Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial

Objectives The objective of this study was to assess the effects of home-based exercise training (HBET) on function and quality of life (QoL) in patients with pulmonary hypertension (PH). Methods A prospective, nonblinded, randomized clinical trial was carried out on 84 medically stable patients with PH belonging to any functional class or etiology and of either sex. Patients were randomized to either standard care or HBET. Both groups also received education using the Pulmonary Hypertension Manual (PulHMan). Outcomes included functional capacity from 6-min walk distance (6MWD), QoL using the Medical Outcomes Survey Short Form – 36, functional class (FC), and right heart indices (right ventricular systolic pressure [RVSP] and tricuspid annular plane systolic excursion [TAPSE]) and were assessed at entry and after 12 weeks. Results HBET improved 6MWD by 48.5 m and 13 m in the experimental and control groups, respectively (p < 0.001). QoL showed statistical improvements after HBET between the groups for the physical and mental components and for the various subdomains (except body pain). Furthermore, FC improved by one grade with HBET (p < 0.001). Conclusion HBET program improved functional capacity, QoL, and FC in patients with PH.

Postural sway in diabetic peripheral neuropathy among Indian elderly.

Background & objectives: Diabetic peripheral neuropathy (DPN) is a major complication of type 2 diabetes and have long term complications on the postural control of the affected population. The objectives of this study were to evaluate postural stability in patients with DPN and to examine correlation of Michigan Neuropathy Screening Instrument (MNSI) with duration of diabetes, age and postural stability measures. Methods: Participants were included if they had clinical neuropathy which was defined by MNSI. Sixty one patients gave their consent to participate in the study and were evaluated on posturography for postural stability measures in four conditions. Repeated measures of analysis of variance (RANOVA) was used to analyze the changes in postural stability measures in different conditions. Results: An increase in mean value of postural stability measures was observed for velocity moment 20.4±1.3, 24.3±2.2, 42.3±20.7, 59±43.03, mediolateral displacement 0.21±0.10, 0.22±0.18, 0.03±0.11, 0.34±0.18, and anteroposterior displacement 0.39 ± 0.09, 0.45±0.12, 0.47±0.13, 0.51±0.20 from EO to EC, EOF, and ECF, respectively. There was a significant difference (P<0.05) in participants with DPN, with greater sway amplitude on firm and foam surface in all the conditions. Moderate correlation of MNSI with age (r=0.43) and postural stability measures were also observed. Interpretation & conclusions: Evaluation of postural stability in Indian DPN population suggests balance impairments on either firm and foam surfaces, with greater likelihood of fall being on foam or deformable surfaces among elderly adults with neuropathy (CTRI/2011/07/001884).

Test-retest reliability of a portable gas analysis system under free living conditions.

Introduction: K4b2 (COSMED Srl Italy) is a portable device that is considered valid and reliable for measuring oxygen uptake (VO2) and carbon dioxide production (VCO2) under laboratory conditions. Objectives: Evaluate the test-retest reliability of K4b2 during walking, stair climbing and descending stairs under free living conditions. Methods: Twelve participants completed two self-selected comfortable paced walking tests and 20 participants completed two self-selected comfortable paced stair climbing and descending tests. VO2 and VCO2 were measured during the tests using K4b2. Results: ICCs for VO2 (ICC & 95% CI: 0.91, 0.72-0.97) and VCO2 (0.91, 0.72-0.97) of walking demonstrated high reliability whereas reliability was moderate for stair climbing (VO2: 0.82, 0.6-0.93; VCO2: 0.73, 0.44- 0.88) and low for descending stairs (VO2: 0.67, 0.33-0.85; VCO2: 0.51, 0.1-0.77). Conclusion: K4b2 is a highly reliable device for VO2 and VCO2 measurement during self-paced walking in free living environment.

Work related musculoskeletal disorders among medical laboratory professionals: a narrative review.

Work related musculoskeletal disorders are common health problem and increasing cause of disability. Laboratory professionals are unique group of healthcare professionals who play an essential part in diagnosis and therapy planning and often their work is associated with potential health hazards. Objective of current study was to review literature on prevalence of work-related musculoskeletal disorders among medical laboratory professionals. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. The searching strategy uncovered 13 reports. Total 7 studies were included for the review. A high degree of heterogeneity among studies was observed. The overall prevalence’s ranges from 40-60%. With neck being more prevalent 18-78%. However additional high quality studies are required in this area.

A review of ongoing trials in exercise based rehabilitation for pulmonary arterial hypertension.

Exercise based rehabilitation for patients with pulmonary arterial hypertension (PAH) is a new treatment option for these patients to improve their functional capacity and quality of life. Despite the benefits seen in cardiopulmonary rehabilitation in various other conditions, it has been underutilized for the patients with PAH. A review of currently registered ongoing trials on exercise training for patients with PAH from the World Health Organization International Clinical Trial Registry Platform was done using the key words “rehabilitation”, “exercise training”, “pulmonary artery hypertension” and “pulmonary hypertension” for a period of 10 years (2002-2012). The search revealed 57 registered trials in various trial registries from which seven met the inclusion criteria. The current studies are being carried out in Germany (n=4), Brazil (n=1), Australia (n=1) and India (n=1). This indicates a shift in focus from the only medical management to the rehabilitation and long term care for patients with PAH.

A questionnaire based survey on awareness of diabetic foot care in Indian population with diabetes: A cross-sectional multicentre study.

Objective: To find awareness regarding foot care in Indian population with diabetes in various parts of India. Materials and Method: A cross-sectional study design was used to perform a multicenter, national level survey from August, 2011 to February, 2012 in various parts of India. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 16. Awareness levels for diabetic foot care were calculated as absolute frequencies and were reported as overall percentages. Spearman test was used to find the correlation for foot problems and diabetic foot care with socioeconomic status. Results: A total of 323 peoples were screened (there were 222 men and 101 women in the study with a mean age of 58.2 ± 8.6 years). 8.7% of men reported ulcer during the 1 st year of onset of diabetes, where as 8.3% of women were prone for ulcers in 16-20 years of diabetes, 56.4% of the population in urban area and 46.6% of the population in the rural area had been educated regarding foot care in diabetes. However, only 30.5% of population in urban areas and 9.7% of population in the rural areas knew about the importance of shoe selection in diabetes. Spearman's correlation was significant for foot problems with family income and educational status, P = 0.03 and P = 0.02 respectively. Conclusion: There is a need to bridge the disparity in awareness regarding diabetic foot management in Indian masses. More aggressive measures are required to implement current preventive foot care strategies in India.