Search

Background: Chest physiotherapy for airway clearance is not recommended in children hospitalized with bronchiolitis. The updated Cochrane meta-analysis suggests that slow expiratory techniques could slightly improve clinical severity, but the evidence certainty is low and the clinical significance of this change is unknown. We investigated whether the prolonged slow expiration technique (PSET) would impact the 24-h food intake of these children., Methods: We conducted a two-arm double-blind randomized controlled trial. Hospitalized children aged from 1 to 12 months, bottle-fed or diversified and referred for airway clearance were included. Both groups received upper airway clearance at inclusion and standard treatments. The experimental group received PSET including rhinopharyngeal unclogging and targeted unprovoked cough. The primary outcome was the 24-h food intake. Clinical severity, vomit episodes and sleep quality were also recorded. An ordinary least squares linear regression for quantitative variables was modelled for between-group comparisons., Results: From January 9, 2019, to December 1, 2022, 42 children were randomized with a 1:1 ratio (mean age: 5.0 (± 2.9) months). The 24-h food intake did not differ between groups (estimate: 1.8% (95%CI -7.0 to 10.6); p = 0.68). PSET had no effect on SpO2, clinical severity, RR and HR at the follow-up assessments (5 min, 30 min and 24 h after intervention), nor on the number of vomit episodes, total sleep time and SpO2 during sleep., Conclusions: PSET did not affect food intake or the 24-h course of bronchiolitis more than standard treatment in children hospitalized for moderate bronchiolitis., Trial Registration: NCT03738501  registered on 13/11/2018, Slow Expiratory Technique to Improve Alimentation in Children With Bronchiolitis (BRONCHIOL-EAT); https://classic., Clinicaltrials: gov/ct2/show/NCT03738501., (© 2024. The Author(s).)

Purpose: Tracheostomized patients often present with muscle weakness, altered consciousness, or swallowing difficulties. Hence, the literature is scarce regarding the challenging management of tracheostomy weaning. There is a need to strengthen the understanding of respiratory mechanisms with the different tracheostomy tube modalities that compose this weaning pathway. We aimed to evaluate the impact of these modalities on the work of breathing (WOB), total positive end-expiratory pressure (PEEPtot), and tidal volume (V T )., Methods: With a three-dimensional (3D) printed head mimicking human upper airways, we added a tracheal extension, and pierced to allow insertion of a size 7.0 tracheostomy cannula. The whole was connected to an artificial lung. Three lung mechanics were simulated (normal, obstructive and restrictive). We compared five different tracheostomy tube modalities to a control scenario in which the tube was capped and the cuff was deflated., Results: A marginal difference was observed on the WOB within conditions with a slight increase + 0.004 [95% CI (0.003-0.004); p < 0.001] when the cuff was inflated in the normal and restrictive models and a slight decrease in the obstructive model. The highest PEEPtot that was reached was + 1 cmH 2 O [95% CI (1-1.1); p < 0.001] with high-flow therapy (HFT) with the cuff inflated in the obstructive model. We observed a statistically significant reduction in V T [up to - 57 mL 95% CI (- 60 to - 54); p < 0.001] when the cuff was inflated, in both the normal and obstructive models., Conclusions: Our results support the use of conditions that involve cuff deflation. Intermediate modalities with the cuff deflated produced similar results than cannula capping., (© 2024. The Author(s).)

Background: Inadequate feeding is a frequent reason for hospital referring in infants with bronchiolitis and may leads to unnecessary prolonged hospitalization. Our objective was to identify the factors associated with the time to recover adequate feeding (TRAF) and the hospital length of stay (LOS) in infants hospitalized for bronchiolitis., Methods: We conducted a single-center retrospective study including infants less than 12 months hospitalized for bronchiolitis at Le Havre Hospital (France) between September 2018 and February 2021. A multivariate logistic regression model was computed to investigate the factors associated with (1) TRAF, and (2) LOS., Results: 268 infants were included to assess the TRAF and 478 infants to assess the LOS. The median age was 3.2 months (1.6-5.4) and the sex ratio M/F was 11/20. The use of accessory muscles, nutritional support, and RR ≥70/min or <30/min or apnea are associated (OR=1.5), from virtually no association (OR=1.0) to a significant positive association (OR=2.6) with the TRAF. Intense use of accessory muscles (OR=3.9; 95% CI 1.6-10.4) and "severe" clinical condition (OR=2.8; 95% CI 1.7-4.8) at admission, O2 supplementation (OR=2.0; 95% CI 1.3-3.1) were significantly related to prolonged LOS in the multivariate analysis., Conclusions: The clinical severity on admission may be related to the TRAF, ranging from none to significant. Other known factors such as oxygen therapy and the new clinical severity scale proposed by the latest French guidelines appeared to be related to the LOS in this work. Further studies are needed to highlight these factors.

Background: Few specific methods are available to reduce the risk of diaphragmatic dysfunction for patients under mechanical ventilation. The number of studies involving transcutaneous electrical stimulation of the diaphragm (TEDS) is increasing but none report results for diaphragmatic measurements, and they lack power. We hypothesised that the use of TEDS would decrease diaphragmatic dysfunction and improve respiratory muscle strength in patients in ICU., Methods: We conducted a controlled trial to assess the impact of daily active electrical stimulation versus sham stimulation on the prevention of diaphragm dysfunction during the weaning process from mechanical ventilation. The evaluation was based on ultrasound measurements of diaphragm thickening fraction during spontaneous breathing trials. We also measured maximal inspiratory muscle pressure (MIP), peak cough flow (PEF) and extubation failure., Results: Sixty-six patients were included and randomised using a 1:1 ratio. The mean number of days of mechanical ventilation was 10 ± 6.8. Diaphragm thickening fraction was > 30% at the SBT for 67% of participants in the TEDS group and 54% of the Sham group (OR1.55, 95% CI 0.47-5.1; p = 0.47). MIP and PEF were similar in the TEDS and Sham groups (respectively 35.5 ± 11.9 vs 29.7 ± 11.7 cmH 2 0; p = 0.469 and 83.2 ± 39.5 vs. 75.3 ± 34.08 L/min; p = 0.83). Rate of extubation failure was not different between groups., Conclusion: TEDS did not prevent diaphragm dysfunction or improve inspiratory muscle strength in mechanically ventilated patients., Trial Registration: Prospectively registered on the 20th November 2019 on ClinicalTrials.gov Identifier NCT04171024., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Competing Interests: Declaration of Competing Interest Dr. Combret, Dr. Prieur and Dr. Medrinal report performing consultations for Air Liquide Medical Systems, outside of the submitted work. The other authors have no conflicts of interest to disclose.

Background: Oxygen uptake (V̇O2) and heart rate (HR) kinetics during a constant work-rate test (CWRT) are used to evaluate the response to exercise in healthy subjects as well as subjects with various pathologies., Objectives: This study aimed to explore the feasibility of these measures and their responsiveness to a prehabilitation program in patients with non-small cell lung cancer (NSCLC)., Method: This study is preregistered (NCT04041297) ancillary analysis of a subgroup of individuals with NSCLC included in the Preo-Dens study (NCT03936764). Thirty individuals performed a moderate-CWRT before and after a 15-session prehabilitation program between July 2019 and April 2021. V̇O2 and HR on-kinetics were extracted from the first 240 s of breath-by-breath data using Box-Jenkins transfer functions., Results: Pre/post V̇O2 on-kinetic feature values were reliable for 25/30 participants, and pre/post HR kinetic feature values were reliable for 19/30. V̇O2 time constant (τ) and mean response time reduced from pre-post prehabilitation (mean difference -7.8 s; 95% CI: -14.6 to -1.0, and -8.4 s; 95% CI: -14.7 to -2.0, respectively). For HR on-kinetics, τ did not change from pre-post prehabilitation (median difference -4.0 s; 95% CI: -36.0 to +11.0). V̇O2 and HR response amplitudes reduced significatively from pre-post prehabilitation (mean difference -38.6 mL/min; 95% CI: -73.3 to -3.9, and -3.1 beats/min; 95% CI: -6.4 to -0.2, respectively)., Conclusion: V̇O2 on-kinetic analysis during moderate-CWRT is feasible in individuals with scheduled NSCLC resection, and results are responsive to prehabilitation. These results support a true speeding of the adaptation of aerobic metabolism after a 15-session prehabilitation program., (© 2023 S. Karger AG, Basel.)

Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results.

Background: Oxygen uptake (V̇O 2 ) kinetics have been shown to be slowed in adolescents with cystic fibrosis (CF) during heavy-intensity cycling and maximal exercise testing., Objectives: This study investigated V̇O 2 kinetics in adolescents with CF compared to control adolescents (CON) during a treadmill-walking exercise., Methods: Eight adolescents with CF and mild-to-moderate pulmonary obstruction (5 girls; 13.1 ± 2.5 years; FEV 1 67.8 ± 21.4%) and 18 CON adolescents (10 girls; 13.8 ± 1.8 years) were recruited. Pulmonary gas exchange and ventilation were measured during a single transition of 10 min of treadmill walking and a 5 min seated recovery period. Participant's walking speed was determined during a one-minute self-paced walking task along a 50-m corridor. A six-parameter, non-linear regression model was used to describe the changes in V̇O 2 function during the treadmill walking and recovery, with monoexponential curve fitting used to describe the mean response time (MRT 1 ) at the onset of exercise, and the half-life (T 1/2 V̇O 2 ) at the offset of exercise. V̇O 2 baseline and amplitude, minute ventilation and respiratory equivalents were recorded., Results: V̇O 2 kinetics were slower in CF group compared to CON group during the treadmill walking with a greater MRT 1 (32 ± 14 s vs 21 ± 16 s; p = .04, effect size = 0.75). The T 1/2 V̇O2 was prolonged during recovery in CF group compared to CON group (86 ± 24 s vs 56 ± 22 s; p = .04, effect size = 1.31). The mean VE/V̇CO 2 during exercise was the only parameter significantly greater in CF group compared to CON group (32.9 ± 2.3 vs 29.0 ± 2.4; p < .01, effect size = 1.66)., Conclusion: V̇O 2 kinetics were found to be slowed in adolescents with CF during treadmill walking.

Competing Interests: Dr. Combret, Dr. Prieur and Dr. Medrinal performed consultations for Air Liquide Medical Systems, outside the submitted work. Dr. Lebret reported to have received personal fees from Air Liquid Medical Systems and non-financial support from NOMICS over the past three years, and is a part-time employee of Air Liquide Medical System (Med2lab).

The positive feedback from patients with COPD reinforces the value of menthol to reduce breathlessness in this population https://bit.ly/3v1UQYQ., Competing Interests: Conflict of interest: None declared., (Copyright ©The authors 2022.)

Introduction: Exercise training before lung resection for non-small cell lung cancer is believed to decrease postoperative complications (POC) by improving cardiorespiratory fitness. However, this intervention lacks a strong evidence base., Aim: To assess the effectiveness of preoperative exercise training compared with usual care on POC and other secondary outcomes in patients with scheduled lung resection., Methods: A systematic search of randomised trials was conducted by two authors. Meta-analysis was performed, and the effect of exercise training was estimated by risk ratios (RR) and mean differences, with their CIs. Clinical usefulness was estimated according to minimal important difference values (MID)., Results: Fourteen studies involving 791 participants were included. Compared with usual care, exercise training reduced overall POC (10 studies, 617 participants, RR 0.58, 95% CI 0.45 to 0.75) and clinically relevant POC (4 studies, 302 participants, Clavien-Dindo score ≥2 RR 0.42, 95% CI 0.25 to 0.69). The estimate of the effect of exercise training on mortality was very imprecise (6 studies, 456 participants, RR 0.66, 95% CI 0.20 to 2.22). The main risks of bias were a lack of participant blinding and selective reporting. Exercise training appeared to improve exercise capacity, pulmonary function and also quality of life and depression, although the clinical usefulness of the changes was unclear. The quality of the evidence was graded for each outcome., Conclusion: Preoperative exercise training leads to a worthwhile reduction in postoperative complications. These estimates were both accurate and large enough to make recommendations for clinical practice., Competing Interests: Competing interests: TB declares receiving grants from Fisher and Paykel and from KerNel Biomedical, both unrelated to this study., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Exacerbations are major events in the course and prognosis of COPD. Following acute exacerbation of COPD (AECOPD), functional recovery is not always complete and the risk of relapse is high, requiring proactive management., State of the Art: Pulmonary and extrapulmonary consequences of AECOPD require comprehensive and individualized care. Muscle function and nutritional status are key elements to target. Pulmonary rehabilitation is an effective strategy designed to deal with these aspects and to facilitate a comprehensive, patient-centered approach., Perspectives: Access to pulmonary rehabilitation programs is limited, and existing barriers need to be more precisely identified as a first step toward their possible removal. Long-term exercise maintenance strategies likewise warrant further study., Conclusion: The physiotherapist has a major role to assume in per- and post-exacerbation management of people with COPD; it is up to him to assess the patient and to put into place an individualized pulmonary rehabilitation program; it is also up to him to provide long-term support, helping the patient to maintain an active lifestyle while coping with a chronic pathology., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Pulmonary rehabilitation (PR) (primarily composed of an exercise training program (ET) and educational workshops) is an effective intervention for patients with chronic obstructive pulmonary disease. Although factors which influence participation in the full PR program have been reported, specific data on the educational component of PR have not been published. We aimed to identify factors which predict refusal to participate in the educational component of PR., Research Design and Methods: 201 patient charts were retrospectively included in the analysis. Patients were classified according to their acceptance or refusal to participate in the educational workshops., Results: The location of ET outside the center was independently related to refusal to participate in the educational workshops (OR = 0.01 [95%CI 0.00 to 0.17]). Patients who refused the workshops were less disabled according to the number of prescriptions of noninvasive ventilation, use of medical transport, oxygen consumption and workload achieved during cardiopulmonary exercise testing., Conclusions: The location of exercise sessions during PR influences patients' decisions to refuse or accept center-based educational workshops. When center-based PR programs are limited, and the ET is relocated to the patient's home, the educational workshops should also be relocated., Trial Registration: The trial is registered at ClinicalTrials.gov (NCT04301245).

Studies have reported persistent symptoms in patients hospitalized for COVID-19 up to 6 months post-discharge; however, sequalae beyond 6 months are unknown. This study aimed to investigate the clinical status of COVID-19 patients one year after hospital discharge and describe the factors related to poor outcomes. We conducted a single-center, prospective, cohort study of patients in Le Havre hospital (France) between 1 March 2020 and 11 May 2020. Baseline characteristics were collected from medical charts (including KATZ index and Clinical Frailty scale (CFS)), and a remote assessment was conducted 12 months after discharge. The main outcomes were the scores of the physical and mental components (PCS and MCS) of the Short-Form 36 (SF-36) and performance on the one-minute sit-to-stand test (STST1'). Scores <50% of the predicted values were considered as poor, and univariate and multivariate analyses were undertaken to investigate factors related to poor outcomes. Remote assessment was performed for 128 of the 157 (82%) eligible patients. Twenty-two patients were admitted to the intensive care unit (ICU), 45 to the intermediate care unit (IU), and 61 to the general ward (GW). Patients who spent time in ICU were more independent and younger. A large proportion of the sample had poor physical (30%) and mental health (27%) and a poor functional exercise capacity (33%) at the remote assessment. Higher levels of frailty at admission and hospital discharge were, respectively, associated with a higher risk of poor functional exercise capacity (StdOR 3.64 (95%CI 1.39-10.72); p = 0.01) and a higher risk of poor mental health (StdOR 2.81 (95%CI 1.17-7.45); p = 0.03). Long-term outcomes following hospitalization for COVID-19 infection may be negative for at least one year after discharge. Remote follow-up assessment could be highly beneficial for COVID-19 patients.

Background: Several studies have evaluated the effect of nasal high-flow (NHF) therapy to enhance exercise performance and tolerance in patients with chronic obstructive pulmonary disease (COPD); however, results are disparate. Objective: The aim of this systematic review and meta-analysis was to assess the effect of NHF therapy as an adjuvant to exercise training on functional exercise capacity in patients with COPD. Data Sources: An electronic search was performed in the following databases: PubMed, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, ScienceDirect, the Web of Science, OpenGrey, ClinicalTrials.gov, and European Respiratory Society and American Thoracic Society databases. Data Extraction: Two authors independently selected relevant randomized trials (parallel-group or crossover design), extracted data, assessed the risk of bias, and rated the quality of the evidence. Synthesis: Eleven studies were included, involving 408 participants (eight full papers and three conference abstracts). Most studies had a high risk of bias or other methodological limitations. The use of NHF therapy during a single session increased functional exercise capacity (standardized mean difference, 0.36 [95% confidence interval (CI), 0.03 to 0.69]; P  = 0.03, heterogeneity [ I 2  = 83%]). When conference abstracts were included in the pooled analysis, the estimated effect did not change ( P  = 0.006). The use of NHF therapy throughout a pulmonary rehabilitation program (parallel-group randomized controlled trials) increased functional exercise capacity at 4-12 weeks compared with training without NHF therapy (standardized mean difference, 0.34 [95% CI, 0.00-0.68]; P  = 0.05, heterogeneity [ I 2  = 18%]). Conclusions: There is very-low-quality to low-quality evidence that NHF therapy improves functional exercise capacity. Patient responses to NHF therapy were highly variable and heterogeneous, with benefits ranging from clinically trivial to worthwhile.

Question: In people with non-small cell lung cancer, what is the effect of condensing 15 prehabilitation sessions into a 3-week regimen compared with a 5-week regimen?, Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of the primary outcome., Participants: People with diagnosed or suspected non-small cell lung cancer and moderate-to-high risk of postoperative complications., Intervention: Fifteen supervised prehabilitation sessions delivered with either a dense regimen of five sessions/week for 3 weeks (experimental group) or a non-dense regimen of three sessions/week for 5 weeks (control group)., Outcome Measures: The primary outcome was the change in cardiorespiratory fitness measured by the V̇O 2peak in ml/kg/min. The secondary outcomes were the change in other variables of interest measured during cardiopulmonary exercise testing, non-invasive nutritional markers, quadriceps maximal voluntary isometric contractions, maximal inspiratory pressure, quality of life, adherence and postoperative complications., Results: Changes with the experimental regimen were similar to or better than changes with the control regimen for: V̇O 2peak (MD 1.2 ml/kg/min, 95% CI -0.1 to 2.6); V̇E/V̇CO 2 slope (MD -3.6 points, 95% CI -8.7 to 1.5); and work rate at ventilatory threshold (MD 3.7 W, 95% CI -5.6 to 13.0). The two regimens had similar effects on: peak work rate (MD 1.3 W, 95% CI -6.4 to 9.0), V̇O 2 at ventilatory threshold (MD 0.0 ml/kg/min, 95% CI -1.4 to 1.4); body mass index (MD -0.2 kg/m 2 , 95% CI -0.5 to 0.1); and maximal inspiratory pressure (MD -0.7 cmH 2 O, 95% CI -9.8 to 8.4). The relative effect was uncertain for quadriceps maximal voluntary isometric contractions, quality of life and complications., Conclusion: Condensing prehabilitation sessions led to similar or better improvement in cardiorespiratory fitness and did not decrease adherence or increase adverse events. This could increase the number of patients who can be referred for prehabilitation, despite short presurgical periods., Trial Registration: NCT03936764., (Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Chewing menthol gum prior to exercise is a safe, easy-to-implement, low-cost, non-pharmacologic intervention that provides a reduction in dyspnoea in a third of patients and decreases the perception of discomfort during exercise in two-thirds of patients https://bit.ly/3FoFHp1., Competing Interests: Conflict of interest: G. Prieur has nothing to disclose. Conflict of interest: M. Beaumont has nothing to disclose. Conflict of interest: M. Delorme has nothing to disclose. Conflict of interest: Y. Combret has nothing to disclose. Conflict of interest: C. Medrinal has nothing to disclose. Conflict of interest: R. Hilfiker has nothing to disclose. Conflict of interest: T. Bonnevie has nothing to disclose. Conflict of interest: F-E. Gravier has nothing to disclose. Conflict of interest: P. Smondack has nothing to disclose. Conflict of interest: B. Lamia has nothing to disclose. Conflict of interest: G. Reychler has nothing to disclose., (Copyright ©The authors 2021.)

The current gold-standard treatment for COVID-19-related hypoxemic respiratory failure is invasive mechanical ventilation. However, do not intubate orders (DNI), prevent the use of this treatment in some cases. The aim of this study was to evaluate if non-invasive ventilatory supports can provide a good therapeutic alternative to invasive ventilation in patients with severe COVID-19 infection and a DNI. Data were collected from four centres in three European countries. Patients with severe COVID-19 infection were included. We emulated a hypothetical target trial in which outcomes were compared in patients with a DNI order treated exclusively by non-invasive respiratory support with patients who could be intubated if necessary. We set up a propensity score and an inverse probability of treatment weighting to remove confounding by indication. Four-hundred patients were included: 270 were eligible for intubation and 130 had a DNI order. The adjusted risk ratio for death among patients eligible for intubation was 0.81 (95% CI 0.46 to 1.42). The median length of stay in acute care for survivors was similar between groups (18 (10-31) vs. (19 (13-23.5); p = 0.76). The use of non-invasive respiratory support is a good compromise for patients with severe COVID-19 and a do not intubate order.

Pulmonary rehabilitation (PR) is an evidence-based intervention to manage symptoms related to chronic obstructive respiratory diseases (CORD). Paradoxically, few people with CORD actually engage in PR, and of those, up to one-third do not complete the program. Additionally, some of those who complete the program do not achieve worthwhile benefits. Therefore, the main challenge for the next decades is to offer PR to as many people (that would potentially benefit from it) as possible. This raises questions about factors influencing participation, completion, and responsiveness to PR programs. Among these factors, urinary incontinence (UI) is highly prevalent among people with CORD (much more than in the general population) and may worsen during PR exercise sessions. Paradoxically, UI is poorly explored in routine and scarcely assessed in research, and none of the actual guidelines about PR mention it. However, its potential influence on engagement, completion, and response to PR is of real concern. Therefore, the aim of this perspective is to describe the mechanisms of UI, particularly in the context of CORD, as well as to highlight its prevalence among people with CORD, their burden, and how it could affect a PR approach based on sustained and regular physical activity., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors., Method: We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation., Results: Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning., Conclusion: The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.

Background: Functional exercise capacity assessment is recommended in children with cystic fibrosis (CF). The six-minute walk test (6MWT) is a valid evaluation of exercise capacity but can be technically complex. Inversely, the sit-to-stand test (STST) is a simple method to evaluate exercise capacity, and is validated in healthy children and adults with CF. This study aimed to evaluate STST measurement properties in children and adolescents with CF., Methods: In this multicenter study, children with CF (6 to 18 years) performed two iterations of both the STST and the 6MWT in a randomized order. Criterion validity was determined by assessing correlations between STST repetitions and 6MWT distance (6MWD). Intra-rater reliability, test-retest repeatability, mean bias and limits of agreement were also assessed. Relationships with other outcomes (i.e. respiratory and quadriceps muscle strength) and cardio-respiratory responses were analysed for both tests., Results: Thirty-six children with CF were included (mean age 12.0 ±3.5 years and FEV1 95.8 ±25.0%). On average, 39.6 ±10.5 repetitions were performed during the STST and mean 6MWD was 596.0 ±102.6 meters. STST number of repetitions was significantly correlated with 6MWD (r = 0.48; p<0.01). Both tests had very good intra-rater reliability (ICCSTST = 0.91 (95%CI 0.76-0.96) and ICC6MWT = 0.94 (95%CI 0.85-0.97)), and a significant test-retest learning effect. The number of STST repetitions was not correlated with quadriceps or respiratory muscle strength test, and the STST induced fewer cardio-respiratory responses than the 6MWT., Conclusions: The STST is an easy-to-use functional test with moderate criterion validity when compared to the 6MWT in children with CF, probably because both tests measure different components of functional exercise capacity. The STST is useful when the 6MWT is unfeasible, however further investigations are required to explore the clinical implications of STST results in children with CF., Clinical Trial Registration: NCT03069625., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests. Prof. Bouchra Lamia reports expertise activities from Novartis, Chiesi, and from Astra Zeneca, non-financial support from Philips Respironics, grants from Lowenstein, grants from Bayer, and expertise activies from Elivie, all outside the submitted work. Mr. Tristan Bonnevie reports grants from Fisher & Paykel, outside the submitted work. All the other authors have no competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Little interest has been paid to expiratory muscle strength, and the impact of expiratory muscle weakness on critical outcomes is not known. Very few studies assessed the relationship between maximal expiratory pressure (MEP) and critical outcomes. The aim of this study was to investigate the relationship between MEP and critical outcomes., Methods: This work was a secondary analysis of a prospective, observational study of adult patients who required mechanical ventilation for ≥ 24 h in an 18-bed ICU. MEP was assessed before extubation after a successful, spontaneous breathing trial. The relationships between MEP and extubation failure, and short-term (30 days) mortality, were investigated. Univariate logistic regressions were computed to investigate the relationship between MEP values and critical outcomes. Two multivariate analyses, with and without maximal inspiratory pressure (MIP), both adjusted using principal component analysis, were undertaken. Unadjusted and adjusted ROC curves were computed to compare the respective ability of MEP, MIP and the combination of both measures to discriminate patients with and without extubation failure or premature death., Results: One hundred and twenty-four patients were included. Median age was 66 years (IQR 18) and median mechanical ventilation duration was 7 days (IQR 6). Extubation failure rate was 15% (18/124 patients) and the rate for 30-day mortality was 11% (14/124 patient). Higher MEP values were significantly associated with a lower risk of extubation failure in the univariate analysis [OR 0.96 95% CI (0.93-0.98)], but not with short-term mortality. MEP was independently linked with extubation failure when MIP was not included in the multivariate model, but not when it was included, despite limited collinearity between these variables. This study was not able to differentiate the respective abilities of MEP, MIP, and their combination to discriminate patients with extubation failure or premature death (adjusted AUC for the combination of MEP and MIP: 0.825 and 0.650 for extubation failure and premature death, respectively)., Conclusions: MEP is related to extubation failure. But, the results did not support its use as a substitute for MIP, since the relationship between MEP and critical outcomes was no longer significant when MIP was included. The use of MIP and MEP measurements combined did not reach higher discriminative capacities for critical outcomes that MEP or MIP alone. Trial Registration This study was retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT02363231?cond=NCT02363231&draw=2&rank=1 (NCT02363231) in 13 February 2015.

Questions: How effective is home-based exercise therapy delivered using advanced telehealth technology (ATT-ET) for people with chronic obstructive pulmonary disease (COPD) compared with: no exercise therapy (ET), in/outpatient ET, and home-based ET without ATT?, Design: Systematic review and meta-analysis of randomised trials., Participants: People with stable COPD referred for ET., Intervention: ATT-ET., Outcome Measures: Exercise capacity, quality of life, functional dyspnoea, cost-effectiveness and various secondary outcomes., Results: Fifteen eligible trials involved 1,522 participants. Compared with no ET, ATT-ET improved exercise capacity (four studies, 6-minute walk test MD 15 m, 95% CI 5 to 24) and probably improved quality of life (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had a similar effect as in/outpatient ET on functional dyspnoea (two studies, SMD -0.05, 95% CI -0.39 to 0.29) and a similar or better effect on quality of life (two studies, SMD 0.23, 95% CI -0.04 to 0.50) but its relative effect on exercise capacity was very uncertain (three studies, 6-minute walk test MD 6 m, 95% CI -26 to 37). ATT-ET had a similar effect as home-based ET without ATT on exercise capacity (three studies, 6-minute walk test MD 2 m, 95% CI -16 to 19) and similar or better effects on quality of life (three studies, SMD 0.79, 95% CI -0.04 to 1.62) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had effects on most secondary outcomes that were similar to or better than each comparator., Conclusion: ATT-ET improves exercise capacity, functional dyspnoea and quality of life compared with no ET, although some benefits may be small. Its benefits are generally similar to in/outpatient ET and similar to or better than home-based ET without ATT., Registration: PROSPERO CRD42020165773., (Copyright © 2020 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Introduction: The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists., State of the Art: In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease., Perspectives: Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19., Conclusion: The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)