Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review

Introduction Exertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests. Methods A systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English. Results Searches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions. Conclusion Considerable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting

Factors associated with student satisfaction within a regional student-led physiotherapy clinic: A retrospective qualitative study

Clinical education requires students to integrate theoretical knowledge and skills into real-life clinical environments. Most clinical education opportunities remain within metropolitan hospitals where student education is often secondary to patient care. In response, many Universities are developing student-led clinics that focus on the student educational experience, whilst providing high-quality patient care. Understanding factors associated with student satisfaction within student-led physiotherapy clinics, particularly in regional areas, is necessary to build the regional and rural workforce. Thirty-eight students from a 3rd and 4th year Bachelor of Physiotherapy (Hons) undergraduate degree completed written open-ended student feedback at the completion of a five-week placement within a student-led allied health clinic in Rockhampton, Queensland between 2018 and 2019. These data were collected as feedback for the clinic and were not related to course evaluations. All responses were then transformed into one document per question and analysed following an inductive approach and semantic thematic analysis. Using thematic analysis, five key themes were identified to impact student satisfaction: 1) clinical educators and clinic staff; 2) feedback to students; 3) professional development opportunities; 4) low patient numbers and a lack of clinical presentations; and 5) facilities, equipment, and resources. This study has identified several key factors associated with positive and negative student satisfaction within a regional student-led physiotherapy clinic. Implementing factors associated with positive student satisfaction will likely enhance student learning experience and improve the clinical placement experience, potentially improving recruitment opportunities in a regional setting

Exertional dyspnea responses to the Dyspnea Challenge in heart failure: Comparison to chronic obstructive pulmonary disease

Background: In heart failure (HF), exertional dyspnea is a common symptom, but validated field-based tests for its measurement are limited. The Dyspnea Challenge is a two-minute uphill treadmill walk designed to measure exertional dyspnea in cardiopulmonary disease. Objectives: The purpose of this study was to establish the test-retest reliability of the Dyspnea Challenge in HF and to compare the exercise responses to a group with chronic obstructive pulmonary disease (COPD). Methods: The study was an experimental, single-blind, randomized, multi-site project that recruited individuals with HF (New York Heart Association I-III) and COPD (Global Initiative for Chronic Obstructive Lung Disease II-IV). Participants completed two visits. On the first visit, participants performed two six-minute walk tests (6MWT), followed by two to three Dyspnea Challenges to calculate treadmill speed and gradient. At Visit Two, participants performed two separate Dyspnea Challenges, with one including measures of pulmonary gas exchange and central hemodynamics. Results: Twenty-one individuals with HF (10 female; 66§11years; ejection fraction:45.3 § 6.1%; six-minute distance(6MWD) 520 § 97 m), and 25 COPD (11 female; 68 § 10 yr; forced expiratory volume in 1 s:47.6 § 11.5%; 6MWD: 430 § 101 m). Intraclass correlation coefficients demonstrated excellent test-retest reliability for HF (0.94, P<.01) and COPD (0.95, P<.01). While achieving similar end-exercise exertional dyspnea intensities (P=.60), the HF group walked at a higher average speed (4.2 § 0.8 vs. 3.5 § 0.8km¢h 1) and gradient (10.3 § 2.8 vs. 9.6 § 2.8%) and a greater oxygen uptake (P<.01) and ventilation (P<.01) than those with COPD. While achieving similar cardiac outputs (P=.98), stroke volumes (P=.97), and heart rates (P=.83), those with HF displayed a larger arteriovenous oxygen difference (P<.01), while those with COPD exhibited greater decreases in inspiratory capacity (P=.03), arterial oxygen saturation (P=.02), and breathing reserve (P<.01). Conclusions: The Dyspnea Challenge is a reliable test-retest measure of exertional dyspnea in HF. Typical to their pathologies, HF seemed limited by an inadequate modulation of cardiac output, while ventilatory constraints hampered those with COPD

Clinical activity profile of physiotherapy students in a regional student-led musculoskeletal clinic: A retrospective study

The study aimed to quantify the clinical activity profile of physiotherapy students within a regional student-led musculoskeletal clinic. A retrospective clinical audit examined all occasions of service (OOS) delivered during 2018. Demographic data and student to clinical educator (CE) ratio were also collected. Descriptive statistics were used to describe patient demographics. The average OOS per student per week between student to CE ratios (i.e., 2:1 and 3:1 group) were analysed using a repeated measures ANOVA. A total of 214 clients were included (mean age 40.9 years (SD 20.4) with 66.5% being female (n = 133)). The shoulder (19.3%) was the most assessed/treated region, followed by the knee (18.9%), and ankle/foot (16.2%). Analysis revealed a main effect of week (p<0.001), but not for student to CE ratio (p=0.125). There was no interaction of week by student to CE ratio (p=0.528). Post hoc analysis revealed the average OOS per student per week was lower for week 1 than in weeks 2, 3, and 4, with a small but statistically significant decrease in average OOS from week 4 to 5. Overall, students attending a regional student-led musculoskeletal clinic see a variety of clinical presentations, from clients across the lifespan, with increasing OOS across the placement