背景:呼吸肌训练是对呼吸肌的连续和标准化训练,但对早期中风患者的影响的证据尚不清楚。本荟萃分析旨在探讨呼吸肌训练对早期脑卒中患者呼吸功能和功能能力的影响。
方法:PubMed,Embase,PEDro,ScienceDirect,AMED,CINAHL,和中国国家知识基础设施数据库从开始到2023年12月8日检索有关1)年龄≥18岁卒中患者研究的文章.早期卒中在诊断时<3个月,2)呼吸肌训练,包括吸气和呼气肌肉训练,3)以下测量结果:呼吸肌力量,呼吸肌耐力,肺功能测试,呼吸困难疲劳评分,和功能能力,4)随机对照试验。符合纳入标准的研究是提取数据,并由两名独立评审员使用物理治疗证据数据库量表和Cochrane偏差风险工具评估方法学质量和偏差风险。使用具有随机效应模型的RevMan5.4进行数据合成和分析。平均差(MD)或标准平均差(SMD),计算95%置信区间(95CI)。
结果:九项研究符合纳入标准,招募526名参与者(平均年龄61.6岁)。呼吸肌训练对改善最大吸气压力具有统计学意义(MD=10.93,95CI:8.51-13.36),最大呼气压(MD=9.01,95CI:5.34-12.69),强迫肺活量(MD=0.82,95CI:0.54-1.10),最大呼气流量(MD=1.28,95CI:0.94-1.63),1s用力呼气量(MD=1.36,95CI:1.13-1.59),早期卒中患者的功能能力(SMD=0.51,95CI:0.05-0.98)。亚组分析显示,吸气肌训练联合呼气肌训练有利于最大吸气压的恢复(MD=9.78,95CI:5.96-13.60),最大呼气压(MD=11.62,95CI:3.80-19.43),强迫肺活量(MD=0.87,95CI:0.47-1.27),最大呼气流量(MD=1.51,95CI:1.22-1.80),1s用力呼气量(MD=0.76,95CI:0.41-1.11),功能容量(SMD=0.61,95CI:0.08-1.13),而吸气肌训练可以提高最大吸气压力(MD=11.60,95CI:8.15-15.05),最大呼气压(MD=7.06,95CI:3.50-10.62),强迫肺活量(MD=0.71,95CI:0.21-1.21),最大呼气流量(MD=0.84,95CI:0.37-1.31),1s用力呼气容积(MD=0.40,95CI:0.08-0.72)。
结论:这项研究提供了高质量的证据,证明呼吸肌训练能有效提高呼吸肌的力量,肺功能,和早期中风患者的功能能力。吸气肌训练结合呼气肌训练似乎比单纯吸气肌训练更能促进早期中风患者的功能恢复。
背景:Prospero注册号:CRD42021291918。
BACKGROUND: Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke.
METHODS: PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and
China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI).
RESULTS: Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51-13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34-12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54-1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94-1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13-1.59), functional capacity (SMD = 0.51, 95%CI: 0.05-0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96-13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80-19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47-1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22-1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41-1.11), functional capacity (SMD = 0.61, 95%CI: 0.08-1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15-15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50-10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21-1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37-1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08-0.72).
CONCLUSIONS: This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone.
BACKGROUND: Prospero registration number: CRD42021291918.