Perceived Barriers to and Facilitators of Physical Activity in Recipients of Solid Organ Transplantation, a Qualitative Study

Background Sufficient physical activity is important for solid organ transplant recipients (heart, lung, liver, kidney). However, recipients do not meet the recommended amount or required type of physical activity. The perceived barriers to and facilitators of physical activity in this population are largely unknown. Methods Semi-structured in depth interviews were conducted with solid organ transplant recipients in order to explore experienced barriers and facilitators. Qualitative methodology with thematic line-by-line analysis was used for analysis, and derived themes were classified into personal and environmental factors. Results The most important indicated barriers were physical limitations, insufficient energy level, fear, and comorbidities. The most frequently mentioned facilitators included motivation, coping, consequences of (in) activity, routine/habit, goals/goal priority, and responsibility for the transplanted organ. Neutral factors acting as a barrier or facilitator were self-efficacy and expertise of personnel. A comparison of barriers and facilitators between transplant recipient groups yielded no overt differences. Conclusion Several personal and environmental factors were indicated that should be considered in intervention development to increase physical activity behavior in solid organ transplant recipients

L’utilizzo delle vibrazioni meccaniche focali nella riabilitazione dell’instabilita posturale in soggetti affetti da malattia di parkinson: revisione della letteratura

Introduzione: linstabilita  posturale nei pazienti con malattia di Parkinson è un sintomo che compare negli stadi avanzati di questa patologia ed, essendo presente sia in stazione eretta sia durante la deambulazione, risulta estremamente invalidante, con un intaccamento dell'autonomia nelle attività di vita quotidiana e della vita sociale. Negli ultimi anni, come strategia di trattamento per l'nstabilità posturale in soggetti con malattia di Parkinson, sono sempre più studiate le vibrazioni meccaniche focali, a cui i fusi muscolari sono estremamente sensibili; grazie a questo esse trasmettono un afflusso propriocettivo al sistema nervoso centrale, che modula lâeccitabilità dei riflessi spinali o le risposte muscolari, indotte dalle alterazioni posturali. Questo ha portato a formulare lâobiettivo di questa tesi, cioè quello di verificare o smentire lâefficacia delle vibrazioni focali meccaniche, quando vengono impiegate nella riabilitazione dellâinstabilità posturale nei soggetti con malattia di Parkinson. Metodi: Per raggiungere lâobiettivo è stata eseguita una ricerca bibliografica nella letteratura internazionale in lingua inglese, su Medline, PubMed, PEDRO e the Cochrane Library. Per eseguire la ricerca sono stati cercati articoli in cui le vibrazioni focali sono state utilizzate come trattamento dellâinstabilità posturale nel Parkinson. Risultati: dalla ricerca bibliografica sono risultati 18 articoli; di questi, 10 parlavano del trattamento, con vibrazioni focali, nellâinstabilità posturale (di cui 7 nella malattia di Parkinson), 2 descrivevano gli effetti di esse nella prevenzione delle cadute, 2 riguardavano il loro impiego nel miglioramento della deambulazione di soggetti con malattia di Parkinson e gli ultimi 3 trattavano degli effetti in generale delle vibrazioni focali. Conclusioni: tutti gli articoli esaminati concordano sul fatto che le vibrazioni focali, utilizzate nel trattamento dellâinstabilità posturale di Parkinson, portano degli effetti benefici, che perdurano nel tempo. Inoltre, questa strategia di trattamento, migliora la deambulazione nei pazienti con malattia di Parkinson, riduce il tasso di cadute ed, essendo uno strumento indossabile, indolore e non invasivo, porta ad un miglioramento della qualità di vita della questi pazienti

Comparison of Two Preoperative Inspiratory Muscle Training Programs to Prevent Pulmonary Complications in Patients Undergoing Esophagectomy: A Randomized Controlled Pilot Study

Postoperative pulmonary complications (PPCs) are the most commonly reported complications after esophagectomy. The aim of this study was to examine the effect and feasibility of preoperative inspiratory muscle training-high intensity (IMT-HI), and IMT-endurance (IMT-E) on the incidence of PPCs in patients following esophagectomy for esophageal cancer (EC). A single-blind, randomized, clinical pilot study was conducted between 2009 and 2012. Forty-five participants were assigned to either IMT-HI or IMT-E. Effectiveness was assessed by analyzing PPCs, length of hospital stay (LOS), duration of mechanical ventilation, stay on the intensive care unit, and number of reintubations. Maximal inspiratory pressure and lung function changes were recorded pre- and post-training. Feasibility was assessed by IMT-related adverse events, training compliance, and patients' satisfaction. Thirty-nine patients could be analyzed, 20 patients in the IMT-HI arm and 19 patients in the IMT-E arm. The incidence of PPCs differed significantly between groups and was almost three times lower for the IMT-HI group (4 vs. 11 patients; p = 0.015). Other differences in favor of the IMT-HI group were LOS (13.5 vs. 18 days; p = 0.010) and number of reintubations (0 vs. 4 patients; p = 0.030). Both interventions proved to be equally feasible. Preoperative IMT-HI showed to be a promising, effective, and feasible intervention to reduce PPCs in EC patients undergoing esophagectomy. Further research with a larger sample size is recommended

Changes of mandibular ramal height, during growth in unilateral hemifacial microsomia patients and unaffected controls

The aim of this study was to design mandibular ramal height growth curves for patients with HFM and compare those with the curves for a Dutch reference population. Two hundred fifty-one pre-operative orthopantomograms (OPTs) from 84 patients with unilateral HFM were used in conjunction with a control set of 2260 OPTs from 329 healthy individuals from the Nijmegen Growth Study (NGS) to determine mandibular ramal distances. For grades I/IIa and IIb/III, and for both sides, growth curves were constructed for mandibular ramal height with a linear curve-fitting procedure. This procedure revealed a significant difference between HFM patients and the NGS control group (p < 0.001); both in the mild and severe group mandibular ramal height differed significantly between the affected and non-affected side (p < 0.001). Growth was similar between HFM patients and the NGS control group. HFM patients therefore start with a smaller mandible and end with a smaller mandible, but experience growth similar to the Dutch normal population. These growth curves may aid the timing and determination of the combined surgical orthodontic treatment plan for HFM patients. (C) 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Multidimensional structure of a questionnaire to assess barriers to and motivators of physical activity in recipients of solid organ transplantation

Purpose: To explore the underlying dimensions of the Barriers and Motivators Questionnaire that is used to assess barriers to and motivators of physical activity experienced by recipients of solid organ transplantation and thereby improve the application in research and clinical settings. Method: A cross-sectional study was performed in recipients of solid organ transplantation (n = 591; median (IQR) age = 59 (49; 66); 56% male). The multidimensional structure of the questionnaire was analyzed by exploratory principal component analysis. Cronbach's alpha was calculated to determine internal consistency of the entire questionnaire and individual components. Results: The barriers scale had a Cronbach's alpha of 0.86 and was subdivided into four components; alpha of the corresponding subscales varied between 0.80 and 0.66. The motivator scale had an alpha of 0.91 and was subdivided into four components with an alpha between 0.88 to 0.70. Nine of the original barrier items and two motivator items were not included in the component structure. Conclusion: A four-dimensional structure for both the barriers and motivators scale of the questionnaire is supported. The use of the indicated subscales increases the usability in research and clinical settings compared to the overall scores and provide opportunities to identify modifiable constructs to be targeted in interventions

Physical Activity, Sedentary Time, and Associated Factors in Recipients of Solid-Organ Transplantation

Background: Short-term survival after solid-organ transplantation has substantially improved, and the focus has shifted to long-term survival, including the role of physical activity (PA). Knowledge about PA and sedentary time in recipients of solid-organ transplantation is limited, and identification of the levels and associated factors is necessary for intervention development. Objective: The objectives of this study were to investigate the level of PA and sedentary time in recipients of solid-organ transplantation and to identify factors associated with these behaviors. Design: The design consisted of a cross-sectional survey. Methods: Questionnaires on PA level, sedentary time, and potential associated factors were used for recipients of solid-organ transplantation (kidney, liver, lung, and heart [N = 656]). Multiple regression analyses with a variable selection procedure were used. Results: Fewer than 60% of the recipients fulfilled the PA guideline. Factors significantly associated with a lower level of PA included being a woman, younger age (nonlinear), not actively working or being retired, physical limitations, and low expectations and self-confidence. Factors significantly associated with less sedentary time included exercise self-efficacy and not actively working or being retired. Significantly associated with more sedentary time were a high education level, fear of negative effects, physical limitations, and the motivator health and physical outcomes. The type of transplantation did not significantly influence either of the outcome measures. Limitations: The design did not allow for causal inferences to be made. The studied associated factors were limited to individual and interpersonal factors. Self-reported measures of PA and sedentary time were used. Conclusions: In intervention development directed at increasing the level of PA and reducing sedentary time in recipients of solid-organ transplantation, attention should be paid to physical limitations, fear of negative effects, low expectations and self-confidence, health and physical outcomes, and exercise self-efficacy

The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer

BACKGROUND: Preoperative inspiratory muscle training (IMT) is frequently used in patients waiting for major surgery to improve respiratory muscle function and to reduce the risk of postoperative pulmonary complications (PPCs). Currently, the mechanism of action of IMT in reducing PPCs is still unclear. Therefore, we investigated the associations between preoperative IMT variables and the occurrence of PPCs in patients with esophageal cancer. METHODS: A multi-center cohort study was conducted in subjects scheduled for esophagectomy, who followed IMT as part of a prehabilitation program. IMT variables included maximum inspiratory pressure (PImax) before and after IMT and IMT intensity variables including training load, frequency, and duration. Associations between PImax and IMT intensity variables and PPCs were analyzed using independent samples t tests and logistic regression analyses, corrected for age and pulmonary comorbidities and stratified for the occurrence of anastomotic leakages. RESULTS: Eighty-seven subjects were included (69 males; mean age 66.7 6 7.3 y). A higher PImax (odds ratio 1.016, P = .07) or increase in PImax during IMT (odds ratio 1.020, P = .066) was not associated with a reduced risk of PPCs after esophagectomy. Intensity variables of IMT were also not associated (P ranging from .16 to .95) with PPCs after esophagectomy. Analyses stratified for the occurrence of anastomotic leakages showed no associations between IMT variables and PPCs. CONCLUSIONS: This study shows that an improvement in preoperative inspiratory muscle strength during IMT and training intensity of IMT were not associated with a reduced risk on PPCs after esophagectomy. Further research is needed to investigate other possible factors explaining the mechanism of action of preoperative IMT in patients undergoing major surgery, such as the awareness of patients related to respiratory muscle function and a diaphragmatic breathing pattern

Le Nouveau journal de Strasbourg

02 novembre 19121912/11/02 (N304).Appartient à l’ensemble documentaire : BNUStr014Appartient à l’ensemble documentaire : BNUStr017Appartient à l’ensemble documentaire : Alsace