Clinical Management Practices Adopted by Physiotherapists in India for Chronic Obstructive Pulmonary Disease: A National Survey.

Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey.

Lung India. 2013 Apr; 30(2): 131-8
Jingar A, Alaparthi GK, Vaishali K, Krishnan S, Zulfeequer , Unnikrishnan B

Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment.A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients.A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards.Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training. HubMed – rehab

Motor dual-task effect on gait and task of upper limbs in older adults under specific task prioritization: pilot study.

Aging Clin Exp Res. 2013 Apr; 25(1): 99-106
Oh-Park M, Holtzer R, Mahoney J, Wang C, Raghavan P, Verghese J

Performing multiple tasks simultaneously may result in reduced performance of subtasks (dual-task cost) particularly among old individuals. Subtask performance during dual tasking is also known to be affected by task prioritization. However, it has not been well studied how the performance of subtasks is affected during motor dual task in old adults compared to young when instructed to prioritize one task over the other. This study aims to investigate the dual-task effect on subtasks during motor dual tasking under specific instruction of task prioritization in old compared to young adults.Sixteen independent old and 18 young adults performed two single tasks (usual walking, holding a tray as steady as possible while standing) and two dual tasks (walking while holding a tray focusing attention on keeping tray as steady as possible-WTAT, and walking while holding tray focusing attention on walking-WTAW). Gait parameters [velocity and variability (coefficient of variation, CV) of stride length] and the pitch (forward-backward) and roll (side-to-side) angles of the tray were measured during the four conditions.During the WTAT compared to single tasks, both young and old groups showed reduced gait velocity (? = -14.0 for old, -34.3 for young), increased gait variability (? = 0.19 for old, 0.51 for young), and increased tray tilt (? = 9.4 for old, 7.9 for young in pitch; ? = 8.8 for old, 5.9 for young in roll). Higher proportion of older individuals showed higher dual-task effect on tray stability, but lower dual-task effect on gait compared to young individuals. During WTAW, there was no difference in dual-task effect between age groups in tray stability or gait performance.Compared to young, older adults tend to compromise the task involving upper limbs during motor dual tasking even when instructed to prioritize this task over gait. These findings may have ramifications on developing training strategies to learn or relearn complex motor activities in seniors. HubMed – rehab

Rehabilitation following carpal tunnel release.

Cochrane Database Syst Rev. 2013 Jun 5; 6: CD004158
Peters S, Page MJ, Coppieters MW, Ross M, Johnston V

BACKGROUND: Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. OBJECTIVES: To review the effectiveness of rehabilitation following CTS surgery compared with no treatment, placebo, or another intervention. SEARCH METHODS: On 3 April 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register (3 April 2012), CENTRAL (2012, Issue 3), MEDLINE (January 1966 to March 2012), EMBASE (January 1980 to March 2012), CINAHL Plus (January 1937 to March 2012), AMED (January 1985 to April 2012), LILACS (January 1982 to March 2012), PsycINFO (January 1806 to March 2012), PEDRO (29 January 2013) and clinical trials registers (29 January 2013). SELECTION CRITERIA: Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, extracted data and assessed the risk of bias according to standard Cochrane methodology. MAIN RESULTS: In this review we included 20 trials with a total of 1445 participants. We studied different rehabilitation treatments including: immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multimodal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo comparison; three trials compared rehabilitation to a no treatment control; three trials compared rehabilitation to standard care; and 14 trials compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Eleven trials explicitly reported random sequence generation and, of these, three adequately concealed the allocation sequence. Four trials achieved blinding of both participants and outcome assessors. Five studies were at high risk of bias from incompleteness of outcome data at one or more time intervals. Eight trials had a high risk of selective reporting bias.The trials were heterogenous in terms of the treatments provided, the duration of interventions, the nature and timing of outcomes measured and setting. Therefore, we were not able to pool results across trials.Four trials reported our primary outcome, change in self reported functional ability at three months or longer. Of these, three trials provided sufficient outcome data for inclusion in this review. One small high quality trial studied a desensitisation program compared to standard treatment and revealed no statistically significant functional benefit based on the Boston Carpal Tunnel Questionnaire (BCTQ) (MD -0.03; 95% CI -0.39 to 0.33). One moderate quality trial assessed participants six months post surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and found no significant difference between a no formal therapy group and a two-week course of multimodal therapy commenced at five to seven days post surgery (MD 1.00; 95% CI -4.44 to 6.44). One very low quality quasi-randomised trial found no statistically significant difference in function on the BCTQ at three months post surgery with early immobilisation (plaster wrist orthosis worn until suture removal) compared with a splint and late mobilisation (MD 0.39; 95% CI -0.45 to 1.23).The differences between the treatments for the secondary outcome measures (change in self reported functional ability measured at less than three months; change in CTS symptoms; change in CTS-related impairment measures; presence of iatrogenic symptoms from surgery; return to work or occupation; and change in neurophysiological parameters) were generally small and not statistically significant. Few studies reported adverse events. AUTHORS’ CONCLUSIONS: There is limited and, in general, low quality evidence for the benefit of the reviewed interventions. People who have had CTS surgery should be informed about the limited evidence of the effectiveness of postoperative rehabilitation interventions. Until the results of more high quality trials that assess the effectiveness and safety of various rehabilitation treatments have been reported, the decision to provide rehabilitation following CTS surgery should be based on the clinician’s expertise, the patient’s preferences and the context of the rehabilitation environment. It is important for researchers to identify patients who respond to a certain treatment and those who do not, and to undertake high quality studies that evaluate the severity of iatrogenic symptoms from the surgery, measure function and return-to-work rates, and control for confounding variables. HubMed – rehab

Parathyroid hormone is significantly associated with body fat compartment in men but not in women following a hip fracture.

Aging Clin Exp Res. 2013 Jun 4;
Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R

BACKGROUND AND AIMS: Parathyroid hormone (PTH) exerts several actions beyond mineral metabolism and may affect body composition. The aim of our study was to assess the association between serum PTH and body fat compartment in hip fracture patients. METHODS: We studied 575 of 630 inpatients with hip fracture consecutively admitted to our Rehabilitation ward. Dual-energy X-ray absorptiometry (DXA) was used to measure body composition. DXA scan was performed 18.5 ± 8.6 (mean ± SD) days after hip fracture occurrence. A blood sample was collected within 4 days after DXA scan. In each subject, we evaluated PTH, 25-hydroxyvitamin D, calcium, phosphate, albumin, magnesium, and creatinine. Glomerular filtration rate was estimated by a conventional formula. RESULTS: In the 57 men, we found a significant correlation between PTH and both body mass index (BMI) (? = 0.37; p = 0.020) and trunk fat percentage (? = 0.62; p < 0.001). After multiple adjustments, we confirmed a significant association between PTH and BMI (r = 0.38; p = 0.004) or trunk fat percentage (r = 0.51; p < 0.001). In the 518 women, we found a slightly significant correlation between PTH and BMI (? = 0.09; p = 0.047), but after adjustments the correlation coefficient dropped to 0.02 (p = 0.69). We found no significant relationships between PTH and trunk fat percentage at bivariate correlation (? = 0.04; p = 0.35) or after adjustments (r = 0.04; p = 0.38). CONCLUSIONS: PTH serum levels were robustly associated with body fat compartment in men, but not in women following a fracture of the hip. A role of PTH in affecting body composition in hip fracture men is suggested. Its potential role in male prognostic disadvantage needs further investigation. HubMed – rehab