Aust J Physiother
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.
Ventilator-associated pneumonia results from bacterial colonisation of the aerodigestive tract or aspiration of contaminated secretions into the lower airways. As a consequence of infection of the lung parenchyma and alveolitis, accumulation of inflammatory exudates and infiltration of airway mucosa can lead to unfavourable respiratory mechanics in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance. ⋯ Data were recorded before, immediately after, and 30 minutes after each intervention protocol. C(L) increased by 22% and R(AW) decreased by 21%, up to 30 minutes after manual hyperinflation plus suction, but not after suction alone. This study suggests that manual hyperinflation in conjunction with suction induces beneficial changes in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.
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Randomized Controlled Trial
The effect of weight-bearing exercise with low frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects.
Patients with low back pain (LBP) often present with impaired proprioception of the lumbopelvic region. For this reason, proprioception training usually forms part of the rehabilitation protocols. New exercise equipment that produces whole body, low frequency vibration (WBV) has been developed to improve muscle function, and reportedly improves proprioception. ⋯ The experimental (WBV) group demonstrated a significant improvement in repositioning accuracy over time (mean 0.78 degrees) representing 39% improvement. It was concluded that WBV may induce improvements in lumbosacral repositioning accuracy when combined with a weightbearing exercise. Future studies with WBV should focus on evaluating its effects with different types of exercise, the exercise time needed for optimal outcomes, and the effects on proprioception deficits in LBP patients.
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Randomized Controlled Trial Clinical Trial
Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints.
An operant behavioural and time-contingent graded exercise therapy program was developed to improve functional ability irrespective of pain experience in patients with chronic shoulder complaints. The clinical effectiveness of graded exercise therapy compared to usual care was evaluated in a randomised clinical trial. Assessments were carried out before and after 12 weeks of treatment. ⋯ Subgroup analysis showed larger improvements on the mean complaints instrument in patients not reporting pain reduction over time. Graded exercise therapy seems to be less effective in restoring performance of daily activities as assessed by the SDQ in patients showing a painful arc during physical examination. Results showed that graded exercise therapy is more effective in restoring the ability to daily activities in patients with chronic shoulder complaints than usual care, although beneficial effects are small.
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The way people with chronic low back pain think about pain can affect the way they move. This case report concerns a patient with chronic disabling low back pain who underwent functional magnetic resonance imaging scans during performance of a voluntary trunk muscle task under three conditions: directly after training in the task and, after one week of practice, before and after a 2.5 hour pain physiology education session. ⋯ The results suggest that pain physiology education markedly altered brain activity during performance of the task. The data offer a possible mechanism for difficulty in acquisition of trunk muscle training in people with pain and suggest that the change in activity associated with education may reflect reduced threat value of the task.
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Randomized Controlled Trial Clinical Trial
Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients.
Postoperative physiotherapy has been shown to reduce the incidence of postoperative pulmonary complications after open abdominal surgery. This study aimed to determine if the addition of deep breathing exercises and secretion clearing techniques to a standardised physiotherapist-directed program of early mobilisation improved clinical outcomes in patients undergoing open abdominal surgery. Fifty-six patients undergoing open abdominal surgery, at high risk of developing postoperative pulmonary complications, were randomised before operation to an early mobilisation-only group or an early mobilisation-plus-deep breathing and coughing group. ⋯ The incidence of postoperative pulmonary complications in the non-deep breathing and coughing group was 14%, and the incidence of postoperative pulmonary complications in the deep breathing and coughing group was 17%, (absolute risk reduction -3%, 95% C1 -22 to 19%). There was no significant difference between groups in the incidence of fever, physiotherapist time, or the number of treatments. This study suggests that, in this clinical setting, the addition of deep breathing and coughing exercises to a physiotherapist-directed program of early mobilisation does not significantly reduce the incidence of clinically significant postoperative pulmonary complications in high risk open abdominal surgery subjects.