Structured Abstract
Multiple Sclerosis Structured Abstract - MS #7
Training the muscles involved in expiration to improve expiration in clients with multiple sclerosis
CITATION: Smeltzer, S. C., Lavietes, M. H., & Cook, S. D. (1996). Expiratory training in multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 77, 909-912.
LEVEL OF EVIDENCE: IB1a
RESEARCH OBJECTIVE/QUESTION
"In an effort to determine if the expiratory muscles in MS patients could be strengthened, this study compared the effect of expiratory training and sham training on expiratory muscle strength in patients with MS" (p. 909).
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
Participants were randomly assigned to either a treatment group or a control group, which received sham training. They were compared in improvement in expiratory training from baseline to follow-up.
SAMPLING PROCEDURE
Unclear how participants were selected, then randomly assigned.
SAMPLE
|
N = 15 |
Mean age = NR |
Male = 7 |
Female = 8 |
NR = Not reported
Initially 20 participants were randomly assigned to treatment and control; however, 5 control participants left prior to completing treatment. All participants had MS and no asthma or emphysema. Time since onset was 5 to 27 years (mean 18.3, S.D. 6.6). Kurtzke disability scores ranged from 6.5 to 9.5. Nine subjects were smokers. No significant difference reported between treatment and control groups.
OUTCOMES
| |
Life roles |
|
Tasks |
|
Activities |
| |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome Area |
Measures |
Reliability |
Validity |
|
Maximal expiratory pressure (PEmax)
Maximal inspiratory pressure (PImax) |
No. 2000 100-cm magneholic pressure gauge. (All participants received training on the device before testing.) |
Reported to be reliable |
Reported to be valid |
INTERVENTION
Description
Experimental group - home program of exercise training to strengthen expiratory muscles through increased resistance to exhalation.
Control group - home program of sham exercise using inhalation instead of exhalation. No resistance set on inhalation.
Who delivered
Experimental group - Reviewed each week by therapist and adjusted as needed.
Control group - Reviewed each week by therapist.
Setting
Home for both groups
Frequency
Two 15-minute sessions daily (independent).
Duration
3 months
RESULTS
Unpaired t-test
- Significant difference between PEmax between experimental and control group (t (13) = 3.65, p = .003). Treatment PEmax difference score = 19.4 (9.9). Control PEmax difference score = -1.2 (11.1).
- No significant difference between treatment and control for PImax difference score.
CONCLUSIONS
Biases - masking, drop outs
Expiratory training can improve the expiration strength of MS clients. It can be completed using a home program with therapist monitoring. Participants spontaneously reported improved functions related to breathing.
Limitations
- Small sample size.
- No measurement of changes in functional ability.
- Therapists not blinded to participant's group.
- A large number of participants dropped out of the control group. No attempt was made to compare dropouts with those who stayed.
COMMENTARY
Training in breathing has the potential to improve expiration. Further research is needed to document the effect on function. This might be a useful adjunct to a home OT program.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Nancy Baker, ScD, OTR, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
