Search Results (78)

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP. Full article

Background/Objectives: Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery and is associated with increased morbidity and prolonged recovery. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program on the incidence of POAF and broader perioperative outcomes. Methods: In this monocentric, observational cohort study, we compared a retrospective pre-ERAS cohort (n = 162) with a prospective ERAS cohort (n = 321). The primary outcome was the incidence of POAF, assessed using two definitions: (1) the American Association for Thoracic Surgery (AATS) 2014 clinical definition, identifying POAF as atrial fibrillation requiring treatment; and (2) the European Society of Cardiology (ESC) 2024 definition, describing new-onset atrial fibrillation occurring immediately after surgery. Secondary outcomes included compliance with POAF prophylaxis measures, length of hospital stay, and the occurrence of postoperative complications. Statistical analyses included propensity score matching and multivariate logistic regression to identify independent predictors of POAF. Results: ERAS implementation was associated with a significant reduction in POAF incidence across both definitions. According to the AATS 2014 definition, POAF occurred in 20% of ERAS patients vs. 39% in the pre-ERAS group (p = 0.001), and 23% vs. 39% in the matched cohort (p = 0.004). Using the ESC 2024 definition, POAF was observed in 21% vs. 37% (p = 0.001) in unmatched and 20% vs. 36% (p = 0.005) in matched populations. Compliance with POAF prophylaxis improved markedly in the ERAS group (70% vs. 21%, p = 0.001). ERAS patients also experienced shorter hospital stays and fewer postoperative complications (26% vs. 38% in the matched cohort, p = 0.033). Conclusions: The implementation of a structured ERAS protocol significantly reduced POAF incidence, improved compliance with preventive strategies, and enhanced key aspects of postoperative recovery. Full article

Spinal muscular atrophy (SMA) is a genetic disorder causing motor neuron loss and progressive muscle weakness, significantly affecting daily activities and breathing in severe cases. While rehabilitation is a crucial component of SMA management, no standardised rehabilitation guidelines currently exist. This review synthesised physiotherapy and respiratory interventions for SMA patients based on a comprehensive literature search from 1990 to 2024. Eighteen studies were analysed: eleven on physiotherapy and seven on respiratory rehabilitation. Five physiotherapy approaches were reported: electrical stimulation, electrotherapy with cycling, strengthening exercises, aerobic training, and hydrotherapy-based rehabilitation. Respiratory interventions, such as non-invasive ventilation and cough assistance, were mainly studied in SMA Type I, reporting prolonged survival and improved respiratory function. A few studies found that combining pharmacotherapy with intensive physiotherapy led to significantly better motor improvements than drugs alone. Despite these promising reported results, the lack of standardised methodologies and long-term clinical trials prevents definitive conclusions. Research should prioritise randomised controlled trial studies with standardised methodologies and larger sample sizes to investigate the efficacy of physiotherapy and respiratory interventions and, secondly, inform evidence-based rehabilitation protocols and clinical guidelines. Full article

Objective: The aim of physiotherapy interventions for palliative care patients is to relieve pain, promote active movement and thereby improve quality of life and wellbeing. Physiotherapy is an important adjunct to medical and pharmacological treatments. The aim of this study is to identify the specific challenges, self-perceptions and therapeutic approaches of physiotherapists working in palliative care. Methods: An online survey of German physiotherapists was conducted using a 22-question questionnaire. The quantitative data were analysed descriptively (frequencies and percentages), and the qualitative responses were reviewed and grouped thematically. Results: A total of 450 valid responses were evaluated, of which 349 respondents worked in palliative care. The most common treatments for palliative care patients are respiratory therapy (85.8%), general physiotherapy measures (82.4%) and massages (72.9%). The analysis of the free-text responses identified five topics representing the work and challenges of physiotherapists in palliative care. A key issue identified is that the standard 20 min therapy session covered by health insurance is often insufficient to meet the individual needs and daily conditions of each patient. Physiotherapists with no previous experience of palliative care patients often require additional training and often feel inadequately prepared to work effectively with this patient population without appropriate further training. Many physiotherapists believe that they are involved in treatment too late. In addition, other healthcare professionals may not fully recognise the scope of their expertise. Conclusions: Physiotherapy in palliative care requires sensitivity, adaptability and sufficient time. Further training and early involvement are necessary to better address patients’ needs and harness the therapeutic potential of physiotherapists. Full article

Objectives: To describe the strengths and barriers of administering a physiotherapy treatment to patients admitted to an intensive care unit. Methods: Qualitative interpretative description study. Twenty-one health professionals working in an intensive care unit in two referral hospitals were recruited in the study. Each personal interview began with open-ended questions and then continued with more interview-inspired questions. All healthcare professionals gave their views on their knowledge, perceptions and observations of the strengths and weaknesses of physiotherapy in the treatment of patients admitted to this unit. Results: The analysis highlighted four main topics: (i) knowledge of the role of physiotherapists at the ICU; (ii) benefits of physiotherapy for patients and in a multidisciplinary team environment; (iii) challenges and proposals for improvement in interprofessional collaboration; iv) needs for the implementation of physiotherapy. Conclusions: This study analyzes the opinion of intensive care unit professionals regarding the strengths and barriers of physiotherapy in these units. Healthcare professionals highlight the importance of early physiotherapy treatment, the insufficient number of physiotherapists in these units and the benefits of physiotherapy in the respiratory and functional improvement of patients. The main perceived barriers are communication between professionals and the need to reduce the ratio of patients per physiotherapist. Full article

Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related adverse drug events (ORADEs). This study evaluates the impact of an ERAS^® Society-certified program on opioid consumption in patients undergoing elective cardiac surgery at Lausanne University Hospital. Methods: A retrospective, monocentric observational study was conducted comparing two patient cohorts: one treated with ERAS protocols (2023–2024) and a retrospective control group from 2019. Data were collected from the hospital’s electronic medical records and the ERAS program database. The primary outcome was total opioid consumption, measured intraoperatively and postoperatively (postoperative day (POD) 0–3). Secondary outcomes included pain control, length of stay, complications, and recovery parameters. Statistical analyses included multivariate logistic regression to identify factors associated with reduced opioid consumption. Results: Patients in the ERAS group demonstrated significantly lower total opioid consumption, whether intraoperatively (median sufentanil: 40 mcg vs. 51 mcg, p < 0.0001) or postoperatively (POD 0–3: p < 0.001). The ERAS group had faster extubation times, earlier mobilization and pain control with non-opioid analgesics, fewer complications, and shorter hospital stays (9 vs. 12 days, p < 0.001). Logistic regression identified fast-track extubation and absence of complications as strong predictors of reduced opioid use. Conclusions: The implementation of an ERAS protocol in cardiac surgery significantly reduces opioid consumption while enhancing recovery. Full article

Background/Objectives: Children who suffer from congenital heart defects (CHDs) have a decreased ability to perform physical exercise and consequently have a decrease in their functional capacity. The main causes of this decrease in functional capacity have been related on the one hand to residual hemodynamic defects and, at the same time, to a situation of physical deconditioning due to inactivity, as well as problems in lung function, especially the presence of restrictive patterns that influence the amount of O₂ insufflated (decreased maximum VO₂), consequently generating a deficient maximum O₂ consumption and maximum work rate. This represents an important prognostic value, since it constitutes an independent predictor of death and hospitalization. This study aims to determine the benefits obtained regarding respiratory function, exercise capacity, and quality of life after implementing a hospital-based cardio-respiratory rehabilitation program compared to a home-based Cardio-respiratory Physical Activity Program in patients with intervened CHDs. Methods: This is a randomized controlled trial on the effectiveness of two different rehabilitation programs on respiratory function, exercise capacity, and quality of life in patients with CHDs conducted at the Child Cardiology and Congenital Heart Disease Unit of the University Hospital Complex of A Coruña (CHUAC). There will be two groups: Cardio-respiratory rehabilitation group program conducted in a face-to-face format at the hospital (n = 26) and a study group that follows a home-based Cardio-respiratory Physical Activity Program (TELEA) (n = 26). The measurement variables will be respiratory function, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), maximum expiratory flow (PEF), the Tiffeneau index (FEV1 /FVC), forced expiratory flow (FEF25%, FEF50%, FEF75%, FEF25–75%), exercise capacity (peak VO₂), and the quality of life of these children and their families. Conclusions: The implementation of cardiac and pulmonary rehabilitation programs in children with CHDs is essential to improve their quality of life, exercise tolerance, and socialization. These programs optimize life expectancy and promote integration, being crucial for their physical and emotional well-being Full article

Objective: This study aimed to evaluate the effects of an 8-week physiotherapy program on muscle strength, functional capacity, respiratory function, and quality of life in women recovering from COVID-19. Methods: A prospective cohort study was conducted with 42 women aged 18–65 who experienced muscle strength loss and functional impairments post-COVID-19. Participants underwent personalized physiotherapy interventions, including resistance training, respiratory therapy, and functional mobility exercises, for 8 weeks. Data were collected at baseline and post-intervention, including handgrip strength, 6-Minute Walk Test (6MWT), forced vital capacity (FVC), Fatigue Severity Scale (FSS), and SF-36 scores. Statistical analyses were performed using paired t-tests and Wilcoxon signed-rank tests. Results: Significant improvements were observed in muscle strength, with right-handgrip strength increasing from 18.5 ± 4.2 kg to 22.8 ± 4.6 kg (p < 0.001) and left-handgrip strength from 17.2 ± 4.1 kg to 21.1 ± 4.5 kg (p < 0.001). Functional capacity improved, as evidenced by a 6MWT distance increase from 382 ± 62 m to 438 ± 57 m (p < 0.001). Respiratory function parameters, including FVC and FEV1, also showed significant gains (p < 0.01). Quality of life scores improved significantly, particularly in physical functioning and vitality domains, while fatigue levels decreased markedly (p < 0.001). Conclusions: The results demonstrate the effectiveness of physiotherapy in addressing the physical and functional consequences of COVID-19 in women. These findings emphasize the importance of incorporating physiotherapy into post-COVID-19 rehabilitation protocols to enhance recovery and quality of life. Full article

Background: Bronchiolitis is a seasonal viral infection of the respiratory tract that causes numerous childhood hospitalizations annually. Treatments vary based on severity, with mild cases requiring fluids and moderate to severe cases involving hospitalization with oxygen therapy, bronchodilators, and chest physiotherapy. Manual bronchial clearance techniques differ between Anglo-Saxon and European schools, and their effectiveness remains a subject of debate. Objective: The aim of this systematic review is to evaluate the effectiveness of manual bronchial clearance techniques in bronchiolitis by assessing clinical outcomes, including improved ventilation, increased oxygen saturation, and enhanced hemodynamic and respiratory stability. Materials and Methods: A systematic review was conducted between 2013 and 2024 using PRISMA guidelines. Databases searched included PubMed, Science Direct, Scopus, Springer, and Google Scholar; the inclusion criteria focused on randomized clinical trials and cohort studies in English, Spanish, and Portuguese. The selection bias was evaluated. The study was registered in Prospero (CRD42023486450). Results: Five articles involving 291 participants diagnosed with mild to moderate bronchiolitis were analyzed. The assessed techniques included Anglo-Saxon school and European School. Heart rate was evaluated in four studies, showing significant reductions in one (p < 0.01), while the significance in the other studies was not specified. Respiratory rate was assessed in three studies, with significant results being seen in two (p < 0.05). SpO2 was examined in all six studies, demonstrating significant improvements in two (p = 0.02 and p < 0.05). The Kristjansson respiratory score showed significant changes in one study (p = 0.005), and the Wang respiratory score indicated significant results in another (p = 0.03). These findings support the efficacy of chest physiotherapy techniques in managing bronchiolitis. Conclusions: While Anglo-Saxon techniques are widely used, their effectiveness remains a subject of debate. In contrast, European techniques indicate promising clinical outcomes, including improved ventilation, increased oxygen saturation, and enhanced respiratory stability; however, additional studies could further validate these findings. Full article

Background/Objectives: Prematurity is a leading cause of infant mortality and mechanical ventilation increases respiratory complication risk. The effects of secretion removal techniques in premature infants remain a topic of ongoing debate. The aim of the study is to compare two secretion removal techniques in premature infants on mechanical ventilation; Methods: The participants were randomized into conventional chest physiotherapy (CPT; n = 22) or expiratory flow increase technique (EFIT; n = 21) groups. Each participant completed four sessions on consecutive days with a minimum of one and a maximum of two sessions per day. We assessed peripheral oxygen saturation (SpO₂), heart (HR) and respiratory rates (RR), tidal volume (VT), and pain levels at specific time points: before the intervention, immediately after the intervention, 5 min after the intervention, and 10 min after the intervention. The partial Eta squared (ŋ_p²) was reported to measure the effect size; Results: HR and RR increased post-intervention in both groups (p < 0.001; HR ŋ_p² = 0.51; RR ŋ_p² = 0.38); post hoc comparisons showed EFIT group decreased RR from the first to last session (p = 0.045). Both groups exhibited increased VT and SpO₂ in all sessions (p < 0.001; VT ŋ_p² = 0.40; SpO₂ ŋ_p² = 0.50). The EFIT group had higher SpO₂ values (p = 0.013; ŋ_p² = 0.15) and lower pain scores (p < 0.001; ŋ_p² = 0.46) post-intervention compared to CPT; Conclusions: CPT and EFIT resulted in similar effects on short-term respiratory parameters and heart rate; however, EFIT had advantages, including lower RR, higher SpO₂, and reduced pain, suggesting it may be a more effective, comfortable neonatal respiratory treatment. Full article

Cardiac surgery procedures are among the main treatments for people with cardiovascular disease, with physiotherapy playing a vital part. Respiratory complications are common and associated with prolonged Intensive Care Unit (ICU) and hospital stay, as well as increased mortality. Inspiratory muscle training has been found to be beneficial in improving respiratory muscle function in critically ill patients and patients with heart failure. The purpose of this review is to present the results of implementing inspiratory muscle training (IMT) programs in patients before and/or after cardiac surgery. The PubMed, Embase and Science Direct databases were searched from January 2012 to August 2023. In the present review, randomized controlled clinical trials (RCTs), clinical trials and quasi-experimental studies conducted in adult patients pre and/or post cardiac surgery were included. Fifteen studies were considered eligible for inclusion in the review. The results revealed that the IMT programs varied in intensity, repetitions, and duration in all included studies. Most studies implemented the IMT after the surgery. Statistical significance between groups was noted in Maximal Inspiratory Pressure and the 6-Minute Walk Distance Test. Preoperative and postoperative programs could improve inspiratory muscle strength, pulmonary function, and functional capacity as well as decrease the length of hospital stay in patients undergoing cardiac surgery. No clear evidence emerged favoring low or higher IMT intensities. The combination of IMT with other forms of exercise might be beneficial in patients undergoing cardiac surgery. However, further RCTs are required to provide confirming evidence. Full article

Nowadays, some of the most severe problems faced by health institutions are related to people’s mental health. According to the World Health Organization, approximately one billion people lived with a condition that affected their mental health in 2020, where depression, anxiety, and stress represent the most common examples. Furthermore, according to the American Psychological Association, stress aggravates the symptoms of depression and anxiety, besides having negative effects on the cardiovascular, respiratory, muscular, nervous, reproductive, endocrine, and gastrointestinal systems. It is estimated that during the COVID-19 pandemic, the number of global cases of major depressive disorder and anxiety disorders increased by 53.2 million and 76.2 million, respectively. Psychophysiology and other health disciplines, such as psychology, neurology, psychiatry, and physiotherapy, provide quantitative data from physiological signals. These signals are acquired through specialized systems that are often very expensive, with most being closed-source hardware and software. This work proposes the development of a low-cost prototype for the acquisition and visualization of a patient’s HR, ECG, EMG, GSR, and body temperature biosignals using the MAX30102, ECG AD8232, EMG Muscle T084, Grove GSR sensor, and LM35 AFEs breakout boards, respectively. Signal acquisition tests were performed with each sensor without post-processing or filtering. The test results prove that the biosignals acquired by the prototype present usability, correct morphology, stability, and can operate without errors for up to 12 h. This is expected to provide an affordable alternative to biosignal acquisition systems for educational and research institutions, offering users a similar experience to that provided by high-cost equipment, thus benefiting the training of studies. Full article

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their measurement properties, their minimum clinically important differences, and their associations with CRD course-related events or prognosis in non-COPD CRD. Methods: Studies employing patient-reported or performance-based instruments to assess FP in non-COPD CRD were systematically identified in the PubMed, PEDro, Embase, and Cochrane Library databases. COPD-exclusive studies or those solely reporting exercise capacity tests were excluded. Examination focused on measurement properties and associations with CRD course-related events or prognosis. The risk of bias was evaluated using the COSMIN, Downs and Black, and PEDro checklists based on the study design. Results: A total of 216 studies across seven CRD categories [asthma, bronchiectasis, cystic fibrosis, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), pre-/post-lung-transplantation] from various study types were included. Thirty-three instruments were identified, with the SF-36 questionnaire’s physical function domain being the most commonly used patient-reported tool. The 1 min sit-to-stand test was the most extensively studied performance-based measure, with its measurement properties frequently reported in non-COPD CRD studies. Associations with events were infrequently documented, primarily in ILD and PAH studies related to mortality. Conclusions: Despite the prevalent use of FP instruments, limited information exists concerning their measurement properties and clinical implications. This review furnishes a concise summary of available evidence, aiding informed clinical decisions when selecting FP tools for non-COPD CRD. Full article

Objective: This systematic review aims to assess the effectiveness of respiratory physiotherapy techniques in oxygenation, chest X-ray findings, and lung auscultation in paediatric patients aged 0 to 18 years diagnosed with atelectasis. Methods: A comprehensive search was conducted in the PubMed, PEDro, Web of Science, and Cochrane Library databases. Results: Eight randomised clinical trials were included, involving 430 children ranging from 35 weeks of gestational age to 14 years. These trials evaluated various respiratory physiotherapy techniques and their effects on oxygenation and chest radiograph outcomes. The methodological quality of the studies ranged from acceptable to good, according to the PEDro scale. Conclusions: Recent evidence indicates that respiratory physiotherapy is effective and safe in the paediatric population with atelectasis. Both manual and instrumental techniques demonstrated efficacy, with instrumental techniques showing superior outcomes in many cases. Full article

Background: Respiratory complications in patients with amyotrophic lateral sclerosis (ALS), due to the involvement of respiratory muscles, are the leading cause of death, and respiratory physiotherapy (RP) focuses on addressing these complications. Objectives: The objective was to evaluate the effectiveness of an RP intervention that combines the four specific techniques (inspiratory muscle training, lung volume recruitment, manually assisted coughing, and diaphragmatic breathing training) in patients with ALS. Methods: A quasi-experimental study was carried out, and a specific RP programme was implemented in 15 patients with ALS (12 sessions, 30 min/session, one session/week, duration of three months), based on directed ventilation techniques, lung volume recruitment, manually assisted coughing, and the use of incentive spirometry and a cough assist device, along with a daily home exercise programme. Respiratory functions were assessed (pre- and post-intervention, with follow-up at three months) using Forced Vital Capacity (FVC) and Peak Expiratory Cough Flow (PECF); functionality was assessed using the Revised ALS Functional Rating Scale (ALSFRS-R) and the Modified Barthel Index by Granger. Results: FVC experienced an increase after three months of the intervention initiation (p = 0.30), which was not sustained at the three-month follow-up after the intervention ended. All other variables remained practically constant after treatment, with their values decreasing at follow-up. Conclusion: A specific RP intervention could have beneficial effects on respiratory functions, potentially preventing pulmonary infections and hospitalisations in patients with ALS. It may improve FVC and help stabilize the patient's functional decline. Considering the progressive and degenerative nature of the disease, this finding could support the usefulness of these techniques in maintaining respiratory function. Full article