Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

Pulmonary function in patients with chronic stroke compared with a control group of healthy people matched by age and sex.

BACKGROUND: Effects of chronic stroke on pulmonary function are largely unknown. AIM: To compare lung volumes in people with chronic stroke with a control group of healthy people matched by age and sex, as well as to investigate the relationship between the lung volumes and functional capacity. METHODS: A cross-sectional study involving people with chronic stroke. Cases were matched to a control group of healthy people. Lung function and the distance walked during the Six-Minute Walk Test (6MWD) were the main outcomes. Independent t-tests were used to compare pulmonary function between groups and the Pearson correlation coefficient was used to assess any relationship between lung volumes and the 6MWD in the stroke group. RESULTS: Sixty-six participants (24 males in each group; 56.5 ± 15.5 years) were included. People with stroke presented significantly lower lung volumes when compared to the control group. The median of forced vital capacity (FVC) was 79% and peak expiratory flow was 64% of the reference value. The 6MWD was found to be weakly correlated with inspiratory reserve volume (r = 0.39, p = .03) and peak inspiratory flow (r = 0.35, p = .05). CONCLUSIONS: People with chronic stroke show decreased lung volumes when compared with healthy people and this likely impacts on their functional capacity.

Comparison of Two Protocols for the Assessment of Maximal Respiratory Pressures: Spanish Society of Pulmonology and Thoracic Surgery Versus American Thoracic Society/European Respiratory Society.

Background The measurement of maximal respiratory pressures (MRPs) is commonly used to assess respiratory muscle strength. However, in Spain, there is no consensus on which is the most adequate measurement protocol, as theSpanish Society of Pneumology and Thoracic Surgery (SEPAR) protocol differs from the one endorsed by the American Thoracic Society/European Respiratory Society(ATS/ERS). This study compared the absolute and predictive values of maximal expiratory and inspiratory pressures (MEP and MIP) in healthy adults obtained with the two protocols. Methods A cross-sectional study with a sample of healthy adults was conducted. Lung function and MRPs were assessed. MEP and MIP were measured using a digital manometer according to the SEPAR and ATS/ERS. Protocols were applied in random order by the same trained physiotherapist. The comfort experienced with each protocol was assessed through a short questionnaire. Paired t-tests were used to compare the results from both protocols. Results A total of 31 subjects (mean age 35.7±12.4 years; 14 females; FEV1=108.3±10.5%; FVC=103.7±10%) were included. There was a significant difference between MRPs favouring the SEPAR protocol, with the mean difference being 34.9±28.1 cmH2O (p˂0.001) for MEP and 8±11.6 cmH2O (p=0.001) for MIP. ATS/ERS protocol was, however, considered more comfortable than SEPAR (p<0.005). Conclusions This study shows that, in healthy adults, higher MRPs are obtained using the SEPAR protocol. Yet, the ATS/ERS protocol is experienced as more comfortable. Future studies are needed to analyse the application of both protocols in other populations and their associated comfort.

¿Qué papel desempeña la Fisioterapia en la pandemia mundial por COVID-19? / What is the role of Physiotherapy in the global COVID-19 pandemic?

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Afrontamiento y regulación emocional en estudiantes de fisioterapia / Coping and Emotional Regulation among Physiotherapy Undergraduates

Resumen Esta investigación tuvo un doble objetivo: la identificación de distintos perfiles de regulación emocional y la comprobación de si estos perfiles se diferencian en el uso de estrategias de afrontamiento ante el estrés académico. Participaron 487 estudiantes de fisioterapia (74% mujeres) de distintas universidades, con edades comprendidas entre 18 y 40 años. Se aplicó la Escala de Dificultades en la Regulación Emocional (Difficulties in Emotion Regulation Scale [DERS]) y la escala de Estrategias de Afrontamiento del Cuestionario de Estrés Académico (CEA). Se obtuvo un total de tres perfiles de regulación emocional en el análisis de conglomerados. El primero está compuesto por estudiantes con una baja regulación emocional, un segundo grupo con resultados mixtos y un tercer conglomerado que muestra una alta regulación emocional. Se encontraron diferencias estadísticamente significativas en el uso del total de estrategias de afrontamiento entre los perfiles de baja y alta regulación emocional.

Abstract This paper aims to identify different profiles of emotional regulation, and to see if they differ in academic stress coping strategies. The participants were 487 physiotherapy students (74% female) from different universities, aged between 18 and 40 years. The Difficulties in Emotion Regulation Scale (DERS) and Cuestionario de Estrés Académico (CEA) were applied. A total of three emotional regulation profiles were obtained in the cluster analysis. The first one is composed of students with low emotional regulation, a second group with mixed results was obtained and a third cluster shows students with high emotional regulation. Statistically significant differences in all the coping strategies were found between the profiles of low and high emotional regulation.

Respiratory Muscle Strength in Chronic Stroke Survivors and Its Relation With the 6-Minute Walk Test.

OBJECTIVES: To compare respiratory muscle strength in stroke survivors (SS) with that in a control group (CG) of healthy people matched by age and sex, as well as to investigate any relation between respiratory muscle strength and the distance walked during the 6-minute walk test (6MWT). DESIGN: Cross-sectional study. SETTING: This study comprised patients from a private neurological rehabilitation center and a public association for patients with acquired brain injury. PARTICIPANTS: Chronic SS with a diagnosis of hemiplegia/hemiparesis who were able to walk (n=30) and healthy individuals matched by sex and age (n=30) (N=60). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Respiratory muscle strength was assessed using maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) with a pressure transducer and a diver nozzle. The distance walked during the 6MWT was also registered for both groups. The motricity index and the Scale Impact of Stroke version 16.0 were also measured in SS. RESULTS: The Student t test revealed significantly lower values of MIP and MEP in SS than in the CG (MEP, 95.93±43.12cmH2O in SS vs 158.43±41.6cmH2O in the CG; MIP, 58.7±24.67cmH2O in SS vs 105.7±23.14cmH2O in the CG; P<.001). Moreover, these findings were clinically relevant because both MIP and MEP in SS were <60% of the predicted values. A positive correlation between the 6MWT and MIP was found using the Pearson coefficient (r=.43; P<.018). CONCLUSIONS: Respiratory muscle weakness should be considered in a holistic approach to stroke rehabilitation.

Effects of a muscular training program on chronic obstructive pulmonary disease patients with moderate or severe exacerbation antecedents.

BACKGROUND: Muscular training is the corner stone of pulmonary rehabilitation programs. AIM: To evaluate the effects of a muscular training program - carried out on chronic obstructive pulmonary disease (COPD) subjects with antecedents of moderate or severe exacerbation - on exercise tolerance, Health Related Quality of Life (HRQoL) and illness prognosis. DESIGN: A quasi-experimental study. SETTING: University Hospital. POPULATION: Twenty-five subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) degrees II, III and IV); with moderate or severe exacerbations and functional deterioration due to respiratory disability; with commitment and capacity to participate in the program. Subjects were selected by consecutive sampling. METHODS: Subjects underwent 20 muscular training sessions consisting of 30 minutes of inspiratory muscle training, 15 minutes of warm-up protocol of upper limb exercises, 30 minutes of muscle training in ergometric cycle, 5 minutes of stretching protocol of lower limbs plus illness awareness. The main outcome measures were six minute walking test (6MWT), specific HRQoL questionnaires (St. Georges Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRDQ) and Airways Questionnaire 20 (AQ20)) and the BODE Index. RESULTS: All subjects improved significantly (P<0.001) their HRQoL in the SGRQ, the CRDQ and the AQ20, and this was demonstrated in each one of the evaluated dimensions. A positive response in relation to exercise tolerance and illness prognosis was observed. Following the program subjects walked an average of 56 meters more (P<0.001) and the BODE index was a mean of 1.5 less regarding the initial value (P<0.001). CONCLUSIONS: A 20-session muscular training program contributes to an improvement in HRQoL, exercise tolerance and illness prognosis in COPD subjects with moderate or severe exacerbations. CLINICAL REHABILITATION IMPACT: The intervention program could be easily implemented since it needs a minimum of human and technological resources.

La Fisioterapia Respiratoria en España: una aproximación a su realidad / Respiratory Physiotherapy in Spain: an approach to its reality

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Nuevo marco académico de la fisioterapia: grado y posgrado / New academic framework of physiotherapy: graduate and postgraduate

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