Simple Functional Performance Tests and Mortality in COPD.

Simple functional performance tests and mortality in COPD.

Eur Respir J. 2013 Mar 21;
Puhan MA, Siebeling L, Zoller M, Muggensturm P, Ter Riet G

Exercise tests are important to characterize COPD patients and predict their prognosis but often not available outside of rehabilitation or research settings. The aim was to assess the predictive performance of the sit-to-stand (STS) and handgrip strength tests.The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with GOLD stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life [HRQL]) while adjusting for age, sex and severity of disease.The STS test was strongly (adjusted hazard ratio per 5 more repetitions of 0.58 [95% CI 0.40-0.85], p=0.004) and the handgrip strength test moderately strongly (0.84 [95% CI 0.72-1.00], p=0.04) associated with mortality. Both tests were also statistically significantly associated with HRQL but not with exacerbations. The STS test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), FEV1 (0.61), dyspnoea (0.63) and handgrip strength (0.62).The STS test may close an important gap in the evaluation of exercise capacity and prognosis of COPD patients across practice settings. HubMed – rehab


Method for Enhancing Real-World Use of a More Affected Arm in Chronic Stroke: Transfer Package of Constraint-Induced Movement Therapy.

Stroke. 2013 Mar 21;
Taub E, Uswatte G, Mark VW, Morris DM, Barman J, Bowman MH, Bryson C, Delgado A, Bishop-McKay S

BACKGROUND AND PURPOSE: Constraint-induced movement therapy is a set of treatments for rehabilitating motor function after central nervous system damage. We assessed the roles of its 2 main components. METHODS: A 2×2 factorial components analysis with random assignment was conducted. The 2 factors were type of training and presence/absence of a set of techniques to facilitate transfer of therapeutic gains from the laboratory to the life situation (Transfer Package; TP). Participants (N=40) were outpatients ?1-year after stroke with hemiparesis. The different treatments, which in each case targeted the more affected arm, lasted 3.5 hours/d for 10 weekdays. Spontaneous use of the more affected arm in daily life and maximum motor capacity of that arm in the laboratory were assessed with the Motor Activity Log and the Wolf Motor Function Test, respectively. RESULTS: Use of the TP, regardless of the type of training received, resulted in Motor Activity Log gains that were 2.4 times as large as the gains in its absence (P<0.01). These clinical results parallel previously reported effects of the TP on neuroplastic change. Both the TP and training by shaping enhanced gains on the Wolf Motor Function Test (P<0.05). The Motor Activity Log gains were retained without loss 1 year after treatment. An additional substudy (N=10) showed that a single component of the TP, weekly telephone contact with participants for 1 month after treatment, doubled Motor Activity Log scores at 6-month follow-up. CONCLUSIONS: The TP is a method for enhancing both spontaneous use of a more affected arm after chronic stroke and its maximum motor capacity. Shaping enhances the latter. HubMed – rehab


Exercise for Managing the Symptoms of Multiple Sclerosis.

Phys Ther. 2013 Mar 21;
Padgett PK, Kasser SL

This excerpt was created in the absence of an abstract. highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medications, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.(1) Each article in this PTJ series summarizes a Cochrane review or other scientific evidence resource on a single topic and presents clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an ambulatory patient with multiple sclerosis and mild to moderate impairments. Can exercise improve the quality of life for individuals like this patient with multiple sclerosis? HubMed – rehab