Alashram Anas R
Department of Physiotherapy, Middle East University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
Injury. 2025 Mar;56(3):112211. doi: 10.1016/j.injury.2025.112211. Epub 2025 Feb 9.
Muscle weakness is among the most common motor deficits in individuals with spinal cord injury (SCI). Acute intermittent hypoxia (AIH) has been used to improve motor function by facilitating neuroplasticity. The purpose of this systematic review is to explore the impacts of AIH on muscle strength in individuals with SCI, identify who would most likely respond well to the intervention, and determine the optimal therapeutic protocol.
Relevant literature was explored in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases until October 2024. Randomized trials that involved SCI patients who underwent AIH, compared with controls, and assessed muscle strength were included in this review. The methodological quality was assessed using the "Physiotherapy Evidence Database (PEDro)" scale. The effect sizes were calculated using Cohen's d.
Of 502 studies, seven studies met the eligibility criteria, and the sample sizes ranged from 12 to 28 participants across the included studies. In total, 146 SCI patients (mean age 46.76 years; 88 % male) were included in this systematic review. The PEDro scores of the studies included varied between 5 and 8, with a median score of 8.
AIH is a promising therapeutic modality for enhancing muscle strength post-SCI, specifically in patients with motor-incomplete injuries. Based on good quality studies, delivering AIH independently or in combination with other treatments for 15 short (60-90 s) episodes of hypoxic exposure (Oxygen = 9 %) alternating with 15 (60-90 s) normoxic episodes (Oxygen = 21 %), across one or more sessions, could yield meaningful outcomes. Nevertheless, the evidence is limited by treatment protocol variations, small sample sizes, and a lack of standardization in combining AIH with other treatments. Therefore, further studies with larger sample sizes, more diverse populations, and standardized treatment protocols are strongly needed to verify our findings. Future studies should also address the potential bias, examine the long-term effects, and investigate underlying mechanisms to provide more generalized evidence.
肌肉无力是脊髓损伤（SCI）患者最常见的运动功能缺陷之一。急性间歇性缺氧（AIH）已被用于通过促进神经可塑性来改善运动功能。本系统评价的目的是探讨AIH对SCI患者肌肉力量的影响，确定最可能对该干预措施反应良好的人群，并确定最佳治疗方案。
在“PubMed、MEDLINE、Cochrane图书馆、Scopus、PEDro和科学网”数据库中检索相关文献，直至2024年10月。本评价纳入了涉及接受AIH治疗的SCI患者、与对照组进行比较并评估肌肉力量的随机试验。使用“物理治疗证据数据库（PEDro）”量表评估方法学质量。效应量使用Cohen's d计算。
在502项研究中，7项研究符合纳入标准，纳入研究的样本量为12至28名参与者。本系统评价共纳入146例SCI患者（平均年龄46.76岁；88%为男性）。纳入研究的PEDro评分在5至8分之间，中位数为8分。
AIH是一种有前景的治疗方式，可增强SCI后的肌肉力量，特别是对于运动不完全损伤的患者。基于高质量研究，单独或与其他治疗联合进行AIH，进行15次短暂（60 - 90秒）的缺氧暴露（氧气 = 9%），与15次（60 - 90秒）常氧暴露（氧气 = 21%）交替，在一个或多个疗程中进行，可能会产生有意义的结果。然而，证据受到治疗方案差异、样本量小以及AIH与其他治疗联合缺乏标准化等因素的限制。因此，迫切需要进行更大样本量且人群更多样化以及治疗方案标准化的进一步研究来验证我们的发现。未来的研究还应解决潜在的偏倚问题，研究长期影响，并探究潜在机制，以提供更具普遍性的证据。
