最大动态吸气压力在心力衰竭中的评估：一项全面的可靠性和一致性研究。
Maximal Dynamic Inspiratory Pressure Evaluation in Heart Failure: A Comprehensive Reliability and Agreement Study.
机构信息
Science and Technology in Health Program, University of Brasília, Brasília, Brazil.
Science and Technology in Health Program and Physical Therapy Department, Science of Rehabilitation Program, University of Brasília.
出版信息
Phys Ther. 2020 Dec 7;100(12):2246-2253. doi: 10.1093/ptj/pzaa165.
OBJECTIVE
The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF).
METHODS
For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD = 1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD = 15%) and a peak oxygen consumption of 13.05 (SD = 5.3) mL·kg·min-1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively.
RESULTS
The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI = 0.58-0.98] and 0.97 [95% CI = 0.89-0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI = 68.27-83.34) of the population. The reproducibility of TFRL measures (S-Index = 68.8 [SD = 32.8] cm H2O; MIP = 66 [SD = 32.3] cm H2O) was slightly lower than that of the SM measurement (MIP = 70.1 [SD = 35.9] cm H2O).
CONCLUSIONS
The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar.
IMPACT
TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF.
目的
本研究旨在分析心力衰竭（HF）患者锥形流量阻力加载（TFRL）测量的可靠性（组内和组间）和一致性（重复性和再现性）特性。
方法
在这项横断面研究中，参与者是 2015 年 7 月至 2016 年 7 月期间在巴西利亚大学心肺康复计划中招募的。所有患者均参加了研究，其中 10 名患者随机选择进行组内和组间可靠性测试。124 名 HF 患者（75%为男性）年龄为 57.6（SD=1.81）岁，平均左心室射血分数为 38.9%（SD=15%），峰值摄氧量为 13.05（SD=5.3）mL·kg·min-1。主要观察指标为使用标准测压计（SM）测量的最大吸气压力（MIP）和使用 TFRL 测量的 MIP 和最大动态吸气压力（S-Index）。通过 2 名评估者评估 S-Index 的可靠性（组内和组间），通过 10 次重复评估 S-Index 的重复性，分别使用 SM 和 TFRL 评估 MIP 和 S-Index 的再现性。
结果
可靠性分析显示 S-Index 具有较高的组内和组间可靠性值（组内相关系数[ICC]分别为 0.89[95%置信区间（CI）=0.58-0.98]和 0.97[95%CI=0.89-0.99]）。重复性分析显示，在 75.81%（95%CI=68.27-83.34）的人群中，需要进行 8 次操作才能达到最大 S-Index。TFRL 测量的再现性（S-Index=68.8[SD=32.8]cmH2O；MIP=66[SD=32.3]cmH2O）略低于 SM 测量的 MIP（MIP=70.1[SD=35.9]cmH2O）。
结论
TFRL 设备在 HF 患者中提供了可靠的组内和组间 S-Index 测量值，具有可接受的重复性，需要进行 8 次操作才能产生稳定的 S-Index 测量值。S-Index、SM 测量的 MIP 和 TFRL 测量的 MIP 的再现性相似。
影响
TFRL 是一种可行的方法，可用于评估 HF 患者的 MIP 和 S-Index，作为吸气肌力量的测量指标，可用于吸气肌训练，使联合测试和训练能力在 HF 患者的临床研究和管理中具有重要意义。
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