The document discusses outcome measures of functional capacity, specifically the 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT). It provides background on each test, how they are implemented, evidence on their validity, reliability and responsiveness. Both tests are described as suitable measures for cardiopulmonary patients, though some evidence suggests the ISWT may better correlate to physiological measures like heart rate and dyspnea. Further research is still needed to establish the tests' validity across specific patient populations.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
Effect of aerobic exercise on walking capacity in subjects with parkinsonism-...Sports Journal
Background Parkinson disease is a neurological syndrome usually resulting from deficiency of
neurotransmitter dopamine as the consequence of degenerative, vascular or inflammatory changes in the
basal ganglia. Aerobic exercise is physical exercise of low to high intensity that depends primarily on the
aerobic energy-generating process. Objective of the study was to review the effect of aerobic exercise on
walking capacity in subject with Parkinson disease. Methods. Total of 7 articles reviewed, which
supports aerobic exercise and walking capacity and conclusion made on the basis of results reviewed.
Conclusion. Thus based on the various results achieved in the previous studies, this literature review
concluded that the aerobic exercises can be a great way to improve walking capacity in patients with
Parkinsonism.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
6. 6 Minute Walk test
Background
Developed in 1963 by Balke to evaluate functional capacity in respiratory
disease and heart failure.
Has since been used in a variety of populations including the elderly, stroke
patients and spinal cord injuries.
Easy to implement, little equipment needed.
7. 6MWT
Application
Measures the amount of distance and individual is able to walk over a
period of 6 minutes on a hard, flat surface.
Self-paced. Resting allowed as necessary. Submaximal test.
Measure Heart Rate and SpO2 before test and upon completion.
8. 6MWT Implementation:
Ideally conducted in a closed quiet hallway by a single administrator.
Variables:
• Test Instructions: Walk at a comfortable pace/ as quickly as possible.
• Resting Instructions (American Thoracic Society ATS)
• Walkway Length: ATS recommend 30m. Others 10m/15m.
• Use of Encouragement: If used the exact protocol should be
documented.
• Number of Trials: Largest improvements seen over first three.
9. 6MWT
Scoring:
Range for healthy adults is 400m-600m
Clinically important difference is 54m for healthy adults (Redelmeier et al,
1997)
50m for stroke patients (Perera et al, 2006) 25m for coronary disease
(Gremeaux et al, 2011). % change of clinical significance not established.
10. Test Evaluation
Validity- Does the test measure what it is said to measure?
Reliability- If the test is repeated on the same patient by the same or
different examiners will the results be similar?
Responsiveness- Is the test responsive to change? e.g.: following completion
of an exercise intervention.
11. Evidence
Systematic review in out-patient cardiac rehabilitation
“Strong evidence suggests that the 6MWT is responsive to clinical
change following cardiac rehabilitation. Intra and inter-tester
reliability of the 6MWT and its validity in patients undergoing cardiac
rehabilitation requires further research.”
-Bellet et al,2012
12. 6MWT Evidence
Validity-Moderate to high relationships have been reported between the
6MWT distance and peak VO2max obtained in persons with heart failure
and COPD (Guyatt et al, 1985, Jaeschke et al 1993)
Reliability-Different encouragements and repeated testing produce variable
results (Guyatt et al, 1984)
Responsiveness- Studies of responsiveness have shown that improvement in
6MWT distance is related to diminished breathlessness (pacemaker
patients), improvements in QOL (elderly, cardiac pts) and changes in VO2
max (COPD)
13. Incremental Shuttle Walking Test
Background
Developed to overcome problems associated with fixed-time, self-paced walking
tests.
Externally Paced
Incremental
Symptom-limited maximal test
Based on the 20m shuttle run test designed by Leger and Lambert to assess fitness
in healthy adults.
14. ISWT Implementation
10m course marked by 2 cones set 0.5m from each end.
Walking speed set by an audio signal on a tape/cd.
Initial pace is 0.5m/sec. Walking speed increases by 0.17m/sec each minute of the
test, indicated by a triple beep from the tape.
Number of shuttles increases by 1 each time the speed of walking increases.
Test ends when the patient is exhausted or too breathless to continue or when the
patient is more than .5m from the cone when the turn signal sounds.
Max 12 levels.HR, SpO2, BORG Dyspea scale used in coherence with the walking
test.
16. Evidence
Validity
Several studies have demonstrated a strong relationship between distance
walked on the ISWT and the directly determined VO2max, advocating the
tests validity in:
-COPD Patients (Singh et al, 2003. Turner et al, 2004. )
-Chronic Heart Failure (Morales et al, 2000. Green et al, 2001)
-Pulmonary Fibrosis (Moloney et al, 2003)
17. ISWT
Reproducibility
Singh et al and Green et al both reported strong test-retest reproducibility
when they compared distance walked during tests spaced 1 week apart.
Reliability
Strong as externally paced and audio cued.
18. 6MWT Vs ISWT
Some studies in people with COPD and CCF have demonstrated that the
6MWT overestimates disability when compared to the ISWT (Singh et al
1994, Green et al 2001, Morales et al, 2000)
Similar distances covered. Peak HR and dyspnea greater on ISWT
Conversely, Turner et al (2004) noted a strong correlation between heart
rate (HR), dyspnea and distances covered in the two tests and strongly
encouraged the 6MWT. This test also used encouragement.
19. Comparison 6MWT Vs ISWT
6 Minute Walk Test Incremental Shuttle Walk Test
Self-Paced Externally Paced
Little Equipment Needed CD for incremental change
Greater Functional Exercise Prediction Greater Physiological Correlation-
HR,Dyspnea
Similar distances covered Similar distances covered
20. Comparison
Randomised Control Trials. ? Conflicting Evidence
The shuttle walk test is simple and easy to implement in patients with chronic obstructive
pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart
rate and greater post-test sensation of dyspnea than did the shuttle walk test. (COPD)
-Rosa et al, 2006.
The shuttle walk test is no more responsive to change than the 6-minute walk test in older
people. It is limited by ceiling effects, and cannot be performed successfully by very frail
older people. (Elderly population)
-Witham et al, 2012.
21. Conclusion
Further evidence is needed for specific patient populations to establish the
true validity in all patient sub-groups.
Current evidence suggests both the 6MWT and Shuttle walk test are
suitable functional capacity outcome measures for cardiopulmonary
patients.
22. References
Bellet et al, 2012. The 6-minute walk test in outpatient cardiac
rehabilitation: validity, reliability and responsiveness- a systematic review.
Guyatt et al, 1985. How should we measure function in patients with chronic
heart and lung disease? J Chronic Disease.
Jaeschke et al, 1989. Measurement of health status: Ascertaining the
minimal clinically important difference. Control clinical trials.
Solway et al, 2001. A qualitative systematic overview of the measurement
properties of functional walk tests used in the cardiorespiratory domain.
Chest.
23. References
Singh et al, 1994. Comparison of oxygen uptake during a conventional treadmill
test and the shuttle walking test in chronic airflow limitation. Eur Resp J.
Turner SE et al, 2004. Physiologic responses to incremental and self-paced
exercise in COPD. A comparison of three tests. Chest.
Moloney ED et al 2003. The Shuttle walk exercise test in idiopathic pulmonary
fibrosis. Resp. Med.
Green DJ et al, 2001 A Comparison of the shuttle and 6 minute walking tests
with measured peak oxygen consumption in patients with CHF. J Sci Med Sports
Morales et al, 2000. Shuttle versus six-minute walk test in the prediction of
outcome in chronic heart failure. Int J Cardiol.