Beatrice Salvi

Purpose: Long-term oxygen therapy (LTOT) is an established treatment for patients with chronic obstructive pulmonary disease (COPD) diagnosed with hypoxemia at rest or during activity. Chronic hypoxemia is a potential mediator of loss of muscle mass and oxidative capacity in COPD. In this retrospective analysis, we sought to determine whether patients with COPD receiving LTOT have impaired muscle oxidative capacity compared to those without LTOT. Methods: Personal characteristics, medical and smoking history, spirometry, diffusing capacity, use of LTOT, 6-min walk distance (6MWD), dyspnea symptoms (mMRC Dyspnea scale) were extracted from medical records. Gastrocnemius muscle oxidative capacity was assessed from the O ₂ consumption recovery rate constant ( k ) using near-infrared spectroscopy. Chi ² and t-tests assessed group differences. ANCOVA was used to compare k , after adjusting for known covariates (FEV ₁ %predicted, age, race), in COPD patients with and without LTOT. Results: 23 COPD with LTOT (LTOT) and 29 COPD (non-LTOT) were included in the analysis. The LTOT group tended to be older (p = 0.060), had worse spirometry and diffusing capacity (p < 0.023) and 6MWD (p < 0.001), but similar dyspnea (p > 0.105) compared to the non-LTOT group. After adjusting for covariates, k was not different between groups (LTOT, 1.06 ± 0.07 vs non-LTOT, 1.09 ± 0.26 min ⁻¹ ; p = 0.436). Conclusions: Contrary to our hypothesis, muscle oxidative capacity was not lower in LTOT-treated COPD compared to those without LTOT. Because COPD patients with LTOT had lower FEV ₁ %pred and tended to be older (known correlates of k ), our findings suggest that LTOT may protect against loss of muscle oxidative function in COPD patients with chronic hypoxemia.

Background. Few studies have evaluated physical fitness (PF) and physical activity (PA) in individuals with heart failure and type 2 diabetes mellitus and the possibility that some telemedicine programs (TMPs) may impact them. This post hoc subgroup analysis of an RCT study aimed to describe PF and PA in this population before and after a TMP. Methods. We evaluated (a) PF as distance, assessed via the 6-Minute Walking Test (6MWT), and PA as daily step count in this population before and after a TMP; (b) their relationship; and (c) the patient characteristics that influence PF and PA. Results. Fifty-eight patients (aged 71.31 ± 7.92 years old, 84% male, BMI 28.01 ± 4.70 Kg/m², ejection fraction 48.64 ± 10.64%) were enrolled between August 2022 and September 2024. All patients received a six-month TMP (nurse teleassistance, telemonitoring, a dedicated app, and PA evaluation using a tracker bracelet and step count goals). The 6MWT improved (from 418 ± 113 to 439 ± 120 m, p < 0.001), while PA remained unchanged after the TMP (from 7181 ± 4149 to 7229 ± 4947 steps/day, p = 0.92). The PA and PF association ranged from moderate at baseline (rho = 0.4958, p < 0.001) to strong at the end of the study (rho = 0.6807, p < 0.001). The regression model shows that following the TMP, PA(y) was associated with baseline 6MWT [β= 8.5, 95%IC −0.31; 17.24], age (β = −144.0, 95%IC −262.14; −25.90)), baseline daily steps (β = 0.5967, 95%IC 0.37; 0.82), and HDL cholesterol (β = 119.7, 95%IC 39.07; 200.31) (R²= 0.6580, F(4.53) = 25.49, p < 0.001), while PF(y) was associated with BMI (β= −2.04, 95%IC −4.30; 0.22)), age (β= 0.90, 95%IC −4.4; 1.32), and baseline 6MWT (β = 0.90, 95%IC 0.79; 1.00) (R² = 0.9007, F(3.54) = 163.29, p < 0.001). Conclusions. Our TMP led to a statistically significant but clinically modest improvement in PF but did not impact PA despite there being variability among patients. PA and PF appear to be interdependent. PF, age, HDL cholesterol, and baseline PA were key predictors of PA, while BMI, age, and baseline 6MWT impacted PF at the end of the TMP.

Background/Objectives: Parkinson’s disease (PD) is a neurodegenerative disorder that impairs mobility. Treadmill training (TT) is a common rehabilitation strategy for improving gait parameters in individuals with PD. This systematic review evaluated the effectiveness of TT in improving motor function, walking ability, and overall functional mobility in PD patients. Methods: We compared TT to other forms of gait and motor rehabilitation, including conventional and robotic gait training. Trials that compared a treadmill training group with a non-intervention group were excluded from this review. We searched multiple databases for RCTs involving Parkinson’s patients until January 2025. The primary outcomes were motor function (UPDRS-III) and walking ability (6 MWT and TUG test). Results: We identified 285 articles; 199 were excluded after screening. We assessed the full text of 86 articles for eligibility, and 13 RCTs met the inclusion criteria. Some of them were included in the meta-analysis. The TT group showed a significant improvement in UPDRS-III scores [mean difference (MD): −1.36 (95% CI: −2.60 to −0.11)] and greater improvement in TUG performance [MD, −1.75 (95% CI: −2.69 to −0.81)]. No significant difference in walking capacity as assessed through the 6 MWT was observed [MD: 26.03 (95% CI: −6.72 to 58.77). Conclusions: The current study suggests that TT is effective in improving the motor symptoms and functional mobility associated with PD. Further studies are needed to develop protocols that consider the patients’ clinical characteristics, disease stage, exercise tolerance, and respiratory function.

This study assessed the feasibility of implementing a hybrid hospital–provider company (PC) clinical pathway for patients with chronic respiratory failure (CRF) through the adaptation and follow-up of non-invasive ventilation (NIV). Over a 3-month period, a PC physiotherapist case manager oversaw the adaptation process, making adjustments as necessary, using remote monitoring and home visits. Outcome measures, including the number of patients enrolled, serious adverse events, hospitalizations, survival rates, professional time allocation, NIV adherence, nocturnal apnea–hypopnea, and oxygen saturation, Δ arterial carbon dioxide pressure (PaCO₂), dyspnea, Short Physical Performance Battery (SPPB), exercise tolerance, quality of life, physical activity, and patient satisfaction, were collected. The recruitment rate was 74% (nineteen patients). Commonly reported adverse events included leakage, discomfort and sleep disturbance. Predominant interventions were four home visits (3; 4) and two NIV adjustments (1; 5). The overall program time commitment averaged 43.97 h per patient (being hospital 40 ± 11% and PC 60 ± 11%). Improvements in PaCO₂, dyspnea, SPPB and exercise tolerance were observed by the third month. Adherence to NIV was high, with good or very good satisfaction with its use. This study demonstrates that a hybrid hospital–PC service for NIV adaptation and follow-up is not only feasible but also shows validity, reliability, and acceptability.

In obstructive sleep apnea syndrome (OSAS) subjects different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are: i) physician-oriented follow-up (P-F); ii) physiotherapist-oriented follow-up (PT-F); and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, pvs 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients’ adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP leading to a significant reduction in physician visits under the PT-F with or without tele-titration, being mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.

The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1^st 2020 to March 1^st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low. At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.