Work Capacity In Patients Research Articles

Фізична терапія при переломах кісток гомілковостопного суглоба

Purpose: to provide a clinical and physiological rationale for the use of physical therapy for patients with ankle bone fractures. Materials and methods: Theoretical analysis and generalization of data from the scientific and methodological literature on physical therapy for patients with ankle bone fractures. Results: physical therapy methods and their effectiveness were evaluated and analyzed. The use of physical therapy programs allows to restore the function of the musculoskeletal system and the working capacity of patients. Conclusions: it was established that the improvement of the results of treatment and rehabilitation depends on complex medical and physical therapy.

Комплексна фізична терапія при порушеннях постави

Purpose: to provide a clinical and physiological rationale for complex physical therapy for patients with postural disorders. Material and methods: Theoretical analysis and generalization of data from scientific and methodical literature on physical therapy of patients with postural disorders. Results: physical therapy methods and their effectiveness were assessed and analyzed. The use of physical therapy programs allows to restore the function of the musculoskeletal system and the working capacity of patients. Conclusions: it was established that the improvement of the results of treatment and rehabilitation depends on complex medical and physical therapy.

Biological necrectomy and vacuum-therapy in complex treatment of decompensated chronic venous insufficiency of the lower extremities

Objective. To improve the results of treatment in patients, suffering decompensated forms of chronic venous insufficiency (CHVI) of the lower extremities, using introduction of biological necrectomy and vacuum-therapy in combination with complex of optimal surgical interventions, depending on state of venous hemodynamics of the lower extremities.
 Materials and methods. In 2015-2018 yrs in Surgical Clinic of the Zakarpattya Regional Clinical Hospital named after Andriy Novak 147 patients, ageing 40 yrs old and older, suffering CHVI Category C6 in accordance to the CEAP Classification, were treated. All the patients were divided into two groups: the Group I consisted of 76 patients, suffering CHVI in decompensated stage on background of varicose disease, and the Group II - 71 patients, suffering trophic ulcers (TU) on background of postthrombophlebitic syndrome (PTHPHS).
 Results. There was established, that the TU clearance under the action of maggot-therapy in patients, suffering decompensated course of CHVI, is significantly more effective, than under the impact of vacuum-therapy. Autodermoplasty must be performed in all the patients, having TU with 4 cm in diameter,
 Good and satisfactory results were observed in 75 (98.7%) patients of Group I and in 63 (88.7%) patients of Group II, while poor results - in 8 (11.3%) patients of Group II. The working capacity of patients, suffering CHVI in decompensated stage of varicose genesis, have enhanced in 16.5 times, while in the patients, suffering TU on background of PTHPHS – in 1.25 times.
 Conclusion. Combined treatment of CHVI in decompensated stage, occurring on background of varicose disease includes the TU clearance, using vacuum-therapy or biological necrectomy with subsequent elimination of vertical reflux. In the patients, suffering TU on the PTHPHS background the biologic necrectomy with elimination of horizontal reflux is advantageous. The working capacity in patients with CHVI in decompensated stage of varicose genesis have enhanced in 16.5 times, while in the patients with TU on the PTHPHS background - in 1.25 times.

Комплексна фізична терапія при порушеннях постави

Purpose: to provide a clinical and physiological rationale for complex physical therapy for patients with postural disorders. Material and methods: Theoretical analysis and generalization of data from scientific and methodological literature on physical therapy of patients with postural disorders. Results: physical therapy methods and their effectiveness were evaluated and analyzed. The use of physical therapy programs allows to restore the function of the musculoskeletal system and the working capacity of patients. Conclusions: it was established that the improvement of the results of treatment and rehabilitation depends on complex medical and physical therapy.

Фізична терапія припереломах кісток гомілковостопного суглоба (оглядова)

Purpose: to provide a clinical and physiological rationale for the use of physical therapy for patients with ankle bone fractures. Material and methods: Theoretical analysis and generalization of data from scientific and methodological literature on physical therapy of patients with fractures of the bones of the ankle joint. Results: physical therapy methods and their effectiveness were evaluated and analyzed. The use of physical therapy programs allows to restore the function of the musculoskeletal system and the working capacity of patients. Conclusions: it was established that the improvement of the results of treatment and rehabilitation depends on complex medical and physical therapy.

Impact of Functional Capacity Evaluation on Patient-Reported Functional Ability: An Exploratory Diagnostic Before-After Study.

Introduction Work capacity in patients with orthopedic trauma and long-lasting inactivity is significantly reduced. Functional capacity evaluation (FCE) is a diagnostic approach for developing recommendations for a return to work and further occupational rehabilitation when the ability to carry out previous job demands is uncertain. However, FCE may also have direct effects on the patients' appraisal of their functional ability. Our study therefore evaluated the change in patient-reported functional ability after the performance of an FCE. Methods We performed a diagnostic before-after study in 161 consecutively recruited patients with trauma who were referred for FCE at the end of an interdisciplinary inpatient rehabilitation program in Austria. Patients completed the Spinal Function Sort to assess patient-reported functional ability both prior to the FCE and after completing it. Results Patient-reported functional ability (0-200 points) improved by 14.8 points (95% CI 11.3-18.2). The number of participants who rated their functional ability below their functional capacity as observed by the FCE decreased from 82.6 to 64.6% by about 18 percentage points. Conclusions The performance of the FCE in patients with trauma was associated with an improvement of patient-reported functional ability. The performance of an FCE in trauma rehabilitation may possibly have a direct therapeutic effect on the patient by allowing a more realistic appraisal of the ability to perform relevant work activities.

Possibilities of retention of work capacity in patients with Parkinson's disease

To study the efficacy of replacement of the single daily dose of two-component levodopa by three-component levodopa in work capable patients with Parkinson's disease with motor fluctuations during the most active working hours. The study included 157 patients from 19 Russian centers specialized in extrapyramidal pathology. The period of highest working activity was analyzed in all patients. In these patients, the previous treatment with two-component levodopa was replaced by three-component levodopa in the equivalent dose. Other antiparkinsonian treatment remained unchanged during the study period. The duration of the study was 1 month. The single replacement of two-component levodopa by stalevo allows increasing the optimal working activity by 19% and improving patient's state.

Реваскуляризація міокарда – провідна методика у лікуванні ішемічної хвороби серця та інфаркту міокарда

У статті наводяться дані про історичні етапи у розвитку провідних методів хірургічного лікування серцево-судинних захворювань – стентування коронарних артерій та аортокоронарного шунтування. Наведений аналіз літературних даних свідчить про переваги та недоліки аортокоронарного шунтування і коронарного стентування при лікуванні ішемічної хвороби серця, інфаркту міокарда. Реваскуляризація міокарда сприяє підвищенню якості життя пацієнтів, зменшенню тяжких кардіальних ускладнень, сприяє підвищенню працездатності пацієнтів у післяопераційному періоді та у віддаленій перспективі.

Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery.

Exercise-induced laryngeal obstruction (E-ILO) causes exertional dyspnoea. There is no standardised methodology which characterises laryngeal obstruction in relation to exercise or links laryngeal obstruction and dyspnoea severity. Continuous laryngoscopy during exercise (CLE) may improve diagnostic sensitivity by enabling laryngeal visualisation at peak work capacity in patients with rapidly resolving obstruction. The time course of laryngeal obstruction across exercise and recovery has not been quantitated until this report.Adolescents and young adults referred for CLE were laryngoscopically monitored across rest, maximal cycle ergometry exercise, and recovery. Three reviewers, blinded to time sequencing, rated inspiratory glottic and supraglottic obstruction during 10 windows of 15-s corresponding to rest, 25%, 50%, 75%, 90% and 100% of individual symptom-limited peak work capacity (expressed in Watts), and four consecutive recovery windows.85 patients were screened and 71 included. Over 96% of time windows were interpretable. Laryngeal obstruction severity reached observed maximal levels at peak work capacity, and rapidly resolved. A spectrum of observed maximal obstruction was measured.CLE provides interpretable data demonstrating laryngeal obstruction in patients with suspected E-ILO that is more severe at peak work capacity than during rest, submaximal exercise, or recovery. Observed maximal obstruction was infrequently severe and rapidly resolved.

The impact of rheumatoid arthritis on work capacity in Chinese patients: a cross-sectional study.

To evaluate the impact of RA on work capacity and identify factors related to work capacity impairment in patients with RA. A cross-sectional multicentre study was performed in 21 tertiary care hospitals across China. A consecutive sample of 846 patients with RA was recruited, of which 589 patients of working age at disease onset constituted the study population. Information on the socio-demographic, clinical, working and financial conditions of the patients was collected. Logistic regression analyses were used to identify factors associated with work capacity impairment. The rate of work capacity impairment was 48.0% in RA patients with a mean disease duration of 60 months (interquartile range 14-134 months), including 11.7% leaving the labour force early, 33.6% working reduced hours and 2.7% changing job. Multivariable logistic regression analysis showed that reduced working hours was significantly related to current smoking [odds ratio (OR) 2.07 (95% CI 1.08, 3.97)], no insurance [OR 1.94 (95% CI 1.20, 3.12)], in manual labour [OR 2.66 (95% CI 1.68, 4.20)] and higher HAQ score [OR 2.22 (95% CI 1.36, 3.60)]. There was an association of current smoking [OR 3.75 (95% CI 1.54, 9.15)], in manual labour [OR 2.33 (95% CI 1.17, 4.64)], longer disease duration [OR 1.01 (95% CI 1.00, 1.01)] and lower BMI [OR 0.90 (95% CI 0.82, 0.99)] with leaving the labour force early. There is a substantial impact of RA on the work capacity of patients in China. Social-demographic, disease- and work-related factors are all associated with work capacity impairment.

General morbidity and working capacity in patients with chronic adrenal insufficiency – A prospective study

Objective: Association of chronic adrenal insufficiency (AI) with reduced subjective health status and increased morbidity and mortality has been observed in retrospective analyses. We aimed to evaluate general morbidity and impairment in working life in a prospective study of patients with chronic primary and secondary AI (PAI/SAI).

Can Functional Capacity Tests Predict Future Work Capacity in Patients With Whiplash-Associated Disorders?

ObjectiveTo determine whether functional capacity evaluation (FCE) tests predict future work capacity (WC) of patients with whiplash-associated disorders (WADs) grades I and II who did not regain full WC 6 to 12 weeks after injury. DesignProspective cohort study. SettingRehabilitation center. ParticipantsWorkers (N=267) listed on workers' compensation with grade I or II WADs 6 to 12 weeks after injury. InterventionsPatients performed 8 work-related FCE tests. Main Outcome MeasuresWC (0–100%) measured at baseline and 1, 3, 6, and 12 months after testing. Correlation coefficients between FCE tests and WC were calculated. A linear mixed-model analysis was used to assess the association between FCE and future WC. ResultsMean ± SD WC increased over time from 20.8%±27.6% at baseline to 32.3%±38.4%, 51.3%±42.8%, 65.6%±42.2%, and 83.2%±35.0% at the 1-, 3-, 6-, and 12-month follow-ups, respectively. Correlation coefficients between FCE tests and WC ranged from r=.06 (lifting low at 12-mo follow-up) to r=.39 (walking speed at 3mo). Strength of the correlations decreased over time. FCE tests did not predict WC at follow-up. The predictors of WC were ln (time) (β=23.74), mother language (β=5.49), WC at baseline (β=1.01), and self-reported disability (β=−.20). Two interaction terms, ln (time) × WC (β=−.19) and ln (time) × self-reported disability (β=−.21), were significant predictors of WC. ConclusionsFCE tests performed within 6 to 12 weeks after WADs injury grades I and II are associated with WC at baseline but do not predict future WC, whereas time course, mother language, WC at baseline, and self-reported disability do predict future WC. Additionally, the interaction between time course WC at baseline and self-reported disability predicted future WC.

THE EFFECTS OF HIGH INTENSITY INTERVAL TRAINING ON CLINICAL SYMPTOMS AND FUNCTIONAL CAPACITY IN ADULTS WITH NEUROMUSCULAR DISEASE

BackgroundNeuromuscular disease includes a spectrum of inflammatory and mitochondrial myopathies where dysfunction in the energy–producing mitochondria can cause muscle weakness, exercise intolerance and fatigue. Continuous endurance training has been shown...

Defining cardiac adaptations and safety of endurance training in patients with m.3243A>G-related mitochondrial disease

BackgroundCardiac hypertrophic remodelling and systolic dysfunction are common in patients with mitochondrial disease and independent predictors of morbidity and early mortality. Endurance exercise training improves symptoms and skeletal muscle function, yet cardiac adaptations are unknown.Methods and resultsBefore and after 16-weeks of training, exercise capacity, cardiac magnetic resonance imaging and phosphorus-31 spectroscopy, disease burden, fatigue, quality of life, heart rate variability (HRV) and blood pressure variability (BPV) were assessed in 10 adult patients with m.3243A>G-related mitochondrial disease, and compared to age- and gender-matched sedentary control subjects. At baseline, patients had increased left ventricular mass index (LVMI, p < 0.05) and LV mass to end-diastolic volume ratio, and decreased longitudinal shortening and myocardial phosphocreatine/adenosine triphosphate ratio (all p < 0.01). Peak arterial–venous oxygen difference (p < 0.05), oxygen uptake (VO2) and power were decreased in patients (both p < 0.01) with no significant difference in cardiac power output. All patients remained stable and completed ≥ 80% sessions. With training, there were similar proportional increases in peak VO2, anaerobic threshold and work capacity in patients and controls. LVMI increased in both groups (p < 0.01), with no significant effect on myocardial function or bioenergetics. Pre- and post-exercise training, HRV and BPV demonstrated increased low frequency and decreased high frequency components in patients compared to controls (all p < 0.05).ConclusionPatients with mitochondrial disease and controls achieved similar proportional benefits of exercise training, without evidence of disease progression, or deleterious effects on cardiac function. Reduced exercise capacity is largely mediated through skeletal muscle dysfunction at baseline and sympathetic over-activation may be important in pathogenesis.

Decreased aerobic capacity 4 years after aortic valve replacement in male patients operated upon for chronic aortic regurgitation

Exercise testing is underutilized in patients with valve disease. We have previously found a low physical work capacity in patients with aortic regurgitation 6 months after aortic valve replacement (AVR). The aim of this study was to evaluate aerobic capacity in patients 4 years after AVR, to study how their peak oxygen uptake (peakVO2) had changed postoperatively over a longer period of time. Twenty-one patients (all men, 52 ± 13 years) who had previously undergone cardiopulmonary exercise testing (CPET) pre- and 6 months postoperatively underwent maximal exercise testing 49 ± 15 months postoperatively using an electrically braked bicycle ergometer. Breathing gases were analysed and the patients' physical fitness levels categorized according to Åstrand's and Wasserman's classifications. Mean peakVO2 was 22·8 ± 5·1 ml × kg−1 × min−1 at the 49-month follow-up, which was lower than at the 6-month follow-up (25·6 ± 5·8 ml × kg−1 × min−1, P = 0·001). All but one patient presented with a physical fitness level below average using Åstrand's classification, while 13 patients had a low physical capacity according to Wasserman's classification. A significant decrease in peakVO2 was observed from six to 49 months postoperatively, and the decrease was larger than expected from the increased age of the patients. CPET could be helpful in timing aortic valve surgery and for the evaluation of need of physical activity as part of a rehabilitation programme.

Strength training increases maximum working capacity in patients with COPD – Randomized clinical trial comparing three training modalities

Skeletal muscle dysfunction contributes to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Strength training increases muscle strength and muscle mass, but there is an ongoing debate on the additional effect concerning the exercise capacity. The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training (ET), progressive strength training (ST) and the combination of strength training and endurance training (CT). A prospective randomized trial. Thirty-six patients with COPD were randomly allocated either to ET, ST, or CT. Muscle strength, cardiopulmonary exercise testing, lung function testing and quality of life were assessed before and after a 12-week training period. Exercise capacity (Wmax) increased significantly in all three training groups with increase of peak oxygen uptake (VO2peak) in all three groups, reaching statistical significance in the ET group and the CT group. Muscle strength (leg press, bench press, bench pull) improved in all three training groups, with a higher improvement in the ST (+39.3%, +20.9%, +20.3%) and the CT group (+43.3%, +18.1%, +21.6%) compared to the ET group (+20.4%, +6.4%, +12.1%). Progressive strength training alone increases not only muscle strength and quality of life, but also exercise capacity in patients with COPD, which may have implications in prescription of training modality. CLINICALTRIALS.GOV IDENTIFIER: NCT01091623.

Hemodynamic and endothelium-protective effects of β-adrenoblockers in patients with coronary heart disease complicated by chronic heart failure and atrial fibrillation

Aim. To elucidate effect of b-adrenoblockers on remodeling of myocardium and adhesive function of endothelium in with ischemic heart disease with chronic heart failure (CHF) and addition of atrial fibrillation (AF). Material and methods. We included into the study 77 patients with functional class II–III CHF and AF of ischemic genesis randomized in 2 groups, In group 1 were included 40 patients who during 24 weeks used carvedilol at the background of basic therapy, in group 2–37 patients receiving metoprolol tartrate. In the work we used clinico-instrumental (echocardiography, test with 60 minute walk), immunoenzymatic (soluble intercellular adhesion molecules (sVCAM, SE – selectin) methods of investigation. Results. Application of both BAB improved clinical state and physical working capacity of patients with CHF and AF. Carvedilol more significantly than metoprolol tartrate prevented remodeling of myocardium, inhibited expression of cellular adhesion molecules. Levels of sE-selectin and VCAM-1 decreased under action of carvedilol. Conclusion. Carvedilol in long term therapy of CHF with AF exerts substantial influence on adhesive function of endothelium and improves hemodynamics.

Measurement of physical work capacity in patients with chronic aortic regurgitation: a potential improvement in patient management

Timing of surgery in aortic regurgitation (AR) is important. Exercise testing is recommended upon uncertainty about functional limitations but reports on cardiopulmonary exercise testing (CPET) in populations with pure chronic AR are scarce. Twenty-eight patients referred for surgery because of chronic AR (13 in NYHA I, 10 in NYHA II and five in NYHA III) were tested by CPET pre- and 6 months postoperatively. Echocardiography, with measurement of left ventricular ejection fraction (LVEF), diameters (LVED, LVES) and volumes (LVEDV, LVESV) was also performed. The patients had normal LVEF pre- and postoperatively. LV diameters and volumes diminished significantly postoperatively (LVED from 67 to 57, LVES from 49 to 41 mm; P < 0.001). The majority of the patients had a 'low' physical work capacity, none of them performed better than 'average' according to Astrand's classification preoperatively and there was no significant postoperative improvement. The mean peak oxygen uptake (VO(2peak)) was 25 ml kg(-1) min(-1) both pre- and postoperatively, and six of the 28 patients had a VO(2peak) of less than 20 ml kg(-1) min(-1). VO(2peak) was not significantly related to NYHA class. LVEF, diameters and volumes at rest did not fulfil the criteria for surgery in most of our AR patients, of whom 46% were asymptomatic. However, many had a remarkably low work capacity, which was neither improved 6 months postoperatively nor correlated to echocardiographic LV dimensions. CPET predicted the postoperative work capacity and may, therefore, be a useful complement for timing of surgery in patients with chronic AR.

The Effect of Total Hip Arthroplasty on Employment

This study was undertaken to investigate the impact of total hip arthroplasty on a patient's work ability. Fifty-four patients who were in the workforce completed a questionnaire 1 year after total hip arthroplasty. Thirty-eight (86%) of 44 patients working preoperatively were working 1 year after surgery, whereas only 2 (20%) of 10 patients who were not working preoperatively resumed work. Those who resumed work were younger and reported better Oxford-12 and physical function scores. Patients who resumed working had improvements in their ability to meet workplace physical demands and in productivity. Total hip arthroplasty has positive effects on work capacity in patients who return to work. To help patients remain in the workforce, surgery should be undertaken before a patient's hip dysfunction forces them off work.

Pharmacological approaches to the therapy of chronic fatigue syndrome.

Although a variety of pharmacological agents have been used to treat patients with chronic fatigue syndrome none has been shown to effect a complete resolution of symptoms. Data obtained from a retrospective study and from an objective assessment of the aerobic work capacity of patients with this disorder suggest that the underlying pathophysiological abnormality is a disorder of sleep regulation. This results not only in profound fatigue and lethargy but also reduced sensory threshold for pain, disordered temperature regulation, cardiovascular abnormalities, disturbed higher cerebral function and mental depression. Drugs which modulate sleep, such as tricyclic antidepressants, have a limited effect in improving the symptoms that CFS patients experience. We suggest that other agents which affect central nervous system neurotransmitters, particularly serotonin, may have potential in the management of this condition and need to be evaluated in large controlled clinical trials.