2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Cardiorespiratory Physiotherapy Australia
Why is positive expiratory pressure physiotherapy
used in children with cystic fibrosis under three years
of age?
Wilson CJ, Wright SE, Wainwright CE, on behalf of the
Australasian Cystic Fibrosis Bronchoalveolar Lavage
(ACFBAL) study
Royal Children’s Hospital, Brisbane
Positive Expiratory Pressure (PEP) physiotherapy is an
option for airway clearance in cystic fibrosis (CF). PEP
theory suggests volume change via collateral ventilation,
and a secondary mechanism of airway stabilisation. PEP is
typically introduced in CF around school commencement.
The ACFBAL study physiotherapy protocol utilised
positioning, chest percussion, and age-appropriate activity
from infant diagnosis, with subsequent treatment changes
made at the discretion of the physiotherapist. This
prospective investigation reports PEP and clinical records
when physiotherapy techniques were changed. Baseline,
exacerbation, admission and routine reviews were analysed
separately. PEP alone or used as an adjunct was compared
to other techniques. 159 of 168 enrolled children (Mean
age 3.6mths, SD 1.6) from 8 Australasian sites have three
year data. 32 of 159 children (20%) used PEP before three
years of age; three of these (9%) were diagnosed with
significant tracheomalacia prior to commencing PEP. In
PEP users, there was no association between barking or
croupy coughs typically associated with tracheomalacia.
Fort percent of the cohort had a cough (any description)
compared with 72% of PEP users. The implications of this
will be discussed Reasons for early initiation of PEP may
include physiotherapist familiarity with PEP, the presence
of persistent cough or unexpected bronchoscopy findings
indicating a need to change the regimen. Our expectation
that early use of PEP would be associated with barking or
croupy cough; nocturnal cough, and/or malacia was not
supported. Further systematic study of this emerging trend
is warranted, particularly where airway malacia is identified
in young children.
The effects of pulmonary rehabilitation in the
treatment of advanced cancer patients
Zafiropoulos B, Jongs W, Glare P
Sydney Cancer Centre Royal Prince Alfred Hospital, Sydney
This study aimed to assess the effects of a multidisciplinary
pulmonary rehabilitation approach in the treatment of
advanced cancer patients. Patients were assessed by
physician, dietician and physiotherapist and provided with
symptom management, dietary intervention, and home
or gym based exercise programs. Fifty-three patients
(median age 62 years, mainly stage III and IV lung or
gastrointestinal cancers) were referred to the program
with 79% of these patients receiving anticancer therapies
concomitantly. Baseline median and interquartile range
(IQR) values for Karnofsky Performance Scores were
70 (60–80), six-minute walk test distances were 442 m
(382–521 m), and handgrip strengths were 69% (left) and
74% (right) of predicted normal values. At baseline, 78%
of the sample was moderately or severely malnourished as
per the Patient Generated Subjective Global Assessment.
Following 3 months in the program, six-minute walk test
distance increased from baseline by 147 m (33%) to 589
m (585 to 600 m) and handgrip strengths increased to
82% (left) and 85% (right) of predicted values. Karnofsky
Performance Scores remained stable with Edmonton
Symptom Assessment System scores decreasing over time.
Weight was observed to stabilise with decreases in Patient
Generated Subjective Global Assessment scores indicating
improvements in nutritional status. Although drop out
rates were high, patients who remained in the program
demonstrated improvements in nutritional status, endurance
and strength, with decreases in cancer related symptoms.
This multidisciplinary pulmonary rehabilitation approach
is innovative and successful in providing supportive care
for patients with advanced cancer.
Prescribing walking training intensity from the sixminute
walk test for people with chronic obstructive
pulmonary disease
Zainuldin R, 1 Mackey MG, 1 Alison JA 1,2
1
The University of Sydney, 2 Royal Prince Alfred Hospital, Sydney
The six-minute walk test (6MWT) is often used to
prescribe walking training intensity for people with chronic
obstructive pulmonary disease (COPD). However, no
research has investigated this training intensity in terms
of oxygen consumption (VO2). The aim of this study was
to examine whether the intensity of walking exercise
prescribed from a 6MWT was within the recommended
training range of 50–85% peak VO2. A prospective repeated
measures study was conducted. Participants performed an
incremental cycle test, and on a separate day two 6MWTs,
each followed by 30 minutes rest and then 10 minutes of
walking training at 80% of the average speed achieved in
the better 6MWT. Each participant wore a rubber facemask
connected to a lightweight portable gas analyser (Cosmed
K4b2) worn on the chest with a harness. Breath-by-breath
values of metabolic parameters were measured during each
test and during walking training. Six participants walked
a mean (SD) distance of 520(33)m and 694(44)m in the
6MWT and the 10-minute walking training respectively.
There was no significant difference between the peak VO2
achieved in the cycle test and 6MWT (1356(255) ml/min
and 1362(226) ml/min respectively). The VO2 from the
10-minute walk training was 76(13)% of the peak VO2
determined by the cycle test. Walking at 80% of the average
speed of the 6MWT resulted in a training intensity within
the recommended training range.
The e-AJP Vol 55: 4, Supplement 27