Functional Capacity Evaluation Research Articles

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.

Evaluation of Functional Capacity and Rate of Perceived Exertion through Six-minute Walk Test in Pre and Post-haemodialysis Patients with Chronic Kidney Disease: A Prospective Cohort Study

Introduction: Chronic Kidney Disease (CKD) is a condition that affects multiple organs, including the respiratory system. Haemodialysis is a commonly used treatment for End-stage Renal Disease (ESRD), but it can lead to respiratory issues, reduced muscle strength, decreased functional capacity, and lower quality of life. The Six-minute Walk Test (6MWT) is widely accepted for assessing functional capacity in CKD patients. Aim: To evaluate the impact of haemodialysis on the functional capacity and Rate of Perceived Exertion (RPE) in patients with CKD by employing the 6MWT as a comprehensive measure. Materials and Methods: A prospective cohort study was conducted in the Department of Nephrology and Dialysis ward at MGM Hospital, Aurangabad, Maharashtra, India, from April 2020 to December 2021. A total of 73 patients were included in the present study. The primary outcome measure was the walked distance assessed using the 6MWT, and secondary outcomes are the RPE were evaluated using the Modified Borg Scale (MBS). Gait speed was also measured. Baseline demographic data, laboratory investigations, and associated co-morbidities were collected. The tests were performed before and immediately after the haemodialysis session. Data were analysed using the Student’s t-test and one-way Analysis of Variance (ANOVA), and the statistical significance level was setup at p&lt;0.05. Results: The mean age of the study participants was 44±8.25 years. The study found a significant reduction in walking distance (mean of 85 meters) after the haemodialysis session compared to the pre-session. The post-haemodialysis session showed a significant increase in RPE and fatigue levels (p=0.0001). Additionally, a significant difference in gait speed (p=0.0001) was observed between the pre and post-haemodialysis sessions. Conclusion: The present study findings indicate a significant decrease in walking distance and noteworthy increase in RPE and fatigue levels following haemodialysis sessions in CKD patients. These results emphasise the impact of haemodialysis on functional capacity and perceived exertion among individuals with this condition.

Carotid endarterectomy (CEA) risk stratification for adverse events at one year follow-up: the role of preoperative functional capacity scores, age, BNP and hemoglobin

The aim of the study was to evaluate combination of functional status tools (American Society of Anesthesiologists Physical Status Classification System (ASA PS)) status, Metabolic Equivalent of Task (METs), Revised Cardiac Risk Index for Pre-Operative Risk (RCRI) largely used in preoperative risk assessment with humoral variables in building powerful predictive models of Major Adverse Cardiac Cerebrovascular Events (MACCE) in a one-year follow-up after carotid endoarterectomy (CEA). All consecutive patients undergoing CEA during a 12-month period, were enrolled in this prospective observational study. Demographic data, functional capacity (FC) measured by risk stratification scores RCRI, ASA physical status, METs and preoperative levels of hemoglobin and Brain Natriuretic Peptide (Pro-BNP), coexisting comorbidities, have been collected. 201 consecutive patients undergoing CEA under local anesthesia (men 137 (68.16%), women 64 (31.84%)) with a median age of 75 years (Interquartile range (IQR) 67–80 years), Body mass index (BMI) median of 26.23 (IQR 24.4–28.89) were enrolled. Combination of all variables studied leave at a good one-year prognostic tool with AUC of 0.93 (Sensitivity (SEN) 46.6, Specificity (SPEC) 95.7). Preoperative hemoglobin correlate with Major Adverse Cardiac Cerebrovascular Events (MACCE) at 3 months (p = 0.018), while the preoperative BNP at 12 months shows correlation with adverse events (p = 0.004). Age has a significant correlation with adverse events at 12 months between demographic and anthropometric factors (p = 0.002). MACCE may adversely affect short- and long-term outcomes after CEA. Evaluation of preoperative functional capacity by RCRI, ASA physical status and METs combined with age and biomarkers such as pro-BNP and hemoglobin, may improve risk stratification in patients undergoing carotid surgery.

Evaluation of risk stratification program based on trajectories of functional capacity in patients with acute coronary syndrome: The REACP study.

As a validated assessment tool for functional disability (activities of daily living), the Barthel index (BI) assessed initially at admission has the potential to stratify patients with high-risk acute coronary syndrome (ACS). Dynamic trajectory evaluation of functional capacity in hospitals may provide more prognostic information. We aimed to establish a novel dynamic BI-based risk stratification program (DBRP) during hospitalization to predict outcomes among ACS patients. A total of 2,837 ACS patients were included from the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain. The DBRP rating (low, medium, and high-risk categories) was calculated from dynamic BI at admission and discharge. The primary outcome was all-cause mortality, and the secondary outcome was cardiac mortality. Of all the included patients, 312 (11%) died during a median follow-up period of 18.0 months. Kaplan-Meier analysis revealed that the cumulative mortality was significantly higher in patients in the higher risk category according to the DBRP. Multivariable Cox regression analysis indicated that, compared to the low-risk category, the higher risk category in the DBRP was an independent strong predictor of all-cause mortality after adjusting for confounding factors (medium-risk category: hazard ratio [HR]: 1.756, 95% confidence interval [95% CI]: 1.214-2.540; P = 0.003; high-risk category: HR: 5.052, 95% CI: 3.744-6.817; P < 0.001), and the same result was found for cardiac mortality. The DBRP was a useful risk stratification tool for the early dynamic assessment of patients with ACS. [http://www.chictr.org.cn], identifier [ChiCTR1900024657].

The association between variables of cardiopulmonary exercise test and quality of life in patients with chronic Chagas cardiomyopathy (Insights from the PEACH STUDY).

Studies investigating the association between functional capacity and quality of life (QoL) in individuals with chronic Chagas cardiomyopathy (CCC) usually do not include a gold-standard evaluation of functional capacity, limiting the validity and the interpretation of the results. The present study is a cross-section analysis aiming to evaluate the association between functional capacity (quantified by cardiopulmonary exercise test [CPET]) and QoL in individuals with CCC. QoL was assessed using the SF-36 questionnaire. Sociodemographic, anthropometric, clinical, cardiac function and maximal progressive CPET variables were obtained from PEACH study. Generalized linear models adjusted for age, sex, and left ventricular ejection fraction were performed to evaluate the association between CPET variables and QoL. After adjustments, VO2 peak and VO2 AT were both associated with physical functioning (β = +0.05 and β = +0.05, respectively) and physical component summary (β = +0.03 and β = +0.03, respectively). Double product was associated with physical functioning (β = +0.003), general health perceptions (β = +0.003), physical component summary (β = +0.002), and vitality (β = +0.004). HRR≤12bpm was associated with physical functioning (β = -0.32), role limitations due to physical problems (β = -0.87), bodily pain (β = -0.26), physical component summary (β = -0.21), vitality (β = -0.38), and mental health (β = -0.19). VE/VCO2 slope presented association with all mental scales of SF-36: vitality (β = -0.028), social functioning (β = -0.024), role limitations due to emotional problems (β = -0.06), mental health (β = -0.04), and mental component summary (β = -0.02). The associations between CPET variables and QoL demonstrate the importance of CPET inclusion for a more comprehensive evaluation of individuals with CCC. In this setting, intervention strategies aiming to improve functional capacity may also promote additional benefits on QoL and should be incorporated as a treatment strategy for patients with CCC.

Myocardial Work Measurement With Functional Capacity Evaluation in Primary Systemic Hypertension Patients: Comparison Between Left Ventricle With and Without Hypertrophy.

Noninvasive measurement of myocardial work (MW) incorporates left ventricular (LV) pressure, and, therefore, allows correction of global longitudinal strain for changing afterload conditions. We sought to investigate MW as a tool to detect early signs of LV dysfunction in primary systemic hypertension patients, particularly with different predictive indices. None left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) patients established were all primary systemic hypertension with preserved ejection fraction. Forty in NLVH and forty in LVH according to left ventricular end-diastolic mass index (LVEDmassI) were prospectively enrolled. The following indices of MW were assessed: global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE). Both global work index ( P =0.348) and global constructive work ( P =0.225) were increased in NLVH and decreased in LVH, and GWW ( P <0.001) was increased significantly in NLVH and increased more in LVH, while GWE ( P <0.001) was decreased significantly in NLVH and decreased more in LVH. The clinical utility of GWW (95% CI: 0.802-0.951) and GWE (95% CI: 0.811-0.950) were verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with LVH and control comparisons. In multivariate linear regression analysis, 4-dimenaional LVEDmassI was independently associated with GWE ( P =0.018) in systemic hypertension patients. Assessment of intraobserver and interobserver variability in the MW echocardiographic data documented good interclass correlation coefficients (all >0.85). GWW and GWE derived from MW are more accurate, sensitive, and reproducible predictors to detect early LV dysfunction in primary systemic hypertension patients, especially in distinguishing the potential functional abnormality of NLVH and LVH, even though the ejection fraction is preserved.

Agreement between tele-assessment and face-to-face assessment of 30-s sit-to-stand test in patients with type 2 diabetes mellitus.

The globalization of healthcare systems, and the aim to lower healthcare costs have all contributed to the growth of telehealth technology in recent years. However, before these systems are put into use, their efficacy should be verified. To the best of our knowledge, this is the first study focusing on the evaluation of functional exercise capacity using the 30-s sit-to-stand (30-s STS) test as a tele-assessment method in patients with type 2 diabetes mellitus (T2DM). The purpose of the study is to investigate the level of agreement between tele-assessment and face-to-face assessment of 30-s STS test in patients with T2DM. Fifty participants performed two times 30-s STS tests separated by 1h: a face-to-face and an Internet-connected video call examination (tele-assessment). Two physiotherapists conduct these evaluations; each was blinded to the other. The order of the evaluations was designated at random for each participant and physiotherapist. There was a good level of agreement between tele-assessment and face-to-face assessment of the 30-s STS test (mean differences = 0.20 ± 0.88, limits of agreement = 1.93 to - 1.53). Excellent interrater reliability was found for scores of the 30-s STS test [ICC = 0.93 (95% CI: 0.88; 0.96)]. In addition, all before and after test parameters show that there was a very good interrater reliability (ρ ≥ 0.75). This study shows a good level of agreement between tele-assessment and face-to-face assessment of the 30-s STS test. Our study's findings indicate that tele-assessment is a potential application to determine the level of physical capacity remotely in patients with T2DM.

Correlation Between Right Ventricular Echocardiography Measurements and Functional Capacity in Patients With Pulmonary Arterial Hypertension.

Accelerometry is an emerging option for real-time evaluation of functional capacity in patients with pulmonary arterial hypertension (PAH). This prospective pilot study assesses the relationship between functional capacity by accelerometry and right ventricular measurements on echocardiography for this high-risk cohort. Patients with PAH were prospectively enrolled and underwent 6-Minute Walk Test and cardiopulmonary exercise testing. They were given a Fitbit, which collected steps and sedentary time per day. Echocardiographic data included right ventricular global longitudinal, free wall, and septal strain; tricuspid regurgitant peak velocity; tricuspid annular plane systolic excursion; tricuspid annular plane systolic velocity; right ventricular myocardial performance index; and pulmonary artery acceleration time. Pairwise correlations were performed. The final analysis included 22 patients aged 13 to 59 years. Tricuspid regurgitant peak velocity had a negative correlation with 6-Minute Walk Test (r = -0.58, P = .02), peak oxygen consumption on exercise testing (r = -0.56, P = .03), and average daily steps on accelerometry (r = -0.59, P = .03), but a positive correlation with median sedentary time on accelerometry (r = 0.64, P = .02). Pulmonary artery acceleration time positively correlated with peak oxygen consumption on exercise testing (r = 0.64, P = .002). There was no correlation between right ventricular strain measurements and functional capacity testing. In this pilot study, tricuspid regurgitant jet and pulmonary artery acceleration time were the echocardiographic variables that correlated most with accelerometry data. With further echocardiographic validation, accelerometry can be a useful, noninvasive, and cost-effective tool to monitor disease progression in patients with PAH.

Impaired functional exercise capacity and greater cardiovascular response to the 6-min walk test in congenital generalized lipodystrophy

BackgroundCongenital Generalized Lipodystrophy (CGL) is an ultra-rare disease characterized by metabolic disorders. However, the evaluation of functional exercise capacity, cardiovascular (CV) response to exercise, and peripheral arterial disease (PAD) in CGL is scarce. Here we evaluated the performance and CV response to exercise and their association with PAD in CGL compared to healthy individuals.MethodsTwelve CGL and 12 healthy subjects matched for age and gender were included. Functional exercise capacity, CV response, and PAD were measured using the six-minute walk test (6MWT) and ankle-brachial index (ABI), respectively.ResultsAt baseline, CGL subjects showed reduced predicted walked distance (6MWD) (p = 0.009) and increased heart rate (HR), systolic (SBP), and diastolic (DBP) pressures compared to healthy subjects (p < 0.05). Most CGL subjects presented normal ABI values (1.0 ≤ ABI ≤ 1.4). Only 25% (n = 3) had ABI ≤ 0.9. CGL subjects did not present changes in ABI and blood pressure 12 months after metreleptin (MLP) replacement, but they walked a greater 6MWD than baseline (p = 0.04). Further, 6MWD and right ABI measurements were positively correlated in CGL subjects (p = 0.03). Right ABI negatively correlated with glucose, triglycerides, and VLDL-c (p < 0.05).ConclusionsWe observed that CGL subjects had lower functional exercise capacity and higher cardiovascular effort for similar performance of 6MWT, suggesting that strategies for decreasing exercise effort in this population should be essential. Furthermore, better physical performance was associated with high ABI in CGL. Additional studies are needed to clarify leptin's role in preserving functional exercise capacity in CGL.

Does category of strength predict return-to-work after occupational injury?

BackgroundOccupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work.MethodsData were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work.ResultsThe unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests.ConclusionThrough thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work.

Test-retest Reliability of Unilateral and Bilateral Carrying Protocol Based on Joule’s Functional Capacity Evaluation

Introduction: Load carriage is one of the most frequent manual material handlings in industrial settings. However, due to the biomechanical risk exposures, carrying could lead to work-related musculoskeletal disorders. Joule’s Functional Capacity Evaluation is an FCE system used widely in Malaysia in return-to-work programs to ensure work readiness and prevent re-injury. However, the literature regarding the test-retest reliability of the carrying protocols is minimal, leading to a questionable level of consistency. Therefore, this study aimed to investigate the test-retest reliability of the carrying protocols in Joule’s FCE. Methods: A cross-sectional study was conducted to evaluate test-retest reliability where the carrying protocol of Joule’s Functional Capacity Evaluation was used among healthy university students (N=30). The participants were asked to perform a retest of the carrying protocol after one week.Results: The ICC values for the carrying protocols were good for dominant unilateral carrying was (ICC: 0.82; 95% CI: -6.00 to 5.81), non-dominant carrying was (ICC: 0.74; 95% CI: -6.78 to 6.02) and bilateral carrying was (ICC: 0.85; 95% CI: -6.26 to 5.51). Bland and Altman’s plot indicated no visible distribution patterns of the differences without exceeding the 95% limits of agreement. The standard error of measurements (SEMs) was relatively small for all carrying protocols. Conclusion: The test-retest reliability of carrying protocols in Joule’s FCE was good. Future studies are needed to replicate this study in real patients to further verify the reliability for clinical settings.

Heart Rate Variability in Huntington Disease: A Long-Term Longitudinal Study

Introduction: The aim of the study was to follow tonic and phasic autonomic nervous activity in Huntington disease (HD) mutation carriers and patients. Methods: Evaluation of motor functions and total functional capacity was performed in 30 HD mutation carriers or patients at the beginning and in 22 subjects after 8–10 years. Continuous arterial blood pressure, heart rate (HR), and ECG at rest were measured, and HR variability analysis was performed in four different ways. A group of matched controls was also evaluated. Results: Eighteen subjects were assorted in 3 groups: 6 HD mutation carriers without motor symptoms (PHD) who remained so (PHD-PHD); 6 early symptomatic patients (EHD) who remained so (EHD-EHD); and 6 early symptomatic patients who deteriorated to a late symptomatic (LHD) (EHD-LHD). At the beginning, sympathetic tonic activity in PHD was elevated, according to mean arterial pressure (99 ± 10.6 mm Hg) higher than in controls (85 ± 8.7 mm Hg) and EHD (82 ± 9.9 mm Hg) (Dunnett’s test, p < 0.05) and higher HR (78 ± 16 beats/min) than after 8–10 years (64 ± 11.3 beats/min) (paired t test, p < 0.05). There was also a decreased phasic sympathetic activity in EHD patients compared controls at the beginning (219 ± 106 vs. 664 ± 466 s²/Hz) and after 8–10 years (182 ± 136 vs. 1,012 ± 1,369 s²/Hz) (Dunnett’s test, p < 0.05). In patients who deteriorated from EHD to LHD, there was a drop in phasic parasympathetic activity from 887 ± 433 to 230 ± 235 s²/Hz (paired t test, p < 0.05). Conclusions: Our long-term observational study provides important information on the timeline of ANS activity in HD progress. There was a temporary increase in cardiac and vascular sympathetic activity in PHD subjects. The normalization of HR in PHD subjects might indicate the approach of an outbreak of clinical disease phase.

Association of right ventricle diastolic diameter with pulmonary function, exercise tolerance and exacerbation period in patients with chronic obstructive pulmonary disease: A prospective study

BackgroundThe echocardiogram is a useful method for monitoring the cardiovascular complications of chronic obstructive pulmonary disease (COPD), but it is not clear if morphological and functional cardiac variables are able to identify patients with unfavorable COPD progression. ObjectiveThe aim of this study was to investigate morphological and functional echocardiographic variables associated with exacerbation of the disease, pulmonary function parameters and functional capacity evaluation in COPD patients. MethodA longitudinal observational study including 91 patients diagnosed with COPD, who were stratified in two groups according to their basal right ventricle diastolic diameter (RVDD) measuring greater and less than 35 mm. They underwent clinical evaluation, echocardiography, spirometry and 6-minute walking-test (6MWT). ResultsThe study found that patients with RVDD greater than 35 mm showed worse functional capacity in the 6MWT (p = 0.05) and more exacerbation of the disease during the one-year follow-up (p = 0.05). There were correlations of greater RVDD vs forced vital capacity (R = -0.27; p = 0.02) and distance in the 6MWT (R = 0.55; p = 0.03) in patients with exacerbation. In the univariate regression analysis, the RVDD was responsible for 55% of the variation in distance in the 6MWT (-0.75 m) in COPD patients. ConclusionThe RV dilation is associated with unfavorable prognostic markers in COPD, such as the worsening of the functional capacity and more frequent exacerbations. The echocardiogram may be a useful tool to identify patients who need more aggressive strategies to control the evolution of the disease with potential impact in pulmonary rehabilitation.

Reproducibility of improvements in patient-reported functional ability following functional capacity evaluation

BackgroundPerformance of functional capacity evaluation (FCE) may affect patients, self-efficacy to complete physical activity tasks. First evidence from a diagnostic before-after study indicates a significant increase of patient-reported functional ability. Our study set out to test the reproducibility of these results.MethodsPatients with musculoskeletal trauma and an unclear return to work prognosis were recruited in a trauma rehabilitation center in Lower Austria. We included patient cohorts of three consecutive years (2016: n = 161, 2017: n = 140; 2018: n = 151). Our primary outcome was patient-reported functional ability, measured using the Spinal Function Sort (SFS). SFS scores were assessed before and after performing an FCE to describe the change in patient-reported functional ability (cohort study). We investigated whether the change in SFS scores observed after performing an FCE in our first cohort could be replicated in subsequent cohorts.ResultsDemographic data (gender, age and time after trauma) did not differ significantly between the three patient cohorts. Correlation analysis showed highly associated before and after SFS scores in each cohort (2016: rs = 0.84, 95% CI: 0.79 to 0.89; 2017: rs = 0.85, 95% CI: 0.81 to 0.91; 2018: rs = 0.86, 95% CI: 0.82 to 0.91). Improvements in SFS scores were consistent across the cohorts, with overlapping 95% confidence intervals (2016: 14.8, 95% CI: 11.3 to 18.2; 2017: 14.8, 95% CI: 11.5 to 18.0; 2018: 15.2, 95% CI: 12.0 to 18.4). Similarity in SFS scores and SFS differences were also supported by non-significant Kruskal–Wallis H tests (before FCE: p = 0.517; after FCE: p = 0.531; SFS differences: p = 0.931).ConclusionsA significant increase in patient-reported functional ability after FCE was found in the original study and the results could be reproduced in two subsequent cohorts.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

ObjectivesRefractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). MethodsThirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. ResultsThe patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). ConclusionPatients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.

Testing method of explosive function based on motion energy balance

The functional capacity of explosives is an important indicator for evaluating the explosive power of explosives. Based on the motion energy balance and the principle of artillery launching, this paper designs a functional capacity evaluation device for explosives. Based on the analysis of the device, an evaluation model for the functional capacity of explosives is established. The measurement parameters is determined according to the model; a comprehensive testing system for functional capacity was constructed, and the feasibility of the functional capacity testing device was verified through testing. The results show that the test method can quantitatively measure the functional capacity of explosives, and can effectively measure and evaluate the explosive performance of explosives.

Analysis of Sub-Items of Functional Capacity Evaluation in Work-Related Patients: Based on the Korean Standard Industrial Classification

Analysis of Sub-Items of Functional Capacity Evaluation in Work-Related Patients: Based on the Korean Standard Industrial Classification