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PubMed2005

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients.

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n = 28) and four-strand semitendinosus/gracilis (ST/G group) (n = 31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends, and 59/61 (97%) of the patients returned for the follow-up examination after a period of 26 (23-31) months. The pre-operative assessments in both groups were similar in terms of the Lysholm score, KT-1000 measurements, one-leg-hop test, and knee-walking test. At the 2-year follow-up, the knee-walking test was significantly worse in the BTB group than in the ST/G group (P = 0.003). Furthermore, the knee-walking test was significantly worse at follow-up than pre-operatively in the BTB group (P < 0.005). The corresponding finding was not made in the ST/G group. A reduction in knee laxity compared with the pre-operative assessments was found in both groups. No significant difference in the post-operative knee laxity measurement was found between the groups. A significant increase in activity level and subjective scores was found in both groups compared with pre-operative values, without any significant differences between the groups. Two years after ACL reconstruction, the groups displayed no significant differences in terms of functional outcome and knee laxity. However, the use of ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BTB autografts.

Adolescent↗

PubMed2005

Evaluation of the human activity profile for use with persons with arthritis.

OBJECTIVE: To investigate the reliability, validity, and responsiveness to change of the Human Activity Profile (HAP), a questionnaire measuring physical activity, in persons with arthritis. METHODS: Twenty-eight subjects completed the following self-report questionnaires: HAP, Modified Health Assessment Questionnaire, Medical Outcomes Study 36-Item Short Form Health Survey, and Arthritis Impact Measurement Scale 2. Subjects also completed a submaximal treadmill test, Timed-Stands Test, and 50-Foot Walk Test. Responses on the HAP resulted in 2 scores: the maximum activity score (MAS) and the adjusted activity score (AAS). These scores were correlated with the other tests and examined for test-retest reliability. A subset of subjects participated in a 12-week exercise program, repeating the same tests when finished. RESULTS: For all subjects, the intraclass correlation coefficient (ICC) was 0.76 for the MAS and 0.87 for the AAS. Significant correlations were found between the HAP scores and the questionnaires, submaximal treadmill test, Timed-Stands Test, and 50-Foot Walk Test. In response to 12 weeks of exercise, both HAP scores had an effect size of 0.5, similar to that of the other questionnaires. CONCLUSION: The ICCs demonstrate that the HAP is reliable, and the correlations between the HAP and other questionnaires, Timed-Stands Test, and 50-Foot Walk Test demonstrate that the HAP is a valid measure of physical function in persons with arthritis. The HAP's correlation with maximum oxygen consumption estimated by the treadmill test validates it as a measure of physical activity. The medium effect size (0.5) demonstrates that the HAP is moderately responsive to change. Its ease of use and broad scope make it a valuable assessment tool for persons with arthritis.

Activities of Daily Living↗

PubMed2003

Bedside B-type natriuretic peptide and functional capacity in chronic heart failure.

OBJECTIVES: To determine if B-type natriuretic peptide (BNP) measurement could be useful in determination of functional capacity in patients suffering from chronic heart failure. BACKGROUND: Evaluating functional capacity is a crucial factor in the follow-up of patients with chronic heart failure. There are numerous methods for measuring functional capacity and their relative merits remain under discussion. Clinical classifications are very subjective and other methods are difficult to use in clinical practice. METHODS: We evaluated functional capacity in 151 consecutive patients using the 6-min walk test. All patients were clinically classified using the New York Heart Association (NYHA) classification. We measured BNP plasma levels using a bedside BNP test. RESULTS: Six minute walk test performance decreased through NYHA classes 1 to 4 (469+/-87, 411+/-82, 325+/-83 and 196+/-63 m, respectively, P<0.01) and BNP levels increased through NYHA classes 1 to 4 (26.3+/-7.2, 73+/-13, 401+/-74 and 924+/-84 pg/ml, respectively, P<0.001). There was a significant correlation between 6-min walk test performance and BNP plasma levels (R=0.69 P<0.001) and a weaker correlation between BNP and left ventricular ejection fraction (R=0.45 P<0.04). In some patients there was a mismatch between NYHA classification and 6-min walk test performance. In all cases BNP could correct the clinical estimation of functional capacity. When we divided the patients into three sub-groups within each NYHA class, we showed that using BNP could better define functional capacity in patients suffering from chronic heart failure in NYHA classes I to III. CONCLUSION: The measurement of BNP levels thus usefully supplements the clinical examination. The existence of bedside BNP testing methods facilitates its use in routine clinical practice. It also permits easier follow-up of patients with chronic heart failure.

Adolescent↗

PubMed1992

Portable liquid oxygen and exercise ability in severe respiratory disability.

BACKGROUND: The development of portable liquid oxygen systems, capable of delivering high flow rate oxygen for long periods, justifies reassessment of the value of supplemental oxygen to aid exercise tolerance in patients with chronic respiratory insufficiency. The type of exercise test and the low oxygen flow rates previously used may account for the variable and often poor responses to supplemental oxygen reported in earlier studies. METHODS: The walking tolerance of 30 patients with severe respiratory disability was measured while they were breathing air and increasing doses of supplemental oxygen (2, 4, 6 1/min) by using both the standard six minute walking test and an endurance walking test. To assess the initial learning effect and repeatability of the walking tests, three six minute walks and three endurance walks were performed on day 1 and a single walk of each type on days 2, 3, and 14. In addition, oxygen dosing studies were performed on days 2 and 3 after the initial baseline walking tests. Each dosing study comprised four endurance walking tests or four six minute walking tests with patients breathing either air at a flow rate of 4 1/min from a portable cylinder or supplemental oxygen at a flow rate of 2, 4 or 6 1/min from a portable liquid oxygen supply. The order of the tests was randomised. Walking distance with each flow rate of oxygen was compared with walking distance with patients carrying cylinder air and for the initial unburdened walks. Breathlessness was assessed by visual analogue scoring on completion of each walk. RESULTS: Exercise ability and breathlessness were significantly improved with supplemental oxygen and this benefit outweighed the reduction in performance resulting from carrying the portable device. Supplemental oxygen at flow rates of 2, 4, and 6 1/min increased mean endurance walking distances by 37.9%, 67.7% and 85.0% and six minute walking distances by 19.2%, 34.5%, and 36.3% by comparison with distances when the patient was carrying air with a flow rate of 4 1/min. The additional work of carrying the portable gas supply reduced endurance walking distance by 22.2% and six minute walking distance by 14.1% by comparison with a baseline unburdened walk. Comparison of supplemental oxygen at 2, 4, and 6 1/min with the baseline unburdened performance showed increased endurance walking distances of 7.3%, 30.4%, and 43.9% and six minute walking distances of 2.3%, 15.5%, and 17.0%. Walking distance was increased by more than 50% by comparison with an unburdened walk in seven patients with the endurance walking test but in only three patients with the six minute walking test. The benefit was similar in patients with obstructive and with interstitial lung disease. Individual responses were variable and only desaturation during the baseline walk in patients with obstructive lung disease had any predictive value for benefit with oxygen. CONCLUSION: As there was no clear relation between response to oxygen therapy and the patients' characteristics, assessment for supplemental oxygen therapy will depend on exercise testing. It is suggested that portable oxygen should be considered only if a patient shows a 50% improvement in exercise ability with high flow rate oxygen (4-6 1/min) by comparison with an unburdened walk.

Ambulatory Care↗

PubMed2000

Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention.

BACKGROUND AND PURPOSE: The reliability and responsiveness of 2 physical performance measures were assessed in this nonrandomized, controlled pilot exercise intervention. SUBJECTS: Forty-five older individuals with mobility impairment (mean age=77.9 years, SD=5.9, range=70-92) were sequentially assigned to participate in an exercise program (intervention group) or to a control group. METHODS: The intervention group performed exercise 3 times a week for 12 weeks that targeted muscle force, endurance, balance, and flexibility. Outcome measures were the 8-item Physical Performance Test (PPT-8) and the 6-minute walk test. Test-retest reliability and responsiveness indexes were determined for both tests; interrater reliability was measured for the PPT-8. RESULTS: The intraclass correlation coefficient for interrater reliability for the PPT-8 was. 96. Intraclass correlation coefficients for test-retest reliability were.88 for the PPT-8 and.93 for the 6-minute walk test. The intervention group improved 2.4 points and the control group improved 0.7 point on the PPT-8, as compared with baseline measurements. There was no change in 6-minute walk test distance in the intervention group when compared with the control group. The responsiveness index was.8 for the PPT-8 and.6 for the 6-minute walk test. CONCLUSION AND DISCUSSION: Measurements for both the PPT-8 and the 6-minute walk test appeared to be highly reliable. The PPT-8 was more responsive than the 6-minute walk test to change in performance expected with this functional training intervention.

Aged↗

PubMed2005

A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction.

PURPOSE: The aim of this study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB group), 3-strand semitendinosus (ST group), or 4-strand semitendinosus/gracilis (ST/G group) autografts. TYPE OF STUDY: Prospective randomized trial. METHODS: A randomized series of 134 patients, all with unilateral ACL rupture was included in the study. In all 3 groups, interference screw fixation of the graft was used at both ends and 125 of 134 (93%) of the patients returned for the follow-up examination after 26 months (range, 20 to 43 months). The preoperative assessments in all 3 groups were similar in terms of gender, Tegner activity level, Lysholm score, KT-1000 measurements, 1-leg hop test, and the knee-walking test. RESULTS: At follow-up, the knee-walking test was significantly worse in the BPTB group than in the ST group (P = .0004) and ST/G group (P < .0001). Furthermore, the knee-walking test was significantly worse at follow-up than preoperatively in the BPTB group (P < .0001). The corresponding findings were not made in the other 2 groups. A significant reduction in knee laxity and an increase in activity level compared with the preoperative assessments were found in all 3 groups, without any significant differences between the groups. CONCLUSIONS: Two years after ACL reconstruction, the use of ST and ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BPTB autografts. However, in terms of functional outcome and knee laxity, the groups displayed no significant differences. LEVEL OF EVIDENCE: Level I.

Adolescent↗

PubMed2006

Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee.

BACKGROUND AND PURPOSE: Pain and physical function are core outcome measures for people with osteoarthritis, and self-report questionnaires have been the preferred assessment method. There is evidence suggesting that self-reports of physical function represent what people experience when performing activities rather than their ability to perform activities. The purpose of this study was to examine the factorial validity of performance-specific assessments of pain and function. SUBJECTS: The sample consisted of 177 participants who had osteoarthritis of the hip (n=81) or knee (n=96) and who were awaiting total joint arthroplasty. METHODS: Through a cross-sectional design, participants performed 4 performance activities (self-paced walk test, stair test, Timed "Up & Go" Test, and Six-Minute Walk Test). OUTCOMES: were time or distance (function) and pain ratings obtained immediately after each activity. The authors conceptualized 2 correlated factors, with pain items loading uniquely on 1 factor and functional items loading on the second factor, and uncorrelated error terms. Confirmatory factor analysis was applied. RESULTS: Initial analysis yielded results consistent with the conceptualized model in this study with the exception of a nonzero correlation between the stair pain and function error terms. Dropping the stair test provided results consistent with the conceptualized model. DISCUSSION AND CONCLUSION: Given the limitations of self-report alone as a method of obtaining reasonably distinct assessments of pain and function, the extent to which performance-specific assessments could accomplish this goal was examined in this study. It was found that collectively the walk test, Timed "Up & Go" Test, and Six-Minute Walk Test yielded 2 factors consistent with the health concepts of pain and function. The authors believe that the application of these tests may provide clinicians and clinical researchers with more distinct impressions of pain and function that complement information from self-report measures.

Aged↗

PubMed2005

Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer.

BACKGROUND: The relationship between the shuttle walk test and peak oxygen consumption in patients with lung cancer has not previously been reported. A study was undertaken to examine this relationship in patients referred for lung cancer surgery to test the hypothesis that the shuttle walk test would be useful in this clinical setting. METHODS: 125 consecutive patients with potentially operable lung cancer were prospectively recruited. Each performed same day shuttle walking and treadmill walking tests. RESULTS: Shuttle walk distances ranged from 104 m to 1020 m and peak oxygen consumption ranged from 9 to 35 ml/kg/min. The shuttle walk distance significantly correlated with peak oxygen consumption (r = 0.67, p<0.001). All 55 patients who achieved more than 400 m on the shuttle test had a peak oxygen consumption of at least 15 ml/kg/min. Seventy of 125 patients failed to achieve 400 m on the shuttle walk test; in 22 of these the peak oxygen consumption was less than 15 ml/kg/min. Nine of 17 patients who achieved less than 250 m had a peak oxygen consumption of more than 15 ml/kg/min. CONCLUSION: The shuttle walk is a useful exercise test to assess potentially operable lung cancer patients with borderline lung function. However, it tends to underestimate exercise capacity at the lower range compared with peak oxygen consumption. Our data suggest that patients achieving 400 m on the shuttle walk test do not require formal measurement of oxygen consumption. In patients failing to achieve this distance we recommend assessment of peak oxygen consumption, particularly in those unable to walk 250 m, because a considerable proportion would still qualify for surgery as they had an acceptable peak oxygen consumption.

Adult↗

PubMed1992

Effects of long-term oxygen therapy due to portable liquid oxygen tanks in disabled malnourished chronic obstructive pulmonary disease patients with borderline hypoxemia. Aim of the study and methods.

Long-term oxygen therapy by light-weight portable liquid oxygen systems may improve the degree of functional handicap in patients with severe chronic obstructive pulmonary disease (COPD), borderline hypoxemia or exertional hypoxemia, limited walking distance and malnutrition who do not fulfill the Nocturnal Oxygen Therapy Trial criteria for long-term oxygen therapy. The paper will discuss a proposal for a study plan to test this hypothesis. After a period of stabilization, the methods of measurements include functional tests (walking tests, cycle exercise test [FiO2 21, 35%], baseline measurements of pulmonary function, arterial blood gases, lactate, right heart catheterization, radionuclide ventriculography). The study is designed as a multicentric, controlled, parallel and randomized test for oxygen treatment and no treatment by oxygen. The main outcome will be tested on the results of functional tests (walking tests, VO2max) to demonstrate the possible benefit of long-term oxygen therapy in borderline hypoxemic COPD patients.

Chronic Disease↗

PubMed2006

Measuring patients' perceptions on their functional abilities: validation of the Haemophilia Activities List.

Recently, the Haemophilia Activities List (HAL), a haemophilia-specific self-assessment questionnaire to assess a patient's self-perceived functional ability, was introduced and a limited pilot study warranted its further development. The present study finalizes the HAL and assesses the convergent and construct validity, as well as the internal consistency of its definitive version. Three questionnaires (HAL, Dutch-Arthritis Impact Measurement Scales 2 and the Impact on Participation and Autonomy questionnaire) were completed by 127 patients with severe haemophilia (<1% clotting activity), as well as four performance tests (button test, 50 metre walking test, timed-up-and-go test and figure-8 walking test). After removal of 15 non-informative items from the provisional HAL, three components within the questionnaire were identified (upper extremity activities, basic lower extremity activities and complex lower extremity activities). The internal consistency of these components was high (Cronbach's alpha = 0.93-0.95), as was internal consistency for the seven domains of the HAL (alpha = 0.61-0.96). The convergent validity of the HAL when compared to the other two questionnaires was good (r = 0.47-0.84). The construct validity of the HAL when compared to the four performance tests was generally lower (r = 0.23-0.77). The final version of the HAL has good internal consistency and convergent validity and gives the clinician insight into a patient's self-perceived ability to perform activities of daily life. It is likely that self-assessment instruments (questionnaires) and performance tests consider different concepts of functional health status and it is therefore recommended that both types are included when clinicians assess a patient's functional abilities.

Activities of Daily Living↗

PubMed1989

The self-selected walking pace test and beta blockade.

The self-selected walking pace test is a safe, simple and inexpensive test to measure an individual's perception of walking speed and is more strongly related to maximal oxygen uptake than to age. This study was carried out to determine whether beta blockade, which commonly causes fatigue, would affect the test. Twenty-three clinically healthy men with a mean age of 43 years completed the test both on and off 80 mg long-acting oxprenolol daily, a beta blocking drug with partial agonist activity. The men walked 80 m at three self-selected speeds (rather slow, normal and rather fast). There was a significant reduction in heart rate on the drug. The walking speed at the three paces on and off medication were 1.08 ms-1 and 1.07 ms-1 (slow), 1.32 ms-1 and 1.33 ms-1 (normal) and 1.63 ms-1 and 1.61 ms-1 (fast). None of these differences reached statistical significance. The stride length also did not change. It is concluded that beta blocking medication does not interfere with the self-selected walking pace test.

Adrenergic beta-Antagonists↗

PubMed2005

The L test of functional mobility: measurement properties of a modified version of the timed "up & go" test designed for people with lower-limb amputations.

BACKGROUND AND PURPOSE: Walk tests provide essential outcome information when assessing ambulation of individuals with lower-limb amputation and a prosthetic device. Existing tests have limitations such as ceiling effects or insufficient challenge. The objective of this study was to assess the reliability and validity of data for a clinical measure of basic mobility, the L Test of Functional Mobility (L Test). SUBJECTS: For this methodological study, 93 people with unilateral amputations (74% transtibial, 26% transfemoral; 78% male, 22% female; mean age=55.9 years) were consecutively recruited from an outpatient clinic. Twenty-seven subjects returned for retesting. METHODS: To assess concurrent validity, subjects completed the L Test, Timed "Up & Go" Test (TUG), 10-Meter Walk Test, and 2-Minute Walk Test, followed by the Activities-specific Balance Confidence scale, Frenchay Activities Index (FAI), and mobility subscale of the Prosthetic Evaluation Questionnaire (PEQ-MS). Amputation cause and level, walking aid use, automatic stepping, and age variables were used to assess discriminant validity. RESULTS: Intraclass correlation coefficients were .96 for interrater reliability and .97 for intrarater reliability, and minimal bias existed upon retesting. The magnitude of concurrent validity correlations (r) was very high between the L Test data and data for other walk tests and fair to moderate between the L Test data and data for self-report measures. The L Test discriminated between all groups as hypothesized. DISCUSSION AND CONCLUSION: The L Test is a 20-m test of basic mobility skills that includes 2 transfers and 4 turns. It demonstrated excellent measurement properties in this study.

Adult↗

PubMed1997

Bilateral versus single lung transplantation for chronic obstructive pulmonary disease.

OBJECTIVE: Traditionally, despite ventilation/perfusion mismatch, single lung transplantation has been the mainstay for end-stage chronic obstructive pulmonary disease. We tested the hypothesis that bilateral sequential lung transplantation has better short- and intermediate-term results than single lung transplantation for chronic obstructive pulmonary disease. METHODS: One hundred twenty-six consecutive lung transplants have been performed from November 1991 to March 1996. Seventy-six have been for chronic obstructive pulmonary disease. The diagnosis of this disease includes emphysema (80.3%), alpha 1-antitrypsin deficiency (9.2%), lymphangioleiomyomatosis (7.9%), and obliterative bronchiolitis (2.6%). Twenty-nine transplants have been bilateral and 47 have been single. Mean age was 55.3 for patients having single lung transplantation and 48.8 for those having bilateral lung transplantation (p = 0.001). The distribution of the diagnoses was similar between the two groups. At 6 months, there were 29 survivors of single lung transplantation and 20 survivors of bilateral lung transplantation, with complete data for evaluation. Pulmonary function tests and 6-minute walk tests were evaluated at a mean of 15.4 and 12.8 months after transplantation, respectively. RESULTS: Sixty-day mortality was 21.3% for single lung transplantation versus only 3.45% for bilateral lung transplantation (p = 0.03). Additionally, Kaplan-Meier analysis revealed 1- and 2-year survivals of 71.1% and 63.3% for single lung transplantation versus 90% and 90% for bilateral lung transplantation, respectively. Multiple major morbidities were analyzed. Primary graft failure was significantly reduced in the bilateral group (p = 0.049). Both 6-minute walk tests and forced expiratory volume in 1 second were improved from baseline by both single and bilateral lung transplantation (p = 0.001). CONCLUSIONS: Bilateral lung transplantation improves forced expiratory volume in 1 second and 6-minute walk tests significantly over single lung transplantation (p < 0.0001). Both perioperative mortality and Kaplan-Meier survival (to 3 years) are significantly improved when bilateral rather than single lung transplantation is used for chronic obstructive pulmonary disease in our series (p < 0.05). This is probably the result of significantly reduced primary graft failure.

Aged↗

PubMed2001

Noninvasive mechanical ventilation improves endurance performance in patients with chronic respiratory failure due to thoracic restriction.

OBJECTIVE: Treatment with noninvasive mechanical ventilation (NMV) alleviates hypoventilation and improves gas exchange in patients with chronic respiratory failure (CRF) due to thoracic restriction. However, little is known about the effects of NMV on respiratory and peripheral muscle endurance. DESIGN: Prospective case-control study. SUBJECTS: Ten patients in clinically stable condition (age, 53.5 +/- 8.2 years [mean +/- SD]) with mild-to-moderate CRF due to thoracic restriction (PCO(2) between 45 mm Hg and 55 mm Hg) were treated with NMV during the night for 3 months. Ten matched patients (age, 52.2 +/- 9.5 years) receiving 3 months of normal care without NMV served as a control group. INTERVENTION AND MEASUREMENTS: After a 3-day period of familiarization with the endurance tests, all patients performed a baseline preintervention inspiratory threshold loading test, cycle ergometer test, and shuttle walking test on the same day. The endurance tests were then repeated following the 3-month intervention period. RESULTS: NMV was used on average for 7.1 +/- 0.9 h/d during the 3-month period. There was a significant improvement in endurance time (p < 0.0001) in all three endurance tests in the NMV group compared with the control group. In the NMV group, endurance time increased by 278 +/- 269% during the inspiratory threshold loading test, by 176 +/- 159% during the cycle ergometer test, and by 32 +/- 22% during the shuttle walking test. Significant improvements (p < 0.01) in both PO(2) and PCO(2) were also observed in the NMV group but not in the control group. CONCLUSIONS: Three months of treatment with NMV increases both respiratory and peripheral muscle endurance in patients with CRF due to thoracic restriction.

Case-Control Studies↗

PubMed2001

Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice?

AIMS: The 6-min walk test has been incorporated into studies on the efficacy of new therapies and into prognostic stratification for chronic heart failure patients. Firm conclusions on the usefulness of the test in clinical practice are still lacking. The aim of this study was to investigate (1) the correlation between walk test performance and standard indices of cardiac function and exercise capacity, and (2) the prognostic value of the walk test with respect to peak VO2 and NYHA class. METHODS AND RESULTS: Three hundred and fifteen chronic heart failure patients (age: 53+/-9 years, NYHA class: II (182), III (133)) underwent a functional evaluation and a 6-min walk test. Of these, 270 were followed-up for a minimum of 6 months (mean 387+/-177 days). Walked distance was 396+/-92 m. There was no significant correlation between distance walked and central haemodynamic data. Functional capacity, as measured by ergometry, correlated moderately with distance walked (duration: r=0.48, peak VO2: r=0.59, anaerobic threshold: r=0.54; all P<0.001). During follow-up, 46 patients died from cardiovascular causes and 12 were urgently transplanted. Either of these events were considered end points of the study. Survival analysis was performed from a continuous walk test and peak VO2 measurements or after categorization of (a) quartile segmentation, (b) cut-off points from the literature and (c) thresholds from receiver operating characteristic curves. At univariate survival analysis (Cox regression), the association of the walk test with survival was of significance (P=0.03, continuous variable), or borderline significance (0.05< or =P< or =0.1, after categorization). Peak VO2 was always significant, independent of the scale used (0.005< or =P< or =0.03). The strongest association was found for NYHA class (P<0.001), which showed the highest sensitivity and specificity for the prediction of the event (0.64 and 0.65, respectively). When walk test performance, continuous or categorized, was entered into a multivariate model with NYHA class or peak VO2, it lost any significant association with survival (P>0.76 in all models with NYHA class and P>0.27 in all models with peak VO2). CONCLUSION: In moderate-to-severe chronic heart failure patients, the 6-min walk test is not related to cardiac function and only moderately related to exercise capacity. Walking performance does not provide prognostic information which can complement or substitute for that provided by peak VO2 or NYHA class. Hence the test is of limited usefulness as a decisional indicator in clinical practice.

Adult↗

PubMed2005

Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial.

OBJECTIVE: To determine whether automated locomotor training with a driven-gait orthosis (DGO) can increase functional mobility in people with chronic, motor incomplete spinal cord injury (SCI). DESIGN: Repeated assessment of the same patients or single-case experimental A-B design. SETTING: Research units of rehabilitation hospitals in Chicago; Heidelberg, Germany; and Basel and Zurich, Switzerland. PARTICIPANTS: Twenty patients with a chronic (>2 y postinjury), motor incomplete SCI, classified by the American Spinal Injury Association (ASIA) Impairment Scale with ASIA grades C (n=9) and D (n=11) injury. Most patients (n=16) were ambulatory before locomotor training. INTERVENTION: Locomotor training was provided using robotic-assisted, body-weight-supported treadmill training 3 to 5 times a week over 8 weeks. Single training sessions lasted up to 45 minutes of total walking time, with gait speed between .42 and .69 m/s and body-weight unloading as low as possible (mean +/- standard deviation, 37%+/-17%). MAIN OUTCOME MEASURES: Primary outcome measures included the 10-meter walk test, the 6-minute walk test, the Timed Up & Go test, and the Walking Index for Spinal Cord Injury-II tests. Secondary measures included lower-extremity motor scores and spastic motor behaviors to assess their potential contribution to changes in locomotor function. All subjects were tested before, during, and after training. RESULTS: Locomotor training using the DGO resulted in significant improvements in the subjects' gait velocity, endurance, and performance of functional tasks. There were no significant changes in the requirement of walking aids, orthoses, or external physical assistance. There was no correlation between improvements in walking speed or changes in muscle strength or spastic motor behaviors. CONCLUSIONS: Intensive locomotor training on a treadmill with the assistance of a DGO results in improved overground walking.

Adolescent↗

PubMed1998

Oral toxicity of bis(2-ethylhexyl) phthalate during pregnancy and suckling in the Long-Evans rat.

Bis(2-ethylhexyl) phthalate (DEHP) is a compound widely used in plastics technology to impart flexibility to rigid polymers. We sought to determine whether the oral exposure of female rats to DEHP during gestation and suckling produces alterations in the litter. Female rats were exposed to different concentrations of DEHP suspended in drinking water (32.5 and 325 microl/litre) from day 1 of pregnancy to day 21 after delivery. Pup body weight gain and kidney, liver and testes weight was measured at different times (21, 28, 35, 42 and 56 days) after birth. Plasma concentrations of DEHP and histopathological alterations in kidneys, liver and testes were also studied. In addition, the ability of female pups (1 month of age) to perform a learned avoidance test, the 'beam walking' test, was evaluated. Perinatal exposure to DEHP produced no statistically significant changes in the body weight gain of offspring. Conversely, it produced a significant decrease in kidney and testes relative weight (organ/body weight) with a significant increase in relative liver weight. Signs of histological damage in kidneys, liver, and particularly testes, were observed. Pups exposed perinatally to the highest concentration of DEHP elicited a significant increase in the time necessary to perform the beam walking test.

Administration, Oral↗

PubMed2002

Prognostic value of 6-minute walk corridor testing in women with mild to moderate heart failure.

BACKGROUND: The prognostic usefulness of 6-min walk testing (6 MWT) was reported both in patients with severe as well as in those with moderate systolic heart failure. However, more than 80% of the patients investigated were males and the value of the test had never been separately evaluated in women. The aim of the present study was to prospectively assess the prognostic value of 6 MWT in women with mild to moderate congestive heart failure. METHODS: Ninety-five women with congestive heart failure (mean age 63.9 years) were enrolled in the study. All patients were followed for a mean period of 38 months in order to assess the event-free survival (death, heart transplantation). The prognostic value of the distance walked during 6 MWT was compared to the NYHA functional classification and to the echocardiographically-derived indexes of heart function. The results were then compared with those of a group of 129 male patients with similar clinical characteristics. RESULTS: Thirty-four female patients (36%) died of cardiovascular causes and 2 underwent heart transplantation. In the same period, the overall survival in male patients was 74% and 3 patients were successfully transplanted. Regardless of gender, the 3-year event-free survival was significantly lower in patients who walked < 300 m during 6 MWT compared to that observed in those with an intermediate (300-400 m) or high level (> 400 m) of performance. At univariate and multivariate analyses, the NYHA class and the distance covered during 6 MWT were significantly related to survival in both genders while with regard to the left ventricular ejection fraction, this relationship was observed only in women. The patient's age was not related to the mortality. CONCLUSIONS: A distance < 300 m during 6 MWT identifies a subgroup at high risk of death even in female patients with mild to moderate heart failure.

Adult↗