Efficiency of the home cardiac rehabilitation program for adults with complex congenital heart disease.

OBJECTIVE: We aimed to study the efficiency and safety of once-a-week outpatient rehabilitation followed by home program with tele-monitoring in patients with complex cyanotic congenital heart disease. DESIGN: Prospective nonrandomized study. METHOD: Patients who have been diagnosed either Eisenmenger's syndrome or inoperable complex cyanotic heart disease and able to attend 12-week cardiac rehabilitation program were included. Training with treadmill walking and bicycling under supervision at cardiac rehabilitation unit once-a-week in the first 6 weeks followed by home-based exercise program (bicycle and walking) with a target at 40%-70% of maximum heart rate (HRmax) at pretraining peak exercise for another 6 weeks was performed in the intervention group. Video and telephone calls were scheduled for evaluation of compliance and complication. Data from cardiopulmonary exercise testing (CPET) on cycle ergometry including peak oxygen consumption (peakVO2 ), oxygen pulse (O2 pulse), ventilatory equivalent for carbon dioxide (VE/CO2 at anaerobic threshold), constant work-rate endurance time (CWRET) at 75% of peak VO2 , and 6-minute walk distance (6MWD) were compared between baseline and after training by paired t test. RESULT: Of the 400 patients in our adult congenital heart disease clinic, 60 patients met the inclusion criteria. Eleven patients who could follow program regularly were assigned home program. There was a statistically significant improvement of CWRET, O2 pulse, and 6MWD after finishing the program (P = .003, .039, and .001, respectively). The mean difference of 6MWD change in the home-program group was significantly higher than in the control group (69.3 ± 47.9 meters vs. 4.1 ± 43.4 meters, P = .003). No serious adverse outcomes were reported during home training. CONCLUSION: Once-a-week outpatient hospital-based exercise program followed by supervised home-based exercise program showed a significant benefit in improvement of exercise capacity in adults with complex cyanotic congenital heart disease without serious adverse outcomes.

The Oswestry low back pain disability questionnaire (version 1.0) Thai version.

OBJECTIVE: To validate the Thai version of the Oswestry low back pain disability questionnaire. MATERIAL AND METHOD: The questionnaire was translated into Thai version by two translators and some statements were adapted Back translation was performed by a language professional. The content validity was evaluated by five experts in physical medicine and rehabilitation field. The scores were calculated Then the questionnaire was completed by the patients and data calculated for Cronbach's alpha. RESULTS: Thirty-two patients who complained of acute low back pain (less than 3 months) completed the Thai version of the questionnaire. The content validity of each item ranged from 0.6-1.0 and the Cronbach's alpha of all items was 0.8107. CONCLUSION: The Thai version of the Oswestry low back disability questionnaire was qualified with good internal consistency for measuring acute low back pain in Thai patients.

Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome.

OBJECTIVE: To assess the effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. DESIGN: Randomized double-blind controlled trial. SETTING: Outpatient clinic of physical medicine and rehabilitation. METHOD: 120 participants who met the diagnostic criteria of acute herniated disc syndrome were randomized into two groups. The study group received treated traction, and the control group received sham traction. All patients had routine conservative treatments (consisting of NSAIDs, instruction of proper back activity and precaution, back exercise, and heat modality). The main outcome measurement was the Oswestry score, which was collected on the first day and at the 4th week of the treatment. At the end of the study, all patients recorded global improvement and satisfaction. RESULTS: Of 120 patients divided into two groups equally, 12 and 6 cases in the control and intervention groups dropped out of the study. The mean (SD) change of the Oswestry score were 19.25 (15.9) and 25.25 (16.68) in control and intervention groups respectively. There was no significant difference between the two groups with the p-value of 0.067 and 95%CI of - 0.42-12.43. Approximately 89% of patients in each group had improvement of their symptoms, and 90% in each group were satisfied with lumbar traction. Co-intervention with heat modality, NSAIDs use and back exercise did not differ between the two groups. CONCLUSION: The data do not support the benefit of traction for patients with acute herniated disc syndrome. The patient can be conservatively treated at home with proper instruction.