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13. Phrenic nerve conduction study to diagnose unilateral diaphragmatic paralysis.

Author

Reynaud, Vivien, Prigent, Hélène, Mulliez, Aurélien, Durand, Marie‐Christine, and Lofaso, Frédéric

Abstract

Background: Unilateral diaphragmatic paralysis (UDP) has major clinical and etiological implications and, therefore, is important to diagnose. Lung function tests and invasive transdiaphragmatic pressure (Pdi) measurements are widely used to this end but, contrary to phrenic nerve conduction study (NCS), they require volitional maneuvers and/or may be poorly tolerated by patients. The purpose of this study was to compare the diagnostic accuracy of Pdi and phrenic NCS for UDP. Methods: We retrospectively reviewed 28 patients with suspected UDP. The diagnosis established during a multidisciplinary meeting was the reference standard. Results: Phrenic NCS correlated well with Pdi (r = 0.82, P <.005), and the two tests showed good agreement (κ = 0.82, P <.005). Phrenic NCS and Pdi measurements both had 95% sensitivity, 87.5% specificity, 95% positive predictive, and 87.5% negative predictive values. Conclusions: Both tests were highly sensitive and specific. Phrenic NCS measurement is a simple, reproducible, noninvasive method whose results correlate well with Pdi and provide insight into the UDP mechanism. In the most difficult cases, combining lung function tests, respiratory muscle assessments, and phrenic NCS can help to establish the diagnosis. [ABSTRACT FROM AUTHOR]

Published
2021
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15. A TUG Value Longer Than 11 s Predicts Fall Risk at 6-Month in Individuals with COPD

Author

Bruno Pereira, Frédéric Costes, Denis Caillaud, Vivien Reynaud, Emmanuel Coudeyre, Ruddy Richard, Annick Greil, Daniela Muti, Service Médecine du Sport et Explorations Fonctionnelles [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Service Médecine physique et de réadaptation [CHU Toulouse], Pôle Neurosciences [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de Pneumologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel Dieu, Clinique Cardio Pneumologique, Biostatistiques, Danone Research, Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre de Recherche en Nutrition Humaine, Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Service de Médecine du Sport et des Explorations Fonctionnelles, Service de Médecine Physique et Réadaptation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Reynaud, Vivien, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Hôtel Dieu, Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), and Université Clermont Auvergne (UCA)

Subjects
medicine.medical_specialty, Copd patients, Pneumologie et système respiratoire, Pulmonary disease, lcsh:Medicine, Médecine humaine et pathologie, Timed Up and Go test, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Article, 03 medical and health sciences, 0302 clinical medicine, Fall, Medicine, 030212 general & internal medicine, Risk factor, Hypoxia, Pulmonology and respiratory tract, COPD, Chronic obstructive pulmonary disease, Postural balance, business.industry, lcsh:R, General Medicine, Fall risk, medicine.disease, Clinical Practice, 030228 respiratory system, Berg Balance Scale, Physical therapy, Human health and pathology, business, human activities, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

This article belongs to the Section Pulmonology; Risk of a fall is increased in individuals with chronic obstructive pulmonary disease (COPD), and is usually evaluated using the Berg Balance Scale (BBS), but this is difficult to perform in everyday clinical practice. We aimed to prospectively predict short-term fall recurrence in COPD patients using a predetermined cut-off value of the Timed Up and Go test (TUG). In stable COPD patients, we collected self-reported records of the number of falls in the previous year, and measured TUG and BBS scores for each individual. Records of fall recurrence were obtained prospectively at 6-months after the initial evaluation. Among the 50 patients recruited, 23 (46%) had at least one fall during the past year. The optimal diagnosis value for the TUG to detect a fall was 10.9 s with a sensitivity of 100% and a specificity of 97%. A cut-off of 11 s predicted fall recurrence with high sensitivity and specificity (93% and 74%, respectively). The TUG as well as the BBS score detected fallers, and a cut-off value of 11 s predicted fall recurrence. TUG could be easily incorporated into the scheduled functional evaluations of COPD patients, could predict the risk of a fall and when appropriate, could guide specific balance training exercises to prevent fall.

Published
2019

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