Objective. After laryngectomy, the breathing resistance of heat and moisture exchangers may limit exercise capacity. Breathing gas analysis during cardiopulmonary exercise testing is not possible using regular masks. This study tested the feasibility of cardiopulmonary exercise testing with a heat and moisture exchanger in situ, using an in-house designed connector. Additionally, we explored the effect of different heat and moisture exchanger resistances on exercise capacity in this group. Methods. Ten participants underwent two cardiopulmonary exercise tests using their daily life heat and moisture exchanger (0.3 hPa or 0.6 hPa) and one specifically developed for activity (0.15 hPa). Heat and moisture exchanger order was randomised and blinded.Results. All participants completed both tests. No (serious) adverse events occurred. Only four subjects reached a respiratory exchange ratio of more than 1.1 in at least one test. Maximum exercise levels using heat and moisture exchangers with different resistances did not differ. Conclusion. Cardiopulmonary exercise testing in laryngectomees with a heat and moisture exchanger is feasible; however, the protocol does not seem appropriate to reach this group's maximal exercise capacity. Lowering heat and moisture exchanger resistance does not increase exercise capacity in this sample.
CC-BY 4.0 Background: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to nonspecific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy.Objectives: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls.Design: Multicenter case control study.Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included.Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, pvalues< 0.05, with Tukey’s HSD post-hoc test were considered significant.Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11–0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10–0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03).Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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SYNOPSIS: Vascular serious adverse events can occur after examining, manipulating, mobilizing, and prescribing exercise for the cervical spine. Patients presenting with neck pain and headache who develop a vascular serious adverse event during or after treatment may have vascular flow limitations that go unrecognized and are aggravated by treatment. Patients with neck pain and headache-the first nonischemic symptoms of arterial dissection-frequently access physical therapists as first-point providers, not all of whom have specialist training in orthopaedic manual physical therapy. All physical therapists, irrespective of their training, who are helping patients manage neck pain, headache, and/or facial symptoms must feel confident to identify potential vascular flow limitations of the neck prior to providing treatment. J Orthop Sports Phys Ther 2021;51(9):418-421. Epub 10 May 2021. doi:10.2519/jospt.2021.10408.
