Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis

Spinal Cord Series and Cases, 2023 · DOI: https://doi.org/10.1038/s41394-023-00594-2 · Published: August 3, 2023

Spinal Cord Injury Pulmonology Rehabilitation

Simple Explanation

This study compares two different methods of inspiratory muscle training (IMT) for people with spinal cord injury (SCI) to see which method is more effective at improving breathing strength. The researchers looked at two existing studies where participants used either a flow-resistive IMT (F-IMT) device or a threshold IMT (T-IMT) device to train their breathing muscles. The study found that both methods improved breathing strength, but there was no clear winner. The amount of breathing work done during training was linked to improvements in breathing strength, and how hard the participants felt they were working was related to the intensity of the training.

Study Duration

4 weeks

Participants

14 participants with chronic spinal cord injury

Evidence Level

Secondary analysis

Key Findings

1
No significant difference was found in the change in maximal inspiratory pressure (PImax) between the F-IMT and T-IMT groups after 4 weeks of training.
2
Participants using F-IMT trained at a higher intensity but took fewer breaths compared to those using T-IMT.
3
A positive correlation was found between the inspiratory work performed (Work-%) and the percentage change in PImax (%ΔPImax), suggesting that higher work leads to greater improvements.

Research Summary

This secondary analysis compared the effectiveness of flow-resistive IMT (F-IMT) and threshold IMT (T-IMT) protocols in people with chronic tetraplegia. The study found that both IMT protocols resulted in similar improvements in maximal inspiratory pressure (PImax) after 4 weeks of training, suggesting that both methods are viable options for improving respiratory muscle strength in this population. The researchers also found a positive correlation between perceived effort and training intensity, which could help clinicians prescribe IMT based on patient feedback when inspiratory pressure monitoring is not available.

Practical Implications

Clinical Practice

Both F-IMT and T-IMT are viable options for improving respiratory muscle strength in individuals with chronic tetraplegia.

Supervision Requirements

In-person supervision may not be required for all IMT sessions, potentially reducing financial and logistical barriers to treatment.

Prescription Guidance

Perceived effort can be used as a surrogate for training intensity when inspiratory pressure monitoring is unavailable.

Study Limitations

1
Small sample size
2
Baseline differences in participant characteristics between the two groups (age, injury duration, baseline PImax)
3
Potential ceiling effect in ΔPImax due to the higher baseline PImax in the F-IMT group

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