Activity levels after pulmonary rehabilitation - what really happens?

OBJECTIVES: To assess the changes in physical activity in subjects with chronic obstructive pulmonary disease over 6months after pulmonary rehabilitation. DESIGN: Prospective, observational study. Activity was measured over 2-day periods at the end of rehabilitation, and repeated every 6weeks for 6months using the ActivPAL uni-axial accelerometer. These results were compared with the shuttle walking test (SWT) and the St. George's Respiratory Disease Questionnaire (SGRDQ). SETTING: UK community hospital. PARTICIPANTS: Adults completing a community rehabilitation programme. MAIN OUTCOME MEASURE: Time spent standing and mobilising ('uptime'). RESULTS: Of 34 subjects recruited, 28 completed the 6-month study period (mean age 69years, mean forced expiratory volume in 1second 1.3l). Participants wore the monitor for 13.8 to 14.2hours/day. At baseline (post-rehabilitation), participants spent 1.7 [standard deviation (SD) 1.3]hours/day walking and 3.5 (SD 2.6)hours/day standing. Taking the group as a whole, mean uptime decreased marginally by 13.6minutes after 24weeks compared with baseline, with significant individual variability. In all but one subject who showed decreased activity, this was apparent after 6weeks. There were no significant changes in the mean SWT or SGRDQ. Significant associations between total uptime and the SWT were found, but coefficients were weak. It was not possible to predict individual responses from baseline data. CONCLUSION: The accelerometer provides useful supplementary data in patients completing rehabilitation programmes, and the results reveal wide variation. The weak associations between activity data and the SWT suggest that monitors provide additional information. More work is required to determine the factors associated with early deterioration in activity in order to design appropriate interventions.

[Treatment of intra-articular metacarpal and phalangeal fractures with an external fixation minidevice]. / Die Behandlung der intraartikulären Metakarpalfrakturen und Phalanxfrakturen mit dem Minifixateur externe.

Open reduction of intraarticular fractures involving the metacarpals and phalanges and fixation with the small external fixation apparatus is a promising new method which fulfills a need. Full return of function in seven patients and a small limitation of function in three patients can be regarded as a satisfactory result. All patients returned to work after a short time without any complications. The external mini-fixation device which has already been useful in the treatment of open and closed fractures, infected nonunions and in performing arthrodeses has now found another application in the treatment of fractures involving finger joints.