Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial
Tóm tắt
Respiratory complications remain a leading cause of morbidity and mortality in people with acute and chronic tetraplegia. Respiratory muscle weakness following spinal cord injury-induced tetraplegia impairs lung function and the ability to cough. In particular, inspiratory muscle strength has been identified as the best predictor of the likelihood of developing pneumonia in individuals with tetraplegia. We hypothesised that 6 weeks of progressive respiratory muscle training (RMT) increases respiratory muscle strength with improvements in lung function, quality of life and respiratory health.
Sixty-two adults with tetraplegia participated in a double-blind randomised controlled trial. Active or sham RMT was performed twice daily for 6 weeks. Inspiratory muscle strength, measured as maximal inspiratory pressure (PImax) was the primary outcome. Secondary outcomes included lung function, quality of life and respiratory health. Between-group comparisons were obtained with linear models adjusting for baseline values of the outcomes.
After 6 weeks, there was a greater improvement in PImax in the active group than in the sham group (mean difference 11.5 cmH2O (95% CI 5.6 to 17.4), p<0.001) and respiratory symptoms were reduced (St George Respiratory Questionnaire mean difference 10.3 points (0.01–20.65), p=0.046). Significant improvements were observed in quality of life (EuroQol-Five Dimensional Visual Analogue Scale 14.9 points (1.9–27.9), p=0.023) and perceived breathlessness (Borg score 0.64 (0.11–1.17), p=0.021). There were no significant improvements in other measures of respiratory function (p=0.126–0.979).
Progressive RMT increases inspiratory muscle strength in people with tetraplegia, by a magnitude which is likely to be clinically significant. Measurement of baseline PImax and provision of RMT to at-risk individuals may reduce respiratory complications after tetraplegia.
Australian New Zealand Clinical Trials Registry (ACTRN 12612000929808).
Từ khóa
Tài liệu tham khảo
DeVivo, 1993, Causes of death during the first 12 years after spinal cord injury, Arch Phys Med Rehabil, 74, 248
Savic, 2017, Causes of death after traumatic spinal cord injury-a 70-year British study, Spinal Cord, 55, 891, 10.1038/sc.2017.64
Roth, 2010, Expiratory muscle training in spinal cord injury: a randomized controlled trial, Arch Phys Med Rehabil, 91, 857, 10.1016/j.apmr.2010.02.012
Metcalf, 1966, Vital capacity and glossopharyngeal breathing in traumatic quadriplegia, Phys Ther, 46, 835, 10.1093/ptj/46.8.835
Montero, 1967, Effects of glossopharyngeal breathing on respiratory function after cervical cord transection, Arch Phys Med Rehabil, 48, 650
Berlowitz DJ , Tamplin J . Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev 2013:CD008507.doi:10.1002/14651858.CD008507.pub2
Lee, 2009, The SF-36 walk-wheel: a simple modification of the SF-36 physical domain improves its responsiveness for measuring health status change in spinal cord injury, Spinal Cord, 47, 50, 10.1038/sc.2008.65
Loveridge, 1990, Breathing pattern in chronic quadriplegia, Arch Phys Med Rehabil, 71, 495
Mueller, 2012, Prediction models and development of an easy to use open-access tool for measuring lung function of individuals with motor complete spinal cord injury, J Rehabil Med, 44, 642, 10.2340/16501977-1011
Arora, 2012, Respiratory care of patients with cervical spinal cord injury: a review, Crit Care Resusc, 14, 64
Boswell-Ruys CL , Lewis CRH , Gandevia SC , et al . Respiratory muscle training may improve respiratory function and obstructive sleep apnoea in people with cervical spinal cord injury. Spinal Cord Ser Cases 2015;1.doi:10.1038/scsandc.2015.10
McDonald, 2019, Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury, J Spinal Cord Med, 42, 220, 10.1080/10790268.2018.1432307
Lindholm, 2007, Resistive respiratory muscle training improves and maintains endurance swimming performance in divers, Undersea Hyperb Med, 34, 169