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Objective. The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). Methods.The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity, and HRQL in individuals with stable COPD were selected. Two authors independently extracted data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. The study effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies, and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in 1 second = 34%-80%) using over 10 diverse protocols for HGS measurement. Statistically significant, small, and negative relationships were found between HGS and mortality (r = -0.03; 95% CI = -0.05 to -0.02). Independent of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Index Updated (r = -0.42; 95% CI = -0.61 to -0.03); exacerbations (r = -0.02; 95% CI = -0.04 to -0.00); and hospitalizations (r = -0.69; 95% CI = -1.70 to 0.32). Similarly, for HRQL, independent of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r = -0.22; 95% CI = -0.32 to -0.12), Chronic Respiratory Disease Questionnaire domains (-0.24 < r < -0.14), EuroQol Five-Dimension Questionnaire (utility score) (r = -0.17; 95% CI = -0.26 to -0.07), EuroQol Five-Dimension Questionnaire domains (-0.32 < r < -0.06), and St George Respiratory Questionnaire total (r = -0.26; 95% CI = -0.33 to -0.17). The quality of the evidence ranged from low to very low across outcomes. Conclusion. Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have an increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity indexes), and poorer HRQL. Keywords: Chronic Respiratory Diseases, Exacerbations, Lung Diseases, Muscle Strength, Introduction Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of mortality worldwide and is projected to be the third leading cause by 2020. (1) COPD is a [...]

Background. The World Health Organization recognizes participation in meaningful life roles as a key component of health. However, the evidence base for interventions to improve participation remains inconclusive. In particular, [...]

Background. The use of standardized assessment tools is an element of evidence-informed rehabilitation, but physical therapists report administering these tools inconsistently poststroke. An in-depth understanding of physical therapists' approaches to walking assessment is needed to develop strategies to advance assessment practice. Objectives. The objective of this study was to explore the methods physical therapists use to evaluate walking poststroke, reasons for selecting these methods, and the use of assessment results in clinical practice. Design. A qualitative descriptive study involving semistructured telephone interviews was conducted. Methods. Registered physical therapists assessing a minimum of 10 people with stroke per year in Ontario, Canada, were purposively recruited from acute care, rehabilitation, and outpatient settings. Interviews were audiotaped and transcribed verbatim. Transcripts were coded line by line by the interviewer. Credibility was optimized through triangulation of analysts, audit trail, and collection of field notes. Results. Study participants worked in acute care (n=8), rehabilitation (n=11), or outpatient (n=9) settings and reported using movement observation and standardized assessment tools to evaluate walking. When selecting methods to evaluate walking, physical therapists described being influenced by a hierarchy of factors. Factors included characteristics of the assessment tool, the therapist, the workplace, and patients, as well as influential individuals or organizations. Familiarity exerted the primary influence on adoption of a tool into a therapist's assessment repertoire, whereas patient factors commonly determined daily use. Participants reported using the results from walking assessments to communicate progress to the patient and health care professionals. Conclusions. Multilevel factors influence physical therapists' adoption and daily administration of standardized tools to assess walking. Findings will inform knowledge translation efforts aimed at increasing the standardized assessment of walking poststroke., Physical Therapists' Use of Standardized Measures for Walking Capacity Worldwide, 15 million people experience a stroke each year. (1) More than half lose their ability to walk independently immediately poststroke. [...]

Background. Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients. Objectives. The purpose of this study was to develop a clinical decision-making tool to guide health care professionals in the assessment, prescription, monitoring, and progression of mobilization and therapeutic exercise for patients with AECOPD. Design and Methods. A 3-round interdisciplinary Delphi panel identified and selected items based on a preselected consensus of 80%. These items were summarized in a paper-based tool titled Mobilization in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD-Mob). Focus groups and questionnaires were subsequently used to conduct a sensibility evaluation of the tool. Results. Nine researchers, 13 clinicians, and 7 individuals with COPD identified and approved 110 parameters for safe and effective exercise in AECOPD. These parameters were grouped into 5 categories: (1) 'What to Assess Prior to Mobilization,' (2) 'When to Consider Not Mobilizing or to Discontinue Mobilization,' (3) 'What to Monitor During Mobilization for Patient Safety,' (4) 'How to Progress Mobilization to Enhance Effectiveness,' and (5) 'What to Confirm Prior to Discharge.' The tool was evaluated in 4 focus groups of 18 health care professionals, 90% of whom reported the tool was easy to use, was concise, and would guide a health care professional who is new to the acute care setting and working with patients with AECOPD. Limitations. The tool was developed based on published evidence and expert opinion, so the applicability of the items to patients in all settings cannot be guaranteed. The Delphi panel consisted of health care professionals from Canada, so items may not be generalizable to other jurisdictions. Conclusions. The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner., The majority of individuals with chronic obstructive pulmonary disease (COPD) experience at least one acute exacerbation of COPD (AECOPD) per year; many have multiple exacerbations. (1) Many of these exacerbations [...]

Background. Little is known of the early changes in physical activity after lung transplantation. Objectives. The purposes of this study were: (1) to describe physical activity levels in patients up to 6 months following lung transplantation and (2) to explore predictors of the change in physical activity in that population. Design. This was a prospective cohort study. Methods. Physical activity (daily steps and time spent in moderate-intensity activity) was measured using an accelerometer before and after transplantation (at hospital discharge, 3 months, and 6 months). Additional functional measurements included submaximal exercise capacity (measured with the 6-Minute Walk Test), quadriceps muscle torque, and health-related quality of life (measured with the Medical Outcomes Study 36-Item Short-Form Health Survey 36 [SF-36] and the St George's Respiratory Questionnaire). Results. Thirty-six lung transplant recipients (18 men, 18 women; mean age=49 years, SD=14) completed posttransplant measurements. Before transplant, daily steps were less than a third of the general population. By 3 months posttransplant, the largest improvement in physical activity had occurred, and level of daily steps reached 55% of the general population. The change in daily steps (pretransplant to 3 months posttransplant) was inversely correlated with pretransplant 6-minute walk distance (r = -.48, P=.007), daily steps (r = -.36, P=.05), and SF-36 physical functioning (SF-36 PF) score (r = -.59, P=.0005). The SF-36 PF was a significant predictor of the change in physical activity, accounting for 35% of the variation in change in daily steps. Limitations. Only individuals who were ambulatory prior to transplant and discharged from the hospital in less than 3 months were included in the study. Conclusions. Physical activity levels improve following lung transplantation, particularly in individuals with low self-reported physical functioning. However, the majority of lung transplant recipients remain sedentary between 3 to 6 months following transplant. The role of exercise training, education, and counseling in further improving physical activity levels in lung transplant recipients should be further explored., An important goal of lung transplantation is the improvement of physical function in individuals with end-stage lung disease. (1) Physical functioning is an important component of health-related quality of life [...]

Background. Aerobic activity positively affects patients recovering from stroke and is part of best practice guidelines, yet this evidence has not been translated to routine practice. Objective. The objective of this study was to evaluate the feasibility of a model of care that integrated aerobic training in an inpatient rehabilitation setting for patients in the subacute stage of stroke recovery. Key elements of the program were personalized training prescription based on submaximal test results and supervision within a group setting. Design. This was a prospective cohort study. Methods. Participants (N=78) completed submaximal exercise testing prior to enrollment, and the test results were used by their treating physical therapists for exercise prescription. Feasibility was evaluated using enrollment, class attendance, adherence to prescription, and participant perceptions. Results. Overall, 31 patients (40%) were referred to and completed the exercise program. Cardiac comorbidities were the main reason for nonreferral to the fitness group. Program attendance was 77%; scheduling conflicts were the primary barrier to participation. The majority of participants (63%) achieved 20 minutes of continuous exercise by the end of the program. No adverse events were reported, all participants felt they benefited from the program, and 80% of the participants expressed interest in continuing to exercise regularly after discharge. Limitations. Cardiac comorbidities prevented enrollment in the program for 27% of the admitted patients, and strategies for inclusion in exercise programs in this population should be explored. Conclusions. This individualized exercise program within a group delivery model was feasible; however, ensuring adequate aerobic targets were met was a challenge, and future work should focus on how best to include individuals with cardiac comorbidities., The majority of individuals recovering from a stroke are left with residual disability or activity limitations, which lead to a lower quality of life. (1,2) Many of these limitations are [...]

Background. Balance is a composite ability requiting the integration of multiple systems. The Balance Evaluation Systems Test (BESTest) and 2 abbreviated versions (the Mini-BESTest and the Brief-BESTest) are balance assessment tools that target these systems. To date, no normative data exist for any version of the BESTest. Objective. The purpose of this study was to determine the age-related normative scores on the BESTest, Mini-BESTest, and Brief-BESTest for Canadians who are healthy and 50 to 89 years of age. Design. A cross-sectional study design was used. Methods. Seventy-nine adults who were healthy and aged 50 to 89 years (mean age=68.9 years; 50.6% women) participated. Normative scores were reported by age decade. Results. Mean BESTest scores were 95.7 (95% confidence interval [CI]=94.497.1) for adults who were aged 50 to 59 years, 91.4 (95% CI=89.8-93.0) for those who were aged 60 to 69 years, 85.4 (95% CI=82.5-88.2) for those who were aged 70 to 79 years, and 79.4 (95% CI =74.3- 84.5) for those who were aged 80 to 89 years. Similar results were obtained for the Mini-BESTest and the Brief-BESTest, and all 3 tests showed statistically significant differences in scores among the age cohorts. Limitations. Because only adults who were 50 to 89 years of age were tested, there are still no normative data for people outside this age range. Also, the scores presented may not be generalizable to all countries. Conclusions. These normative data enhance the clinical utility of the BESTest, Mini-BESTest, and Brief-BESTest by providing clinicians with reference points to guide treatment., Approximately one third of people who live in the community and are more than 65 years of age fall each year. (1) Falls are associated with increased morbidity and mortality [...]

Study objectives: This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most [...]

Objectives: To develop valid and reliable hospital discharge criteria and a scoring system that would be used to assess when a patient should be discharged from perioperative physical therapy (PT) [...]

Study objective: To evaluate the influence of oral anabolic steroids on body mass index (BMI), lean body mass, anthropometric measures, respiratory muscle strength, and functional exercise capacity among subjects with [...]

This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 (n = 21), 2 to 4 (n = 23), and 5 to 7 (n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.

Objective: We conducted a systematic overview of randomized controlled trials (RCTs) to clarify the contribution of nutritional supplementation for patients with stable COPD. Methods: RCTs were identified from several sources, [...]

Objective: To perform a qualitative systematic overview of the measurement properties of the most commonly utilized walk tests in the cardiorespiratory domain: the 2-min walk test (2MWT), 6-min walk test [...]

A Meta-analysis Rationale: Malnutrition in patients with COPD is associated with an impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rate when compared to adequately nourished [...]

Purpose: To describe trends in the epidemiology of COPD in Canada from 1980 to 1995, in terms of perceived prevalence, mortality, and hospital morbidity. Data sources: We limited the analysis [...]

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