Browsing by Author "Šmite, Daina"

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    Activity of Scapular Muscles : Comparison of Open and Closed Kinetic Chain Exercises
    (Rēzeknes Tehnoloģiju akadēmija, 2017) Šmite, Daina; Upeniece, Irēna; Runce, Agnese; Gapeyeva, Helena; Lubkina, Velta; Zvaigzne, Anda; Department of Rehabilitation; Department of Sports and Nutrition
    The function of the shoulder region and cervical spine are regulated by the motor control of the scapula. It is important to selectively activate weak muscles and minimally involve tense muscles to improve scapular motor control. The objective of this study was to compare the activity of scapular muscles and the intramuscular balance during various open and closed kinetic chain exercises. Methods: This study included 20 female sedentary office workers. A surface electromyography was used to analyze the activity of the scapular muscle in the correct exercise starting position and during 6 different exercises. Additionally, the optimal intramuscular balance was examined. Results and conclusions: Open kinetic chain exercises is more suitable than closed kinetic chain exercises for training scapular active stability. Horizontal shoulder abduction with external rotation (scapula retraction and internal rotation) while in the prone position was optimal and could be recommended (as well as its modifications with a resistance band) for training programs to improve scapula active stability.
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    Comprehensive Home-based and Remotely Supervised Physiotherapy Programme within Interdisciplinary Treatment Approach in Patients with Pulmonary Arterial Hypertension. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Introduction. Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease that refers to one of the five subgroups of pulmonary hypertension (PH). PAH refers to a group of rare diseases. PAH is characterized by a progressive course of the disease with increased pulmonary vascular resistance and pulmonary arterial pressure, leading to overload and failure of the right ventricle. The initial clinical symptoms of PAH are commonly induced by exertion and can include shortness of breath, excessive fatigue and weakness, chest pain, and episodes of syncope. Pathologic processes in pulmonary arteries alter oxygen uptake and consumption in the body, decreasing SpO2 and restricting the ability to perform physical activities. Various factors including limited exercise tolerance in combination with muscle weakness, as well as sleep disorders, depression, and inability to adapt to the persistent anxiety caused by severe, chronic, and life-threatening disease, lead to poor quality of life and contribute to social isolation. Today, the appropriate target medical treatment allows patients with PAH not only to survive but also to live a relatively normal life. However, patients face the challenge of adapting and maintaining a good quality of life, thus it is important to consider complex interventions related not only to medical treatment. This study appears to be the first to develop and investigate a comprehensive structured physiotherapy program, which is expected to be implemented in an interdisciplinary treatment approach in patients with PAH in Latvia. Furthermore, the novelty of the thesis obviously shows in the approach used in the study to assess the quality of life of patients with PAH, including the perceived opportunity to live as one wants to in the context of one’s health condition, thus opening opportunities to shed more light on the perspective of the patient on one’s life with a rare, chronic, and life-threatening disease. The aim of the study was to investigate the effectiveness of the comprehensive home-based and remotely supervised physiotherapy program within the interdisciplinary treatment approach to improve and maintain participation in everyday life activities, along with exercise capacity and inspiratory muscle strength, perceived self-efficacy, daily physical activity and sleep quality in patients with PAH. Methods. This is a prospective, randomized, controlled and single-blind study. We recruited patients from the Latvian PH registry with PAH diagnosed by right heart catheterization based on the study inclusion criteria. We randomly assigned the patients to the training group (TG) or the control group (CG). All participants were evaluated at baseline, after 12 weeks and 24 weeks after the start (follow-up). Blinded assessor conducted the assessments in an on-site visit to the University Clinic, and accelerometer data with MOX sensor from 7 consecutive days were obtained too. All participants continued target medical therapy under the supervision of the study cardiologist specialized in PH. Furthermore, TG underwent the developed comprehensive home-based and remotely supervised physiotherapy program led by the study physiotherapist specialized in cardiopulmonology. As primary outcome, perceived autonomy and participation was assessed with the IPA scale. Furthermore, as secondary outcomes 6 minutes walking tests (6MWT), inspiratory muscle strength, perceived self-efficacy, daily physical activity, and sleep quality were evaluated. The choice of mathematical methods of statistics was made in a stepwise fashion, based on small group recommendations. α level 0.05 was chosen; therefore, the results were determined as statistically significant if p < 0.05. For repeated measures, the significance values were adjusted using the Bonferroni correction and set α level 0.025. To measure the effect size, Cohen’s d or rank biserial coefficient was calculated. For statistically significant results, the post hoc statistical power was calculated and a power of at least 80 % (1-β ≥ 0.8) was assumed to be appropriate to control β error. Results. A significant difference between the groups was found in the follow-up assessment in three of four IPA subscales analysed: autonomy outdoors (p = 0.01, rg = 0.66, 1- β = 0.95), family role (p = 0.04, rg = 0.55, 1-β = 0.8), autonomy indoors (p = 0.04, rg = 0.51, 1-β = 0.68) based on median scores. indicating greater limitations of perceived participation in CG compared to TG. The total IPA score significantly decreased in TG after the program: from baseline to 12 weeks assessment (p = 0.005, d = 1.1, 1-β = 0.96), from baseline to follow-up (p = 0.004, d = 1.1, 1-β = 0.97) pointing to improved participation of patients in their everyday life; no significant changes in CG were observed. A significant increase in 6MWT results in TG after 12 weeks and at follow-up. In contrast, no significant improvement was presented in CG. Significant differences in 6MWT results between the groups at 12 weeks and follow-up were approved. Accelerometry data show a significant reduction in sedentary time from baseline to 12 weeks in both groups, and from baseline to follow-up in TG. No significant differences were observed between the groups in sedentary time. Only in TG a significant increase in low or moderate intensity physical activities was observed from baseline to follow-up, and significant difference between groups at follow-up was present in the mentioned activities. Perceived general self-efficacy increased significantly in TG from baseline to 12 weeks; no improvement was present in CG. At follow-up, statistically significant differences between groups were observed, although the results did not reach the appropriate statistical power. Conclusions. In summary, the comprehensive home-based and remotely supervised physiotherapy program within the interdisciplinary treatment approach in patients with PAH prevents the possible deterioration of the perceived participation of patients in activities of their everyday life in the context of one’s health condition and is a resource to encourage the improvement of the perceived opportunity to live life as one wants, despite the long-term impact of PAH and its treatment.
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    Hronisku muguras lejasdaļas sāpju pacientu analīze biopsihosociālā modeļa ietvaros. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2011) Šmite, Daina; Ancāne, Gunta
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    Ikdienā integrēta un attālināti pārraudzīta fizioterapijas programma starpdisciplināras ārstēšanas pieejā pacientiem ar pulmonālo arteriālo hipertensiju. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Ievads. Pulmonālā arteriālā hipertensija (PAH) pieder reto slimību grupai, un to raksturo progresējoša gaita ar paaugstinātu plaušu artēriju rezistenci un pieaugošu asinsspiedienu plaušu artērijās, kam seko sirds labā kambara pārslodze un mazspēja. Slimības simptomi, slodzes tolerance, hemodinamiskie rādītāji ir tikai aisberga redzamā daļa no kopējās PAH radītās negatīvās ietekmes uz pacienta dzīvi, aktualizējot starpdisciplināras un kompleksas ārstēšanas pieejas nepieciešamību. Pacientu ar PAH ārstēšanā nepieciešams apvienot gan specializētas veselības aprūpes pakalpojumus, gan ilgtermiņa intervences, kas vērstas uz hroniskas slimības pārvaldības spējas uzlabošanu un dinamisku adaptāciju. Tas aktualizē nepieciešamību veidot kompleksas fizioterapijas intervences, kas mērķētas ne tikai uz fizisko funkciju uzlabošanu, bet arī uz slimības pašpārvaldes veicināšanu un veselīgu ikdienas ieradumu veidošanu. Šis ir Latvijā pirmais pētījums par starpdisciplināru pieeju pacientu ar PAH ārstēšanā, mērķa medikamentozo terapiju apvienojot ar kompleksu, ikdienā iekļautu un attālināti pārraudzītu fizioterapijas programmu. Turklāt pētījumā izmantotā pieeja pacientu ar PAH dzīves kvalitātes izvērtēšanā, ietverot pašvērtējumu par izjusto iespēju piedalīties savā ikdienas dzīvē kontekstā ar veselības stāvokli, līdz šim nav bijusi aktualizēta, tādējādi paverot iespējas plašāk izgaismot pacienta perspektīvu par dzīvi ar retu, dzīvību apdraudošu un hronisku slimību. Mērķis. Izpētīt ikdienā integrētas, attālināti pārraudzītas fizioterapijas programmas efektivitāti starpdisciplināras ārstēšanas pieejā, lai uzlabotu un saglabātu pacientu ar PAH izjusto iespēju piedalīties savā ikdienas dzīvē, saistībā ar veselības stāvokli, paaugstinot fizisko funkciju rādītājus, izjusto pašefektivitāti, kā arī pilnveidojot fizisko aktivitāšu ieradumus un miega kvalitāti. Materiāli un metodes. Šis bija kontrolēts nejaušināts pētījums ar prospektīvu datu vākšanu laika periodā no 2020. gada februāra līdz 2020. gada septembrim, kurā tika analizēta izveidotā 12 nedēļu garā kompleksā fizioterapijas programma, kas ietvēra četrus pamatelementu: fiziskos vingrojumus; relaksācijas metodes; paškontroli un pašpārvaldi; izglītošanu un pārraudzību. Programma tika realizēta mājas vidē, integrēta pacienta ikdienas dzīvē un attālināti pārraudzīta. Dalībnieku izlase tika izveidota no Latvijas Pulmonālās hipertensijas reģistrā esošajiem pacientiem, balstoties uz definētajiem iekļaušanas kritērijiem. Izveidotā izlase tika nejaušināti sadalīta terapijas (n = 11) un kontroles grupā (n = 10) (turpmāk TG un KG). Abām grupām tika turpināta medikamentozā terapija, bet TG dalībniekiem papildus tika pievienota izveidotā fizioterapijas programma. Dalībnieku novērtēšana tika veikta trīs reizes – sākotnēji, pēc 12 nedēļām un atkārtoti (24 nedēļas kopš sākuma). Primārais rezultātu mērījums bija izjustās autonomijas un līdzdalības ierobežojuma izvērtējums ar IPA anketu, savukārt sekundārie rezultātu mērījumi ietvēra fizisko funkciju novērtējumu: 6 minūšu iešanas testā (6MIT) noietais attālums un desaturācija; ieelpas muskuļu spēks (cm H2O); izjustās pašefektivitātes izvērtējums ar GSE anketu; ikdienas fizisko aktivitāšu novērtējums ar akselerometriju; miega kvalitātes pašvērtējums (PSQI). Matemātiskās statistikas metožu izvēle tika veikta, ievērojot pakāpienu principu, vadoties pēc ieteikumiem mazo izlašu pētījumiem. Datu analīze veikta statistiskās nozīmības līmenī p < 0,05, savukārt atkārtotajiem mērījumiem tika piemērota Bonferroni korekcija (p < 0,025). Lai noteiktu efekta lielumu, tika aprēķināts Cohen’s d vai Glass rank biserial coefficient (rg), un statistiski nozīmīgiem rezultātiem post hoc analīzē tika noteikta statistiskā jauda, pieņemot, ka jauda vismaz 80 % (1- β ≥ 0,8) ir piemērota β kļūdas kontrolei. Rezultāti. Atkārtotajā novērtējumā tika vērota statistiski nozīmīga atšķirība starp grupām trijās IPA apakšskalās: autonomija ārpus mājas (p = 0,01, rg = 0,66, 1-β = 0,95), loma ģimenē (p = 0,04, rg = 0,55, 1-β = 0,8), autonomija mājās (p = 0,04, rg = 0,51, 1-β = 0,68), norādot uz lielākiem izjustās līdzdalības ierobežojumiem KG dalībniekiem, salīdzinot ar TG dalībniekiem. IPA summārajā rezultātā tika konstatēts statistiski nozīmīgs izjusto ierobežojumu samazinājums tikai TG gan pēc 12 nedēļām (vidēji par 4,4 % (TI 1,6–7,1)), gan atkārtotajā novērtējumā (vidēji par 5,8 % (TI 2,3–9,2)). Tikai TG novēroja statistiski nozīmīgu 6MIT noietā attāluma uzlabojumu: pēc 12 nedēļām vidēji par 51,8 m (TI 25,7–77,9; p < 0,001; d = 1,7), bet atkārtotajā novērtējumā vidēji par 75,5 m (TI 46,1–104,8; p < 0,001; d = 2,1), liecinot par klīniski nozīmīgu uzlabojumu. Kā arī tikai TG novēroja statistiski nozīmīgu ieelpas muskuļu spēka pieaugumu gan pēc 12 nedēļām – vidēji par 9,8 cm H2O (TI 6,9–12,7; p < 0,001; d = 2,2) –, gan atkārtotajā novērtējumā – vidēji par 10,5 cm H2O (TI 7,6–13,5; p < 0,001; d = 2,4). Statistiski nozīmīgu GSE pieaugumu konstatēja tikai TG pēc 12 nedēļām – vidēji par 9,4 % (TI 3,7–15,0; p = 0,004; d = 1,04). Akselerometrijas rezultāti uzrādīja nozīmīgu mazkustīgi pavadītā laika samazinājumu abās grupās, savukārt nozīmīgu zemas un vidējas intensitātes aktivitāšu pieaugumu tikai TG. Vienlaikus TG novērtējumā pēc 12 nedēļām tika vērota statistiski nozīmīga miega kvalitātes uzlabošanās (p = 0,013, rc = 0,76). Secinājumi. Kopumā pētījumā iegūtie rezultāti apliecina, ka pētītā fizioterapijas programma, kas tika realizēta starpdisciplināras ārstēšanas pieejā, aizkavē pacientu ar PAH izjustās līdzdalības pasliktināšanos ikdienas dzīves aktivitātēs, kā arī veido resursu, lai pacients ar PAH varētu uzlabot savas iespējas piedalīties ikdienas dzīves aktivitātēs tādā veidā, kā vēlas, neņemot vērā PAH un tās ārstēšanas ilgtermiņa ietekmi.
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    Ikdienā integrēta un attālināti pārraudzīta fizioterapijas programma starpdisciplināras ārstēšanas pieejā pacientiem ar pulmonālo arteriālo hipertensiju. Promocijas darbs
    (Rīgas Stradiņa universitāte, 2023) Butāne, Līna; Šmite, Daina; Skride, Andris
    Ievads. Pulmonālā arteriālā hipertensija (PAH) pieder reto slimību grupai, un to raksturo progresējoša gaita ar paaugstinātu plaušu artēriju rezistenci un pieaugošu asinsspiedienu plaušu artērijās, kam seko sirds labā kambara pārslodze un mazspēja. Slimības simptomi, slodzes tolerance, hemodinamiskie rādītāji ir tikai aisberga redzamā daļa no kopējās PAH radītās negatīvās ietekmes uz pacienta dzīvi, aktualizējot starpdisciplināras un kompleksas ārstēšanas pieejas nepieciešamību. Pacientu ar PAH ārstēšanā nepieciešams apvienot gan specializētas veselības aprūpes pakalpojumus, gan ilgtermiņa intervences, kas vērstas uz hroniskas slimības pārvaldības spējas uzlabošanu un dinamisku adaptāciju. Tas aktualizē nepieciešamību veidot kompleksas fizioterapijas intervences, kas mērķētas ne tikai uz fizisko funkciju uzlabošanu, bet arī uz slimības pašpārvaldes veicināšanu un veselīgu ikdienas ieradumu veidošanu. Šis ir Latvijā pirmais pētījums par starpdisciplināru pieeju pacientu ar PAH ārstēšanā, mērķa medikamentozo terapiju apvienojot ar kompleksu, ikdienā iekļautu un attālināti pārraudzītu fizioterapijas programmu. Turklāt pētījumā izmantotā pieeja pacientu ar PAH dzīves kvalitātes izvērtēšanā, ietverot pašvērtējumu par izjusto iespēju piedalīties savā ikdienas dzīvē kontekstā ar veselības stāvokli, līdz šim nav bijusi aktualizēta, tādējādi paverot iespējas plašāk izgaismot pacienta perspektīvu par dzīvi ar retu, dzīvību apdraudošu un hronisku slimību. Mērķis. Izpētīt ikdienā integrētas, attālināti pārraudzītas fizioterapijas programmas efektivitāti starpdisciplināras ārstēšanas pieejā, lai uzlabotu un saglabātu pacientu ar PAH izjusto iespēju piedalīties savā ikdienas dzīvē, saistībā ar veselības stāvokli, paaugstinot fizisko funkciju rādītājus, izjusto pašefektivitāti, kā arī pilnveidojot fizisko aktivitāšu ieradumus un miega kvalitāti. Materiāli un metodes. Šis bija kontrolēts nejaušināts pētījums ar prospektīvu datu vākšanu laika periodā no 2020. gada februāra līdz 2020. gada septembrim, kurā tika analizēta izveidotā 12 nedēļu garā kompleksā fizioterapijas programma, kas ietvēra četrus pamatelementu: fiziskos vingrojumus; relaksācijas metodes; paškontroli un pašpārvaldi; izglītošanu un pārraudzību. Programma tika realizēta mājas vidē, integrēta pacienta ikdienas dzīvē un attālināti pārraudzīta. Dalībnieku izlase tika izveidota no Latvijas Pulmonālās hipertensijas reģistrā esošajiem pacientiem, balstoties uz definētajiem iekļaušanas kritērijiem. Izveidotā izlase tika nejaušināti sadalīta terapijas (n = 11) un kontroles grupā (n = 10) (turpmāk TG un KG). Abām grupām tika turpināta medikamentozā terapija, bet TG dalībniekiem papildus tika pievienota izveidotā fizioterapijas programma. Dalībnieku novērtēšana tika veikta trīs reizes – sākotnēji, pēc 12 nedēļām un atkārtoti (24 nedēļas kopš sākuma). Primārais rezultātu mērījums bija izjustās autonomijas un līdzdalības ierobežojuma izvērtējums ar IPA anketu, savukārt sekundārie rezultātu mērījumi ietvēra fizisko funkciju novērtējumu: 6 minūšu iešanas testā (6MIT) noietais attālums un desaturācija; ieelpas muskuļu spēks (cm H2O); izjustās pašefektivitātes izvērtējums ar GSE anketu; ikdienas fizisko aktivitāšu novērtējums ar akselerometriju; miega kvalitātes pašvērtējums (PSQI). Matemātiskās statistikas metožu izvēle tika veikta, ievērojot pakāpienu principu, vadoties pēc ieteikumiem mazo izlašu pētījumiem. Datu analīze veikta statistiskās nozīmības līmenī p < 0,05, savukārt atkārtotajiem mērījumiem tika piemērota Bonferroni korekcija (p < 0,025). Lai noteiktu efekta lielumu, tika aprēķināts Cohen’s d vai Glass rank biserial coefficient (rg), un statistiski nozīmīgiem rezultātiem post hoc analīzē tika noteikta statistiskā jauda, pieņemot, ka jauda vismaz 80 % (1- β ≥ 0,8) ir piemērota β kļūdas kontrolei. Rezultāti. Atkārtotajā novērtējumā tika vērota statistiski nozīmīga atšķirība starp grupām trijās IPA apakšskalās: autonomija ārpus mājas (p = 0,01, rg = 0,66, 1-β = 0,95), loma ģimenē (p = 0,04, rg = 0,55, 1-β = 0,8), autonomija mājās (p = 0,04, rg = 0,51, 1-β = 0,68), norādot uz lielākiem izjustās līdzdalības ierobežojumiem KG dalībniekiem, salīdzinot ar TG dalībniekiem. IPA summārajā rezultātā tika konstatēts statistiski nozīmīgs izjusto ierobežojumu samazinājums tikai TG gan pēc 12 nedēļām (vidēji par 4,4 % (TI 1,6–7,1)), gan atkārtotajā novērtējumā (vidēji par 5,8 % (TI 2,3–9,2)). Tikai TG novēroja statistiski nozīmīgu 6MIT noietā attāluma uzlabojumu: pēc 12 nedēļām vidēji par 51,8 m (TI 25,7–77,9; p < 0,001; d = 1,7), bet atkārtotajā novērtējumā vidēji par 75,5 m (TI 46,1–104,8; p < 0,001; d = 2,1), liecinot par klīniski nozīmīgu uzlabojumu. Kā arī tikai TG novēroja statistiski nozīmīgu ieelpas muskuļu spēka pieaugumu gan pēc 12 nedēļām – vidēji par 9,8 cm H2O (TI 6,9–12,7; p < 0,001; d = 2,2) –, gan atkārtotajā novērtējumā – vidēji par 10,5 cm H2O (TI 7,6–13,5; p < 0,001; d = 2,4). Statistiski nozīmīgu GSE pieaugumu konstatēja tikai TG pēc 12 nedēļām – vidēji par 9,4 % (TI 3,7–15,0; p = 0,004; d = 1,04). Akselerometrijas rezultāti uzrādīja nozīmīgu mazkustīgi pavadītā laika samazinājumu abās grupās, savukārt nozīmīgu zemas un vidējas intensitātes aktivitāšu pieaugumu tikai TG. Vienlaikus TG novērtējumā pēc 12 nedēļām tika vērota statistiski nozīmīga miega kvalitātes uzlabošanās (p = 0,013, rc = 0,76). Secinājumi. Kopumā pētījumā iegūtie rezultāti apliecina, ka pētītā fizioterapijas programma, kas tika realizēta starpdisciplināras ārstēšanas pieejā, aizkavē pacientu ar PAH izjustās līdzdalības pasliktināšanos ikdienas dzīves aktivitātēs, kā arī veido resursu, lai pacients ar PAH varētu uzlabot savas iespējas piedalīties ikdienas dzīves aktivitātēs tādā veidā, kā vēlas, neņemot vērā PAH un tās ārstēšanas ilgtermiņa ietekmi.
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    Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients : A preliminary study
    (2019) Butane, Lina; Šmite, Daina; Šablinskis, Matīss; Skride, Andris; Rīga Stradiņš University
    Background: Exercise-based rehabilitation has been proved as a benefi cial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term efect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training efects of 12-week individualized home-based exercise program in patients with idiopathic PAH. Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confi rmed by right-heart catheterization from the Latvian PAH registry were selected. A 12-week exercise program adaptable for each patient's functional state and home environment was created. The program included muscle strength training, respiratory, aerobic exercise and neuro-muscular relaxation techniques, self-control monitoring, weekly phone control and on-site re-assessment by physiotherapist were parts of the program to ensure both individualized adjustments and proper execution, and to maximize clinical safety. The primary outcome measures for training efects were exercise capacity, breathing pattern and quality of life, for adherence days of performance, for safety any event of "alarm sign" indicators during exercising, incomplete recovery, worsening of PH symptoms. Results: The results showed a rather high degree of adherence to the prescribed exercise regimen (in average 92.5%). No adverse events were observed during the course of the program. The results proved the importance of ensuring optimal self-control skills both for objective measures and subjective symptoms. The 6-minute walking test (6MWT) results show that the developed program signifi cantly improves exercise capacity (mean improvement 39 ± 17.5 m). In four participants (66.7%) the minimum clinically important diference (MCID) for 6MWT distance in PAH patients was observed (25-33 m). Signifi cant improvement in chest excursions confi rm changes in breathing pattern suggesting better engagement of diaphragm during breathing after the program. Results did not show signifi cant improvements in either SF-36 survey domain. However, half of the participants reached MCID (11%) after the program at the physical health subscales. Conclusion: The results of this preliminary study prove that the created individualized home-based exercise program is safe, easily followed and allows progression in exercise intensity and improves physical functional state in clinically stable iPAH patients. This study hypothesis supports the need for RCT to continue research and approve the results.
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    Individually tailored 12-week home-based exercise program improves both physical capacity and sleep quality in patients with pulmonary arterial hypertension
    (2021) Butāne, Līna; Šablinskis, Matīss; Skride, Andris; Šmite, Daina; Rīga Stradiņš University
    Background: Most patients with optimal PAH-targeted medical therapy suffer from clinical symptoms, reduced exercise tolerance and have a poor quality of life. The 2019 European Respiratory Society task force statement on physical exercise and rehabilitation in patients with severe, chronic PH suggests that individually adjusted and monitored exercise programs are likely to be safe for PH patients, who are clinically stable on medical therapy. Currently, the development of PAH-specific rehabilitation interventions is still in the research stage. We present the preliminary results of a more extensive study with the aim to show the effectiveness of a 12-week individualized, home-based exercise program in promoting physical capacity, quality of sleep and reducing signs of emotional distress in patients with PAH. Methods: This was a prospective randomized controlled interventional study. 16 PAH patients were included in the analysis. Training group underwent a complex training program, consisting of 12-week individually tailored home-based exercise training, education, self-control measures and tele-rehabilitation components. The program included muscle strength training, respiratory, aerobic exercise and relaxation techniques. Results: A statistically significant mean increase in 6MWT distance was observed for the training group (Δ = 51.7 ± 45.1 m). In six participants (66.7%) from the training group and two patients (28.6%) from the control group, the minimal clinically significant difference for 6MWT distance was observed (25–33 m). IPsubmax test results changed significantly in training group (Δ = 9.8 ± 4.7 cm H20). PSQI values sleep quality improved from poor to good in four (44.5%) patients from training group. HADS sub-scales scores values confirmed clinically important reduction of anxiety symptoms in both groups. Depression symptoms did not show clinically important changes. No adverse events were observed. Conclusion: The studied 12-week individually tailored home-based exercise program is effective in stable PAH patients by improving physical functional capacity, as well as sleep quality. Further studies are required to solidify the methodology of exercise programmes in the field of PAH. These are the preliminary results of ongoing study.
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    Individually tailored home-based physiotherapy program makes sustainable improvement in exercise capacity and daily physical activity in patients with pulmonary arterial hypertension
    (2022-11) Butāne, Līna; Spilva-Ekerte, Liene; Šablinskis, Matīss; Skride, Andris; Šmite, Daina; Rehabilitācijas fakultāte; Department of Internal Diseases
    BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive, and life-threatening cardiopulmonary disease. This study investigated the impact of an individually tailored 12 weeks home-based physiotherapy program in PAH patients, with the aim to evaluate change in exercise capacity and daily physical activity level. METHODS: This was an analysis of secondary outcomes from a prospective, randomized, controlled intervention study. Twenty-one participants were recruited from the Latvian PH registry based on inclusion criteria and randomized in a training group (TG) and control group (CG). Both groups continued a medical target therapy, but for TG, the individually tailored home-based physiotherapy program was added including physical exercises, relaxation, self-control, education, and supervision with telehealth elements. Outcomes included a 6-min walk test (6MWT) (m) and daily physical activity based on accelerometry results assessed at baseline, after 12 weeks, and at follow-up 6 months after commencement of intervention. RESULTS: 6MWT distance significantly (p < 0.05) and clinically (>33 m) increased within TG after 12 weeks (51.8 m, 95% CI = 25.7-77.9 m, Cohen's d = 1.7) and at follow-up (75.5 m, 95% CI = 46.1-104.8 m, Cohen's d = 2.1). A significant difference in 6MWT results between the groups at 12 weeks and follow-up was approved. In TG, low-intensity activities significantly (p < 0.05) increased both after 12 weeks (Cohen's d = 1.6) and at follow-up (Cohen's d = 1.2), moderate-intensity activities significantly (p < 0.05) increased at follow-up (Cohen's d = 1.3), and no significant improvements were present in CG. CONCLUSION: The individually tailored 12 weeks home-based physiotherapy program comprising comprehensive physical exercise training, relaxation, self-control skills training, and education, added to stable medical target therapy and supervised by physiotherapist through telehealth elements, is effective in improving exercise capacity and increasing daily time in low or moderate physical activities 6 months after commencement of the intervention in patients with PAH.
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    Individually Tailored Remote Physiotherapy Program Improves Participation and Autonomy in Activities of Everyday Life along with Exercise Capacity, Self-Efficacy, and Low-Moderate Physical Activity in Patients with Pulmonary Arterial Hypertension : A Randomized Controlled Study
    (2022-05) Butāne, Līna; Spilva-Ekerte, Liene; Skride, Andris; Šmite, Daina; Rehabilitācijas fakultāte; Department of Internal Diseases
    Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare, chronic, pro-gressive, and life-threatening disease; however, the appropriate target medical treatment today allows patients with PAH not only to survive but also to live a relatively normal life. However, patients face the challenge of adapting and maintaining a good quality of life, thus it is important to consider complex interventions related not only to medical treatment. Methods: This was a prospective, ran-domized, controlled, single-blind study. Twenty-one (21) patients diagnosed with PAH were included and randomly assigned to training or control group. All participants continued target medical therapy. Furthermore, TG underwent the individually tailored 12-week remote physiotherapy program. As a primary outcome measurement, the Impact on Participation and Autonomy Questionnaire (IPA) was used. Secondary outcome included aerobic capacity (6MWT), accelerometery and general self-efficacy (GSE). Data were collected at baseline, after 12 weeks and at follow-up 6 months after the beginning of the intervention. Results: A significant difference between the groups was found in the follow-up assessment on three of the four IPA subscales analyzed, AO, RF, and AI. The total IPA score decreased significantly in TG after the program, indicating an improved participation. In addition, in TG a significant increase in 6MWT results, daily time in low-or moderate-intensity physical activities, and GSE was observed. Conclusions: In summary, the individually tailored physiotherapy program inves-tigated added to stable target medical therapy in patients with PAH encourages improvement and prevents possible deterioration of perceived participation of patients in activities of their everyday life in the context of one’s health condition in the long term, along with improved exercise capacity and increased time spent in low-or moderate-intensity physical activities. Future studies are needed to develop and evaluate long-term intervention to support patients living with this rare, chronic, and life-threatening disease.
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    Outpatient physiotherapy services in Latvian regional hospitals : Characteristics of receivers, the volume of services and source of funding
    (EDP Sciences, 2019) Šmite, Daina; Heize, Ilze; Berķis, Uldis; Vilka, Lolita; Department of Rehabilitation
    Objective: To analyse the outpatient physiotherapy services provided in the regional hospitals of Latvia in 2017 and the profile of their receivers. Methods: In the research, 7 regional hospitals of Latvia participated, in which the analysis of statistical documentation of 2017 was carried out. The following data was collected about the receivers of outpatient physiotherapy services: age, gender, clinical diagnosis and place of residence; about the volume of service provided - the number of visits per patient; about the source of funding (state budget, private resources, insurance). Results: In the regional hospitals of Latvia, outpatient physiotherapy services in 2017 were received by 6957 patients, the most commonly adults of working age with basic clinical diagnosis of the musculoskeletal system and connective tissue diseases, and children up to the age of one year with diagnosis of certain conditions originating in the perinatal period. Among the regional hospitals of Latvia there are significant differences in the volume of outpatient physiotherapy services provided to one patient with a similar clinical diagnosis and age. Latvian regional hospitals still do not have electronic records of all outpatient physiotherapy services, which does not allow to judge about provided services and their receivers, which are financed by patients private resources.
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    Psychosomatic aspects of chronic low back pain syndrome
    (2010-01) Šmite, Daina; Ancāne, Gunta; Rīga Stradiņš University
    The purpose of the study was to determine the relationships between emotional distress and pain syndrome, its characteristic parameters and impact on the quality of life in patients with chronic low back pain. The study included 110 patients, mean age 44.2 ± 8.0 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome. The results showed that the studied patients differed by their emotional state. Emotional distress was associated with high intensity and specific symptoms of low back pain syndrome. Musculoskeletal dysfunction was associated with both physical and psychoemotional factors. The interaction of chronic low back pain syndrome complexity and biopsyhosocial factors is shown by a correlation between cytokines IL- 10 and IL-8 level in blood serum and both pain intensity and duration, characteristics of emotional and physical status, and level of physical activities.
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    Usability and utility of the SnipTouch innovative agility training device prototype in patients with upper extremity impairments after stroke : a multiple case study
    (Rēzeknes Tehnoloģiju akadēmija, 2024-06-27) Snipkis, Andrejs; Semjonova, Guna; Šmite, Daina; Department of Rehabilitation
    Research focus and aim: To investigate the usability and utility of the SnipTouch innovative agility training device prototype in patients with upper extremity impairments after stroke. Research methods used: The study of several case studies was selected by formulating the research phenomenon and proposing two units of analysis- 1) usability and 2) utility of innovative prototype device SnipTouch. The multiple case study involved 7 stroke survivors with impaired upper limb functions who participated in eight physiotherapy sessions adding the SnipTouch intervention. The device operates on a dexterity training principle, where the main task is to quickly touch a lit button. Participants underwent pre-intervention upper extremity assessments using ROM, MMT, NRS, MAS, FMA-UE, 9HPT, BBT, and RTT. After the eighth session of physical therapy, reassessments were conducted with the same tools, supplemented by semi-structured interviews and usability evaluations using UEQ and SUS. The collected data were compiled and analysed using established data analysis methods. Results: Five participants assessed the usability of the equipment in the SUS questionnaire as outstanding (from 87,5 to 97,5 points), one participant as excellent (82,5 points) and one very good (77,5 points). The UEQ on six scales resulted in the following device evaluation: attractiveness 2.6, perspicuity 2.79, efficiency 2.32, dependability 2.14, stimulation 2.64, novelty 2.43. The UEQ benchmark classifies the innovative prototype device SnipTouch into Excellent category. The results of the upper limb functional tests show improvements in all participants. The main Conclusions and Recommendations: The results of the study demonstrate that the SnipTouch innovative device prototype is usable and the overlap of qualitative and quantitative data confirmed the utility of the device in improving reaction time, range of motion, agility, movement coordination, muscle strength, in addition to conventional rehabilitation therapy methods for stroke patients.