013,24(3):21-29
Purpose
The purpose of the present pilot study was to provide a preliminary estimate of the minimum detectable difference (MDD) and minimum clinically important difference (MCID) of the six-minute walk test (6MWT) and daily activity in outpatients with chronic heart failure (CHF).Methods
A convenience sample of 22 adults with stable New York Heart Association Functional Class II and III CHF performed two baseline 6MWTs separated by 30 minutes of rest. Subjects then wore a triaxial accelerometer for 7 days to monitor daily activity. After 7 weeks of usual care, subjects again wore the accelerometer for 7 days and then returned to the clinic to complete the Global Rating of Change Scale (GRS) with regard to their heart disease and perform another set of 6MWTs. For the 6MWT, the MDD was calculated using the two baseline 6MWT distances. For daily activity, the MDD was calculated using two methods: (1) day-to-day test-retest reliability during baseline monitoring, and (2) baseline to follow-up test-retest reliability in those who reported no change on the GRS. The MCID for the 6MWT and daily activity was calculated using the mean and 95% confidence interval (CI95%) for those subjects who reported ‘improvement’ on the GRS.Results
The MDD at the CI95% for the 6MWT was 32.4 meters. The MCID for the 6MWT was 30.1 (CI95% 20.8, 39.4) meters. The MDD for daily activity was 5,909 vector magnitude units (VMU·hr.−1) The MCID for daily activity was 1,337 VMU·hr.−1 There was good alignment of the MDD and MCID for the 6MWT, suggesting that clinically meaningful change is approximately 32 meters. However, the calculated MCID was substantially less than measurement error as represented by the MDD, indicating that the MCID was underestimated in this sample or that daily activity may be robust to change in overall disease status.Key Words: six-minute walk test, daily activity, heart failure, clinically meaningful change 相似文献2.
3.
Neeti Pathare Esther M. Haskvitz Marjane Selleck 《Cardiopulmonary Physical Therapy Journal》2012,23(4):12-18
PURPOSE
The primary purpose of this study was to investigate 6-minute walk test (6MWT) performance in young children who were normal weight (NW) and overweight (OW).METHODS
Seventy children, 5-9 years of age, participated in this study. The 6MWT was performed on an indoor walkway. Heart rate (HR), blood pressure (BP), and oxygen saturation (SaO2) were measured. A self-reported physical activity questionnaire was completed by a parent/guardian. Data were analyzed with independent t tests, ANOVA, correlation analyses, and logistic regression.RESULTS
The systolic BP values were higher in the children who were OW compared with their NW peers (resting mean 104.1 (8.9) mmHg vs. 97.5 (7.8) mmHg, P < 0.05; post-6WMT: mean 118.4 (10.78) mmHg vs. 109.9 (9.1) mmHg, P < 0.05). The SaO2 values were lower in the children who were OW compared to their NW counterparts (resting: mean 97.2 (1.1) % vs. 98.0 (1.0) %, P < 0.05; post-6WMT: mean 96.8 (1.0) % vs. 97.7 (1.0) %, P < 0.05).CONCLUSIONS
The children who were OW had higher systolic BP and lower SaO2 levels at rest and post-6WMT. More research is needed to determine if these differences contribute to children who are OW having difficulty performing exercise.Key Words: obesity, children, exercise capacity 相似文献4.
Anna E. Mattlage Abigail L. Ashenden Angela A. Lentz Michael A. Rippee Sandra A. Billinger 《Cardiopulmonary Physical Therapy Journal》2013,24(3):14-20
Purpose
Reduced cardiovascular fitness post-stroke may negatively impact recovery. There is little information regarding exercise testing performance and cardiorespiratory response to an aerobic exercise intervention in subacute stroke. The purpose of this study was to examine cardiorespiratory response in subacute stroke after an 8-week aerobic exercise intervention using a total body recumbent stepper (TBRS).Methods
Nine individuals with mean age 61.2 (SD 4.7) years and mean 66.7 (SD 41.5) days post-stroke completed the exercise intervention. Participants had a mean Fugl-Meyer score of 100.3 (SD 29.3). Outcome measures were obtained at baseline and postintervention. A peak exercise test using a TBRS assessed oxygen consumption, heart rate, and minute ventilation. Participants completed an 8-week exercise intervention on a recumbent stepper 3 times per week at a prescribed heart rate intensity.Results
Submaximal VO2 was significantly lower from baseline to postintervention with a main effect of Study Visit (F1,8 = 8.5, p = 0.02). Heart rate was not significantly different pre- to postintervention. Minute ventilation exhibited no main effect of Study Visit or Test Minute.Conclusion
Moderate-high intensity aerobic exercise in subacute stroke appears to be beneficial for improving cardiovascular outcomes during submaximal performance of an exercise test.Key Words: oxygen uptake, cerebrovascular accident, cardiovascular fitness, submaximal exercise 相似文献5.
Michael J. Shoemaker Jeffrey L. Wilt Rajkumar Dasgupta Ronald J. Oudiz 《Cardiopulmonary Physical Therapy Journal》2009,20(4):12-18
Purpose: To describe the benefits of a feasible, outpatient exercise training program on exercise tolerance and health-related quality of life (HRQL) in individuals with pulmonary arterial hypertension (PAH). Methods: Case report on two subjects recruited from a tertiary care pulmonary hypertension clinic. Subject 1 was a 50-year-old male with idiopathic PAH. Subject 2 was a 54-year-old female with a 20+ year history of scleroderma and 6-year history of PAH. Both subjects underwent exercise training 3 times per week for 6 weeks using a cycle ergometer at workloads progressing from 50% to 80% of peak workload. Outcomes were assessed using cardiopulmonary exercise testing, six-minute walk test (6MWT), and HRQL using the Chronic Respiratory Disease Questionnaire (CRQ) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). Results: Both subjects made substantial improvements in oxygen consumption and workload at anaerobic threshold (improvements of 3.8 and 4.2 mL·kg−1·min,−1 26 and 18 W, respectively) and 6MWT distance (from 496 to 586m and 416 to 517m, respectively). Only Subject 1 made substantial improvements in peak oxygen consumption (from 16.0 to 18.3 mL·kg−1·min−1and from 15.0 to 15.6 mL·kg−1·min,−1 respectively) and peak work rate (from 112 to 130W and 66 to 69W, respectively). Both subjects demonstrated improved HRQL. No adverse events were noted. CONCLUSIONS: A short and practical exercise training program can improve measures of workload, aerobic capacity, and HRQL in individuals with PAH with no adverse effects shown in these two case studies.Key Words: pulmonary arterial hypertension, exercise training 相似文献
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7.
Suh-Jen Lin Jessica McElfresh Benjamin Hall Rachel Bloom Kellie Farrell 《Cardiopulmonary Physical Therapy Journal》2012,23(3):29-36
Purpose
The purpose of this review was to assess the quality of evidence on inspiratory muscle training (IMT) in patients with heart failure and to provide an overview on subject selection, training protocols, and outcome achieved with IMT.Methods
Literature search was first performed via the PubMed database, and additional references were identified from the Scopus citation index. Articles of the review type and of clinical trials published in English were included. Quality of the articles was assessed using Sackett''s levels of evidence and rigor of methodology was assessed using PEDro (Physiotherapy Evidence Database) criteria for randomized controlled trials and the Downs & Black tool for cohort studies.Results
Twelve articles of clinical trials were included. Typical training protocols involved daily training with intensity greater than 30% of maximal inspiratory pressure (PImax), duration of 20 to 30 minutes (continuous or incremental) and using a pressure threshold muscle trainer. The effect sizes of PImax, walk test distance, and dyspnea were moderate to large across these studies. Effects on quality of life scores were inconsistent.Conclusion
Inspiratory muscle training is beneficial for improving respiratory muscle strength, functional capacity, and dyspnea in patients with stable heart failure and respiratory muscle weakness.Key Words: inspiratory muscle training, heart failure, maximal inspiratory pressure 相似文献8.
Brittany Pollentier Sonya L. Irons Courtney Manfredi Benedetto Anne-Marie DiBenedetto Dana Loton Rebecca Diane Seyler Mira Tych Roberta A. Newton 《Cardiopulmonary Physical Therapy Journal》2010,21(1):13-21
Purpose: To evaluate the reliability and validity of the six-minute walk test (6MWT) with respect to its ability to predict functional capacity in patients with chronic heart failure. Methods: A systematic review was performed via 8 databases to assess relevant English language full-text articles published from January 1, 1980 to October 31, 2009. Participant characteristics, interventions, reliability, validity, and predictive value for each article with respect to functional capacity as defined by peak VO2 levels were extracted and compared. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scores were determined for each study. Results: Fourteen studies met the selection criteria. Comparison of the studies investigating reliability shows that the 6MWT has good reproducibility. The 6MWT demonstrates moderate correlation with peak VO2 levels, and ability to predict VO2 (functional capacity) dependent on distance walked. Cut-off distances vary from 300 to 490 meters depending on the study; if total distance walked remains equal or less than these values, the 6MWT retains its strong predictive value. Conclusion: The 6MWT has good reliability, moderate validity, and a significant ability to predict functional capacity in patients with CHF who do not walk greater than 490 meters.Key Words: six-minute walk test, chronic heart failure, functional capacity, peak VO2 相似文献
9.
Purpose
The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety.Methods
We searched the electronic databases of PubMed, CINAHL, Medline (Ovid), and The Cochrane Library for a period spanning 2000–2011. Articles used in this review included randomized and nonrandomized clinical trials, prospective and retrospective analyses, and case series in peer-reviewed journals. Sackett''s Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported.Results
Fifteen studies met inclusion criteria and were reviewed. According to Sackett''s Levels of Evidence, 9 studies were level 4 evidence, one study was level 3, 4 studies were level 2, and one study was level one evidence. Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories.Conclusion
A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit. However, literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes.Key Words: mobilization, exercise, intensive care unit, critical illness, physical therapy 相似文献10.
Eduard Gappmaier Sima F. Tavazoie Michael G. Jacketta 《Cardiopulmonary Physical Therapy Journal》2013,24(3):5-13
Purpose
Large therapeutic rolls (LTR) and balls are popular rehabilitation tools and have also been advertised as cardiovascular training devices. The aim of this study was to determine if individuals of varying fitness levels would reach aerobic training levels by evidence-based standards as described in American College of Sports Medicine (ACSM) publications.Methods
Fourteen volunteers performed a maximal exercise test and on subsequent days, two submaximal exercise tests on the LTR (LTR-A and -B). LTR-A consisted of four 5-minute stages of exercise at progressive intensity levels. LTR-B included 20 minutes of continuous exercise. Oxygen consumption (VO2) and heart rate (HR) during exercise on the LTR were compared with ACSM recommended standards.Results
The average (range) peak intensity achieved during LTR-A was 66.8% (51.7-82.7%) of maximal VO2 reserve (VO2R) and 82.9% (70.7%-91.2%) of maximal heart rate (HRmax). During LTR-B, HR and VO2 of all participants was maintained at moderate exercise intensity and averaged 56% of VO2R and 78% of HRmax during the 20 minute exercise period.Conclusions
These findings suggest that individuals with a wide range of aerobic fitness are able to reach and maintain aerobic training levels with appropriate exercise on a large therapeutic roll or ball.Key Words: large therapeutic roll, Swiss Ball, aerobic exercise, exercise intensity 相似文献11.
I Anne Leditschke Margot Green Joelie Irvine Bernie Bissett Imogen A. Mitchell 《Cardiopulmonary Physical Therapy Journal》2012,23(1):26-29
Purpose
Recently there has been increased interest in early mobilization of critically ill patients. Proposed benefits include improvements in respiratory function, muscle wasting, intensive care unit (ICU), and hospital length of stay. We studied the frequency of early mobilization in our intensive care unit in order to identify barriers to early mobilization.Methods
A 4-week prospective audit of 106 patients admitted to a mixed medical-surgical tertiary ICU (mean age 60 ± 20 years, mean APACHE II score 14.7 ± 7.8) was performed. Outcome measures included number of patient days mobilized, type of mobilization, adverse events, and reasons for inability to mobilize.Results
Patients were mobilized on 176 (54%) of 327 patient days. Adverse events occurred in 2 of 176 mobilization episodes (1.1%). In 71 (47%) of the 151 patient days where mobilization did not occur, potentially avoidable factors were identified, including vascular access devices sited in the femoral region, timing of procedures and agitation or reduced level of consciousness.Conclusions
Critically ill patients can be safely mobilized for much of their ICU stay. Interventions that may allow more patients to mobilize include: changing the site of vascular catheters, careful scheduling of procedures, and improved sedation management.Key Words: intensive care units, mobility, physical therapy 相似文献12.
Arzu Genc Seher Ozyurek Ugur Koca Ali Gunerli 《Cardiopulmonary Physical Therapy Journal》2012,23(1):14-18
Purpose
The aim of this study was to investigate the effects of mobilization on respiratory and hemodynamic parameters in critically ill obese patients.Methods
Critically ill obese patients (n = 31) were included in this retrospective study. Data were collected from patients’ files and physiotherapy records of mobilization sessions. Heart rate (HR), systolic/diastolic/mean blood pressure, respiratory rate (RR), and percutaneous oxygen saturation (SpO2) were recorded. Cardiorespiratory parameters were collected just prior to the mobilization, just after the completion of the mobilization and after 5 minutes recovery period. Respiratory reserve was calculated before and after the mobilization.Results
A total of 37 mobilization sessions in 31 obese patients (mean age: 63.3 years, mean BMI: 32.2 kg/m2) who received physiotherapy were analyzed. Respiratory rate increased significantly after the completion of the mobilization compared to initial values (p < 0.05). SpO2 significantly increased (p < 0.05) and all other parameters remained similar (p > 0.05) compared to initial values after the recovery period. Mobilization resulted in a significant increase in respiratory reserve (p < 0.05).Conclusion
Early mobilization in intensive care unit promotes respiratory reserve in obese patients. We found that mobilization can be performed safely in critically ill obese patients if cardiorespiratory parameters are continuously monitored.Key Words: obesity, mobilization, critically ill patients, physiotherapy 相似文献13.
14.
Jaca L. Stephens John D. Lowman Cecilia L. Graham David M. Morris Connie L. Kohler Jonathan B. Waugh 《Cardiopulmonary Physical Therapy Journal》2013,24(1):14-23
Purpose
Physical therapists (PTs) have a unique opportunity to intervene in the area of health promotion. However, no instrument has been validated to measure PTs’ views on health promotion in physical therapy practice. The purpose of this study was to evaluate the content validity and test-retest reliability of a health promotion survey designed for PTs.Methods
An expert panel of PTs assessed the content validity of “The Role of Health Promotion in Physical Therapy Survey” and provided suggestions for revision. Item content validity was assessed using the content validity ratio (CVR) as well as the modified kappa statistic. Therapists then participated in the test-retest reliability assessment of the revised health promotion survey, which was assessed using a weighted kappa statistic.Results
Based on feedback from the expert panelists, significant revisions were made to the original survey. The expert panel reached at least a majority consensus agreement for all items in the revised survey and the survey-CVR improved from 0.44 to 0.66. Only one item on the revised survey had substantial test-retest agreement, with 55% of the items having moderate agreement and 43% poor agreement.Conclusions
All items on the revised health promotion survey demonstrated at least fair validity, but few items had reasonable test-retest reliability. Further modifications should be made to strengthen the validity and improve the reliability of this survey.Key Words: health promotion, physical therapy, validity, reliability 相似文献15.
Pamela R. Bosch Joseph Poloni Andrew Thornton James V. Lynskey 《Cardiopulmonary Physical Therapy Journal》2012,23(2):13-29
Purpose
To determine if 30 minutes of Nintendo Wii Sports boxing provides cardiorespiratory benefits and contributes to the daily exercise recommendations for healthy young adults.Methods
Twenty healthy 23- to 27-year-olds participated in two sessions to measure maximum heart rate (HRmax) via a treadmill test and heart rate (HR) response to 30 minutes of Wii Sports boxing. Heart rate in beats per minute (bpm) was measured continuously, and exercise intensity during each minute of play was stratified as a percentage of HRmax. Mixed designs analysis of variance (ANOVA) and Pearson product moment correlations were used to analyze the data.Results
Mean (SD) HR response to boxing was 143 (15) bpm or 77.5% (10.0%) of HRmax. The mean HR response for experienced participants was significantly lower than inexperienced participants, P = .007. The ANOVA revealed a significant interaction between experience and time spent at various intensities, P = .009. Experienced participants spent more time in light to vigorous intensities, inexperienced participants in moderate to very hard intensities. Fitness was not correlated with mean HR response to boxing, P = .49.Conclusion
Thirty minutes of Nintendo Wii Sports boxing provides a moderate to vigorous aerobic response in healthy young adults and can contribute to daily recommendations for physical activity.Key Words: exergaming, cardiorespiratory training, active video games 相似文献16.
17.
Joseph F. Norman Bunny J. Pozehl Kathleen A. Duncan Melody A. Hertzog Steven K. Krueger 《Cardiopulmonary Physical Therapy Journal》2012,23(4):19-25
Purpose
The purpose of this study was to compare an Exercise Training Group (EX) with an Attention-Control Group (AT-C) to more specifically assess the impact of exercise training on individuals with heart failure (HF).Methods
Forty-two individuals with HF were randomized to AT-C or EX that met with the same frequency and format of investigator interaction. Baseline, 12- and 24-week measurements of B-type naturetic peptide (BNP), 6-minute walk test (6-MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were obtained.Results
BNP tended to increase in the AT-C while remaining stable in the EX over time. A clinically significant increase in 6-MWT was demonstrated by the EX but not the AT-C. The EX achieved a clinically significant change on the KCCQ at 12 weeks, with further improvement by 24 weeks, while the AT-C demonstrated a clinically significant change at 24 weeks.Conclusions
Attention alone was inadequate to positively impact BNP levels or 6-MWT distances, but did have a positive impact on quality of life after 24 weeks. Although exercise offers enhanced benefits, individuals with HF unable to participate in an exercise program may still gain quality of life benefits from participation in a peer-support group that discusses topics pertinent to HF.Key Words: heart failure, attention, exercise 相似文献18.
Nancy Smith Sharon Prybylo Teresa Conner-Kerr 《Cardiopulmonary Physical Therapy Journal》2012,23(1):36-42
Purpose
The aims of the study were to differentiate: (1) physical therapy (PT) students’ preferred method for learning electrocardiographic (ECG) recognition utilizing standardized patient (SP) and human patient simulation (HPS) approaches, (2) the impact of HPS or SP on confidence in interpreting ECG, and 3) the effect of HPS or SP on students’ ability to make clinical decisions based upon ECG interpretation.Methods
“Three educational methods were employed to teach ECG recognition to two different years of novice PT students enrolled in a cardiopulmonary physical therapy class. First, all students had a traditional lecture on ECG. Following the lecture, two problem-based learning (PBL) approaches were utilized. One approach used a SP and paper ECG strips, and the second approach utilized HPS with simulated ECG monitoring.”1 Following the two PBL approaches, a post instructional survey regarding the learning experiences was conducted. Following instruction, each cohort (n = 24, n = 29) of PT students was given a mixed methods survey about their experience.Results
Survey return rate amongst both cohorts was 77%. Independent sample of individual cohort and paired t-tests of combined data comparing HPS to SP revealed a strong preference for HPS (p = 0.003 (2008 cohort) and p = 0.0001 (2010 cohort)) and combined cohort (p = 0.0001). There were no significant differences in responses between cohorts or preference between the HPS method and the use of SP and HPS combined. Additionally, 75% of respondents either strongly agreed or agreed that they felt confident with their skill in ECG interpretation as presented with HPS or SP. 90% either strongly agreed or agreed that they understood how the ECG relates to patient treatment. Summative assessment utilizing HPS revealed that students were competent in their performance in ECG recognition and clinical decision making related to patient treatment.1Conclusion
Data support that HPS was the preferred method to improve student confidence in ECG recognition and interpretation.Key Words: human patient simulation, electrocardiography, critical care management, educational technology 相似文献19.
R Scott Van Zant Kelly Jo Cape Katrina Roach Janie Sweeney 《Cardiopulmonary Physical Therapy Journal》2013,24(2):18-26
Purpose
The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention.Methods
A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed.Results
Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health.Conclusions
Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.Key Words: cardiovascular disease, primary disease prevention, secondary disease prevention 相似文献20.
Gayle L. Flo Robb W. Glenny Peter J. Kudenchuk Cynthia M. Dougherty 《Cardiopulmonary Physical Therapy Journal》2012,23(3):16-22