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Years after suffering from poliomyelitis and completely recuperating from any of its acute complications, patients can develop postpolio syndrome (PPS), thought to be caused by progressive neuronal loss. The symptoms and manifesta...
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Years after suffering from poliomyelitis and completely recuperating from any of its acute complications, patients can develop postpolio syndrome (PPS), thought to be caused by progressive neuronal loss. The symptoms and manifestations of PPS vary in intensity and distribution, but many patients have respiratory involvement and will require a pulmonary evaluation for new or increased dyspnea, fatigue, or symptoms suggestive of sleep-related disordered breathing. The diagnosis, evaluation, and management of this complex problem are discussed in the first part of this article. In the second part, pulmonary complications of multiple sclerosis are described. This common neurological disease affects young adults and often requires evaluation by a pulmonologist. This review centers on the acute respiratory manifestations of multiple sclerosis and also describes the chronic effects.
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BackgroundTo examine the effect of rehabilitation on postoperative pulmonary complication when it is conducted in combination of both before and after lung cancer surgery, as compared with either before or after surgery and no reh...
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BackgroundTo examine the effect of rehabilitation on postoperative pulmonary complication when it is conducted in combination of both before and after lung cancer surgery, as compared with either before or after surgery and no rehabilitation.MethodsA retrospective cohort study was conducted to examine the effect of rehabilitation before and after lung cancer surgery on the causes of postoperative pneumonia. Data were collected from the diagnosis procedure combination (DPC) database. Patients admitted who received operative treatment for a new primary (ICD codes: C34) were selected. The inclusion criteria were patients who had pneumonectomy, malignant tumor surgery for the lung (thoracotomy), or thoracoscopic surgery (endoscopic; treatment code: K511-00, K513-00.03, and K514-00, 02). The exclusion criteria were patients who had a lung transplantation (treatment code: K514-03.06), suspected diagnosis, and a pneumonia within 3months before being diagnosed as having lung cancer. Main outcome was onset of postoperative pneumonia.ResultsAmong 76,739 lung cancer patients, 15,146 who underwent lung cancer surgery were included in the analysis. In the combination of pre- and postoperative group, as compared with the preoperative [odds ratio (OR), 95% confidence interval (CI) 2.8, 1.8-4.4], postoperative (1.9, 1.6-2.3), and no rehabilitation group (2.5, 2.1-2.8), the onset of pneumonia was less frequent.ConclusionsCombination of preoperative and postoperative rehabilitations significantly prevents postoperative pneumonia as compared with having preoperative, postoperative, or no rehabilitation.
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Lung cancer is a common malignant tumour threatening human health, and is also the primary cause of cancer-related death in China and worldwide (1). According to the latest data released by the International Agency for Research on...
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Lung cancer is a common malignant tumour threatening human health, and is also the primary cause of cancer-related death in China and worldwide (1). According to the latest data released by the International Agency for Research on Cancer of the World Health Organization, by 2020, lung cancer will rank 2nd in the global new cancer incidence rate and 1st in the worldwide cancer mortality rate (2). An epidemiological investigation illustrated that the 5-year survival rate of lung cancer was only about 13% (3). Cancer places a heavy disease burden on patients.
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Objective: To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer r...
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Objective: To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. Design: Randomized single-blinded study. Setting: A teaching hospital. Participants: Patients undergoing lung cancer resection (N=24). Interventions: Patients were randomly assigned to receive PR (strength and endurance training) versus CPT (breathing exercises for lung expansion). Both groups received educational classes. Main Outcome Measures: Functional parameters assessed before and after 4 weeks of PR or CPT (phase 1), and pulmonary complications assessed after lung cancer resection (phase 2). Results: Twelve patients were randomly assigned to the PR arm and 12 to the CPT arm. Three patients in the CPT arm were not submitted to lung resection because of inoperable cancer. During phase 1 evaluation, most functional parameters in the PR group improved from baseline to 1 month: forced vital capacity (FVC) (1.47L [1.27-2.33L] vs 1.71L [1.65-2.80L], respectively; P=.02); percentage of predicted FVC (FVC%; 62.5% [49%-71%] vs 76% [65%-79.7%], respectively; P<.05); 6-minute walk test (425.5±85.3m vs 475±86.5m, respectively; P<.05); maximal inspiratory pressure (90±45.9cmH 2O vs 117.5±36.5cmH2O, respectively; P<.05); and maximal expiratory pressure (79.7±17.1cmH2O vs 92.9±21.4cmH2O, respectively; P<.05). During phase 2 evaluation, the PR group had a lower incidence of postoperative respiratory morbidity (P=.01), a shorter length of postoperative stay (12.2±3.6d vs 7.8±4.8d, respectively; P=.04), and required a chest tube for fewer days (7.4±2.6d vs 4.5±2.9d, respectively; P=.03) compared with the CPT arm. Conclusions: These findings suggest that 4 weeks of PR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.
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The aim of this study was to determine whether walking at 4 h after surgery as a more aggressive way to proceed with early mobilization could be a safe approach compared with the patients who walked the day after surgery.
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? 2021 Elsevier B.V.Objectives: This study aimed to assess the effect of home-based preoperative pulmonary rehabilitation (HBPPR) on the incidence of postoperative complications, length of stay (LOS), and duration of intercostal c...
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? 2021 Elsevier B.V.Objectives: This study aimed to assess the effect of home-based preoperative pulmonary rehabilitation (HBPPR) on the incidence of postoperative complications, length of stay (LOS), and duration of intercostal catheterization in non-small cell lung cancer (NSCLC) patients who underwent lung resection. Materials and methods: In this retrospective cohort study, 144 patients who underwent lung resection were recruited, 51 of whom received HBPPR, comprising respiratory muscle training and was supervised (for patients undergoing it for the first time). Patients continued these programs for 2–4 weeks during the preoperative waiting period, in their homes. Data on postoperative complications graded according to the Clavien-Dindo classification, LOS, and intercostal catheterization duration were collected from medical records. These outcomes were compared between the HBPPR and non-HBPPR groups using Fisher's exact test and Wilcoxon rank sum test, after 1:1 propensity score matching to avoid selection bias. Results: Forty-nine matched pairs were extracted using propensity score matching. HBPPR reduced the onset of postoperative complications (p = 0.04), with the relative ratio (RR) for Clavien-Dindo Class I postoperative complications showing a significant difference (RR 0.55, 95% CI 0.30-1.02; p = 0.05), whereas RRs for the other Clavien-Dindo classes were not statistically significant. There was no significant difference in LOS or the duration of intercostal catheterization. Conclusion: HBPPR reduced the incidence of Clavien-Dindo Class I postoperative complications after lung resection. Implementing HBPPR practices in a clinical setting would benefit patients unable to receive supervised preoperative pulmonary rehabilitation due to access barriers, time, and financial constraints.
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Objective: To compare the postoperative outcomes of preoperative respiratory muscle training (RMT) with a device to preoperative aerobic exer-cise training (AET) in patients undergoing thoracic surgeries (cardiac and lung).Data So...
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Objective: To compare the postoperative outcomes of preoperative respiratory muscle training (RMT) with a device to preoperative aerobic exer-cise training (AET) in patients undergoing thoracic surgeries (cardiac and lung).Data Sources: PubMed, EMBASE, Cochrane, and Web of Science were comprehensively searched upon inception to 9/2020.Study Selection: All randomized control studies, including preoperative RMT and preoperative AET compared with a non-training control group, were included.Data Extraction: The meta-analysis was performed for outcomes including postoperative pulmonary complications (PPC), pneumonia, postopera-tive respiratory failure (PRF), hospital length of stay (HLOS), and mortality. We performed a network meta-analysis based on Bayesian random -effects regression models.Data Synthesis: A total of 25 studies, 2070 patients were included in this meta-analysis. Pooled data for the patients who performed RMT with a device showed a reduction in PPCs, pneumonia, PRF with odds ratio (OR) of 0.35 (P value .006), 0.38 (P value .002), and 0.22 (P value .008), respectively. Pooled data for the patients who performed AET showed reduction in PPC, pneumonia with a OR of 0.33 (P value <.00001) and OR of 0.54 (P value .01), respectively. HLOS was decreased by 1.69 days (P value <.00001) by performing RMT and 1.79 days (P value .0008) by performing AET compared with the usual group. No significant difference in all-cause mortality compared with usual care in both RMT and AET intervention groups. No significant difference in the incidence of PRF compared with usual group in RMT + AET and AET alone intervention groups (OR 0.32; P=.21; OR 0.94; P=.87). Based on rank probability plots analysis, on network meta-analysis, RMT and AET ranked similarly on the primary outcome of PPC and secondary outcomes of pneumonia, PRF and HLOS. Conclusions: In thoracic surgeries, preoperative RMT is comparable with preoperative AET to prevent PPC, pneumonia, and PRF and reduce HLOS. It can be considered in patients in resource-limited settings. Archives of Physical Medicine and Rehabilitation 2023;104:790-8 (c) 2022 by the American Congress of Rehabilitation Medicine.
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<abstract_text><p>Objectives Following major thoracic surgery physiotherapy is recommended to improve reduced lung volume, aid secretion clearance, and improve mobility, however, in many centres physiotherapy provision is variable...
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<abstract_text><p>Objectives Following major thoracic surgery physiotherapy is recommended to improve reduced lung volume, aid secretion clearance, and improve mobility, however, in many centres physiotherapy provision is variable following minimally invasive video-assisted thoracoscopic surgery (VATS). The objective of this study was to observe frequency of problems potentially amenable to physiotherapy following VATS lobectomy, and to identify associated baseline factors of patients in whom physiotherapy may be beneficial.</p><p>Methods A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012-2016). Standard postoperative care included early mobilisation by nursing staff from postoperative day one (POD1). Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to physiotherapy intervention, and treatment was commenced. Outcome measures included postoperative pulmonary complication (PPC) development, hospital and high dependency unit (HDU) length of stay (LOS).</p><p>Results Of 285 patients, 209 (73%) received physiotherapy to assist/improve reduced mobility, of these 23 (8%) also received sputum clearance therapies and 65 (23%) specific therapy for lung volume loss. The remaining 76 (27%) patients had significantly lower hospital/HDU LOS (P < 0.001) reflecting uncomplicated recovery. Chronic obstructive pulmonary disease (COPD), body mass index (BMI), preoperative mobility and age were independently associated with issues potentially amenable to physiotherapy (P = 0.013).</p><p>Conclusion Following VATS lobectomy a large proportion of patients demonstrated issues potentially amenable to physiotherapy. The authors recommend that patients receive routine physiotherapy assessment following this type of surgery to ensure that all issues are identified early. Screening of COPD, BMI, preoperative mobility and age will allow early identification of patients who may benefit most from postoperative physiotherapy and preoperative optimisation, however, these factors cannot predict the need for physiotherapy. (C) 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.</p></abstract_text>
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ObjectiveTo assess the effect of participating in an exercise intervention compared with no exercise during cancer treatment on the duration and frequency of hospital admissions.DesignSystematic review and meta-analysis.Data sourc...
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ObjectiveTo assess the effect of participating in an exercise intervention compared with no exercise during cancer treatment on the duration and frequency of hospital admissions.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, EMBASE, PEDro and Cochrane Central Registry of Randomized Controlled Trials.Eligibility criteria for selecting studiesRandomised studies published until August 2023 evaluating exercise interventions during chemotherapy, radiotherapy or stem cell transplant regimens, compared with usual care, and which assessed hospital admissions (length of stay and/or frequency of admissions).Study appraisal and synthesisStudy quality was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analyses were conducted by pooling the data using random-effects models.ResultsOf 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention and 1252 control). Twelve studies were conducted during haematopoietic stem cell transplantation regimens. There was a small effect size in a pooled analysis that found exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: -2.26 to -0.54 days; low-quality evidence) and lowered the rate of hospital admission by 8% (difference in proportions=-0.08, 95% CI: -0.13 to -0.03, low-quality evidence) compared with usual care.ConclusionExercise during cancer treatment can decrease hospital length of stay and admissions, although a small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, it could be included as standard practice for patients as cancer care pathways evolve.
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O teste cardiopulmonar de exercício (TECP) permite uma avalia??o completa do sistema cardiorrespiratório. é o exame padr?o-ouro para definir o prognóstico em diversas doen?as cardíacas e pulmonares e pode discriminar os mecan...
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O teste cardiopulmonar de exercício (TECP) permite uma avalia??o completa do sistema cardiorrespiratório. é o exame padr?o-ouro para definir o prognóstico em diversas doen?as cardíacas e pulmonares e pode discriminar os mecanismos subjacentes associados à redu??o da capacidade funcional. 5 , 6 Cardiopulmonary Exercise Test (CPET) allows a complete assessment of the cardiorespiratory system. It is the gold standard exam to define prognosis in several heart and lung diseases and can discriminate the underlying mechanisms associated with reduced functional capacity. 5 , 6
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