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Background: Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. Methods: This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. Results: Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. Conclusions: This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings. [ABSTRACT FROM AUTHOR]

Anxiety and depression are two psychological illnesses that are linked to chronic obstructive pulmonary disease (COPD). In Saudi Arabia, no research has been done on the prevalence of psychological disorders among patients with COPD and their association with COPD severity. This study aims to screen for anxiety and depression among Saudi patients with COPD and to explore the impact of COPD severity on the patients' psychological status. In this cross-sectional study, we recruited 70 stable patients with COPD from outpatient respiratory clinics. Anxiety and depression were evaluated using the Anxiety Inventory for Respiratory Disease (AIR) scale and Patient Health Questionnaire-9 (PHQ-9). The AIR identified that 46% of patients with COPD had anxiety and the PHQ-9 identified that 60% had depression. Patients with severe COPD stages were at greater risk of anxiety [AIR odds ratio (OR) = 2.54, 95% confidence interval (CI): 2.31-2.86] and depression (PHQ-9 OR = 3.08, 95% CI: 2.76-3.45). Patients with severe COPD stages are at increased risk of both anxiety and depression compared to patients with less severe COPD stages. [ABSTRACT FROM AUTHOR]

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is the most specific and widely used questionnaire for assessing health-related quality of life (HRQoL) in chronic heart failure (CHF). This study aimed to examine reliability and validity of the KCCQ in Arabic patients with CHF. Material and Methods: Patients with CHF filled out the Arabic versions of the Minnesota Living with Heart Failure (MLHF) and KCCQ questionnaire, and performed a six-minute walk test (6MWT) on their first visit. On the return, the patients filled out the KCCQ along with the global rating of change (GRC) scale. Internal consistency, test–retest reliability, and construct validity were examined. Results: A total of 101 Arabic patients with CHF, with a mean (SD) age of 55 (11) years old, completed the study. The Cronbach's alpha was 0.97, and the ICC2,1 = 0.95 (95%CI: 0.92 to 0.97, p < 0.001). The Arabic version of KCCQ was correlated with the MLHF (r = −0.57, p = 0.01) and with the 6MWT (r = 0.70, p < 0.001). Conclusions: The Arabic version of KCCQ is a reliable and valid measure of HRQoL, which could be utilized in routine clinical practice for Arabic-speaking patients with CHF. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt the original Duke Activity Status Index (DASI) into the Arabic language and examine its psychometric properties in Arabic speaking patients with Chronic Obstructive Pulmonary Disease (COPD). The DASI was translated into the Arabic language and tested on 70 Arabic patients with COPD. Patients with COPD completed also the Six-Minute Walk Test (6MWT) and Saint George Respiratory Questionnaire (SGRQ) on the first visit. On the second visit, the patients with COPD completed the Arabic version of DASI along with the global rating of change scale (GRC). The internal consistency, test-retest reliability and construct validity were examined. Seventy Arabic speaking patients with COPD (56 males), mean (SD) age was 63.2 (11.1) year, completed the study. The patients reported no difficulty in understanding and completing the scale. Three items were modified and adapted to the Arabic culture. The Cronbach's alpha was 0.87, and the ICC2,1 was 0.95. The Arabic version of DASI correlated with the 6MWT (r = 0.55), the total score of SGRQ (r = −0.64) and its activity domain (r = −0.67), all p < 0.001. The Arabic version of DASI is a simple, quick, reliable, and valid measure of functional capacity in Arabic speaking patients with COPD. The Arabic DASI can be used in all Arabic-speaking countries given that the scale was adapted to standard Arabic language. The Arabic DASI would yield similar scores with administrations over time in patients with unchanged condition and stable COPD. This questionnaire could be used for screening of functional capacity in COPD in primary care settings. [ABSTRACT FROM AUTHOR]

To examine the psychometric properties of the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in people with chronic obstructive pulmonary disease (COPD). Stable individuals with COPD (N = 70) confirmed by spirometry were asked to complete the LEFS-Ar, St George's Respiratory Questionnaire (SGRQ) and performed the Six-Minute Walk Test (6MWT). Participants were also asked to complete LEFS-Ar for the second time within 10 days. The LEFS-Ar floor and ceiling effects, internal consistency, test–retest reliability, measurement error, and construct validity were examined. The LEFS-Ar had excellent internal consistency with Cronbach's alpha of 0.95 and excellent test–retest reliability (ICCagreement=0.91) with no floor and ceiling issues. Standard error of measurement was 4.78 points while the minimal detectable change at 90% confidence was 11.15 points. Consistent with our hypotheses, the LEFS-Ar scores correlated significantly with 6MWT (r= −0.66, p < 0.001), activity domain of the SGRQ (r = 0.55, p < 0.001), and were significantly different according to COPD disease severity (p= 0.02). In people with COPD, the LEFS-Ar has excellent reliability with no floor or ceiling effects. The LEFS-Ar demonstrated evidence supporting its validity as a measure of activity limitation that can be used in clinical practice and in research studies. The Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) is a reliable measure in people with chronic obstructive pulmonary disease (COPD). Rehabilitation specialists can use the LEFS-Ar to validly measure activity limitation in people with COPD. [ABSTRACT FROM AUTHOR]

The Anxiety Inventory for Respiratory Disease (AIR) is a reliable and valid scale for examining the anxiety in patients with COPD. This study aimed to cross-culturally adapt and translate the original AIR scale into the Arabic language and to examine its reliability and validity in Arab patients with COPD. This was a validation study conducted on 70 Arabic patients with COPD. The AIR-A and the Hospital Anxiety and Depression Scale (HADS) were completed on the first assessment. After two weeks, 55 patients completed the AIR-A scale again. The reliability was assessed by Cronbach's α and intraclass correlation coefficients (ICC2,1). Exploratory factor analysis (EFA), and the confirmatory factor analysis (CFA) were used to measure the structural validity. The construct validity was also explored. The AIR-A questionnaire had a Cronbach's α of 0.91 and ICC2,1 of 0.86. The EFA revealed that the AIR-A was unidimensional. The CFA showed the single-factor model required minor modifications to reach the best fit. The AIR-A was correlated with the HADS- anxiety (r = 0.89, p < 0.001). The Arabic version of AIR scale is reliable, and valid for assessing the anxiety disorder in Arabic speaking patients with COPD worldwide. The Arabic version of AIR will be useful for examining anxiety in Arabic speaking patients with COPD worldwide. The Arabic version of AIR will help clinicians to monitor the effect of interventions in Arabic speaking patients with COPD who suffer from anxiety. The Arabic version of AIR assess only the anxiety. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diaphragmatic release technique and thoracolumbar manipulation have been found effective in restoring normal diaphragmatic movement in healthy and diseased populations. Smoking has deleterious effects on human systems, including the musculoskeletal system. OBJECTIVE: The current study aimed to investigate the immediate effects of diaphragmatic release technique and thoracolumbar manipulation on diaphragm muscle strength in healthy smokers. METHODS: A double-blinded randomized clinical trial was conducted on 30 asymptomatic healthy smokers randomly assigned into two groups [intervention group (IG) and sham group (SG)] with 15 participants each. The IG received thoracolumbar manipulation and diaphragmatic release techniques, while the SG received no active treatment. The outcome measure was sniff nasal inspiratory pressure (SNIP). RESULTS: The IG showed a significant increase in the SNIP with a mean difference of 20.13 cmH 2 O (95% CI: 13.62–26.64; P < 0.001), while the SG had a reduction in the SNIP value - 3.27 cmH 2 O (95% CI: - 0.65 to - 5.89; P = 0.02). Diaphragmatic release technique and thoracolumbar manipulation significantly improved SNIP values immediately after the intervention, with a between-group difference of 31.07 cmH 2 O (95% CI: 15.26–46.87; P < 0.001). CONCLUSIONS: Diaphragmatic release technique and thoracolumbar manipulation increased the diaphragm strength in healthy adult smokers, suggesting its potential utility in the management of participants with reduced respiratory muscle strength. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM). Methods: This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six‐minute walking test (6MWT) were measured at baseline and 8 weeks post incremental inspiratory muscle training. Results: At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8 weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ± 5.30 cm H2O vs 2.8 ± 4.8 cm H2O) and MIP (mean difference: 19.4 ± 4.3 Vs 5.4 ± 3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70 ± 29 m vs 34 ± 24 m) compared to the placebo group, P <.05. Conclusion: Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity. [ABSTRACT FROM AUTHOR]