Putting the Physiology Back in Physiotherapy No abstract available

Applying Clinical Decision Rules in a Patient With Venous Thromboembolism After an Elective Total Knee Arthroplasty: A Case Report Introduction: Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease behind myocardial infarction and stroke, and is responsible for 10% of hospital deaths as a result of PE. The purposes of this case report are to (1) describe such an incident in a 63-year-old man status-post right total knee arthroplasty who is referred to physical therapy and (2) highlight the role of using clinical decision rules (CDRs) and the recently published VTE clinical practice guidelines. Case presentation: A 63-year-old man presented to an orthopedic surgeon for elective total knee arthroplasty of the right knee. The patient reported for his initial physical therapy session 3 weeks after surgery, and while warming up on a recumbent bicycle, he started having difficulty catching his breath. The patient was ultimately diagnosed with bilateral PE and a right lower extremity proximal DVT. Conclusion: This case illustrates the importance of using an evidence-based approach for determining the clinical probability of VTE by following clinical guidelines. This case also highlights the importance of using CDRs and communicating in a timely manner to ensure patient safety.

Reproducibility of Measurements Obtained During Cardiopulmonary Exercise Testing in Individuals With Fatiguing Health Conditions: A Case Series Purpose: Measurements obtained during maximal cardiopulmonary exercise testing (CPET) demonstrate high test–retest reliability, which indicates low error variance. However, measurements obtained from people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may depart from typically observed high reproducibility, which could represent functionally relevant biological variability that is characteristic of the underlying pathophysiology. The purpose of this case series was to document individual experiences with test–retest variability in CPET measurements in individuals with ME/CFS compared with other fatiguing health conditions. Methods: In this case series, 6 women matched for age and body mass index underwent 2 maximal CPETs spaced 24 hours apart. Clients comprised 1 sedentary individual without fatigue, 1 active individual without fatigue, 1 individual with multiple sclerosis (MS), 1 individual diagnosed with HIV, 1 individual with ME/CFS and low maximal volume of oxygen consumed (VO2max), and 1 high-functioning individual with ME/CFS and high VO2max. Percent change in CPET measurements between tests was calculated for each client. Results: Nondisabled clients and clients with MS and HIV reproduced or improved in their volume of oxygen consumed (VO2), workload (WL), heart rate (HR), and minute ventilation (VE) at ventilatory anaerobic threshold (VAT) and at peak exercise (except peak WL and VE for the individual with HIV). Neither individual with ME/CFS reproduced VO2, WL, HR, or VE at VAT within literature estimates. Conclusions: Measurements during CPET for individual patients may relate to potential condition-specific deficits in cardiac, pulmonary, and metabolic functioning.

Accuracy of 6 Commercially Available Activity Monitors in Measuring Heart Rate, Caloric Expenditure, Steps Walked, and Distance Traveled Purpose: The purpose of this study was to determine the accuracy of 5 different commercially available activity monitors (AMs) and 1 smartphone application in identifying mean number of steps, mean distance traveled, estimated caloric expenditure, and heart rate (HR). Methods: Subjects (N = 120) performed two 6-minute walks (MWs), one at a comfortable pace (C6MW) and the other at a fast pace (F6MW), around an indoor track wearing all 6 AMs and a StepWatch Activity Monitor in the community. Accuracy and agreement between AM-estimated metrics and actual metrics were examined using the intraclass correlation coefficient (ICC2,1) and Bland–Altman technique (BAM). Results: The ICC2,1 and BAM varied for all 3 conditions with the Fitbit Zip being the most accurate. Conclusions: The AMs exhibited varying degrees of accuracy for identifying steps, calories expended, HR, and distance walked across all different walking conditions. No single AM was accurate across conditions or metrics. Clinicians should be cautious when using data from these AMs to estimate patient activity levels.

Balance Training in Pulmonary Rehabilitation to Reduce Fall Risk Purpose: To determine the efficacy of a balance training program for fall risk reduction in outpatient pulmonary rehabilitation (PR). Methods: Forty-nine participants in an outpatient PR program participated in a balance training program in addition to the standard PR exercises. Balance was assessed with the Activities-Specific Balance Confidence (ABC) scale, Mini-BESTest (MBT), and Short Physical Performance Battery (SPPB). Gait speed, 5 times sit to stand test (5TSTS), and Timed Up and Go (TUG) data were extracted for analysis. Progressive lower-extremity strengthening and balance specific exercises were performed during each PR session. Results: Over 90% of participants presented with at least one balance assessment that indicated an increased fall risk and 81% had mobility limitations based on an SPPB score <10. During the final assessment, only 16.2% of the participants were at fall risk and 13.5% had mobility limitations. Significant improvements (P < .001) were seen in the mean differences from baseline to final in the ABC scale 31.6% (95% CI [24.8, 38.5]), MBT 9.3 (95% CI [7.6, 11.0]), SPPB 4.1 (95% CI [3.4, 4.7]), gait speed 0.37 m/s (95% CI [0.29, 0.46]), 5TSTS −7.8 seconds (95% CI [−10.5, −5.0]), and TUG −4.7 seconds (95% CI [−5.7, −3.7]). Conclusions: Incorporating a balance training program into a PR program may help to decrease fall risk and increase balance confidence in functional activities.

Retrospective Balance Study for Individuals With Chronic Obstructive Pulmonary Disease: Evaluating the Effect of a 1-Month Physical Therapy Program Purpose: To determine whether a 1-month physical therapy (PT) program that includes a balance component improves balance impairments and fear of falling in individuals with chronic obstructive pulmonary disease (COPD), and to evaluate the utility of the Four Square Step Test (FSST) and Functional Reach Test (FRT) in this population. Methods: A retrospective analysis of participants with COPD in a PT program between May 2015 and December 2015. Assessments performed before and after therapy were the Berg Balance Scale (BBS), FRT, FSST, and Activities Balance Confidence Scale (ABC) questionnaire. Statistical analysis used Pearson product–moment coefficient of correlation, 1-tailed T test, and Independent T test. Results: Twenty-five individuals with COPD completed the PT program. Individuals at high risk of falls experienced significant improvements on the BBS (6.6 points, P = .0097), FSST (6.75 seconds, P = .001), and FRT (5.63 cm, P = .01333). The BBS and FSST were correlated with each other (r = 0.70) at baseline. Improvements in the ABC were not statistically significant (P = .071). Use of supplemental oxygen was not correlated with any assessment tool. Conclusions: People with greater balance deficits had significant improvements in balance after a 1-month PT program. The FSST should be investigated further in patients with COPD.