Maki Naoki, Sakamoto Harumi, Takata Yu, Taniguchi Keisuke, Wijesinghe Ashoka, Okamura Junko, Kawamura Tomoyuki, Yanagihara Takahiro, Saeki Yusuke, Kitazawa Shinsuke, Kobayashi Naohiro, Kikuchi Shinji, Goto Yukinobu, Ichimura Hideo, Sato Yukio, Yanagi Hisako
Department of Thoracic Surgery Faculty of Medicine University of Tsukuba Tsukuba Japan.
AHR Medical and Welfare College School Tsuchiura Japan.
J Gen Fam Med. 2021 Nov 30;23(3):140-148. doi: 10.1002/jgf2.511. eCollection 2022 May.
Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community-dwelling, frail elderly people with chronic stroke.
This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group ( = 15) and control ( = 15). All participants (65-94 years) attended twelve 20-min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8･PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6-min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions.
The intervention group showed significant improvement in %MIP (95% CI, 2.9-31.6; < 0.01), DRACE (95% CI, -4.1-0.1; < 0.01), and SF8･PCS (95% CI, 2.5-7.2; < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction.
These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.
肺功能下降和吞咽功能差是卒中后吸入性肺炎的主要危险因素。我们分析了肺部训练对社区居住的慢性卒中体弱老年人的肺功能、吞咽功能和生活质量（QOL）的益处。
本研究设计为开放性、随机对照试验。将有卒中病史的体弱老年人随机分为2个康复组：干预组（n = 15）和对照组（n = 15）。所有参与者（65 - 94岁）每周参加两次，每次20分钟，共12节课程，为期6周，接受标准康复治疗（对照组）或包括家庭肺部锻炼的标准康复治疗与肺部训练（干预组）。主要结局指标为肺功能（%MIP）、吞咽功能（DRACE）和生活质量（SF8･PCS），次要结局指标为肌肉力量（握力和腹部力量）、胸廓柔韧性、6分钟步行距离和日常生活活动能力。所有结局指标在训练前和12节课程后均进行测量。
与对照组相比，干预组在%MIP（95%CI，2.9 - 31.6；P < 0.01）、DRACE（95%CI， - 4.1 - 0.1；P < 0.01）和SF8･PCS（95%CI，2.5 - 7.2；P < 0.01）方面有显著改善。没有认知功能下降和高级脑功能障碍。
这些结果表明，在标准康复计划中加入包括家庭肺部锻炼的肺部训练可以改善慢性卒中体弱老年人的肺功能、吞咽功能和生活质量。
