Mobility impact and methods of diaphragm monitoring in patients with chronic obstructive pulmonary disease: a systematic review

The objectives of the study were to identify the factors that limit diaphragmatic mobility and evaluate the therapeutic results of the monitoring methods previously used in patients with chronic obstructive pulmonary disease. The PubMed, Web of Science, Scopus, and LILACS databases were used. A gray literature search was conducted with Google scholar. PRISMA was used, and the bias risk analysis adapted from the Cochrane Handbook for clinical trials and, for other studies, the Downs and Black checklist were used. Twenty-five articles were included in the qualitative synthesis analysis on physiotherapeutic techniques and diaphragmatic mobility. Eight clinical trials indicated satisfactory domains, and on the Downs and Black scale, 17 cohort studies were evaluated to have an acceptable score. Different conditions must be observed; for example, for postoperative assessments the supine position is suggested to be the most appropriate position to verify diaphragm excursion, although it has been shown to be associated with difficulty of restriction and matching in samples. Therefore, we identified the need for contemporary adjustments and strategies that used imaging instruments, preferably in the dorsal position. Therapeutic evidence on the association between the instrumental method and diaphragmatic mobility can be controversial. The ultrasound measurements indicated some relevance for different analyses, for pulmonary hyperinflation as well as diaphragm thickness and mobilization, in COPD patients. In particular, the study suggests that the ultrasound technique with B-mode for analysis and M-mode for diaphragmatic excursion be used with a 2 - 5 MHz with the patient in the supine position. However, the methods used to monitor diaphragm excursion should be adapted to the conditions of the patients, and additional investigations of their characteristics should be performed. More selective inclusion criteria and better matching in the samples are very important. In addition, more narrow age, sex and weight categories are important, especially in patients with chronic obstructive pulmonary disease.

Resultados e reconhecimento das terapias fisioterápicas no período pré e pós-operatório de cirurgia cardíaca: uma revisão sistemática / Results and recognition of physiotherapy in the preoperative and postoperative period of cardiac surgery: a systematic review

Os fisioterapeutas, no pré e pós-operatório das cirurgias cardíacas, necessitam métodos inovadores para melhor caracterizar seus resultados terapêuticos e atuação do profissional? Realizou-se uma busca de artigos publicados nas bases Medline, Lilacs, Embase e da biblioteca Cochrane. Através dos achados científicos observou-se que no pré-operatório necessita-se de novos parâmetros comparativos despadronizados levando em consideração o tempo de tratamento. Existe uma contraposição quanto à eficiência do trabalho da Fisioterapia. Todavia, estudos demonstraram valores de impacto após o treinamento muscular respiratório intensificado para o pós-operatório das cirurgias cardíacas. Sugere-se uma inovadora metodologia, relacionando características específicas do paciente e aspectos clínicos da doença com o propósito de gerar motivação para adoção da intervenção e, consecutivamente, melhorar a concepção e impacto das terapias fisioterápicas e qualidade de evidência científica para os diferentes estudos a serem desenvolvidos. (AU)

Do physiotherapists in the preoperative cardiac surgery and postoperative period of cardiac surgeries require innovative methods to better characterize their therapeutic and professional performance? A search of articles published between the years 2000 and 2017 was carried out on the Medline, Lilacs, Embase and Cochrane databases. Through the scientific findings it was observed that in the preoperative cardiac it needs new unbalanced comparative parameters taking into consideration the time of treatment. There is a contraposition as to the efficiency of physiotherapy work. However, studies have shown impact values following intensified respiratory muscle training for postoperative period of cardiac. We suggest an innovative methodology, relating specific patient characteristics and clinical aspects of the disease with the purpose of generating motivation to adopt the intervention and, consecutively, to improve the conception and impact of physiotherapeutic therapies and quality of scientific evidence for the different studies to be developed. (AU)