Physical therapy
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Lung transplantation requires the skillful attention of a health care team to provide optimal results. The physical therapist is an integral part of this team, providing expertise in exercise testing and prescription in all phases, from initial evaluation through postoperative rehabilitation and beyond. ⋯ It is important for the physical therapist to stay abreast of the evolving field of lung transplantation, including medications and complications. The physical therapist has a critical role in helping lung transplant recipients achieve optimal function, increased survival, and improved quality of life.
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The purposes of this article are to introduce the reader to patient-controlled analgesia (PCA) and to summarize its use in several selected pain-related conditions. patient-controlled analgesia is a relatively new technique for managing pain in which patients are able to self-administer small doses of opioid analgesic medications when needed. The authors briefly review some of the problems associated with current and previous opioid delivery strategies and highlight the advantages of PCA over these other methods. They then discuss the components of the PCA system and briefly describe how the system is operated and controlled. ⋯ The authors close with a brief summary of several reports describing the use of PCA in the management of postoperative pain, cancer pain, and pain associated with labor and delivery. Indications and contraindications for use in these conditions are presented. Because physical therapists often play a major role in pain management, it is important for them to be well informed with regard to recent developments in this rapidly developing area of clinical practice.
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Review
Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment.
Patients with recurrent or persistent low back pain (LBP) and disability represent a formidable challenge to physical therapists. Classic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and reported pain, or the level of pain and disability. Research over the past decade that considers the interactive role of biological, environmental, and psychological processes in pain and disability has supported the involvement of a number of biobehavioral factors in these conditions. ⋯ Despite this recognition, little information is available that translates the implications of this research to direct care within physical therapy practice. The purposes of this article are (1) to provide an operational definition of biobehavioral factors; (2) to review the role of these factors in the clinical presentation of LBP, functional limitation, and disability; (3) to identify commonly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist the physical therapist in evaluation and treatment of patients with LBP; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Given the central role assumed by many physical therapists in the management of LBP, acknowledging and addressing these factors in clinical practice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and management.
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This article reviews the principles of pulse oximetry and assesses the accuracy of pulse oximeter measurements obtained during exercise, based on reports of 10 studies that evaluated 24 pulse oximeters. Nine of the studies used cycle exercise, and 1 study utilized treadmill running for mode of activity. Subject populations included patients with cardiovascular or pulmonary disorders, nondisabled individuals, and athletes. ⋯ Recent studies suggest the current generation of finger-probe-equipped pulse oximeters may be more accurate than ear-probe-equipped models. We recommend that clinicians carefully secure the probe; monitor signal strength; be wary of %SpO2 values of < or = 68% to 78% to avoid undetected severe hypoxemia; and be alert to whether a patient is a smoker, in which case %SpO2 will likely be overestimated. Researchers interested in using pulse oximeter estimates should validate their particular pulse oximeter(s) via arterial blood sampling.
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Review
Injury to skeletal muscle fibers during contractions: conditions of occurrence and prevention.
Contraction-induced injury results in the degeneration and regeneration of muscle fibers. Of the three types of contractions--shortening (concentric), isometric, and lengthening (eccentric)--injury is most likely to occur and the severity of the injury is greatest during lengthening contractions. ⋯ The recovery from contraction-induced injury is usually complete within 30 days. Repeated exposures to protocols of lengthening contractions result in "trained" muscles that are not injured by the protocol that previously caused injury.