Effect of Intermittent Pneumatic Compression on Functional Level and Quality of Life in Community-Dwelling Older Adults with Limited Ambulation Due to Leg Pain: A Randomized Controlled Trial

Background and Purpose: Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. Methods: In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. Results and Discussion: IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. Conclusions: The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.

Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for diabetic peripheral neuropathy and the effect on HIF-1α and VEGF levels

Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF and HIF-lα levels of patients. Methods： Ninety-six patients were randomly divided into electroacupuncture treatment group （EA group）, intermittent pneumatic compression treatment group （IPC group）, electroacupuncture combined with intermittent pneumatic compression treatment group （EA ＋ IPC group） and cobamamide group （CM group）, with 24 cases in each group. Electroacupuncture treatment （once a day）, intermittent pneumatic com pression treatment （twice a day） and intramuscular injection with cobamamide （1 rag, once a day） were carried out in EA group, IPC group and CM group, respectively, and intermittent pneumatic compres- sion treatment （twice a day） was conducted on the basis of electroacupuncture treatment （once a day） in EA＋IPC group. After treatment for 2 consecutive weeks, the differences in subjective symptoms, mo- tor nerve conduction velocity, sensory nerve conduction velocity and serum HIF-lα and VEGF levels of patients in the four groups before and after treatment were observed and compared. Results： After treatment for 2 weeks, the differences in total effective rate between EA group and CM group, IPC group and CM group, as well as EA ＋ IPC group and CM group were all significant （all P 〈 0.05）, and the total effective rate in EA＋ IPC group was significantly higher than that in EA group and IPC group （both P 〈 0.05）. After treatment for 2 weeks, the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve of patients in EA group, 1PC group and EA＋IPC group were all higher than that before treatment （all P 〈 0.05）; the motor nerve conduction velocity of median nerve and the sensory nerve conduction velocity of common peroneal nerve in EA group were all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve in IPC group were also all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve in EA＋IPC group were all higher than that in CM group （both P 〈 0.05）; the sensory nerve conduction velocity of common peroneal nerve in EA ＋ 1PC group was higher than that in EA group and IPC group （both P 〈 0.05）, and the motor nerve conduction velocity of median nerve in EA＋IPC group was higher than that in IPC group （P 〈 0.05）. The serum HIF-1α and VEGF levels of patients in EA group, IPC group and EA ＋ IPC group after treatment significantly reduced （all P 〈 0.05）. and were lower than that in CM group after treatment （all P 〈 0.05）; the serum HIF-lα and VEGF levels of patients in EA ＋ IPC group after treatment were lower than that in EA group and IPC group, and the difference in serum HIF-lα level was statistically significant （both P 〈 0.05）. Conclusion： Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus can effectively improve the clinical symptoms of patients with diabetic peripheral neuropathy, the efficacy were better than electroacupuncture, intermittent pneumatic compression treatment and cobamamide.

Is mannitol combined with furosemide a new treatment for refractory lymphedema?A case report

BACKGROUND Mannitol is a hyperosmolar agent and the combination of mannitol and furosemide is a widely used treatment for intracranial pressure control.Considering the hypertonic properties of mannitol to move water out of intracellular spaces,we hypothesized that mannitol combined with furosemide could relieve focal tissue swelling in refractory lymphedema.CASE SUMMARY A 90-year-old female had been diagnosed with intracranial hemorrhage and received a combination of mannitol and furosemide for intracranial pressure control.Independent of the intracranial hemorrhage,she had refractory lymphedema of the left lower extremity since 1998.Remarkably,after receiving the mannitol and furosemide,the patient’s lower extremity lymphedema improved dramatically.After the mannitol and furosemide were discontinued,the lymphedema worsened in spite of complete decongestive therapy(CDT)and intermittent pneumatic compression treatment(IPC).To identify the presumed effect of mannitol and furosemide on the lymphedema,these agents were resumed,and the lymphedema improved again.CONCLUSION The present case raises the possibility that a combination of mannitol and furosemide might be considered another effective therapeutic option for refractory lymphedema when CDT and IPC are ineffective.

Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery： a prospective, randomised study

Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings （GCS） and intermittent pneumatic compression （IPC） or GCS alone. Methods The study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation （IPC＋GCS group）, The second group received GCS before the operation （GCS group）. To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed. Results The morbidity associated with DVT was 4.8% （5/104） in the IPC＋GCS group and 12.5% （14/112） in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group. Conclusions The therapeutic combination of GCS and prevention in high-risk patients undergoing gynaecological group.（No. ChiCTR-PRC-10000935）. IPC was more effective than GCS alone for thrombosis pelvic surgery, and there were no adverse effects in either

Noninvasive mechanical auxiliary circulation(NMAC):A general concept and the technological trends

A series of noninvasive mechanical auxiliary circulation(NMAC)technologies,such as intermittent pneumatic compression(IPC),external counterpulsation(ECP),and anti-G suit,had been widely used to realize noninvasive intervention of human cardiovascular system for different purposes,such as treatments of cardiovascular diseases and protecting pilot from G-induced loss of consciousness(G-LOC)during exposure to sustained accelerations.There are lots of similarities among these NMAC technologies,especially on aspects of hardware constitutions and their physiological effects.However,these technologies were almost independently developed in the past few decades.The similarities and differences were summarized on aspects of hardware constitutions and physiological effects of IPC,ECP and anti-G suit in this paper,and a general concept for NMAC technologies was proposed.This concept did not include a restrict definition,but generally focused on the physiological benefits,while any noninvasive mechanical methods that can achieve such benefits are welcomed.Trends for these typical NMAC technologies,especially about the strategies to realize personalized therapy or to meet new challenges,are discussed.This paper provided a unified perspective for non-invasive mechanical technologies aiming at cardiovascular benefits,and might inspire new technologies to be introduced in.