Biomedical subjects

Birgitta Lindmark

Publications and source records attributed to Birgitta Lindmark.

7 recordsLinked to original sources

PubMed2005

Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery.

STUDY OBJECTIVES: To investigate the effects of deep-breathing exercises on pulmonary function, atelectasis, and arterial blood gas levels after coronary artery bypass graft (CABG) surgery. DESIGN, SETTING, AND PATIENTS: In a prospective, randomized trial, patients performing deep-breathing exercises (n = 48) were compared to a control group (n = 42) who performed no breathing exercises postoperatively. Patient management was similar in the groups in terms of assessment, positioning, and mobility. INTERVENTIONS: The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days. The exercises consisted of 30 slow, deep breaths performed with a positive expiratory pressure blow-bottle device (+ 10 cm H(2)O). MEASUREMENTS AND RESULTS: Spirometric measurements, spiral CT (three transverse levels), arterial blood gas analysis, and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day. Atelectasis was only half the size in the deep-breathing group compared to the control group, amounting to 2.6 +/- 2.2% vs 4.7 +/- 5.7% (p = 0.045) at the basal level and 0.1 +/- 0.2% vs 0.3 +/- 0.5% (mean +/- SD) [p = 0.01] at the apical level. Compared to the control subjects, the patients in the deep-breathing group had a significantly smaller reduction in FVC (to 71 +/- 12%, vs 64 +/- 13% of the preoperative values; p = 0.01) and FEV(1) (to 71 +/- 11%, vs 65 +/- 13% of the preoperative values; p = 0.01). Arterial oxygen tension, carbon dioxide tension, fever, or length of ICU or hospital stay did not differ between the groups. In the deep-breathing group, 72% of the patients experienced a subjective benefit from the exercises. CONCLUSIONS: Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises.

Aged↗

PubMed2003

Development and reliability of the General Motor Function Assessment Scale (GMF)--a performance-based measure of function-related dependence, pain and insecurity.

PURPOSE: To develop a scale for assessment of three components-dependence, pain and insecurity - related to motor functions of importance for activities of daily living among older rehabilitation patients and to establish its clinical practicality and reliability. METHOD: A General Motor Function Assessment Scale (GMF) with the above aims was constructed. Clinical practicality was explored by questionnaires to 14 physiotherapists. Inter-rater and test-retest reliability was tested on patients in three different forms of geriatric rehabilitation (n=20-25) and analysed by percentage agreement (PA) and a non-parametric statistical method, which provide measures of the random disagreement separately from the systematic part of the disagreement. RESULTS: In the clinical test the GMF was found to be time efficient and clinically adequate. Analysis of reliability showed overall high values of PA (PA> or =70) and of the rank-order agreement coefficient (r(a)>0.82), and low degrees of systematic disagreement. CONCLUSIONS: GMF was found to be a clinically useful assessment scale in geriatric rehabilitation. The statistical analyses indicted a high degree of reliability. Comparison of these results with reliability of comparable rating scales is difficult on account of the statistical methods used in other studies, which commonly do not take into account the non-metric properties of the data.

Activities of Daily Living↗

PubMed2003

Evaluation and application of the General Motor Function assessment scale in geriatric rehabilitation.

PURPOSE: To test General Motor Function assessment scale (GMF) for concurrent validity, to analyse the distribution of scores and its clinical sensitivity in a setting of geriatric rehabilitation. METHOD: A descriptive and comparative study involving comparisons between GMF and Katz Index of ADL, analyses of GMF scores concerning distribution and comparisons between three geriatric care levels and between assessments pre- and post-intervention. One group of 20 in-patients and one group of 154 patients in three different care forms - institutional care, home rehabilitation and day care were included. Non parametric statistics were utilized, including a method which can separately measure the level of change for the group and for the individuals in that group. RESULTS: High correlation with r(s) = 0.80 (p < 0.001) between the subscale Dependence and the Katz Index of ADL verified that this part of the GMF measures variables related to ability in ADL. No floor effects in any of the subscales of the GMF were shown. The GMF was found to be sufficiently sensitive to demonstrate change from pre- and post-intervention assessments. CONCLUSION: This study indicates that GMF could be useful as a satisfactorily valid and sensitive tool for physiotherapists' standardized assessments in geriatric practice.

Activities of Daily Living↗

PubMed2003

The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery.

Objective--To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery. Design--The immediate effects of 30 deep breaths performed without a mechanical device (n = 21), with a blow bottle device (n = 20) and with an inspiratory resistance-positive expiratory pressure mask (n = 20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention. Results--Deep breathing caused a significant decrease in atelectatic area from 12.3 +/- 7.3% to 10.2 +/- 6.7% (p < 0.0001) of total lung area 1 cm above the diaphragm and from 3.9 +/- 3.5% to 3.3 +/- 3.1% (p < 0.05) 5 cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p < 0.001). The PaO (2) increased by 0.2 kPa (p < 0.05), while PaCO (2) was unchanged in the three groups. Conclusion--A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO (2) were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.

Aged↗

PubMed2003

Test-retest intra-rater reliability of grip force in patients with stroke.

OBJECTIVE: Coefficients of repeatability and reproducibility can be guides in differentiating between real changes and measurement error. The aim was to evaluate test-retest intra-rater reliability of a clinical procedure measuring grip force with Grippit in stroke patients, to assess relationship between grip force of the hands and between sustained and peak grip force. PATIENTS AND METHODS: Eighteen patients were tested using the Grippit at two occasions one hour apart. Each occasion comprised three consecutive trials per hand. RESULTS: The paretic hand needs to score a 50 N change within and between occasions to exceed the measurement error in 95% of the observations, irrespective of calculation method. Expressed by CV(within) the measurement error was 10%. There was no learning or fatigue effect during measuring. There was a wide variation between subjects but the mean ratio between sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84. CONCLUSION: The measurement errors were acceptable and the instrument can be recommended for the use in stroke patients at a department of rehabilitation medicine.

Female↗

PubMed2003

Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation.

OBJECTIVES: The objectives of this prospective study, undertaken in elderly patients with stroke undergoing rehabilitation, were to determine to what extent fall-related self-efficacy changes over time, its relationships to objectively assessed functions and activities, and the predictive capacity of self-efficacy at discharge for activities of daily living 10 months after stroke. METHODS: The study comprised 37 patients, aged 66-89 years. Main outcome measurement instruments were the Falls Efficacy Scale (Swedish version), Berg Balance Scale and Functional Independence Measure. RESULTS: Significant improvements occurred in all these measures from admission to discharge, but patients with low self-efficacy at discharge showed less pronounced improvements than those with high self-efficacy. Falls Efficacy Scale (Swedish version) was closely associated with all other measures and was a more powerful predictor of activities of daily living than the observer-based measures of balance. CONCLUSION: To minimize dependence in activities of daily living, rehabilitation interventions should incorporate self-efficacy enhancement.

Accidental Falls↗

PubMedDate not supplied

Early postmenopausal hormone therapy improves postural balance.

OBJECTIVE: Postmenopausal hormone therapy (HT) results in more substantial reductions in the risk of hip fracture when initiated sooner rather than later after menopause. We studied the effects of postmenopausal HT on the postural balance of postmenopausal women, with further assessment according to the time since they achieved menopause. DESIGN: One hundred women with a mean age of 52.5 years (91 evaluable) were randomly and blindly assigned to either a sequential estradiol-norethisterone acetate regimen or placebo for 3 months, after which all participants received open HT for a further 3 months. Postural balance was assessed as sway velocity using a force platform. RESULTS: After 3 months of HT, sway velocity had improved (decreased) from baseline by 7.0% (P = 0.007 vs baseline and P = 0.038 vs placebo). Continued HT for 6 months further improved sway velocity by 12% from baseline (P < 0.0001) to reach values similar to those historically found in younger women or in postmenopausal women after long-term HT. Closer proximity to menopause and more pronounced increases in serum estradiol values were associated with stronger improvements in sway velocity (P = 0.018 for interaction). HT also improved dizziness (P = 0.016 vs baseline and 0.022 vs placebo). (Nonparametric statistics are used throughout, except for analyses of interaction and dizziness.) CONCLUSIONS: Initiation of HT soon after menopause rapidly improved postural balance to levels normally seen in young women. We suggest that improved postural balance can contribute to the protection against fractures associated with HT and explain the more substantial reduction in hip fracture risk after HT initiated sooner, compared with later, after menopause. Further study is required to confirm these results.

Dizziness↗