Inspiratory Muscle Trainer Effectiveness in Chronic Obstructive Pulmonary Disease Rehabilitation Program

Nury Nusdwinuringtyas, Balqis Islamadina, Cleopas Martin Rumende, Telly Kamelia

Abstract


Chronic obstructive pulmonary disease (COPD) is marked by persistent respiratory disturbance which results in altered health status as well as functional capacity. Pulmonary rehabilitation (PR) is a part of comprehensive therapy in patients suffering from respiratory disturbance. This study focused on inspiratory muscles exercise using the inspiratory muscle trainer(IMT), which is a form of a weight training exercise. This experiment was conducted at the COPD outpatient clinic of Dr. Cipto Mangunkusumo Hospital during the period of September 2017 until April 2018. Patients were recruited consecutively. The criteria for inclusion were stable COPD patient with GOLD criteria A-D and never received prior exercise for pulmonary rehabilitation. Patients underwent interview about their medical history followed by spirometry testing using Carefusion® and  inspiratory muscle strength assessment using Micro RPM Carefusion®. The St George Respiratory Questionnaire (SGRQ) was used to assess the health status and the 6-minute walking test (6MWT) was conducted to assess the functional capacity. Subject exercised using IMT (Philips Respironic®) for eight weeks. Data were analyzed using paired t-test in statistical package for social sciences (SPSS) version 21. A total of 15 subjects with and average age of 65.6±8.40 years old were recruited. Pre-Post difference in inspiratory muscle strength was 11.31 cmH2O, showing a statistically significant impact. The significant impact was also shown clinically through the results of the Minimal Clinical Important Difference (MCID) on health status and functional capacity. The health status was evaluated using SGRQ with p exceeding 4%. A combined Pulmonary Rehabilitation (PR) and inspiratory muscles exercise program is proven to improve the health status and functional capacity.

Key words: COPD, inspiratory muscle trainer, pulmonary rehabilitation, SGRQ, 6MWT

 

Keefektifan Inspiratory Muscle Trainer Pada Program Rehabilitasi  Penyakit Paru Obstruktif Kronik

Penyakit paru obstruktif kronik (PPOK) ditandai dengan gangguan pernapasan yang persisten yang mengganggu status kesehatan dan kapasitas fungsional. Pulmonary rehabilitation (PR) merupakan bagian dari terapi komprehensif pasien dengan ganguan respirasi. Penelitian ini memfokuskan pada latihan otot inspirasi menggunakan inspiratory muscle trainer (IMT), suatu bentuk latihan otot pernapasan dengan pemberian beban. Eksperimen ini dilakukan di Rumah Sakit Cipto Mangunkusumo selama periode September 2017 hingga April 2018. Pasien direkrut secara consecutive sampling. Kriteria inklusi adalah pasien PPOK yang stabil dengan kriteria GOLD A-D yang belum pernah menerima latihan sebelumnya untuk rehabilitasi paru. Pasien menjalani wawancara, diuji dengan spirometri Carefusion®, dan kekuatan otot inspirasi dinilai menggunakan Micro RPM Carefusion®. St George Respiratory Questionnaire (SGRQ) digunakan untuk menilai status kesehatan dan 6-minute Walking Test (6MWT) dilakukan untuk menilai kapasitas fungsional. Subyek menggunakan alat IMT (Philips Respironic®) selama 8 minggu. Data dianalisis menggunakan SPSS versi 21 dengan uji T berpasangan. Subjek penelitian berjumlah 15 orang dengan rerata usia 65,6 ± 8,40 tahun. Kekuatan otot inspirasi awal didapatkan perubahan sebesar 11,31 cmH2O, yang memberikan dampak bermakna dilihat dengan pencapaian minimal clinical important difference (MCID) pada status kesehatan dan kapasitas fungsional. PR bersama dengan program latihanotot inspirasiterbukti memberikan hasil perbaikan status kesehatan dan kapasitas fungsional.

Kata kunci: COPD, inspiratory muscle trainer, pulmonary rehabilitation, SGRQ, 6MWT

 


Keywords


COPD; inspiratory muscle trainer; pulmonary rehabilitation; SGRQ; 6MWT

Full Text:

PDF

References


Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2018 Report) 2018:1-142.

Bell M, Fotheringham I, Punekar YS, Riley JH, Cockle S, Singh SJ. Systematic review of the association between laboratory- and field-based exercise tests and lung function in patients with chronic obstructive pulmonary disease. J COPD Foundation. 2015;2(3):321–42.

Mannino DM, Higuchi K, Yu TC, Zhou HX, Li YY, Tian HJ, et al. Economic Burden of COPD in the presence of comorbidities. Chest. 2015;148(1):138–50.

Guidelines for pulmonary rehabilitation programs. 4th Ed. Rehabilitation AAoCP, ‘. Champaign: Human Kinetics; 2011.

Geddes EL, O’Brien K, Reid WD, Brooks D, Crowe J. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review. Respiratory Medicine. 2008;102(12):1715–29.

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131:4S–42.

Mullerova H, Gelhorn H, Wilson H, Benson VS, Karlsson N, Menjoge S, et al. St. George’s respiratory questionnaire score predicts outcomes in patients with COPD: analysis of individual patient data in the COPD biomarkers qualification consortium database. J COPD Foundation. 2017;4(2):141–9.

Criner G. 6-minute walk testing in COPD: is it reproducible?. Eur Respir J. 2011;38:244–5.

Dajczman E, Wardini R, Kasymjanova G, Préfontaine D, Baltzan MA, Wolkove N. Six minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Can Respir J. 2015;22(4):225–9.

Hwang SL, Lin YC, Guo SE, Chi MC, Chou CT, Lin CM. Prevalence of chronic obstructive pulmonary disease in Southwestern Taiwan: a population-based study. J Respir Pulm Med. 2016;3(2):1–4.

Cortopassi F, Gurung P, Pinto-Plata V. Chronic obstructive pulmonary disease in Elderly patients. Clin Geriatr Med. 2017;33:539–52.

Incalzi RA. An epidemiological overview and clinical picture of COPD in the elderly. J Gerontology and Geriatrics. 2016;64:119–25.

Obando LMG, López AL, Ávila CL. Normal values of the maximal respiratory pressures in healthy people older than 20 years old in the city of Manizales – Colombia. Colombia Medica. 2012;43(2):119–25.

Jones PW, Spencer S, Adie S. The St George’s respiratory questionnaire manual. London: Respiratory Medicine, St George’s University of London; 2009.

Cook CE. Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense. J Manual Manipulative Ther. 2008;16(4):E82–3.

Jones PW, Beeh KM, Chapman KR, Decramer M, Mahler DA, Wedzicha JA. Minimal clinically important differences in pharmacological trials. Am J Res Crit Care Med. 2014;189(3):250–5.

Elmorsi AS, Eldesoky ME, Mohsen MAA, Shalaby NM, Abdalla DA. Effect of inspiratory muscle training on exercise performance and quality of life in patients with chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc. 2016;65:41–6.

McKenzie DK, Butler JE, Gandevia SC. Respiratory muscle function and activation in chronic obstructive pulmonary disease. J Appl Physiol. 2009;107:621–9.

Geddes EL, Reid WD, Brooks D, O'Brien K, Crowe J. A primer on inspiratory muscle trainers: the buyers’ guide to respiratory care products. Canada; 2019. Available from: https://www.researchgate.net/publication/228373385_A_primer_on_inspiratory_muscle_trainers.




DOI: https://doi.org/10.15395/mkb.v51n1.1600

Article Metrics

Abstract view : 1482 times
PDF - 604 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats