背景:大多数关于改善呼吸肌力量的研究,日常生活活动(ADL)和生活质量(QoL)的中风患者接受阈值呼吸肌训练(TRMT)的样本量小,和一些研究有矛盾的结果。
目的:为了评估TRMT对呼吸肌力量的影响,中风患者的肺功能和运动耐力。
方法:PubMed,科克伦图书馆,物理治疗证据数据库(PEDro),从开始到2024年1月17日,搜索Embase(通过OVID)和WebofScience数据库进行随机对照试验(RCT)。主要结果是最大吸气压力(MIP)或最大呼气压力(MEP)。次要结果包括通过用力肺活量(FVC)测量的肺功能,1秒用力呼气容积(FEV1)和最大呼气流量(PEF),和通过6分钟步行测试(6MWT)测量的运动耐力。
结果:共有8项随机对照试验(RCT),包括305人,包括在这项研究中。训练时间3周至10周。其中,干预组在4项研究中使用吸气肌训练,其他4项研究采用吸气肌训练和呼气肌训练。对于主要结果,TRMT显著改善MIP(平均值=14.68cmH2O,95CI=2.28至27.09cmH2O,P=0.02)和MEP(平均值=9.37cmH2O,95CI=2.89至15.84cmH2O,中风患者的P=0.005)。关于次要结果,TRMT改进了FVC,FEV1和6MWT(P<0.05)但未显著改良PEF。
结论:TRMT改善了吸气肌力量和呼气肌力量,提高运动耐力,改善肺功能的FVC和FEV1,但未明显改善PEF。
BACKGROUND: Most studies on improvements in respiratory muscle strength, activities of daily living (ADL) and quality of life (QoL) in stroke patients receiving threshold respiratory muscle training (TRMT) have small sample sizes, and some studies have contradictory results.
OBJECTIVE: To evaluate the effectiveness of TRMT on respiratory muscle strength, pulmonary function and exercise endurance in stroke patients.
METHODS: PubMed, Cochrane Library, Physical Therapy Evidence Database (PEDro), Embase (via OVID) and Web of Science databases were searched for randomized controlled trial (RCT) from inception to January 17, 2024. The primary outcome was maximum inspiratory pressure (MIP) or maximum expiratory pressure (MEP). Secondary outcomes included pulmonary function measured by forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF), and exercise endurance measured by 6-minute walk test (6MWT).
RESULTS: A total of eight randomized controlled trials(RCTs), including 305 persons, were included in this study. The training time ranged from 3 weeks to 10 weeks. Among them, the intervention group in 4 studies used inspiratory muscle training, and the other 4 studies used inspiratory muscle training and expiratory muscle training. For the primary outcome, TRMT significantly improved MIP (mean=14.68 cmH2O, 95 %CI=2.28 to 27.09 cmH2O, P=0.02) and MEP (mean=9.37 cmH2O, 95 %CI=2.89 to 15.84 cmH2O, P=0.005) in stroke patients. Regarding the secondary outcomes, TRMT improved FVC, FEV1 and 6MWT (P<0.05) but did not significantly improve PEF.
CONCLUSIONS: TRMT improved inspiratory muscle strength and expiratory muscle strength, improved exercise endurance, and improved FVC and FEV1 of pulmonary function but did not significantly improve PEF.