PICO
Patient/Population
Adults older than 18 years diagnosed with stroke (n=523)
Intervention
Respiratory muscle training aimed at increasing strength of the inspiratory or expiratory muscles by using threshold resistance trainer or flow-oriented resistance trainer
Comparison
- Sham intervention without effective respiratory muscle training or no intervention was considered as the control
Outcomes
Primary – occurrence of respiratory complications (lung infections or pneumonia)
Secondary – swallowing function and cough
Translatability: (3/3) Easy
Comments: “Respiratory muscle training is effective in reducing the risk of respiratory complications and improving dysphagia by reducing penetration or aspiration during swallowing liquid bolus after stroke. However, there was no sufficient evidence to determine that respiratory muscle training improves cough function.”
Limitations: Small sample size, especially for the outcome of PAS scores and FOIS scores. The presence of various risk of bias for each included study such as the risk of performance bias, attrition bias, or detection bias became the other primary factors that lower the level of evidence.
Appraisals:
Trustworthiness – Systematic review or meta-analysis based on randomized control studies is a very appropriate design (LEVEL A+) to measure an effect, impact, or causal relation. The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (95%). This means there is a 5% chance that alternative explanations for the effect found are possible. (by CAT)
Tripdatabase Guidelines Grading – 7/8 (by TCPG Grade)
BTB
Intervention
- Respiratory muscle training
Dose
- 20 to 30 minutes
Periodicity
- 5 times per week for 4 to 5 weeks
Local/Technic:
Respiratory muscle training is delivered by a threshold resistance trainer or flow-oriented resistance trainer, targeting the expiratory muscles a combination of inspiratory and expiratory muscles, and inspiratory and expiratory muscles.
Citation: Zhang, W., Pan, H., Zong, Y., Wang, J., & Xie, Q. (2022). Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Archives of physical medicine and rehabilitation,103(6), 1179–1191. https://doi.org/10.1016/j.apmr.2021.10.020