The Efficacy Of Inspiratory Muscle Training In Improving Respiratory Function And Walking Ability In Post-stroke Patients.A Systematic Review And Meta-analysis

Background: Stroke is defined as a loss of focal neurological function that occurs suddenly due to a hemorrhage or infarction in a relevant area of the brain.Previous studies have demonstrated that neurological damage causes muscle weakness not only seen in the peripheral muscles but also in the respiratory muscles;weakness of the intercostal,diaphragm,and abdominal muscles on the affected side,causing abnormal changes in the respiratory function,altered respiratory pattern,and decreases in the respiratory volumes and flows leading to elevated risk for respiratory complications.Aims: This systematic review and meta-analysis aimed to compile the most recent information on the efficacy of inspiratory muscle training(IMT)in improving respiratory function,and respiratory muscle strength activity in post-stroke patients.Methods: A systematic electronic search was performed in MEDLINE,EMBASE,and Web of Science databases,from January 2010 to December 2021.Mean differences(MD)with95% confidence intervals were presented.The Cochrane tool was used to assess the risk of bias.After study selection and data extraction,we selected 11 randomized controlled trials(RCTs)that measured the effects of IMT versus non-IMT or sham IMT in post-stroke patients.We extracted data about respiratory muscle strength,respiratory function,and walking capacity.Results: Our study comprised 299 participants from 11 randomized controlled trials(RCTs).The sample size of the included articles varied between 12 and 51 participants.The age of the patients in the present study ranged from 54 to 68 years.The time since stroke onset ranged from 14 days to 18 months.Of the 11 trials,5 involved patients with acute and subacute stroke(< 6 months after the stroke incident),while 6 of the studies were in the chronic phase of stroke(> 6 months after the stroke incident).The meta-analysis revealed evidence of beneficial effects of inspiratory muscle training on maximum inspiratory pressure(MD=15.42,95 % CI: 1.23 to 29.62,P=0.03),inspiratory muscle endurance(MD=18.04,95% CI: 10.50 to25.58,P<0.001),forced expired volume in 1 second(MD=0.24,95 % CI: 0.11 to 0.38,P=0.005),forced vital capacity(MD =0.28,95 % CI: 0.15 to 0.41,P<0.001),peak expiratory flow(PEF)(IV=0.37,95% CI: 0.06 to 0.68,P=0.02)and 6-minute walk test(MD=40.79,95 %CI: 26.36 to 55.23,P<0.001),The sub-group analysis revealed that inspiratory muscle training had a better effect on pulmonary function FEV1,FVC,and walking ability(6-MWT)in patients who suffered from stroke for less than 6 months.Conclusion: The results demonstrated that inspiratory muscle training interventions had substantial beneficial effects in improving several clinical outcomes such as pulmonary function parameters(FEV1,FVC,PEF),the strength of inspiratory muscles(MIP,IME),and walking ability in post-stroke patients with duration less than 6 months.