bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Diagnostic SCAR Markers for Meloidogyne graminicola, M. oryzae, and M. salasi Associated with Irrigated Rice Fields in Americas
Authors: da Silva Mattos Vanessa , Mulet Karine , Cares Juvenil Enrique , Gomes Cesar Bauer , Fernandez Diana , de Sá Maria Fátima Grossi , Carneiro Regina M. D. G. , Castagnone-Sereno Philippe
Published: July 2018

Root-knot nematodes (RKN) cause important production losses of rice (Oryza sativa L.) in the world. Together with Meloidogyne graminicola Golden and Birchfield 1965, M. oryzae Maas, Sanders and Dede, 1978 and M. salasi López, 1984 have been causing damages in irrigated rice fields in Central and South America. In addition, six other RKN species may occur in rice fields in other regions of the world. Correct identification of Meloidogyne spp. is difficult but essential for the management of rice RKNs. The objective of this study was to develop some species-specific molecular markers for the diagnosis of South American RKN rice-related species. Isozyme phenotypes indicated the occurrence of some RKN species in the Brazilian samples, namely M. graminicola, M. oryzae, M. javanica, and two cryptic species designated as Meloidogyne sp. 2 and Meloidogyne sp. 3. Random amplified polymorphic DNA (RAPD) analysis of 16 isolates revealed interspecific genetic polymorphism between Meloidogyne spp., but isolates belonging to the same species (i.e., sharing the same esterase phenotype) always clustered together, whatever the species considered. Specific SCAR markers of 230, 120, and 160 bp were developed for M. graminicola, M. oryzae, and M. salasi, respectively. These SCAR markers may be potential molecular tools for application in routine diagnostic procedures subject to their validation with other rice RKN field populations in the world.
Motion Analysis of a Jumping Task in Childhood Leukemia Survivors
Authors: Marchese Victoria , Sanders Ozell , York Teresa , Creath Robert , Rogers Mark
Published: July 2018

Background:

Acute lymphoblastic leukemia childhood cancer survivors (ALL CCS) are at risk for long-term musculoskeletal and neuromuscular deficits in balance, motor proficiency, mobility, and peripheral neuropathy. However, studies have not rigorously quantified kinematic and kinetic differences between children developing typically and ALL CCS, as well as its effect on functional movement.

Purpose:

The purpose of this study was to examine kinematic and kinetic characteristics of ALL CCS and children developing typically while performing a functional movement, jump.

Methods:

The study population comprised 5 ALL CCS (aged 6-17 years) from the Department of Hematology/Oncology-Pediatrics at the University of Maryland Medical System and 5 age- and gender-matched controls. Mobility was assessed through the Timed Up and Go (TUG) test, and functional movement performance was evaluated during a vertical jump task. Balance was evaluated using Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Biomechanical measures included ankle, knee, and hip kinematics of the lower extremity and vertical ground reaction forces (VGRF) during impact from a vertical jump.

Results:

Significant differences were identified in the modulation of VGRF, and passive ankle range of motion between ALL CCS and children developing typically. Significant relationships between BOT-2 balance subtest score, TUG time, and the modulation of VGRF were also observed.

Conclusions:

We recommend physical therapists provide interventions focused on improving balance and mobility in ALL CCS. Future studies with a larger sample size should explore a wide variety of functional movement tasks in ALL CCS.
Does Psychoeducation Added to Oncology Rehabilitation Improve Physical Activity and Other Health Outcomes? A Systematic Review
Authors: Dennett Amy M. , Shields Nora , Peiris Casey L. , Reed Melissa S. , O'Halloran Paul D. , Taylor Nicholas F.
Published: July 2018

Background:

Oncology rehabilitation programs improve a variety of health outcomes in cancer survivors. However, little is known about what components of rehabilitation are essential for improving outcomes.

Objective:

To evaluate the effectiveness of psychoeducational interventions added to exercise rehabilitation programs for cancer survivors.

Methods:

Electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed, and PEDro were systematically searched from the earliest available time to March 2016. Randomized controlled trials describing psychoeducational interventions added to exercise programs for cancer survivors were included for review. The primary outcome of interest was physical activity measured either subjectively or objectively. Meta-analyses using standardized mean differences were used to synthesize data. Risk of bias within trials was evaluated using the PEDro scale and between trials was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach.

Results:

Six articles reporting outcomes from 2 trials were included for review. There was low- to high-quality evidence that there was no difference between exercise rehabilitation programs that included psychoeducation and exercise-only programs for improving physical activity levels, exercise capacity, general quality of life, and disease-specific quality of life. It is possible that exercise interventions alone include psychological elements that affect behavior change.

Conclusion:

There is insufficient evidence to support adding psychoeducational interventions to exercise-based oncology rehabilitation programs. More fully powered trials that directly compare different rehabilitation models are required to determine the most effective oncology rehabilitation model to improve health outcomes in cancer survivors.
Effect of Arm Position on Circumference Measurement of Upper Arms in Healthy and in Women With Breast Cancer–Related Lymphedema
Authors: Peleg Ruthi , Katz-Leurer Michal
Published: July 2018

Background:

Arm circumference measurement for women with breast cancer–related lymphedema (BCRL) using a tape measure is reliable, valid, and widespread in clinical practice. Arm position for measurement varies among therapists and lacks uniformity in the literature.

Objective:

To examine the effect of arm position on total arm and segment volume for both arms in healthy women and women with BCRL.

Design:

Case-control study.

Methods:

Fourteen women in the maintenance phase of treatment of unilateral BCRL and 16 healthy women matched for age and body mass index. Three sequential circumferential measurements were performed in 2 different resting arm positions (90° supported forward flexion, dependent alongside the body) in both arms during 1 session. Arm volume was calculated using the summed truncated cone formula.

Results:

A nonsignificant interaction effect of arm (small vs large), position (horizontal vs vertical), and group (women with BCRL vs healthy women) on limb volume was noted (F
1,28 = 3.30, P = .08). While among women with BCRL (study group), the mean percentage volume change in the large arm between positions was lower than in the small arm (1.37% ± 1.97%) vs 1.61% ± 1.99%, respectively), the opposite was noted among healthy women (control group) (3.36% ± 1.45% vs 2.46% ± 1.59%, respectively).

Limitations:

Participants with BCRL presented with nonpitting mild lymphedema, and 2 specific positions that were selected limit the external validity to this stage of lymphedema and to these positions.

Conclusions:

Measurements should be performed in the same position; if not, according to the findings of this study, testing for systematic bias between positions should be performed.
Stewart-Treves Syndrome in a Patient Following Mastectomy: A Case Report
Authors: Jung Yong Jae , Cho Yun Woo , Chang Min Cheol
Published: July 2018

Background:

Stewart-Treves syndrome (STS) is a rare and deadly entity, involving the development of lymphangiosarcoma in chronically lymphedematous upper extremities following mastectomy.

Case Description:

A 57-year-old woman presented with a 3-month history of rapidly growing, painful skin lesions on her left distal forearm. Fourteen years previously, she had undergone a radical mastectomy with axillary lymph node dissection, adjuvant chemotherapy, and radiation therapy due to invasive left breast cancer. A surgical biopsy specimen obtained from the lesion revealed a high-grade angiosarcoma, indicative of STS. Magnetic resonance imaging and whole-body positron emission tomography revealed that the left distal forearm lesion extended to the condyle of the left humerus. The patient underwent a transhumeral amputation of the left upper limb, and an 8-month combination chemotherapy regimen was scheduled. She is still alive 22 months after the diagnosis of STS.

Conclusion:

This study may increase the clinician's awareness regarding the occurrence of STS in patients with chronic lymphedema, especially after mastectomy.
Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA
Authors: Levenhagen Kimberly , Davies Claire , Perdomo Marisa , Ryans Kathryn , Gilchrist Laura
Published: July 2018

Introduction:

The Oncology Section of APTA developed a clinical practice guideline to aid the clinician in diagnosing secondary upper-quadrant cancer-related lymphedema.

Methods:

Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in their diagnostic process. Overall, clinical practice recommendations were formulated on the basis of the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility.

Recommendations:

In an effort to make these clinically applicable, recommendations were based on the characteristics as to the location and stage of a patient's upper-quadrant lymphedema.
A 12-Week Exercise and Stress Management Pilot Program From Theory Through Implementation and Assessment
Authors: Packel Lora , Fang Carolyn Y. , Handorf Elizabeth , Rodoletz Michelle
Published: July 2018

Purpose:

To assess the response of a 12-week exercise, education, and stress management program on the fatigue levels of a heterogeneous group of fatigued cancer survivors in a community setting.

Methods:

Peer-reviewed evidence was translated into a community-based exercise and stress management program for cancer-related fatigue. Inclusion criteria were adult with a cancer diagnosis, a score of 4 or more on a 0-10 fatigue scale, and the ability to walk for 10 continuous minutes. The 12-week program included 10 weeks of supervised moderate-intensity aerobic and strength training combined with 2 unsupervised weeks. During the 10 supervised sessions, participants also received education on nutrition, stress management, and sleep.

Outcome Measures:

Functional Assessment of Chronic Illness Therapy–Fatigue, Hospital Anxiety and Depression Scale (HADS), National Comprehensive Cancer Network Distress Thermometer, Six-Minute Walk Test (6MWT), and Sit-to-Stand Test.

Results:

Sixteen cancer survivors completed the program (mean age = 68.5 years). Sixty-two percent were female, and 24% had breast cancer. Significant improvements were noted in fatigue (P = .008), physical well-being (P = .004), and in the anxiety subscale scores of the HADS (P = .047). Increases in 6MWT distance (P = .002) and Sit-to-Stand Test score (P = .018) were also observed. Significant reductions in psychological distress were found (P = .003); however, no significant changes were observed in emotional well-being ( P = .855), social well-being (P = .327), or depression (P = .221).

Limitations:

Because of attrition, this pilot study had a modest sample size. Study findings require replication with larger sample sizes.

Conclusions:

A 12-week exercise, stress management, and education program may be effective in reducing fatigue in a heterogeneous group of cancer survivors in a community setting.
Detecting Change in Activity Using the Patient-Specific Functional Scale With Breast Cancer Survivors
Authors: Davies Claire C. , Lengerich Alexander , Bugajski Andrew , Brockopp Dorothy
Published: July 2018

Background:

Breast cancer survivors (BCSs) commonly report physical impairments in the upper extremity following treatment. Identifying and measuring active daily living limitations of BCSs can direct interventions. Presently, psychometrically tested outcome measures for BCSs are limited.

Objective:

To investigate the responsiveness of the Patient-Specific Functional Scale (PSFS) compared with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire in BCSs and identify common activity limitations BCSs reported using the PSFS.

Methods:

Forty female BCSs were referred to a community hospital–based outpatient physical therapy clinic following a mastectomy. The PSFS and the DASH questionnaire were assessed at initial evaluation and discharge. Active shoulder range of motion (ROM) and pain were measured to construct a pooled index. A standard response mean was calculated to determine the internal responsiveness of the PSFS.

Results:

A significant correlation was found between the PSFS change and ROM change of r
s = 0.466 (P = .003) but not between the DASH and ROM change scores: r
s = 0.098 (P = .558). The PSFS has a significantly higher standardized response mean of 1.2701 than the DASH questionnaire (0.5244). Common activity limitations reported by BCSs are reaching, mopping, sweeping, and dressing.

Limitations:

No standardization regarding the order of the evaluations may have introduced bias.

Conclusions:

The PSFS detects change in activity over time in BCSs. The PSFS allows individuals to report their specific activity limitations. Awareness of common activity limitations reported by BCSs can influence interventions.
Physical Agents for Cancer Survivors: An Updated Literature Review
Authors: Wilson Ann , Ensign Gentry , Flyte Kathryn , Moore Michael , Ratliff Katelyn
Published: July 2018

Background:

A 2001 review by Lucinda Pfalzer, PT, PhD, titled, “Physical Agents/Modalities for Survivors of Cancer,” was the first to examine the safety and efficacy of physical agent use for individuals with cancer. The agents included in that review were those predominantly used in clinical practice at that time. As the physical therapy profession has evolved, the use of some physical agents has changed.

Purpose:

The purpose of this literature review was to update Pfalzer's original work and to discuss the contemporary use of physical agents as part of a comprehensive rehabilitation program for individuals with cancer.

Methods:

A comprehensive review of literature published between 2001 and 2016 regarding the safety, efficacy, and use of physical agents was conducted. Information was extracted, and the findings were compared with the original article.

Results:

Much of the information in Pfalzer's review remains unchanged; however, new agents such as low-level laser and scrambler therapy have emerged. The safety, use, and efficacy of those agents are described.

Limitations:

The literature search focused only on articles written in English. Therefore, information regarding contemporary use of physical agents in other countries may have been missed.

Conclusions:

No new evidence was found for many of the physical agents described by Pfalzer. This may be due to the reluctance of clinicians to use physical agents on patients with cancer because of possible adverse effects or because physical agents are not as widely used now as in the past.
Occurrence of Peroneal Neuropathy in Oncology Patients: A Systematic Review
Authors: Jesse Mary
Published: July 2018

Background:

Many patients may experience signs and symptoms of neuropathy during oncology treatment. One source of issues may be common peroneal neuropathy.

Objective:

To evaluate the incidence of common peroneal neuropathy among cancer survivors and identify factors that may predispose a patient to this complication.

Methods:

Electronic databases PubMed, PEDro (Physiotherapy Evidence Database), and CENTRAL (Cochrane Central Register of Controlled Trials) were systematically searched from January 2007 to March 2017. All types of studies, data collections, and review articles were included in the adult population. Because of the limited data available on this topic, articles were not excluded on quality.

Results:

Nine articles describing peroneal neuropathy in the oncology population were included in the review. Two of the studies analyzed patient-specific data regarding patients presenting with peroneal neuropathy, 3 were case study reports, and 4 articles were written as review articles. Data were presented on the common factors that have been identified in this group.

Limitations:

Limited data is available on the occurrence of common peroneal neuropathy in the oncology population. More research is needed to draw better conclusions.

Conclusions:

Current information on the incidence of common peroneal neuropathy in cancer survivors has not been established. Although several mechanisms predisposing a patient to issues with nerve transmission may exist, the primary common factor identified in the occurrence of peroneal neuropathy in the oncology population in this review was weight loss related to a decrease in adipose tissue protecting the common peroneal nerve at the fibular head. Further support was given for compression due to leg crossing. Identification of these risk factors may assist the clinician to help prevent this problem.
Indocyanine Green Demonstrating Positive Anatomical Changes 1 Year After Initiation of Conservative Therapy for Lymphedema: A Case Report
Authors: Little Amy , Bowen Mindy , Chen Wei F.
Published: July 2018

Introduction:

Lymphedema is the abnormal accumulation of protein-rich fluid due to a damaged or insufficient lymphatic system. Lymphatic vessels can be mapped using indocyanine green (ICG). The purpose of this case report is to demonstrate anatomical changes after 1 year of conservative care as demonstrated through ICG for the first time to the authors' knowledge.

Case Description:

The patient was a 53-year-old woman who reported a 7-year history of left lower extremity swelling. She completed a short course of physical therapy elsewhere and wore a thigh-high compression garment of 20 to 30 mm Hg. She noted worsening of swelling over time and no longer got resolution of swelling with elevation. She presented to a multidisciplinary clinic for further evaluation and treatment.

Objective Findings:

The patient completed ICG lymphography demonstrating bilateral disease states in her lower extremities: Campisi stage II with lymphographic stage IV in the right lower extremity and lymphographic stage V in the left lower extremity. Bioimpedance scores, body mass index (BMI), and circumferential measurements were documented as well.

Interventions:

The patient underwent physical therapy including manual lymphatic drainage (MLD), increasing compression garment to 30 to 40 mm Hg, beginning use of a compression pump at home, exercise, and instructing the patient in self-MLD. There were 6 treatment sessions over a 3-month period.

Assessment:

At 1-year follow-up, the patient had positive changes in her bioimpedance scores, circumferential measurements, BMI, and ICG lymphography studies. Her ICG lymphography demonstrated increased “linear” patterns instead of diffuse or stardust patterns, suggesting improved lymphographic staging.

Discussion:

These findings imply that conservative therapies positively affect anatomy and physiology in a compromised lymphatic system after 1 year, allowing the system to work more effectively. These changes indicate lymphangiogensis, recanalization, or tissue recovery, but a causal relationship cannot be drawn at this time. These conservative therapies include complex decongestive therapy (MLD, compression, exercise) and weight loss.
Self-care in Female Cancer Survivors With Secondary Lymphedema: Characteristics of Women Needing Support to Perform Self-care
Authors: Lindquist Helene , Nyberg Tommy
Published: July 2018

Purpose:

The purpose with this cross-sectional study was to investigate performance of self-care in female cancer survivors with secondary lymphedema and to investigate characteristics of the survivors related to frequency of self-care.

Methods:

Eighty-three women with upper (83%) or lower (17%) extremity secondary lymphedema were included. Frequency of self-care of their lymphedema and, in total, 23 sociodemographic, clinical, and individual characteristics were analyzed in relation to the outcomes “do self-care at home,” “do self-care at work,” “can take care of their lymphoedema,” and “self-care helps.”

Results:

Fifty-seven percent of women performed self-care at home and 12% at work at least every day; 43% thought that self-care helped. Women with low well-being (odds ratio [OR] = 4.5; 95% confidence interval [CI], 1.7-11.7), not accepting their body (OR = 3.9; 95% CI, 1.0-15.3), and with ethnicities other than Swedish (OR = 5.3; 95% CI, 1.1-25.6) were more likely to perform self-care seldom. The characteristics depressed mood (R = −0.23), anxious mood (R = −0.14), low self-esteem (R = 0.3), and low quality of sleep (R = 0.2) were related to a lower frequency of performance of self-care.

Conclusions:

Almost 60% of women performed self-care every day. At risk for not taking care of themselves with self-care were women with low well-being, difficulties accepting their body, or ethnicities other than Swedish, which implicate identification and extra support to women with such characteristics.
Cancer Survivors Awaiting Rehabilitation Rarely Meet Recommended Physical Activity Levels: An Observational Study
Authors: Dennett Amy M. , Peiris Casey L. , Shields Nora , Prendergast Luke A. , Taylor Nicholas F.
Published: July 2018

Objective:

We aimed to describe physical activity levels and identify factors associated with physical activity of cancer survivors awaiting oncology rehabilitation.

Methods:

A pilot observational study evaluating physical activity levels of 49 cancer survivors referred to outpatient rehabilitation was assessed using accelerometers worn continuously for 6 days. Multiple linear regression analyses were completed to identify factors associated with physical activity. Variables included demographic factors (cancer type, treatment, body mass index), physical factors (walking capacity, physical performance), and psychological factors (anxiety).

Results:

Four participants achieved recommended physical activity levels. Participants recorded an average of 12 minutes (SD = 12) of daily moderate-intensity activity. Walking capacity had the strongest independent association with physical activity (P < .001). A 10-m increase in distance in the 6-Minute Walk Test was associated with a 7% improvement in physical activity. Breast cancer diagnosis (P = .005), increased anxiety (P = .007), and lower body mass index (P = .014) were also independently associated with high physical activity. The final model explained 70.5% of the variance in physical activity levels (P ≤ .001).

Conclusion:

Few cancer survivors awaiting rehabilitation achieve recommended physical activity levels. Factors associated with low levels of physical activity such as reduced walking capacity may be modified by oncology rehabilitation.
Arthroscopic Capsulolabral Reconstruction for Posterior Shoulder Instability Is Successful in Adolescent Athletes
Authors: McClincy Michael P. , Arner Justin W. , Thurber Laura , Bradley James P.
Published: July 2018

Background:

Posterior shoulder instability is an increasingly common pathology recognized in athletes. Adolescent athletes are especially at risk for this condition due to the widespread participation in numerous sports, including both overhead throwing and collision activities. Little data are available regarding surgical outcomes in these athletes with only a single small case series (N=25) currently published.

Methods:

In total, 68 athletes (82 shoulders) with unidirectional posterior shoulder instability were treated with arthroscopic posterior capsulolabral reconstruction and underwent an evaluation at a mean of 36 months postoperatively. The average age for our cohort was 17.2 years (range, 14 to 19 y), with 66 males (80%) and 16 females (20%). A total of 55 athletes (67%) participated in contact sports and 32 athletes (39%) participated in overhead throwing. Thirty athletes (37%) participated in multiple sports. Preoperative and postoperative outcomes data were retrospectively reviewed, and included the American Shoulder and Elbow Surgeons (ASES) shoulder score, subjective stability score, strength, range of motion, and return-to-play status. Intraoperative findings and methods of fixation were also recorded.

Results:

Mean ASES score improved from 48.6 to 85.7 (P<0.001) after surgery. There were also significant improvements in stability, pain, and functional scores after surgery. Contact, throwing, and multisport athletes all showed similar scores at preoperative and follow-up timepoints, and no differences were noted between these athlete groups for any patient-reported outcome measure. Female athletes tended to have significantly lower preoperative and postoperative ASES scores, specifically within the pain domain when compared with males. With regard to the method of internal fixation, patients who underwent capsulolabral plications with suture anchors showed a trend toward greater improvement in ASES scores which did not reach statistical significance. Overall, 89% of athletes were able to return to competition, with 71% returning to their preinjury level of play. In total, 8.5% of athletes failed their initial surgical procedure with continued pain or instability that required revision surgery.

Conclusions:

Arthroscopic capsulolabral reconstruction is a reliable treatment for unidirectional posterior shoulder instability in an adolescent population, and does well for athletes involved in a variety of sporting activities.

Level of Evidence:

Level IV—case series.
Treatment of Ankle Fracture Complications and Subacute or Malreduced Ankle Fractures
Authors: Doty Jesse F. , Fogleman Jason A.
Published: July 2018

Rotational ankle fractures are among the most prevalent intra-articular fractures of the body. When managed appropriately, they have favorable outcomes with relatively low complication rates. The proper management of these injuries requires an understanding of the radiographic imaging, surgical anatomy, and biomechanics of both the tibiotalar and distal tibiofibular joint. Some of the most common and impactful complications of operatively treated ankle fractures include wound necrosis, surgical site infection, malunion, nonunion, and posttraumatic ankle arthritis. The management of these complications must be assessed on an individual case basis, but often requires a thorough preoperative evaluation and meticulous surgical planning to insure a successful outcome. This chapter provides a review of the management of subacute and malreduced ankle fractures as well as a brief review of the rates, risk factors, and management of other common complications associated with ankle fractures.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of Energy Expenditure Across 3 Gaming Platforms Using an Activity-Based Dance Game
Authors: Powers Matthew M. , Henning Daniel L. , Stafford Christian P. , Eason Jane M.
Published: July 2018

Background:

Obesity rates have continued to increase and much of this increase is due to physical inactivity. One of the major contributors to physical inactivity is excessive participation in sedentary activities such as playing video games. However, game developers recently have begun developing more active gaming and many of these games are available across a variety of gaming systems. With several platforms available for active video gaming, there is limited research comparing differences in energy expenditure (EE) across the different devices.

Objective:

The purpose of this study was to compare EE and heart rate (HR) responses while playing an activity-based dance game on the Xbox Kinect, Playstation Move, and Nintendo Wii.

Design:

This was a repeated-measures study design.

Methods:

Fifty-one participants played Just Dance 3 on each system for 15 minutes per session in a randomized order. Energy expenditure in kilocalories per minute was estimated using a triaxial accelerometer, and HR in beats per minute was measured with a HR belt monitor.

Results:

Participants burned significantly more kilocalories on the Kinect compared with the Playstation and the Wii. There was no significant difference in EE between the Playstation and the Wii. As regards average HR, the Kinect resulted in a higher HR compared with the Playstation and the Wii. There was no difference in HR response between the Playstation and Wii.

Conclusions:

This study demonstrates that the Kinect is the best gaming platform for promoting higher EE and HR when playing an activity-based dance game.
Concurrent Validity of Daily Activity Data From Medtronic ICD/CRT Devices and the Actigraph GT3X Triaxial Accelerometer: A Pilot Study
Authors: Shoemaker Michael J. , Cartwright Kelly , Hanson Kim , Serba Deb , Dickinson Michael G. , Kowalk Amy
Published: July 2018

Purpose:

The purpose of this pilot study was to examine the concurrent validity of daily activity data from Medtronic implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices and the Actigraph GT3X triaxial accelerometer in patients with heart failure (HF).

Methods:

Analysis of the first 16 subjects with HF completing 3-month follow-up in a randomized trial with a secondary purpose to examine concurrent validity of Medtronic ICD/CRT device-based daily activity and the following Actigraph GT3X parameters: hours of activity per day, activity counts, and steps per day. Daily activity data were measured at baseline and 3-month follow-up and analyzed using Pearson correlation coefficients to measure intraindividual correlations and Bland–Altman plots to examine agreement between devices.

Results:

Moderate-to-strong, statistically significant correlations were found between the Medtronic ICD/CRT and Actigraph GT3X devices for all parameters measured. The Bland–Altman plots revealed approximately 0.80 hours less activity per day measured by the Medtronic ICD/CRT compared with the Actigraph GT3X. Strong agreement for the 7-day average and moderate-to-strong agreement for all daily observations for hours of activity per day was found between both devices. Similarly, there was moderate-to-strong agreement for change in hours of activity and steps per day between baseline and 3-month follow-up.

Conclusions:

The Medtronic ICD/CRT devices seem to be a sufficiently accurate, responsive measure of daily activity in patients with HF when compared with the Actigraph GT3X.
Associations of Constructs of Transtheoretical Model With Physical Activity Behavior Among Individuals With Essential Hypertension
Authors: Maruf Fatai Adesina , Umunnah Joseph Onuwa , Akindele Mukadas Oyeniran
Published: July 2018

Background:

There is a dearth of studies on transtheoretical model (TTM) in relation to physical activity (PA) behavior among individuals with hypertension. This study explored the TTM in relation to PA behavior among Nigerians with essential hypertension.

Methods:

This cross-sectional survey involved 299 individuals with hypertension from teaching hospitals. Information on sociodemographics, constructs of TTM for PA, and PA level of participants was collected.

Results:

Cognitive process of change (PoC) (β = 67.90 [34.74–101.06]; P < .001) was a predictor of walking PA, and accounted for 14% of the prediction. Predictors of moderate-intensity PA were cognitive PoC (β = 239.98 [135.53–344.44]; P < .001), stage of change (SoC) (β = 991.69 [391.67–1591.71]; P = .001), and behavioral PoC (β = −139.81 [−249.77 to −29.85]; P = .01), with cognitive PoC accounting for 26% of the 36% prediction. Age (β = −179.91 [−265.81 to −94.02]; P < .001), cognitive PoC (β = 96.32 [20.73–171.91]; P = .01), and perceived barrier to PA (β = −168.81 [−327.85 to −9.77]; P = .04) were predictors of vigorous-intensity PA, with age accounting for 20% of the 33% prediction. Predictors of overall PA were cognitive PoC (β = 324.03 [194.77–453.29]; P < .001) and age (β = −239.09 [−449.04 to −137.14]; P < .001), with cognitive PoC accounting for 25% of the 34% prediction.

Conclusions:

Cognitive PoC of TTM is an independent predictor of PA behavior and may be vitally important in PA behavior change in hypertensive individuals.
Vital Signs Before Preemployment and Functional Testing: An Observational Study
Authors: Daley Deirdre , Miller Margot , Collins Sean
Published: July 2018

Purpose:

To test the impact of pretest blood pressure (BP) and heart rate (HR) screening criteria used to determine risk of adverse events (AEs) during preemployment functional testing for jobs in the “medium” to “very heavy” physical demand categories.

Methods:

Retrospective analysis of functional testing data collected from 2005 to 2012 at 990 regional service clinics for 37 employers on job applicants from 16,511 zip codes across all the US states and the District of Columbia.

Results:

Data on 269,527 subjects demonstrate that failure rates [99% CIs] for BP screening criteria based on general health risk (GHR) are much higher when compared with screening criteria–based risk of AEs during testing. Using systolic BP and diastolic BP, first trial failure rate (% [99% CI]) increased from 1.74 [1.66, 1.78] when based on AE to 39.31 [39.07, 39.55] when based on GHR. Of subjects that took the functional test but failed GHR screening criteria (MAP ≥ 106 mm Hg), 27.18% [26.73, 27.63] failed functional testing and no subjects experienced an AE during the functional testing.

Conclusions:

Screening criteria based on GHR intended to be predictive of future disease risk is too stringent as a screening criteria for preemployment functional testing and may unduly penalize job applicants by delaying the opportunity for functional preemployment testing. Further work is needed to identify safe boundaries and risk factors of an AE during functional testing besides use of isolated vital signs such as BP and HR.
Clinical Reasoning and Collaboration for Functional Mobility and Ambulation Under Multiple Conditions of Concurrent CentriMag Ventricular Assistive Devices: A Case Report
Authors: Lammers Kerry J. , Shumock K , Ricard P. E. H.
Published: July 2018

Background:

The CentriMag Extracorporeal Blood Pumping System is an effective means of temporary ventricular support for patients acutely decompensating from cardiac shock. Out-of-bed activities are not currently recommended by the manufacturer, leaving patients functionally limited and restricted to the intensive care unit (ICU).

Purpose:

This report aims to describe progression of functional mobility and ambulation with CentriMag ventricular assist device (VAD) equipment using appropriate clinical reasoning and multidisciplinary collaboration.

Methods:

Functional mobility activities were initiated on the first physical therapy (PT) session and progressed throughout the length of stay and included sit–stand transfers, bed–chair transfers, standing activities, and ambulation.

Outcomes:

The patient remained in the cardiovascular surgical ICU for 30 days and received PT for 13 total treatment sessions with 4 different physical therapists without adverse events. Out-of-bed activities were performed during all 13 PT sessions and the average session duration was 49.8 minutes. Ambulation was documented on 9/13 sessions and on the days the patient ambulated, and the average distance was approximately 183 feet. The patient was seen on 7 occasions with biventricular assist device CentriMag devices and 6 occasions with the concurrent CentriMag right VAD–HeartMate II left VAD.

Discussion:

As the technology and scope of application for VADs continues to progress, it is imperative that the acute care PT understands the complexities, risks, and benefits of functional mobility in critically ill patients.

Conclusion:

This report suggests that mobilization with CentriMag devices is feasible, without adverse events, using appropriate clinical decision-making, and suggests that patients who ambulate under multiple conditions of CentriMag VADs may demonstrate functional improvements.
Feasibility of Supramaximal Verification of Peak Oxygen Uptake of a Graded Maximal Treadmill Test in Adults With Intellectual Disability
Authors: Weterings Stijn , Takken Tim , Hilgenkamp Thessa I. M.
Published: July 2018

Purpose:

To determine the feasibility of aerobic capacity measurement (V̇o
2max) of adults (18–50 years) with an intellectual disability (ID) through supramaximal verification.

Methods:

A cross-sectional observational design was used that consisted of 2 sessions. Before testing, a 3-step familiarization process was performed (session 1), after which the V̇o
2peak of a graded maximal treadmill test (GXTT) (V̇o
2peakGXTT) and a supramaximal exercise test (SET) (V̇o
2peakSET) were measured (session 2). The feasibility parameters used in this study were completion rate (based on the criteria for maximal effort), agreement between the V̇o
2peakGXTT and the V̇o
2peakSET (through intraclass correlation coefficient [ICCagreement]) and acceptance (through a custom-made questionnaire).

Results:

Twelve participants performed the measurement procedure. The completion rate was 75% and the ICCagreement was 0.99 (P < .001). The questionnaire showed that the measuring procedure was acceptable for the participants.

Conclusions:

This study demonstrated that it appears feasible to perform a maximal treadmill test (GXTT) followed by a SET for adults with ID. Therefore, it can be possible to verify the V̇o
2peak of the GXTT as a true V̇o
2max in adults with an ID.
Formal Balance Assessment and Intervention in Patients With Newly Implanted Left Ventricular Assist Devices: A Retrospective Analysis
Authors: Appel Jessica , Vatwani Archana , Sutton Kristin , Hall Amy , Russell Stuart D.
Published: July 2018

Purpose:

The purpose of this study was to retrospectively review the implementation of a formal balance assessment and directed interventions in a sample of patients with newly implanted left ventricular assist devices (LVADs).

Methods:

Electronic medical records were reviewed in patients with newly implanted LVADs from January 2014 through August 2015. Patients were assessed using Tinetti Performance Oriented Mobility Assessment (Tinetti) and AM-PAC Inpatient Basic Mobility Short Form (AM-PAC). Patients participated in formal balance interventions. Data was analyzed using Microsoft Excel (Kirkland, WA) using a Student t test with 2-sided tail or paired t test, with a P-value of <.05 indicating statistical significance.

Results:

Of those patients included in the study, 94% of patients demonstrated initial fall risk, and 82% of patients demonstrated initial high fall risk. The initial Tinetti score was 13.7 (SD 7.2), increasing to 24.5 (SD 4.0) (P < .001) after intervention. Patients with high fall risk had an average length of stay of 27.36 days (SD 24.42 days) compared with those with lower fall risk with an average length of stay of 19.67 days (SD 6.55 days) (P = .62).

Conclusions:

A balance deficit was observed in patients with newly implanted LVADs. Following standardized intervention, deficits improve. These results warrant further exploration into proper dosing of intervention, additional outcome measures, and further research development.
Blood Pressure Attitudes, Practice Behaviors, and Knowledge of Outpatient Physical Therapists
Authors: Arena Sara K. , Reyes Alicia , Rolf Matthew , Schlagel Nicole , Peterson Edward
Published: July 2018

Purpose:

The purpose of this study is to describe and determine correlations among blood pressure (BP) attitudes, practice behaviors, and knowledge among physical therapists (PTs) practicing in the outpatient (OP) settings.

Methods:

A survey was mailed to 1440 OP PTs matching inclusion criteria and through random selection from the American Physical Therapy Association Listserv. Self-reported demographics, attitudes, practice behaviors, and knowledge regarding BP measures of survey respondents were recorded. Descriptive statistics analyzed demographics and question responses; whereas a nonparametric Spearman version of the correlation coefficient analyzed correlations between variables.

Results:

Three hundred thirteen surveys from males (41.3%), females (58.7%), and PTs with greater than 10 years' of experience (57.8%). Although 51.8% of respondents did not feel importance in measuring BP during evaluation, 94.2% felt confident in their ability to do so. In addition, 85.0% of respondents did not routinely measure BP during evaluations. One-third and two-third of respondents correctly identified criteria matching a prehypertensive or hypertensive BP, respectively. Furthermore, a positive correlation (r = 0.84, P < .001) was identified between attitude and practice behaviors; however, not between attitude or practice behavior and knowledge.

Conclusion:

Initiatives to address misinformed BP attitudes and behaviors as well as gaps in knowledge of PTs providing care in OP settings is warranted.
Short Physical Performance Battery Can Be Utilized to Evaluate Physical Function in Patients After Cardiac Surgery
Authors: Katijjahbe Md Ali , Granger Catherine L. , Denehy Linda , Royse Alistair , Royse Colin , Clarke Sandy , El-Ansary Doa
Published: July 2018

Purpose:

The Short Physical Performance Battery (SPPB) is a test used to assess physical function; however, the minimal clinically important difference (MCID) in patients after cardiac surgery is unknown. The aim of this study was to determine the MCID of the SPPB after cardiac surgery.

Methods:

Seventy-two participants performed the SPPB at 4 weeks and 3 months postoperatively. The Short Form-36 version 2 was used to assess physical function and the Global Rating of Change (GRC) scale was used to assess patients' perceived change. Distribution-based methods were used to determine the MCID.

Results:

The mean (95% confidence intervals [CIs]) change of the SPPB between testing time points was +1.04 (0.67–1.42) points. Ninety-eight percent of patients rated their function as “changed” on the GRC scale. The MCID calculated using distribution-based methods ranged from 0.44 points (95% CI [0.191, 0.613]) for the effect size-based estimate to 1.35 points for the standard error of measurement–based estimate. No participants scored 0/12; however, 45% and 69% of participants scored 12/12 at 4 weeks and 3 months postoperatively, respectively.

Conclusion:

The MCID for SPPB is estimated to be between 0.44 and 1.35 points out of 12 for patients in the early postoperative period. Nearly half of the participants scored the maximum score at 4 weeks, increasing to two-thirds at 3 months meaning that the SPPB may be too easy as time from surgery increases and patients recover. Further research is required to confirm the MCID in patients closer to surgery where the ceiling effect is likely to be lower.
Six-Minute Walk Test as a Predictive Measure of Exercise Capacity in Adults With Type 2 Diabetes
Authors: Nolen-Doerr Eric , Crick Kent , Saha Chandan , de Groot Mary , Pillay Yegan , Shubrook Jay H. , Donley David , Hornsby W. Guyton
Published: July 2018

Objective:

The 6-minute walk test (6MWT) is a measure that is routinely used to assess a response to treatment for cardiopulmonary diseases such as pulmonary fibrosis and congestive heart failure. The measure has never been verified as a valid measure of exercise capacity in the highly prevalent patient population of type 2 diabetes (T2DM). This study investigated the correlation between the 6MWT and graded exercise testing (GXT) in an effort to validate the 6MWT as a quality tool for assessing exercise capacity in adults with T2DM.

Research Design and Method:

This is a secondary data analysis of Program ACTIVE II, a randomized controlled trial designed to assess the effectiveness of 2 behavioral interventions on depression and glycemic outcomes in adults with T2DM. The correlation of 6MWT and predicted VO2 max (PVO2M) using GXT was examined in a subsample of participants at the time of study enrollment and at postintervention.

Results:

PVO2M showed a significant correlation with 6MWT distance both at baseline (r = 0.57, P = .014) and postintervention (r = 0.66, P = .037). The regression analysis of baseline data revealed that 6MWT distance alone explained 45% (F = 13.03, P = .0024) of the variability in PVO2M. When combined with the SF-12 physical health component score (Physical Components Subscale [PCS]), 6MWT explained 66% (F = 13.62, P < .001) of the variance in PVO2M. After adjusting for PCS, 6MWT distance explained an additional 30% variability in PVO2M.

Conclusions:

Findings from this study indicate that the 6MWT and predicted exercise capacity are significantly correlated. The 6MWT can be used to estimate exercise capacity in adults with T2DM.
Comparison of Physical Fitness and Cardiopulmonary Exercise Test Performance Using Arm Versus Leg Cycling in Patients With Cardiovascular or Pulmonary Disease–A Systematic Review and Meta-analysis
Authors: Tolstrup Larsen Rasmus , Hermann Tang Lars , Keller Camilla , Christensen Jan , Taylor Rod S. , Doherty Patrick , Langberg Henning , Zwisler Ann-Dorthe
Published: July 2018

Purpose:

Alternative modes of cardiopulmonary exercise testing are needed and an arm cycle (AC) is a promising alternative to the gold standard of the leg cycle (LC). The aim of this study was to undertake a systematic review comparing maximal oxygen consumption (VO2max) obtained from AC and LC in patient populations with cardiovascular disease (CVD) and pulmonary disease (PD).

Methods:

A systematic review was undertaken with literature searches on December 5, 2016. Studies were included if they directly compared aerobic capacity values obtained from AC and LC in patients with CVD or PD. Results across studies were pooled using random effects meta-analysis and univariate meta-regression were used to assess potential associations between variables.

Results:

A total of 14 studies in 411 patients were included. On average, VO2max of LC exceeded AC mean difference by 3.48 mL·kg−1·min−1, (95% confidence interval [CI]: 1.94, 5.03) and a mean AC/LC ratio of 0.83, (95% CI: 0.77, 0.90). VO2max differences between AC and LC were similar in patients with CVD compared with PD but were found to be higher in older individuals and those with higher VO2max.

Conclusions:

Although AC offers an important alternative form of exercise testing for patients with CVD or PD, clinicians must take into account that VO2max values obtained from AC are consistently lower than those obtained on LC. However, the results of this article offer an evidence-based estimation for the proportional differences between AC values and LC values for groups with CVD or groups with PD.