- Email: [email protected]
Inspiratory muscle training for asthma
694
Inspiratory muscle training for asthma F S F Ram, S R Wellington, N C Barnes Background In moderate to severe chronic obstructive pulmonary disease there is good evidence of a generalised loss of muscle bulk (including the respiratory muscles). It is possible that a similar loss of respiratory muscle strength occurs, particularly in more severe asthma related in part to the effects of steroid therapy. Thus the respiratory muscle function may well be of relevance in asthma and, if dysfunctional, may be a suitable target for training. Objectives To evaluate the efficacy of inspiratory muscle training with an external resistive device in patients with asthma. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2002), Medline (January 1966 to March 2002), Embase (January 1985 to March 2002), Cinahl (to March 2002) and the UK National Research Register of trials (January 1982 to March 2002) and reference lists of articles. We also searched on-line respiratory journals and contacted manufacturers of training devices to obtain reports of trials. Selection criteria All randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion.
Ram, F S F, Wellington, S R and Barnes, N C (2003). ‘Inspiratory muscle training for asthma’, The Cochrane Library, 4, John Wiley & Sons, Ltd, Chichester, UK.
Data collection and analysis Two reviewers independently selected articles for inclusion, evaluated their methodological quality, and abstracted data. Main results Five studies were included in the review with four of the studies being produced by the same group. PImax (maximum inspiratory pressure) reported in three studies with 76 patients showed significant improvement with inspiratory muscle training when compared to the control group (weighted mean difference 23.07 cm H 2 O, 95% confidence interval 15.65 to 30.50). Unfortunately, due to the paucity of included studies and data, no other outcome was reported by more than one study. Therefore it is not possible to confirm whether this increase seen with PImax translates into any measurable clinical benefit. Reviewers’ conclusions There is little evidence to suggest that inspiratory muscle training provides any clinical benefit to patients with asthma. Due to the limited availability of studies, further trials are needed to evaluate inspiratory muscle training devices for patients with asthma. They should investigate clinically relevant outcomes such as lung function, symptoms, exacerbation rate and concomitant medications in asthmatics with a range of severity. Contact address Dr Felix S F Ram, Senior Lecturer/Research Fellow, National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG. Telephone 020 7772 6200 E-mail [email protected]
Fax 020 7772 6390
Thermotherapy for treatment of osteo-arthritis L Brosseau, K A Yonge, V Robinson, S Marchand, M Judd, G Wells, P Tugwell Background Osteo-arthritis is a degenerative joint disease that affects mostly the weight-bearing joints in the knees and hips. As the affected joint degenerates, pain and restriction of movement often occur. Inflammation can also occur, sometimes resulting in oedema of the joint with osteo-arthritis. Treatment focuses on decreasing pain and improving movement. Objectives To determine the effectiveness thermotherapy in the treatment of osteo-arthritis the knee. The outcomes of interest were relief pain, reduction of oedema, and improvement flexion or range of motion and function. Physiotherapy December 2003/vol 89/no 12
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Search strategy Two independent reviewers selected randomised and controlled clinical trials with participants with clinical and/or radiological confirmation of osteo-arthritis of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head-to-head therapies, such as two different types of diathermy, were excluded. Selection criteria Randomised and controlled clinical trials including participants with clinical or radiographical confirmation of osteo-arthritis of the knee; and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion.
Inspiratory muscle training for asthma F S F Ram, S R Wellington, N C Barnes Background In moderate to severe chronic obstructive pulmonary disease there is good evidence of a generalised loss of muscle bulk (including the respiratory muscles). It is possible that a similar loss of respiratory muscle strength occurs, particularly in more severe asthma related in part to the effects of steroid therapy. Thus the respiratory muscle function may well be of relevance in asthma and, if dysfunctional, may be a suitable target for training. Objectives To evaluate the efficacy of inspiratory muscle training with an external resistive device in patients with asthma. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2002), Medline (January 1966 to March 2002), Embase (January 1985 to March 2002), Cinahl (to March 2002) and the UK National Research Register of trials (January 1982 to March 2002) and reference lists of articles. We also searched on-line respiratory journals and contacted manufacturers of training devices to obtain reports of trials. Selection criteria All randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion.
Ram, F S F, Wellington, S R and Barnes, N C (2003). ‘Inspiratory muscle training for asthma’, The Cochrane Library, 4, John Wiley & Sons, Ltd, Chichester, UK.
Data collection and analysis Two reviewers independently selected articles for inclusion, evaluated their methodological quality, and abstracted data. Main results Five studies were included in the review with four of the studies being produced by the same group. PImax (maximum inspiratory pressure) reported in three studies with 76 patients showed significant improvement with inspiratory muscle training when compared to the control group (weighted mean difference 23.07 cm H 2 O, 95% confidence interval 15.65 to 30.50). Unfortunately, due to the paucity of included studies and data, no other outcome was reported by more than one study. Therefore it is not possible to confirm whether this increase seen with PImax translates into any measurable clinical benefit. Reviewers’ conclusions There is little evidence to suggest that inspiratory muscle training provides any clinical benefit to patients with asthma. Due to the limited availability of studies, further trials are needed to evaluate inspiratory muscle training devices for patients with asthma. They should investigate clinically relevant outcomes such as lung function, symptoms, exacerbation rate and concomitant medications in asthmatics with a range of severity. Contact address Dr Felix S F Ram, Senior Lecturer/Research Fellow, National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG. Telephone 020 7772 6200 E-mail [email protected]
Fax 020 7772 6390
Thermotherapy for treatment of osteo-arthritis L Brosseau, K A Yonge, V Robinson, S Marchand, M Judd, G Wells, P Tugwell Background Osteo-arthritis is a degenerative joint disease that affects mostly the weight-bearing joints in the knees and hips. As the affected joint degenerates, pain and restriction of movement often occur. Inflammation can also occur, sometimes resulting in oedema of the joint with osteo-arthritis. Treatment focuses on decreasing pain and improving movement. Objectives To determine the effectiveness thermotherapy in the treatment of osteo-arthritis the knee. The outcomes of interest were relief pain, reduction of oedema, and improvement flexion or range of motion and function. Physiotherapy December 2003/vol 89/no 12
of of of of
Search strategy Two independent reviewers selected randomised and controlled clinical trials with participants with clinical and/or radiological confirmation of osteo-arthritis of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head-to-head therapies, such as two different types of diathermy, were excluded. Selection criteria Randomised and controlled clinical trials including participants with clinical or radiographical confirmation of osteo-arthritis of the knee; and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion.