哮喘患者呼吸肌训练效果的系统评价和荟萃分析。
Effect of respiratory muscle training in asthma: A systematic review and meta-analysis.
机构信息
University of A Coruña, Faculty of Physiotherapy, A Coruña, Spain; Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña, A Coruña, Spain.
University of A Coruña, Faculty of Physiotherapy, A Coruña, Spain.
出版信息
Ann Phys Rehabil Med. 2023 Apr;66(3):101691. doi: 10.1016/j.rehab.2022.101691. Epub 2022 Dec 1.
BACKGROUND
The last systematic review about respiratory muscle training (RMT) in people with asthma was published almost 10 years ago. Since then, several works have been published.
OBJECTIVE
To review the effect of RMT in people with asthma.
METHODS
We conducted a systematic review of research included up to September 2021 in PubMed/MEDLINE, PEDro, Scopus, Web of Science, CINAHL, LILACS, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. We included randomized controlled trials and quasi-experimental studies assessing the effect of RMT on respiratory muscle function, rescue medication, asthma-related symptoms, lung function, exercise capacity, healthcare use, health-related quality of life (HRQoL) and adverse effects in people with asthma. Risk of bias and methodological quality were assessed with the Cochrane Risk of Bias assessment tool and the PEDro scale. Meta-analysis was performed whenever possible; otherwise a qualitative approach was followed.
RESULTS
Eleven studies (270 participants) were included, 10 with only adults and were included in the meta-analysis. Inspiratory muscle training (IMT) had beneficial effects on maximal inspiratory pressure (PImax: mean difference [MD] 21.95 cmHO [95% confidence interval [CI] 15.05; 28.85]), with no changes in maximal expiratory pressure (MD 14.97 cmHO [95%CI -5.65; 35.59]), lung function (forced expiratory volume in 1 sec: MD 0.06 [95%CI -0.14; 0.26] L; force vital capacity: MD 0.39 [95%CI -0.24; 1.02] L) and exercise capacity (standard mean difference [SMD] 1.73 [95%CI -0.61; 4.08]). Subgroup analysis revealed that IMT load >50% PImax and duration >6 weeks were beneficial for exercise capacity. The qualitative analysis suggested that IMT may have benefits on respiratory muscle endurance, rescue medication and exertional dyspnoea, with no adverse effects.
CONCLUSIONS
This systematic review and meta-analysis showed a significant increase in PImax after IMT in adults with asthma and reinforced the relevance of the dose-response principle of training. More evidence is needed to clarify the effect of IMT in respiratory muscle endurance, rescue medication, exercise capacity, healthcare use and HRQoL.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42020221939; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221939.
背景
关于呼吸肌训练（RMT）在哮喘患者中的最新系统评价发表于近 10 年前。此后，又有几项研究发表。
目的
综述 RMT 对哮喘患者的影响。
方法
我们对截至 2021 年 9 月在 PubMed/MEDLINE、PEDro、Scopus、Web of Science、CINAHL、LILACS、Cochrane 对照试验中心注册库和 ClinicalTrials.gov 上发表的研究进行了系统评价。我们纳入了评估 RMT 对呼吸肌功能、急救药物、哮喘相关症状、肺功能、运动能力、医疗保健使用、健康相关生活质量（HRQoL）和不良反应影响的随机对照试验和准实验研究。使用 Cochrane 偏倚风险评估工具和 PEDro 量表评估偏倚风险和方法学质量。只要有可能，就进行荟萃分析；否则，采用定性方法。
结果
纳入了 11 项研究（270 名参与者），其中 10 项仅纳入成年人，并纳入荟萃分析。吸气肌训练（IMT）对最大吸气压力（PImax：平均差异 [MD] 21.95 cmHO [95%置信区间 [CI] 15.05；28.85]）有有益影响，对最大呼气压力（MD 14.97 cmHO [95%CI -5.65；35.59]）、肺功能（用力呼气量 1 秒：MD 0.06 [95%CI -0.14；0.26] L；用力肺活量：MD 0.39 [95%CI -0.24；1.02] L）和运动能力（标准均数差 [SMD] 1.73 [95%CI -0.61；4.08]）没有变化。亚组分析显示，IMT 负荷>50%PImax 和持续时间>6 周对运动能力有益。定性分析表明，IMT 可能对呼吸肌耐力、急救药物和运动性呼吸困难有益，且无不良反应。
结论
本系统评价和荟萃分析显示，哮喘成人接受 IMT 后 PImax 显著增加，强化了训练的剂量-反应原则的相关性。需要更多证据来阐明 IMT 在呼吸肌耐力、急救药物、运动能力、医疗保健使用和 HRQoL 方面的作用。
试验注册
PROSPERO 国际前瞻性系统评价注册库 CRD42020221939；https://www.crd.york.ac.uk/prospero/display_record.php？RecordID=221939。
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