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Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

ABSTRACT: Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. Study selection and data extraction: randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. Results: nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. Conclusions: RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.

SUBMITTER: Pozuelo-Carrascosa DP

PROVIDER: S-EPMC7432552 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

Pozuelo-Carrascosa Diana P DP Carmona-Torres Juan Manuel JM Laredo-Aguilera José Alberto JA Latorre-Román Pedro Ángel PÁ Párraga-Montilla Juan Antonio JA Cobo-Cuenca Ana Isabel AI

International journal of environmental research and public health 20200724 15

Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May ...[more]

PMID: 32722338

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Project description:ObjectiveTo examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke.DesignProspective, randomized controlled trial.SettingTertiary hospital.ParticipantsThe trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups.InterventionInspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks.Main outcome measuresMIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis.ResultsSignificant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups.ConclusionsAltogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

Project description:BackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients.MethodsPubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I 2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated.ResultsWe ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43-28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39-13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53-58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score.ConclusionBased on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972].

Project description:BackgroundElectromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007.ObjectivesTo investigate the effects of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke.Search methodsWe searched the Cochrane Stroke Group Trials Register (last searched April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2), MEDLINE (1966 to November 2012), EMBASE (1980 to November 2012), CINAHL (1982 to November 2012), AMED (1985 to November 2012), SPORTDiscus (1949 to September 2012), the Physiotherapy Evidence Database (PEDro, searched November 2012) and the engineering databases COMPENDEX (1972 to November 2012) and INSPEC (1969 to November 2012). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists and contacted authors in an effort to identify further published, unpublished and ongoing trials.Selection criteriaWe included all randomised and randomised cross-over trials consisting of people over 18 years old diagnosed with stroke of any severity, at any stage, or in any setting, evaluating electromechanical and robotic-assisted gait training versus normal care.Data collection and analysisTwo review authors independently selected trials for inclusion, assessed methodological quality and extracted the data. The primary outcome was the proportion of participants walking independently at follow-up.Main resultsIn this update of our review, we included 23 trials involving 999 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (OR) (random effects) 2.39, 95% confidence interval (CI) 1.67 to 3.43; P < 0.00001; I² = 0%) but did not significantly increase walking velocity (mean difference (MD) = 0.04 metres/s, 95% CI -0.03 to 0.11; P = 0.26; I² = 73%) or walking capacity (MD = 3 metres walked in six minutes, 95% CI -29 to 35; P = 0.86; I² = 70%). The results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variations between the trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Our planned subgroup analysis suggests that people in the acute phase may benefit but people in the chronic phase may not benefit from electromechanical-assisted gait training. Post hoc analysis showed that people who are non-ambulatory at intervention onset may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk, but significant differences were found between devices in terms of walking velocity.Authors' conclusionsPeople who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of a large definitive, pragmatic, phase III trial undertaken to address specific questions such as the following: What frequency or duration of electromechanical-assisted gait training might be most effective? How long does the benefit last?

Project description:ObjectiveAfter a stroke, patients usually suffer from dysfunction, such as decreased balance ability, and abnormal walking function. Whole-body vibration training can promote muscle contraction, stimulate the proprioceptive system, enhance the muscle strength of low limbs and improve motor control ability. The study aims to evaluate the effectiveness of whole-body vibration training on the balance and walking function of patients with stroke.MethodsPubMed, CNKI, VIP, CBM, EBSCO, Embase and Web of Science were searched. According to the inclusion and exclusion criteria, randomized controlled trials on the effectiveness of whole-body vibration training on the balance and walking function of patients with stroke were collected. The search time ranged from the date of database construction to November 2022. The included trials were evaluated by the Cochrane risk-of-bias tool. The meta-analysis was performed using two software packages, consisting of RevMan 5.4 and Stata 12.2. If the results included in the literature were continuous variables, use the mean difference (MD) and 95% confidence interval (CI) for statistics.Results(1) A total of 22 randomized controlled trials (RCTs) with a total of 1089 patients were included. (2) The results of meta-analysis showed that: compared with the controls, step length (MD = 6.12, 95%CI [5.63, 6.62], p < 0.001), step speed (MD = 0.14, 95%CI [0.09, 0.20], p < 0.001), cadence (MD = 9.03, 95%CI [2.23, 15.83], p = 0.009), stride length (MD = 6.74, 95%CI [-3.47, 10.01], p < 0.001), Berg Balance Scale (BBS) (MD = 4.08, 95%CI [2.39, 5.76], p < 0.001), Timed Up-and-Go test (TUGT) (MD = -2.88, 95%CI [-4.94, 0.81], p = 0.006), 10-meter Walk Test (10MWT) (MD = -2.69, 95%CI [-3.35, -2.03], p < 0.001), functional ambulation category scale (FAC) (MD = 0.78, 95%CI [0.65, 0.91], p < 0.001), Fugl-Meyer motor assessment of lower extremity (FMA-LE) (MD = 4.10, 95%CI [2.01, 6.20], p = 0.0001). (3) The results of subgroup analysis showed that, compared with other vibration frequencies, at 20-30 Hz frequency, WBV training had an obvious improvement effect only in TUGT. (4) The safety analysis showed that WBV training may be safe.ConclusionWhole-body vibration training has a positive effect on the balance and walking function of patients with stroke. Thus, whole-body vibration training is a safe treatment method to improve the motor dysfunction of patients with stroke.Systematic review registration[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD4202348263].

Project description:BackgroundIn patients with multiple sclerosis (MS), there is a decline in muscle strength and physical capacity due to demyelination and axonal loss in the central nervous system. In patients with advanced MS or in a later stage of the disease, also respiratory impairment may occur. The degree of pulmonary dysfunction in the earlier stages of MS has not been thoroughly described. Therefore, the primary aims of this study are to describe pulmonary function and respiratory muscle strength in patients with a moderate disease course and to identify associations between respiratory muscle strength and functional capacity.MethodsA sample of 48 patients with a diagnosis of MS and mean age 56 ± 11 years was studied using a descriptive cross-sectional design. The patients had a disease duration of 24 ± 11 years and a median Expanded Disability Status Scale (EDSS) score of 4.5 (interquartile range 4.0-6.5). Pulmonary function assessed by spirometry, respiratory muscle strength, peak cough flow and peripheral oxygen saturation, subjective breathing and coughing ability, and physical capacity measured using the 6MWT were evaluated.ResultsThe patients had normal pulmonary function with no significant abnormalities in dynamic spirometry (vital capacity 103 ± 16% predicted, forced expiratory volume in 1 second 95 ± 15% predicted). Peak expiratory flow rate 89 ± 17% predicted was in the lower limit of normal. Respiratory muscle strength, determined by maximal inspiratory (MIP) and expiratory (MEP) static pressures, was normal but with large differences between individuals. MIP ranged from 26 to 143 cmH2O (98 ± 31% predicted); the MEP values ranged from 43 to 166 cmH2O (104 ± 29% predicted), with two patients having values below the lower limit of normal. Significant positive associations between MIP as well as MEP were found in several pulmonary function variables. A significant negative association was found between EDSS score and MEP (r = -0.312, p = 0.031). Mean peak cough flow was 389 ± 70 L/min, which is comparable with the values reported for healthy adults. The patients did not experience a severely decreased ability to take deep breaths or cough. There was a moderate correlation between MEP and physical capacity, as assessed by the 6MWT (r = 0.399, p = 0.010) and between peak expiratory flow (PEF) and the 6MWT (r = 0.311, p = 0.048).ConclusionRespiratory muscle strength, pulmonary function assessed by spirometry, and peak cough flow were normal in patients with mild to moderate MS; however, there were large individual differences demonstrating low respiratory muscle strength in some patients. Significant associations between MEP and functional capacity and between MEP and disease severity were found, indicating that patients with impaired respiratory muscle strength have lower functional capacity and more severe disease.

Dataset Information

Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

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Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

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