Respiratory muscle training in persons with spinal cord injury: A systematic review

Abstract

The purpose of this paper was to review the effectiveness of respiratory muscle training (RMT) on respiratory muscle strength and endurance, pulmonary function, quality of life, respiratory complications and exercise performance in persons with spinal cord injury. A MEDLINE (National Library of Medicine, Bethesda, MD, USA) database was used for selection of the literature (from 1980 to November 2004), and relevant references from peer-reviewed articles were retrieved as well. Studies investigating the effects of RMT (i.e. resistive breathing weight lifting or normocapnic hyperpnea) in persons with spinal cord injury were selected. Two independent reviewers investigated controlled studies for methodological quality by using a modification of the framework for methodological quality. Methodological quality ranged between 15 and 29 (maximal feasible score=40). Twenty-three papers were retrieved and six controlled trials were kept for further analysis. A meta-analysis and calculation of effect-size of each individual study and weighted summary effect-size was intended. However, unreported data and heterogeneity in outcome variables did not allow performing a meta-analysis. From the systematic review it is concluded that RMT tended to improve expiratory muscle strength, vital capacity and residual volume. Insufficient data was available to make conclusions concerning the effects on inspiratory muscle strength, respiratory muscle endurance, quality of life, exercise performance and respiratory complications.

A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia

“…31,32 Consideration should be given to the standardization of peak cough flow as an index to enable future comparison and meta-analyses across studies. An important limitation of this meta-analysis is the inclusion of a few participants with paraplegia in the papers of Van Houtte et al 11 and Litchke et al 15 In any meta-analysis, it is always debatable whether it is better to be broadly inclusive in terms of study selection or to be very selective and specific with the selection of studies to be included. In this paper, we chose to be inclusive to examine the overall question as to whether RMT has a role in tetraplegia.…”

“…Specifically, if we exclude the Litchke et al 15 The results of this meta-analysis indicate that RMT is able to increase the functional capacity of the lungs as measured by MVV, which may affect quality-of-life outcomes for people with tetraplegia. Van Houtte et al 11 found that significant improvements in MVV following RMT were coupled with significant improvements in respiratory endurance and health-related quality of life, as measured by the Index of Pulmonary Dysfunction. Litchke et al 15 proposed a similar hypothesis regarding the effect of RMT on overall lung function for wheelchair athletes and the potential subsequent effect on the overall quality of life.…”

“…Previous attempts at systematically reviewing the research to evaluate the effect of RMT in patients with SCI [9][10][11] have reported that heterogeneity, in terms of research design, participant characteristics, training techniques used and outcomes measured, has prohibited meta-analysis. We recently published a Cochrane review (including meta-analysis) of RMT in cervical SCI.…”

Treinamento de músculos inspiratórios em pacientes com quadriplegia

“…(6,(8)(9)(10)(11)(12)(13)(14)(15)(16) Those studies have used different methods for overloading inspiratory muscles, such as the use of threshold trainers, resistive trainers or abdominal weights, as well as normocapnic hyperpnea and training protocols involving high or unknown loads. (11)(12)(13) Some studies have included a control group, (2,11,16,17) whereas others have included only a training group or compared the type of training used with that of another protocol. Although two recent systematic reviews have pointed to a few "trends", no evidence of the effectiveness of respiratory muscle training in spinal cord-injury patients has been established.…”

Developing swiss paraplegic research: Building a research institution from the comprehensive perspective

“…In addition, many potential interventions like respiratory muscle training [82] still lack supportive evidence with regard to their efficacy and long-term effectiveness.…”