Pulmonary Physiotherapy Research Articles

Fisioterapia pulmonar pós-COVID-19: um estudo de caso

The COVID-19 pandemic emerged in Wuhan in late December 2019, spreading across the world with a high rate of contamination. The COVID-19 covers a large number of sequelae in the respiratory system, which entails a need for intense physiotherapy intervention. Thus, it was objected in the present study to evaluate the effectiveness of post-COVID-19 pulmonary physiotherapy in a patient at a Physiotherapy Clinic School in the city of Montes Claros, MG. For this, it was used the case study as a methodology, which was carried out with a male patient, 62 years old, brown, divorced, with one child, with no report of previous illnesses, coming from the city of Montes Azul-MG, admitted in a Physiotherapy Clinic School with Severe Acute Respiratory Syndrome, post-COVID-19, being submitted to tests to assess their perceptions of exertion through the modified Borg scale, that is, the Six-Minute Walking Test and the muscle strength based on the Kendall scale. In view of the conduct performed, it is concluded that physiotherapy rehabilitation is an important resource in post-Covid-19 treatment, with regard to the proportion of sequelae caused by such infection.

Predicting nosocomial pneumonia risk in level-1 trauma patients: An external validation study using the trauma quality improvement program

BackgroundEarly identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers. MethodsA retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration. ResultsThe study comprised 902,231 trauma patients (N2013–2015 ​= ​180,601; N2017–2019 ​= ​721,630), with a median age of 52 in both periods, 64–65 ​% male, and approximately 90 ​% sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 ​%, VAP incidence was 0.7 ​%. The original model demonstrated good to excellent discrimination for both periods (c-statistic2013–2015 0.84, 95%CI 0.83–0.84; c-statistic2017–2019 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved. ConclusionsThe Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.

A Comparative on the Effects of Thoracic Squeeze Technique Versus Manual Diaphragm Release Technique on Sputum Clearance among Patient with Chronic Obstructive Pulmonary Disease

Background: The COPD, a prevalent and manageable condition, leads to diminished airflow and tissue damage.It is associated with structural lung problems caused by prolonged inflammation due to continuous exposure toharmful particles or gases, particularly from cigarette smoke.Purpose: To compare the effectiveness of thoracic squeeze technique and manual diaphragm release technique onsputum clearance among patient with COPD.Materials and Methods: A total of 30 participants were selected according to inclusion and exclusion criteriawere deliberately sampled. Group A (n=15) received thoracic squeeze technique and the Group B (n=15) receivedmanual diaphragm release technique. All individuals were assessed for COPD assessment test as a pre-test priorto the intervention and again after 6 weeks of intervention. The entire process was performed from November2022 to April 2023.Result: Statistical analysis was done for all the collected data using paired t- tests. The test shows significant effects (p<0.0001)in both groups. The test shows that the subjects receiving thoracic squeeze technique have improved sputum clearance amongpatients with COPD.Conclusion: The results and the data obtained from this research was statistically significant and concludedthat there was a definite and positive effect of thoracic squeeze technique on sputum clearance. This can berecommended in Pulmonary Physiotherapy Practise.

Exploring the impact of the environment on physical activity in patients with chronic obstructive pulmonary disease (EPCOT)-A comparative analysis between suggested and free walking: Protocol study.

Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced levels of physical activity, which are associated with poorer outcomes. The number of clinical trials aiming to promote behavioral changes to increase physical activity in this population has grown; therefore, these trials have yet to produce satisfactory results. An ecological model encompassing individual, social, environmental, and political factors represent a potentially more effective approach to promoting physical activity. While favorable urban environments can positively impact physical activity, specifically tailored environmental interventions for individuals with COPD could enhance their engagement in physical activity. Therefore, the aim of this randomized controlled trial (RCT) study was to analyze the effects of walking in a suggested environment and free walking on physical activity levels in individuals with COPD. The environment on physical activity for chronic obstructive disease (EPCOT) is a randomized controlled clinical trial protocol approved by our institution's Ethics Committee and registered with The Brazilian Registry of Clinical Trials (ReBEC) (https://ensaiosclinicos.gov.br, number RBR-4tfwdhp). This protocol will involve 38 volunteers diagnosed with COPD recruited from the pulmonary physiotherapy and rehabilitation service. The volunteers were randomly divided into two walking groups: an experimental group (ERG) with guidance for walking in a suggested environment and an active control group (ACG) instructed to choose their own routes. The intervention consisted of eight consecutive weeks, with progressive walks carried out 3 to 5 times weekly. The primary outcome will be assessing participants' physical activity levels. Secondary outcomes will include exercise capacity, quality of life, dyspnea levels, motivation, anxiety, depression, and perceptions of the environment. All assessments will occur before and after the intervention period, aiming to fill a literature gap by investigating the impact of urban environments on COPD-related physical activity. The results may shed light on the importance of environmental factors in promoting physical activity among individuals with COPD, helping to develop more effective interventions.

Effects of Respiratory Physiotherapy in Pulmonary Dysfunction after Cardiac Surgery

Background: Cardiovascular system diseases are a leading cause of death globally. Heart surgeries, performed worldwide to treat these conditions, are often followed by high rates of postoperative complications. Objective: The study aimed to compare the effects of pulmonary physiotherapy on respiratory dysfunction following cardiac surgery. Methods: Forty patients with pulmonary dysfunction post-coronary artery bypass grafting (CABG) participated in the study. They were randomly assigned to receive either postoperative pulmonary physical therapy, including breathing exercises and respiratory muscle training, or conventional physical therapy exercises. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and inspiratory capacity (IC) were measured using spirometry. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS), with paired t-tests comparing all variables. Results were considered significant at a p-value < 0.05. Results: The study included 21 participants in each group, with a mean age of 55.37 ± 8.72 years. Mean vital capacity in Group A was 2.40 ± 0.46 pre-treatment, increasing to 2.97 ± 0.43, while in Group B it was 2.34 ± 0.41 at baseline, increasing to 2.98 ± 0.36, with a p-value > 0.05 indicating no significant pre- and post-test effects in Group A. Significant pre-post differences in spirometry values were observed within both groups, but no significant differences were noted when compared across the groups following CABG. Conclusion: The study concluded that pulmonary rehabilitation post-cardiac surgery is highly recommended to minimize postoperative complications of heart surgery. It contributes significantly to the prognosis of these patients, emphasizing the importance of preoperative procedures focused on preventing pulmonary system complications and facilitating recovery in the postoperative period after major cardiac surgeries.

Pulmonary Physiotherapy in Kidney Recipients: Evaluation of Effects on Functional Capacity


 Introduction: Renal replacement therapy (RRT), including dialysis and kidney transplantation (KT), is employed for treating patients with end-stage renal disease (ESRD). Among RRT options, KT offers the highest quality of life (QoL) and overall survival. However, pulmonary complications following KT remain significant contributors to morbidity, mortality, and potential graft failure. The primary objective of this study is to assess the impact of respiratory and strengthening exercises on respiration, body composition, physical performance, and QoL of the patients following KT. Materials and Methods: Preoperative assessments included forced expiratory volume in one second (FEV1), 6-minute walking test (6MWT) scores, body composition measurements, hand grip strength, and QoL scores using the Short Form 36 Scale (SF-36) for the patients undergoing their first KT at Antalya Medical Park Hospital. Participants were randomly assigned to two groups. The experimental group (EG) received respiratory exercises until discharge, followed by combined respiratory, upper, and lower extremity strengthening exercises three days a week for two weeks post-discharge, while the control group (CG) received standard care. Measurements were repeated at the end of the third postoperative week, and the changes from the initial measurements were statistically compared between the groups. Results: Demographic characteristics were comparable between the groups. The SF-36 physical function sub-parameter demonstrated a significant increase in the experimental group, while it decreased in the control group. Pain sub-parameter scores and grip strengths of the SF-36 QoL scale did not exhibit statistically significant changes in either group. Conclusion: Implementing early respiratory physiotherapy and strengthening program over three weeks following KT improved QoL and physical function significantly.

Quality and reliability of YouTube videos as a source of information on pulmonary rehabilitation

Objectives: We aimed to evaluate the quality and reliability of the most watched YouTube videos in pulmonary rehabilitation (PR) and to determine the criteria that may be important in the selection of high quality and reliable videos by patients and their relatives. Methods: We searched for the keywords “pulmonary exercise,” “pulmonary rehabilitation,” and “pulmonary physiotherapy” on December 12th, 2021. Modified DISCERN (mDISCERN) and Global Quality Score (GQS) were used to assess the quality and reliability of the videos. Results: Of the 150 videos screened and 76 (50.7%) videos were identified for inclusion. The median mDISCERN score was 2, indicating that most of the videos were of low quality. A statistically significant relationship was found between video reliability classification in terms of video duration, time since upload, number of subscribers, and number of likes (p < 0.05). In addition, in terms of video upload source, it was determined that most of the high reliability videos were uploaded by healthcare professionals and most of the low reliability videos were uploaded by independent users (p < 0.05). When the videos were compared according to the quality groups subcategory, significant differences were detected in video duration, number of subscribers, average number of views per day, upload sources and mDISCERN scores (p < 0.05). Conclusions: According to the current study results, most of the PR-related videos on YouTube were found to be of poor quality and low reliability. Sharing more videos on social platforms by healthcare professionals in the future may be effective in increasing video quality and reliability.

Cardiovascular and Pulmonary Entry-Level Physical Therapist Competencies: Update by Academy of Cardiovascular & Pulmonary Physical Therapy Task Force

Purpose: Competency-based education and creation of profession-based entrustable professional activities are current trends in physical therapist (PT) education. The purpose of this project is to determine the current entry-level PT competencies for cardiovascular & pulmonary (CVP) physical therapy. Methods: The Academy of Cardiovascular & Pulmonary Physical Therapy Competency Task Force was established to update and expand previous competencies. A mixed method approach of Subject Matter Expert (SME) consensus (modified Delphi process) and a broader survey process was used to develop these entry-level competencies. With SME guidance, a modified version of the levels of competence, None-to-Proficient, was adopted based on previous competency work by the American Council of Academic Physical Therapy. Results: Twenty-nine SME members engaged in the consensus process, and 268, 194, 305, and 222 respondents completed the 4 surveys, respectively. Six hundred fifty-one competency items were rated across most Commission on the Accreditation of Physical Therapy Education Standard 7 Curriculum areas, following the patient–client management model. Conclusions: These competencies establish specific expected levels of knowledge, skills, and behaviors essential for entry-level CVP PT practice. Adopting these competencies will help lay the groundwork for future competency-based PT education and aid in the development of the physical therapy profession's core entrustable professional activities.

Cardiovascular and Pulmonary Research: The Year (2022) in Review

Practitioners need access to and the ability to openly discuss advances in practice and concepts as they apply to the practice of cardiovascular and pulmonary physical therapy (PT). Lack of accessibility to research literature, limited personal time, or insufficient knowledge to adequately review the breadth of literature published each year can hinder this process. This article provides a limited overview of cardiovascular and pulmonary research published in 2022 that the authors believe most important and relevant or speaks to the volume or trend of current topics in the clinical practice of cardiovascular and pulmonary PT. Each topic area is followed by a brief overview of clinical relevance and was open to discussion with the participants present at the 2023 Combined Sections Meeting held on February 24, 2023.

The efficacy of pulmonary physiotherapy in bariatric surgery: A comparative study

The efficacy of pulmonary physiotherapy in bariatric surgery: A comparative study

Future of the Academy 2023-2025

Future of the Academy 2023-2025

Effect and Safety of Amoxicillin-Clavulanate Potassium and Ceftriaxone Combined with Pulmonary Physical Therapy on Neonatal Pneumonia

Effect and Safety of Amoxicillin-Clavulanate Potassium and Ceftriaxone Combined with Pulmonary Physical Therapy on Neonatal Pneumonia

Proprietary Model of Qualification for In-Hospital Rehabilitation after COVID-19.

Background: Since the beginning of the SARS-CoV-2 epidemic in Poland, 6,128,006 people have been diagnosed, of which 116,798 died. Patients who recovered from COVID-19 and require rehabilitation due to varied impairments should be provided an opportunity to participate in an individualized, complex rehabilitation program starting from acute care and being continued in the post-acute and long-term rehabilitation phase. It is recommended to offer out-patient and in-hospital rehabilitation procedures depending on the type and persistence of symptoms and dysfunctions. The aim of this paper is to present the qualification process of post-COVID19 patients for an in-hospital complex rehabilitation program developed on the basis of pulmonary physical therapy. Methods: The presented qualification program was developed on the basis of clinical experience of over 2000 patients participating in the pilot program of in-hospital rehabilitation launched in September 2020 and based on the Regulation of the Polish Minister of Health of 13 July 2020. Results: The proposed model of patients’ qualification rests on well-known and validated tools for functional assessment: exercise tolerance assessment, dyspnea intensity assessment, functional fitness assessment, assessment of arterial blood saturation, lung ventilation function assessment, assessment of long-lasting COVID-19 symptoms, and patient’s basic mental health condition. Conclusions: The proposed qualification model for the post-COVID rehabilitation program allows us to introduce adequate qualifications followed by much needed assessment of the health effects.

Cardiovascular and Pulmonary Research: The Year (2021) in Review

Practitioners need access to and the ability to openly discuss advancement in practice and concepts as they apply to the practice of cardiovascular and pulmonary physical therapy (PT). Lack of accessibility to research literature, limited personal time, or insufficient knowledge to adequately review the breadth of literature published each year can hinder this process. This article provides a limited overview of cardiovascular and pulmonary research published in 2021 that the authors believe most important and relevant or speaks to the volume or trend of current topics in the clinical practice of cardiovascular and pulmonary PT. Each topic area is followed by brief overview of clinical relevance and was open to discussion with the participants present at the 2022 Combined Sections Meeting held on February 4, 2022.

Pathogens Isolated and Their Association With the Long-Term Outcome in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Background: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation.Materials and methods: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded.Results: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection.Conclusion: Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.

Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022.

No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key action statements (KAS), including guidance on upper extremity DVT, pulmonary embolism, and special populations. This document will guide physical therapist practice in the prevention of and screening for VTE and in the management of patients who are at risk for or who have been diagnosed with VTE. Through a systematic review of published studies and a structured appraisal process, KAS were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms based on the KAS were developed that can assist with clinical decision-making. Physical therapists, along with other members of the health care team, should implement these KAS to decrease the incidence of VTE, improve the diagnosis and acute management of VTE, and reduce the long-term complications of VTE.

The Effect of Pulmonary Physical Therapy and Exercise Therapy for a Sever COVID-19 Patient

The Effect of Pulmonary Physical Therapy and Exercise Therapy for a Sever COVID-19 Patient

Akciğer Rezeksiyonu Uygulanan Hastalarda Pedometre ile Postoperatif Mobilizasyonun Pulmoner Fonksiyonlar ve Postoperatif Yatış Süresi Üzerine Etkisi: Kesitsel Çalışma

Objective: Mobilization takes an important place in providing postoperative pulmonary rehabilitation and is accepted as an effective factor in accelerating the recovery process and improving physical and mental health. This study aims to determine the effect of postoperative mobilization with a pedometer on pulmonary functions and length of postoperative hospital stay in patients undergoing lung resection. Material and Methods: This descriptive and cross-sectional study was conducted with the participation of 52 patients in a thoracic surgery clinic of a university hospital . The 'patient identification form' and the 'patient results evaluation form' were used to collect the data. Data were analyzed using IBM SPSS Statistics 22.0. Shapiro-Wilk test was used to test the compatibility of the data to normal distribution. The Spearman correlation analysis was used in analyzing the data. Result: It was revealed that the total step count and walking distance did not affect the postoperative forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC values (p>0.05). A weak negative correlation was determined between total step count and the length of postoperative hospital stay (p<0.05). It was found that 84.6% of the patients were satisfied/very satisfied with the use of a pedometer. Conclusion: The study demonstrated that the increase in the step count was not effective on pulmonary functions in the early period but shortened the length of postoperative hospital stay. We recommend the use of a pedometer after lung resections since it standardizes the mobilization measurement, promotes mobilization, and shortens the length of hospital stay owing to its contributions to pulmonary physiotherapy.

Results of the application of pulmonary physiotherapy in a 38-year-old post-COVID19 patient after severe pneumonia and type 2 diabetes mellitus

Objectives General: to create a Pulmonary Physiotherapy Program to ensure that the patient with severe or severe post-COVID-19 disease with pulmonary compromise and, with oxygen supplementation, reaches their maximum functional capacity, which in turn facilitates the maximum degree of autonomy and improvement in health-related quality of life. Specific objectives: Minimize the sensation of dyspnea. Improvement of ventilatory mechanics, oxygenation and reduction of supplemental oxygen. Increased strength of respiratory muscles. Promote functional independence through improvement in cardiopulmonary capacity. Evaluate the impact of the program using the quality of life assessment scale. Methodology: Case report, quantitative, longitudinal and prospective. Contribution: The scientific contribution of this article focuses on the knowledge of non-pharmacological treatment (Pulmonary Physiotherapy) in the post-COVID-19 and type 2 Diabetes Mellitus patient.

COVID and Post COVID Physical Therapy of a 63-year-old male with affection of Balance: A Case Report

Background: The global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) has a harsh effect throughout the world. A wide range of neuromuscular symptoms including myalgia, anosmia, loss of taste and muscle weakness have been seen post COVID-19 infection. Some of these symptoms may impair balance and activities of daily living. Balance is defined as ability of an individual to maintain the line of gravity within the base of support. Objective: This case report study shows how physiotherapy management was helpful for a 63-year-old male during COVID and post-COVID rehabilitation to enhance his functional recovery. It also describes balance training strategies which were used in addition to regular pulmonary physiotherapy in a patient affected with COVID-19. Case Study: This study reports a four-month long physiotherapy protocol of a 63-year-old male patient admitted to a hospital due to COVID-19 in whom imbalance was also observed. Physiotherapy management was started for the same. The protocol included in-patient as well as out-patient exercises. Pulmonary physiotherapy along with neuro physiotherapy, in the form of balance training, were included. The patient showed good improvement in balance and regained his functional independence and hence discharged from physiotherapy treatment. Conclusion: Thus, Covid and post- COVID-19 physiotherapy rehabilitation is essential to elicit positive adaptive changes to improve the functional capacity, independence in the daily activities and QOL. KEY WORDS COVID-19, Static Balance, Dynamic Balance, Fatigue, Neuromuscular Disorders.