2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Cardiorespiratory Physiotherapy Australia
secondary outcome measures were resting and post-test
heart rate, blood pressure and oxygen saturation, peak
heart rate, and perceived intensity of exertion. A training
effect was observed, in that patients walked further on the
second walk test (p < 0.001). Peak heart rate (p = 0.002)
and perceived intensity of exertion (p = 0.003) were also
higher for the second walk test. The mean improvement in
distance (18 m) from first to second test was small relative
to total six-minute walk distance (test one: 471 m, test two:
489 m). It is recommended that a training effect be taken
into consideration when comparing pre-operative to postoperative
six-minute walk test performance in patients
undergoing coronary artery bypass graft surgery.
A randomised controlled trial of staircase recruitment
manoeuvres, high PEEP and low airway pressure as a
bundle of protective ventilation
Hodgson CL, 1,2 Nichol A, 1,2 Tuxen DV, 1,2 Bailey M, 1,2
Holland AE, 1,3 Keating J, 2 Pilcher D, 1 Davies A, 1,2
Westbrook A, 2 Hilton A, 1 Cooper DJ 1,2
1
The Alfred Hospital, Melbourne, 2 Monash University, Melbourne, 3 La
Trobe University, Melbourne
The aim of this study was to examine the effectiveness of an
‘optimal’ ventilatory strategy including staircase recruitment
manoeuvres compared to current best practice in patients
with acute respiratory distress syndrome (ARDS). The
‘optimal’ ventilator strategy consisted of a novel open lung
low airway pressure approach (Permissive Hypercapnia
and Alveolar Recruitment with Limited Airway Pressures:
PHARLAP ACTRN12607000465459) compared to the
current ARDS net low tidal volume strategy. In this report,
we describe the oxygenation results of our first interim
analysis. Fifteen subjects (ten males) with ARDS and a
mean age of 57.2 ± 15.3 years and baseline PaO2/FiO2 157
± 54 were randomly allocated into experimental PHARLAP
ventilation (n = 8) or control ventilation (n = 7). Outcomes
were gas exchange and lung compliance at 1, 3, 6 and 24
hours. At 24 hours PHARLAP ventilation improved PaO2/
FiO2 ratio (PHARLAP 223.06 ± 25.46, Control 130.9 ±
13.06, p = 0.009) and lung compliance (PHARLAP 43.62
± 3.85, Control 27.7 ± 2.33, p = 0.001). These preliminary
results suggest that a package of ventilation including
staircase recruitment manoeuvres and high PEEP are well
tolerated and may be effective to improve oxygenation and
lung compliance in patients with acute respiratory distress
syndrome.
The effects of a thoracic mobilisation exercise program
following open heart surgery: a randomised
controlled pilot study
Hoggins TR, 1 Denehy L, 2 Tully EA, 2 El-Ansary D 2
1
Monash Medical Centre, Melbourne 2 The University of Melbourne,
Melbourne
The aims of this study were to investigate any trends in
differences for thoracic and shoulder range of movement,
pain and function, between participants provided with a
thoracic mobilisation exercise program and those receiving
standard care after open heart surgery. A single-blinded
randomised controlled pilot study was carried out in a tertiary
public hospital in Melbourne. Thirty-eight participants who
underwent open heart surgery were randomly allocated
using concealed allocation to a treatment (n = 23), or a
control (n = 15) group. In addition to standard post-operative
physiotherapy care, treatment group participants received an
individualised, progressive thoracic mobilisation exercise
program on discharge from the acute hospital. Control group
participants received no thoracic mobilisation exercises.
Baseline pre-operative outcome measures of shoulder and
thoracic range of movement, pain, function and health
related quality of life were repeated post-operatively prior
to discharge, at 4 weeks and 3 months post-operatively.
Reliability of measures of range of movement using ImageJ
was established prior to use. At the conclusion of the followup
period, participants completed a global rating of change.
Treatment group participants reported less sternal pain at 4
weeks post discharge (p = 0.029) and greater improvements
on the global rating of change assessment (p = 0.04). There
were no significant differences between groups for shoulder
or thoracic range of movement, function, or health related
quality of life. The role of thoracic mobilisation exercises
following open heart surgery in reducing sternal pain
warrants further investigation.
The functional difficulties questionnaire: a new tool
for measuring physical function in an open heart
surgery population
Hoggins TR, 1 Denehy L, 2 Tully EA, 2 El-Ansary D 2
1
Monash Medical Centre, Melbourne 2 The University of Melbourne,
Melbourne
A functional questionnaire suitable for a population following
open heart surgery which addresses the thoracic region and
has been validated currently does not exist. A new tool, the
functional difficulties questionnaire, was developed for this
purpose and comprises 13 functional tasks that are likely
to cause difficulty following open heart surgery, as well
as being tasks necessary in everyday life. The respondent
marks the degree of difficulty they experience for each
component task on a 10 cm visual analogue scale (VAS).
Individual VAS scores are aggregated to form a total out of
130, with higher scores representing greater difficulty. The
aims of this study were to provide preliminary evidence as
to the functional difficulties questionnaire’s validity and
sensitivity to change. Thirty-eight participants undergoing
open heart surgery completed the questionnaire preoperatively,
post-operatively, 4 weeks post-operatively and
3 months post-operatively. The questionnaire showed good
internal consistency, with a Cronbach alpha coefficient of
0.971. Results showed a significant increase in functional
difficulties questionnaire scores from pre-operatively to
post-operatively (p < 0.001) and a significant decrease in
scores from post-operatively to 4r weeks post-operatively
(p < 0.001) and from 4 weeks post-operatively to 3 months
post-operatively (p = 0.006). There was a moderate to good
correlation between the questionnaire’s scores and sternal
pain (rho = 0.60, p < 0.001), shoulder pain (rho = 0.51, p
= 0.001) and total pain (rho = 0.69, p < 0.001). Further
investigation of the tool, particularly with regards to test
re-test reliability, is required.
The e-AJP Vol 55: 4, Supplement 9