Association between the Hopkins Falls grading scale and motor function tests in patients with multiple sclerosis.

Introduction: One of the main complications of multiple sclerosis (MS) is imbalance and walking problems that can lead to falls. This study investigated the association between a fall measurement scale called the Hopkins Falls Grading Scale (HFGS) and motor function tests in patients with MS. Material and Methods: This cross sectional study was conducted using convenience sampling on 85 patients referred to the MS Association of Mashhad, Iran, in 2023. The HFGS examined falls during the past year and divided them into 4 degrees, and the function test included the timed 25 foot walk (T25FW) test and the timed up and go (TUG) test. Kruskal-Wallis test and Spearman's correlation coefficient were used for data analysis. Results: A statistically significant association was obtained between HFGS and functional tests (T25FW and TUG) (for both P < 0.0001). A significant association was observed between the variables of age (P = 0.006), duration of the disease (P = 0.03), the use of mobility devices (P = 0.05), and HFGS. Conclusion: Considering the association between HFGS and motor function tests in MS patients, clinical experts should pay attention to patients who have slower movement and evaluate them in terms of falling status when performing motor function tests.

REALM-DCM: A Phase 3, Multinational, Randomized, Placebo-Controlled Trial of ARRY-371797 in Patients With Symptomatic LMNA-Related Dilated Cardiomyopathy.

BACKGROUND: LMNA (lamin A/C)-related dilated cardiomyopathy is a rare genetic cause of heart failure. In a phase 2 trial and long-term extension, the selective p38α MAPK (mitogen-activated protein kinase) inhibitor, ARRY-371797 (PF-07265803), was associated with an improved 6-minute walk test at 12 weeks, which was preserved over 144 weeks. METHODS: REALM-DCM (NCT03439514) was a phase 3, randomized, double-blind, placebo-controlled trial in patients with symptomatic LMNA-related dilated cardiomyopathy. Patients with confirmed LMNA variants, New York Heart Association class II/III symptoms, left ventricular ejection fraction ≤50%, implanted cardioverter-defibrillator, and reduced 6-minute walk test distance were randomized to ARRY-371797 400 mg twice daily or placebo. The primary outcome was a change from baseline at week 24 in the 6-minute walk test distance using stratified Hodges-Lehmann estimation and the van Elteren test. Secondary outcomes using similar methodology included change from baseline at week 24 in the Kansas City Cardiomyopathy Questionnaire-physical limitation and total symptom scores, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration. Time to a composite outcome of worsening heart failure or all-cause mortality and overall survival were evaluated using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: REALM-DCM was terminated after a planned interim analysis suggested futility. Between April 2018 and October 2022, 77 patients (aged 23-72 years) received ARRY-371797 (n=40) or placebo (n=37). No significant differences (P>0.05) between groups were observed in the change from baseline at week 24 for all outcomes: 6-minute walk test distance (median difference, 4.9 m [95% CI, -24.2 to 34.1]; P=0.82); Kansas City Cardiomyopathy Questionnaire-physical limitation score (2.4 [95% CI, -6.4 to 11.2]; P=0.54); Kansas City Cardiomyopathy Questionnaire-total symptom score (5.3 [95% CI, -4.3 to 14.9]; P=0.48); and NT-proBNP concentration (-339.4 pg/mL [95% CI, -1131.6 to 452.7]; P=0.17). The composite outcome of worsening heart failure or all-cause mortality (hazard ratio, 0.43 [95% CI, 0.11-1.74]; P=0.23) and overall survival (hazard ratio, 1.19 [95% CI, 0.23-6.02]; P=0.84) were similar between groups. No new safety findings were observed. CONCLUSIONS: Findings from REALM-DCM demonstrated futility without safety concerns. An unmet treatment need remains among patients with LMNA-related dilated cardiomyopathy. REGISTRATION: URL: https://classic.clinicaltrials.gov; Unique Identifiers: NCT03439514, NCT02057341, and NCT02351856.

Segmentectomy versus lobectomy: does FEV1.0 change accurately reflect the postoperative cardiopulmonary function?

OBJECTIVE: The postoperative respiratory function has been compared between lobectomy and segmentectomy based on the resting spirometric change in many previous studies. However, spirometric change has only been assessed in static conditions, and it is unclear whether it accurately reflects the cardiopulmonary function. METHODS: We used spirometry and a 6-min walk test to evaluate patients who underwent lobectomy and segmentectomy and examined the changes in heart rate (HR), respiratory rate (RR), and saturation of percutaneous oxygen (SpO2) before and after walking between the two groups. RESULTS: The present study included 24 patients who underwent segmentectomy and 21 who underwent lobectomy. There was no significant difference in the reduction of the median forced expiratory volume in 1 s (FEV1.0) after surgery. In the 6-min walk test, the increase in HR and RR after surgery has no significant differences between lobectomy and segmentectomy (HR: p = 0.372 and RR: p = 0.131). However, the two groups showed a significant difference in the reduction of SpO2 (p < 0.001). In addition, correlation analysis found that the more the number of resected segments, the more the reduction of SpO2 with a statistical significance (p = 0.002). CONCLUSIONS: Patients who received segmentectomy showed to suppress the reduction of SpO2 with a statistical difference after the 6-min walk test in comparison to those who received lobectomy. These results suggest that segmentectomy has less impact on the cardiopulmonary function and the 6-min walk test is useful for evaluating the postoperative cardiopulmonary function.

Comparison of cardiorespiratory parameters between 6-minute walk test and 1-minute sit to stand test in young adults with post-COVID-19: follow-up 3 months.

Background: The investigation of cardiorespiratory fitness in young adults post-coronavirus disease 2019 (COVID-19) is interesting because this information may help in understanding cardiorespiratory function in these populations. Moreover, it helps to know that these impairments possibly interfere with study, learning, and the activities of daily life in young adults post-COVID-19. This study aims to investigate and compare the cardiorespiratory parameters between 6-minute walk test (6MWT) and 1-minute sit-to-stand test (1-min-STST) in healthy young adults and post-COVID-19 and at a 3-month follow-up. Methods: Forty-six young adults were recruited and divided into two groups including healthy young adults in one group (n=23) and post-COVID-19 patients in the other group (n=23). The young adults were assessed for cardiorespiratory parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO2), rate of perceived exertion (RPE), and leg fatigue before and after performing a 6MWT and a 1-min STST at baseline and the 3-month follow-up. Test sequences were randomly assigned using the website randomizer.org. Results: Post-COVID-19 had significantly decreased post-HR, post-SBP, post-SpO2, post-RPE, post-leg fatigue, and increased the distance of 6MWT, and number of steps of 1-min-STST when compared with the baseline (P<0.05). However, all parameters of cardiorespiratory could recover and return to the values of healthy young adults by the follow-up at 3 months. Conclusions: Post-COVID-19 who recovered from mild-COVID-19 for about 6 months recovered their cardiorespiratory parameters to the values of healthy young adults.

The heart rate response to the 6-min walk test in atrial fibrillation patients with or without beta-blockers: Referring to patients with sinus rhythm.

BACKGROUND: The aim was to evaluate the effect of beta-blockers (BB) on the response of heart rate (HR) to 6-min walk test (6MWT) in atrial fibrillation (AF) and whether the AF patients treated with BB have a similar HR response to 6MWT as the AF and sinus rhythm (SR) patients without BB treatment at the same resting HR level. METHODS: The before-after study involving 74 AF patients was to evaluate the effect of BB treatment (pre-BB and with BB). The comparison study included 74 BB-treated AF patients (with BB), 74 matched AF patients without BB (no BB), and 74 SR patients. The percentage increase amplitude of HR (HR-PIA) in 6MWT was calculated: [(the exercise HR - the resting HR)/(the resting HR)] × 100%. RESULTS: The before-after study showed that BB treatment decreased the resting and mean exercise HR (98.6 ± 15.2 vs. 85.5 ± 11.2 bpm and 121.3 ± 17.3 vs. 109.0 ± 16.7 bpm) during 6MWT. The comparison study demonstrated that against the SR, the AF with BB and no BB groups have higher mean exercise HR-PIA (28.2 ± 17.1% and 22.0 ± 9.6%, vs. 6.9 ± 3.7%) when their resting HR is similar. Moreover, the mean exercise HR-PIA was also significantly higher in the with BB group than in the no BB group. CONCLUSION: In AF patients with relatively higher resting HR, BB treatment could decrease the resting and exercise HR during 6MWT. However, BB treatment could not effectively attenuate the exercise HR rise as compared with AF without BB treatment, even with similar resting HR levels.

Association between the 6MWT and other measurements of physical functioning in patients with cancer awaiting major surgery.

BACKGROUND: The Six Minute Walk Test (6MWT) is a widely used measure of functional capacity in (p)rehabilitation of cancer patients, but it is time-consuming and requires specific space conditions. In this study we explore the association between the 6MWT with other measurements of physical functioning and their predictive value in classifying patients according to their estimated functional capacity. DESIGN: This prospective study included cancer patients referred to a prehabilitation programme prior to major surgery. For each patient, data on different measurements of physical functioning including the Duke Activity Status Index (DASI), the handgrip strength, the 30" Sit-to-Stand Test and self-reported physical activity levels were collected. Bivariate associations were performed to determine the association between the 6MWT and other variables. Multivariate analyses were performed to identify potential predictive factors of 6MWT in this population. A subsequent algorithm was developed to classify patients based on their functional capacity (good performance - 6MWT>400 m or poor performance 6MWT<400 m) RESULTS: Between mid-2018 to mid 2022, 692 patients were assessed of whom the 6MWT was performed in 524 (75.7 %) (mean age 72.5 ± 11.8 years; 57.1 % men). Moderate-to-strong correlations were found between 6MWT and 30" Sit-To-Stand Test (r = 0.54, p < 0.001), DASI (r = 0.68; p < 0.001) and handgrip strength (r = 0.5; p < 0.001). Multivariate analyses confirmed that a combination of six variables were able to classify 80 % of patients in good (>400 m) or poor (<400 m) performance in the 6MWT. CONCLUSION: The 6MWT was moderately associated with several variables of physical functioning, a combination of which can be used to predict performance in the 6MWT.

Long-term tafamidis efficacy in patients with transthyretin amyloid cardiomyopathy by baseline left ventricular ejection fraction.

AIMS: Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) present with diverse left ventricular ejection fraction (LVEF). This study assessed tafamidis efficacy by baseline LVEF in the phase 3 Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) and its long-term extension (LTE) study. METHODS AND RESULTS: Patients were randomized to 30 months of tafamidis or placebo treatment in ATTR-ACT. On completion, patients could join an LTE study to receive tafamidis. All-cause mortality (death, heart transplant, or cardiac mechanical assist device implantation) from baseline to the end of follow-up was assessed in patients continuously treated with tafamidis (80 mg meglumine or 61 mg free acid) or delayed tafamidis treatment (placebo in ATTR-ACT; tafamidis in the LTE study) according to baseline LVEF (<50% or ≥50%). Supportive outcomes were evaluated over a shorter follow-up. Patients with baseline LVEF <50% (n = 177: 88 tafamidis- and 89 placebo-treated) had signs of more severe heart failure, a higher proportion were Black, and had variant ATTR-CM than those with LVEF ≥50% (n = 171: 85 tafamidis- and 86 placebo-treated). At the end of follow-up (median 60-64 months), all-cause mortality was numerically higher in patients with baseline LVEF <50%; however, consistent with supportive findings, continuous tafamidis treatment was associated with a 47% reduction in mortality risk compared with delayed tafamidis treatment in patients with LVEF <50% and ≥50% (hazard ratio 0.53 [95% confidence interval 0.367-0.758]; p < 0.001, and 0.53 [0.344-0.818]; p < 0.01, respectively). CONCLUSIONS: Early initiation of tafamidis is associated with reduced mortality in patients with ATTR-CM, irrespective of initial LVEF value. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01994889, NCT02791230.

Quality of Life in Follow-Up up to 9 Months after COVID-19 Hospitalization among the Polish Population-A Prospective Single Center Study.

The consequences of COVID-19 constitute a significant burden to healthcare systems worldwide. Conducting an HRQoL assessment is an important aspect of the evaluation of the impact of the disease. The aim of this study was to investigate the prevalence of persistent symptoms and their impact on HRQoL and health status in COVID-19 convalescents. The study group consists of 46 patients who required hospitalization due to respiratory failure and who were subsequently evaluated 3 and 9 months after hospital discharge. At the follow-up visits, the patients were asked to assess their HRQoL using the EQ-5D-5L questionnaire. The results of chest CT, 6MWT, as well as the severity of the course of COVID-19 were also considered in the analysis. The obtained results have identified fatigue as the most common persistent symptom. The majority of the convalescents reported an impairment of HRQoL in at least one domain (80% and 82% after 3 and 9 months, respectively), of which the most common was that of pain/discomfort. The presence of ongoing symptoms may affect HRQoL in particular domains. The 6MWT outcome correlates with HRQoL 3 months after hospital discharge. Therefore, it may be useful in identifying patients with reduced HRQoL, allowing early interventions aimed at its improvement.

Evaluation of Patients' Levels of Walking Independence Using Inertial Sensors and Neural Networks in an Acute-Care Hospital.

This study aimed to evaluate walking independence in acute-care hospital patients using neural networks based on acceleration and angular velocity from two walking tests. Forty patients underwent the 10-m walk test and the Timed Up-and-Go test at normal speed, with or without a cane. Physiotherapists divided the patients into two groups: 24 patients who were monitored or independent while walking with a cane or without aids in the ward, and 16 patients who were not. To classify these groups, the Transformer model analyzes the left gait cycle data from eight inertial sensors. The accuracy using all the sensor data was 0.836. When sensor data from the right ankle, right wrist, and left wrist were excluded, the accuracy decreased the most. When analyzing the data from these three sensors alone, the accuracy was 0.795. Further reducing the number of sensors to only the right ankle and wrist resulted in an accuracy of 0.736. This study demonstrates the potential of a neural network-based analysis of inertial sensor data for clinically assessing a patient's level of walking independence.

Six-minute walk test as clinical end point in cardiomyopathy clinical trials, including ATTR-CM: a systematic literature review.

Aim: The six-minute walk test (6MWT) is a common measure of functional capacity in patients with heart failure (HF). Primary clinical study end points in cardiomyopathy (CM) trials, including transthyretin-mediated amyloidosis with CM (ATTR-CM), are often limited to hospitalization and mortality. Objective: To investigate the relationship between the 6MWT and hospitalization or mortality in CM, including ATTR-CM. Method: A PRISMA-guided systematic literature review was conducted using search terms for CM, 6MWT, hospitalization and mortality. Results: Forty-one studies were identified that reported 6MWT data and hospitalization or mortality data for patients with CM. The data suggest that a greater 6MWT distance is associated with a reduced risk of hospitalization or mortality in CM. Conclusion: The 6MWT is an accepted alternative end point in CM trials, including ATTR-CM.

Evaluating current assessment techniques of cardiorespiratory fitness.

INTRODUCTION: Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. AREAS COVERED: In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. EXPERT OPINION: The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.

Impact of Real-Time Assessment of Pulse Oximetry on the 6-Min Walk Distance in Patients With Chronic Respiratory Disease.

BACKGROUND: Continuous monitoring of pulse oximetry (SpO2 ) is recommended during the 6-min walk test (6MWT) to ensure that the lowest SpO2 is recorded. In this case, severe exercise induced desaturation (EID; SpO2 < 80%) triggers walking interruption by the examiner. Our main objective was to assess the impact of this approach on 6MWT distance in patients with chronic respiratory diseases and, second, to evaluate the safety of the test without interruption due to severe EID. METHODS: 6MWTs with continuous monitoring of SpO2 were prospectively performed in subjects with chronic respiratory disease. The participants were randomly allocated to walk with or without SpO2 real-time assessment. SpO2 visualization during the test execution was available only in the first group, and walking interruption was requested by the examiner if SpO2 < 80%. RESULTS: One hundred forty-five participants were included in each group (68.6% females, 62 [52-69] y old) without differences in demographic and resting lung function parameters between them. The main respiratory conditions were COPD (n = 101), asthma (n = 73), pulmonary hypertension (n = 47), and interstitial lung disease (n = 39). The walked distance was similar comparing groups (349.5 ± 117.5 m vs 351.2 ± 105.4 m). Twenty-five subjects presented with severe EID in the group with real-time SpO2 assessment, and 20 subjects had severe EID in the group without real-time assessment respectively (overall prevalence of 15.5%). The 23 participants who had their test interrupted by the examiner due to severe EID in the first group (2 subjects stopped by themselves due to excessive symptoms) walked a shorter distance compared to the 11 subjects with severe EID without test interruption in the second group (9 subjects stopped by themselves due to excessive symptoms): 240.6 ± 100.2 m versus 345.9 ± 73.4 m. No exercise-related serious adverse events were observed. CONCLUSIONS: Interruption driven by severe EID reduced the walked distance during the 6MWT. No serious adverse event, in turn, was observed in subjects with severe desaturation without real-time SpO2 assessment.

Gait speed in knee osteoarthritis: A simple 10-meter walk test predicts the distance covered in the 6-minute walk test.

BACKGROUND: The 6-Minute Walk Test (6MWT) is a common performance-measure in Knee Osteoarthritis (KOA), but the pain and functional impairment characterizing the condition may interfere its adequate performance. OBJECTIVES: The shorter 10-m Walk Test (10mWT) could predict the distance performed on the 6MWT, therefore decreasing the burden on patients, enhancing efficiency, and reducing space- and time-constraints in clinical settings. DESIGN: A cross sectional study was conducted. METHODS: The scores from the 6MWT and the shorter 10mWT of 58 ambulatory subjects with KOA were compared. Correlation, and a univariate regression analysis to explore the predictive ability of the 10mWT, were calculated. RESULTS: Correlation was excellent (r = 0.913, p-value<0.001), and the predictive equation based on the 10mWT scores (R2 = 0.834, p-value<0.001) estimates the distance walked in the 6MWT with a relative error of 7.62%. CONCLUSIONS: The 10mWT may be an excellent assessment-tool to predict the distance walked in the 6MWT, due to its low strain on patients and as a means of improving efficiency and reducing time-constraints.

The bodyweight walking distance product and its relationship with clinical markers in patients with symptomatic peripheral artery disease.

PURPOSE: The six-minute walk test (6MWT) is extensively employed to evaluate gait impairment in patients with symptomatic peripheral artery disease (PAD) and has been associated with different health outcomes. However, various approaches exist for calculating and interpreting the six-minute test in order to address the needs of patients more effectively. Therefore, we investigated how these different approaches correlate with functional capacity and cardiovascular health in patients with symptomatic PAD. METHODS: In total, 227 PAD patients [65.2% men and 67 (13) y.o.] were included in this cross-sectional study. The 6MWT was performed along a 30-meter corridor and the distance was expressed in three ways: absolute (described as the meters walked during the test), relativized (based on the results of the 6MWT in healthy individuals), and DW (multiplying the body weight in kilograms by the absolute distance in the 6MWT). A functional capacity z-score was calculated using the results of the handgrip strength test, 4-meter walking test, and sit-and-stand test. A cardiovascular parameter z-score was calculated with data on brachial and central blood pressure, the low-frequency component/high-frequency component ratio, and carotid-femoral pulse wave velocity. RESULTS: The absolute (b = 0.30, 95%CI: 18-0.43, R² = 0.11, p < 0.001) and DW (b = 0.40, 95%CI: 27-0.53, R² = 0.17, p < 0.001) measures were related to functional capacity, independently of sex, age, and the ankle-arm index of the patients. Neither absolute nor DW were related to cardiovascular health. The relativized measure was not associated with either functional capacity or cardiovascular health. CONCLUSION: In patients with symptomatic PAD, absolute and DW measures are related to functional capacity, but not cardiovascular function.

Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols.

Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.

Accuracy of the 6-Minute Walk Test for Assessing Functional Capacity in Patients With Heart Failure With Preserved Ejection Fraction and Other Chronic Cardiac Pathologies: Results of the ExIC-FEp Trial and a Meta-Analysis.

BACKGROUND: Heart diseases, particularly heart failure, significantly impact patient quality of life and mortality rates. Functional capacity assessment is vital for predicting prognosis and risk in these patients. While the cardiopulmonary exercise test is considered the gold standard, the 6-minute walk test has emerged as a more accessible alternative. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity in cardiac pathologies, including heart failure with preserved ejection fraction, are unclear. The study aimed to analyse the diagnostic accuracy of the 6-minute walk test for detecting reduced functional capacity, defined as VO2max < 14 ml/kg/min, compared with the cardiopulmonary exercise test in participants with heart failure with preserved ejection fraction using data from the "Ejercicio en Insuficiencia Cardiaca con Fracción de Eyección Preservada" (ExIC-FEp) trial; and to compare these results with previous studies investigating the screening accuracy for assessing functional capacity of the 6-minute walk test in participants with other chronic cardiac pathologies through a meta-analysis. RESULTS: The ExIC-FEp trial involved 22 participants with heart failure with preserved ejection fraction, who were not treated with beta-blockers, using the cardiopulmonary exercise test, specifically VO2max, as the reference test. The 6-minute walk test had a sensitivity of 70%, a specificity of 80%, and an area under the curve of 76% in the ExIC-FEp trial. Five studies were included in the meta-analysis showing a sensitivity of 79%, a specificity of 78%, and an area under the curve of 85%. CONCLUSION: In conclusion, the 6-minute walk test holds promise as a screening tool for assessing functional capacity in heart failure with preserved ejection fraction and chronic heart diseases, with a VO2max < 14 ml/kg/min as a reference point. It demonstrates moderate to good screening accuracy. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity, regardless of aetiology, are unclear. TRIAL REGISTRATION: NCT05726474. Registered 16 February 2023, https://clinicaltrials.gov/study/NCT05726474 .

Impact of Long COVID on Lung Function in Children.

Objective: While the coronavirus disease-2019 (COVID-19) pandemic has generally resulted in milder illness among children than adults, persistent respiratory symptoms have been increasingly reported in this population. Methods: We conducted a prospective, single-center cohort study focusing on children experiencing prolonged respiratory symptoms after contracting COVID-19. Spirometry, 6- minute walk tests (6MWTs), and tests of lung volume, the diffusing capacity of the lungs for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO) were performed on COVID-19 survivors at least 4 weeks after infection and a group of healthy control subjects. Results: Fifty-five children with long-term COVID and 55 healthy control subjects were recruited. The weight, height, and body mass index Z-scores were similar in the groups. Within a median duration of 85 days (minimummaximum: 35-194) following COVID-19 infection, a restrictive pattern was observed to be more common in the study group (p=0.021). In children with long COVID, 6MWT distances, DLCO Z-scores, and the predicted values of spirometry and lung volume tests were found to be significantly lower but in the normal range. The average predicted values for DLCO, FeNO, and 6MWT were similar in the two groups. Conclusions: Prolonged respiratory symptoms often persist long after COVID-19 infection, necessitating comprehensive evaluation of affected children. Close monitoring, including spirometry and lung volume assessments, is crucial for children with abnormalities in lung imaging. However, FeNO measurements were found to be ineffective in monitoring long COVID.

The Assessment of Functional Status Among COVID-19 Patients at Three Months Using Pulmonary Function Tests.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has impacted the lives of thousands of patients worldwide with many patients having residual symptoms months after the acute infection. The severity of lung involvement ranges from mild asymptomatic to severe acute respiratory distress syndrome (ARDS), which may lead to pulmonary fibrosis. Pulmonary fibrosis increases the long-term morbidity of post-COVID-19 patients in the form of restrictive lung disease. The six-minute walk test (6MWT), Borg scale, and spirometry are simple and low-cost tests used to evaluate a patient's exercise capacity and functional status. This study was conducted to assess the residual symptoms and functional status using spirometry and 6MWT in COVID-19 patients of moderate to severe category after three months of discharge. Methods This was an observational, prospective, and cross-sectional study conducted at a tertiary care center in North India, aiming to enroll a minimum of 50 patients who recovered from COVID-19 pneumonia. These patients were previously hospitalized with moderate to severe disease severity as defined by the Indian Council of Medical Research (ICMR) criteria, and the assessment occurred at least three months after their discharge. Individuals who were under 18 years of age or pregnant or had any respiratory or cardiac illness in the past were excluded from the study. Results A total of 50 patients were included in the study for final analysis. After a three-month follow-up, 40 (80%) patients were still symptomatic. The most commonly reported symptom was exertional dyspnea in 21 (42%), dyspnea at rest in 16 (32%), and fatigue in three (6%) patients. Of the total patients, 37 (74%) covered a distance less than expected in the six-minute walk test. The mean distance covered by patients was 426.1 ± 115.01 m, in contrast to the expected mean distance of 537.22 ± 37.61 m according to standard equations for Indian males and females. A fall in oxygen saturation by more than or equal to 3% was observed in approximately 24 (48%) patients after the six-minute walk test. The mean value of fatigue and dyspnea score was 3.2 ± 1.7 (moderate score). Among patients with moderate disease during their hospital stay, a higher proportion exhibited a normal pattern on pulmonary function tests (PFT) compared to those severely affected, 23 (69.70%) versus two (11.76%), respectively. Conclusion The persistence of symptoms and functional limitation of activities should be anticipated in patients with COVID-19. Spirometry and 6MWT can be a valuable tool in determining the prevalence of functional limitation in recovered patients of COVID-19. It can potentially help in determining and further planning the rehabilitative measures in the management of COVID-19 survivors. It can also be concluded that it is important to have a long-term follow-up in patients with moderate to severe COVID-19.

Effects of Exercise Rehabilitation on Cardiorespiratory Fitness in Long-COVID-19 Survivors: A Meta-Analysis.

Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19-93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11-1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty.

Novelty of Physiotherapy Protocols in a Classic Case of Extrapulmonary Tuberculosis in a 35-Year-Old Male Patient: A Case Report.

Tuberculosis is the most frequent cause of death, specifically caused by a single infectious agent, Mycobacterium tuberculosis. There are two types of tuberculosis: pulmonary tuberculosis and extrapulmonary tuberculosis. Patients with extrapulmonary tuberculosis often have reduced lung function due to the disease's structural abnormalities, which also significantly impair their quality of life. The suggested standard of care for the treatment of extrapulmonary tuberculosis patients is pulmonary rehabilitation. A 35-year-old male patient who complained of shortness of breath, dry cough, and on-and-off fever diagnose with extrapulmonary tuberculosis was the subject of the case study. The patient had extrapulmonary tuberculosis with a history of pleural effusion, which was managed with proper medications. After increasing symptoms of the disease, the patient was referred for pulmonary rehabilitation. Physiotherapy protocol includes breathing exercises, relaxation techniques, and mobility exercises for the upper limb and lower limb. Effective physical rehabilitation was necessary to minimize complications and allow him to resume daily activities. Several outcome measures, like the dyspnea scale, visual analog scale, six-minute walk test, and World Health Organization-Quality of Life (WHO-QOL) questionnaire, were used to monitor the patient's progress during rehabilitation. The benefits of physiotherapy protocols emphasize the need for tailored approaches to addressing individual patient needs for comprehensive recovery as it significantly enhances clinical, physical, psychosocial, and overall quality of life, making it crucial for patients with extrapulmonary tuberculosis. The protocols are beneficial to improve exercise capacity, muscle force, symptoms such as dyspnea, cough, and health-related quality of life in these patients. In this study, the focus was more on breathing exercises such as segmental breathing exercises for lung expansion and increasing air entry in the lungs followed by improving functional capacity and strength.