Glossopharyngeal breathing

Introduction and aims: The technique of glossopharyngeal breathing was introduced already in the 1950 s, but today, few health professionals are aware of its uses. The technique is performed by using the glossopharyngeal muscles to piston boluses of air into the lungs. Is has been used by patients to improve ventilation and cough function and by breath-hold divers to prolong their period of time under water. The aims of the present thesis were to determine whether healthy women, elite swimmers, people with cervical spinal cord injury (CSCI) and children with spinal muscular atrophy (SMA) type II were able to learn glossopharyngeal pistoning for lung insufflation (GI) and if so, to describe and evaluate the immediate and long-term effects after a training period of GI on pulmonary function and chest expansion. Methods: In Study I 26 healthy women were recruited; 16 were randomly assigned to the training group (TG) and nine to the control group (CG). In Study II 26 elite swimmers were recruited, 16 men and 10 women. In Study III 25 participants with CSCI were recruited, 20 men and five women. In Study IV 11 children with SMA type II were recruited, eight boys and three girls. All participants performed 10-15 cycles of GI, three to four times a week for five to eight weeks. Pulmonary function tests and chest expansion were measured before and after the training period and also three months after training completed. Results: All of the healthy participants in Study I and II, with the exception of one woman, were able to learn GI. Five of the participants with CSCI and six of the children with SMA type II were not able to perform the technique. The participants in all studies who did learn GI were able to exceed their vital capacity (VC) by 23% and to increase their chest expansion. The men with CSCI had a higher glossopharyngeal insufflation volume (GIV) than the male swimmers in relation to their VC and their chest expansion was also improved in relation to their normal chest expansion. VC increased in the TG compared to the CG in Study I, p<0.01. VC increased for the female swimmers and chest expansion increased for all the swimmers after the training period. Most of the pulmonary function variables and chest expansion increased in participants with CSCI. Some pulmonary function variables tended to improve in the children with SMA type II and chest expansion tended to increase at the level of the processus xiphoideus. Some of the participants reported temporary symptoms when performing the technique, such as dizziness, tension in the chest and some participants even fainted. The improvements in VC persisted three months after training completed. Conclusions: Nearly all of the healthy participants, most of the participants with CSCI and half of the children with SMA type II were able to learn GI. They all performed the technique without any major discomfort. Performance of a training period of five to eight weeks of GI produced positive effects on pulmonary function and chest expansion both in the healthy participants, the participants with CSCI and the children with SMA type II. The improvements were still noticeable three months after training, regardless of whether the participants had continued to train or not

Association between early mobilisation after abdominal cancer surgery and postoperative complications

INTRODUCTION: Postoperative complications and readmission to hospital after major cancer surgery are common. Early mobilisation in hospital is thought to reduce complications, and patients are recommended to mobilise for at least 2 h on the day of surgery, and thereafter at least 6 h per day. Evidence for early mobilisation is limited and therefore also how early mobilisation may influence the development of postoperative complications. The aim of this study was to evaluate the association between early mobilisation after abdominal cancer surgery and readmission to hospital due to postoperative complications. MATERIAL AND METHODS: Adult patients who had abdominal cancer surgery due to ovarian, colorectal, or urinary bladder cancer between January 2017 and May 2018 were included in the study. Exposure was set to the mean number of steps taken over the first three postoperative days, measured with an activity monitor. Primary outcome was readmission to hospital within 30 days after discharge, and secondary outcome was severity of complications. Data were obtained from medical records. Logistic regression was used to investigate the association between exposure and outcomes. RESULTS: Of 133 patients included in the study, 25 were readmitted to the hospital within 30 days after discharge. The analysis showed no association between early mobilisation and readmission or severity of complications. CONCLUSION: Early mobilisation does not seem to increase the odds of readmission, nor the severity of complications. This study contributes to the limited research on the association between early mobilisation and postoperative complications after abdominal cancer surgery

Effects of Glossopharyngeal Insufflation in Ankylosing Spondylitis: A Pilot Study

In Ankylosing Spondylitis (AS), thoracic range of motion is often greatly limited. The objective of the study was to describe the effects of 12 weeks of Glossopharyngeal Insufflation (GI) training in patients with AS. Dynamic spirometry included vital capacity, forced expiratory volume, and peak expiratory flow. Thoracic and lumbar range of motion was assessed by tragus-to-wall distance, modified Schober test, and tape measure. Disease activity, activity limitation, and health perception were assessed using the BAS-Indices, and tension in the thoracic region during GI was assessed using the Borg CR-10 scale. Adherence to training was recorded in an activity log, along with any remarks on the training. Ten patients were recruited and six male patients fulfilled the study protocol. Three patients were able to learn GI by exceeding their maximal vital capacity with 5% using GI. A significant increase in thoracic range of motion both on costae IV (P=0.04) and at the level of the xiphoid process (P=0.04) was seen. Thus, patients with AS can practice GI, it is safe if maximal exertion is avoided, and patients with some mobility in the chest can increase their lung function substantially by performing GI during 12 weeks

Like I said, I would not have likely gotten up otherwise : Patient experiences of using an Activity Board after abdominal cancer surgery.

PURPOSE: Most patients treated in a hospital setting are fully or partially immobilised. The Activity Board (Träningstavlan® Phystec) is a useful tool to enhance mobilisation after major abdominal cancer surgery. Knowledge of patient experiences of the mobilisation tool is crucial in implementing the Activity Board in health care. This study aimed to describe patient experiences of using the Activity Board after surgery for abdominal cancer. MATERIALS AND METHODS: Semi-structured face-to-face interviews were conducted in 15 patients who underwent abdominal surgery due to colorectal, ovarian or urinary bladder cancer. All 15 patients (mean age 67.7 years, range 40-86) used the Activity Board postoperatively. The interviews were transcribed verbatim and analysed according to inductive content analysis. RESULTS: The overarching theme that emerged from the interviews was that "enabling participation facilitates empowerment over rehabilitation". Three categories supported the theme: prerequisites for using the Activity Board, the value of using supportive behavioural techniques, and the possibility to influence the patients' care. CONCLUSIONS: These findings suggest that the Activity Board could be a viable tool that activates the person-centred postoperative rehabilitation process by cooperating with the medical team at the hospital ward.Implications for rehabilitationPatients who are in hospital due to cancer surgery are often immobilised, which increases the risk of complications.The Activity Board can stimulate the patients to participate in the rehabilitation process in a more active way.The Activity Board can be used to improve and clarify the person-centred approach in hospital settings

An evaluation of the short physical performance battery following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective There is a need for simple tools to evaluate physical performance in patients with COPD before and after pulmonary rehabilitation. The aims of this study were to evaluate changes in short physical performance battery (SPPB)-scores in patients with COPD after a 4-week pulmonary rehabilitation program; explore possible relationships between SPPB-scores and exercise capacity (6-min walk distance), dyspnea (modified Medical Research Council’s dyspnea scale), disease-specific quality of life (COPD assessment test), and pulmonary function (predicted forced expiratory volume in one second) at baseline; and explore if changes in SPPB-scores are related to changes in exercise capacity, dyspnea, and disease-specific quality of life following pulmonary rehabilitation. Results Forty-five patients with COPD were included in the final analysis. SPPB-scores improved following pulmonary rehabilitation (mean change: 1.2 ± 1.7 points, p < 0.001). There were moderate correlations between SPPB-scores and exercise capacity (r = 0.50, p < 0.001) and dyspnea (r = − 0.45, p = 0.003) at baseline, but not with pulmonary function or disease-specific quality of life. Changes in SPPB-scores were not associated with changes in exercise capacity or dyspnea scores. The SPPB may be a useful tool for evaluating physical performance in COPD Trial registration ClinicalTrials.gov NCT02314338, December 11, 2014

COVID-19-related stigma among infected people in Sweden; psychometric properties and levels of stigma in two cohorts as measured by a COVID-19 stigma scale

Background Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event. Methods Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach’s α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test. Results The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19–80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26–79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3–12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma. Conclusions The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV

Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery - A randomized controlled design

Preoperative physical exercise is emerging as a growing field of research globally. There are still challenges in recruiting vulnerable older people, and time constraints in preoperative cancer care to consider. We therefore evaluated the feasibility of short-term supervised home-based exercise in older people prior to colorectal cancer surgery. This feasibility study was conducted between September 2016 and June 2018. People ≥70 years scheduled for colorectal cancer surgery were recruited and randomized to an intervention group receiving supervised home-based physical exercise at a high level of estimated exertion or a standard care group following the standard preoperative path. The exercise (respiratory, strength, and aerobic) consisted of 2-3 supervised sessions a week in the participants' homes, for at least 2-3 weeks or until surgery, and a self-administered exercise program in between. The primary outcome was process feasibility, including aspects specifically related to recruitment rate, compliance to the intervention, and acceptability. The secondary outcome was scientific feasibility including treatment safety, description of dose level and response, and estimation of treatment results. Twenty-three participants were included (recruitment rate 35%). A median of 6 supervised sessions was conducted over a 17-day exercise period. Compliance with the supervised sessions was 97%, and participants found the intervention acceptable. Concerning the self-administered exercise, a median of 19 inspiratory muscle training, 6 functional strength, and 8.5 aerobic sessions were reported. Challenges reported by program instructors were time constraints and difficulties in achieving high exercise intensities on the Borg CR-10 scale. A statistically significant between-group difference was only found in inspiratory muscle strength, favoring the intervention group (p<0.01). A short-term preoperative supervised home-based physical exercise intervention can be conducted, with respect to compliance and acceptability, in older people with similar physical status as in this study prior to colorectal cancer surgery. However, modifications are warranted with respect to improving recruitment rates and achieving planned intensity levels prior to conducting a definitive trial

Long-Haul Post–COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome: The Swedish Experience

Major clinical centers in Sweden have witnessed an inflow of patients with chronic symptoms following initial outpatient care for coronavirus disease-2019 (COVID-19) infection, suggestive of postural orthostatic tachycardia syndrome. This report presents the first case series of 3 Swedish patients diagnosed with postural orthostatic tachycardia syndrome more than 3 months after the primary COVID-2019 infections

CANOPTIPHYS study protocol: Optimising PHYSical function before CANcer surgery: effects of pre-operative optimisation on complications and physical function after gastrointestinal cancer surgery in older people at risk—a multicentre, randomised, parallel-group study

Abstract Background This multicentre study explores the effects of pre-operative exercise on physical fitness, post-operative complications, recovery, and health-related quality of life in older individuals with low pre-operative physical capacity scheduled to undergo surgery for colorectal cancer. We hypothesise that this group of patients benefit from pre-operative exercise in terms of improved pre-operative physical function and lower rates of post-operative complications after surgery compared to usual care. Standardised cancer pathways in Sweden dictate a timeframe of 14–28 days from suspicion of cancer to surgery for colorectal cancer. Therefore, an exercise programme aimed to enhance physical function in the limited timeframe requires a high-intensity and high-frequency approach. Methods Participants will be included from four sites in Stockholm, Sweden. A total of 160 participants will be randomly assigned to intervention or control conditions. Simple randomisation (permuted block randomisation) is applied with a 1:1 allocation ratio. The intervention group will perform home-based exercises (inspiratory muscle training, aerobic exercises, and strength exercises) supervised by a physiotherapist (PT) for a minimum of 6 sessions in the pre-operative period, complemented with unsupervised exercise sessions in between PT visits. The control group will receive usual care with the addition of advice on health-enhancing physical activity. The physical activity behaviour in both groups will be monitored using an activity monitor. The primary outcomes are (1) change in physical performance (6-min walking distance) in the pre-operative period and (2) post-operative complications 30 days after surgery (based on Clavien-Dindo surgical score). Discussion If patients achieve functional benefits by exercise in the short period before surgery, this supports the implementation of exercise training as a clinical routine. If such benefits translate into lower complication rates and better post-operative recovery or health-related quality of life is not known but would further strengthen the case for pre-operative optimisation in colorectal cancer. Trial registration ClinicalTrials.gov NCT04878185. Registered on 7 May 2021. https://clinicaltrials.gov/ct2/hom

First mobilisation after abdominal and cardiothoracic surgery: when is it actually performed? A national, multicentre, cross-sectional study

Objectives Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively.Design A prospective observational national multicentre study.Setting 18 different hospitals in Sweden.Participants 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia&gt;2 hours.Primary and secondary outcomes Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs.Results Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia &lt;4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1–2, (OR: 1.63, 95% CI: 1.13 to 2.36).Conclusions In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation.Trial registration number FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634)