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Cayeiro-Marín M, Merino-Andrés J, Hidalgo-Robles Á, Ladriñán-Maestro A, Sánchez-Sierra A. Effects of pulmonary function improvement devices in the pediatric population with cerebral palsy: Systematic review and meta-analysis of randomized clinical trials. Respir Med 2024; 231:107717. [PMID: 38908411 DOI: 10.1016/j.rmed.2024.107717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 05/31/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters. METHODS A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias (RoB2). RESULTS Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size -0.604; confidence interval -1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size -0.500; confidence interval -1.259 to 0.259), the Tiffeneau index, and quality of life. CONCLUSION Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.
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Affiliation(s)
| | - Javier Merino-Andrés
- Asociación Centro Crecer, Toledo, Spain; Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain.
| | - Álvaro Hidalgo-Robles
- International University of La Rioja, Spain; Toledo University Hospital, Toledo, Spain
| | - Arturo Ladriñán-Maestro
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain; Toledo University Hospital, Toledo, Spain
| | - Alberto Sánchez-Sierra
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain; Department of Physiotherapy, Camilo José Cela University, Madrid, Spain; Department of Physiotherapy, European University, Madrid, Spain; Research Group in Therapeutic Exercise and Functional Rehabilitation, Department of Physiotherapy, European University, Madrid, Spain
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Kolumbán E, Szabados M, Hernádfői M, Nguyen Do To U, Nagy R, Zolcsák Á, Müller KE, Sipos Z, Veres DS, Szőllősi A, Hegyi P, Garami M, Túri I. Supplementary Respiratory Therapy Improves Pulmonary Function in Pediatric Patients with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:888. [PMID: 38337582 PMCID: PMC10856351 DOI: 10.3390/jcm13030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite medical advances, individuals with cerebral palsy (CP) face significant respiratory challenges, leading to heightened hospitalization rates and early mortality among this population. We hypothesize that integrating supplementary respiratory therapy into standard rehabilitation will result in significant improvements in pulmonary function, enhanced respiratory muscle strength, and an overall increase in the quality of life among pediatric patients with CP. METHODS A systematic search of literature across five databases was conducted, and random-effects meta-analyses were performed to assess the impact of supplementary respiratory therapy on (a) pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio, peak expiratory flow (PEF), and (b) respiratory muscle strength: maximal inspiratory and expiratory pressure (MIP, MEP), and (c) quality of life. Certainty of evidence was determined by the GRADE assessment. RESULTS Analysis of data from 11 eligible randomized controlled trials revealed clinically meaningful changes in pulmonary function. We found a relevant mean difference (MD) in absolute PEF of 0.50 L/s (95% confidence interval (CI): 0.19; 0.82 p = 0.0107). The certainty of the evidence ranged from moderate to high. CONCLUSIONS This study presents current evidence on the impact of various supplementary respiratory therapies for CP patients classified under gross motor function classification level I-IV, demonstrating clinically meaningful improvements in pulmonary function and respiratory muscle strength. These improvements suggest the potential for an enhanced quality of life. Our findings hold the promise of serving as a foundational reference for potential revisions to conventional rehabilitation care, incorporating supplementary respiratory therapy.
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Affiliation(s)
- Erika Kolumbán
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary;
| | - Márton Szabados
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Pediatric Center, Semmelweis University, 1083 Budapest, Hungary
| | - Márk Hernádfői
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Bethesda Children’s Hospital, 1146 Budapest, Hungary;
| | | | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Zolcsák
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Department of Biophysics and Radiation Biology, Semmelweis University, 1089 Budapest, Hungary
| | - Katalin Eszter Müller
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, 1088 Budapest, Hungary
| | - Zoltán Sipos
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Department of Biophysics and Radiation Biology, Semmelweis University, 1089 Budapest, Hungary
| | | | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Institute of Pancreatic Diseases, Semmelweis University, 1085 Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Pediatric Center, Semmelweis University, 1083 Budapest, Hungary
| | - Ibolya Túri
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary;
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