Effects of an incentive spirometer versus a threshold inspiratory muscle trainer on lung functions in Parkinson's disease patients: a randomized trial.

Upper airway obstruction, reduced maximal expiratory and inspiratory flows, reduced lung volumes, abnormal ventilatory control, and diaphragmatic dyskinesias are reported in patients with Parkinson's disease (PD). Inspiratory muscle training (IMT) has been reported to be effective in improving respiratory functions; however, no studies have compared the effects of the incentive spirometer (IS) with the threshold inspiratory muscle trainer (TIMT) in patients with PD. The study aimed to compare the effects of IS and TIMT on maximum inspiratory pressure (MIP), 6-min walk distance (6-MWD), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) in patients with stage 1-3 according to the Hoehn and Yahr scale. 18 patients were randomly assigned to two groups, i.e., incentive spirometer (IS) and threshold inspiratory muscle trainer (TIMT) group. The IS group received IMT with volume-based IS, and the TIMT group received IMT with TIMT. MIP, 6-MWD, FVC, FEV1, and PEFR were measured before and after six weeks of training. In IS group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 18.13 and 5%, respectively. In the TIMT group: A significant increase (p < 0.05) was observed in MIP and 6-MWD by 30.15 and 8.94%, respectively. Both groups observed no significant difference (p > 0.05) in FVC, FEV1, and PEFR. When the two groups were compared, a greater increase (p < 0.05) was observed in the MIP and 6-MWD in the TIMT group compared to IS group. IMT with IS or TIMT for six weeks effectively increased MIP and 6-MWD in patients with stage 1-3 (Hoehn and Yahr scale) of PD. No improvement was observed in FVC, FEV1, or PEFR with any of the techniques. TIMT is more effective than IS in improving MIP and 6-MWD.

Systematic review of cancer-related fatigue instruments in breast cancer patients.

OBJECTIVE: Fatigue is having high prevalence and increased acknowledgment of negative effect on the patient's well-being which has resulted in fatigue being important research variable in breast cancer patients. The recent development shows greater receptivity of health professionals to assessing cancer-related fatigue (CRF). In this review, an attempt has been made to identify CRF instruments which have been used in breast cancer patients with the detailed description about the instruments and their psychometric properties. METHOD: A search was conducted from January 2000 to April 2020 from electronic databases such as PubMed, Cochrane, Embase, and Google Scholar. The studies were included if the instrument was used to measure fatigue in breast cancer patients and its description and psychometric properties reported in breast cancer patients. The search was limited to studies in the English language and use of English version of instruments. RESULTS: Among 34 CRF instruments, 9 instruments were included according to inclusion and exclusion criteria. From nine instruments, six were multidimensional, two were unidimensional, and one instrument was quality-of-life (QOL) subscale. All the scales have showed accepted reliability and validity in breast cancer patients. A minimal clinically important difference was available for Multidimensional Fatigue Symptom Inventory - Short Form, Brief Fatigue Inventory, Piper Fatigue Scale - Revised, FACIT Fatigue scale, and Fatigue symptom inventory instruments. SIGNIFICANCE OF RESULTS: This review will help healthcare providers who are dealing with breast cancer patients to acknowledge and better understand what their patients are experiencing. The most appropriate tool will allow healthcare providers to use for holistic assessment of CRF. The instrument will help them to monitor their patient's condition or treatment progress, so it can be incorporated into treatment decisions for better management of fatigue.

Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

BACKGROUND: With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS: Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS: The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION: This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE: Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Beyond COVID-19: Evidence-Based Consensus Statement on the Role of Physiotherapy in Pulmonary Rehabilitation in the Indian Context.

Post COVID-19 sequelae includes breathlessness, weakness, fatigue, decreased exercise tolerance and impaired quality of life. Physiotherapy based rehabilitation program is an essential component for post COVID-19 patients in facilitating maximum functional recovery. Expert consensus statements are available from the developed countries. There is a need for a guidelines to manage post COVID-19 sequelae in Indian context. The objective of this consensus statement is to provide evidence informed guidelines for post COVID-19 physiotherapy management as a component of pulmonary rehabilitation. This consensus statement was developed by expert panel across India. Published literatures were appraised and used to prepare the recommendations. This is the first of its kind of work providing preliminary guidelines for post COVID-19 physiotherapy.

Effect of Aerobic Exercise on Cancer-related Fatigue.

BACKGROUND: Fatigue is the most common side effect of cancer treatment with chemotherapy and/or radiation therapy, selected biologic response modifiers. The main purpose of this study is to evaluate the effects of aerobic exercise on cancer-related fatigue in patients of the solid tumor after chemotherapy and radiotherapy. METHODS: After screening for cancer-related fatigue, 34 patients fulfilled the inclusive criteria and were assigned into two groups (n = 17 recruited in the intervention group and n = 17 in control group). The intervention group received aerobic exercise program which included treadmill walking with low to moderate intensity (50%-70% of maximum heart rate), for 20-40 min/day for 5 days/week. Control group were taught stretching exercises of hamstrings, gastrocnemius, and soleus (to be done at home) and were encouraged to remain active. Outcome measures such as brief fatigue inventory (BFI), 6-min walk test, and functional assessment of cancer therapy-general (FACT-G) were taken at baseline and after 6-weeks. RESULTS: The data were analyzed using the Wilcoxon matched-pairs signed rank test for within group and Mann-Whitney U-test for between group comparisons. The results of this study showed that there was a significant reduction in cancer-related fatigue BFI score (P < 0.0001,), also there was significant improvement in the physical performance as in 6-min walk distance (P < 0.0001) and quality of life, FACT-G score (P = 0.0001). CONCLUSION: Aerobic exercise for 6 weeks has beneficial effects on cancer-related fatigue in patients with solid tumor after chemotherapy and/or radiotherapy.

Cotton dust exposure: Analysis of pulmonary function and respiratory symptoms.

BACKGROUND: Cotton industry workers are exposed to various hazards in the different departments of textile factories. The major health problems associated with cotton dust are respiratory problems, byssinosis, bronchitis and asthma. OBJECTIVE: To study the effect of cotton dust exposure on pulmonary function and respiratory symptoms. SETTINGS AND DESIGN: This cross-sectional observational study was conducted at cotton mill in the Ahmedabad city. MATERIALS AND METHODS: One hundred cotton mill workers of the weaving and spinning area participated in this study while 100 age- and gender-matched male subjects living in the residential area served as the control group. A questionnaire was used to inquire about respiratory symptoms and spirometry was done in both the groups. STATISTICAL ANALYSIS USED: Student's t-test was used to find the difference between spirometric parameters, and Chi-square test was used to find the difference between respiratory symptoms. RESULTS: Respiratory symptoms were statistically significantly more common in the cotton mill workers compared to control group. Cotton mill workers group also showed significant (P < 0.0001) decrease in forced expiratory volume in 1 s (FEV1), ratio of FEV1 and forced vital capacity (FVC) and peak expiratory flow rate, and no significant difference of FVC between groups. There was an association of duration of exposure and symptoms with spirometric abnormality. CONCLUSION: Cotton mill workers showed a significant decrease in spirometric parameters and increase in respiratory symptoms. As the duration of exposure and symptoms increased, spirometric abnormality increased.

A study on spirometry in petrol pump workers of Ahmedabad, India.

BACKGROUND: Lung reactions to exposure to dust, gases, and fumes at work places have been studied in different populations. The emission level of pollutants that emit particulate matter less than 10 micrometers in size (PM 10) has been found very high in Ahmedabad. Hence, petrol pump workers in Ahmedabad are likely to get exposed to a high level of air pollution along with petrol and diesel vapors. Both of these factors can affect the respiratory health of petrol pump workers. MATERIALS AND METHODS: A cross-sectional observational study was conducted at 53 different petrol pumps of Ahmedabad. A total of 227 petrol pump workers underwent pulmonary function testing. Their spirometry parameters were compared with 227 age-matched, healthy controls. RESULTS: A significant reduction (P < 0.001) was found in the spirometry parameters, such as, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory flow (FEF25-75), and peak expiratory flow rate (PEFR) in petrol pump workers, as compared to the controls. The mean values of FEV1/FVC (%) were significantly increased (P < 0.001). A decline in FVC was not significantly different among the workers according to the duration of exposure. As the duration of exposure increased, there was a progressive decline in FEV1/FVC (%) and FEF25-75. CONCLUSION: The study concludes that the deleterious effects of air pollution and petrol/diesel vapor inhalation on the lung function of petrol pump workers results in a restrictive type of lung function abnormality. The pattern of respiratory impairment changes to a mixed type as the duration of exposure increases.

The First Physical Therapy Summit on Global Health: implications and recommendations for the 21st century.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.