OBJECTIVES:(i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45-85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients. METHODS:First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test. RESULTS:568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV1 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations. CONCLUSIONS:The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.

BACKGROUND:Fatigue is one of the most limiting symptoms in individuals with heart disease (HD). However, valid and reliable instruments for assessing fatigue in clinical practice still need to be improved. OBJECTIVE:To assess the dimensional structure of the self-reported Spanish Multidimensional Fatigue Inventory (MFI) and analyze its psychometric properties in individuals with HD. METHODS:A longitudinal observational study included 247 participants (age 57.71 years; 23.9 % women; 89.9 % Caucasian). Test-retest reliability was assessed 10-14 days after the first evaluation. Measures evaluating fatigue, health-related quality of life (HRQoL), and functional capacity were collected to assess convergent validity. Acceptability, practicality, construct validity, floor/ceiling effects, internal consistency, and measurement error were also calculated. RESULTS:Confirmatory factor analysis supported the 4-factor structure of the MFI and the deletion of 3 items for its application in individuals with HD. The 17-item version showed no floor-ceiling effects and exhibited excellent internal consistency (Cronbach's α = 0.90) and test-retest reliability (Intraclass Correlation Coefficient (ICC) = 0.94). While all subscales demonstrated adequate internal consistency (Cronbach's α > 0.70) and good to excellent test-retest reliability (ICC, 0.75 - 0.91), the reduced motivation subscale showed slightly lower internal consistency. The minimal detectable change was 9.5 points for the total score. Convergent validity was established through moderate-strong correlations with fatigue, HRQoL, and functional capacity measures (r = |0.320-0.729|). CONCLUSIONS:The shortened version of the Spanish MFI (MFI-17) is a valid and reliable tool for quantifying fatigue in individuals with HD, supporting its clinical and research applicability.

BACKGROUND:Inspiratory and expiratory muscle training (RMT) has been shown to have beneficial effects in individuals with long-term post-COVID-19 symptoms. OBJECTIVE:To assess the effects of adding RMT to an aerobic exercise (AE) training program for health-related quality of life (HRQoL) and exercise tolerance in individuals with long-term post-COVID-19 symptoms, and to evaluate the effects on physical and lung function, and psychological status. METHODS:64 individuals with long-term post-COVID-19 symptoms of fatigue and dyspnoea were randomly assigned to AE+RMT or AE+RMTsham groups for an 8-wk intervention (AE: 50min/day, 2 times/wk; RMT: 40min/day, 3 times/wk). Primary outcomes were HRQoL (EuroQol-5D questionnaire) and exercise tolerance (cardiopulmonary exercise test). Secondary outcomes were physical function: respiratory muscle function (inspiratory/expiratory muscle strength and inspiratory muscle endurance), lower and upper limb strength (1-min Sit-to-Stand and handgrip force); lung function: spirometry testing and lung diffusing capacity; and psychological status (anxiety/depressive levels). RESULTS:Postintervention, there were no statistically significant improvements in HRQoL or exercise tolerance in the AE+RMT compared with the AE+RMTsham group. In the AE+RMT group, large improvements in respiratory muscle function (d = 0.7 to 1.3) and low-moderate improvements in peak expiratory flow (d = 0.4) occurred compared with the AE+RMTsham group. Lung function outcomes, lower and upper limb strength and psychological status did not increase more in the AE+RMT group than in the AE+RMTsham group. CONCLUSION:For individuals with long-term post-COVID-19 symptoms, combining RMT with an AE training program resulted in improvements in respiratory muscle strength, inspiratory muscle endurance and peak expiratory flow; however, the differences between groups were not statistically significant for HRQoL, exercise tolerance, psychological distress, and lung diffusing capacity. DATABASE REGISTRATION:United States Clinical Trials Registry (NCT05597774).

Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [−1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [−0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [−5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.

OBJECTIVE:This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on functional exercise capacity, health-related quality of life (HRQoL), respiratory muscle function, and pulmonary function in individuals with ischemic heart disease (IHD). METHODS:The MEDLINE, Web of Science, Scopus, PEDro, CINAHL, Science Direct, and CENTRAL electronic databases were searched in January 2023. Randomized controlled trials published in English, Spanish, or Portuguese that were conducted to determine the effect of RMT versus passive control and/or sham RMT on the target variables in individuals with IHD, irrespective of age or sex were included. Two reviewers performed the searches and extraction of the most relevant data. The quality and risk of bias for each included study were examined with the PEDro scale and Cochrane risk-of-bias tool. RESULTS:Thirteen studies (849 participants) were included. The meta-analysis showed a significant increase in peak oxygen consumption (mean difference [MD] = 2.18 mL·kg-1·min-1 [95% CI = 0.54 to 3.83]), inspiratory muscle strength (MD = 16.62 cm H2O [95% CI = 12.48 to 20.77]), inspiratory muscle endurance (standardized mean difference = 0.39 [95% CI = 0.19 to 0.60]), and expiratory muscle strength (MD = 14.52 cm H2O [95% CI = 5.51 to 23.53]). There were no benefits in 6-minute walking distance (MD = 37.57 m [95% CI = -36.34 to 111.48]), HRQoL (standardized mean difference = 0.22 [95% CI = -0.16 to 0.60]), pulmonary function (forced vital capacity; MD = 2.07% of predicted value [95% CI = -0.90 to 5.03], or forced expiratory volume at the first second (MD = -0.75% of predicted value [95% CI = -5.45 to 3.95]). CONCLUSION:This meta-analysis provided high- and moderate-quality evidence that inspiratory muscle training (IMT) improves inspiratory muscle strength and endurance, respectively; and very low-quality evidence for effects on peak oxygen consumption and expiratory muscle strength in individuals with IHD. No superior effects were found in the 6-minute walking test, HRQoL, or pulmonary function compared with the control group. IMPACT:The results shown in this systematic review with meta-analysis will provide clinicians a better understanding of the effects of IMT in people with IHD. IMT could be integrated into the cardiac rehabilitation management, although more research is needed.

The aim of this meta-analysis was to determine the effects of low-load blood flow restriction training (LL-BFRT) on muscle anabolism and thrombotic biomarkers compared with the effects of traditional LL training and to analyse the changes in these biomarkers in the short and medium term (acute/immediate and after at least 4 weeks of the training programme, respectively). A search was conducted in the following electronic databases from inception to 1 March 2024: MEDLINE, CENTRAL, Web of Science, PEDro, Science Direct, CINHAL, and Scopus. A total of 13 randomized controlled trials were included, with a total of 256 healthy older adults (mean (min–max) age 68 (62–71) years, 44.53% female). The outcome measures were muscle anabolism biomarkers and thrombosis biomarkers. The standardized mean difference (SMD) was calculated to compare the outcomes reported by the studies. The overall meta-analysis showed that LL-BFRT produces a large increase in muscle anabolism biomarkers compared with traditional LL training (eight studies; SMD = 0.88 [0.39; 1.37]) and compared with a passive control (four studies; SMD = 0.91 [0.54; 1.29]). LL-BFRT does not produce an increase in thrombotic biomarkers compared with traditional LL training (four studies; SMD = −0.02 [−0.41; 0.36]) or compared with a passive control (two studies; SMD = 0.20 [−0.41; 0.80]). The increase in muscle anabolism biomarkers was large after applying a single session (four studies; SMD = 1.29 [0.18; 2.41]) and moderate after applying a training programme (four studies; SMD = 0.58 [0.09; 1.06]). In conclusion, LL-BFRT increases muscle anabolism biomarkers to a greater extent than traditional LL training (low-quality evidence) or a passive control (moderate-quality evidence) in healthy older adults. This superior anabolic potential of LL-BFRT compared with LL training is sustained in the short to medium term. LL-BFRT is a safe training methodology for older adults, showing moderate-quality evidence of no increase in thrombotic biomarkers compared with traditional LL training.

OBJECTIVE:The purpose of this study was to describe the experiences of individuals with post-coronavirus 19 (COVID-19) condition symptoms who underwent a supervised telerehabilitation and home-based respiratory muscle training (TSHB-RMT) program. METHODS:A qualitative descriptive study was conducted. Participants were recruited using purposeful sampling. The inclusion criteria consisted of: patients aged over 18 years who presented persistent COVID-19 symptoms of fatigue and dyspnea for at least 3 months after the COVID-19 diagnosis. In total, 28 patients were included. In-depth interviews and researcher field notes were used to collect the data. A thematic analysis was performed. RESULTS:Three themes reflect the patients' perspective on the TSHB-RMT before the program (reasons for participating), during the treatment program, and upon completion of the study. Among the reasons for participation, participants highlighted the absence of improvement and treatment, and feeling abandoned and forgotten by the health system. The treatment required discipline on behalf of the patients. Mondays and Tuesdays were the most difficult days for performing the therapy, and the physical therapist was perceived as a tool for adherence, change, and a source of validated information. The patients perceived positive effects quite soon; however, it was necessary to extend the follow-up after completing the program because they abandoned the program due to the lack of guidance for exercise supervision. CONCLUSION:This study described relevant aspects that physical therapist professionals should consider when providing TSHB-RMT treatment. IMPACT:TSHB-RMT requires discipline, perseverance, effort, and a commitment to the group. The physical therapist is perceived as the tool that facilitates adherence and participation. The effects are rapidly perceived, leading to improved self-confidence and autonomy; however, it is necessary to increase the follow-up time.

OBJECTIVE:The purpose of this study was to validate a maximum inspiratory pressure (MIP) test protocol based on the principles of the 1-repetition maximum (1RM) test, assess its test-retest reliability, and establish minimal detectable change (MDC) in individuals with chronic obstructive pulmonary disease (COPD). METHODS:Forty-nine individuals with COPD were included in the study, of whom 44 individuals attended 2 appointments separated by 7 to 10 days for test-retest reliability. The MIP test was performed using a threshold valve device (1RM-based protocol) and the digital manometer (reference test). The 1RM-based protocol consisted of an incremental phase (inspiratory load increase [10 cm H2O] to achieve respiratory failure) and an approach phase (load halfway between the lowest failed attempt and the last valid attempt was prescribed). RESULTS:The concurrent validity of the 1RM-based protocol for the MIP test was good with respect to the reference test (day 1, intraclass correlation coefficient [ICC] = 0.81; day 2, ICC = 0.85). The test-retest reliability was excellent (ICC = 0.92), with a standard error of measurement of 6.3 cm H2O and a MDC of 17.5 cm H2O. CONCLUSION:This study validated a new 1RM-based protocol for the MIP test using an inspiratory muscle training (IMT) device in individuals with COPD, showing good concurrent validity compared with the reference test, as well as excellent test-retest reliability. The MDC reported can be interpreted and applied in the clinical setting. IMPACT:There was a need for developing new, inexpensive, simple, and feasible methods for the MIP test. The validation of the 1RM-based protocol addresses this issue, allowing for the appropriate prescription of IMT, favoring its widespread use in people with COPD, and therefore improving their physical therapist care.

OBJECTIVE:The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN:Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods. RESULTS:The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001). CONCLUSIONS:Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.

AbstractAimsTo investigate the health‐related quality of life (HRQoL), symptoms, psychological and cognitive state and pulmonary and physical function of nonhospitalised COVID‐19 patients at long‐term, and to identify factors to predict a poor HRQoL in this follow‐up.BackgroundStudies have focused on persistent symptoms of hospitalised COVID‐19 patients in the medium term. Thus, long‐term studies of nonhospitalised patients are urgently required.DesignA longitudinal cohort study.MethodsIn 102 nonhospitalised COVID‐19 patients, we collected symptoms at 3 months (baseline) and at 6–7 months (follow‐up) from diagnosis (dyspnoea, fatigue/muscle weakness and chest/joint pain), HRQoL, psychological state, cognitive function, pulmonary and physical function. This study adhered to the STROBE statement.ResultsHRQoL was impaired in almost 60% of the sample and remained impaired 6–7 months. At 3 months, more than 60% had impaired physical function (fatigue/muscle weakness and reduced leg and inspiratory muscle strength). About 40%–56% of the sample showed an altered psychological state (post‐traumatic stress disorder (PTSD), anxiety/depression), cognitive function impairment and dyspnoea. At 6–7‐months, only a slight improvement in dyspnoea and physical and cognitive function was observed, with a very high proportion of the sample (29%–55%) remained impaired. Impaired HRQoL at 6–7 months was predicted with 82.4% accuracy (86.7% sensitivity and 83.3% specificity) by the presence at 3 months of muscle fatigue/muscle weakness (OR = 5.7 (1.8–18.1)), PTSD (OR = 6.0 (1.7–20.7)) and impaired HRQoL (OR = 11.7 (3.7–36.8)).ConclusionA high proportion of nonhospitalised patients with COVID‐19 experience an impaired HRQoL, cognitive and psychological function at long‐term. HRQoL, PTSD and dyspnoea at 3 months can identify the majority of patients with COVID‐19 who will have impaired quality of life at long‐term.Relevance to clinical practiceTreatments aimed at improving psychological state and reducing the fatigue/muscle weakness of post‐COVID‐19 patients could be necessary to prevent the patients’ HRQoL from being impaired at 6–7 months after their reported recovery.

The primary aim of this study was to determine the minimal clinically important difference (MCID) for the EuroQol-5D questionnaire (EQ-5D-5L) index and visual analogic scale (VAS) in individuals experiencing long-term post-COVID-19 symptoms. In addition, it was pretended to determine which variable discriminates better and to compare changes between individuals classified by the MCID. Design: Secondary analysis of a randomized controlled trial involving 42 individuals who underwent an 8-week intervention in a respiratory muscle training program. Results: A change of at least 0.262 and 7.5 for the EQ-5D-5L index and VAS represented the MCID, respectively. Only the EQ-5D-5L VAS showed acceptable discrimination between individuals who were classified as "improved" and those classified as "stable/not improved" (area under the curve = 0.78), although with a low Youden index (Youden index, 0.39; sensitivity, 46.2%; specificity, 93.1%). Those individuals who exceeded the established MCID for EQ-5D-5L VAS had significantly greater improvements in inspiratory muscle function, exercise tolerance, and peripheral muscle strength compared to participants classified as "stable/not improved". Conclusions: Only the EQ-5D-5L VAS, especially when MCID was exceeded, showed an acceptable discriminative ability to evaluate the efficacy of an intervention in individuals with long-term post-COVID-19 symptoms.

OBJECTIVE:To evaluate the effects of a home-based respiratory muscle training programme (inspiratory [IMT] or inspiratory/expiratory muscles [RMT]) supervised by telerehabilitation on quality of life and exercise tolerance in individuals with long-term post-COVID-19 symptoms. The secondary objective was to evaluate the effects of these programmes on respiratory muscle function, physical and lung function, and psychological state.METHODS:88 individuals with long-term symptoms of fatigue and dyspnoea after COVID-19 diagnosis were randomly (1:1 ratio) assigned to IMT, IMTsham, RMT or RMTsham groups for an 8-week intervention (40min/day, 6 times/week). Primary outcomes were quality of life (EuroQol-5D questionnaire) and exercise tolerance (Ruffier test). Secondary outcomes were respiratory muscle function (inspiratory/expiratory muscle strength; inspiratory muscle endurance), physical function (lower and upper limb strength [1-min Sit-to-Stand and handgrip force]), lung function (forced spirometry), and psychological status (anxiety/depression levels and post-traumatic stress disorder). All outcomes were measured pre-, intermediate- (4th week), and post-intervention.RESULTS:At post-intervention, there was a statistically significant and large (d>0.90) improvement in quality of life, but not in exercise tolerance, in the RMT group compared with the RMTsham group. Both of the real training groups produced a statistically significant and large increase in inspiratory muscle strength and endurance (d≥0.80) and in lower limb muscle strength (d≥0.77) compared with the 2 sham groups. Expiratory muscle strength and peak expiratory flow showed a statistically significant and large (d≥0.87) increase in the RMT group compared with the other 3 groups.CONCLUSION:Only an 8-week supervised home-based RMT programme was effective in improving quality of life, but not exercise tolerance, in individuals with long-term post-COVID-19 symptoms. In addition, IMT and RMT programmes were effective in improving respiratory muscle function and lower limb muscle strength, but had no impact on lung function and psychological status.

Objective: To establish the minimal clinically important difference (MCID) for inspiratory muscle strength (MIP) and endurance (IME) in individuals with long-term post-COVID-19 symptoms, as well as to ascertain which of the variables has a greater discriminatory capacity and to compare changes between individuals classified by the MCID. Design: Secondary analysis of randomised controlled trial of data from 42 individuals who performed an 8-week intervention of respiratory muscle training programme. Results: A change of at least 18 cmH2O and 22.1% of that predicted for MIP and 328.5s for IME represented the MCID. All variables showed acceptable discrimination between individuals who classified as “improved” and those classified as “stable/not improved” (area under the curve ≥0.73). MIP was the variable with the best discriminative ability when expressed as a percentage of prediction (Youden index, 0.67; sensitivity, 76.9%; specificity, 89.7%). Participants classified as “improved” had significantly greater improvements in quality of life and lung function compared with the participants classified as “stable/not improved”. Conclusion: In individuals with long-term post-COVID-19 symptoms, the inspiratory muscle function variables had an acceptable discriminative ability to assess the efficacy of a respiratory muscle training programme. MIP was the variable with the best discriminative ability, showing better overall performance when expressed as a percentage of prediction.

OBJECTIVE:To evaluate the psychometric properties of the Spanish versions of the child- and parent-report cystic fibrosis questionnaire-revised (CFQ-R). METHODS:A Spanish adaptation of the CFQ-R was performed; 68 children with CF (6-13 years) and their parents completed the child- and parent-report CFQ-R, respectively, and the Revidierter KINDer Lebensqualitätsfragebogen (KINDL) questionnaire. The CFQ-R was completed twice, 7-10 days apart, and its psychometric properties were analyzed. RESULTS:The internal consistency of both CFQ-R versions was adequate (child-report version, Cronbach's α >.60 for all domains except "Treatment Burden" [α = .42] and "Social Functioning" [α = .57]; parent-report version, α > .60 for all domains except "Social Functioning" [α = .58]). For the child-report version, the lowest measurement error was for "Emotional Functioning" (standard error of measurement [SEM]: 8.3%; minimal detectable change [MDC90 ]: 19.3%), and the highest was for "Body Image" (SEM: 15%; MDC90 : 35%). For the parent-report version, the lowest measurement error was for "Physical Functioning" (SEM: 7.1%; MDC90 : 16.5%), and the highest was for "Weight" (SEM: 17.2%; MDC90 ; 40.1%). The correlation between the versions showed higher agreement for the domains related to observable signs ("Physical Functioning") and lower agreement for "Emotional Functioning." There was a significant correlation between the CFQ-R and KINDL. CONCLUSION:Both the child- and parent-report versions of the Spanish CFQ-R have adequate reliability and validity for clinical and research purposes. These versions can be administered before and after starting modulator therapy to assess its effect on daily functioning. The MDC90 can help identify, with a high probability, whether real changes have occurred in the quality-of-life subscales in children with CF.

Background and Purpose: The test-retest reliability and minimal detectable changes (MDCs) for respiratory muscle strength measures have not been determined in individuals with multiple sclerosis (MS). This study determined the test-retest reliability and MDCs for specific respiratory muscle strength measures, as well as their associations with health-related quality of life (HRQoL), disability, dyspnea, and physical activity level measures in this population. In addition, the study examined differences in respiratory muscle strength between different degrees of disability. Methods: Sixty-one individuals with MS attended 2 appointments separated by 7 to 10 days. Respiratory muscle strength was evaluated by maximal inspiratory and expiratory pressures (MIP/MEP), HRQoL by EuroQol-5D-5L (index and visual analog scale [EQ-VAS]), disability by the Expanded Disability Status Scale, dyspnea by the Medical Research Council scale, and physical activity levels by the International Physical Activity Questionnaire. Results: Respiratory muscle strength measures had excellent test-retest reliability (ICC ≥ 0.92). The MDC for MIP is 15.42 cmH 2 O and for MEP is 17.84 cmH 2 O. Participants with higher respiratory muscle strength (MIP/MEP cmH 2 O and percentage of predicted values) had higher HRQoL ( r = 0.54-0.62, P < 0.01, EQ-5D-5L index; r = 0.30-0.42, P < 0.05, EQ-VAS); those with higher expiratory muscle strength (cmH 2 O and percentage of predicted values) had lower levels of disability ( r ≤ −0.66) and dyspnea ( r ≤ −0.61). There were differences in respiratory muscle strength between different degrees of disability ( P < 0.01; d ≥ 0.73). Discussion and Conclusion: Respiratory muscle strength measures provide excellent test-retest reliability in individuals with MS. MDCs can be interpreted and applied in the clinical setting. Low respiratory muscle strength can contribute to a poor HRQoL; specifically, expiratory muscle strength appears to have the strongest influence on disability status and dyspnea.

Purpose To determine the differences in respiratory muscle strength and pulmonary function between patients with chronic neck pain (CNP) and asymptomatic individuals. Methods Databases were MEDLINE, CINAHL, Scopus, Web of Science and EMBASE up to the end of September 2021. Studies with cross-sectional and longitudinal design were selected, with adult patients with CNP and asymptomatic individuals with reports respiratory function. Results 11 studies met the inclusion criteria and 10 were included in the meta-analysis showing a statistically significant reduction in inspiratory/expiratory muscle strength (MIP/MEP) in the patients with CNP compared with the asymptomatic individuals (mean difference (MD) for MIP, -11.67 [-14.57 to -8.77]; MD for MEP, -11.80 [-14.99 to -8.60]) and pulmonary function: vital capacity (standardized mean difference (SMD), -0.31 [-0.56 to -0.06]); maximum voluntary ventilation (SMD, -0.36 [-0.59 to -0.14]); forced vital capacity (SMD, -0.53 [-0.99 to -0.06]); peak expiratory flow (SMD, -0.58 [-1.03 to -0.12]); and forced expiratory volume in the first second (SMD, -0.28 [-0.51 to -0.05]). Conclusions Patients with CNP have reduced respiratory muscle strength and pulmonary function compared with asymptomatic individuals, and this difference could be clinically meaningful. However, more studies of high methodological quality and longitudinal studies are needed to strengthen the results of this meta-analysis.

Purpose: Patients with multiple sclerosis (MS) with respiratory muscle weakness could have physical function impairments, given the functional/biomechanical link of the trunk stabilising system. Thus, clinicians could employ new treatment strategies targeting respiratory muscles to improve their physical function. This study pretends to evaluate the relationship between respiratory muscle strength, pulmonary function and pelvic floor function, and also to correlate these variables with physical function (gait function, disability and quality of life) in patients with MS. Methods: 41 patients participated in this descriptive cross-sectional study. Respiratory muscle strength [maximal respiratory pressures (MIP/MEP)], pulmonary function (forced spirometry), pelvic floor function [urinary incontinence (UI)], physical function [Timed Up & Go (TUG) test, Barthel index and health status questionnaire (SF-12)] were evaluated. Results: Respiratory muscle strength and pulmonary function were moderately related to UI (MIP: rho = -0.312; MEP: rho = -0.559). MEP was moderately related to physical function (TUG: rho = -0.508; Barthel index: rho = 0.418). Patients with and without expiratory muscle weakness showed differences in UI, pulmonary and physical function. Conclusion: Patients with MS with greater deterioration in pulmonary function and respiratory muscle strength, especially expiratory muscles, showed greater deterioration in UI and physical function. Expiratory muscle weakness had a negative impact on urinary, physical and pulmonary function. IMPLICATIONS FOR REHABILITATION Pulmonary function is associated with urinary incontinence and gait functionality in patients with multiple sclerosis (MS). Expiratory muscle weakness is associated with impaired urinary and physical function in patients with MS. The inclusion of respiratory muscle training to the rehabilitation programs of patients with MS could improve their pelvic floor disorders and physical function.

Background: Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poor-quality studies (PEDro score <= 4). Objectives: With this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and medium-term in post-stroke. Methods: Databases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool. Results: Nine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27 - 1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17-1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71-1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43 - 1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03-1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term. Conclusions: The meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone. (C) 2021 Elsevier Masson SAS. All rights reserved.

Background: The aims of this study were to develop a web-based Spanish form of the Barthel index (BI), to evaluate its psychometric properties and stability over time (test-retest), and to determine minimal detectable change (MDC) in patients with multiple sclerosis (MS). Methods: Participants answered the BI on two forms (web-based and face-to-face interview), 7–10 days apart. The internal consistency was evaluated using Cronbach’s alpha, and intraclass correlation (ICC) and kappa (κ) coefficients were used to investigate the agreement between both forms. Results: 143 participants were included. The Spanish web-based form of the BI showed excellent agreement between both forms for each item (κ = 0.86 (0.79 to 0.92), and for total score (κ = 0.87 (0.81 to 0.93); ICC = 0.99 (0.98 to 0.99). The internal consistency was good–excellent (Cronbach’s alpha = 0.89 (0.86–0.91)). The stability over time was adequate, the agreement of each item was κ = 0.63 (0.52–0.74)), and for total score (ICC = 0.97), determining a MDC95 of 12.09 points. Conclusions: The Spanish web-based form of the BI is a valid and reliable tool to assess functionality and can be applied in both formats in patients with MS. A total score difference of more than 12 points was found to indicate a deterioration or improvement in the patient’s functionality.

Background: There is clinical interest in determining the effects of low-load blood flow restriction (LL-BFR) resistance training on muscle strength and hypertrophy compared with traditional high- and low-load (HL and LL) resistance training in healthy older adults and the influence of LL-BFR training cuff-pressure on these outcomes. Methods: A search was performed on the MEDLINE, PEDro, CINHAL, Web of Science, Science Direct, Scopus, and CENTRAL databases. Results: The analysis included 14 studies. HL resistance training produces a small increase in muscle strength (eight studies; SMD, −0.23 [−0.41; −0.05]) but not in muscle hypertrophy (six studies; (SMD, 0.08 [−0.22; 0.38]) when compared with LL-BFR resistance training. Compared with traditional LL resistance training, LL-BFR resistance training produces small–moderate increases in muscle strength (seven studies; SMD, 0.44 [0.28; 0.60]) and hypertrophy (two studies; SMD, 0.51 [0.06; 0.96]). There were greater improvements in muscle strength when higher cuff pressures were applied versus traditional LL resistance training but not versus HL resistance training. Conclusions: LL-BFR resistance training results in lower muscle strength gains than HL resistance training and greater than traditional LL resistance training in healthy adults older than 60 years. LL-BFR resistance training promotes a similar muscle hypertrophy to HL resistance training but is greater than that of traditional LL resistance training. Applying cuff pressures above the limb occlusion pressure could enhance the increases in muscle strength compared with traditional LL resistance training.