Australian Journal of Physiotherapy最新文献

{"title":"Non-invasive weaning from ventilation reduces mortality, ventilator-associated pneumonia, and length of stay in intubated adults","authors":"Grant Willson","doi":"10.1016/S0004-9514(09)70083-2","DOIUrl":"10.1016/S0004-9514(09)70083-2","url":null,"abstract":"<div><h3>Objective</h3><p>To review the evidence as to whether early extubation with immediate application of non-invasive ventilation reduces mortality and ventilator-associated pneumonia and improves other outcomes in criticallyill adults receiving invasive ventilation.</p></div><div><h3>Data sources</h3><p>Medline, Embase, CENTRAL, searched up to April, 2008. This search was supplemented by hand-searching of conference proceeding and citation tracking.</p></div><div><h3>Study selection</h3><p>Randomised and quasi-randomised controlled trials involving adults with respiratory failure who required invasive ventilation for at least 24 hours in which extubation with immediate application of noninvasive ventilation was compared to continued invasive weaning. Outcome measures were mortality, ventilatorassociated pneumonia, weaning failure, length of stay in intensive care or hospital, total duration of ventilation (invasive and non-invasive), duration of ventilation related to weaning (after randomisation), duration of invasive-only ventilation, adverse events (arrhythmia, reintubation, tracheostomy), and quality of life.</p></div><div><h3>Data extraction</h3><p>Two reviewers extracted data and discrepancies were resolved by consensus and arbitration. Methodological quality was assessed.</p></div><div><h3>Data synthesis</h3><p>Of 1368 studies identified by the initial search, 12 studies with a total of 530 patients met the selection criteria and were included in the review. All included studies were of moderate to high quality according to the reviewers’ criteria. Based on the quantitative pooling of the available data from these trials, there was a statistically significant difference in mortality in favour of non-invasive weaning, relative risk 0.55 (95% CI 0.38 to 0.79). Non-invasive weaning also significantly reduced ventilator-associated pneumonia (relative risk 0.29, 95% CI 0.19 to 0.45), length of stay in the intensive care unit (by 6 days, 95% CI 4 to 9) and in the hospital (by 7 days, 95% CI 4 to 11), total duration of ventilation (by 6 days, 95% CI 2 to 9), duration of invasive ventilation (by 8 days, 95% CI 4 to 11), and tracheostomy (relative risk 0.16, 95% CI 0.04 to 0.75). The remaining secondary outcomes did not differ significantly. None of the included studies measured quality of life.</p></div><div><h3>Conclusion</h3><p>Non-invasive ventilation facilitates weaning and has substantial clinical benefits in adults with respiratory failure who require invasive ventilation.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 3","pages":"Page 207"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70083-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28389168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of trials in Australian Journal of Physiotherapy","authors":"Mark Elkins ,&nbsp;Louise Ada","doi":"10.1016/S0004-9514(09)70001-7","DOIUrl":"10.1016/S0004-9514(09)70001-7","url":null,"abstract":"","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 4","pages":"Pages 233-234"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70001-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28521042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive resistance exercise improves glycaemic control in people with type 2 diabetes mellitus: a systematic review","authors":"Casey Irvine ,&nbsp;Nicholas F. Taylor","doi":"10.1016/S0004-9514(09)70003-0","DOIUrl":"10.1016/S0004-9514(09)70003-0","url":null,"abstract":"<div><h3>Question</h3><p>Is progressive resistance exercise a safe and effective form of exercise to improve glycaemic control in people with type 2 diabetes?</p></div><div><h3>Design</h3><p>Systematic review with meta-analysis of randomised controlled trials.</p></div><div><h3>Participants</h3><p>People with type 2 diabetes mellitus.</p></div><div><h3>Intervention</h3><p>Progressive resistance exercise.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was glycaemic control measured as percentage glycosylated haemoglobin (HbA1c). Secondary outcomes were body composition (lean body and fat free mass in kg), and muscle strength (% change in 1RM, dynamometry, change in maximum weight lifted).</p></div><div><h3>Results</h3><p>The search yielded nine relevant trials that evaluated 372 people with type 2 diabetes. Compared to not exercising, progressive resistance exercise led to small and statistically significant absolute reductions in HbA1c of 0.3% (SMD –0.25, 95% CI –0.47 to –0.03). When compared to aerobic exercise there were no significant differences in HbA1c. Progressive resistance exercise resulted in large improvements in strength when compared to aerobic (SMD 1.44, 95% CI 0.83 to 2.05) or no exercise (SMD 0.95, 95% CI 0.58 to 1.31). There were no significant changes in body composition.</p></div><div><h3>Conclusions</h3><p>Progressive resistance exercise increases strength and leads to small reductions in glycosylated haemoglobin that are likely to be clinically significant for people with type 2 diabetes. Progressive resistance exercise is a feasible option in the management of glycaemia for this population.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 4","pages":"Pages 237-246"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70003-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28521043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cincinnati Orthopaedic Disability Index in canines","authors":"Stephanie Valentin","doi":"10.1016/S0004-9514(09)70014-5","DOIUrl":"10.1016/S0004-9514(09)70014-5","url":null,"abstract":"","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 4","pages":"Page 288"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70014-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28522543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Rating of Change scales","authors":"Steve Kamper","doi":"10.1016/S0004-9514(09)70015-7","DOIUrl":"10.1016/S0004-9514(09)70015-7","url":null,"abstract":"","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 4","pages":"Page 289"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70015-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28522544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instillation of normal saline before suctioning reduces the incidence of pneumonia in intubated and ventilated adults","authors":"Julie C. Reeve","doi":"10.1016/S0004-9514(09)70044-3","DOIUrl":"10.1016/S0004-9514(09)70044-3","url":null,"abstract":"<div><h3>Question</h3><p>Does the instillation of normal saline before suctioning reduce the incidence of ventilator-associated pneumonia in intubated and ventilated adults?</p></div><div><h3>Design</h3><p>Randomised, controlled trial with blinded outcome assessment.</p></div><div><h3>Setting</h3><p>The medical/surgical intensive care unit of a tertiary oncology hospital in Brazil.</p></div><div><h3>Participants</h3><p>Adults expected to require at least 72 hours of mechanical ventilation via an endotracheal or tracheostomy tube. Previous ventilation within the past month and contraindications to bronchoscopy were exclusion criteria. Randomisation of 262 participants allotted 130 to the intervention group and 132 to a control group.</p></div><div><h3>Interventions</h3><p>Closed tracheal suction systems with heat and moisture exchangers were used with both groups and were changed regularly. All patients were nursed with backrest elevation to 45 degrees. Medical or nursing staff, who were blinded to group allocations, requested suctioning when any of the following occurred: visible or audible secretions, ventilator-patient asynchrony, and increased peak inspiratory pressures or decreased tidal volumes attributed to secretions. Respiratory therapists performed the suctioning according to a standardised procedure that included preoxygenation. The therapists instilled 8 mL of normal saline prior to suctioning in the intervention group only.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was the incidence of ventilator-associated pneumonia (VAP). If VAP was suspected because of radiographic evidence plus either fever, leukocytosis, or purulent secretions, a bronchoscopy with standardised lavage was performed. VAP was considered confirmed if the bacterial density of the lavage fluid exceeded 1000 colony-forming units/mL. Secondary outcome measures included time to VAP, duration of mechanical ventilation, length of stay and mortality in the intensive care unit, unscheduled ventilation circuitry changes due to secretions, and number of suctions per day.</p></div><div><h3>Results</h3><p>All participants completed the study. Significantly fewer participants in the saline group developed VAP (14/130) than in the control group (31/132), relative risk reduction 0.54 (95% CI 0.18 to 0.74). This indicates that one patient will avoid developing VAP for every 8 patients in which saline instillation is used. Significant benefits of saline instillation were also seen in the incidence of VAP (9 vs 21 per 1000 days of mechanical ventilation, <em>p</em> = 0.01) and in the time to first VAP (<em>p</em> = 0.02). The groups did not differ significantly on the remaining secondary outcomes.</p></div><div><h3>Conclusion</h3><p>Instillation of normal saline before tracheal suctioning decreases the incidence of VAP in mechanically ventilated adults.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 2","pages":"Page 136"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70044-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28250259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar spinal stenosis","authors":"Sandra Brauer","doi":"10.1016/S0004-9514(09)70068-6","DOIUrl":"10.1016/S0004-9514(09)70068-6","url":null,"abstract":"","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 1","pages":"Page 67"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70068-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129027409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical stimulation is a useful adjunct in the management of urinary incontinence in people with multiple sclerosis","authors":"Eleanor Lee-Bognar","doi":"10.1016/S0004-9514(09)70063-7","DOIUrl":"10.1016/S0004-9514(09)70063-7","url":null,"abstract":"<div><h3>Question</h3><p>Does neuromuscular electrical stimulation improve lower urinary tract dysfunction in people with multiple sclerosis (MS), when given in addition to pelvic floor exercises and electromyographic biofeedback?</p></div><div><h3>Design</h3><p>Randomised, controlled trial with concealed allocation and blinded assessment of some outcomes.</p></div><div><h3>Setting</h3><p>Twelve health-care facilities in Northern Ireland.</p></div><div><h3>Participants</h3><p>Adults with MS with no hospital admissions in the preceding 3 months. They were required to have lower urinary tract dysfunction (involuntary leakage, &gt; 8 voids per day, nocturia, or voiding dysfunction) but not to score more than 7.5 on the Expanded Disability Status Scale (EDSS) from 0 (normal) to 10 (death due to MS). Symptomatic prolapse, prostatic hyperplasia, infection and contraindications to electrical stimulation were exclusion criteria. Randomisation of 74 participants allotted 37 to each of two groups.</p></div><div><h3>Interventions</h3><p>Both groups were taught skills and strategies to prevent incontinence and trained in pelvic floor muscle exercises. Both groups were taught to perform the exercises with electrical stimulation via a hand-held unit with a vaginal or anal probe. The treatment group received active stimulation while the control group received sham stimulation. Both groups performed the exercises daily for 9 weeks. The exercises were reviewed with electromyographic biofeedback at a weekly clinic visit.</p></div><div><h3>Outcome measures</h3><p>The primary outcome was the number of leakage episodes per day as monitored by diary. Secondary outcome measures included gain in pad weight after use, voiding measures, symptom questionnaires, and assessment of pelvic floor muscle function using the Oxford classification and EMG. All outcomes were measured at 9, 16, and 24 weeks.</p></div><div><h3>Results</h3><p>In each group, 36 participants completed the study. At 9 weeks, the treatment group had significantly less incontinence, with 0.8 fewer episodes per day (95% CI 0.1 to 1.4) and 89 g lighter pads (95% CI 8 to 171) than the control group. The treatment group also had significantly larger voids, by 47 ml (95% CI 1 to 93), and significantly smaller post-void residual volumes. Symptoms were also rated as significantly less bothersome. At 24 weeks, however, pad weight was the only objective outcome that remained statistically significant. Nevertheless, patients in the treatment group still rated their symptoms as significantly less bothersome on two questionnaires.</p></div><div><h3>Conclusion</h3><p>For people with MS, the addition of electrical stimulation to a program of pelvic floor muscle training and EMG biofeedback induces several improvements in lower urinary tract dysfunction. Although some improvements were temporary, symptoms remained less bothersome for 24 weeks.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 1","pages":"Page 62"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70063-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27993069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endurance and strength training have different benefits for people with peripheral arterial disease, but both improve quality of life","authors":"Sandeep Gupta","doi":"10.1016/S0004-9514(09)70064-9","DOIUrl":"10.1016/S0004-9514(09)70064-9","url":null,"abstract":"<div><h3>Question</h3><p>Do treadmill training and resistance training improve the functional performance of patients with peripheral arterial disease (PAD)?</p></div><div><h3>Design</h3><p>Randomised, controlled trial with blinded outcome assessment and stratification for symptoms of intermittent claudication (IC).</p></div><div><h3>Setting</h3><p>Tertiary hospital in the USA.</p></div><div><h3>Participants</h3><p>Participants with an ankle brachial index of 0.95 or less were recruited from vascular clinics and the community. Key exclusion criteria were critical limb ischaemia, foot ulcers, amputation, inability to attend or perform the interventions, and usual exercise comparable to the study regimens. Randomisation of 156 participants allotted 51 to treadmill training, 52 to resistance training and 53 to a control group.</p></div><div><h3>Interventions</h3><p>The treadmill group performed supervised treadmill exercise 3 times per week for 6 months. Participants aimed to increase to 40 minutes by week 8, after which the speed or grade of the treadmill was progressed. Participants with IC were encouraged to exercise to near maximal leg symptoms. Asymptomatic participants exercised at a perceived exertion of 12 to 14 on the Borg scale. The resistance group also performed supervised exercise 3 times per week for 6 months, including 3 sets of 8 repetitions of resisted lower limb exercises. External resistance was maintained above 50% of 1 repetition maximum and perceived exertion at 12 to 14. The control group attended 11 sessions that were designed to provide contact with a health professional but not to change behaviour.</p></div><div><h3>Outcome measures</h3><p>The primary outcomes were the change in the six-minute walk test (6MWT) and the short physical performance battery (SPPB) at 6 months. The SPPB assesses walking speed, balance, and sit-to-stand performance. Secondary outcome measures were treadmill endurance, lower limb strength, endothelial function measured non-invasively at the brachial artery, habitual physical activity measured over 7 days via an accelerometer, a walking impairment questionnaire (WIQ), and the SF-36 quality of life questionnaire.</p></div><div><h3>Results</h3><p>Compared to control, treadmill training significantly improved 6MW distance (by 36 m, 95% CI 15 to 57), total treadmill time (by 3.4 min, 95% CI 2 to 4.8), pain-free treadmill time (by 1.6 min, 95% CI 0.3 to 2.9), endothelial function, and the Distance domain of the WIQ. Compared to control, resistance training significantly improved total treadmill time (by 1.9 min, 95% CI 0.5 to 3.3), knee extension strength (by 80 N, 95% CI 37 to 124), and the Distance and Stair Climbing domains of the WIQ. Both regimens produced significant, 7.5-point improvements in the Physical Functioning domain of the SF-36.</p></div><div><h3>Conclusion</h3><p>Treadmill and resistance training have different benefits for people with peripheral arterial disease, but both improve qualit","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 1","pages":"Page 63"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70064-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27993070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Independence Measure","authors":"Shylie Mackintosh","doi":"10.1016/S0004-9514(09)70066-2","DOIUrl":"10.1016/S0004-9514(09)70066-2","url":null,"abstract":"","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 1","pages":"Page 65"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70066-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27993072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}