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To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury. Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion. Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group. The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency. The lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled. Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity. Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity. Wheelchair quality and body weight – next to wheelchair fitness and skill – require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury. [ABSTRACT FROM AUTHOR]

Background: Small airways dysfunction (SAD) in asthma is difficult to measure and a gold standard is lacking. The aim of this study was to develop a simple tool including items of the Small Airways Dysfunction Tool (SADT) questionnaire, basic patient characteristics and respiratory tests available depending on the clinical setting to predict SAD in asthma., Methods: This study was based on the data of the multinational ATLANTIS (Assessment of Small Airways Involvement in Asthma) study including the earlier developed SADT questionnaire. Key SADT items together with clinical information were now used to build logistic regression models to predict SAD group (less likely or more likely to have SAD). Diagnostic ability of the models was expressed as area under the receiver operating characteristic curve (AUC) and positive likelihood ratio (LR+)., Results: SADT item 8, "I sometimes wheeze when I am sitting or lying quietly", and the patient characteristics age, age at asthma diagnosis and body mass index could reasonably well detect SAD (AUC 0.74, LR+ 2.3). The diagnostic ability increased by adding spirometry (percentage predicted forced expiratory volume in 1 s: AUC 0.87, LR+ 5.0) and oscillometry (resistance difference between 5 and 20 Hz and reactance area: AUC 0.96, LR+ 12.8)., Conclusions: If access to respiratory tests is limited ( e.g. primary care in many countries), patients with SAD could reasonably well be identified by asking about wheezing at rest and a few patient characteristics. In (advanced) hospital settings patients with SAD could be identified with considerably higher accuracy using spirometry and oscillometry., Competing Interests: Conflict of interest: J. Kocks reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline, grants and personal fees from Chiesi and Teva, nonfinancial support from Mundi Pharma, personal fees from MSD and COVIS Pharma, grants from Valneva, outside the submitted work; holds <5% shares of Lothar Medtec GmbH and 72.5% of shares in the General Practitioners Research Institute. T. van der Molen reports personal fees and nonfinancial support from Chiesi, GlaxoSmithKline and AstraZeneca. J. Voorham reports no conflict of interest. S. Baldi reports no conflict of interest. M. van den Berge reports research grants paid to institution from Chiesi, Novartis, Genentech, Roche, AstraZeneca and GlaxoSmithKline. C. Brightling reports support for the present manuscript from Chiesi and NIHR BRC; grants and consulting fees from AstraZeneca, GlaxoSmithKline, Chiesi, Sanofi, Roche, Genentech, Mologic and 4DPharma, outside the submitted work. L.M. Fabbri reports grants, personal fees, and nonfinancial support from AstraZeneca, Chiesi, GlaxoSmithKline, Alfasigma, Lusofarma and Novartis. M. Kraft reports grants (paid to institution) for research from the National Institutes of Health, American Lung Association and Chiesi (for support of this study), AstraZeneca and Sanofi Regeneron; personal fees for consultancies from Chiesi, Genentech (Roche), GlaxoSmithKline, Sanofi Regeneron and AstraZeneca, speaker fees from Chiesi; personal fees from participation on data safety and monitoring boards from AstraZeneca and ALung; and leadership of the American Thoracic Society. G. Nicolini is an employee of Chiesi, the company who sponsored the ATLANTIS study generating the data analysed in the current manuscript. A. Papi reports grants from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Teva and Sanofi; consulting fees, honoraria for lectures or advisory boards from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Novartis, Sanofi, IQVIA, Avillon, Elpen Pharmaceuticals, Menarini, Zambon and Mundipharma. K.F. Rabe reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Chiesi, DevPro and Sanofi Regeneron. Klaus F. Rabe is co-founder of rnatics and receives federal grants from the BMBF, Germany for the German Center for Lung Research. S. Siddiqui reports grants, personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Boehringer Ingelheim, Novartis, ERT Medical, Knopp Biosciences and Thorasys Ltd. D. Singh has received personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epiendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona. J. Vonk reports no conflict of interest. M. Leving and B. Flokstra-de Blok were employed by General Practitioners Research Institute (GPRI) at the time of the study. In the past 3 years (2019–2021), GPRI conducted investigator- and sponsor-initiated research funded by noncommercial organisations, academic institutes, and pharmaceutical companies (including AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis and Teva)., (Copyright ©The authors 2023.)