Weak For Recommendation
Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness.
| Respiratory muscle training (v no intervention) on respiratory muscle strength in people with SCI who have respiratory muscle weakness | |||||||
|---|---|---|---|---|---|---|---|
| P | People with SCI who have respiratory muscle weakness | Evidence recommendation Weak for (100%) | Weak evidence recommendation FOR Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness. Clinical note: Respiratory muscle training most commonly involves inspiratory muscle training but can also include expiratory muscle training |
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| I | Respiratory muscle training | ||||||
| C | No intervention | Opinion statement No opinion statements |
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| O | Muscle strength (mean inspiratory pressure) | ||||||
| SUMMARY | 10 RCTs (see references) | Mean difference (95% CI): Muscle strength in Mean Inspiratory Pressure -13 (-17 to -9) Favours respiratory muscle training |
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| GRADE Very low certainty ⨁◯◯◯ | Risk of bias Serious | Inconsistency Serious | Imprecision Not serious | Indirectness Not serious | Publication bias Serious |
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| RESPIRATORY MUSCLE TRAINING FOR RESPIRATORY MUSCLE STRENGTH: GRADE Evidence to Decision | ||||||
|---|---|---|---|---|---|---|
| PROBLEM | No | Probably no | Probably yes | Yes | Don't know | |
| DESIRABLE EFFECTS | Trivial | Small | Moderate | Large | Don't know | |
| UNDESIRABLE EFFECTS | Large | Moderate | Small | Trivial | Don't know | |
| CERTAINTY OF EVIDENCE | Very low | Low | Moderate | High | No included studies | |
| HOW MUCH PEOPLE VALUE THE MAIN OUTCOME | Important uncertainty or variability | Possibly important uncertainty or variability | Probably no important uncertainty or variability | No important uncertainty or variability | ||
| BALANCE OF EFFECTS | Favours the Control | Probably favours the Control | Does not favour either the intervention (I) or the comparison (C) | Probably favours the I | Favours the I | Don't know |
| RESOURCES REQUIRED | Large costs | Moderate costs | Negligible costs and savings | Moderate savings | Large savings | Don't know |
| CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES | Very low | Low | Moderate | High | No included studies | |
| COST EFFECTIVENESS | Favours the comparison | Probably favours the comparison | Does not favour either the intervention or the comparison | Probably favours the intervention | Favours the intervention | No included studies |
| EQUITY | Reduced | Probably reduced | Probably no impact | Probably increased | Increased | Don't know |
| ACCEPTABILITY | No | Probably no | Probably yes | Yes | Don't know | |
| FEASIBILITY | No | Probably no | Probably yes | Yes | Don't know | |
| RESPIRATORY MUSCLE TRAINING FOR RESPIRATORY MUSCLE STRENGTH: Randomised Controlled Trial Details | ||||||
|---|---|---|---|---|---|---|
| STUDY | COMPARISON | DOSAGE/DETAILS | PARTICIPANTS | N (Rx/C) | OUTCOME | ROB 2 PEDRo |
| BOSWELL-RUYS 2020 | Resistive Inspiratory muscle training (RMT) V Sham RMT | 3-5 sets 12 breaths 2 x day 5 days per week for 6 weeks @ > 30% MIP | C4-C8 SCI AIS A, B, C > 4 weeks post-injury | 29/31 | Maximal Inspiratory pressure (MIP) | Very low Risk of Bias PEDro = 10/10 |
| Liaw 2000 | Inspiratory muscle training (& usual care) V Usual care | 15-20 minutes 2 x day; 7 days per week for 6/52 | C4-C7 complete SCI < 6 months post-injury | 10/10 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
| LITCHKE 2008 | Respiratory resistance training V No intervention | 1 set of exercises 2-3 x per day daily for 10 weeks | >80% participants with SCI C5-T12 SCI > 6 months post-injury | 4/5 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 5/10 |
| LITCHKE 2011 | Concurrent flow resistance V No intervention | 10 breaths 3 different x per day daily for 9 weeks | >80% participants with SCI C5-C7 SCI | 5/7 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 3/10 |
| LOVERIDGE 1989 | Concurrent flow resistance V No intervention | 85% of sustained inspiratory pressure 2 x day for 15 minutes 5 days per week for 8 weeks | C6-C7 complete SCI >1 year post-injury | 6/6 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 4/10 |
| MUELLER 2013 | Inspiratory resistance training V placebo | 90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks | C6-C7 complete SCI >1 year post-injury | 8/8 | Maximal Inspiratory pressure (MIP) | Some Concerns about Risk of Bias PEDro = 4/10 |
| POSTMA 2014 | Resistive Inspiratory muscle training (& usual care) V Usual care | 90 breaths @ > 80% max inspiratory power 4 x per week for 8 weeks | T12 and above SCI AIS A-D initial rehab FEV1 <80% predicted | 19/21 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 7/10 |
| ROTH 2010 | Expiratory muscle training V Sham | Exp muscle resistive training 10 reps, twice a day, 5 x per week for 6 weeks | T1 and above motor complete SCI | 16/13 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
| SOUMYASHREE 2018 | Inspiratory muscle training V Breathing exercises | 15 minutes @ 40 MIP 5 x per week for 4 weeks | T1-12 SCI AIS A-D | 15/12 | Maximal Inspiratory pressure (MIP) | Some Concerns of Risk of bias PEDro = 7/10 |
| WEST 2014 | Inspiratory muscle training V Sham | 30 breaths at 50-60% Pimax 2 x day 5 days per week for 6 weeks | C5-C7 SCI AIS A or B ≥3 years post-injury | 5/5 | Maximal Inspiratory pressure (MIP) | High Risk of Bias PEDro = 4/10 |
The Australian and NZ SCI Physiotherapy guideline committee recommends respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness. This is an evidence recommendation supported by the results of ten randomised controlled trials. The guideline states:
Respiratory muscle training may be used to improve respiratory muscle strength in people with SCI who have respiratory muscle weakness.
This recommendation was formed by considering the results of ten randomised controlled trials alongside other factors. The combined trial results indicate that respiratory muscle training is better than no respiratory muscle training in people with SCI. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend respiratory muscle training for respiratory muscle strength in people with SCI (who have respiratory muscle weakness) based on the evidence.
To learn more about this recommendation go to the research summary.
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Liaw MY, Lin MC, Cheng PT, et al. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Archives of Physical Medicine and Rehabilitation 2000 Jun;81(6):752-756.
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Litchke L, Lloyd L, Schmidt E, et al. Comparison of two concurrent respiratory resistance devices on pulmonary function and time trial performance of wheelchair athletes. Therapeutic Recreation Journal 2011;45(2):147-159.
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Litchke LG, Russian CJ, Lloyd LK, et al. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes. The Journal of Spinal Cord Medicine 2008;31(1):65-71.
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Loveridge B, Badour M, Dubbo H. Ventilatory Muscle Endurance Training in Quadriplegics; effects on breathing pattern. Paraplegia 1989; 27: 329-339.
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Mueller G, Hopman MTE and Perret C. Comparison of respiratory muscle training methods in individuals with motor complete tetraplegia. Topics in Spinal Cord Injury Rehabilitation 2012;18(2):118-121.
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Postma K, Haisma JA, Hopman MTE, et al. Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Physical Therapy 2014 ;94(12):1709-1719 2014.
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Soumyashree S, Kaur J. Effect of inspiratory muscle training (IMT) on aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics. Journal of spinal cord medicine 2018: 1-7.
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West CR, CR, Taylor BJ, Campbell IG, Romer LM. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scandinavian journal of medicine & science in sports 2014; 24: 764.
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Boswell-Ruys CL, Lewis CRH, Wijeysuriya NS, et al. Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial. Thorax 2020;75:279-288.
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Roth EJ, Stenson KW, Powley S, Oken J, Primack S, Nussbaum SB, Berkowitz M. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2010 Jun;91(6):857-61.