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PubMed2005

The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India.

The aim of this study was to find predictors of neuropathy and reactions, determine the most sensitive methods for detecting peripheral neuropathy, study the pathogenesis of neuropathy and reactions and create a bank of specimen, backed up by detailed clinical documentation. A multi-centre cohort study of 303 multibacillary leprosy patients in Northern India was followed for 2 years. All newly registered MB patients requiring a full course of MDT, who were smear positive and/or had six or more skin lesions and/or had two or more nerve trunks involved, were eligible. A detailed history was taken and physical and neurological examinations were performed. Nerve function was assessed at each visit with nerve conduction testing, warm and cold detection thresholds, vibrometry, dynamometry, monofilaments and voluntary muscle testing. Because the latter two are widely used in leprosy clinics, they were used as 'gold standard' for sensory and motor impairment. Other outcome events were type 1 and 2 reactions and neuritis. All subjects had a skin biopsy at registration, repeated at the time of an outcome event, along with a nerve biopsy. These were examined using a variety of immunohistological techniques. Blood sampling for serological testing was done at every 4-weekly clinic visit. At diagnosis, 115 patients had an outcome event of recent onset. Many people had skin lesions overlying a major nerve trunk, which were shown to be significantly associated with an increased of sensory or motor impairment. The most important adjusted odds ratios for motor impairment were, facial 4.5 (1.3-16) and ulnar 3.5 (1.0-8.5); for sensory impairment they were, ulnar 2.9 (1.3-6.5), median 3.6 (1.1-12) and posterior tibial 4.0 (1.8-8.7). Nerve enlargement was found in 94% of patients, while only 24% and 3% had paraesthesia and nerve tenderness on palpation, respectively. These increased the risk of reactions only marginally. Seven subjects had abnormal tendon reflexes and seven abnormal joint position sense. In all but one case, these impairments were accompanied by abnormalities in two or more other nerve function tests and thus seemed to indicate more severe neuropathy. At diagnosis, 38% of a cohort of newly diagnosed MB leprosy patients had recent or new reactions or nerve damage at the time of intake into the study. The main risk factor for neuropathy found in this baseline analysis was the presence of skin lesions overlying nerve trunks. They increased the risk of sensory or motor impairment in the concerned nerve by 3-4 times. For some nerves, reactional signs in the lesions further increased this risk to 6-8 times the risk of those without such lesions. Patients with skin lesions overlying peripheral nerve trunks should be carefully monitored for development of sensory or motor impairment.

Adolescent↗

PubMed2005

[Characteristics of non-symptomatic chronic obstructive pulmonary disease patients].

OBJECTIVE: To evaluate the epidemiological characteristics of non-symptomatic chronic obstructive pulmonary disease (COPD) patients in a rural area in Beijing. METHODS: The data of 1,624 people aged more than 40 in 5 villages in Yanqing county in Beijing were collected. Information of medical history and symptom were obtained, and physical examination and lung function test were performed. RESULTS: The prevalence of COPD was 9.1% (148/1 624) in this area. In these 148 patients, 62 (42%) were non-symptomatic and 86 (58%) were symptomatic, the prevalence of non-symptomatic COPD being 3.8% (62/1 624). There was no statistical difference in the sex, age, occupation, marriage status, education level and smoking index between the symptomatic and the non-symptomatic groups (all P > 0.05). The forced expired volume in one second (FEV(1)) and FEV(1)% predicted were lower in the symptomatic group [(1.3 +/- 0.7) L, (61 +/- 23)%] than those in the non-symptomatic group [(1.5 +/- 0.6) L, (70 +/- 22)%; all P < 0.05]. CONCLUSIONS: The prevalence of COPD was high in this area with a high percentage of non-symptomatic patients. The COPD prevalence might be underestimated due to the symptom free patients.

Adult↗

PubMed1990

[Ergometric assessment of functional performance deficit in psychosomatic patients].

Patients with marked loss of physical and psychological fitness and cardiovascular symptoms without objective findings often pose diagnostic problems. Fifteen patients hospitalized for general incapacity with normal cardiovascular findings were tested in the ECG laboratory on a conventional bicycle ergometer and in a more natural environment climbing stairs in a windowed staircase. Work capacity in the two tests was compared. Eight out of fifteen patients achieved only 40% of their age and weight adjusted nominal value on the bicycle ergometer, while they were fully efficient on the staircase (= discordant result). Four patients reached their expected nominal values in both tests. The performance of three patients was much lower than expected, more markedly so in the laboratory situation on the bicycle. All patients' performance was limited by central nervous incapacitating cardiovascular symptoms. Diagnosis of psychosomatic situational cardiovascular insufficiency in the absence of pathological findings can be substantiated by comparing exercise tests in a physiological and non-physiological environment. This is helpful to both patient and physician by facilitating a more precise diagnostic process and documentation of therapeutic improvement.

Adult↗

PubMed1988

[Pulmonary gas exchange and hemodynamics].

The purpose of investigating pulmonary gas exchange and pulmonary circulation is detection of functional abnormalities of the cardiorespiratory system. Other than clinical features, a number of specialized methods used today are of high accuracy and therefore serve to recognize early disorders and to quantify functional impairment. In clinical practice arterial blood gas analysis and the measurement of diffusing capacity are sensitive screening tests for patients with acute and chronic respiratory failure and thus have important diagnostic and therapeutic implications (e.g. indication for oxygen therapy, mechanical ventilation, chest physiotherapy, specific drug regimen etc.). Spiroergometry and right heart catheterization, as the more invasive methods, are useful tests in evaluating overall cardiopulmonary function to detect limiting factors in physical performance (e.g. thoracic surgery, occupational diseases, sport medicine).

Blood Gas Analysis↗

PubMed1986

L-carnitine and rehabilitative respiratory physiokinesitherapy: metabolic and ventilatory response in chronic respiratory insufficiency.

Twelve subjects suffering from type A chronic respiratory insufficiency were admitted to a double blind, randomized, placebo-controlled trial. The aim of the trial was the evaluation of the effects of the oral administration of L-carnitine, 2 g twice daily for 15 days, on the metabolic and respiratory parameters, at the mild physical work load involved in rehabilitative respiratory physiokinesitherapy. As previously reported, treatment with L-carnitine prevents the metabolic acidosis and hyperventilation caused by physiokinesitherapy in patients with chronic respiratory insufficiency. In correlation with the metabolic role of L-carnitine, the results of this trial suggest that L-carnitine is an essential training-like metabolic factor, particularly when the physical performance is impaired by inadequate respiratory function.

Blood Gas Analysis↗

PubMed1983

Double-blind evaluation of methylprednisolone versus placebo for acute asthma episodes.

Twenty-eight children with persistent bronchospasm after outpatient therapy were treated for eight days with methylprednisolone or placebo in a prerandomized double-blind manner, in addition to treatment with optimal oral bronchodilators. At follow-up visits 1, 7, and 14 days after onset of therapy, a history was taken and physical examination and pulmonary function tests were performed. Initially and on the 14th day, patients underwent cosyntropin tests of adrenal function. Patients kept daily peak flow charts. Both groups improved with time. However, by 24 hours after starting methylprednisolone therapy, the placebo group continued to show reversibility after isoproterenol inhalation whereas the methylprednisolone group did not. By day 7 there were significantly more patients with normal 1-second forced expiratory volume (FEV1) and forced expiratory flow in the middle half of the forced vital capacity (FEF25-75%) in the methylprednisolone group and mean FEF25-75% was significantly higher for this group (P less than .02). By day 14, six days after finishing treatment with the study drugs, more patients in the placebo group had residual wheezing, but pulmonary function tests were now similar for the two groups. Although both groups showed a decline in cosyntropin responsiveness on day 14 compared with day 1, there was no difference between the steroid- and placebo-treated patients. This study proves that short-term corticosteroid therapy will accelerate resolution of moderately severe and severe-acute attacks of asthma without significant suppression of adrenal function.

Adrenal Glands↗

PubMed1997

[Therapy of heart failure. II. Therapy of chronic heart failure].

Current medical treatment of chronic heart failure makes use of a combination of diuretics, cardiac glycosides and ACE inhibitors. The latter have improved the chances of survival of patients with chronic cardiac insufficiency. The combination of hydralazine hydrochloride and isosorbide dinitrate also improves survival, but direct comparison of both regimens provided evidence for a less favourable effect than that of the ACE inhibitors. Inhibition of neuroendocrine activation has been demonstrated only for ACE inhibitors and cardiac glycosides. The use of beta blockers represents a new therapeutic strategy that over the long term improves cardiomyocyte function, cardiac output at rest, and physical performance. For this indication, however, beta blockers should be used with extreme caution and at very low initial doses. New approaches in the area of clinical research are, for example, calcium sensitizers, modulators of intracellular calcium and/or sodium homeostasis, imidazolin receptor antagonists with an action on the central nervous system and AT1 receptor antagonists.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1997

[Rehabilitation of cystic fibrosis in adulthood].

By the example of 2 adult patients with cystic fibrosis (CF) problems of pulmonary manifestation of CF and its complications are discussed. In both patients disease manifested late. Life expectancy of CF-patients has markedly increased over the last decades. In the adult distinct complications appear more often such as exacerbation of bronchitis due to pseudomonas aeruginosa, colonisation of air ways by Burkholderia cepacia or by atypical mycobacteria, development of allergic bronchopulmonary aspergillosis, bronchiectases and spontaneous pneumothorax. Today, even in adults with chronic bronchitis of unknown origin the possibility of CF has to be considered. Optimized treatment under clinical conditions, in combination with a physical training program and a diet rich in calories will ameliorate subjective physical performance as well as objective pulmonary function and work capacity. Regular rehabilitation programs contribute to better compliance. In patients with CF direct transition from pediatric to pneumologic/internistic treatment for adults is mandatory in order to optimize expectancy and quality of life.

Adult↗

PubMed2006

A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children.

OBJECTIVE: Wrist buckle fractures are a frequent reason for emergency department visits. Although textbooks recommend 2 to 4 weeks of immobilization in a short arm cast, management varies. Treatment with both casts and splints is common, and length of immobilization varies. The objective was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks. METHODS: This was a randomized, controlled trial in the emergency department of an academic, tertiary care children's hospital. Participants were children 6 to 15 years of age with distal radius and/or ulna buckle fractures who were randomly assigned to treatment with a short arm cast for 3 weeks or a removable splint. Cast removal was at 3 weeks. A validated self-reported outcome tool, the Activities Scales for Kids performance version (ASKp), was used to measure physical functioning over a 4-week period. The main outcome was the ASKp score at 14 days postinjury. RESULTS: We randomly assigned 113 patients, and 87 were included in the final analysis: 42 in the splint group and 45 in the cast group. Study groups were similar in age, gender, bone fractured, and dominant hand injured. There were significant differences in ASKp score at day 14 and change in ASKp from baseline at days 14 and 20, indicating better functioning in the splint group. Splinted children had less difficulty with bathing throughout the entire study. There were no significant differences in pain between groups as measured by visual analog scale. There were no refractures. CONCLUSIONS: Children treated with removable splinting have better physical functioning and less difficulty with activities than those treated with a cast.

Adolescent↗

PubMed2005

Genes and human elite athletic performance.

Physical fitness is a complex phenotype influenced by a myriad of environmental and genetic factors, and variation in human physical performance and athletic ability has long been recognised as having a strong heritable component. Recently, the development of technology for rapid DNA sequencing and genotyping has allowed the identification of some of the individual genetic variations that contribute to athletic performance. This review will examine the evidence that has accumulated over the last three decades for a strong genetic influence on human physical performance, with an emphasis on two sets of physical traits, viz. cardiorespiratory and skeletal muscle function, which are particularly important for performance in a variety of sports. We will then review recent studies that have identified individual genetic variants associated with variation in these traits and the polymorphisms that have been directly associated with elite athlete status. Finally, we explore the scientific implications of our rapidly growing understanding of the genetic basis of variation in performance.

Cardiovascular Physiological Phenomena↗

PubMed1995

Interrelationships of peak expiratory flow rate with physical and cognitive function in the elderly: MacArthur Foundation studies of aging.

BACKGROUND: Peak expiratory flow rate (PEFR) is correlated with several measures of health in the elderly, including physical and cognitive function. It is unclear, however, whether these relationships persist among the non-frail. METHODS: The Community-based Studies of the MacArthur Foundation Research Network on Successful Aging included measures of PEFR using a mini-Wright peak flow meter on a sample of 1,354 subjects selected from those aged 70-79 in three population samples. Subjects were chosen on the basis of simple measures of physical and cognitive function (high = 1192; medium = 80; low = 82), and were given a series of more detailed tests. RESULTS: Residual PEFR, adjusted for age, sex, height, weight, and smoking, was highly correlated (p < .001) with several physical performance measures, including number of steps in a tandem walk, number of seconds in a single leg stand, times to turn in a circle, write one's name, and walk 10 feet at a fast pace, foot-tapping (time per tap), and hand grip strength. The strongest association was evident for a combination of six physical function items. Residual PEFR was also correlated with cognitive performance, including tests of similarities, naming, spatial recognition, memory, and figure drawing. The strongest association was present for a combined measure. These associations persisted in analyses restricted to those in the "high" function group as well as with no history of previous myocardial infarction, stroke, or cancer. Residual PEFR also exhibited a strong independent association with urinary norepinephrine, as measured in 12-hour overnight urine specimens. This relation did not appear to be mediated by smoking or medication use.

Aged↗

PubMed1992

Rehabilitation, aging and chronic renal disease.

Restorative management of the disabled elderly requires knowledge about realistic functional expectations, in addition to knowledge about a patient's particular disease. Health outlook, especially sense of control, should also be assessed because rehabilitation depends on the patient's active participation. A comparison of 349 older end-stage renal disease (ESRD) patients on chronic dialysis and 354 similar-age persons selected as a control group showed that significantly compromised physical function and health outlook were reported by the dialysis patients compared with the control group. Increasing exercise capacity and participation in dialysis self-care activity are recommended ways to improve physical functioning and health outlook among ESRD patients. Individuals who cannot perform strenuous activity can improve in level of fitness; improvements in anemia and muscle strength are key variables. Clinical application of therapeutic and rehabilitative strategies to improve physical function and health outlook in the geriatric renal patient is greatly needed.

Activities of Daily Living↗

PubMed2004

Physical function in sedentary and exercising older veterans as compared to national norms.

We examined the associations between sedentary older veterans, those regularly involved in an outpatient exercise program and physical function. Sedentary and currently exercising older veterans performed a 30 s chair-stand test and 6 min walk test as part of an exercise program. Test results were then compared to national norms. The exercisers' test scores were not significantly different from the national averages. However, their mean 6 min walk score approached being significantly better than the national average (p = 0.095). The sedentary group's scores were significantly lower (p < or = 0.05) than the exercisers' scores and the national averages for both tests. In this cohort, older veterans who maintain a regular program of physical activity function at a level considered average or slightly above average compared to their age-matched peers, while sedentary veterans are significantly below average. Healthcare providers need to stress the importance of regular exercise to their older veteran patients.

Aged↗

PubMedDate not supplied

Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease.

Although most patients are improved after shoulder arthroplasty, the degree of improvement is variable. The factors contributing to this variability are not well understood. In particular, little information is available regarding the preoperative characteristics of the patient that may influence the quality of the result. This study correlated patient demographics, preoperative health status, and preoperative shoulder function with 3 outcome metrics: comfort, physical role function, and shoulder-specific function. One hundred thirty-four shoulders having total shoulder arthroplasty for degenerative glenohumeral joint disease had an average follow-up of 3.4 +/- 1.8 years. The SF-36 Comfort score improved from 39 to 61 (P < .0001). The SF-36 Physical Role Function score improved from 30 to 52 (P < .0001). The average number of Simple Shoulder Test functions performable (out of 12) improved from 4 to 9 (P < .0001). The strongest correlates with postoperative comfort included preoperative physical function (P < .0001), general health (P < .0001), and social function (P < .001). The strongest correlates with postoperative physical role function included preoperative physical function (P < .0001) and general health (P < .001). The strongest correlates with postoperative shoulder function included male gender (P < .0001), and preoperative physical function (P < .0001), social function (P < .0001), mental health (P < .0001) and shoulder function (P < .0001). These data indicate that the overall well-being of the patient before surgery is strongly correlated with the quality of the outcome from total shoulder arthroplasty for degenerative glenohumeral joint disease.

Adult↗

PubMed2002

Effect of statin (HMG-Co-A-Reductase Inhibitor) use on 1-year mortality and hospitalization rates in older patients with cardiovascular disease living in nursing homes.

OBJECTIVES: To quantify the effect of statins on 1-year mortality, hospitalizations, and decline in physical function among patients with cardiovascular disease (CVD) aged 65 and older living in nursing homes. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes (N = 1,492) in Maine, New York, Mississippi, and South Dakota. PARTICIPANTS: We identified 51,559 older patients with CVD from a population database that merged sociodemographic data and functional, clinical, and drug treatments from more than 300,000 newly admitted nursing home residents from 1992 to 1997. Statin users (n = 1,313) were matched with nonusers (n = 1,313) in the same facilities. MEASUREMENTS: All-cause mortality, hospitalization, combined endpoint of mortality or hospitalization, and decline in physical function were determined at 1 year, and survival analysis was performed. RESULTS: Prevalence of statin use in this frail older cohort with CVD was 2.6%. Statin use varied by age, gender, comorbid condition, medication use, and cognitive and physical function. One-year mortality was 229/1,000 person-years in the statin group and 404/1,000 person-years in the nonusers, with an adjusted hazard rate ratio (HRR) of 0.69, 95% confidence interval (CI) = 0.58-0.81. The estimated number needed to treat was seven (95% CI = 5-13). This association with improved all-cause mortality was evident for women and men and for age groups 75 to 84, and 85 and older. CONCLUSION: Statin therapy is associated with improved clinical outcomes, including reduction in 1-year all-cause mortality, and the combined endpoint of death or hospitalization in a frail older population with CVD. Some caution should be taken in interpreting these results because potential bias from residual confounding could affect these results.

Activities of Daily Living↗

PubMed1993

Nursing implications. Functional status of older persons with schizophrenia.

1. Older persons with schizophrenia underreport medical symptoms and overrate physical well-being. 2. Changes in mental functioning and ability to perform activities of daily living are often the first signs of physical illness. 3. Completing a drug inventory for tardive dyskinesia and extrapyramidal side effects should be ongoing. 4. Social assessment and intervention should focus on the well part of the person.

Activities of Daily Living↗

PubMed2006

Management of shoulder hemiarthroplasty in a patient with rheumatoid arthritis.

STUDY DESIGN: Case report. BACKGROUND: Rehabilitation after shoulder hemiarthroplasty for rotator cuff tear arthropathy (RCTA) represents a significant challenge to physical therapists. Limited goals have been defined for this patient population and include no pain or slight pain at rest, moderate pain with vigorous activity, shoulder external rotation active range of motion (AROM) greater than 20 degrees, and shoulder abduction AROM greater than 90 degrees. CASE DESCRIPTION: The patient was a 60-year-old female elementary school teacher with functional class III adult-onset rheumatoid arthritis, who came to physical therapy 2 weeks after undergoing a hemiarthroplasty for RCTA of the right shoulder. Physical therapy included 33 treatment sessions involving 4 to 11 exercises each session. All sessions were performed under the direct supervision of a physical therapist utilizing specially designed equipment. Physical therapy emphasized early active assisted elevation range of motion (ROM), graded progressive exercise, and functional training. All exercises were performed in a pain-free ROM or a ROM that did not increase shoulder pain. OUTCOMES: Following physical therapy, subjective pain scale at rest was 0/10 and during vigorous activity 1/10 to 2/10. Shoulder AROM was normal and shoulder rotation and elevation strength was good. There was a significant improvement in shoulder proprioception and the patient demonstrated a negative belly press test for subscapularis muscle integrity. Additionally, the patient's score on the self-report section of the American Shoulder and Elbow Surgeons Assessment Form increased from 0% at the initial examination to 70% at discharge. DISCUSSION: Despite limited expectations, this patient achieved normal shoulder ROM and near normal shoulder strength after 14 weeks of physical therapy. Overall, an early, aggressive, progressively graded exercise program appears to be a safe and effective form of treatment after shoulder hemiarthroplasty for RCTA.

Arthritis, Rheumatoid↗

PubMed1996

Cognitive performance after strenuous physical exercise.

Stimulating as well as detrimental effects of exercise on cognitive functioning have been reported. In the present study, 15 endurance-trained athletes (aged 18 to 42 years) performed a bicycle ergometer endurance test at 75% of their maximal work capacity (Wmax). Psychomotor and cognitive tests were administered before and immediately after exercise. These consisted of simple reaction time (RT), 3-choice RT and Stimulus-Response (S-R) incompatible RT tasks, a finger-tapping task, and the Stroop test. Simple RT tasks, but also the more complex S-R in compatible RT, and Color Word Interference in the Stroop test showed an increase in speed of performance after exercise relative to baseline. An enhanced activation was probably responsible for this better performance on psychomotor and cognitive tests. Since performance on the most complex task, the Interference subtest of the Stroop, was especially improved after exercise, the expectancy of the subjects of a potential positive effect of exercise was thought to have been responsible.

Adolescent↗