Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident

Martín-Valero, Rocío; de-la-Casa-Almeida, María; Casuso-Holgado, María Jesús; Heredia-Madrazo, Alfonso

doi:10.4187/respcare.03981

Cited by 26 publications

(38 citation statements)

References 26 publications

(45 reference statements)

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“…Studies were considered of high enough methodological quality if they had a score of at least 5. This was based on the fact that studies with a score closer to 4 did not use a triple-blind methodology (subject, evaluator, and treatment provider) [45]. …”

Section: Resultsmentioning

confidence: 99%

Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

et al. 2017

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BackgroundIn addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions.ObjectivesThe aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions.MethodsStudy quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine.ResultsWe found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A–B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C).ConclusionsConclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors’ knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review.

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Section: Resultsmentioning

confidence: 99%

Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

et al. 2017

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“…[9,38] Another systematic review including 3 randomized controlled trials and 3 cross-sectional studies compared IMT with a control intervention in stroke patients, and the results showed that the stroke patients had improvement in MIP after the IMT program. [16] …”

Section: Discussionmentioning

confidence: 99%

“…The training intensity, frequency, and duration were similar to those used in other trials (5–6 d/wk for 6–12 weeks). [4,14,16,17,35,42] …”

Section: Discussionmentioning

confidence: 99%

“…[45] Future studies should address how to deal with this methodological challenge. Finally, the follow-up duration in previous IMT trials ranged from 4 to 12 weeks, [16,17] and no long-term follow-up results have been published. Further studies with larger sample size and longer duration are warranted to investigate the long-term efficacy among these patients.…”

Section: Discussionmentioning

confidence: 99%

“…IMT has recently been applied in both patients with stroke [16] and CHF [17] patients separately, and most of these patients had significant improvement in cardiopulmonary functions. However, there was no study about IMT in stroke patients combined with CHF.…”

Section: Introductionmentioning

confidence: 99%

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Inspiratory muscle training in stroke patients with congestive heart failure

Chen¹,

Liaw²,

Wang³

et al. 2016

Medicine

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BackgroundCardiopulmonary function can be adversely affected after a cerebrovascular accident in patients with congestive heart failure (CHF). The aim of this study was to investigate the efficacy and feasibility of inspiratory muscle training (IMT) for stroke patients with CHF.MethodsA prospective randomized single-blind controlled trial was conducted in a single tertiary medical center in southern Taiwan between May 2011 and July 2015. Forty-one patients were enrolled, of whom 21 completed the study (IMT group n = 11 and control group n = 10). Both groups participated in a conventional stroke rehabilitation program. Patients in the IMT group received an additional IMT program beginning with an intensity of 30% maximal inspiratory pressure (MIP), then increased by 2cmH2O each week for 30 minutes daily for at least 5 days a week for 10 weeks. MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient.ResultsThere were significant differences from baseline in MIP (P = 0.008), percent predicted forced vital capacity (P = 0.033), forced expiratory volume in 1 second (FEV1) (P = 0.008), percent predicted FEV1 (P = 0.008), and Barthel Index (P = 0.012) in the IMT group, and Barthel Index (P = 0.027) in the control group. There were significant differences between groups in MIP (20.91 ± 19.73 vs −9.00 ± 26.01, adjusted P value = 0.023) and Barthel Index (24.55 ± 22.30 vs 7.50 ± 8.25, adjusted P value = 0.044).ConclusionThe 10-week IMT was feasible and effective in improving inspiratory force and activities of daily living for the stroke patients with CHF.

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Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke

Lewko

Sidaway

Kulnik

et al. 2021

Physiotherapy Res Intl

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Background and Purpose Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce. Methods This study employed a test–retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21–128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1–3) conducted within 24 h and following international standards. Intra‐rater agreement between testing sessions was analyzed using the Bland–Altman method. Test–retest reliability was analyzed using intra‐class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho. Results Mean difference and 95% limits of agreement for MIP were −0.40 (−23.02, 22.22) cmH2O between S1 and S2, and 2.14 (−12.79, 16.99) cmH2O between S2 and S3; for MEP, −4.56 (−29.01, 19.90) cmH2O between S1 and S2, and 0.29 (−24.28, 24.87) cmH2O between S2 and S3; and for SNIP, −10.56 (−38.48, 17.37) cmH2O between S1 and S2, and −6.06 (−27.32, 15.20) cmH2O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment. Discussion MIP, MEP, and SNIP in acute and subacute stroke patients show good test–retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.

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Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident

Cited by 26 publications

References 26 publications

Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review

Inspiratory muscle training in stroke patients with congestive heart failure

Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke

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