[Critical quality standards for extramural nursing care].
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Biomedical subjects
Publications and source records attributed to K Huisman.
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Thirty-nine subjects, mean age 72 (range 52 to 89), with a leg amputation because of peripheral vascular disease performed graded exercise testing at the start of their prosthetic training program. Their walking performance at the end of the program was assessed and compared with the test findings. They had a history and rest electrocardiogram (ECG) examination which revealed cardiac problems in 75% of the patients. The exercise test was performed on a specially designed arm ergometer permitting coordinated exercise of arm and trunk muscles. Cardiac condition was judged by the achieved peak heart rate (mean 125 +/- 3.8 beats per minute) and observed ECG abnormalities. In only three patients exercise-induced ECG abnormalities were found at peak workload. The mean peak workload was 52 +/- 1.9W. It was concluded from these results that the average physical and cardiac condition is poor in vascular leg amputees. In 34 patients (87%) the prosthetic training was successful. Fourteen patients needed a walking frame and twenty could walk without a walking frame. The probability of achieving walking without a walking frame was 70% in patients with peak workload above 45W and 30% in those with peak workload lower than 45W.
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Patients unable to perform heavy leg exercises cannot perform standard exercise ECG tests using bicycle or treadmill ergometry. A rowing ergometer was developed to enable an electrocardiographic stress test. Sixteen ambulatory patients with documented coronary insufficiency performed graded exercises. Comparison revealed no significant differences in several areas. Eleven patients with above-knee amputations, inevitable because of peripheral vascular disease, were able to perform rowing exercise only. This can result in cardiac loads adequate for diagnosis of coronary heart disease. No patient experienced difficulties with rowing. Rowing exercise can be a suitable alternative to bicycle exercise for the evaluation of coronary artery disease.
Thirty-nine patients undergoing rehabilitation following leg amputation were examined to determine cardiac status, which included clinical examination and a graded exercise ECG test, using an arm ergometer. Results were compared to final walking ability. It was found that the cardiac status of these patients was generally poor and that the exercise ECG results did co-relate to walking ability.