2009 APA Conference Week Abstracts - Australian Physiotherapy ...

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Cardiorespiratory Physiotherapy Australia Static and dynamic changes in thoracic function following bariatric surgery for patients with morbid obesity Skinner MA, 1 Sutherland TJT, 2 Cowan JO, 2 Taylor DR 2 1 School of Physiotherapy and 2 Dunedin School of Medicine, University of Otago, Dunedin Our aim was to examine the effect of weight-loss following bariatric surgery on thoracic mobility and respiratory function. A before–after study was carried out on 14 subjects with morbid obesity (mean body mass index 61.4kg/m 2 ) immediately prior to and six months following surgery. Outcomes included thoracic circumference at three standardised levels taken at rest, on full inspiration, and full expiration, as a measure of dynamic function of the thorax; measurement of the global thoracic angle in the upright, fully flexed and fully extended positions using an external electronic device, to record thoracic spine mobility; and forced expiratory volume in one second and forced vital capacity, as a measure of respiratory function. Mean body mass index reduced to 40.3kg/m2 and results for all repeated measures were highly significant (p < 0.01). Mean maximum respiratory excursion at the sternal angle improved from 0.45cm to 3.25cm (n = 10). The mean global thoracic angle in upright standing reduced from 64.70 to 57.10, with the change in kyphosis being greater in the upper thoracic spine (n = 8). Mean forced expiratory volume in one second improved from 3.0L to 3.5L and forced vital capacity from 3.8L to 4.4L (n = 11). Improvements in the dynamic and static function of the thorax and thoracic posture occur along with improvement in respiratory function and other benefits of surgically achieved weight loss in morbidly obese subjects. Ventilatory, metabolic and symptom responses to maximal treadmill and cycle exercise tests in people with chronic obstructive pulmonary disease (COPD) Smith KF, 1,2,3 Jenkins SC, 1,2, Williamson J, 3 Cecins N, 1,2 Hillman D, 3 Eastwood P 1,3,4 1 School of Physiotherapy, Curtin University of Technology, Perth; Departments of 2 Physiotherapy & 3 Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth; 4 School of Anatomy & Human Biology, University of Western Australia, Perth Cycling and walking tests are used to measure exercise capacity in people with COPD. Different responses have been reported between these modalities. The aim of this study was to characterise the ventilatory, metabolic and symptom responses to maximal cycling and supported treadmill walking tests in subjects with COPD. Sixteen subjects (three females) aged 66–67 years with COPD, (forced expiratory volume in one second 42–14% predicted), exercised to a symptom-limited maximum during a treadmill (TMT) and cycle ergometry (CET) test. Dyspnoea, heart rate, oxygen saturation (SpO2) and breath-by-breath metabolic and ventilatory variables were collected. Blood lactate concentration and inspiratory capacity (IC) were measured before and at test end. Compared to the CET, the TMT resulted in significantly (p < 0.001) higher oxygen uptake (VO2peak) (17.8–3.4 vs 15.83.4 ml/kg/min) and dyspnoea (5.7–1.6 vs 4.41.0 Borg score), and lower SpO2 (86.3–5.5 vs 90.2–4.9%) and blood lactate (2.8–1.5 vs 4.7– 1.9 mmol/L). Inspiratory capacity decreased at the end of both tests (p < 0.001), but the magnitude of change was not significantly different between modalities. The higher blood lactate and lower VO2peak at the end of the cycle test is most likely a consequence of the smaller muscle mass recruited during cycling than walking. The lack of significant difference in the change in IC indicates that degree of dynamic hyperinflation is likely to have been similar with both exercise modalities. Testing exercise capacity on a cycle ergometer may underestimate the extent of oxygen desaturation occurring in COPD subjects during activities of daily living that include walking. Maintaining exercise capacity and quality of life twelve months following pulmonary rehabilitation in chronic obstructive pulmonary disease: a randomised trial Spencer LM, 1, 2 Alison JA, 1, 2 McKeough ZJ 2 1 Royal Prince Alfred Hospital, Sydney, 2 The University of Sydney Pulmonary rehabilitation programs of eight weeks have been shown to increase functional exercise capacity and quality of life in chronic obstructive pulmonary disease (COPD) patients, however benefits begin to decline unless patients participate in ongoing maintenance exercise. The aim of this study was to determine if weekly-supervised, outpatient based exercise maintained functional exercise capacity and quality of life twelve months following pulmonary rehabilitation compared to unsupervised, home exercise. COPD participants were recruited after completing an eight-week pulmonary rehabilitation program and were randomised to an intervention group of weeklysupervised outpatient based exercise plus home exercise or to a control group of unsupervised home exercise. Outcome measurements immediately following pulmonary rehabilitation and 3, 6 and 12 months later included the six-minute walk test (6MWT) and St George’s Respiratory Questionnaire (SGRQ). Of 59 participants, 48 completed the study (24 in each group). Twelve months following pulmonary rehabilitation, there was no significant decline in either group for the 6MWT [intervention: -11m (-21 to 10); control: -6 m (-34 to 11)] or the SGRQ [intervention: 3 (0.8 to 7); control: -3 (0.7 to 3)]. Twelve months following pulmonary rehabilitation, both weekly-supervised outpatient based exercise and unsupervised home exercise maintained six-minute walk distance and quality of life in COPD participants. Efficacy and safety of instillation of normal saline in intubated patients: a systematic review Stockton K, Paratz JD Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane Instillation of normal saline in patients with artificial airways is a controversial technique. This systematic review aimed to critically analyse the current evidence. Using keywords ‘saline instillation,’ ‘tracheal toilet’ and related synonyms, randomised controlled trials, crossover trials, within patient studies, quasi and full systematic reviews were identified through electronic database searches and citation tracking. From 66 articles screened, 17 articles (two quasi systematic reviews and 15 empiric studies) met the eligibility criteria and were included for data extraction. The outcomes in the reviewed studies included oxygenation, lung mechanics, sputum yield, dyspnoea, tube patency and ventilator associated pneumonia (VAP). Data from identified studies were extracted and assessed by two independent reviewers. The e-AJP Vol 55: 4, Supplement 23
Cardiorespiratory Physiotherapy Australia Standardised mean differences (effect sizes) with 95% confidence intervals were determined, and overall effects calculated using meta-analysis where possible. Studies were mainly of low methodological quality due to factors such as lack of assessor blinding and within group only statistics. Overall there was a positive effect favouring the use of saline to increase sputum yield (d = 0.50 95% CI 0.10 to 0.90). One well conducted study found a relative risk reduction in VAP of 54% (95% confidence interval, 18% to 74%). While a decrease was found in SpO 2 post instillation of normal saline compared to no saline, this was of limited clinical significance. There is little evidence for benefit but also minimal evidence of safety risks. Controlled trials of better quality and more clinically relevant outcomes need to be performed before this technique is either accepted or rejected. 24 Exercise and metabolism post burn injury Stockton K, 1 Plaza A, 1 Paratz J, 1 Davis M, 2 Brown M, 2 Boots R, 1 Muller M 1 1 Burns, Trauma & Critical Care Research Centre, RB&WH, UQ, 2 Thoracic Medicine, RB&WH, UQ Following severe burns to large body surface areas, patients often have major problems with decreased functional outcome and poor quality of life. The hypermetabolic and catabolic responses to large burns also result in decreased muscle mass and muscle weakness. Aerobic and resistance exercise has been strongly recommended to assist the recovery of muscle mass and to improve overall outcomes, but there is currently almost no evidence in adults with burn injuries to indicate whether early exercise is safe and effective. Two studies investigating exercise responses and training following burn injury to greater than 20% body surface area are currently being conducted at the RB&WH Burns Unit. An RCT investigating whether exercise training can improve exercise capacity, strength, quality of life and metabolic profile in adults post burn injury. In addition an observational study investigating maximal exercise response following burn injury has commenced. Twenty patients with burns to greater than 20% of their body will undergo a maximal exercise test on cycle ergometry within 6 weeks of discharge. To date 10 patients have completed the study (nine males), age 29.6 (11.7) The results demonstrate a trend towards normal maximal exercise results in the population studied -predicted maximal heart rate 98% (5.5), VO2 max 36.2 ml/min/kg (7.8). As the studies are currently still in progress preliminary data will be presented. The knowledge of specific physiologic responses induced by specific exercise testing protocols in burns patients will enable the clinician to prescribe and evaluate appropriate individualised exercise programs. Therapeutic exercise Taylor NF, Dodd KJ La Trobe University, Melbourne Therapeutic exercise is one of the main interventions employed by physiotherapists and there is increasing evidence of its efficacy. Our summary of 38 systematic reviews concluded that there is high quality evidence that therapeutic exercise can reduce pain and improve activity in many health conditions, and reduce mortality rates in some conditions such as coronary heart disease. Exercise programs appear to be relatively safe, and more effective if they are intensive and individualised rather than standardised. Apart from therapeutic exercise, physiotherapists are increasingly involved in prescribing physical activity. Physical activity is an umbrella term that includes therapeutic exercise, purposeful exercise and activities of daily living. National guidelines recommend at least 30 minutes of moderateintensity physical activity on most, preferably all, days. Activity prescription has an important role in the prevention of disease, and the management of chronic diseases. However, just meeting physical activity guidelines may not be enough if people are sedentary for the rest of each day. Recent evidence has found that the total amount of sedentary time is associated with risk factors for cardiovascular disease and type 2 diabetes. Breaking up sedentary time with frequent light movements has been associated with improved health outcomes. Physiotherapists with their skills and knowledge as educators, motivators, prescribers, problem solvers and contributors to public health policy have important roles in prescribing therapeutic exercise to help manage health conditions, and prescribing and promoting increased physical activity and reduced sedentary time to help prevent disease and promote good health. A survey into the use of non-invasive ventilation by Australian physiotherapists Tooth AM, 1 Kuys SS 1, 2 1 Princess Alexandra Hospital, Brisbane, 2 University of Queensland, Brisbane Physiotherapists use positive pressure devices such as IPPB for the treatment of atelectasis, lobar collapse and sputum retention. The last decade has seen the advent of many more sophisticated bi-level positive pressure ventilators and their application has expanded to exercise training as well as airway clearance. In the United Kingdom and Europe, physiotherapists appear to have embraced this new technology but it is unclear whether Australian physiotherapists are as confident in their use or whether they have as large a role in assessing and initiating noninvasive ventilation for respiratory failure as their overseas colleagues. In an attempt to benchmark Australian physiotherapists’ current use of positive pressure devices (IPPB, BiPAP), a survey was piloted on 21 tertiary hospitals in all states and territories. A follow up survey aimed to expand on issues raised by the pilot survey responses, such as staff training and use of outcome measures. Of the 14/21 (67%) surveys returned, three centres stated they did not use any positive pressure devices for physiotherapy, 4/11 (36%) departments owned at least one IPPB and 5/11 (45%) owned at least one BiPAP. Other centres reported treating patients on BiPAP but the ownership of equipment and initiation of this therapy was by medical and nursing staff. No consensus in the form of a protocol or treatment guidelines was reported for any patient groups where positive pressure devices were used for physiotherapy. Management of chronic cough Vertigan A Area Director Speech Pathology, Hunter New England Health Chronic cough is a common condition defined as a cough lasting longer than eight weeks. Chronic cough is associated with vocal cord dysfunction, a condition whereby the vocal The e-AJP Vol 55: 4, Supplement
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