Abstract
Background People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects.
Objective The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI.
Design This was a single-blinded randomized controlled trial.
Setting The study was conducted at 4 specialized SCI units in the Netherlands.
Patients The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation.
Intervention Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer.
Measurements Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications.
Results During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cm H2O, 95% confidence interval=4.3 to 19.0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health.
Limitations The sample size was insufficient to study effects on respiratory complications.
Conclusions Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.
Footnotes
All authors provided concept/idea/research design. Ms Postma, Dr Haisma, and Dr Bussmann provided writing. Ms Postma provided data collection. Ms Postma and Dr Haisma provided data analysis. Ms Postma, Dr Stam, and Dr Bussmann provided project management and fund procurement. Ms Postma and Dr Stam provided facilities/equipment. Ms Postma and Dr Bussmann provided institutional liaisons. Dr Haisma, Dr Hopman, Dr Bergen, Dr Stam, and Dr Bussmann provided consultation (including review of the manuscript before submission). The authors thank all participants, the participating rehabilitation centers and their research assistants and physicians who collected data, and the physical therapists who were involved in the training: Rijndam Rehabilitation Center (Rotterdam) and Rehabilitation Center De Hoogstraat (Utrecht), Reade (Amsterdam), and Heliomare (Wijk aan Zee).
Part of the manuscript was presented as a poster at the International Spinal Cord Society (ISCOS); October 28–30, 2013; Istanbul, Turkey.
The study was approved by the Medical Ethics Committee of Erasmus University Medical Centre, Rotterdam, the Netherlands.
This study was supported by the Kinderrevalidatie Fonds Adriaanstichting (grant no. 2007/0179-063).
The trial was registered at the Dutch trial register (NTR1921) in July 2009.
- Received February 26, 2014.
- Accepted July 19, 2014.
- © 2014 American Physical Therapy Association
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