P108 The case for inspiratory muscle training: a (true) South African story

• Published in: Neuromuscular disorders : NMD Vol. 33; pp. S171 - S172
• Main Authors: Human, A., Corten, L., Lozano-Ray, E., Morrow, B.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2023
• ISSN: 0960-8966; 1873-2364
• DOI: 10.1016/j.nmd.2023.07.415

Progressive respiratory muscle weakness and ineffective cough contribute to respiratory morbidity and mortality in children with neuromuscular disease (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength, reduce respiratory complications and improve health-related quality of life (HRQoL). This study aimed to describe South African physiotherapists’ knowledge and respiratory management strategies and evaluate the safety and efficacy of IMT for children (>5 years of age) with NMD. Four phases were conducted: i) a quantitative survey; ii) a systematic review; iii) a prospective, observational study and iv) a prospective, cross-over randomised controlled trial (RCT) using a standardised 12-week IMT programme. South African physiotherapists (n=64) favoured manual airway clearance techniques and supported IMT as part of chronic management. The systematic review (7 studies; n=168) concluded that despite the possible benefit of IMT, there was insufficient evidence to guide clinical practice. The pre-experimental, pilot study (n=8) suggested that a 6-week IMT programme was safe, viable, acceptable and associated with a significant increase in inspiratory muscle strength. The cross-over RCT (n=23) showed no evidence of a difference in hospitalisations and respiratory tract infections between intervention and control periods. No adverse events related to IMT were reported. Inspiratory muscle strength (Pimax) and peak cough flow improved with 14.6 (±15.7)cmH₂O and 32.3 (±36.6)L/min, respectively, during intervention compared to a change of 3.0 (±11.9)cmH₂O (p=0.01) and -16.6 (±48.3)L/min (p<0.001) during the control period. There was no evidence of a change in spirometry, function or total HRQoL scores. Participant satisfaction with IMT was high and adherence was good. Inspiratory muscle training in children with NMD is well tolerated, safe and associated with significant improvements in inspiratory muscle strength and cough efficacy.