Making tables Carlos

Berlowitz and Tamplin 2013;

        (Tamplin & Berlowitz, 2014)

Australia

Reviewed published articles (searches were not restricted by date, language, or publication status)

N=11

Level of evidence:

PEDro scale was used to evaluate studies

Type of study:

11 RCT

AMSTAR: 10

1. 11 RCTs with 212 participants with cervical SCI were included.
2. Meta-analysis revealed a statistically significant effect of RMT for 3 outcomes: VC (MD mean end point 0.4L, 95% CI 0.1 to 0.7), MIP (MD mean end point 10.5 cmH₂O, 95% CI 3.4 to 17.6), and maximal expiratory pressure (MD mean end point 10.3 cmH₂O, 95% CI 2.8 to 17.8). (Berlowitz and Tamplin 2013)
3. Meta-analysis revealed a statistically significant effect of RMT for 2 extended outcomes: MVV (MD mean end point 17.51L/min, 95% CI 5.20 to 29.81), and IC (MD mean end point 0.35L, 95% CI 0.05 to 0.65) (Tamplin & Berlowitz, 2014)
4. RMT showed a combined benefit in VC & FVC (MD mean end point 0.41L, 95% CI 0.17 to 0.64) (Tamplin & Berlowitz, 2014)
5. There was no effect on forced expiratory volume in one second or dyspnoea.
6. The results from quality of life assessment tools could not be combined from the three studies for meta-analysis.

No adverse effects as a result of

Wadsworth et al. 2009;

Australia

Reviewed published articles from databases’ inception to March 2008

N=11

Level of Evidence:

PEDro scale

Type of study:

5 crossover randomized

1 crossover pseudorandomized

1 crossover

4 within-patient

AMSTAR: 9

Methods:

Literature search for randomized control and randomized crossover studies reporting the effects of AB in acute or chronic SCI individuals

Interventions included different types of abdominal binding.

Databases: MEDLINE, CINAHL, Cochrane, EMBASE, PEDro

1. Some evidence that the use of an abdominal binder improves VC, but decreases FRC when assuming the sitting or tilted position.
2. AB did not influence total lung capacity.
3. PEDro mean score of 4.3/8.

Available evidence is not yet sufficient to either support or discourage the use of an abdominal binder in this patient population.

Berney et al. 2011;

Australia

Reviewed published articles from 1950 to 2008

N= 21

Level of Evidence:

PEDRo Scale

Newcastle–Ottawa Scale (NOS) with nine scored criteria

Type of study:

1 RCT

3 cohort

3 case–control

14 retrospective case series reports.

AMSTAR: 6

Methods: Literature search for English articles with quantitative study designs on the effectiveness of treatment strategies for the respiratory management of acute tetraplegia

Databases:

MEDLINE (1950–2008), CINAHL (1982–2008), EMBASE (1980–2008), the Cochrane Library (2008), Web of Science (1900–1914–2008), http://www.guideline.gov and http://www.icord.org/scire/ chapters.php on 20 October 2008.

1. A clinical pathway with a structured respiratory protocol that includes a combination of treatment techniques, provided regularly is effective in reducing respiratory complications and cost.
2. Mortality (ARR=0.4, 95% confidence interval (CI) 0.18, 0.61), the incidence of respiratory complications (ARR=0.36, 95% CI (0.08, 0.58)), and requirement for a tracheostomy (ARR=0.18, 95% CI (-0.05, 0.4)) were significantly reduced by using a respiratory protocol.

Overall, study quality was moderate. Further studies using specific interventions that target respiratory complications associated with specific regions of the cervical spine, using more methodologically rigorous designs are required.

Reid et al. 2010;

Canada

Reviewed published articles from databases’ inception to May 2009

N=24

Level of Evidence:

PEDro scale – RCTs

Modified Downs and Black – non RCTs

Type of study:

2 RCT

3 prospective controlled

9 pre-post

3 retrospective case series

7 case reports

AMSTAR: 6

Methods: Literature search for English articles assessing  physical therapy secretion removal techniques

Databases: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO

1. Level 4/5 evidence supports the use of secretion removal techniques in people with SCI.
2. Level 2 evidence (from 1 prospective controlled trial) and level 4 evidence (based on 2 pre-post studies) support the effectiveness of abdominal binders for assisted breathing.
3. Level 1 evidence that respiratory muscle training improves respiratory muscle strength and decreases the number of respiratory infections, both of which infer improved airway clearance.
4. Level 4 evidence based on 2 pre-post trials and level 5 evidence from 2 case reports support the use of electrical stimulation of the lower thoracic-lumbar spinal cord (T9, T11, and L1) and the abdominal wall muscles to improve expiratory flow rates during cough.
5. Level 2 (based on 2 prospective controlled trials) and level 4 (based on 1 pre-post trial) evidence support the effectiveness of assisted coughing by manual abdominal compression.
6.  

Sheel et al. 2008;

Canada

Review published articles from 1980 to 2006

N=13

Level of Evidence:

PEDro scale – RCTs

Modified Downs and Black – non RCTs

Type of study:

3 RCTs

1 pre-post

6 case series

2 cohort

1 case report

AMSTAR: 6

Methods: Literature search for articles assessing exercise training and IMT in individuals for the improved respiratory function of patients with SCI

Databases:

MEDLINE/ PubMed, CINAHL, EMBASE, PsycINFO

1. There is Level 2 evidence supporting exercise training as an intervention to improve respiratory strength and endurance.
2. There is Level 4 evidence to support exercise training as an intervention to improve resting and exercising respiratory function in people with SCI.
3. There is Level 4 evidence to support IMT as an intervention to decrease dyspnea and improve cardiovascular function in people with SCI.

Van Houtte, Vanlandewijck, and Gosselink 2006;

Belgium

Reviewed published articles from 1980 to November 2004

N= 21

Level of Evidence:

Modification of the framework for methodological quality developed by Smith et al. and Lotters et al.

– Max score of 40

Type of study:

6 controlled studies

15 non controlled studies

AMSTAR: 5

Methods: Literature search for articles assessing the effectiveness of RMT on individuals with SCI

Databases:  MEDLINE (National Library of Medicine, Bethesda, MD, USA) database (from 1980 to November 2004) and relevant references from peer-reviewed articles

1. RMT tended to improve expiratory muscle strength, VC and residual volume.
2. 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.

Giannoccaro et al. 2013;

Italy

Reviewed published articles up to October 2012.

N=113

Level of evidence:

Methodological quality was not assessed

Type of study:

Types of studies included not specified.

AMSTAR: 1