Functional Capacity Evaluation Research Articles

Complex issues in vocational rehabilitation with functional capacity evaluation results

BACKGROUND: The American Physical Therapy Association (APTA) conducted a two-year process of literature review, writing, discussion, and debate within a panel of four subject matter experts in design, administration, and interpretation of Functional Capacity Evaluations (FCE). This process resulted in a Best Practice Guidelines document which was then adopted by the APTA. OBJECTIVE: This article provides additional clarification regarding best practices and standard methodology for functional capacity evaluations including standard terminology for use by physical therapists and vocational rehabilitation professionals in determining the types of work a patient has the capacity of performing. METHODS: The clarification of the role of the FCE, who is qualified to conduct an FCE, complexities such as ‘good effort’ and pain in the evaluation process, clarification of terms from different government agencies, and the implications for disability determination are discussed. RESULTS: Specific guidelines for best practice with FCE are suggested and demonstrated through case studies. CONCLUSION: The best practice guidelines are detailed here to set forth qualification standards for FCE examiners and to promote clinical excellence, accountability, and consistency in the design, administration, and interpretation of FCEs.

Technological interventions in functional capacity evaluations: An insight into current applications

BACKGROUND: Functional Capacity Evaluation (FCE) is a crucial component within return-to-work decision making. However, clinician-based physical FCE interpretation may introduce variability and biases. The rise of technological applications such as machine learning and artificial intelligence, could ensure consistent and precise results. OBJECTIVE: This review investigates the application of information and communication technologies (ICT) in physical FCEs specific for return-to-work assessments. METHODS: Adhering to the PRISMA guidelines, a search was conducted across five databases, extracting study specifics, populations, and technological tools employed, through dual independent reviews. RESULTS: Nine studies were identified that used ICT in FCEs. These technologies included electromyography, heart rate monitors, cameras, motion detectors, and specific software. Notably, although some devices are commercially available, these technologies were at a technology readiness level of 5–6 within the field of FCE. A prevailing trend was the combined use of diverse technologies rather than a single, unified solution. Moreover, the primary emphasis was on the application of technology within study protocols, rather than a direct evaluation of the technology usability and feasibility. CONCLUSION: The literature underscores limited ICT integration in FCEs. The current landscape of FCEs, marked by a high dependence on clinician observations, presents challenges regarding consistency and cost-effectiveness. There is an evident need for a standardized technological approach that introduces objective metrics to streamline the FCE process and potentially enhance its outcomes.

Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing.

Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105mmHg in males ≥190/105mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6±-2.3, -19.7±-1.9, p:.13; -21.3±-2.7, -21±-2.4, p:.68; -21.2±-2.2, -21.2±-2.3, p:.93; and -20.8±-1.5, -20.4±-1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374±210, 2465±204, p:.10; 142±64, 127±42, p:.31; 94.3±2.5, 95.1±1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036±149, 2147±150, p<.001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p=.03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.

Clinical trial design, endpoints and regulatory considerations in heart failure

Following the withdrawal of flosequinan in the early 1990s due to heightened mortality and fatal arrhythmia risks, regulatory agencies have demanded evidence of the efficacy of novel treatments in managing heart failure, with mortality and morbidity endpoints becoming more stringent criteria for approval. In recent times, regulatory agencies have exhibited a greater willingness to permit the evaluation of functional capacity as an efficacy endpoint, albeit limited to specific patient groupings. Consequently, a novel therapeutic intervention for heart failure may be granted approval provided that it enhances survival rates, decreases length of hospital stays, and/or safely improves functional capacity. This article reviews clinical trial design, trial endpoints and regulatory issues in heart failure trials.

Musculoskeletal complaints, physical work demands, and functional capacity in individuals with a brachial plexus injury: An exploratory study.

Musculoskeletal complaints (MSCs) may be more common in individuals with brachial plexus injury (BPI), whose physical work demands exceed their functional capacity (FC). (a) To assess the concurrent validity of five methods for measuring upper extremity work demands and the Dictionary of Occupational Titles (DOT). (b) To explore the relations between MSCs, physical work demands, and FC in individuals with BPI. This study had a descriptive correlational design. Physical work demands of 16 individuals with BPI (12 males, 6 one-handed workers) were assessed during work using five assessment methods and the DOT. Spearman correlation coefficients between work demand methods were determined. FC was assessed using the functional capacity evaluation one-handed (FCE-OH). A questionnaire was used to examine MSCs. The relationship between MSCs, physical work demands and FC was analyzed visually, using Spearman correlation coefficients, and by comparing FCE-OH results to FCE reference values. Spearman correlation coefficients for the DOT and four out of five assessment methods for determining work demands on upper extremities were significant and moderate (four combinations: r = 0.65-0.79) to strong (five combinations: r = 0.81-0.94). Correlations of the fifth method with the other methods were weak to fair. No significant relationships were found between MSCs, physical work demands and FCE-OH results. The relationships between MSCs, physical work demands, and FC are evidently complex and require further investigation. In this small sample the concurrent validity of the DOT and four methods for determining work demands on upper extremities was moderate to good.

Work readiness and trending avenues for future studies: a systematic literature review and bibliometric analysis

PurposeThis study aims to undertake a theoretical and technical exploration of the literature on Work Readiness (WR) through the implementation of a systematic literature review and bibliometric analysis. The present study addresses seven distinct research questions: (1) an examination of the descriptive features characterizing the literature on WR, (2) an analysis of trends in annual scientific publications related to WR, (3) the identification of the most pertinent and high-impact sources contributing to WR, (4) the delineation of the globally cited articles exerting the most influence on WR, (5) the determination of the most relevant countries associated with WR, (6) an evaluation of the outcomes derived from Bradford’s Law of Scattering and Lotka’s Law of scientific productivity in the context of WR, and (7) the identification of the prevailing research avenues that hold significance for future studies on WR.Design/methodology/approachThe present study employed Systematic Literature Review (SLR) and bibliometric analysis mapping techniques to analyze 521 articles extracted from the Scopus database. The analysis utilized Biblioshiny software and VOSviewer software as the primary tools.FindingsThe findings reveal that WR constitutes a steadily expanding subject discipline, showcasing a notable 9.12% annual growth in scientific production spanning from 1975 to 2023. Australia, the USA, and Canada emerged as the most productive countries within the field of WR, as evidenced by their cumulative scientific production. The thematic map of keyword analysis suggests several burgeoning pathways for future researchers in the WR domain, including workplace learning, functional capacity evaluation, graduate WR, digital literacy, blended learning, resilience, and curriculum.Originality/valueThis study contributes to the WR discourse by providing a comprehensive literature review. The findings of this study hold significance for graduates, universities, employers, the higher education industry, and the broader community.

Analysis and correlation of the Six-Minute Walk Test and Two-Minute Step Test in an elderly population participating in a cardiac rehabilitation program

The six-minute walk test (6MWT) and two-minute step test (2MST) are submaximal tests widely used in the elderly population functional capacity evaluation. Objective: To investigate whether the cardiac rehabilitation (CR) program was able to promote an increase in these tests and if there was an association between them; and to compare the hemodynamic stress caused by each of the tests. Methods: Retrospective, observational study in elderly participants in CR program. 24 elderly people were evaluated and classified according to the Fried frailty phenotype. The 6MWT and the 2MST were applied, observing the mean distance walked and the number of steps performed, respectively, as well as the double cardiac product (DP) at the beginning and after 4 months of the CR program. Results: There was an increase of 57 meters in the mean distance covered by the 6MWT (364.31±108.01 vs. 421.65±108.73, P&lt;0.001) and 14 steps performed in the 2MST (62.17±22.50 vs. 76.17±25.56, P= 0.011) after 4 months of CR and we found a significant correlation between the tests and their results (P &lt;0.001). When comparing the DP, both tests had a significant reduction (14469.92±2497.91 vs. 13348.21±2839.36, P= 0.022 and 15744.17±3591.87 vs. 13222.29±2505.39, P&lt;0.001; respectively). Conclusion: A relationship between the number of steps performed in the 2MST with the mean distance covered of 6MWT suggest the use of them as an effective indicator in CR program and the association between them offers greater possibilities for treatment and evaluation of an elderly population.

SIOG2023-5-P-367 - Evaluation of Functional Capacity with 6 Minute Walk Test (6MWT) in Indian Geriatric Lung Cancer & it’s comparison with the Reference Equation Values- A Retrospective Study

SIOG2023-5-P-367 - Evaluation of Functional Capacity with 6 Minute Walk Test (6MWT) in Indian Geriatric Lung Cancer & it’s comparison with the Reference Equation Values- A Retrospective Study

Evaluation of functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers: a comparative study

BackgroundElectronic cigarettes or e-cigarettes have gained significant popularity as an alternative to traditional combustible tobacco smoking particularly among the youth. Although there is a growing prevalence of e-cigarette usage, the effects on cardiovascular function and physical capacity have not been adequately studied. The toxic products in combustible tobacco cigarettes negatively impact functional exercise capacity. However, the available data regarding the effect of e-cigarette use on functional exercise capacity are scarce. Thus, in the current study, we aimed to evaluate the functional aerobic exercise capacity among chronic e-cigarette users compared to combustible cigarette smokers and non-smokers.ResultsThis comparative, cross-sectional study was conducted on 105 healthy volunteers. Participants were assigned into three study groups each consisting of 35 participants: chronic e-cigarette users, combustible cigarette smokers, and a non-smoker control group. Basal demographic and clinical data were similar in all groups. Mean heart rates and respiratory rates were significantly higher among e-cigarette smokers and combustible cigarette smokers compared to non-smoker controls (p < 0.001). Chronic e-cigarette users and combustible cigarette smokers had shorter 6-MWT distances compared to non-smokers (508.3, 488, and 616.6 m, respectively, p < 0.001). Borg scale scores after performing the six-minute walking test were significantly higher in chronic e-cigarette users and combustible cigarette smokers groups compared to non-smokers, where perceived exertion (4.9, 5.5, 2.1, respectively, p < 0.001), dyspnea (5.7, 6.5, 0.1, respectively, p < 0.001) and leg fatigue (4.2, 5.4, 1.4, respectively, p < 0.001).ConclusionIn this cross-sectional study, significant evidence demonstrates that e-cigarette use is not harmless. This was particularly presented in apparently healthy e-cigarette users in comparison to the healthy non-smoker control group. Chronic e-cigarette use is associated with reduced functional capacity compared to non-smoker controls. This was signified by decreased 6MWT walking distances, higher Borg scale scores, and lower oxygen saturation percentages among the chronic electronic cigarette users as compared to non-smoker controls after performing the six-minute walking test. All the evaluated parameters in the current study were similarly reduced among both the e-cigarette users group and the combustible cigarette smokers group compared to non-smokers with no statistically significant differences between both smoker groups.

Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that, due to dyspnea, decreases patients' physical function and quality of life. The aim of the research was to evaluate the effectiveness of water-based exercise (WE) in improving functional capacity and respiratory muscle strength in patients with COPD. It consisted of a systematic review and meta-analysis of eight randomized clinical trials (RCTs) from the last 10 years, found in PubMed, PEDro, Scopus and Web of Science databases. Methodological quality was analyzed using the PEDro scale and the Cochrane Collaboration Risk of Bias Tool. Regarding the evaluation of functional capacity, mainly assessed were lung function, respiratory muscle strength, and maximal or aerobic exercise. The results showed that WE improves functional capacity compared to a non-exercising control group (SMD: 73.42; IC 95%: 40.40 to 106.45; I2: 0%). There are no statistically significant differences between a WE treatment and a land exercise (LE) treatment (p = 0.24) in functional capacity, nor with respect to respiratory muscle strength (p = 0.97). These data should be interpreted with caution, as more RCTs with aquatic intervention in COPD patients are needed to elucidate whether there are differences between WE or LE according to patient characteristics and comorbidities.

Hypopharyngeal cancer trends in a high-incidence region: A retrospective tertiary single center study.

Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, 1` diet, and socioeconomic conditions. While squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal tumors, it remains a rare form, comprising only 3%-5% of all SCC cases in the head and neck region. Globally, Central and Eastern Europe have the highest incidence rates for males (3.9 per 100000) and the third highest for females (2.26 per 100000), underscoring the significance of this seemingly uncommon condition. In Romania, hypopharyngeal cancer ranked 24th in incidence rate, with 634 new cases in 2020. To study the incidence, treatment and survival rates of hypopharyngeal tumor cases in a major ear, nose, throat (ENT) surgical center. A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of "Carol Davila Central University Emergency Military Hospital" in Bucharest between January 2018 and August 2022. The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) and the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania). Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer, tumor localization in the hypopharyngeal region, and informed consent for data usage. Exclusion criteria involved major psychiatric pathologies and disagreement for data usage. Diagnosis was based on ENT assessment, imaging reports, and laboratory data. Treatment methods were determined based on various factors. Additional tools, such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale, were used for risk assessment and functional capacity evaluation. Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire. Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022. The majority of patients were male (94.3%), with an average age at diagnosis of 62.5 years. Among the patients, 20.75% were employed, 66.03% were retired, and 9.43% were unemployed. Smoking was prevalent among 69.81% of patients, while alcohol consumption was frequent in 32.07% of cases. The tumors were mostly diagnosed at an advanced stage (stage IV) and were predominantly SCC. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Dysphagia and neck mass were the most common symptoms reported. Treatment methods included surgery, radiation therapy, and chemotherapy. A favorable treatment response was observed in 22.64% of cases, while relapse occurred in 6 cases. Follow-up data was unavailable for some patients. In summary, our findings align with existing literature; however, we observed a higher severity.

Tele-Assessment of Functional Capacity: Validity, Intra- and Inter-rater Reliability.

Functional capacity evaluation is a standardized tool that assesses work-related skills. Although there are different test batteries, the most frequently used one is Work Well Systems. This study aims to determine the validity and inter- and intra-rater reliability of remote implementation of functional capacity tests (repetitive reaching, lifting object overhead, and working overhead) in asymptomatic individuals. A total of 51 asymptomatic individuals were included in the study. Participants completed all tests both face-to-face and remotely. Remote assessment videos were rewatched by the same researcher and different researchers for intra- and inter-rater reliability. All processes were scored by two independent researchers. Remotely performing repetitive reaching (intraclass correlation coefficient [ICC]: 0.85-0.92, p < .001), lifting object overhead (ICC: 0.98, p < .001), and working overhead (ICC: 0.88 p < .001) tests are valid and reliable. Repetitive reaching, lifting an object overhead, and sustained overhead work tests in the Work Well Systems-Functional Capacity Evaluation test battery can be performed remotely through videoconferencing. Remotely evaluating these tests, which are especially important in work-related situations, may be important in pandemic conditions and hybrid working conitions.

Variations in phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study.

Bioimpedance phase angle (PA) is a measure of cell membrane integrity, whereas handgrip strength (HGS) is an evaluation of functional capacity. Although both are related to the prognosis of patients undergoing cardiac surgery, their changes over time are less known. This study followed variations in PA and HGS for 1 year in these patients, determining associations with clinical outcomes. This prospective cohort study included 272 cardiac surgery patients. PA and HGS were measured at six predetermined times. The evaluated outcomes were surgery type; bleeding; time of surgery, cardiopulmonary bypass, aortic cross-clamp, and mechanical ventilation; postoperative (PO) length of stay (LOS) in the intensive care unit (ICU) and hospital; and infections, hospital readmission, reoperation, and mortality. There were reductions in PA and HGS values after surgery, with total recovery beginning at 6 months for PA and 3 months for HGS. In the PA area under the curve (AUC), age, combined surgery, and sex (β = -9.66, P < 0.001; β = -252.85, P = 0.005; β = -216.56, P < 0.001, respectively) were predictors for PA-AUC reduction. Stratified by sex, age (β = -93.54, P < 0.001) and PO LOS (β = -46.91, P = 0.003) were predictors for HGS-AUC reduction in women, but only age was a predictor in men (β = -77.02, P = 0.010). PA and HGS had an effect in hospital LOS and ICU LOS. Age, combined surgery, and female sex were predictors of reduced PA-AUC, whereas reduced HGS-AUC was predicted by age in both sexes and PO hospital LOS in women, which suggests that these factors could interfere in prognosis.

Timed up and go test associated and may predict peak vo2

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): No funding. Background the Timed Up And Go test (TUG) is a form of mobility and functional capacity evaluation, but is still not well studied in cardiac patients. Objective test TUG association and prediction capacity for peak VO2. Methods cross sectional study. Patients with cardiophaties, admitted to a cardiac rehabilitation facility, who were submitted to TUG and a cardiopulmonary exercise test (CPET). Pearson correlation, multiple linear regression, ROC curves and Bland-Altman analysis were applied. From the total 2/3 were designated to the creation and 1/3 to the validation population. A p value &amp;lt; 0.05 was admitted as significant. Results 201 patients, mean age of 67±13 years, 30% were female, 70% had ischaemic cardiopathy. Heart failure was present in 30%, 53% were NYHA I, 37% NYHA II, the mean left ventricle ejection fraction was 56±16%. Mean peak VO2 was 17±6 ml.kg-1.min-1 and mean TUG was 7±2.5 seconds (s). The correlation between TUG and peak VO2 was: r= -0.53 (IC95%= -0.62 -0.42; p&amp;lt;0.001) with a R² of 0.28. The AUC to predict a peak VO2 ≥20 ml.kg-1.min-1 based on TUG was 0.80 (IC95% 0.74-0.86; p&amp;lt;0.001) and the best cut point ≤5.47s (sensitivity 83% and specificity 63%). Based in 134 patients (2/3 of the total), the following equation was described to peak VO2 prediction based in TUG results: peak VO2= 33.553+ (-0.149*age) + (-0.738*TUG) + (-2.870*sex); male=0, female=1. In the validation population (1/3 of the total), the peak VO2 estimated by TUG was 18.8±3.2 ml.kg-1.min-1 and the CPET measured was 18.1±5.9 ml.kg-1.min-1 (p &amp;gt; 0.05). Conclusion TUG and peak VO 2 were moderately but significantly associated. A equation to predict peak VO2 based on TUG was described and validated with good performance. Achieving 5.47s or less in TUG was related levels of peak VO2 that are related to better prognosis.

A comprehensive wellness profile in sedentary office employees: Health, musculoskeletal pains, functional capacity, and physical fitness indices.

One of the most important steps for the successful designing, execution, and sustainability of a workplace wellness program is the evaluation stage. The purpose of this research was to create a comprehensive wellness profile through selected and reliable testing protocols used for the evaluation of health, functional capacity, and physical fitness in office employees. One hundred office employees (32-55year-old) were evaluated to create a comprehensive wellness profile. Health indices (body composition, blood pressure, respiratory function, lipidemic profile), musculoskeletal pains, functional capacity, physical fitness (cervical, handgrip, back, leg strength, cardiorespiratory fitness), and lifestyle behaviors (physical activity levels, viewing habits, smoking, alcohol consumption) were measured. Thirty of the participants performed two assessment sessions to examine the reliability of functional capacity and physical fitness indices. A significant proportion of employees were overweight (40.7%) and obese (18.5%). The largest percentage of employees (78%) presented musculoskeletal problems in various areas of the body (higher rates in lower back, neck, and/or hip). A large percentage of the employees (40-65%) showed low-moderate levels in selected indices of health, physical activity (<6000 steps/day), functional capacity and physical fitness, and high levels of unhealthy lifestyle behaviors. The test-retest reliability for the assessment of functional capacity and physical fitness profile was high for all testing variables (ICC = 0.92-0.99; SEM% = 2.5-4.5). The testing protocols are reliable and can be used in conjunction with the reference values created to evaluate selected health and wellness indicators in office-employees.

Fitbit Data to Assess Functional Capacity in Patients Before Elective Surgery: Pilot Prospective Observational Study.

Preoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide less intrusive assessment methods, reduce costs, and improve accuracy. The aim of this study was to present and evaluate the possibility of using commercial smartwatch data, such as those retrieved from the Fitbit Inspire 2 device, to assess functional capacity before elective surgery and correlate such data with the current gold standard measure, the 6-Minute Walk Test (6MWT) distance. During the hospital visit, patients were evaluated in terms of functional capacity using the 6MWT. Patients were asked to wear the Fitbit Inspire 2 for 7 days (with flexibility of -2 to +2 days) after the hospital visit, before their surgical operation. Resting heart rate and daily steps data were retrieved directly from the smartwatch. Feature engineering techniques allowed the extraction of heart rate over steps (HROS) and a modified version of Non-Exercise Testing Cardiorespiratory Fitness. All measures were correlated with 6MWT. In total, 31 patients were enrolled in the study (n=22, 71% men; n=9, 29% women; mean age 76.06, SD 4.75 years). Data were collected between June 2021 and May 2022. The parameter that correlated best with the 6MWT was the Non-Exercise Testing Cardiorespiratory Fitness index (r=0.68; P<.001). The average resting heart rate over the whole acquisition period for each participant had r=-0.39 (P=.03), even if some patients did not wear the device at night. The correlation of the 6MWT distance with the HROS evaluated at 1% quantile was significant, with Pearson coefficient of -0.39 (P=.04). Fitbit step count had a fair correlation of 0.59 with 6MWT (P<.001). Our study is a promising starting point for the adoption of wearable technology in the evaluation of functional capacity of patients, which was strongly correlated with the gold standard. The study also identified limitations in the availability of metrics, variability of devices, accuracy and quality of data, and accessibility as crucial areas of focus for future studies.

Is Liver Frailty and functional capacity associated with severity of liver disease in patients awaiting Liver Transplantation? - A prospective Observational Study

Background: Liver is a major metabolic organ, interfering with the function of all organs and systems. So, the patients with severe liver disease may display wide manifestations of metabolic disorders, loss of muscle mass and function. Combination of these factors leads to decreased exercise tolerance and physical inactivity and it may be exaggerated with increasing severity of liver disease. The functional capacity could be severely affected due to multiple physiological derangements in these population. Hence, a liver transplant is the only cure for end stage liver disease. Currently only few literature are available that evaluated and described the status of frailty and functional capacity in these population. So we have tried to evaluate the same in Indian Population. Methodology: After ethical committee approval and written inform consent, 85 cirrhotic patients who fulfilled the Inclusion and Exclusion criteria were included in the study. Disease specific history, Severity of Liver disease, Physical evaluation of frailty via Hand grip strength, Balance and time taken to do 5 chair stands , subjective functional capacity evaluation was done through Duke activity status Index (DASI). Result: In 85 patients, the average Hand grip strength was 23.70 ± 10.60kg in males and 15.02± 5.08kg in females , average value of timed chair stands (TCS) was 18.18± 6.60 in males and 14.18± 8.65 in females , average balance score was 28.00 ±4.99 in males and 29.33± 2.58 in females and the average value of MELDNa was 22.2± 6.9. Conclusion: When compared with normal Indian standard Liver cirrhotic patient, form of frailty and reduced functional capacity non predominant. That stressed emphasis on rehabilitation and nutritional counselling during waiting period for Transplantation.

Effects of Spinal Stabilization Exercises Delivered Using Telerehabilitation on Outcomes in Patients with Chronic Neck Pain: A Randomized Controlled Trial

Background When spinal stabilization exercises (SSE) are performed regularly, they may provide benefits on outcome measures in chronic nonspecific neck pain (CNNP) patients. The pandemic has made it difficult for CNNP patients to access regular physiotherapy-exercise services. This study aims to compare telerehabilitation (TR) with face-to-face rehabilitation in CNNP patients. Methods Neck Functional Capacity Evaluation Test (NFCET) results were the primary outcomes. Pain intensity (PI), disability, awareness, the architecture of the neck muscles, and exercise satisfaction were the secondary outcomes. Patients were randomized into the TR group (TRG) (n=15) and the control group (CG) (n=16). All patients performed SSE 3 days a week, for 8 weeks. The TRG was instructed remotely while the CG was instructed in the clinic. Results After 8 weeks, NFCET values increased (p<0.05). In both groups, PI and disability decreased and neck awareness increased (p<0.05). Muscle architecture parameters improved in both groups (p<0.05), except for the Right Sternocleidomastoideus in both groups and the Right Upper-Trapezius in TRG (p>0.05). There was no difference between the groups for all variables and exercise satisfaction after 8 weeks (p>0.05). Conclusion SSE for neck pain, whether supervised by a therapist in the clinic or by telerehabilitation, was equally effective.

Reliability and validity of the incremental shuttle walk test in patients with fully ambulatory multiple sclerosis.

Functional exercise capacity evaluation is crucial to monitor treatment effects and disease progression in people with multiple sclerosis (pwMS). Compared to other tests, the incremental shuttle walking test (ISWT), which more accurately reflects cardiovascular responses, may be more useful for assessing exercise capacity. The aim of the study is to investigate the reliability and validity of the ISWT. Thirty-six pwMS with an Expanded Disability Status Scale (EDSS) score<4.5 between the ages of 25 and 65 were included in the study. The subjects underwent practice (ISWT-p) before undergoing the test-retest protocol in order to rule out the ISWT learning effect (ISWT-1 - ISWT-2). ISWT-1 and ISWT-2 were administered with a 3-7 day interval for test-retest reliability. Six-minutes walking test (6MWT) were applied for concurrent validity. The EDSS, pulmonary function tests, Fatigue Impact Scale (FIS), respiratory muscle strength [maximum inspiratory and expiratory pressure (MIP-MEP)] measurements were made for convergent validity. ISWT was found to have excellent test-retest reliability with an ICC value of 0.97. The area under the curve value was 0.904 indicating that ISWT has a good performance for predicting disease severity. The moderate correlation between ISWT and 6MWT (rho: 0.68, p<0,001) proved concurrent validity. It was also moderately correlated with EDSS, MEP (rho: -0.58 and 0.47 respectively), weakly correlated with MIP and FIS (rho:0.37 and -0.36, respectively) while not correlated with pulmonary function tests. The ISWT had excellent test-retest reliability, acceptable criterion and construct validity in ambulatory MS patients.

Evaluation of Functional Capacity and Satisfaction of Patients With Lumbosacral Fusion.

Spinal fusion is a surgical procedure that has been successfully conducted for many years. It is applied for various indications, such as degeneration, deformity, instability, spinal stenosis, trauma, tumor, and infection. This study aims to determine the effects of this procedure on daily life and sleep quality by examining postoperative symptoms and refractory complaints of patients who underwent lumbosacral fusion for various indications. The files of the patients who underwent only posterolateral lumbosacral fusion for various indications between June 2021 and July 2022 were reviewed retrospectively. Patients who had had regular clinical follow-ups for at least six months postoperatively were included in the study. Preoperative and postoperative Visual Analog Scale (VAS), Oswestry Disability Index(ODI), and Pittsburgh Sleep Quality Index (PSQI) scores were compared using the Wilcoxon Ordinal Signs test. A p-value of <0.05 was considered statistically significant. Twenty patients were included in the study. The mean age of the patients was 68.2 ± 7.5 (54-79). Three (15%) of the patients were males, and seventeen (85%) were females. Improvement was observed in all three scores, i.e., VAS,ODI, and PSQI assessments. No correlation was found between the number of segments undergoing fusion, body mass index (BMI), and clinical outcomes. Spinal fusion surgery is still viewed as the gold standard treatment method for many indications. Posterolateral fusion provides adequate stabilization in many cases when applied correctly. However, the possibility of persistent or newly developing low back pain in the postoperative period as a result of mechanical reasons should not be forgotten, and patients should be informed about the same. Postoperative expectations should, thus, be shaped accordingly.