Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial.

OBJECTIVE: To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD). DESIGN: Randomised controlled trial. SETTING: Primary care physiotherapy. PARTICIPANTS: Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale. INTERVENTION: Ten-week combined exercise training and home-based walking programme compared with standard medical care. MAIN OUTCOMES: At baseline and after 10 weeks, daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task. In addition, daily activities (Physical Activity Scale for the Elderly), functional exercise capacity (6-minute Walk Test), health-related quality of life (Chronic Respiratory Questionnaire) and exercise self-efficacy (Exercise Self-Regulatory Efficacy Scale) were measured. RESULTS: Fifty-two patients {34 females; mean age 70.2 [standard deviation (SD) 9.5] years; mean forced expiratory volume in 1second 67% (SD 9.2) of predicted} were randomised. PA, adjusted for baseline differences, increased significantly in the intervention group compared with the control group, by 26.1minutes/day [95% confidence interval (CI) 7.3 to 44.9]. The increase in functional capacity between groups was clinically relevant (34.0m, 95% CI 2.3 to 65.6) in favour of the intervention group. CONCLUSIONS: A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD. Clinical trial registration number NL24766.018.08.

Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review.

BACKGROUND: The objective of this review was to summarize the available evidence regarding the effects of mechanical tongue cleaning compared with no mechanical tongue cleaning on breath odour and tongue coating (TC). METHODS: PubMed-MEDLINE, EMBASE and Cochrane-CENTRAL were searched to identify potentially relevant studies. The inclusion criteria included the following: randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs) conducted in humans in good general health (no systemic disorders) and a patient age of ≥17 years. For the intervention, we considered tongue cleaning [the use of a tongue scraper (TS) or tongue brush (TB)] and for the control, brushing only (B) groups. Clinical parameters such as volatile sulphur compound concentration, organoleptic scores and TC were the outcome variables of interest. Study selection, quality assessment and data extraction were carried out by two independent reviewers. RESULTS: After screening of the titles and abstracts and subsequent full text reading of the potential papers, we identified five publications that met the eligibility criteria and provided seven experiments. The five studies consisted of three RCTs and two CCTs. All experiments show a positive effect of mechanical tongue cleaning in addition to toothbrushing on various parameters of oral malodour. CONCLUSIONS: This review demonstrated that mechanical approaches, such as tongue brushing or tongue scraping to clean the dorsum of the tongue, have the potential to successfully reduce breath odour and TC. However, data concerning the effect of mechanical tongue cleaning on chronic oral malodour (halitosis) are insufficient.

Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: a systematic review.

A systematic review was conducted to determine inter-examiner reliability of passive assessment of segmental intervertebral motion in the cervical and lumbar spine as well as to explore sources of heterogeneity. Passive assessment of motion is used to decide on treatments for neck and low-back pain patients. Inter-examiner reliability has been a matter of debate, resulting in questions about professional credibility and accountability. A structured search for relevant studies in MEDLINE and CINAHL was followed by extensive reference tracing and hand searching. Studies presenting estimates of reliability for individual motion segments were included. No language restrictions were imposed. Study quality was assessed using criteria derived from the Standards for Reporting of Diagnostic Accuracy (STARD) statement and a quality assessment tool for studies of diagnostic accuracy included in systematic reviews (QUADAS). Study selection, quality assessment, and data extraction were performed by two reviewers independently. Qualitative analyses and additional subgroup analyses were conducted. Nineteen studies were included. Two studies satisfied criteria for external and internal validity, of which one found fair to moderate reliability. Assessment of motion segments C1-C2 and C2-C3 almost consistently reached at least fair reliability. Overall, inter-examiner reliability was poor to fair. However, most studies were found to be of poor methodological quality. We propose explicit recommendations for the conduct and reporting of future research.