The Impact of Respiratory Muscle Training on Respiratory Function in Patients with Neuromuscular Diseases: A Systematic Review and Meta-analysis
Angie Carolina Alonso-Ramírez1, Nancy Yesenia Ortiz-Garcia2, Diego Eduardo Rueda-Capristran3, Ajay Kumar4, Domenica Alejandra Herrera5, Diana Othón-Martínez6, Jonathan Reyes-Rivera7, Frances Marie Mejia8, Jonathan David Martinez-Illan9, Elda Janette Perez-Moreno3, Camila Sanchez-Cruz3, Ernesto Calderón-Martínez3
1Pontificia Universidad Javeriana, 2Universidad Juárez del Estado de Durango, 3Universidad Nacional Autónoma de México, 4Isra University Hyderabad, 5Pontificia Universidad Católica de Ecuador, 6University of Texas Rio Grande Valley, 7Universidad Autónoma de San Luis Potosí, 8Yale New Haven Health Bridgeport Hospital, 9Universidad del Noreste
Objective:
To evaluate the impact of respiratory physiotherapy, particularly respiratory muscle training (RMT), on patients with neuromuscular diseases (NMDs).
Background:
NMDs impair respiratory muscle function, increasing morbidity and mortality. RMT is used to manage these complications, but its efficacy across NMDs remains uncertain. This systematic review and meta-analysis assessed the effect of RMT on respiratory muscle function in NMD patients.
Design/Methods:
A systematic search of databases, including MEDLINE, EMBASE, Web of Science, Cochrane, CRS-Web, PEDro, LILACS, ICTPR, the China National Knowledge Infrastructure database, and ClinicalTrials.gov, was conducted up to September 2023. Randomized controlled trials (RCTs) and cohort studies evaluating RMT’s effect on lung volumes and respiratory muscle strength in NMD patients were included. Risk of bias was evaluated using the Cochrane tool for RCTs and Newcastle-Ottawa Scale for cohorts. Meta-analyses used random-effects models, and heterogeneity was assessed with I² statistics.
Results:
Seventeen studies from 7669 screened articles were analyzed. Meta-analysis showed significant improvements in respiratory muscle strength, particularly in peak inspiratory static maximum (PISMax) (MD: 2.49 cmH₂O, 95% CI: 1.74-3.23, p < 0.0001) and peak esophageal pressure maximum (PESMax) (MD: 2.08 cmH₂O, 95% CI: 1.30-2.87, p < 0.0001). Nonsignificant increases were observed in forced vital capacity (FVC%) (MD: 2.07%, 95% CI: -3.01 to 7.14, p = 0.42) and maximal inspiratory pressure (MIP) (MD: 4.72 cmH₂O, 95% CI: -2.13 to 11.58, p = 0.17). The review indicated over two-thirds of patients experienced improved respiratory muscle strength with RMT. Heterogeneity was moderate to high in some outcomes (I² > 50%).
Conclusions:
RMT improves respiratory muscle strength in NMD patients. However, variability in study designs and populations limits statistical significance in some parameters. Future studies should standardize interventions and outcomes to better evaluate RMT efficacy.
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