Six-minute Walk Test Research Articles

Inspiratory Muscle Trainer Versus Diaphragmatic Breathing Exercise on 6-Minute Walk Test in Adolescent Girls with End-Stage Renal Disease

Objective: Inspiratory muscle weakness (IMW) is very common among adolescents with end-stage renal disease (ESRD). Untreated IMW in ESRD adolescents induces acute and chronic pulmonary complications, low physical performance, and impairment in quality of life (QoL). This was a 12-week breathing-retraining trial that compared the effects of threshold inspiratory muscle trainer (TIMT) versus the diaphragmatic breathing exercise procedure (DBEP), on ESRD adolescent girls’ maximal inspiratory pressure (MIP) and QoL, which was assessed by the Child Health Questionnaire (50-item parent form) (CHQ/PF50), pulmonary functions, and six-minute walk test (6MWT).Material and Methods: This breathing-retraining trial enrolled forty adolescent girls with ESRD. The girls were randomly divided into two groups: one group contained twenty girls that were trained by TIMT, while the other group contained 20 girls whom were trained by DBEP. The 20-minute rehabilitation of IMW by TIMT or DBEP was applied 3 times weekly. Adolescent girls’ forced vital capacity (FVC), CHQ/PF50-related score of physical summary, MIP, 6MWT, CHQ/PF50-related score of psychosocial summary, forced expiratory volume in the first second of girls’ expiration (FEV1), and 6MWT-associated physiological data (blood pressure, heart rate, and rate of perceived exertion) were assessed.Results: All outcomes of adolescent girls with ESRD in the first group that were trained by TIMT showed significant improvements, whereas the other group’s girls did not show the same reported significant improvements. Conclusion: Compared to DBEP, the 12-week training by TIMT significantly improved ESRD adolescent girls’ FVC, CHQ/PF50-related score of physical summary, MIP, 6MWT, CHQ/PF50-related score of psychosocial summary, FEV1, and 6MWT-associated physiological data.

High-Intensity Exercise Training Impact on Cardiorespiratory Fitness, Gait Ability, and Balance in Stroke Survivors: A Systematic Review and Meta-Analysis.

Stroke survivors commonly face challenges such as reduced physical activity and cardiorespiratory fitness (CRF) as well as balance and gait impairments, exacerbating their disability. While high-intensity exercise interventions have demonstrated some potential, their effects on these items remain uncertain. Therefore, our study aimed to investigate the impact of high-intensity training protocols on CRF, gait ability, and balance in stroke survivor populations. Two independent investigators systematically searched five databases for relevant RCTs following the PICO model. Through a systematic review of 25 RCTs published up to 31 May 2023, including adult first-stroke survivors, comparing high-intensity exercise training versus low-to-mild or no exercises, we evaluated outcomes such as the Six-Minute Walking Test (6 MWT), peak oxygen uptake (VO2peak), Ten-Meter Walk Test (10 MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG). The protocol was registered in PROSPERO (registration number CRD42023456773). Meta-analyses indicated significant enhancements in CRF, as measured by 6 MWT and VO2peak, following high-intensity exercise interventions. However, no significant differences were observed in BBS, 10 MWT, and TUG. Our findings underscore the potential of high-intensity exercise interventions in ameliorating CRF among stroke survivors, although further research involving standardized protocols and long-term follow-ups is imperative to optimize rehabilitation outcomes.

Lifestyle intervention in workers with obesity and sedentary behavior: A pilot study for the “OTTiMo LavorO” project

BACKGROUND: Workplace barriers to physical activity (PA) and sedentary work contribute to obesity. Workplace lifestyle interventions are needed to reduce sedentary behavior. OBJECTIVE: The study evaluates the effects of a self-monitoring PA protocol plus diet on general health of workers with obesity. METHODS: Thirty-nine workers affected by obesity were enrolled in this pilot intervention study. Monthly and daily PA diary, six-minute walking test (6MWT), Short Form-36 health survey (SF-36), and Global Physical Activity Questionnaire (GPAQ) results were evaluated prior (T0) and at the end of the study (T1). A personalized low-calorie diet based on the Mediterranean diet model was also implemented. Participants followed the protocol from one to three months depending on the date of recruitment. RESULTS: Significant improvements in SF36 and GPAQ scores were recorded, along with reductions in sedentary activity, weight, and BMI (p < 0.001). 6MWT significantly increased from 462.5 [412.5–500] m at T0 to 500 [462.5–550] m at T1 (p < 0.001). A multiple linear regression analysis to investigate the impact of selected covariates (PA, body weight reduction, and sedentary time) on the 6MWT was significant in men. CONCLUSIONS: PA self-monitoring protocols and diets are effective and sustainable for workplace interventions. PA should be part of daily medical practice and occupational physicians should encourage behavioral changes in workers.

Six-minute walking test in post-cardiac surgery versus chronic heart failure patients attending cardiac rehabilitation: a measure of exercise tolerance and association with patients functioning by ICF.

Six-minute walking test in post-cardiac surgery versus chronic heart failure patients attending cardiac rehabilitation: a measure of exercise tolerance and association with patients functioning by ICF.

Effects of Heart Rate Variability (HRV) Biofeedback in Pulmonary Indicators and HRV Indices Among Patients with Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) exhibit reduced cardiac autonomic activity, linked to poor prognosis and exercise intolerance. While heart rate variability biofeedback (HRVB) can enhance cardiac autonomic activity in various diseases, its use in patients with COPD is limited. This study explored the impact of the HRVB on cardiac autonomic activity and pulmonary indicators in patients with COPD. Fifty-three patients with COPD were assigned to either the HRVB (n = 26) or the control group (n = 27), with both groups receiving standard medical care. The HRVB group also underwent one-hour HRVB sessions weekly for six weeks. All participants had pre- and post-test measurements, including the Six-Minute Walking Test (6MWT), lead II electrocardiogram (ECG) recording, Modified Medical Research Council Dyspnea Scale (mMRC), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. ECG data were analyzed for heart rate variability (HRV) as an index of cardiac autonomic activity. A two-way mixed analysis of variances demonstrated significant interaction effects of Group × Time in pulmonary indicators and HRV indices. The HRVB group exhibited significant post-test improvements, with decreased mMRC and BODE scores and increased 6MWT distance and HRV indices, compared to pre-test results. The 6MWT distance significantly increased and mMRC significantly decreased at post-test in the HRVB group compared with the control group. This study confirmed the efficacy of HRVB as an adjunct therapy in patients with COPD, showing improvements in exercise capacity, breathing difficulties, and cardiac autonomic activity.

Factors associated with six-minute walk distance among Indonesian Hajj Pilgrims

The Hajj pilgrimage is a physically demanding religious rite that is associated with the health status of pilgrims. Several factors are associated with functional limitations. We aimed to determine the relationship between clinical data and six-minute walk test (6-MWT) findings. The 6-MWT is a measure of functional capacity that is routinely applied to Indonesian pilgrim candidates before they embark on the Hajj. This cross-sectional study analysed Indonesian Hajj pilgrimage data obtained from 2,933 participants before their departure for the Hajj in 2022. The data included participants’ characteristics, laboratory results, and six-minute walk findings. The resulting aggregates were analysed using Pearson correlations. Serum creatinine significantly correlated with 6-MWT findings (r = 0.003; p <0.05). Low-density lipoprotein-cholesterol (LDL-C) values and platelet counts were significantly associated with 6-MWT results (r = 0.101 and 0.038, respectively; p <0.05). Serum creatinine, LDL-C, and platelet values were associated with increased 6-MWT, indicating a correlation with functional capacity among Hajj pilgrims.

Association of pulmonary function with functional capacity among middle-aged women

INTRODUCTION: Age-related decline in pulmonary function and functional capacity is seen in adults. The menopausal process leads to a decline in pulmonary function and functional capacity which is essential in maintaining independence in daily life. OBJECTIVE: The present study aimed to explore the association of pulmonary function with functional capacity among middle-aged women. METHODS: One hundred and eight female participants aged 40–55 years were included in this cross-sectional study; depending on their menstrual history participants were classified as premenopausal and postmenopausal. After initial screening and assessment, six-minute walk test (6MWT) and pulmonary function (FEV1, FVC, FEV1/FVC) were recorded as per standardised guidelines. The mean and standard deviation for all continuous variables were calculated. Correlations were estimated using Pearson’s coefficient of correlation. A comparison of premenopausal and postmenopausal groups was done by independent t-test. A two-tailed p-value < 0.05 was considered statistically significant. RESULTS: There were significant differences in values of six-minute walk distance (6MWD) and pulmonary function values of pre and postmenopausal women (p < 0.05). The Pearson coefficient of correlation showed t significant association of FEV1, FVC and FEV1/FVC with 6MWD among middle-aged women. There was fair positive correlation of FEV1 (r = 0.391, p = 0.002) and FEV1/FVC (r = 0.395, p = 0.002) with 6MWD among postmenopausal women. CONCLUSION: There exists a fair positive correlation of pulmonary function with 6MWD among middle-aged women particularly postmenopausal women. Early screening of respiratory health and functional capacity should be initiated for middle-aged women as a preventive strategy.

Diaphragm Muscle Atrophy Contributes to Low Physical Capacity in COVID-19 Survivors.

Fatigue and dyspnea are the most commonly reported long-term complaints in individuals previously infected with SARS-CoV-2. This study aimed to comprehensively evaluate diaphragm muscle function in post-COVID-19 patients and investigate whether potential diaphragm dysfunction contributes to physical functioning impairment. A total of 46 patients who qualified for pulmonary rehabilitation were examined. Diaphragm muscle function parameters were evaluated using ultrasonography, while the severity of dyspnea, aerobic capacity, and the amount of energy used by the body during physical activity were assessed using the six-minute walk test, mMRC scale, and Metabolic Equivalent Task (MET), respectively. We identified that 69.5% of patients had diaphragm atrophy and 6.5% had diaphragm paralysis. The percentage of atrophy was not related to age, gender, BMI, oxygen therapy usage during the COVID-19 infection course, and disease severity. Patients who experienced cough, fever, and no loss of smell during the COVID-19 course had significantly greater diaphragm inspiratory thickness values, while patients with cough and no smell disorders had a significantly lower percentage of diaphragm atrophy. Diaphragm functional parameters were strongly associated with selected variables of exercise tolerance, such as distance in the six-minute walk test, oxygen saturation levels, fatigue, and exertion on the Borg scale. In conclusion, diaphragm muscle dysfunction is a serious long-term post-COVID-19 consequence and can be viewed as a major contributing factor to prolonged functional impairments.

Association of physical symptoms with accelerometer-measured movement behaviors and functional capacity in individuals with Long COVID

Long COVID has been linked to a decline in physical activity and functional capacity. However, it remains unclear which physical symptoms are associated with specific aspects of movement behaviors and functional capacity. We aimed to investigate the associations of fatigue, dyspnea, post-exertional malaise, myalgia, and the co-occurrence of symptoms with movement behaviors and functional capacity in individuals with Long COVID. A cross-sectional multicenter study was conducted. Questionnaires were used to assess fatigue, dyspnea, post-exertional malaise, and myalgia. Accelerometry was employed to assess sedentary time, steps per day, light physical activity, and moderate-to-vigorous physical activity. The six-minute walk test, 30-s chair stand test, and timed up and go were used to assess functional capacity. One hundred and two community-dwelling individuals who had been living with Long COVID for 15 ± 10 months participated in the study. Fatigue, post-exertional malaise, and the co-occurrence of physical symptoms showed a negative association with step count, while post-exertional malaise was also negatively associated with moderate-to-vigorous physical activity. Dyspnea showed a negative association with the functional score, including all tests. Our findings suggest that fatigue, post-exertional malaise, and the co-occurrence of physical symptoms are negatively associated with physical activity, while dyspnea is negatively associated with functional capacity in individuals with Long COVID.

Daily physical activity and prognostic implications in patients with heart failure: an accelerometer study.

Physical activity (PA) measured by accelerometry is proposed as a novel trial endpoint for heart failure (HF). However, standardised methods and associations with established markers are lacking. This study aimed to examine PA measurements and accelerometer repeatability in patients with HF and age- and sex-matched controls, and study correlations with established prognostic HF markers, body composition, and quality of life (QoL). Accelerometry was performed in 105 patients with HF with left ventricular ejection fraction (LVEF) ≤ 40% and in 46 controls. Participants also underwent dual X-ray absorptiometry, cardiopulmonary exercise testing, a six-minute walking test (6MWT), echocardiography, and NT-proBNP measurement, and completed a QoL questionnaire. Average acceleration was markedly reduced in patients with HF compared with healthy controls (16.1 ± 4.8mg vs 27.2 ± 8.5mg, p < 0.001). Healthy controls spent a median daily 56min (IQR 41-96min) in moderate-to-vigorous PA (MVPA), whereas HF patients spent only 12min (IQR 6-24) in MVPA. In HF patients, average acceleration correlated moderately with 6MWT (R = 0.41, p < 0.001) and maximal oxygen uptake (peak VO2) (R = 0.36, p < 0.001) but not with NT-proBNP, LVEF, or QoL. Patients in NYHA class II showed a higher average acceleration than patients in NYHA III (16.6 ± 4.9mg vs 14.0 ± 3.6mg, p = 0.01). Daily PA was severely reduced in patients with HF compared with healthy controls. In HF patients, we found moderate correlations of accelerometer measurements with markers of physical capacity but not with LVEF or NT-proBNP. NCT05063955. Registered 01 June 2021-retrospectively registered.

The Impact of Stimulation Parameters on Cardiovascular Outcomes in Chronic Stroke Patients Following Transcranial Direct Current Stimulation-A Pilot Controlled, Randomized, Double-Blind Crossover Trial.

Stroke survivors often experience autonomic nervous system (ANS) dysfunction. While Transcranial Direct Current Stimulation (tDCS) has been shown to modulate the ANS when applied to the left hemisphere, its effects on the right hemisphere remain unexplored. We aimed to compare the effects of tDCS applied to both the injured and the contralateral hemispheres on heart rate variability (HRV) and functional capacity in individuals post-stroke. Twenty individuals with cerebral hemisphere lesions (ten with right-hemisphere lesions and ten with left-hemisphere lesions) were randomized into four groups: anodal and sham tDCS on the left temporal cortex (T3) and anodal and sham tDCS on the right temporal cortex (T4). HRV was assessed before the intervention, after the six-minute walk test (6MWT), and following tDCS. HRV data were categorized into frequency ranges: low frequency (LF), high frequency (HF), and sympathovagal balance. The 6MWT (meters) was conducted both pre- and post-tDCS. In individuals with right-hemisphere lesions, a higher global LF value was observed (right side: 71.4 ± 16.8 nu vs. left side: 65.7 ± 17.3 nu; p = 0.008), as well as lower values of the HF component (right side: 29.5 ± 18.9 nu vs. left side: 34.0 ± 17.4 nu; p = 0.047), consequently exhibiting higher global values of the low/high-frequency ratio (right side: 3.9 ± 2.8 vs. left side: 2.9 ± 2.4). Regarding the stimulation site, tDCS over T3 led to a lower overall value of the low/high-frequency ratio (left hemisphere: 3.0 ± 2.2 vs. right hemisphere: 3.7 ± 2.9; p = 0.040) regardless of the lesion location. A significant increase in the distance covered in the 6MWT was observed for individuals with lesions in both hemispheres after tDCS at T3. Participants with right-hemisphere lesions exhibited superior global sympathetic autonomic nervous system activity. When the tDCS was applied on the left hemisphere, it maintained lower sympathovagal balance values and improved functional capacity regardless of the hemisphere affected by the stroke.

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.

Exploring Functional Improvements by Sex in Six-Minute Walk Test, Exertional Angina, and Dyspnea After Enhanced External Counterpulsation Therapy.

The objective of this study was to explore functional improvements by sex for patients with refractory angina pectoris using a 6-min walk test (6MWT) after enhanced external counterpulsation (EECP) therapy. All patients who completed EECP from 2015 to 2023 were identified for analysis retrospectively, utilizing the electronic medical record. Patients completed 35 1-hr EECP sessions 5 d/wk over 7wk. All baseline and post-EECP intervention 6MWT, exertional angina, and dyspnea measurements were assessed on the first and last sessions, respectively. Paired and unpaired t tests and linear and stepwise multivariable regression analyses were performed. The cohort consisted of 116 patients (24 female) with a mean age of 69±13yr. After EECP, there was a mean improvement of 128 m (72%) in distance walked during the 6MWT ( P <.001) with 126±91 m improvement in males and 134±73 m in females. The improvement in angina and dyspnea scores was 3.5±2.1 and 4.2±2.4, respectively. There were no differences between the sexes for improvements in 6MWT distance, angina, or dyspnea. Univariate associations for change in 6MWT distance included body mass index (BMI; adjusted R2 =.05) and being a nonsmoker (adjusted R2 =.03). The only independent predictor for increasing distance during 6MWT was BMI (adjusted R2 =.1; P =.001). Patients who have refractory angina pectoris can improve their functional capacity while simultaneously decreasing exertional angina and dyspnea using EECP. This study highlights the equal efficacy of EECP therapy for females.

The Combined Effects of Endurance and Strength Training on Exercise Tolerance and Quality of Life in Patients with COPD

Chronic Obstructive Pulmonary Disease (COPD) significantly impairs exercise tolerance and quality of life due to respiratory and systemic effects. Exercise training, including endurance and strength modalities, is a cornerstone of pulmonary rehabilitation, yet the combined effects of these training methods remain underexplored. This study aimed to evaluate the combined effects of endurance and strength training on exercise tolerance and quality of life in COPD patients. A randomized controlled trial was conducted involving 100 COPD patients assigned to four groups: Endurance Training, Strength Training, Combined Training, and Control. The interventions were implemented over 12 weeks, with outcomes assessed pre- and post-intervention, including the six-minute walk test (6MWT) for exercise tolerance and the St. George’s Respiratory Questionnaire (SGRQ) for quality of life. Statistical analyses included ANOVA and post-hoc comparisons to determine group differences. The Combined Training group demonstrated the most significant improvement in exercise tolerance, with a mean increase of 72.4 meters in 6MWT distance, compared to 48.7 meters in the Endurance group and 34.2 meters in the Strength group. Quality of life, measured by SGRQ, improved significantly across all intervention groups, with the greatest reduction in total SGRQ scores observed in the Combined Training group (12.6 points), indicating enhanced physical and psychological well-being. Additional improvements in muscle strength and endurance capacity were also most pronounced in the Combined Training group. Combined endurance and strength training provide superior benefits in enhancing exercise tolerance, muscle strength, and quality of life in COPD patients compared to either modality alone. These findings support the integration of multimodal exercise regimens in pulmonary rehabilitation programs to optimize outcomes for COPD patients.

P189 HYPERTENSION AND OBSTRUCTIVE SLEEP APNOEA SYNDROME IN ADULTS WITH HEART FAILURE IN NIGERIA: CLINICAL CORRELATES AND ASSOCIATION WITH CLINICAL OUTCOMES

Rationale: Heart failure (HF) is a common endpoint for cardiovascular diseases. It is a major cause of morbidity and mortality worldwide. Hypertension is a leading cause of HF; a significant proportion of HF patients also have obstructive sleep apnea syndrome (OSAS) which is known to impact clinical outcomes adversely. The diagnosis of OSAS is often missed due to inadequate clinical diagnosis and diagnostic backup. This study aims to add to the body of evidence thereby improving outcomes in HF patients. Methods: This cross-sectional descriptive study involved 200 consenting adults with HF at Jos University Teaching Hospital, Nigeria. Each participant had relevant medical history, physical examination (including a six-minute walk test distance) and relevant investigations. OSAS was diagnosed using high-risk scores obtained using Berlin and STOP-Bang questionnaires, daytime somnolence was assessed by Epworth questionnaire and quality of life by Minnesota living with HF questionnaire. Comorbidities were assessed using Charlson comorbidity index (CCI)) and hospitalizations in the preceding 12 months documented. Data was analyzed using Stata version 13. Results: Hypertension was the aetiology of HF in 41% of the study population and 62.8% of the subset with OSAS (p=0.001). OSAS was identified in 47% and 45.5% by high-risk scores obtained using Berlin and STOP-Bang questionnaires respectively. Significant daytime somnolence was identified in 56.0% of the study population and 93.6% of those with OSAS, (p&lt;0.001). Those with OSAS had a significant association with hypertension (p=0.001), atrial fibrillation (p&lt;0.001), obesity (p=0.002), higher comorbidity index (p=0.001), HF with preserved ejection pattern (p=0.001) and NYHA ≥3 (p&lt;0.001). OSAS was significantly associated with six-minute WTD ≤ 300m, hospitalizations (p&lt;0.001) and sub-optimal quality of life (p=0.003). Conclusion: Hypertension and OSAS are significantly associated and are common in HF. It is recommended to routinely screen HF patients for OSAS as the diagnosis is often missed with consequent adverse clinical outcomes. This will facilitate prompt diagnosis, enhance management and favourable clinical outcomes in HF patients.

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome.

The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome. A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years. A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen's d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen's d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05). The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.

Whole-body vibration versus gravity force stimulation on postural stability in children with Down syndrome: A randomized controlled trial

Purpose. To compare how functional walking ability and postural stability are affected in children with DS by whole-body vibration and gravity force stimulation. Methods. This study enrolled sixty DS children from both sexes into three groups at random. A structured physical therapy plan was given to the control and both study groups. Whole-body vibration (WBV) and gravity force stimulation (GFS) were given to the study groups (I) and (II) respectively. Postural stability indices (overall, mediolateral, and anteroposterior) and functional walking capacity were assessed by the Biodex balance system (BBS) and six-minute walk test (6MWT) respectively. The intervention session was conducted thrice/week for 12 consecutive weeks. Results. All stability indices at stability levels 8 and 5 significantly decreased after-intervention compared to before-intervention, but the 6MWT significantly increased in all three groups. All stability indices at stability levels 8 and 5 showed a significant decrease after-intervention, and the 6MWT in all three groups significantly increased in favor of study groups (WBV) and (GFS). However, there were no significant differences in all stability indices at stability levels 8 and 5 and in 6MWT between study groups (WBV) and (GFS) after-intervention. Conclusion. Whole-body vibration and gravity force stimulation both had a similar effect on postural stability and functional walking capacity among children who have Down syndrome.

A Randomized Study of Myostaal® Liniment as an Add-On Therapy for Muscle Strengthening in Cases of Knee Osteoarthritis.

Knee osteoarthritis (OA) is a prevalent degenerative musculoskeletal condition, affecting approximately 277 million people worldwide, with significant impacts on mobility, especially in women and obese patients, and an increasing incidence among Indians aged 30 to 50 years. The primary objective was to evaluate the knee muscle-strengthening effect of Myostaal® liniment (Solumiks Herbaceuticals Limited, Mumbai, India) as an add-on to physiotherapy for 90 days compared to physiotherapy alone in participants with knee OA. Secondary objectives included assessing changes in the total Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score, WOMAC Subscale scores, Six-Minute Walk Test(6MWT) distance, Single Leg Stance Test (SLST) duration, Visual Analogue Scale (VAS) score, and the number of adverse events from baseline to Day 90 between the two groups. Seventy participants were randomly allocated to Group A (Myostaal® liniment plus physiotherapy) or Group B (physiotherapy alone) for 90 days, with Myostaal® liniment applied twice daily in Group A. Data were recorded in Case Report Forms (CRFs) and analyzed using parametric tests for within-group comparisons (one-way ANOVA or Friedman test) and non-parametric tests (Mann-Whitney test) for between-group comparisons, with significance set at p<0.05. The knee muscle strength (index knee) in Group A (test medication group) was significantly greater compared to Group B (standard treatment group) at Visit 3 (p<0.05; Day 60±3) and Visit 4 (p<0.001; Day 90±3). For the non-index (other) knee, a statistically significant increase in knee muscle strength was observed (p<0.001 at Day 90±3) solely in Group A. A notable reduction in total WOMAC score was seen in Group A from Visit 2 (p<0.01; Day 30±3) onward, compared to Visit 1 (Day 0). The scores at Visit 3 (p<0.001; Day 60±3) and Visit 4 (p<0.001; Day 90±3) were significantly lower than those at Visit 2 (Day 30±3). The local application of Myostaal® liniment through massage as an adjunct to a physiotherapy regimen, improved knee muscle strength in participants with knee OA, leading to an enhancement in joint functionality. Additionally, Myostaal® linimentprovided superior pain relief as an add-on therapy.

Evaluation and Prevention of Perioperative Respiratory Failure.

Respiratory failure is a common perioperative complication. The risk of respiratory failure can be reduced with effective preoperative evaluation, preventative measures, and knowledge of evidence-based management techniques. Effective preoperative screening methods include ARISCAT scoring, OSA screening, and the LAS VEGAS score (including the ASA physical status score). Evaluation by the six-minute walk test and a routine pulmonary physical exam has been shown to be effective at predicting postoperative pulmonary complications, whereas evidence on the predictive power of pulmonary function tests and chest radiography has been inconclusive. Preoperative smoking cessation and lung expansion maneuvers have been shown to decrease the risk of pulmonary complications postoperatively. Intraoperative management techniques that decrease the pulmonary complication risk include neuromuscular blockade reversal with sugammadex, limiting surgical times to less than 3 h when possible, lung-protective ventilation techniques, and multimodal analgesia to decrease opioid usage. In the immediate postoperative period, providers should be prepared to quickly treat bronchospasm, hypoventilation, and upper airway obstruction. For post-surgical patients who remain in the hospital, the risk of pulmonary complications can be decreased with lung expansion techniques, adequate analgesia, automated continuous postoperative ward monitoring, non-invasive ventilatory support, and early mobilization. This article was written to analyze the available literature on this topic in order to learn and practice the prevention of perioperative respiratory failure when caring for patients on a daily basis.

Balance confidence classification in people with a lower limb amputation using six minute walk test smartphone sensor signals.

The activities-specific balance confidence scale (ABC) assesses balance confidence during common activities. While low balance confidence can result in activity avoidance, excess confidence can increase fall risk. People with lower limb amputations can present with inconsistent gait, adversely affecting their balance confidence. Previous research demonstrated that clinical outcomes in this population (e.g., stride parameters, fall risk) can be determined from smartphone signals collected during walk tests, but this has not been evaluated for balance confidence. Fifty-eight (58) individuals with lower limb amputation completed a six-minute walk test (6MWT) while a smartphone at the posterior pelvis was used for signal collection. Participant ABC scores were categorized as low confidence or high confidence. A random forest classified ABC groups using features from each step, calculated from smartphone signals. The random forest correctly classified the confidence level of 47 of 58 participants (accuracy 81.0%, sensitivity 63.2%, specificity 89.7%). This research demonstrated that smartphone signal data can classify people with lower limb amputations into balance confidence groups after completing a 6MWT. Integration of this model into the TOHRC Walk Test app would provide balance confidence classification, in addition to previously demonstrated clinical outcomes, after completing a single assessment and could inform individualized rehabilitation programs to improve confidence and prevent activity avoidance.