Biomedical subjects

Dina Brooks

Publications and source records attributed to Dina Brooks.

27 records · Page 2Linked to original sources

PubMed2002

Discharge criteria from perioperative physical therapy.

OBJECTIVES: To develop valid and reliable hospital discharge criteria and a scoring system that would be used to assess when a patient should be discharged from perioperative physical therapy (PT) care. DESIGN: We developed the postoperative physiotherapy discharge scoring tool (POP-DST), a tool composed of objective criteria and a scoring system that would be used to determine when a patient should be discharged from perioperative PT. It is a composite score of the following five subcategories: mobility; breath sounds; secretion clearance; oxygen saturation; and respiratory rate. The score for the POP-DST ranges from 6 to 15, with a score of > 13 indicating readiness for discharge. We examined the content validity of the the POP-DST using focus groups and a mailed survey. To determine interrater reliability, two therapists, who were blinded to each other's scores, assessed postsurgical patients. Validity was examined by comparing the decision to discharge based on the score on the POP-DST to the decision to discharge according to the therapist's judgment. In addition, subjects who were discharged from PT were followed-up 7 to 10 days later to determine whether they had developed any subsequent respiratory problems. PATIENTS: One hundred four surgical patients were assessed to determine the reliability and validity of the POP-DST. For the ability of the test to detect postoperative complications following discharge from PT, 204 surgical patients were followed-up after discharge from PT. RESULTS: Interrater reliability was moderately high (intraclass correlation coefficient = 0.76; r = 0.77). There was strong agreement between the decision to discharge the patient from PT based on the tool criteria compared to the therapist's judgment (kappa range, 0.91 to 0.96). The ability of the POP-DST to predict those patients who would not develop complications postoperatively was 94%. CONCLUSION: The results indicate that the POP-DST would facilitate clinical decision making related to PT discharge planning in postsurgical populations. The instrument demonstrated strong content validity and predictive validity, as well as high levels of interobserver agreement. This tool should be considered as a work in progress until it is more fully validated.

Decision Making↗

PubMed2002

The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD.

STUDY OBJECTIVES: This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use. DESIGN: Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure. SETTING: Respiratory rehabilitation center. PATIENTS: Forty stable subjects who had received a diagnosis of COPD. INTERVENTIONS: Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day. RESULTS: Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided. CONCLUSIONS: Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked.

Aged↗

PubMedDate not supplied

Evaluating the effects of music on dyspnea during exercise in individuals with chronic obstructive pulmonary disease: a pilot study.

In this study, we examined the effects of music on the dyspnea and anxiety experienced by people with chronic obstructive pulmonary disease (COPD) when they are walking. A crossover design was used. Patients walked for 10 minutes without music and for 10 minutes while listening to music. The order of the interventions was determined by chance. The levels of perceived dyspnea (modified Borg scale) and anxiety (State-Trait Anxiety Inventory-State) were measured at baseline (before a 6-minute walk), at pretest (after that walk and before the 10-minute walks), and after the walks. Thirty subjects with a mean age of 70 +/- 7 years participated in the study. There were no differences in dyspnea or anxiety levels between the walks with music and with no music (p > 0.05). Despite some positive trends, this study did not provide conclusive evidence to support the efficacy of listening to music during exercise; further research is needed to support this intervention.

Aged↗

PubMedDate not supplied

The flutter device and expiratory pressures.

PURPOSE: Flutter therapy uses a handheld instrument that consists of a pipe-like device with a ball in the central core that oscillates during exhalation, providing oscillating positive expiratory pressure. The purpose of this study was to determine the effect of airflow and the incline of the device at the mouth on expiratory pressure and oscillation frequency. METHODS: A Flutter device was attached to a circuit that consisted of a pneumotachograph and a ventilator. The ventilator generated different flows and expiratory pressure was measured with a pressure transducer. The angles considered were +40 degrees to -40 degrees in increments of 10 degrees , with the reference for incline being the horizontal line. Expiratory pressure, airflow, angle of incline, and oscillation frequency were measured. RESULTS: There was a strong and significant correlation between flow and expiratory pressure at each level of incline (P < or =006; r > 0.93). There also was a significant and strong correlation between expiratory pressure and oscillation frequency (P <.05; r = 0.81-0.97). There was a significant reduction in expiratory pressure at a negative incline of -40 degrees. CONCLUSIONS: The results of this study indicate that a positive incline and a large airflow result in an increase in expiratory pressure. This information will assist clinicians to better understand the effects of the Flutter device.

Analysis of Variance↗

PubMedDate not supplied

Pre-coronary artery bypass graft measures and enrollment in cardiac rehabilitation.

PURPOSE: The aim of this study was to examine the relationship between exercise tolerance, functional status, exercise behavior, and enrollment in cardiac rehabilitation (CR), preoperatively in individuals undergoing coronary artery bypass graft (CABG) surgery. METHODS: Seventy-eight individuals undergoing CABG were evaluated 1 to 7 days preoperatively using the following measures: 2-minute walk test (2MWT), Duke Activity Status Index (DASI), Cardiac Exercise Self-Efficacy Instrument (CESEI), Stages of Change Questionnaire (SCQ), Short-Form 12 (SF-12), Hospital Anxiety Depression scale, location of residence, and education level. Participants were contacted via telephone 10 to 12 weeks postoperatively to determine if they were referred and enrolled in CR. Participants completed mailed questionnaires for follow-up. In subsequent telephone interviews, individuals who were not enrolled in CR were asked to provide reasons for nonenrollment. RESULTS: Overall enrollment in CR was 46%. No significant differences were found in 2MWT, CESEI, and DASI scores between enrolled and nonenrolled participants. Fifty-seven percent of urban-dwelling participants enrolled in CR compared to 29% of rural-dwelling participants (P < .01). Similarly, 65% of individuals with post-secondary education enrolled in CR compared to 38% of individuals without a post-secondary education (P = .05). The primary reasons for nonenrollment were behavioral intentions toward exercise and CR, accessibility, and healthcare team recommendation. Individuals who enrolled in CR demonstrated a larger postoperative improvement in CESEI score. CONCLUSIONS: Location of residence and education level predicted CR enrollment, whereas preoperative exercise tolerance, functional status, and exercise attitudes did not predict enrollment.

Adult↗

PubMedDate not supplied

The acute effects of a rollator in individuals with COPD.

PURPOSE: To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease. METHODS: Thirty-one stable subjects with chronic obstructive pulmonary disease (13 men, 18 women), aged 68 +/- 8 years, with a forced expiratory volume in 1 second of 0.7 +/- 0.2 L (33% +/- 12% predicted) and a baseline 6-minute walk (6MW) of 261 +/- 68 m, were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program. Two 6MWs were performed at baseline, 4 weeks, and 8 weeks, one walking unaided and the other walking with the assistance of a rollator. The test order was randomly chosen at baseline, and the same test order was used at each time point. The primary outcome measures were distance walked in 6 minutes (meters), perceived dyspnea using a modified Borg scale, and number of rests taken. RESULTS: Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline (292 +/- 67 vs 263 +/- 67 m), 4 weeks (296 +/- 62 vs 275 +/- 63m), and 8 weeks (283 +/- 65 vs 259 +/- 68 m) (P = .013), with no time effect (P = .5). In addition, use of a rollator resulted in a significant improvement in dyspnea (P = .004) at baseline, 4 weeks, and 8 weeks, with no time effect (P = .7). The use of a rollator also reduced the number of rests taken during the 6MW (P < .001), with no time effect (P = .9). CONCLUSIONS: Rollator use resulted in improvements in performance in the 6MW, which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW.

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PubMedDate not supplied

Long term follow-up of ventilated patients with thoracic restrictive or neuromuscular disease.

OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV) on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk). Patients with respiratory failure attributable to thoracic restrictive disease (TRD) (kyphoscoliosis) or neuromuscular disease (NMD) were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation. DESIGN: All patients admitted for home ventilation training since 1988 were reviewed. Measurements of lung function, gas exchange during wakefulness and sleep, as well as functional exercise capacity, were recorded before and immediately after the establishment of HMV. Measurements were repeated one to two years, five years and eight to 10 years later. PATIENTS: Seventy-four individuals with TRD or NMD who completed the home ventilation training program and continued with HMV during all or part of the day for at least one year were studied. RESULTS: Forty patients had TRD. The characteristics of these patients were (mean SE) as follows: age 58 2.4 years; vital capacity (VC) 27% 1.6% predicted, forced expiratory volume in 1 s (FEV1) 25% 1.5% predicted; FEV1/forced VC (FVC) 78% 1.8%. Thirty-four patients had NMD. The characteristics of these patients were as follows: age 44 3.1 years; VC 41% 4.9% predicted, FEV1 44 5.3% predicted; FEV1/FVC 83% 4.2%. There was a significant improvement in distance walked in 6 min (maximum change 51.2 m in patients with NMD and 93.0 m in patients with TRD), daytime partial pressure of arterial carbon dioxide (maximum change 12.9 mmHg in patients with NMD and 10.4 mmHg in patients with TRD) and nighttime partial pressure of arterial carbon dioxide (maximum change 11.7 mmHg in patients with NMD and 18.0 mmHg in patients with TRD) over time (P 0.004). Ventilation resulted in an improvement in partial pressure of arterial oxygen in patients with TRD (68.1 2.8 mmHg to 80.1 3.5 mmHg) and in patients with NMD (52.9 1.7 mmHg to 65.3 2.1 mmHg), although the change was not statistically significant in patients with NMD (P=0.001 in patients with TRD; P=0.105 in patients with NMD). The improvement after ventilation was maintained over several years. Sleep efficiency (75% 18%, 79% 2.2%), the arousal index (13.4 13 events/h, 28.2 17 events/h) and the apnea-hypopnea index (10.1 11.3 events/h, 13.9 9.5 events/h) did not change with time in either patients with TRD or patients with NMD, respectively (P 0.5). CONCLUSIONS: HMV was associated with sustained, long term improvements in nighttime and daytime gas exchange in patients with TRD and NMD. Function exercise capacity increased in patients with TRD and in a subgroup of ambulatory patients with NMD. In patients with TRD, these improvements were maintained for up to 10 years after HMV was established.

Analysis of Variance↗

PubMedDate not supplied

User perspectives on issues that influence the quality of daily life of ventilator-assisted individuals with neuromuscular disorders.

OBJECTIVES: To identify user perspectives on the issues that impact the quality of the daily lives of ventilator-assisted individuals living in the community. METHODS: Semistructured interviews were held with 26 Canadian ventilator-assisted individuals (mean age 44+/-14 [SD] years, range 23 to 60 years; mean ventilator experience 18+/-13 years, range three to 53 years) whose disability from neuromuscular conditions necessitated assistance with activities of daily living. Participants described their daily life experiences and perceptions of the factors that limited or enhanced their quality. Interviews were tape-recorded, transcribed and analyzed for emergent codes and themes. RESULTS: Ventilator users characterized important issues in terms of personal successes and limitations, as well as dependencies on others for daily living. Personal support services, income security, health care and transportation were important positive contributors to their quality of life. Dependency on others was clearly a negative contributor. The ventilator was regarded as a form of assistive technology, similar to a wheelchair. Ventilator users perceived that ventilation was associated with a stigma and negative assumptions about disability, particularly if suctioning was required. CONCLUSIONS: The majority of participants considered home mechanical ventilation to be a positive benefit for independent living, enhancing their overall health. They were clear as to the issues of importance to them, and formulated recommendations for health care providers and policy makers that could improve the quality of their daily lives. Many of the issues identified in the present report are faced by the growing community of ventilator users.

Activities of Daily Living↗

PubMedDate not supplied

State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society's evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.

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