yoga for burn survivors: impact on range of motion
TRANSCRIPT
Lehigh Valley Health NetworkLVHN Scholarly Works
Department of Surgery
Yoga for Burn Survivors: Impact on Range ofMotion, Cardiovascular Function and Quality ofLifeChristina Miller PT, DPTLehigh Valley Health Network
Sandra M. Tremblay PT, MS, CWS, MSCSLehigh Valley Health Network, [email protected]
Elizabeth Dideon-Hess LSW
Sigrid A. Blome-Eberwein MDLehigh Valley Health Network, [email protected]
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Published In/Presented AtMiller, C., Tremblay, S., Dideon-Hess, E., & Blome-Eberwein, S. (2015, April 23). Yoga for Burn Survivors: Impact on range of motion,cardiovascular function and quality of life. Poster presented at the American Burn Association 47th Annual Meeting, Chicago, IL.
Lehigh Valley Health Network, Allentown, PA
Yoga for Burn Survivors: Impact on Range of Motion, Cardiovascular Function and Quality of life
Christina Miller, PT DPT, Sandra M. Tremblay, PT DPT CWS, Elizabeth Dideon-Hess, LSW, Sigrid A. Blome-Eberwein, MD
© 2015 Lehigh Valley Health Network
Background and Purpose:As medical management of burns has improved, the survival rate has increased leading to a paradigm shift of examining the long-term outcomes in a burn injury. Post burn survivors often experience a decline in physical function after a burn injury, including decreased strength, cardiovascular endurance, joint range of motion and flexibility. This case series study examined the effects of a yoga practice on range of motion, cardiovascular function and quality of life of people after burn injury.
Methods: • Subjects: 5 participants –Median age: 61 –TBSA: 5%-65% –Hospital Length of Stay: 10 days- 4 months with bedrest and surgical
interventions
• Yoga Intervention: 60 minute classes, 2 times per week for 8 weeks –All classes included a warm-up, hatha yoga, pranayama, and meditation –Classes were performed by a trauma certified yoga instructor
ABSTRACT:Objective: To characterize the use of the new commercial tests for aneuploidy screening using cell-free fetal DNA (cffDNA) by women at high risk for fetal aneuploidy.
Study Design: This is a retrospective cohort study of all women undergoing cffDNA testing in the first 6 months the tests were offered in the Lehigh Valley Health Network Maternal Fetal Medicine practice. All patients were high risk for fetal aneuploidy defined as advanced maternal age, abnormal aneuploidy screening, abnormal ultrasound findings and/or personal/family history. Medical records were reviewed for patient demographics, indication for testing, other tests performed, pregnancy outcomes (maternal and fetal) and insurance information.
Results: A total of 142 patients underwent cffDNA testing from 1/1/12 to 6/30/12. The mean age of patients having the test performed was 32.3 ± 6.5 years. Most patients were Caucasian (72%), non-hispanic (83%), multiparous (64%), married (58%), had private obstetrician (77%), had private insurance (51%) and were singleton gestations (95%). The median gestational age the test was performed was 18 5/7 weeks (range 10 2/7 – 28 3/7). Most tests were performed in the second trimester (73%). Insurance coverage varied and evolved significantly during this time period. Four patients had positive test results (3%) and three had uninformative results (2%). There was one false negative and there were no false positives. Sensitivity, specificity, positive predictive value and negative predictive value were 80%, 100%, 100% and 99%, respectively.
Conclusion: Our study provides some information on the use of new commercial tests for aneuploidy screening using cffDNA in clinical practice in a non-research setting. Although the potential for these tests to provide women with information regarding their pregnancies without the risk of an invasive procedure is exciting, additional studies are needed to validate their performance in both low and high risk populations, and providers and patients need to be aware of their limitations.
DISCUSSION:Burn survivors, like others with critical illness and prolonged intensive care stays, experience decreased exercise capacity and weakness, in addition to the joint, muscular and skin limitations specific to burn. The results of this pilot study suggest that cardiovascular function can be improved with a 60-minute yoga intervention two times per week for eight weeks. This study also demonstrated a significant improvement in the functional score of the quality of life measure, as well as a significant improvement in the emotional score of the quality of life in these 5 participants. Anecdotal evidence suggests improved range of motion in our participants. Further research is necessary to evaluate the effectiveness of yoga in burn survivors.
Outcomes: • Cardiovascular –Significantly improved 6 Minute Walk Test distances (Figure 1) –Improved Oxygen Consumption (VO2 Max) post intervention
(Figure 2)
• ROM Changes: Four of five of the participants had improvements in their burn joints. Remarkably even those participants who were 4,5, and even 12 years post-burn demonstrated 10-15 degrees improvement in their Active Range of Motion of some of their burn joints.
• Quality of Life: –A generalizable significant improvement in the SF36 Functional
Score (Figure 3) –A non-generalizable significant improvement in the SF36
Emotional Score (Figure 4)
• Interesting to note that for every subscale score, with the exception of the physical functioning subscale score, the highest score occurred during phase 2
200
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400
500
600
Dist
ance
Trav
eled
(inm
eter
s)
1Phase
2 3
Average Distance Traveled During the 6 Month Walk Test by Phase
13.5
14.5
15.0
15.5
16.5
VO2
Max
1Phase
2 3
Average VO2 Max After 6 Minute Walk Test for Each Phase
13.523
15.392
16.413
16.0
14.0
40
50
55
60
70
Scor
e
1Phase
2 3
Average Physical Functioning Subscale Score by Phase
41.222
58
70
65
45
50
60
70
80
90
Scor
e
1Phase
2 3
Average Role Limitations Due to Emotional Problems SubscaleScore by Phase
75
93.333
50
Figure4.Average Role Limitations Due to Emotional Problems Subscale Score by Phase
Figure3.Average Physical Functioning Subscale Score by Phase
Figure1.Average Distance Traveled During the 6 Minute Walk Test by Phase
Figure2.Average VO2 Max After 6 Minute Walk Test for Each Phase