Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis Reabilitação pulmonar domiciliar ou comunitária para indivíduos com doença pulmonar obstrutiva crônica: revisão sistemática e meta-análise Rehabilitación pulmonar domiciliaria o comunitaria para individuos con enfermedad pulmonar obstructiva crónica: revisión sistemática y metaanálisis

BACKGROUND: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (P E max 21.49 cm H 2 O, 95% CI 13.39 -29.59) and maximum inspiratory pressure (P I max 7.68 cm H 2 O, 95% CI 0.90 -14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI ؊39.62 to 97.65) and dyspnea (0.15, 95% CI ؊0.77 to 1.08). In relation to EMT plus IMT, we observed that P E max (31.98 cm H 2 O, 95% CI 26.93-37.03) and P I max (27.98 cm H 2 O, 95% CI 20.10 -35.85) presented higher values compared to control groups. CONCLUSIONS: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.

Neuromuscular control of the lower limbs has been explored in the liturgy in an attempt to elucidate possible causes and mechanisms of lower limb injuries. Among other instruments, the Y Balance Test has been used to evaluate neuromuscular control, mobility and stability of lower limbs and hip. The device used to perform the test uses the anterior posteromedial and posterolateral components of the Star Excursion Balance Test, the test that gave rise to the Y Balance Test. During the test, the individual needs a maximum distance in each direction in a stable way without leaving the posture indicated by the evaluator. To express a reach distance as a division of the length, are calculated as normalized distances of each direction for each lower limb, asymmetry between the limbs, and a composite score of the whole test. Asymmetries with a value equal to or higher than 4 cm and/or composite score below 94% are related to neuromotor deficit suggesting a greater probability of injuries in the lower limbs. Keywords

No abstract