Single breath counting as a respiratory muscle function assessment test

Background: Spirometry may be used as a surrogate marker of respiratory muscle strength in patients with neuromuscular disorders. However, it is an aerosol-generating procedure, not readily conducted during remote consultation, and its use has been limited by infection control guidance during the COVID-19 pandemic. Single breath counting (SBC) has been reported to predict vital capacity (VC). We aimed to evaluate the utility of SBC in our clinic. Method(s): We conducted an evaluation to compare SBC and VC measurements in healthy volunteers and patients with respiratory muscle weakness. To perform SBC, individuals were asked to maximally inhale and then count every second in time with a metronome from 1 to the highest number they could manage in a single breath. SBC was repeated 3 times and the mean and maximum results were recorded. Individuals performed spirometry for slow VC in accordance with ERS guidelines. Results were compared using Spearman's rank correlation coefficient. Result(s): 31 healthy controls and 18 cases were included. The correlation between VC and SBC were rho=0.697 (p<0.001) and rho=0.694 (p<0.001) for mean and maximal efforts respectively (Figure). Conclusion(s): Primary findings highlight the potential usefulness of SBC for respiratory muscle function assessment. This promising technique is simple and feasible with current infection control guidelines and may be useful in remotely conducted appointments.

Multidimensional Assessment of Dyspnea in Postcovid Patients Referred to Pulmonary Rehabilitation

MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA IN POSTCOVID PATIENTS REFERRED TO PULMONARY REHABILITATION In patients who suffer sequels after severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV2), dyspnea is the most prevalent respiratory symptom. We aimed to analyze a subgroup of patients under follow-up in the pulmonology rehabilitation units after hospitalization for moderate-severe SARS-CoV2 pneumonia. We prospectively studied 455 patients until November 2021. We analyzed: dyspnea by mMRC scale, grade of fatigue by FACIT-F (0 without fatigue-4 intense fatigue), spirometry and DLCO, 6-minute walk test (Osses'equations), isometric strength of dominant quadriceps (weakness threshold <70%), maximal sniff nasal inspiratory pressure test (weakness thresholds <70 cmH2O for men and <60 cmH2O for women), body composition and physical activity IPAQ-7. We grouped our sample according to the severity of the mMRC dyspnea (>= 2 vs < 2) and results were compared for the global sample and separately for men and women. Table 1 shows the baseline characteristics. 41.5% of women and 19.5% of men showed inspiratory muscle weakness. 52.7% of the patients reported dyspnea mMRC >= 2 and studied variables were significantly worse (Table 2). In the women group, only the 6-minute walk distance, the level of physical activity and the fatigue grade were significantly worse in patients with greater dyspnea (Table 2). Conclusion(s): In our sample, multifactorial moderate-intense dyspnea becomes a good marker of functional capacity, muscle function, grade of fatigue and physical activity in patients who have suffered from moderate-severe Covid-19 pneumonia.

Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19

Malnutrition estimates range between 5 and 69% in acute Coronavirus disease 2019 (COVID-19) patients. With respect to body composition (BC) and muscle function, low values of phase angle (PhA) and handgrip strength (HGS) have been related to poor disease outcomes. Little evidence is available in post-acute patients. We aimed to combine the evaluation of nutritional status, BC, and muscle strength in a real-life cross-sectional cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. The study population included 144 patients (M=95;mean age 64.8yrs), of which 37% bedridden (M=60%). Nutritional status was evaluated with the Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT) scores. Fat-free mass (FFM), skeletal muscle (SM), and raw variables, i.e. PhA, were estimated with bioelectrical impedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% of patients were malnourished and 62% at risk of malnutrition. As for CONUT, 21% of patients had moderate-severe malnutrition, while 58%light malnutrition. Overall, malnutrition was highly prevalent in older patients with more comorbidities. Marked abnormalities of PhAand HGSwere more frequent in bedridden or malnourished patients, and when FFM or SM were low. Dynapenic patients were 65% males and 47% females. Malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients. Future studies will help to tailor screening algorithms for full nutritional status assessment to appropriate care processes and rehabilitation strategies.

The Adaptive Force as a Potential Biomechanical Parameter in the Recovery Process of Patients with Long COVID.

Long COVID patients show symptoms, such as fatigue, muscle weakness and pain. Adequate diagnostics are still lacking. Investigating muscle function might be a beneficial approach. The holding capacity (maximal isometric Adaptive Force; AFisomax) was previously suggested to be especially sensitive for impairments. This longitudinal, non-clinical study aimed to investigate the AF in long COVID patients and their recovery process. AF parameters of elbow and hip flexors were assessed in 17 patients at three time points (pre: long COVID state, post: immediately after first treatment, end: recovery) by an objectified manual muscle test. The tester applied an increasing force on the limb of the patient, who had to resist isometrically for as long as possible. The intensity of 13 common symptoms were queried. At pre, patients started to lengthen their muscles at ~50% of the maximal AF (AFmax), which was then reached during eccentric motion, indicating unstable adaptation. At post and end, AFisomax increased significantly to ~99% and 100% of AFmax, respectively, reflecting stable adaptation. AFmax was statistically similar for all three time points. Symptom intensity decreased significantly from pre to end. The findings revealed a substantially impaired maximal holding capacity in long COVID patients, which returned to normal function with substantial health improvement. AFisomax might be a suitable sensitive functional parameter to assess long COVID patients and to support therapy process.

The Impact of Long COVID-19 on Muscle Health.

COVID-19 negatively impacts several organs and systems weeks or months after initial diagnosis. Skeletal muscle can be affected, leading to fatigue, lower mobility, weakness, and poor physical performance. Older adults are at increased risk of developing musculoskeletal symptoms during long COVID. Systemic inflammation, physical inactivity, and poor nutritional status are some of the mechanisms leading to muscle dysfunction in individuals with long COVID. Current evidence suggests that long COVID negatively impacts body composition, muscle function, and quality of life. Muscle mass and function assessments can contribute toward the identification, diagnosis, and management of poor muscle health resulting from long COVID.

Web-based physical activity interventions are feasible and beneficial solutions to prevent physical and mental health declines in community-dwelling older adults during isolation periods.

BACKGROUND: Periods of prolonged lockdown increase the risk of physical inactivity, which can contribute to physical decline among older adults. Online technology could be an innovative solution to promote physical activity habits in this context. The goal of this study was to examine and compare the acceptability, feasibility and potential benefits of two modalities of web-based PA interventions in older adults during the COVID-19 lockdown. METHODS: Eighty-three non-physically active community-dwelling older adults (age 60 and over) were randomized to a 12-week web-based PA intervention delivered either in a Live Group (LG; n=38) or a Recorded Group (RG; n=45). Acceptability, feasibility as well as functional capacities, physical performance, quality of life and PA level were assessed pre- and post-intervention. RESULTS: There were fewer dropouts in the LG than RG (LG:16% vs. RG:46%). However, adherence rate (LG:89%; RG:81%), level of satisfaction (LG:77% vs. RG:64%) and enjoyment (LG:68% vs. RG:62%) were similar across groups, even if the participants found the intervention slightly difficult (LG:58% vs. RG:63%). Both groups significantly improved on functional capacities, physical performance and quality of life. Only the LG showed significant improvements in perceived health and PA level. The LG showed greater improvements in physical performance and quality of life than the RG. CONCLUSION: Web-based PA interventions are feasible, acceptable and beneficial for improving functional capacities and physical performance during periods of lockdown. However, the interactive web and live modalities appear to be more effective for promoting some of these outcomes than recorded and individual modalities.

TH-248. Electrophysiologic changes in patients with new-onset neuromuscular disorder after COVID-19

Introduction: Many neurological complications have been described in association with the COVID-19 infection. The pathogenesis of the complications associated with COVID-19 may arise due to direct invasion of the central nervous system, autoimmune mechanisms, and concomitant disease. We aimed in this study to investigate peripheral nerve and muscle function electrophysiologically in patients with neuromuscular symptoms following COVID-19 diagnosis. Method(s): In this study, the data of 13 patients who were diagnosed with COVID-19 between February 2020 and December 2021 and who developed a new-onset neuromuscular disorder after COVID-19 were retrospectively reviewed. Neuromuscular symptoms, neurological examination, nerve conduction studies (NCS) and concentric-needle electromyography (EMG) were obtained from the patient records. Result(s): Four female and nine male patients with a mean age 48.3+/- 9.3 years were enrolled. There were six cases (46.1%) with neuropathy, one case (7.5%) with myopathy, two cases (15.8%) with myastenia graves, one case (7.5%) with rhabdomyolysis and three cases (23.1%) with subclinical myopathic findings. Electrodiagnostic studies were obtained in all 13 patients. Mean time to performing electrodiagnostic study from onset of neurological symptom was 7 days with standard deviation of 6.25. 3 out of 6 patients with neuropathy had demyelinating patterns (prolonged motor latencies, severe conduction velocity slowing, and conduction blocks). Two patients had acute sensory motor axonal neuropathy and one had acute motor axonal neuropathy. Conclusion(s): More research is needed to fully understand the spectrum, pathogenesis, preventive strategies, and treatment of neuromuscular outcomes post-COVID-19. Copyright © 2022

Applicability of the SARC-F questionnaire by remote interview.

OBJECTIVE: The aim of this study was to assess the applicability of the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire by telephone to identify sarcopenia risk (SR; SARC-F ≥6) and low muscle function risk (LMFR; SARC-F ≥ 4) and their associated risk factors in a cohort of community-dwelling older adults in southern Brazil. METHODS: A longitudinal study was carried out with community-dwelling older individuals from COMO VAI? STUDY: Sociodemographic, behavioral, and health-related information were collected at baseline, and, in the second assessment, the SARC-F questionnaire was applied by phone or in-person interviews. Older adults identified with sarcopenia at the baseline assessment were excluded. Adjusted analysis by Poisson regression according to hierarchical levels was performed. RESULTS: Of the 1451 participants interviewed at baseline, only 951 participated in the second assessment. During the second assessment, 732 adults (77%) were interviewed by phone and 219 (23%) in person. There was no statistically significant difference for the SR (9.1 versus 9.7%, P = 0.802) and LMFR (22.4 versus 20.0%, P = 0.435) prevalence when the SARC-F questionnaire was administered in person or by phone, respectively. Age ≥80 y, presence of depressive symptoms, multimorbidity, dependence to perform one or more daily activities, and polypharmacy were factors associated with a higher risk for poor outcomes in older adults interviewed by phone. CONCLUSIONS: The similar prevalence between in-person and remote assessments suggests the feasibility of using the SARC-F questionnaire by phone interview as a reliable alternative for sarcopenia and low muscle function risk assessment without the requirement of face-to-face evaluations.

Impairment of Inspiratory Muscle Function after COVID-19.

BACKGROUND: Persistent symptoms after acute coronavirus-disease-2019 (COVID-19) are common, and there is no significant correlation with the severity of the acute disease. In long-COVID (persistent symptoms >4 weeks after acute COVID-19), respiratory symptoms are frequent, but lung function testing shows only mild changes that do not explain the symptoms. Although COVID-19 may lead to an impairment of the peripheral nervous system and skeletal muscles, respiratory muscle function has not been examined in this setting. METHODS: In this study, we assessed the severity of dyspnea (NYHA-function class) in long-COVID patients and analyzed its association with body mass index (BMI), FEV1, forced vital capacity, other parameters of body plethysmography, diffusing capacity for carbon monoxide (DLCO), arterial blood gases, and inspiratory muscle function, assessed by airway occlusion pressure (P0.1) and maximal inspiratory pressure (PImax) in two respiratory clinics in Germany between Oct 2020 and Aug 2021. RESULTS: A total of 116 patients were included in the study. The mean age was 50.2 ± 14.5 years; BMI, 26.7 ± 5.87 kg/m2; NYHA class I, 19%; II, 27%; III, 41%; and IV, 14%. While lung function values and computed tomography or conventional X-ray of the chest were in the normal range, inspiratory muscle function was markedly impaired. P01 was elevated to 154 ± 83%predicted and PImax was reduced to 41 ± 25%predicted. PImax reduction was strongly associated with the severity of dyspnea but independent of BMI, time after acute COVID-19 and most of the other parameters. CONCLUSIONS: This study shows that in long-COVID patients, respiratory symptoms may be mainly caused by reduced inspiratory muscle strength. Assessment of PImax and P0.1 might better explain dyspnea than classical lung function tests and DLCO. A prospective study is needed to confirm these results.

THE EFFECTS of TELEREHABILITATION with REMOTELY SPINAL STABILIZATION EXERCISES on CLINICAL VARIABLES, FUNCTIONAL ACTIVITIES, EXERCISE ADHERENCE and MUSCLE ARCHITECTURE of NECK MUSCLES in INDIVIDUALS with CHRONIC NECK PAIN

Background: Doing a job with functional activity may aggravate chronic neck pain(CNP). Thickness, PCSA of the neck muscles can be improved with exercise. During the Covid-19 pandemic, people has caused an increase in home workload, the frequency of performing functional activities related to performance has increased. The distance between physiotherapists and the patient should be at least 2 meters in clinics due to the risk of transmission. As a result, the importance of telerehabilitation has increased. Objectives: Our aim is to investigate the effect of remotely spinal stabilization exercises(SSE) with telerehabilitation on clinical variables, the functional activities, exercise adherence and muscle architecture patients with CNP. Methods: The demographic characteristics were recorded. Pain intensity with Visual Analog Scale (VAS), disability level with Neck Disability Index (NDI), neck awareness with Fremantle Neck Awareness Questionnaire (FreNAQ), the functional capacity levels with neck function capacity evaluation test, the difficulty of functional activities with VAS were assessed. Muscle thickness of M. Sterno-cleideomastoideus, M. Upper Trapezius, PCSA of M. Longus Colli, M. Cervical Multifdus was evaluated in the resting with 3.5-10 MHz ultrasound. The exercise adherence with Exercise Adherence Rating Scale and exercise program satisfaction with VAS were evaluated. The telerehabilitation group (TG) used exercises videos and video conferences, control group (CG) did SSE in the clinic. To study the effects of the interventions, the outcome measures were compared time-by-group interaction effects, one the within-groups factor (time) and one the between-groups factor (group) by repeated-measures two-way ANOVA. The Mann Whitney-U test was performed to compare two groups for non-parametric data. Results: Twenty-eight patients were randomly allocated to the TG and the CG. The VAS, NDI, FreNAQ, the functional capacity levels, muscle architecture showed similar changes over time in both groups. Results showed no signifcant time-by-group interaction effects of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05);a signifcant effect for time in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p<0.001). There was no difference between the groups in terms of VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture. Results showed no signifcant effect for the group in the VAS, NDI, FreNAQ, the functional capacity levels, the difficulty of functional activities and muscle architecture (p>0.05). Both groups adapted well to the exercise program and were highly satisfed with the SSE (p<0.05). Conclusion: The VAS, NDI, difficulty of functional activities decreased;FreNAQ, functional capacity levels, architecture of neck muscles increased in both groups after 8 weeks SSE. It was determined that telerehabilitation with remotely SSE was benefcial as face-to-face SSE.

THE DECREASE of MUSCLE MASS by the BEHAVIORAL RESTRICTION of COVID-19 PANDEMIC in PATIENTS with RHEUMATOID ARTHRITIS

Background: We previously reported the prevalence of sarcopenia and body compositions at patients with rheumatoid arthritis (RA)1. The behavioral restriction of COVID-19 pandemic influenced for the lifestyle of people included patients with RA. Objectives: The change of exercise and daily life activity of patients with RA were investigated and body composition and muscle function were compared pre-and post-behavioral restriction. Methods: We used the date from prospective observational study (CHIKARA study: UMIN000023744). 70 from 100 patients with RA were followed-up and evaluated the change of exercise and daily life activity by visual analog scale. They were measured the muscle mass, fat mass, basal metabolic rate by body composition analyzer and grip strength as muscle function. The relationship between the change of exercise and daily life activity and body composition was investigated by univariate analysis. Results: Mean age was 69.7 years (women n=57, men n=13). The rate of decrease of exercise by <25%, 26~50%, and 51%< were 70%, 21%, and 9%, respectively (mean:20% decrease). Whereas, the rate of decrease of daily life activities by <25%, 26~50%, and 51%< were 37%, 27%, and 36%, respectively (mean:44% decrease). Muscle mass at post-behavioral restriction decrease signifcantly compared that at pre-behavioral restriction activities (34.0kg vs 34.7kg, P<0.001). Fat mass at post-behavioral restriction increase signifcantly compared that at pre-behavioral restriction (16.2kg vs 15.5kg, P=0.014). Grip strength at post-behavioral restriction decrease signifcantly compared that at pre-behavioral restriction (16.2kg vs 17.2kg, P=0.026). The change of exercise was signifcantly positively correlated with the change of muscle mass and basal metabolic rate (R=0.273, P=0.021 and R=0.256, P=0.033, relatively) at Table 1. Whereas, the change of daily living activities was not signifcantly correlated with the change of muscle mass and muscle function. Conclusion: Muscle mass and grip strength decrease and fat mass increase in patients with RA by the behavioral restriction of COVID-19 pandemic. Muscle mass and basal metabolic rate decrease in patients without exercise habits. Maintenance of muscle mass might be important during the COVID-19 pandemic.

Malnutrition risk and the need for dietetic intervention post COVID-19 infection on a care of the elderly rehab ward

Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References I. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4)

Adapted physical activity in subjects and athletes recovering from covid-19: a position statement of the Società Italiana Scienze Motorie e Sportive.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic illness that is impacting the cardiovascular, pulmonary, musculoskeletal, and cognitive function of a large spectrum of the worldwide population. The available pharmacological countermeasures of these long-term effects of COVID-19 are minimal, while myriads of non-specific non-pharmacological treatments are emerging in the literature. In this complicated scenario, particular emphasis should be dedicated to specific exercise interventions tailored for subjects and athletes recovering from COVID-19. Specific guidelines on adapted physical activity in this critical population are unavailable so far, therefore, in this position statement of the Società Italiana di Scienze Motorie e Sportive (SISMeS) the members of the steering committee of the research group Attività Motoria Adattata, Alimentazione, Salute e Fitness have indicated the adapted physical activity approaches to counteract the long-term effects of the COVID-19, both in good health people and athletes.

ASSESSMENT OF DETERMINANTS OF PRACTICES REGARDING USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) AMONG MEDICAL STUDENTS

Objective: To assess the knowledge, attitudes regarding hygienic and personal protective practices and to evaluate the factors associated with the knowledge regarding use of PPE among medical college students. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Foundation University, Islamabad Pakistan, from Mar to May 2021. Methodology: Using non-probability consecutive sampling, a self-administered questionnaire will be given to students. Questions will be asked about their knowledge of the types of PPE and its correct use and analyzed in SPSS-20. Results: Out of 289 respondents, one hundred and sixty-eight (58%) belongs to 1st - 3rd year of MBBS and one hundred and twenty-one (42%) were in 4th and final year. Majority (68%) were females and ninety-two (32%) males. Two hundred and forty-three (84%) of them agreed that main goal of infection control is to prevent infection among patients and health care workers. Two hundred and twenty-eight (79%) of them had knowledge regarding correct duration of hand washing and ninety-eight (34%) agreed that use of gloves replaced the need of hand washing. More than half (78%) had knowledge that hand washing is indicated after removal of gloves. Majority (92%) knows that PPE provides barrier against infection. About half (53%) and (48%) had correct knowledge regarding donning and doffing of PPE respectively. Regarding attitudes, half of the respondent (50%) strongly agrees towrds correct use of PPE and hand hygiene. Conclusion: The levels of self-reported PPE information and Infection prevention and control training are sub-optimal in medical students of FFH which significantly correlates to COVID-19 and other infectious diseases-related anxiety.

Preliminary results of a complex program: Care for metabolic state of musculoskeletal system-a key to long-life independence in patients with osteoporosis and osteopenia

Objective: Ever since the times of ancient physicians and surgeons like Sushruta (600 BC) or Hippocrates (400 BC), it is clear that physical development of individuals with sedentary lifestyle is different from the one of the physically active individuals. Only after the year 2000, with the first discovery of causality of IL-6 and muscular movement, an intensive study of this problematics has begun. Currently, there are about 600 known operations (myokins) that are interrelated with muscle functions. Muscular tissue interrelates with others mechanistically, but it also forms humoral harmony in which the muscular tissue has a dominant and determining role. This phenomenon is relevant for pathophysiology of chronical low-grade inflammation, muscle loss, origin and development of noncommunicable diseases. These cause approx. 75% of deaths in population. Solution of this problem has been considerably affecting cost-effectivity in the health care system today and thus the state economy as well. Therapeutic recommendations together with the whole health care strategy need to be adjusted according to the above mentioned findings, including the patients with osteoporosis and osteopenia. There are, so far, no known suitable medicaments which would be used for solving problematics of muscular loss. This is a reason why more attention needs to be paid to the recommended physical regime (150 min/week, according to WHO) and dietary regime (basic diet + proteins). We have built a complex diagnostic and therapeutic program for our patients. Definition of pathological values follows EWGSOP and WHO. Methods: Patient cohorts: Osteoporosis 60-70 y, 70-80 y, osteopenia 60- 70 y and 70-80 y. Control group for osteopenia 60-80 y. We followed information about the control group during the COVID-19 time period, particularly their physical activity regime. 1) Instructions for patients used to be delivered in a form of lectures for different age groups. Now, during the COVID-19 time period, instructions are provided individually. 2) SarQol (Sarcopenia and Quality of Life) questionnaire (Beaudart 2015). Czech version used with agreement from sarqol.org. Assessment is now done individually only. 3) Measuring hand-grip is standardised according to Southampton protocol with a dynamometer Jamar. Values of 20 kg are found pathological (female values). 4) Determination of BMI, according to WHO, the border figure is 25 or 30 kg/m2 . 5) DXA method determination of selective muscle index as a measure for muscle mass. ALM/Ht2 for age above 60 y, border value for sarcopenia is ≤5.45 kg/m2 . 6) From laboratory examinations we aimed at IL-6 and CRP(hs) - these are not a subject of this report. Results: Conclusion: We have been running a physical activity and dietary program for our patients for more than 2 y. Physical activity is aimed at 150 min/week (WHO) and basic diet aims at the Mediterranean type + protein saturation, considerable stress is given to whey proteins enriched with Leucin. Patients have been instructed. Due to adherence to this regime we are able to report on statistically relevant changes in muscle power and also in complex muscle mass, even during the current pandemic situation. (Table Presented).

Effects of Core Stabilization Exercise Programs on Changes in Erector Spinae Contractile Properties and Isokinetic Muscle Function of Adult Females with a Sedentary Lifestyle

This study aimed to investigate the effect of core stabilization exercises on the contractile properties and isokinetic muscle function of adult females with a sedentary lifestyle. We enrolled 105 adult females. Tensiomyography was performed on the erector spinae, and the isokinetic muscular functional test was performed on the trunk at an angular velocity of 60°/s and 90°/s. All participants performed the exercise for 60 min per day, 3 times a week, for 7 weeks. A Wilcoxon signed-rank test was performed at a significance level of 0.05. Tensiomyography (TMG) of the erector spinae revealed no significant post-exercise change in the contraction time;however, there was a significant post-exercise increase in the maximum radial displacement and mean velocity until 90% of the TMG was displaced. Additionally, the isokinetic muscular functional test of the trunk revealed a significant post-exercise increase in almost all variables. Our findings demonstrated that the core stabilization exercise reduced stiffness in the erector spinae, increased the velocity of erector spinae contraction, and effectively improved the isokinetic muscular function of the trunk.

The assessment and management of breathing dysfunction in musculoskeletal conditions: A survey of current United Kingdom physiotherapy practice

Keywords: Breathing dysfunction, Evolving musculoskeletal practice, Survey Purpose: The prevalence of breathing dysfunction (BD) is estimated at 10% of the United Kingdom (UK) adult population, and higher in those with asthma (Thomas et al., 2005), while an estimated 20% of adults attend primary care each year with musculoskeletal conditions (Department of Health and Social Care, 2019). Current research indicates a possible relationship between BD and musculoskeletal conditions including alterations in thoracic mechanics, respiratory muscle strength and spirometry, however, there is a lack of evidence regarding the most appropriate BD assessment and management strategies. Therefore, this study investigated physiotherapists’ use of BD assessment and management strategies for patients with musculoskeletal conditions and explored relationships between professional characteristics and current practice variation. Methods: An observational cross-sectional online survey was utilised. UK-based musculoskeletal physiotherapists were invited to participate via social media, professional networks and email. The survey consisted of 28 closed and 16 open questions informed by similar surveys and relevant BD literature. The survey was piloted by five musculoskeletal physiotherapists and was open for eight weeks between 22/05/2020 - 17/07/2020 with a half-way reminder. Data analysis included descriptive statistics and Fishers exact test. Results: 257 questionnaires were completed. 81% (n = 208) of participants worked within the NHS and 31.1% (n = 80) in private practice, with the majority working at an equivalent band 6 (23%, n = 58), band 7 (33%, n = 84) and band 8a (31%, n = 79). 13.2% (n = 34) reported a special interest in BD. 72% (n = 185) of participants did not assess or manage BD, 28% (n = 72) did. In this latter group 100% (n = 72) assessed using subjective indicators and patient observation, while muscle-length testing (69%, n = 50), physical assessment (68%, n = 49), respiratory parameters (26%, n = 19) and BD specific questionnaires (14%, n = 10) were less commonly reported. BD management consistently included breathing retraining (94%, n = 68), general exercise and BD education (89%, n = 64). The inclusion of BD assessment and management in musculoskeletal conditions was statistically significantly associated with BD special interest (p < 0.001), NHS equivalent banding (p = 0.034) and post-graduate BD training including self-directed learning, in-service training, online training, formal lectures, short courses and PhD level study (p < 0.001-0.049). Conclusion(s): This is the first survey of BD assessment and management in musculoskeletal conditions and indicates infrequent assessment and management of BD. For physiotherapists who do assess and manage BD, subjective indicators and observation were the most commonly assessed, while breathing retraining was the most frequent management strategy. BD special interest, relevant post-graduate training and NHS equivalent banding were statistically significantly associated with use of BD assessment and management. Impact: Findings will inform future survey design including international surveys comparing findings across a more diverse sample. Qualitative work or use of vignettes could explore rationales regarding the inclusion of BD assessment and management in musculoskeletal practice. Due to the potentially detrimental clinically important reduced respiratory muscle function associated with mechanical ventilation (Lu et al., 2016;Nassar et al., 2018) and COVID-19 illness (Brosnahan et al., 2020), future quantitative research could investigate whether there is an association between COVID-19 and BD or the effect of long COVID on breathing mechanics. Funding acknowledgements: Project was unfunded.

Respiratory and Peripheral Muscle Weakness and Body Composition Abnormalities in Non-Cystic Fibrosis Bronchiectasis Patients: Gender Differences.

As demonstrated in COPD, bronchiectasis patients may experience respiratory and peripheral muscle dysfunction. We hypothesized that respiratory and peripheral (upper and lower limbs) muscle function and nutritional status may be more significantly altered in female than in males for identical age and disease severity. In mild-to-moderate bronchiectasis patients (n = 150, 114 females) and 37 controls (n = 37, 21 females), radiological extension, maximal inspiratory and expiratory pressures (MIP and MEP), sniff nasal inspiratory pressure (SNIP), hand grip and quadriceps muscle strengths, body composition, and blood analytical biomarkers were explored. Compared to the controls, in all bronchiectasis patients (males and females), BMI, fat-free mass index (FFMI), fat tissue, upper and lower limb muscle strength, and respiratory muscle strength significantly declined, and FFMI, fat tissue, and quadriceps muscle function were significantly lower in female than male patients. In patients with mild-to-moderate bronchiectasis, respiratory and peripheral muscle function is significantly impaired and only partly related to lung disease status. Quadriceps muscle strength was particularly weakened in the female patients and was negatively associated with their exercise tolerance. Muscle weakness should be therapeutically targeted in bronchiectasis patients. Body composition and peripheral muscle function determination should be part of the comprehensive clinical assessment of these patients.