Inspiracijski trening mišića, sa ili bez istodobne plućne rehabilitacije, za kroničnu opstruktivnu bolest pluća (KOPB).
The Cochrane database of systematic reviews
Sažetak istraživanja
Pozadina Trening inspirativnih mišića (IMT) ima za cilj poboljšanje snage i izdržljivosti respiratornih mišića. U kliničkim ispitivanjima korišteni su različiti protokoli obuke, uređaji i respiratorna mjerenja kako bi se provjerila efikasnost ove intervencije. Trenutne smjernice navode moguću prednost IMT-a, posebno kod osoba sa slabošću respiratornih mišića. Međutim, ostaje nejasno u kojoj mjeri je IMT klinički koristan, posebno kada je povezan s plućnom rehabilitacijom (PR). CILJEVI: Procijeniti učinak treninga inspiratornih mišića (IMT) na kroničnu opstruktivnu plućnu bolest (KOPB), kao samostalnu intervenciju iu kombinaciji s plućnom rehabilitacijom (PR).
Metode pretraživanja Pretražili smo registar ispitivanja Cochrane Airways-a, CENTRAL, MEDLINE, Embase, PsycINFO, kumulativni indeks literature o sestrinstvu i srodnoj zdravstvenoj literaturi (CINAHL) EBSCO, bazu podataka o dokazima fizioterapije (PEDro) ClinicalTrials. gov i Međunarodna platforma za registar kliničkih ispitivanja Svjetske zdravstvene organizacije 20. oktobra 2021. Također smo provjerili referentne liste svih primarnih studija i preglednih članaka. Kriterijumi odabira Uključili smo randomizirane kontrolirane studije (RCT) koje su upoređivale IMT u kombinaciji sa PR u odnosu na sam PR i IMT naspram kontrolne/lažne. Uključili smo različite vrste IMT-a bez obzira na način isporuke. Isključili smo ispitivanja koja su koristila otporne uređaje bez kontrole obrasca disanja ili opterećenja treninga manjeg od 30% od maksimalnog inspiratornog pritiska (PImax), ili oboje. Prikupljanje i analiza podataka Koristili smo standardne metode koje je preporučio Cochrane, uključujući procjenu rizika od pristranosti sa RoB 2. Naši primarni ishodi bili su dispneja, funkcionalni kapacitet vježbanja i kvalitet života vezan za zdravlje. GLAVNI REZULTATI: U ovaj pregled smo uključili 55 RCT-ova. I IMT i PR protokoli značajno su varirali u ispitivanjima, posebno u trajanju obuke, opterećenju, uređajima, broju/učestalosti sesija i PR programima. Samo osam studija je bilo pod niskim rizikom od pristrasnosti. PR+IMT naspram PR-a U ovo poređenje uključili smo 22 ispitivanja (1446 učesnika). Na osnovu minimalne klinički važne razlike (MCID) od -1 jedinica, nismo pronašli poboljšanje dispneje procijenjene Borgovom skalom pri submaksimalnom kapacitetu vježbanja (srednja razlika (MD) 0,19, 95% interval povjerenja (CI) -0,42 do 0,79; 2 RCTs; način rada 202 izvješća). Također nismo pronašli poboljšanje u dispneji procijenjenoj modificiranom skalom dispneje Vijeća za medicinska istraživanja (mMRC) prema MCID između -0. 5 i -1 jedinica (MD -0,12, 95% CI -0,39 do 0,14; 2 RCTs, 204 učesnika; dokazi vrlo niske sigurnosti). Objedinjavanje dokaza za 6-minutnu udaljenost hoda (6MWD) pokazalo je povećanje od 5,95 metara (95% CI -5,73 do 17,63; 12 RCT-a, 1199 učesnika; dokazi vrlo niske sigurnosti) i nisu uspjeli postići MCID od 26 metara. U analizi podgrupa, podijelili smo RCT-ove prema trajanju treninga i srednjem osnovnom PImax. Test za razlike u podgrupama nije bio značajan. Ispitivanja sa niskim rizikom od pristrasnosti (n = 3) pokazala su veću procjenu učinka od ukupne. Sumarni efekat Respiratornog upitnika Svetog Đorđa (SGRQ) otkrio je ukupan ukupan rezultat ispod MCID od 4 jedinice (MD 0,13, 95% CI -0,93 do 1,20; 7 RCTs, 908 učesnika; dokazi niske sigurnosti). Zbirni efekat testa za procjenu COPD (CAT) nije pokazao poboljšanje u HRQoL-u (MD 0,13, 95% CI -0,80 do 1,06; 2 RCTs, 657 učesnika; dokazi vrlo niske sigurnosti), prema MCID od -1. 6 jedinica. Objedinjavanje RCT-ova koji su prijavili PImax pokazalo je povećanje od 11,46 cmH 2 O (95% CI 7,42 do 15,50; 17 RCTs, 1329 učesnika; dokazi umjerene sigurnosti), ali nije uspjelo postići MCID od 17,2 cmH 2 O (95% CI 7,42 do 15,50; 17 RCT-ova, 1329 učesnika; dokazi umjerene sigurnosti), ali nije uspjelo da se postigne MCID od 17,2 cmH 2 O. ocijenjeno sa i bez slabosti respiratornih mišića. Jedan sažetak izvještava o nekim štetnim efektima koji su smatrani "manjim i samoograničenim". IMT naspram kontrolne/lažne Trideset sedam RCT-a sa 1021 učesnikom doprinijelo je našem drugom poređenju. Postojao je trend poboljšanja kada je Borg izračunat na submaksimalni kapacitet vježbanja (MD -0,94, 95% CI -1,36 do -0,51; 6 RCTs, 144 učesnika; dokazi vrlo niske sigurnosti). Samo jedno ispitivanje je imalo mali rizik od pristrasnosti. Osam studija (devet krakova) koristilo je osnovni indeks dispneje – indeks tranzicijske dispneje (BDI-TDI). Na osnovu MCID-a od +1 jedinice, pokazali su poboljšanje samo sa 'ukupnim rezultatom' TDI (MD 2.98, 95% CI 2.07 do 3.89; 8 RCTs, 238 učesnika; dokazi vrlo niske sigurnosti). Nismo pronašli razliku između studija klasificiranih kao sa i bez slabosti respiratornih mišića. Samo jedno ispitivanje imalo je mali rizik od pristrasnosti. Četiri studije su prijavile mMRC, otkrivajući moguće poboljšanje dispneje u IMT grupi (MD -0,59, 95% CI -0,76 do -0,43; 4 RCT-a, 150 učesnika; dokazi niske sigurnosti). Dva ispitivanja su bila pod niskim rizikom od pristrasnosti. U poređenju sa kontrolnom/lažnom, MD u 6MWD nakon IMT-a bio je 35,71 (95% CI 25,68 do 45,74; 16 RCTs, 501 učesnik; dokaz umjerene sigurnosti). Dvije studije su bile pod niskim rizikom od pristrasnosti. U analizi podgrupa, nismo pronašli razliku između različitih trajanja treninga i između studija koje su ocijenjene sa i bez slabosti respiratornih mišića. Šest studija je prijavilo ukupan rezultat SGRQ, pokazujući veći efekat u IMT grupi (MD -3,85, 95% CI -8,18 do 0,48; 6 RCTs, 182 učesnika; dokazi vrlo niske sigurnosti). Donja granica CI od 95% premašila je MCID od -4 jedinice. Samo jedna studija je bila pod niskim rizikom od pristrasnosti. Došlo je do poboljšanja kvaliteta života sa CAT (MD -2,97, 95% CI -3,85 do -2,10; 2 RCTs, 86 učesnika; dokazi umjerene sigurnosti). Jedno ispitivanje je bilo pod malim rizikom od pristrasnosti. Trideset i dva RCT-a su prijavila PImax, pokazujući poboljšanje bez dostizanja MCID (MD 14,57 cmH2O, 95% CI 9,85 do 19,29; 32 RCTs, 916 učesnika; dokazi niske sigurnosti). U analizi podgrupa, nismo pronašli razliku između različitih trajanja treninga i između studija koje su ocijenjene sa i bez slabosti respiratornih mišića. Nijedan od uključenih RCT-a nije prijavio neželjene događaje.
Zaključci autora IMT možda neće poboljšati dispneju, funkcionalni kapacitet vježbanja i kvalitet života kada je povezan s PR. Međutim, IMT će vjerovatno poboljšati ove rezultate kada se pruža sam. Za obje intervencije još treba potvrditi veći učinak kod učesnika sa slabošću respiratornih mišića i s dužim trajanjem treninga.
Prikaži originalni naslov i sažetak na engleskom
Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD).
Background Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle weakness. However, it remains unclear to what extent IMT is clinically beneficial, especially when associated with pulmonary rehabilitation (PR). OBJECTIVES: To assess the effect of inspiratory muscle training (IMT) on chronic obstructive pulmonary disease (COPD), as a stand-alone intervention and when combined with pulmonary rehabilitation (PR). Search methods We searched the Cochrane Airways trials register, CENTRAL, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Physiotherapy Evidence Database (PEDro) ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 20 October 2021. We also checked reference lists of all primary studies and review articles. Selection criteria We included randomized controlled trials (RCTs) that compared IMT in combination with PR versus PR alone and IMT versus control/sham. We included different types of IMT irrespective of the mode of delivery. We excluded trials that used resistive devices without controlling the breathing pattern or a training load of less than 30% of maximal inspiratory pressure (PImax), or both. Data collection and analysis We used standard methods recommended by Cochrane including assessment of risk of bias with RoB 2. Our primary outcomes were dyspnea, functional exercise capacity and health-related quality of life. MAIN RESULTS: We included 55 RCTs in this review. Both IMT and PR protocols varied significantly across the trials, especially in training duration, loads, devices, number/ frequency of sessions and the PR programs. Only eight trials were at low risk of bias. PR+IMT versus PR We included 22 trials (1446 participants) in this comparison. Based on a minimal clinically important difference (MCID) of -1 unit, we did not find an improvement in dyspnea assessed with the Borg scale at submaximal exercise capacity (mean difference (MD) 0.19, 95% confidence interval (CI) -0.42 to 0.79; 2 RCTs, 202 participants; moderate-certainty evidence). We also found no improvement in dyspnea assessed with themodified Medical Research Council dyspnea scale (mMRC) according to an MCID between -0.5 and -1 unit (MD -0.12, 95% CI -0.39 to 0.14; 2 RCTs, 204 participants; very low-certainty evidence). Pooling evidence for the 6-minute walk distance (6MWD) showed an increase of 5.95 meters (95% CI -5.73 to 17.63; 12 RCTs, 1199 participants; very low-certainty evidence) and failed to reach the MCID of 26 meters. In subgroup analysis, we divided the RCTs according to the training duration and mean baseline PImax. The test for subgroup differences was not significant. Trials at low risk of bias (n = 3) demonstrated a larger effect estimate than the overall. The summary effect of the St George's Respiratory Questionnaire (SGRQ) revealed an overall total score below the MCID of 4 units (MD 0.13, 95% CI -0.93 to 1.20; 7 RCTs, 908 participants; low-certainty evidence). The summary effect of COPD Assessment Test (CAT) did not show an improvement in the HRQoL (MD 0.13, 95% CI -0.80 to 1.06; 2 RCTs, 657 participants; very low-certainty evidence), according to an MCID of -1.6 units. Pooling the RCTs that reported PImax showed an increase of 11.46 cmH 2 O (95% CI 7.42 to 15.50; 17 RCTs, 1329 participants; moderate-certainty evidence) but failed to reach the MCID of 17.2 cmH 2 O. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. One abstract reported some adverse effects that were considered "minor and self-limited". IMT versus control/sham Thirty-seven RCTs with 1021 participants contributed to our second comparison. There was a trend towards an improvement when Borg was calculated at submaximal exercise capacity (MD -0.94, 95% CI -1.36 to -0.51; 6 RCTs, 144 participants; very low-certainty evidence). Only one trial was at a low risk of bias. Eight studies (nine arms) used the Baseline Dyspnea Index - Transition Dyspnea Index (BDI-TDI). Based on an MCID of +1 unit, they showed an improvement only with the 'total score' of the TDI (MD 2.98, 95% CI 2.07 to 3.89; 8 RCTs, 238 participants; very low-certainty evidence). We did not find a difference between studies classified as with and without respiratory muscle weakness. Only one trial was at low risk of bias. Four studies reported the mMRC, revealing a possible improvement in dyspnea in the IMT group (MD -0.59, 95% CI -0.76 to -0.43; 4 RCTs, 150 participants; low-certainty evidence). Two trials were at low risk of bias. Compared to control/sham, the MD in the 6MWD following IMT was 35.71 (95% CI 25.68 to 45.74; 16 RCTs, 501 participants; moderate-certainty evidence). Two studies were at low risk of bias. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. Six studies reported theSGRQ total score, showing a larger effect in the IMT group (MD -3.85, 95% CI -8.18 to 0.48; 6 RCTs, 182 participants; very low-certainty evidence). The lower limit of the 95% CI exceeded the MCID of -4 units. Only one study was at low risk of bias. There was an improvement in life quality with CAT (MD -2.97, 95% CI -3.85 to -2.10; 2 RCTs, 86 participants; moderate-certainty evidence). One trial was at low risk of bias. Thirty-two RCTs reported PImax, showing an improvement without reaching the MCID (MD 14.57 cmH 2 O, 95% CI 9.85 to 19.29; 32 RCTs, 916 participants; low-certainty evidence). In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. None of the included RCTs reported adverse events. Authors' conclusions IMT may not improve dyspnea, functional exercise capacity and life quality when associated with PR. However, IMT is likely to improve these outcomes when provided alone. For both interventions, a larger effect in participants with respiratory muscle weakness and with longer training durations is still to be confirmed.
Izvorni podaci
- DOI
- 10.1002/14651858.cd013778.pub2
- PMID
- 36606682
- PMCID
- PMC9817429
- Provjereno
- 2026-07-26
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