Efficacy of respiratory muscle training on pulmonary function of spinal cord injury patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XU Yang ^1,2 , GAO Ya ^1,2 , XIE Qing ^3,4,5 ,  WANG Pu ^3,4,5 , CHEN Yi ^1,2 , ZHANG Qing ^1,2 , ZHANG Jiaqi ⁶

1. Department of Rehabilitation Sciences, West China Medical School of Sichuan University, Chengdu, 610041, P.R.China;
2. Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Rehabilitation Medicine, Ruijin Affiliated Hospital, Medicine School of Shanghai Jiaotong University, Shanghai, 200025, P.R.China;
4. Department of Rehabilitation Medicine, Medicine School of Shanghai Jiaotong University, Shanghai, 200025, P.R.China;
5. Shanghai Ruijin Rehabilitation Hospital, Shanghai, 200025, P.R.China;
6. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, P.R.China;

Corresponding author：

WANG Pu, Email: wangpu_03@126.com

Keywords：

Respiratory muscle training; Spinal cord injuries; Respiratory function; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201704109

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Objective To systematically review respiratory muscle training (RMT) on respiratory functions of patients with spinal cord injury (SCI). Methods PubMed, EMbase and The Cochrane Library were electronically searched to collect the randomized controlled trials (RCTs) about RMT on pulmonary functions in patients with SCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 263 patients were included. The results of meta-analysis showed that, compared with conventional rehabilitation group, RMT effectively improved vital capacity (MD=0.41, 95%CI 0.12 to 0.69, P=0.005), inspiratory capacity (MD=0.35, 95%CI 0.05 to 0.65, P=0.02), maximal inspiratory pressure (MD=7.75, 95%CI 0.11 to 15.39, P=0.05) and maximal voluntary ventilation (MD=17.52, 95%CI 8.11 to 26.93, P=0.000 3). There were significant differences between two groups. Conclusion Current evidence shows that RMT can effectively improve the respiratory function of patients with SCI. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

Citation： XU Yang, GAO Ya, XIE Qing, WANG Pu, CHEN Yi, ZHANG Qing, ZHANG Jiaqi. Efficacy of respiratory muscle training on pulmonary function of spinal cord injury patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(10): 1150-1157. doi: 10.7507/1672-2531.201704109 Copy

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2.	Postma K, Haisma JA, de Groot S, et al. Changes in pulmonary function during the early years after inpatient rehabilitation in persons with spinal cord injury: a prospective cohort study. Arch Phys Med Rehabil, 2013, 94(8): 1540-1546.
3.	Cardozo CP. Respiratory complications of spinal cord injury. Spinal Cord Med, 2007, 30(4): 307-308.
4.	Brown R, DiMarco AF, Hoit JD, et al. Respiratory dysfunction and management in spinal cord injury. Respir Care, 2006, 51(8): 853-868.
5.	Derrickson J, Ciesla N, Simpson N, et al. A comparison of two breathing exercise programs for patients with quadriplegia. Phys Ther, 1992, 72(11): 763-769.
6.	Postma K, Haisma JA, Hopman MT, et al. Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Phys Ther, 2014, 94(12): 1709-1719.
7.	Roth EJ, Stenson KW, Powley S, et al. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil, 2010, 91(6): 857-861.
8.	Gounden P. Progressive resistive loading on accessory expiratory muscles in tetraplegia. S Afr J Physiother, 1990, 46(4): 4-12.
9.	Kim CY, Lee JS, Kim HD, et al. Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: a pilot randomized controlled trial. J Spinal Cord Med, 2017, 40(1): 17-25.
10.	West CR, Taylor BJ, Campbell IG, et al. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scand J Med Sci Sports, 2014, 24(5): 764-772.
11.	Litchke LG, Russian CJ, Lloyd LK, et al. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes. J Spinal Cord Med, 2008, 31(1):65-71.
12.	Tamplin J, Baker FA, Grocke D, et al. Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(3): 426-434.
13.	Liaw MY, Lin MC, Cheng PT, et al. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Arch Phys Med Rehabil, 2000, 81(6): 752-756.
14.	Mueller G, Hopman MT, Perret C. Comparison of respiratory muscle training methods in individuals with motor and sensory complete tetraplegia: a randomized controlled trial. J Rehabil Med, 2013, 45(3): 248-253.
15.	Litchke L, Lloyd L, Schmidt E, et al. Comparison of two concurrent respiratory resistance devices on pulmonary function and time trial performance of wheelchair athletes. Ther Recreation J, 2011, 45(2): 147-159.
16.	易超然. 湖南省 261 例脊髓损伤住院患者流行病学调查分析. 湖南衡阳: 南华大学, 2015.
17.	何霏, 张雯, 杨蓉, 等. 脊髓损伤患者肺康复治疗的现状和进展. 中国康复医学杂志, 2014, 29(2): 176-179.0.
18.	钮晟佳. 苏州市脊髓损伤患者流行病学分析及相关因素研究. 江苏苏州: 苏州大学, 2016.
19.	宁广智. 天津市脊髓损伤流行病学调查研究. 天津: 天津医科大学, 2012.
20.	Berlowitz D, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev, 2013, 7(7): CD008507.

1. Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord, 2012, 50(5): 365-372.
2. Postma K, Haisma JA, de Groot S, et al. Changes in pulmonary function during the early years after inpatient rehabilitation in persons with spinal cord injury: a prospective cohort study. Arch Phys Med Rehabil, 2013, 94(8): 1540-1546.
3. Cardozo CP. Respiratory complications of spinal cord injury. Spinal Cord Med, 2007, 30(4): 307-308.
4. Brown R, DiMarco AF, Hoit JD, et al. Respiratory dysfunction and management in spinal cord injury. Respir Care, 2006, 51(8): 853-868.
5. Derrickson J, Ciesla N, Simpson N, et al. A comparison of two breathing exercise programs for patients with quadriplegia. Phys Ther, 1992, 72(11): 763-769.
6. Postma K, Haisma JA, Hopman MT, et al. Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Phys Ther, 2014, 94(12): 1709-1719.
7. Roth EJ, Stenson KW, Powley S, et al. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil, 2010, 91(6): 857-861.
8. Gounden P. Progressive resistive loading on accessory expiratory muscles in tetraplegia. S Afr J Physiother, 1990, 46(4): 4-12.
9. Kim CY, Lee JS, Kim HD, et al. Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: a pilot randomized controlled trial. J Spinal Cord Med, 2017, 40(1): 17-25.
10. West CR, Taylor BJ, Campbell IG, et al. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scand J Med Sci Sports, 2014, 24(5): 764-772.
11. Litchke LG, Russian CJ, Lloyd LK, et al. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes. J Spinal Cord Med, 2008, 31(1):65-71.
12. Tamplin J, Baker FA, Grocke D, et al. Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(3): 426-434.
13. Liaw MY, Lin MC, Cheng PT, et al. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Arch Phys Med Rehabil, 2000, 81(6): 752-756.
14. Mueller G, Hopman MT, Perret C. Comparison of respiratory muscle training methods in individuals with motor and sensory complete tetraplegia: a randomized controlled trial. J Rehabil Med, 2013, 45(3): 248-253.
15. Litchke L, Lloyd L, Schmidt E, et al. Comparison of two concurrent respiratory resistance devices on pulmonary function and time trial performance of wheelchair athletes. Ther Recreation J, 2011, 45(2): 147-159.
16. 易超然. 湖南省 261 例脊髓损伤住院患者流行病学调查分析. 湖南衡阳: 南华大学, 2015.
17. 何霏, 张雯, 杨蓉, 等. 脊髓损伤患者肺康复治疗的现状和进展. 中国康复医学杂志, 2014, 29(2): 176-179.0.
18. 钮晟佳. 苏州市脊髓损伤患者流行病学分析及相关因素研究. 江苏苏州: 苏州大学, 2016.
19. 宁广智. 天津市脊髓损伤流行病学调查研究. 天津: 天津医科大学, 2012.
20. Berlowitz D, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev, 2013, 7(7): CD008507.

Chinese Journal of Evidence-Based Medicine

Efficacy of respiratory muscle training on pulmonary function of spinal cord injury patients: a meta-analysis

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