Brisswalter, J.

Gruet, M.

Mely, L.

Vallier, J.-M.

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208 Neuromuscular electrical stimulation in cystic fibrosis 

Posters 8. Physiotherapy S109
205 What do our adult CF patients know about bone health?
S. Lenaghan1, C. Knowles1, M. Caraher1, A. Anderson1, K. Heslop1, S. Doe1,
S. Bourke1. 1Adult Cystic Fibrosis Centre, Royal Victoria Inﬁrmary, Newcastle-
upon-Tyne, United Kingdom
Background: Reduced bone mineral density (BMD) is common in patients with
CF. Many patients are unaware of the problems which low BMD can lead to, such as
susceptibility to fractures, pain and disability. Education regarding CF bone health
is currently undertaken as part of standard consultations by the team, including
doctors, physiotherapists and dieticians.
Method: 50 randomly selected patients completed a questionnaire on bone health
in CF, which assessed their knowledge of bone health, treatments, adherence to
taking prescribed vitamins and pancreatic enzymes. Knowledge regarding exercise
was evaluated by asking which activities could improve BMD and which should be
avoided if an individual had low BMD.
Results: 74% patients were aware that people with CF tend to have low BMD.
Vitamins (88%), calcium supplements (68%) and exercise (62%) were the most
identiﬁed treatments for BMD. However 48% were unable to identify any exercises
that might need to be avoided with low BMD. 68% of patients were aware that
steroids might affect their BMD. Patients were unable to describe what osteopenia
(84%) or osteoporosis (42%) was. 58% did not know what symptoms someone with
low BMD might experience.
Conclusion: In general patients had a reasonably good knowledge of bone health
in CF but reported suboptimal adherence to vitamin supplements and were unsure
of the role of exercise in particular. Speciﬁc education about bone health in CF may
be needed to improve awareness of bone health, to enable patients to understand
how different treatments help maintain bone health. This might improve adherence
to vitamin supplements and appropriate exercise.
206 Stress urinary incontinence in adult CF patients: prevalence and
physiotherapy management in Wales
S. Thomas1, A. Stokes1, V. Angulatta1, I. Ketchell1, J. Duckers1. 1University
Hospital Llandough, All Wales Adult Cystic Fibrosis Centre, Cardiff, United
Kingdom
Stress urinary incontinence (SUI) is an under diagnosed and under reported
condition in CF. SUI affects males and females. However, previous reports show
the prevalence in women with CF is higher than in their age matched peers.
Purpose:
i. To identify the prevalence of adult CF patients experiencing symptoms of SUI
ii. To compare current management of SUI with the CF Trust Physiotherapy
Recommendations of Best Practice.
Method: A retrospective review of SUI in adult CF patients was conducted. Data
was collected from the 160 (91 male) annual reviews completed between July 2010
and July 2011. All patients received care at the All Wales Adult CF Centre and
had a conﬁrmed diagnosis of CF. The following data was collected: Age; sex;
FEV1; phenotype; number of exacerbations requiring IV’s; any history of SUI; any
physiotherapy assessment, intervention, investigations or referrals relating to SUI.
Results: SUI was reported in 10 (14.5%) female and 0 male patients. All pa-
tients identiﬁed with SUI were taught pelvic ﬂoor exercises. No formal objective
assessments were completed. No follow up assessments were recorded. Females
reporting SUI had a tendency to be older and have a lower FEV1 but this was
not statistically signiﬁcant (p = 0.07 and p = 0.47). No correlation was seen between
SUI and severity of phenotype or number of exacerbations requiring IV’s.
Conclusions: The prevalence of SUI in both males and females identiﬁed in
this cohort is lower than in previously published data. This could partly be due
to under reporting of symptoms however this review highlights the need for
development of a physiotherapy pathway for the identiﬁcation and management
of patients with SUI.
207 The development of a musculoskeletal screening tool for adults
with cystic ﬁbrosis: stage 2
J. Ashbrook1, J. Taylor1, S. Johnson1. 1University Hospital South Manchester,
Manchester Adult Cystic Fibrosis Centre, Manchester, United Kingdom
Introduction: Following the presentation of stage 1 of the musculoskeletal (MSK)
screening tool (ST) there was discussion around how it could be developed further
to be used as a data collection tool and guide pathways of care.
Objectives:
1. To include validated pain and stress urinary incontinence (UI) questionnaires.
2. To increase the data set to enable future research into predictors of pain.
3. To develop care pathways guided by MSKST outcome.
Method: The MSKST was redeveloped. The McGill Pain Questionnaire (MPQ)
and the International Incontinence Q (ICIQ-UI) were included. Care pathways for
pain and UI were developed with assistance from msk and women’s health physios.
A pilot of 14 patients was carried out.
Results: Male = 8, female = 6.
Microbiological group: Ps group 1 = 6, Ps group 2 = 5, non-Ps = 3.
7 diabetics.
Median FEV1 was 1.3.
10 complained of a pain with a mean MPQ of 48/150.
Site of pain: Spine = 8, peripheral = 1, non-msk = 1.
6 complained of UI with a mean ICIQ of 6/21.
13 had postural concerns with 4 having a ﬁxed thoracic kyphosis.
Msk physio = 9, posture and exercise leaﬂet = 3, pelvic ﬂoor leaﬂet = 4, no
intervention, screen in 1−2 years = 1.
Conclusion: The inclusion of the MPQ and ICIQ validates the MSKST to be used
to assess and monitor severity of pain and UI.
The addition of care pathways ensures all patients have the opportunity to receive
optimal management of their symptoms.
Large amounts of data need to be collected before analysis can be performed to gain
insight into predictors of pain and correlation between pain and other parameters.
It is hoped that the MSKST can be rolled out to other centers to help improve the
management of these symptoms nationally.
208 Neuromuscular electrical stimulation in cystic ﬁbrosis
M. Gruet1, L. Mely2, J. Brisswalter1, J.-M. Vallier3. 1University of Nice Sophia
Antipolis, Human Motricity, Education Sport and Health, EA 6574, Nice, France;
2Regional Cystic Fibrosis Unit (CRCM), Giens, France; 3University of Toulon,
Human Motricity, Education Sport and Health, EA 6574, Toulon, France
The purpose of the present study was to evaluate the feasibility and efﬁcacy of
the addition of neuromuscular electrical stimulation (NMES) to endurance training
(ET) in adults with cystic ﬁbrosis (CF).
Fifteen patients with mild to moderate CF were randomised to 6 weeks of ET
alone or combined with NMES (ET+NMES), performed at home. Each patient
served as its own control and realized both training modalities. Ten healthy controls
also performed the ET+NMES. Measurement of peripheral muscle strength and
endurance, peak oxygen uptake, maximal aerobic power and lactate concentration
determined during maximal incremental cycling test and six-min walking distance
(6MWD) were obtained at baseline and after training.
Nine patients completed ET and ET+NMES and constituted the study group (age:
27±7 yr, FEV1 = 52±15.7% predicted). ET+NMES was well tolerated in both
groups. Improvements in 6MWD (p = 0.01) and maximal aerobic power (p = 0.008)
were observed only after ET+NMES in CF patients. Trends towards improvement
in quadriceps endurance (p = 0.07) and reduction in whole blood lactate for a given
workload (p = 0.07) were also observed in this group after ET+NMES.
The addition of NMES to classic ET is safe and may improve some markers of
muscle function and aerobic ﬁtness in CF patients. However, further studies using
larger cohorts of patients across the disease spectrum are required to conﬁrm these
preliminary ﬁndings.
This work was ﬁnancially supported by the French Cystic Fibrosis Association
“Vaincre La Mucoviscidose”.


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208 Neuromuscular electrical stimulation in cystic fibrosis

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