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Effect of Synchronized Transcutaneous Electrical Diaphragm Stimulation Using Surged Faradic Current Combined With Inspiratory Muscle Training on Diaphragm Function and Clinical Outcomes in Patients With COPD (COPD TEDS)

31 agosto 2026 aggiornato da: DR MINAZ NAIK, Maharashtra University of Health Sciences

Effect of Synchronized Transcutaneous Electrical Diaphragm Stimulation Using Surged Faradic Current Combined With Inspiratory Muscle Training on Diaphragm Function and Clinical Outcomes in Patients With COPDEffect of Synchronized Transcutaneous Electrical Diaphragm Stimulation Using Surged Faradic Current Combined With Inspiratory Muscle Training on Diaphragm Function and Clinical Outcomes in Patients With COPDEffect of Synchronized Transcutaneous Electrical Diaphragm Stimulation Using Surged Faradic Current Combined With Inspiratory Muscle Training on Diaphragm Function and Clinical Outcomes

Chronic kidney disease (CKD) is a progressive condition that can be associated with reduced physical capacity, muscle weakness, fatigue, respiratory impairment and frailty. These problems may affect daily activities and quality of life. Exercise-based renal rehabilitation has been increasingly considered as an important part of the management of physical problems in CKD. However, evidence regarding multimodal rehabilitation in frail patients with CKD remains limited. Therefore, the present randomized controlled trial was conducted to evaluate the effect of a 12-week multimodal renal rehabilitation programme on pulmonary function, functional capacity and fatigue in patients with CKD who were classified as frail according to the Fried Frailty Phenotype. Frailty was defined by the presence of three or more of the five Fried criteria.

A total of 54 patients were screened, and 42 eligible participants were included and randomly allocated into two equal groups, with 21 participants in each group. Group A received the multidisciplinary renal rehabilitation, which included aerobic training, resistance training, inspiratory muscle training and multidisciplinary supportive care.

Group B received conventional physiotherapy along with standard medical care. The intervention was provided 3 times a week for 12 weeks. Pulmonary function was assessed using forced expiratory volume in one second, forced vital capacity and FEV₁/FVC ratio. Functional capacity was assessed using the 6-Minute Walk Test (6MWT) and the reported VO₂max measure. Fatigue was assessed using the Daily Fatigue Impact Scale. Assessments were performed before and after the intervention.

At baseline, there were no statistically significant differences between the two groups for pulmonary function, functional capacity or fatigue measures (p>0.05), indicating that the groups were comparable before the intervention. Following the 12-week intervention, significant improvements were observed within Group A for FEV₁, FVC, FEV₁/FVC ratio, 6MWD, VO₂max and D-FIS (p<0.001 for all outcomes). Significant within-group improvements were also observed in Group B for the measured pulmonary function, functional capacity and fatigue outcomes (p<0.001).

The between-group analysis showed statistically significant differences in favour of Group A for FEV₁, FVC, 6MWD, VO₂max and D-FIS (p<0.001). However, the between-group difference in FEV₁/FVC ratio was not statistically significant (p>0.05).

Thus, although both groups demonstrated improvement over time, the multimodal renal rehabilitation group demonstrated significantly greater improvement in most of the measured outcomes compared with conventional physiotherapy along with standard medical care.

The findings suggested that the multidisciplinary renal rehabilitation was effective in

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improving pulmonary function, functional capacity and fatigue in CKD patients with frailty over the 12-week intervention period. The improvement in fatigue was particularly evident from the significant reduction in D-FIS scores in Group A compared with Group B (between-group p<0.001). Similarly, the significant between group improvement in 6MWD and VO₂max (p<0.001) indicated better functional exercise capacity following the rehabilitation programme. The findings were consistent with previous research showing beneficial effects of exercise-based interventions on physical function and fatigue in patients with CKD. However, the study evaluated a combined rehabilitation programme, and therefore the individual contribution of aerobic training, resistance training, inspiratory muscle training and multidisciplinary support could not be determined separately. Other limitations included the relatively small sample size, and limited follow-up period.

Therefore, larger randomized controlled trials with longer follow-up are required to confirm the findings and determine whether the observed improvements are observed over time. Overall, the study concluded that a 12-week multidisciplinary renal rehabilitation may be a useful approach for improving pulmonary function, functional capacity and fatigue in CKD patients with frailty.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

Ethical clearance was obtained from the Institutional Ethics Committee before commencement of the study. A total of 54 CKD patients were screened, of whom 42 participants fulfilling the eligibility criteria were included in the study. Written informed consent was obtained from all participants. Baseline assessment was performed using Pulmonary Function Tests (FEV₁, FVC and FEV₁/FVC ratio), 6-Minute Walk Test (6MWD, VO₂max) and Daily Fatigue Impact Scale (D-FIS).

The 42 participants were randomly allocated into two equal groups of 21 participants each.

Group A - Renal Rehabilitation :

Participants received a structured renal rehabilitation programme consisting of aerobic training, resistance training and inspiratory muscle training for 3 days per week for 12 weeks.

Each session started with 5-10 minutes of warm-up, followed by the training programme and ended with 5-10 minutes of cool-down.

• Aerobic Training: Aerobic exercise included cycle ergometer. Exercise intensity was maintained at approximately 40-60% of maximum heart rate and RPE 11-13. Aerobic exercise was initially performed for approximately 20-30 minutes and progressively increased by 5 minutes every 2 weeks according to tolerance, up to a maximum of 60 minutes.

• Resistance Training: Exercises were performed for major upper- and lower-limb muscle groups using free weights. The initial resistance was approximately 50% of 10RM, with 10 repetitions per set. Exercises included functional lower-limb and upper-limb strengthening such as sit-to-stand, knee extension, heel raises, biceps curls and shoulder exercises. Rest intervals of approximately 1-2 minutes were provided between exercises/sets. Resistance was progressively increased according to the participant's tolerance and ability to complete the prescribed repetitions with proper technique.

• Inspiratory Muscle Training: IMT was performed using a Threshold Inspiratory Muscle Trainer. Participants performed 5 sets of 10 breaths per session, with 1minute rest between sets. Training intensity was progressively increased according to MIP: 50% MIP during weeks 1-3, 60% during weeks 4-6, 70% during weeks 7-9 and 80% during weeks 10-12, as tolerated.

During all sessions, exercise intensity was individualized according to vitals stability, patient tolerance and clinical condition. Heart rate, blood pressure, SpO₂, fatigue and symptoms were monitored throughout the intervention.

Group B - Conventional Physiotherapy with standard medical care :

Group B received conventional physiotherapy with standard medical care, consisting of general upper- and lower-limb mobility exercises, diaphragmatic breathing exercises, stretching and active range-of-motion exercises for 30-40 minutes per session, 3 days per week for 12 weeks.

Multidisciplinary Care

  • Nephrologist: Conducted the initial CKD assessment, staging, medication review, blood pressure assessment and medical clearance before starting rehabilitation (Week 1). Medical review was repeated at Week 4, Week 8 and Week 12, or earlier if clinically indicated, to assess medical problems and exercise safety.
  • Renal dietitian: Provided individualized renal dietary counselling at Week 1, including appropriate protein and energy intake, sodium, potassium, phosphorus and fluid management according to CKD stage and laboratory findings. Dietary follow-up was conducted at Week 4, Week 8 and Week 12 to reinforce dietary adherence and modify recommendations when required.
  • Nurse: Monitored vital signs and exercise-related symptoms during every rehabilitation session throughout Weeks 1-12. The nurse also provided patient education, reinforced adherence to the exercise programme and coordinated with the rehabilitation team. Additional monitoring was performed whenever clinically required.

At the end of 12 weeks, all participants were reassessed using the same outcome measures. Pre- and post-intervention data were recorded and statistically analyzed to determine the effect of renal rehabilitation on pulmonary functions, functional capacity and fatigue.

Tipo di studio

Interventistico

Iscrizione (Effettivo)

42

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

    • Maharashtra
      • Latur, Maharashtra, India, 413531
        • Maharashtra Institute of Physiotherapy, Mimsr Campus, Latur

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion Criteria:

- Participants were medically diagnosed with moderate COPD (GOLD stage II-III) and were 40-70 years of age. Eligible participants included both males and females who were clinically stable, had the ability to understand and follow study instructions, and had a maximal inspiratory pressure (MIP) below 60 cmH₂O in males or below 50 cmH₂O in females

Exclusion Criteria:

  • Patients were excluded if they had an acute COPD exacerbation, a cardiac pacemaker, unstable cardiovascular disease such as recent myocardial infarction or unstable angina, uncontrolled hypertension, or recent fractures.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione di gruppo singolo
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Group A - Experimental group
Transcutaneous electrical diaphragm stimulation (TEDS) with inspiratory muscle training (IMT)
: TEDS was delivered bilaterally using two channels and four surface electrodes. The frequency was fixed at 30 Hz, pulse duration at 400 µs, rise time at approximately 1 s, ON time at 1 s, and OFF time at 3 s. Current amplitude was individually adjusted according to participant tolerance and increased to achieve a visible or palpable diaphragmatic contraction. Electrode placement was standardized bilaterally at the 7th-8th intercostal spaces along the mid-axillary lines. Stimulation was synchronized manually with the inspiratory phase.The stimulation was synchronized with the inspiratory phase of breathing. The patient was instructed to start inspiration when the electrical stimulation started and to breathe out during the relaxation phase. The therapist monitored the patient's breathing and stimulation timing throughout the session to maintain synchronization.
Altri nomi:
  • TEDS

The IMT protocol used a Threshold IMT device. Training was initiated at 30% of MIP and progressed to 60% of MIP. Each session lasted 15-20 minutes and was performed three times per week for 8 weeks.

IMT: 5 sets × 10 breaths, with 1-minute rest between sets, 3 sessions/week for 8 weeks.

Altri nomi:
  • IMT
Comparatore attivo: Group B - Inspiratory muscle training
Inspiratory muscle training (IMT) alone

The IMT protocol used a Threshold IMT device. Training was initiated at 30% of MIP and progressed to 60% of MIP. Each session lasted 15-20 minutes and was performed three times per week for 8 weeks.

IMT: 5 sets × 10 breaths, with 1-minute rest between sets, 3 sessions/week for 8 weeks.

Altri nomi:
  • IMT

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Diaphragm excursion
Lasso di tempo: Before and after 8 weeks
Diaphragm excursion was assessed using chest radiographs obtained at maximum inspiration and maximum expiration. The highest point of each hemidiaphragm during maximum expiration was identified, and a longitudinal line was drawn to the corresponding point during maximum inspiration. The distance between the inspiratory and expiratory positions was measured as diaphragm excursion. A radiographic ruler was used for correction of image magnification. The same measurement procedure was applied at baseline and after the intervention. Measurements were performed by a single assessor using a radiographic scale to account for image magnification.
Before and after 8 weeks
Maximal inspiratory pressure
Lasso di tempo: before and after 8 weeks
Measured by manometer
before and after 8 weeks
Pulmonary function
Lasso di tempo: before and after 8 weeks
Measured by PFT device known as SP 10 BT. Components were FEV1, FVC
before and after 8 weeks
Six minute walk distance
Lasso di tempo: before and after 8 weeks
Measured by six minute walk test
before and after 8 weeks

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Modified research council scale (mMRC)
Lasso di tempo: before & after 8 weeks
It is a scale has 4 components with grading according to the dysnea level
before & after 8 weeks
COPD assessment test score
Lasso di tempo: Before and after 8 weeks
health status related quality of life scales for COPD patients specifically.
Before and after 8 weeks

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Investigatori

  • Investigatore principale: Dr.Minaz J Naik, MPT (Pursuing) (CVRS), Maharashtra Institute of Physiotherapy, Mimsr Campus, Latur

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

  • 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. Fontana (WI): GOLD; 2025. 2. World Health Organization. Chronic obstructive pulmonary disease (COPD). Geneva: World Health Organization; 2024. 3. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-e64. 4. Ottenheijm CAC, Heunks LMA, Dekhuijzen PNR. Diaphragm adaptations in patients with chronic obstructive pulmonary disease. Respir Res. 2008;9:12. 5. Rocha FR, Brüggemann AK, Francisco DS, Medeiros CS, Rosal D, et al. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea and physical activity in daily life in patients with COPD. J Bras Pneumol. 2017;43(1):32-37. 6. Yamaguti WP, Paulin E, Shibao S, Chammas MC, Salge JM, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology. 2008;13(1):138-144. 7. American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. 8. Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006;27(6):1119-1128. 9. Ammous O, Feki W, Lotfi T, Khamis AM, Gosselink R, et al. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2023;1(1):CD013778. 10. Sbruzzi G, Callegari G, Marques CF, Chiappa GR. Effects of electrical stimulation on inspiratory muscles in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2021;35(10):1363-1373. 11. Zhao Z, Sun W, Zhao

Collegamenti utili

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

28 gennaio 2025

Completamento primario (Effettivo)

30 maggio 2025

Completamento dello studio (Effettivo)

30 maggio 2025

Date di iscrizione allo studio

Primo inviato

31 agosto 2026

Primo inviato che soddisfa i criteri di controllo qualità

31 agosto 2026

Primo Inserito (Effettivo)

4 settembre 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

4 settembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

31 agosto 2026

Ultimo verificato

1 agosto 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • MIPT,Latur
  • Dr,Minaz jamaluddin naik (Identificatore di registro: Dr. Minaz naik)

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

INDECISO

Descrizione del piano IPD

Because its a patient data, patient was blinded in my study. I have explain all the study details to them if they ever come to know that i have done bias with them by given conventional physiotherapy (for control group) then will feel bad so. if its necessary for trial registration to share data , then i will share.

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .