Abstract：
BACKGROUND: Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters.
METHODS: A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration\'s tool for assessing the risk of bias (RoB2).
RESULTS: Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size -0.604; confidence interval -1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size -0.500; confidence interval -1.259 to 0.259), the Tiffeneau index, and quality of life.
CONCLUSIONS: Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.
METHODS: A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration\'s tool for assessing the risk of bias (RoB2).
RESULTS: Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size -0.604; confidence interval -1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size -0.500; confidence interval -1.259 to 0.259), the Tiffeneau index, and quality of life.
CONCLUSIONS: Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.
摘要：
背景：增强肺功能可以显著改善脑瘫患儿的日常生活功能，导致临床实践中对呼吸理疗训练设备的兴趣增加。本研究旨在评估通过各种呼吸参数改善肺功能的设备（吸气肌肉训练和反馈设备）的功效。
方法：在7个数据库中对随机临床试验进行了系统评价和荟萃分析，直至2023年5月。纳入的研究重点是使用特定设备（吸气肌肉训练和反馈设备）训练脑瘫儿童的吸气肌肉功能。主要结果为最大呼气压力和最大吸气压力。次要结果包括强制肺活量，一秒钟内用力呼气量,呼气流量峰值,和Tiffenau指数.通过估计效果大小及其95％置信区间来计算呼吸治疗的效果。使用CochraneCollaboration的偏倚风险评估工具（RoB2）评估纳入研究的偏倚风险。
结果：九项研究被纳入系统评价和荟萃分析，共涉及321名年龄在6至18岁之间的儿童进行二次分析后.发现反馈装置在改善最大呼气压力方面更有效（效应大小-0.604；置信区间-1.368至0.161），呼气流量峰值,一秒钟内用力呼气量,和强制肺活量。吸气肌肉训练装置在改善最大吸气压力方面产生了更好的效果（效应大小-0.500；置信区间-1.259至0.259），Tiffeneau指数,和生活质量。
结论：两种装置均显示出改善脑瘫患儿肺功能的潜力。需要进一步的高质量临床试验来确定每个肺功能参数的最佳剂量和最有益的设备类型。
方法：在7个数据库中对随机临床试验进行了系统评价和荟萃分析，直至2023年5月。纳入的研究重点是使用特定设备（吸气肌肉训练和反馈设备）训练脑瘫儿童的吸气肌肉功能。主要结果为最大呼气压力和最大吸气压力。次要结果包括强制肺活量，一秒钟内用力呼气量,呼气流量峰值,和Tiffenau指数.通过估计效果大小及其95％置信区间来计算呼吸治疗的效果。使用CochraneCollaboration的偏倚风险评估工具（RoB2）评估纳入研究的偏倚风险。
结果：九项研究被纳入系统评价和荟萃分析，共涉及321名年龄在6至18岁之间的儿童进行二次分析后.发现反馈装置在改善最大呼气压力方面更有效（效应大小-0.604；置信区间-1.368至0.161），呼气流量峰值,一秒钟内用力呼气量,和强制肺活量。吸气肌肉训练装置在改善最大吸气压力方面产生了更好的效果（效应大小-0.500；置信区间-1.259至0.259），Tiffeneau指数,和生活质量。
结论：两种装置均显示出改善脑瘫患儿肺功能的潜力。需要进一步的高质量临床试验来确定每个肺功能参数的最佳剂量和最有益的设备类型。
