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Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests.

Abstract

PURPOSE

To evaluate the effectiveness of a home-based inspiratory muscle training (IMT) programme using multiple inspiratory muscle tests.

METHOD

Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were randomised into an experimental or control group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or <15% PImax, respectively, for 7 weeks. Thirty-nine patients (23 M) completed the study. The following measures were assessed pre- and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA).

RESULTS

PImax and perception of well-being improved significantly post-IMT [p = 0.04 and <0.05 in four domains, respectively]. This was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or ISWT [p = 0.5].

CONCLUSIONS

A seven-week, community-based IMT programme, with realistic use of health-care resources, improves PImax and perception of well-being but a different design may be required for improvement in other measures. Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT.

IMPLICATIONS FOR REHABILITATION

A seven-week, home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes. Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity.

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  • Authors+Show Affiliations

    ,

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK . b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK .

    ,

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK . c NIHR Biomedical Research Unit for Advanced Lung Disease, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London , London , UK .

    ,

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK . d Department of Respiratory Medicine , University Hospital of North Staffordshire NHS Trust , London , UK , and.

    ,

    e King's College Hospital NHS Trust , London , UK.

    ,

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .

    ,

    b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK .

    ,

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .

    a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .

    Source

    MeSH

    Aged
    Aged, 80 and over
    Double-Blind Method
    Exercise Test
    Exercise Tolerance
    Female
    Health Status
    Home Care Services
    Humans
    Male
    Middle Aged
    Physical Therapy Modalities
    Pulmonary Disease, Chronic Obstructive
    Respiratory Function Tests
    Respiratory Muscles
    Respiratory Therapy
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25885668

    Citation

    Nikoletou, Dimitra, et al. "Evaluation of the Effectiveness of a Home-based Inspiratory Muscle Training Programme in Patients With Chronic Obstructive Pulmonary Disease Using Multiple Inspiratory Muscle Tests." Disability and Rehabilitation, vol. 38, no. 3, 2016, pp. 250-9.
    Nikoletou D, Man WD, Mustfa N, et al. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil. 2016;38(3):250-9.
    Nikoletou, D., Man, W. D., Mustfa, N., Moore, J., Rafferty, G., Grant, R. L., ... Moxham, J. (2016). Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disability and Rehabilitation, 38(3), pp. 250-9. doi:10.3109/09638288.2015.1036171.
    Nikoletou D, et al. Evaluation of the Effectiveness of a Home-based Inspiratory Muscle Training Programme in Patients With Chronic Obstructive Pulmonary Disease Using Multiple Inspiratory Muscle Tests. Disabil Rehabil. 2016;38(3):250-9. PubMed PMID: 25885668.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. AU - Nikoletou,Dimitra, AU - Man,William D-C, AU - Mustfa,Naveed, AU - Moore,Julie, AU - Rafferty,Gerrard, AU - Grant,Robert L, AU - Johnson,Lorna, AU - Moxham,John, Y1 - 2015/04/17/ PY - 2015/4/18/entrez PY - 2015/4/18/pubmed PY - 2016/9/23/medline KW - COPD KW - home-based programme KW - inspiratory muscle training KW - randomised controlled trial KW - respiratory muscles SP - 250 EP - 9 JF - Disability and rehabilitation JO - Disabil Rehabil VL - 38 IS - 3 N2 - PURPOSE: To evaluate the effectiveness of a home-based inspiratory muscle training (IMT) programme using multiple inspiratory muscle tests. METHOD: Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were randomised into an experimental or control group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or <15% PImax, respectively, for 7 weeks. Thirty-nine patients (23 M) completed the study. The following measures were assessed pre- and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA). RESULTS: PImax and perception of well-being improved significantly post-IMT [p = 0.04 and <0.05 in four domains, respectively]. This was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or ISWT [p = 0.5]. CONCLUSIONS: A seven-week, community-based IMT programme, with realistic use of health-care resources, improves PImax and perception of well-being but a different design may be required for improvement in other measures. Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT. IMPLICATIONS FOR REHABILITATION: A seven-week, home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes. Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity. SN - 1464-5165 UR - https://www.unboundmedicine.com/medline/citation/25885668/Evaluation_of_the_effectiveness_of_a_home_based_inspiratory_muscle_training_programme_in_patients_with_chronic_obstructive_pulmonary_disease_using_multiple_inspiratory_muscle_tests_ L2 - http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1036171 DB - PRIME DP - Unbound Medicine ER -