Respiratory Muscle Training in Patients With Subacute Ischemic Stroke

Effect of Respiratory Muscle Training on Diaphragm Function and Activity Performance in Subacute Ischemic Stroke Patients: A Single-blind Randomised-controlled Trial

Stroke, which can occur due to many different reasons and is one of the most common neurological conditions, is one of the leading causes of disability worldwide. The most common disorders that occur after stroke are motor disorders. In addition, these patients may be accompanied by respiratory problems such as changes in breathing patterns and decreased ventilation function. Respiratory problems are an important risk factor for the development of long-term mortality for both cardiovascular diseases and stroke. With all these changes, there is a serious decrease in the activity performance of the patients. While stroke rehabilitation focuses on motor function losses, problems in pulmonary functions do not receive the necessary attention. Evaluating and treating patients from every aspect in stroke rehabilitation will further increase the effectiveness of the treatments applied.

Ultrasonography (USG), which has been used in the field of healthcare for more than 40 years, works with a mechanism based on the principle of sound waves traveling and reflecting at different speeds in tissues of different densities. USG is a very useful and effective imaging method used by modern medicine as a part of examination and patient care, based on its advantages such as sound waves being harmless to living beings because they are non-ionizing, the image being real-time and being viewable at the time of the procedure, being a non-invasive method, and being inexpensive. This study will be included in the literature as an original study in terms of examining both the development of the patients and the effectiveness of the treatment in many aspects, with many parameters obtained by ultrasonography in subacute stroke patients who will receive respiratory muscle training.

Study Overview

• Status: Completed
• Conditions: Inspiratory Muscle Training; Subacute Stroke
• Intervention / Treatment: Device: PowerBreathe; Other: Conventional Physiotherapy

Detailed Description

According to WHO, stroke, also known as cerebrovascular accident, is a neurological condition that results in rapidly developing loss of brain function as a result of a problem in the blood supply to the brain. Stroke, which ranks third among the causes of death, is one of the leading causes of disability. This neurological condition affects not only the periphery but also the respiratory muscles such as the diaphragm and intercostal muscles, causing respiratory weakness, changes in breathing patterns, and a decrease in respiratory volume. These changes in breathing lead to a decrease in physical activity and therefore limitation in daily living activities. The decrease in respiratory muscle strength results in an increase in morbidity and mortality due to decreased pulmonary function.

Pulmonary rehabilitation (PR) is the most common non-pharmacological treatment method for pulmonary diseases. PR has been studied extensively in patients with neuromuscular disease or spinal cord injury patients with restrictive pulmonary disease; However, studies in stroke patients with respiratory complications such as pneumonia are limited.

There are studies in the literature showing that respiratory muscle training applied after stroke has positive effects on various respiratory parameters.

In this study, the development of the pulmonary muscles with respiratory muscle training after stroke will be followed by ultrasound and functional tests, and the effect of this development on hand grip strength and activity performance, which is an indicator of general muscle strength, will be examined.

• Study Type: Interventional
• Enrollment (Actual): 26
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Europe
    • Istanbul, Europe, Turkey, 34668
      • Saglik Bilimleri University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Having had a stroke for the first time,
• Being 18 years or older,
• Having an ischemic type stroke,
• At least 1 month has passed since the stroke,
• Modified Rankin Score ≥ 3,
• Ability to communicate,
• Agreeing to participate in the study.

Exclusion Criteria:

• Hemispatial neglect,
• Having a psychiatric disease,
• Having any breathing problems before the stroke,
• Not having any orthopedic, neurological or cardiopulmonary disease that would constitute a contraindication for the protocols to be applied,
• Being diagnosed with sarcopenia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Experimental Group; Inspiratory muscle training, aerobic training, breathing exercises neurophysiologic rehabilitation will be applied to the experimental group. This treatment program will be applied 5 sessions a week and totally 30 sessions (6 weeks).; Inspiratory muscle training; Aerobic training; Breathing Exercises; Neurophysiological Exercise Program	Device: PowerBreathe; Primary Outcome Measurement: 1. Maximal Inspiratory Pressure (MIP) Secondary Outcome Measurements: Chest circumference measurements; Diaphragm movements and thickness (ultrasound); Hand grip strength (with a Jamar hand dynamometer); Motor Activity Log; 6 Minute Walk Test (6MWT); Canadian Occupational Performance Measure; Charlson Comorbidity Index; Other: Conventional Physiotherapy; Primary Outcome Measurement: 1. Maximal Inspiratory Pressure (MIP) Secondary Outcome Measurements: Chest circumference measurements; Diaphragm movements and thickness (ultrasound); Hand grip strength (with a Jamar hand dynamometer); Motor Activity Log; 6 Minute Walk Test (6MWT); Canadian Occupational Performance Measure; Charlson Comorbidity Index
Active Comparator: Control Group; The control group will receive aerobic training, breathing exercises and neurophysiological rehabilitation, excluding inspiratory muscle training. This treatment program will be applied 5 sessions a week and totally 30 sessions (6 weeks).	Other: Conventional Physiotherapy; Primary Outcome Measurement: 1. Maximal Inspiratory Pressure (MIP) Secondary Outcome Measurements: Chest circumference measurements; Diaphragm movements and thickness (ultrasound); Hand grip strength (with a Jamar hand dynamometer); Motor Activity Log; 6 Minute Walk Test (6MWT); Canadian Occupational Performance Measure; Charlson Comorbidity Index

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximal Inspiratory Pressure (MIP)	Maximal inspiratory pressure (MIP) is the most commonly used measure to evaluate inspiratory muscle strength. Measurement of MIP is a straightforward test in which individuals are asked to perform a forceful inspiration against an occluded mouthpiece. The advantages of this test are that it is noninvasive and performed quickly.	Change from pre-interventional MIP score at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest circumference measurements	In order to evaluate chest mobility and breathing type, chest circumference measurements are taken from the axillary (4th rib level), epigastric (xiphoid process level) and subcostal (above the 11th and 12th ribs) regions using a tape measure.	Change from pre-interventional Chest circumference measurements at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
Diaphragm movements and thickness (ultrasound)	Diaphragm ultrasonography is a non-invasive and portable imaging method that eliminates radiation exposure and does not require transfer of the person. Inspiratory thickness of the diaphragm (Ti), expiratory thickness of the diaphragm (Te), and mobility of the diaphragm will be measured.	Change from pre-interventional diaphragm movements and thickness (ultrasound) at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
Hand grip strength	Jamar hand dynamometer, which is accepted as the gold standard by the American Association of Hand Therapists (AETD) and has high validity and reliability in many studies, will be used to measure hand grip strength.	Change from pre-interventional hand grip strength at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
Motor Activity Log (MAL)	Motor Activity Log is a measure used to assess the amount of use and quality of movement of paretic arms and hands in daily living activities for hemiparetic stroke patients. It consists of 30 items.	Change from pre-interventional MAL at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
6 Minute Walk Test (6MWT)	6 Minute Walk Test (6MWT) is a test adapted from the 12-minute Cooper test developed by Cooper and his colleagues in 1960 by the American Thoracic Society (ATS). 6MWT is defined as a submaximal test that can be easily applied to healthy or sick individuals and is considered as an indicator of exercise capacity and walking capacity as well as many cardiovascular diseases. 6MWT is referred to as the "Gold Standard" test of walking capacity.	Change from pre-interventional 6MWT at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
Canadian Occupational Performance Measure (COPM)	The Canadian Occupational Performance Measure (COPM) is a standard measurement tool used to determine an individual's activity performance problems and to measure the perception of performance change and performance satisfaction. In addition, COPM is an outcome measure that systematically helps identify activity performance problems that are important for the individual and rates improvements in these problems according to the individual's perspective. COPM consists of 3 parts: personal care (activities of daily living), productivity (education and work) and leisure (play, leisure activities, social participation).	Change from pre-interventional COPM at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.
Charlson Comorbidity Index	Charlson comorbidity index was developed by Charlson et al. in 1987 to classify patients' comorbidities, determine their severity, and predict mortality rates. Each comorbidity of the patient is marked as "present" or "absent" and all scores are summed to obtain the total score. It is scored between 0-37.	Change from pre-interventional Charlson Comorbidity Index score at the end of the 30 sessions intervention that will be performed 5 days in a week at a total of 6 weeks.

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi
• Investigators: Study Chair: Dudu Kübra Akyol, PT, IAU Medical Park Florya Hospital; Study Chair: Zuhal Kunduracılar, Prof. Dr., Saglik Bilimleri University; Study Chair: Dilber Karagözoğlu Coşkunsu, Ass.Prof., Fenerbahçe University; Principal Investigator: Sümeyye Akçay, PT, Saglik Bilimleri University; Study Chair: Arzu Dinç Yavaş, M.D., IAU Medical Park Florya Hospital; Study Chair: Arsida Bajrami, M.D., IAU Medical Park Florya Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 20, 2024
• Primary Completion (Actual): September 17, 2024
• Study Completion (Actual): October 17, 2024

Study Registration Dates

• First Submitted: January 4, 2024
• First Submitted That Met QC Criteria: January 7, 2024
• First Posted (Actual): January 18, 2024

Study Record Updates

• Last Update Posted (Actual): October 21, 2024
• Last Update Submitted That Met QC Criteria: October 17, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: Ischemic; Ultrasonography; Subacute Stroke; Respiratory Muscle Training; Activity Performance
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke; Ischemic Stroke
• Other Study ID Numbers: UniversityofHealthSciences

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No