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Respiratory muscle weakness resulting from conditions such as neuromuscular disease can lead to respiratory infection, hospitalization and serious pulmonary complications. Secretion clearance from the airways is correlated with peak expiratory cough flow, which can be enhanced by physical manoeuvres coupled with manual or mechanical resuscitator devices. Cough-assistance devices, such as the mechanical insufflator-exsufflator, can increase inspiratory lung volumes and peak expiratory cough flows beyond the patient's spontaneous ability and significantly augment lung secretion clearance. This study was prompted by the lack of data regarding current practices and availability of mechanical insufflator-exsufflator devices in Canada.

This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness., Author(s): Sanaa A. Alsubheen [sup.1] , Ana Oliveira [sup.1] [sup.2] [sup.3] [sup.4] , Razanne Habash [sup.2] , Roger Goldstein [sup.2] [sup.5] , Dina Brooks [sup.1] [sup.2] [sup.6] Author Affiliations: (1) [...]

Background and objectives: Available evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD. Methods: We conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2–3 times per week for 8–12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values. Results: Of 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67). Conclusions: PR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD. Trial registration: The study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016. [ABSTRACT FROM AUTHOR]

The Hospital Anxiety and Depression Scale (HADS) is used to assess anxiety and depression in individuals with chronic obstructive pulmonary disease (COPD); however, its measurement properties lack critical appraisal. We aimed to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in COPD. Five electronic databases were searched. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines were used to assess the methodological and evidence quality in the selected studies. Twelve studies assessed the psychometric properties of the HADS-Total and its subscales HADS-Anxiety and HADS-Depression in COPD. High-quality evidence supported the structural and criterion validity of the HADS-A, the internal consistency of the HADS-T, HADS-A, and HADS-D with Cronbach's alpha values of 0.73–0.87, and before–after treatment responsiveness of HADS-T and its subscales (minimal clinically important difference = 1.4–2; effect size = 0.45–1.40). Moderate-quality evidence supported the test–retest reliability of the HADS-A and HADS-D with excellent coefficient values of 0.86–0.90. The HADS-A is recommended for use in individuals with stable COPD. The lack of high-quality evidence on the validity of the HADS-D and HADS-T prevented drawing robust conclusions about their clinical utility in COPD. Anxiety and depression are common in individuals with chronic obstructive pulmonary disease (COPD). Anxiety and depression can negatively impact the physical and mental health of individuals with COPD. The HADS can be used to assess anxiety and depression in COPD in rehabilitation settings. [ABSTRACT FROM AUTHOR]

Introduction: Inspiratory muscle training (IMT) is one possible strategy to ameliorate respiratory muscle weakness due to invasive mechanical ventilation. Recent systematic reviews have focused on respiratory outcomes with minimal attention to physical function. The newest systematic review searched the literature until September 2017 and a recent preliminary search identified 5 new randomized controlled trials focusing on IMT in critical care. As such, a new systematic review is warranted to summarize the current body of evidence and to investigate the effect of IMT on physical function in critical care. Materials and methods: We will search for three main concepts ("critical illness", "inspiratory muscle training", "RCT") across six databases from their inception (MEDLINE, EMBASE, Emcare, AMED, CINAHL, CENTRAL) and ClinicalTrials.gov. Two reviewers will independently screen titles, abstracts, and full texts for eligibility using the Covidence web-based software. Eligible studies must include: (1) adult (≥18 years) patients admitted to the intensive care unit (ICU) who required invasive mechanical ventilation for ≥24 hours, (2) an IMT intervention using a threshold device with the goal of improving inspiratory muscle strength, with or without usual care, and (3) randomized controlled trial design. The primary outcome of interest will be physical function. We will use the Cochrane Risk of Bias Tools (ROB2) and will assess the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. This protocol has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA- P) guidelines and is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Conclusion: Results will summarize the body of evidence of the effect of IMT on physical function in critically ill patients. We will submit our findings to a peer-reviewed journal and share our results at conferences. [ABSTRACT FROM AUTHOR]