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European Geriatric Medicine Feb 2024The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and... (Randomized Controlled Trial)
Randomized Controlled Trial
"Inspiratory muscle weakness in acutely hospitalized patients 75 years and over": a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training.
PURPOSE
The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay.
DESIGN AND METHODS
This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW.
RESULTS
In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention.
CONCLUSION
IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NTC03604640. May 3, 2018.
Topics: Male; Humans; Female; Aged, 80 and over; Breathing Exercises; Acute Disease; Physical Therapy Modalities; Muscle Weakness; Paresis; Muscles
PubMed: 37755683
DOI: 10.1007/s41999-023-00865-z -
Expert Review of Neurotherapeutics Mar 2021: This Perspective reassesses the consensus opinion that statin-associated muscle symptoms (SAMS) occur in <1% of users and associated myopathic proximal muscle weakness...
: This Perspective reassesses the consensus opinion that statin-associated muscle symptoms (SAMS) occur in <1% of users and associated myopathic proximal muscle weakness is even more rare.: Of the over 180,000 participants in clinical trials and large registries of statin users, only a few studies have included a standard manual muscle test (MMT), dynamometry or a focused questionnaire to assess for proximal weakness and related disability in daily and recreational activities. Formal strength testing suggests, however, that weakness can be demonstrated in at least 10% of users.: Reporting inaccuracies about SAMS, confirmation bias among experts and physicians, absence of a standard questionnaire regarding the potential consequences of weakness on physical capacity, and the failure to routinely perform an objective assessment of strength may have led to under-diagnosis of statin-induced myopathy. A brief MMT before cholesterol-lowering agents are started and at follow-up visits, a 12-week withdrawal of the statin in the presence of new paresis without an alternative cause, and the exam finding that strength recovers off the statin are necessary to assess the incidence of drug-induced proximal weakness and inform alternative therapeutic strategies.
Topics: Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Muscle Weakness; Muscular Diseases
PubMed: 33339465
DOI: 10.1080/14737175.2021.1866988 -
Seminars in Neurology Jul 2006Functional weakness and sensory loss are common clinical problems with variable presentations. Functional weakness commonly presents as weakness of an entire limb,... (Review)
Review
Functional weakness and sensory loss are common clinical problems with variable presentations. Functional weakness commonly presents as weakness of an entire limb, paraparesis, or hemiparesis, with observable or demonstrable inconsistencies and nonanatomic accompaniments. Documentation of limb movements during sleep, the arm drop test, the Babinski thigh-trunk test, Hoover tests, the Sonoo abductor test, and various dynamometer tests can provide useful bedside diagnostic information on functional weakness. Functional sensory loss typically affects all sensory modalities, either in a hemisensory distribution or affecting an entire limb. Although often inconsistent over serial examinations with nonanatomic features, many clinical findings reported to be helpful in diagnosing functional sensory loss are neither sensitive nor specific for functional sensory loss. The yes-no test, Bowlus-Currier test, and forced-choice tests can provide useful bedside diagnostic information on functional sensory loss. Clinicians must be prepared to make more than one diagnosis in some cases, including an organic neurological diagnosis and a diagnosis of functional overlay. Recent studies have reported relatively low rates (<5%) of misdiagnosis of functional weakness or sensory loss as indicated by subsequent diagnosis of neurological or psychiatric conditions that explained the presenting symptoms. Most neurologists find such patients more difficult to help than patients with organic disease. Management focuses on supportive psychotherapy and behavioral management, exploration of social and psychological issues, treatment of comorbid depression or anxiety, and facilitation of development of more appropriate and constructive coping methods. Many patients with functional weakness, and to a somewhat lesser extent functional sensory loss, have persisting or relapsing-remitting somatic symptoms and persistently impaired social/interpersonal, occupational, and psychological functioning.
Topics: Adult; Female; Humans; Male; Middle Aged; Muscle Weakness; Neurologic Examination; Psychophysiologic Disorders; Sensation Disorders
PubMed: 16791776
DOI: 10.1055/s-2006-945516 -
Acupuncture in Medicine : Journal of... Aug 2021
Review
Topics: Electroacupuncture; Humans; Intensive Care Units; Muscle Strength; Muscle Weakness; Randomized Controlled Trials as Topic
PubMed: 32731740
DOI: 10.1177/0964528420938390 -
The International Journal of Eating... Mar 2003Nutritional recovery in anorexia nervosa (AN) is associated with improved exercise tolerance.
BACKGROUND
Nutritional recovery in anorexia nervosa (AN) is associated with improved exercise tolerance.
METHOD
We describe the investigation of a male with AN. Despite nutritional recovery, he complained of impaired exercise tolerance.
RESULTS
Respiratory muscle weakness was demonstrated as the cause of the impaired exercise tolerance.
DISCUSSION
Weakness of the muscles of respiration results from prolonged malnutrition. The diaphragmatic muscle may be slower to recover than other muscles. This can cause impaired exercise tolerance due to shortness of breath on exertion, despite nutritional recovery.
Topics: Anorexia Nervosa; Exercise; Humans; Lung; Male; Middle Aged; Muscle Weakness; Respiratory Function Tests; Respiratory Muscles
PubMed: 12616590
DOI: 10.1002/eat.10131 -
Intensive Care Medicine Dec 2013
Topics: Critical Illness; Humans; Intensive Care Units; Muscle Weakness; Muscle, Skeletal
PubMed: 24154675
DOI: 10.1007/s00134-013-3132-4 -
Neurology India 2023
Topics: Humans; Vascular Diseases; Vascular Malformations; Muscle Weakness; Paresis
PubMed: 37929499
DOI: 10.4103/0028-3886.388087 -
Acta Neurologica Belgica Oct 2022Intensive care unit-acquired weakness (ICUAW) defines generalized muscle weakness seen in critically ill patients in the absence of other causative factors. Herein, we...
BACKGROUND
Intensive care unit-acquired weakness (ICUAW) defines generalized muscle weakness seen in critically ill patients in the absence of other causative factors. Herein, we aimed to evaluate ICUAW in stroke patients by electrodiagnostic testing, histopathology, and assessment of respiratory complex activities (RCA), to define the frequency of ICUAW in this patient group, and to reach new parameters for early prediction and diagnosis.
METHODS
We prospectively recruited twenty-four severe acute stroke patients during a sixteen-month period. In addition to serial nerve conduction studies (NCS), we performed muscle biopsy and RCA analysis on the non-paretic side when ICUAW developed. Patients undergoing orthopedic surgery without metabolic and neuromuscular diseases constituted the control group for RCA. Survival and longitudinal data were analyzed by joint modeling to determine the relationship between electrophysiological parameters and ICUAW diagnosis.
RESULTS
Eight patients (33%) developed ICUAW, and six of them within the first two weeks. Extensor digitorum brevis, abductor digiti minimi (ADM), rectus femoris and vastus medialis (VM) compound muscle action potential (CMAP) amplitudes showed a significant decrease in the ICUAW group. VM CMAP amplitude (BIC = 358.1574) and ADM CMAP duration (BIC = 361.1028) were the best-correlated parameters with ICUAW diagnosis. The most informative electrophysiological findings during the entire study were obtained within the first 11 days. Muscle biopsies revealed varying degrees of type 2 fiber atrophy. Complex I (p = 0.003) and IV (p = 0.018) activities decreased in patients with ICUAW compared to controls.
CONCLUSION
VM CMAP amplitude and ADM CMAP duration correlate well with ICUAW diagnosis, and may aid in the early diagnosis.
Topics: Humans; Intensive Care Units; Muscle Weakness; Muscle, Skeletal; Stroke
PubMed: 35790678
DOI: 10.1007/s13760-022-02009-9 -
Pain Physician May 2021Herpes zoster is an acute infectious skin disease that is induced by the re-activation of the virus incubated in nerve ganglions following initial infection with... (Review)
Review
BACKGROUND
Herpes zoster is an acute infectious skin disease that is induced by the re-activation of the virus incubated in nerve ganglions following initial infection with varicella-zoster virus in childhood. Herpes zoster mainly affects sensory nerves, resulting in severe acute pain, which is also the most common reason for medical intervention in this patient group. The concurrent involvement of motor nerves could induce the symptoms of segmental zoster paresis, which is manifested by localized asymmetric myasthenia, whose range generally follows the distribution of myomere with skin rashes. Due to the low incidence and unspecific clinical manifestations, segmental zoster paresis has not been sufficiently recognized by clinicians, and can easily be misdiagnosed.
OBJECTIVE
To summarize the previous studies on segmental zoster paresis and analyze the pathogeneses, diagnosis, and treatment of this disease, as well as stress the challenges in current treatment, which could provide useful evidence for the clinical diagnosis and better the treatment of patients with segmental zoster paresis in the future.
STUDY DESIGN
We conducted a narrative review.
SETTING
Hospitals, neurology departments, pain departments, and private practices.
METHODS
We searched PubMed and Chinese CNKI libraries using the terms "herpes zoster," "muscle paresis," "segmental zoster paresis," and "motor nerve." Clinical trials, reviews, and case reports were collected and reviewed.
RESULTS
As a rare complication following varicella-zoster virus infection, segmental zoster paresis has not been sufficiently recognized by clinicians, and there are still no guidelines available to guide the clinical treatments. The exact mechanism of segmental zoster paresis is still unclear. Electromyographic and magnetic resonance imaging examinations could be used as auxiliary diagnostic methods for segmental zoster paresis. Early regular anti-viral therapy could substantially decrease the risk of herpes zoster related complications. Combined application of glucocorticoids and some other physical therapy may also be useful in certain patients. The general prognosis of segmental zoster paresis is relatively good, with 67% patients achieving complete or almost complete recovery of the muscle function.
LIMITATIONS
More clinical trials are needed to clarify the exact mechanisms and best treating methods.
CONCLUSION
As the symptom in most segmental zoster paresis patients is self-limited, and the patients' prognosis is generally good, early diagnosis of the disease is especially important, due to the avoidance of unnecessary diagnostic procedures and incorrect treatments. Standard treatment guidelines regarding the functional rehabilitation are still needed for patients with refractory segmental zoster paresis.
Topics: Herpes Zoster; Humans; Magnetic Resonance Imaging; Muscle Weakness; Paresis; Skin
PubMed: 33988945
DOI: No ID Found -
BMC Medicine Oct 2012Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent complication in survivors of critical illness. The absence of a... (Review)
Review
Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent complication in survivors of critical illness. The absence of a consistent nomenclature and diagnostic criteria for ICUAW has made research in this area challenging. Although many risk factors have been identified, the data supporting their direct association have been controversial. Presently, there is a growing body of literature supporting the utility and benefit of early mobility in reducing the morbidity from ICUAW, but few centers have adopted this into their ICU procedures. Ultimately, the implementation of such a strategy would require a shift in the knowledge and culture within the ICU, and may be facilitated by novel technology and patient care strategies. The purpose of this article is to briefly review the diagnosis, risk factors, and management of ICUAW, and to discuss some of the barriers and novel treatments to improve outcomes for our ICU survivors.
Topics: Critical Care; Critical Illness; Humans; Muscle Weakness; Physical Therapy Modalities; Rehabilitation
PubMed: 23033976
DOI: 10.1186/1741-7015-10-115