背景:卒中通常会导致患者明显的呼吸功能障碍。呼吸肌训练(RMT)已被提议作为一种康复干预措施来应对这些挑战,但与常规训练相比,其有效性仍存在争议。本系统评价和荟萃分析旨在评估RMT对运动耐量的影响。肌肉力量,卒中后患者的肺功能。
目的:系统评估RMT改善运动耐量的疗效,呼吸肌力量,中风后恢复的患者的肺功能,并评估RMT在增强卒中后人群的这些关键健康结局方面是否比常规训练模式具有显著优势。
方法:遵循系统评价和荟萃分析指南的首选报告项目,跨PubMed的全面搜索,Embase,WebofScience,Cochrane图书馆于2023年10月19日进行,没有时间限制。根据预定义的纳入和排除标准选择研究,重点是各种形式的RMT,控制组,和结果测量[包括第一秒用力呼气量(FEV1),强迫肺活量(FVC),最大自主通气(MVV),峰值呼气流量(PEF),最大吸气压力(MIP),最大呼气压(MEP),和6分钟步行测试(6MWT)]。仅包括随机对照试验(RCTs)。数据提取和质量评估由两名评审员使用CochraneCollaboration的偏倚风险工具独立进行。统计分析,包括那些使用固定效应和随机效应模型的模型,敏感性分析,和出版偏见评估,使用ReviewManager软件进行。
结果:共纳入15项随机对照试验。结果表明MIP显着改善(12.51cmH2O增加),MEP(增加6.24cmH2O),和各种肺功能参数(包括FEV1、FVC、MVV,和PEF)。还注意到6MWT距离(22.26米)的大幅增加。然而,研究之间的异质性是可变的,并且没有检测到显著的发表偏倚。
结论:RMT显著增强步行能力,呼吸肌力量(MIP和MEP),和关键肺功能参数(FEV1、FVC、MVV,和PEF)在中风后患者中。这些发现支持将RMT纳入卒中后康复方案。
BACKGROUND: Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic
review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients.
OBJECTIVE: To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.
METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration\'s risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using
Review Manager software.
RESULTS: A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected.
CONCLUSIONS: RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.