Table 8: Effect of Respiratory Muscle Training on Pulmonary Function during Acute SCI

Author Year
Country
Research Design
PEDro
Sample Size
Methods Outcomes
Postma et al. (2014)
The Netherlands
RCT
PEDro=7
N=40
Population: Resistive inspiratory muscle training group (RIMT): Mean age: 47.1 yr; Gender: male=20, female=1; Control Group: Mean age: 46.6 yr; Gender: male=15, female=4; Level of injury: T12 and above; Severity of injury: complete=24, incomplete=16.
Intervention: Patients were randomly assigned to receive usual rehabilitation care plus RIMT with a threshold trainer (RIMT group), or usual rehabilitation care only (control group).
Outcome Measures: The following at baseline, after 8 weeks of intervention, 8 weeks after intervention, 1 yr after discharge from inpatient rehabilitation: maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate, maximum ventilation volume, health-related quality of life (HRQoL), and 36-item short-form health survey (SF-36).
Chronicity: Median number of days since injury was 74 (RIMT group) and 88 (control group).
1. MIP improved more in the RIMT group compared with the control group 1 week after the intervention period (mean difference=11.67 cm H2O, p=0.002); this difference was no longer significant 8 weeks after the intervention period (p=0.065) or at 1 yr after discharge from inpatient rehabilitation (p=0.271).

2. No other between-group differences were found in any of the other measures of respiratory function.

3. The RIMT group improved more in mental health compared with the control group 1 week after the intervention period (p=0.006).

Effect Sizes
Roth et al. (2010)
USA
RCT
PEDro=4
N=29
Population: Resistance Training Group: Mean age: 31.1 yr; Gender: male=81%, female=19%; Sham Training Group: Mean age: 28.9 yr; Gender: male=69%, female=31%; Level of injury: C4-C7, T1; Severity of injury: complete.
Intervention: Patients were randomly assigned to either expiratory muscle resistance training or sham training for a total of 6 weeks.
Outcome Measures: The following before and after the training program: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), inspiratory capacity, expiratory reserve volume (ERV), total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV).
Chronicity: Patients were invited to participate in the study if the SCI was recent and had occurred within 6 months’ time. No further information regarding time since injury was provided.
1. Multivariate analysis did not reveal any significant differences between the resistance training and sham training groups for any of the pulmonary function tests (p=0.22).

2. Univariate analysis revealed significant improvements in FVC (p=0.02), FEV1 (p=0.02), ERV (p=0.04), MIP (p=0.002), and MEP (p<0.001) in the resistance training group.

3. Univariate analysis revealed significant improvements in FVC (p=0.04), FEV1 (p=0.01) and ERV (p<0.01) in the sham training group.

 

 

Derrickson et al. (1992)
USA
RCT
PEDro=3
N=11
Population: Age range: 16-41 yr; Gender: male=6, female=5; Level of injury: C4-5 to C7; Severity of injury: complete.
Intervention: Patients were randomly assigned to receive resistive inspiratory muscle training (RIMT) or abdominal weights (AbWts) training for 7 weeks. Training sessions consisted of two 15-minute treatments each day, 5 days a week.
Outcome Measures: The following after one week and seven weeks: forced vital capacity (FVC), inspiratory capacity (IC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF) rate, and increased inspiratory mouth pressure (PImax).
Chronicity: Time since injury was an average of 12 days (RIMT group) and 25 days (AbWts group).
Between group comparison:

1. There were no significant differences in FVC, MVV, PEFR, PImax, and IC between patients who received RIMT training and those who received AbWts training (p>0.05 in all cases).

Within group comparison:

1. After 7 weeks, patients who received RIMT training experienced a significantly larger FVC (p<0.001), a larger MVV (p<0.05), a higher PEF (p<0.01), a lower PImax (p<0.001), and a higher IC (p<0.05) compared to these measures after 1 week.

2. After 7 weeks, patients who received AbWts training experienced a significantly larger FVC (p<0.001), a larger MVV (p<0.001), a higher PEF (p<0.001), and a lower PImax (p<0.001) compared to these measures after 1 week.

Raab et al. (2018)
Switzerland
Case Control
N=79
Population: Inspiratory Muscle Training Group – AIS A/B: Mean age: 48 yr; Gender: male=10, female=5; Level of injury: N/R; Injury severity: tetraplegia=7, paraplegia=8. Inspiratory Muscle Training Group – AIS C/D: Mean age: 63 yr; Gender: male=22, female=5; Level of injury: N/R; Injury severity: tetraplegia=22, paraplegia=5. Combined In- and Expiratory Muscle Training Group – AIS A/B: Mean age: 44.5 yr; Gender: male=14, female=2; Level of injury: N/R; Injury severity: tetraplegia=7, paraplegia=9. Combined In- and Expiratory Muscle Training Group – AIS C/D: Mean age: 60 yr; Gender: male=18, female=3; Level of injury: N/R; Injury severity: tetraplegia=18, paraplegia=3.
Intervention: Individuals had up to 5 training sessions per week of either inspiratory muscle training or combined in- and expiratory muscle training.
Outcome Measures: Maximal inspiratory pressure (PImax), expiratory pressure (PEmax), forced vital capacity, forced expiratory volume, sniff nasal inspiratory pressure, and peak expiratory flow. Results were stratified by AIS groups A/B and C/D.
Chronicity: On average patients were 2.4 mo post injury.
1. PI max was seen to significantly increase for those treated with combined muscle training, regardless of AIS score (p<0.001) and for those treated with inspiratory muscle training only (p=0.008).

2. PEmax was seen to significantly increase for those treated with combined muscle training, regardless of AIS score (p<0.001) and for those with AIS scores of C or D treated with inspiratory only muscle training (p<0.001).

3. Forced vital capacity was seen to significantly increase in those who were treated with combined muscle training, regardless of AIS score (p<0.001). The same trends were observed for those in the inspiratory only muscle training groups (p<0.05).

4. Forced expiratory volume was found to significantly increase in individuals treated with combined muscle training, regardless of AIS score (p<0.05), while the same trend was observed for those treated with inspiratory only muscle training (p<0.05).

5. Sniff nasal inspiratory pressure was found to significantly increase in those treated with combined muscle training (p<0.001), regardless of AIS score. No significant improvements were observed in the inspiratory only muscle training group.

6. Peak expiratory flow was only seen to improve significantly in the AIS C and D groups regardless of type of intervention (p<0.05), but not the AIS A/B groups.

Berney et al. (2002)
Australia
Case Control
N=14
Population: Mean age: 28 yr; Gender: male=11, female=3; Level of injury: C5-C7; Severity of injury: complete.
Intervention: Patients who received a tracheostomy were compared to patients who were extubated and received physiotherapy.
Outcome Measures: The following at the time of extubation/the day of tracheostomy: forced vital capacity (FVC), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), total number of physiotherapy treatments, number of physiotherapy treatments in intensive care unit (ICU), length of stay in ICU, days requiring mechanical ventilation, length of stay in acute ward after discharge from ICU, days from injury to fixation.
Chronicity: Patients were studied beginning within 24 hr of injury.
1. There was no significant difference in FVC between tracheostomized patients and physiotherapy patients (p>0.05).

2. There was no significant difference in PaO2/FiO2 ratios between tracheostomized patients and physiotherapy patients (p>0.05).

3. There was no significant difference in total number of physiotherapy treatments between tracheostomized patients and extubated patients. Patients who were extubated and received physiotherapy required significantly fewer treatments compared to tracheostomized patients in ICU (p=0.047).

4. Tracheostomized patients spent significantly more days in ICU than physiotherapy patients (p=0.006) and required mechanical ventilation significantly longer than the physiotherapy group (p=0.018).

5. There was no significant difference in the length of stay in the acute ward between groups (p>0.05).

6. There was no significant difference in the time from injury to fixation between groups (p>0.05).

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