Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,
KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium.
Respiration. 2024;103(10):601-621. doi: 10.1159/000539726. Epub 2024 Jun 10.
BACKGROUND: Respiratory muscle training (RMT) aims to improve inspiratory and/or expiratory muscle function in neuromuscular disorders (NMDs). A comprehensive overview of the available literature is lacking. This scoping review explores methodological characteristics, (adverse) effects, and adherence of RMT studies in NMDs. Moreover, it identifies limitations and research gaps in the literature and provides future research directions. SUMMARY: Eligible studies were identified using MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases. Three reviewers independently selected articles. Inclusion criteria were English language, original research articles on RMT using a device, patients with an NMD, and pulmonary function tests or respiratory muscle strength as outcome measures. We included NMDs with slow, intermediate and fast progression. Exclusion criteria were critically ill patients, weaning from mechanical ventilation, other neurological disorders, and RMT combined with non-respiratory interventions. One reviewer extracted the data on patients' characteristics, methodological characteristics, results of outcome measures, adverse events, and patient adherence. Forty-five studies were identified. We found a large diversity in study designs and training protocols. The effects of RMT on respiratory muscle strength and/or endurance are variable. Patient adherence was high and no serious adverse events were reported. KEY MESSAGES: The diversity in studies across the available literature precludes definitive conclusions regarding the effects of RMT on respiratory muscle function and clinically relevant outcomes in NMDs. Therefore, well-powered and -designed studies that focus on clinically relevant outcomes and assess whether RMT can improve or offset deterioration of respiratory muscle weakness in NMDs are needed.
背景:呼吸肌训练(RMT)旨在改善神经肌肉疾病(NMD)中的吸气和/或呼气肌功能。目前缺乏对可用文献的全面综述。本范围综述探讨了 NMD 中 RMT 研究的方法学特征、(不良)影响和依从性。此外,它还确定了文献中的局限性和研究空白,并提供了未来的研究方向。
摘要:使用 MEDLINE、Embase、Cochrane 系统评价数据库和 Cochrane 对照试验中心注册数据库确定了合格的研究。三名审查员独立选择文章。纳入标准为使用设备的 RMT 的英文原始研究文章、NMD 患者以及肺功能测试或呼吸肌力量作为结局测量。我们纳入了进展缓慢、进展中等和进展迅速的 NMD。排除标准为危重症患者、从机械通气中脱机、其他神经疾病以及 RMT 与非呼吸干预相结合。一名审查员提取了患者特征、方法学特征、结局测量结果、不良事件和患者依从性的数据。确定了 45 项研究。我们发现研究设计和培训方案存在很大差异。RMT 对呼吸肌力量和/或耐力的影响是可变的。患者依从性高,未报告严重不良事件。
关键信息:现有文献中的研究多样性使得无法确定 RMT 对 NMD 中呼吸肌功能和临床相关结局的影响。因此,需要进行有足够效力和设计的研究,重点关注临床相关结局,并评估 RMT 是否可以改善或抵消 NMD 中呼吸肌无力的恶化。
Cochrane Database Syst Rev. 2019-9-5
Cochrane Database Syst Rev. 2013-7-23
Cochrane Database Syst Rev. 2017-12-21
J Strength Cond Res. 2013-6
J Neuromuscul Dis. 2023
Eur Respir Rev. 2022-12-31
J Clin Med. 2022-11-9
Cochrane Database Syst Rev. 2021-4-22
Front Physiol. 2020-12-3
Neuromuscul Disord. 2020-11