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01-12-2020 | Stroke | Study protocol

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial

Authors: Renata Janaína Pereira de Souza, Daniella Cunha Brandão, José Vicente Martins, Juliana Fernandes, Armele Dornelas de Andrade

Published in: Trials | Issue 1/2020

Abstract

Background

Individuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke.

Objective

To assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes.

Methods/design

A blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured.

Discussion

The association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke.

Trial registration

ClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.

Available only for authorised users

Saunders DH, Sanderson M, Hayes S, et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2016;93(12):1707–16. https://doi.org/10.1002/14651858.CD003316.pub6.CrossRef

Pang MY, Harris JE, Eng JJ. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87(1):1–9. https://doi.org/10.1016/j.apmr.2005.08.113.CrossRefPubMedPubMedCentral

Lin K, Fu T, Wu C, Hsieh C. Assessing the stroke-specific quality of life for outcome measurement in stroke rehabilitation: minimal detectable change and clinically important difference. Health Qual Life Outcomes. 2011;9(1):5. https://doi.org/10.1186/1477-7525-9-5.CrossRefPubMedPubMedCentral

Verheyden G, Vereeck L, Truijen S, et al. Additional exercises improve trunk performance after stroke: a pilot randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):281–6. https://doi.org/10.1177/1545968308321776.CrossRefPubMed

Lista Paz A, González Doniz L, Ortigueira García S, Saleta Canosa JL, Moreno Couto C. Respiratory muscle strength in chronic stroke survivors and its relation with the 6-minute walk test. Arch Phys Med Rehabil. 2016;97(2):266–72. https://doi.org/10.1016/j.apmr.2015.10.089.CrossRefPubMed

Brogårdh C, Lexell J. Effects of cardiorespiratory fitness and muscle-resistance training after stroke. PM R. 2012;4(11):901–7. https://doi.org/10.1016/j.pmrj.2012.09.1157.CrossRefPubMed

Hugues A, Di Marco J, Janiaud P, et al. Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis. BMJ Open. 2017;7(1):1–8. https://doi.org/10.1136/bmjopen-2016-013348.CrossRef

Teixeira-Salmela LF, Parreira VF, Britto RR, et al. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phys Med Rehabil. 2005;86(10):1974–8. https://doi.org/10.1016/j.apmr.2005.03.035.CrossRefPubMed

Lanini B, Bianchi R, Romagnoli I, et al. Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med. 2003;168(1):109–13. https://doi.org/10.1164/rccm.200207-745OC.CrossRefPubMed

10.

Lacerda N, Gomes É, Pinheiro H. Efeitos da facilitação neuromuscular proprioceptiva na estabilidade postural e risco de quedas em pacientes com sequela de acidente vascular encefálico: estudo piloto. Rev Fisioter e Pesqui. 2013;20(1):37–42. https://doi.org/10.1590/S1809-29502013000100007.CrossRef

11.

Sutbeyaz ST, Koseoglu F, Inan L, Coskun O. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil. 2010;24(3):240–50.CrossRef

12.

Baert I, Vanlandewijck Y, Feys H, Vanhees L, Beyens H, Daly D. Determinants of cardiorespiratory fitness at 3, 6 and 12 months poststroke. Disabil Rehabil. 2012;34(21):1835–42. https://doi.org/10.3109/09638288.2012.665130.CrossRefPubMed

13.

Kim M, Cho K, Lee W. Community walking training program improves walking function and social participation in chronic stroke patients. Tohoku J Exp Med. 2014;234(4):281–6. https://doi.org/10.1620/tjem.234.281.CrossRefPubMed

14.

De Chen M, Rimmer JH. Effects of exercise on quality of life in stroke survivors: a meta-analysis. Stroke. 2011;42(3):832–7. https://doi.org/10.1161/STROKEAHA.110.607747.CrossRefPubMed

15.

Billinger SA, Taylor JM, Quaney BM. Cardiopulmonary response to exercise testing in people with chronic stroke: a retrospective study. Stroke Res Treat. 2012;2012. https://doi.org/10.1155/2012/987637.

16.

Tomczak CR, Jelani A, Haennel RG, Haykowsky MJ, Welsh R, Manns PJ. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke. Stroke. 2008;39(11):3102–6. https://doi.org/10.1161/STROKEAHA.108.515346.CrossRefPubMed

17.

Zhang F-L, Guo Z-N, Wu Y-H, et al. Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China. BMJ Open. 2017;7(9):e015758. https://doi.org/10.1136/bmjopen-2016-015758.CrossRefPubMedPubMedCentral

18.

Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke. 2016;47(6):e98–e169. https://doi.org/10.1161/STR.0000000000000098.CrossRefPubMed

19.

Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit. 2014;20:2543–9. https://doi.org/10.12659/MSM.891112.CrossRefPubMedPubMedCentral

20.

Saltychev M, Sjögren T, Bärlund E, Laimi K, Paltamaa J. Do aerobic exercises really improve aerobic capacity of stroke survivors? A systematic review and meta-analysis. Eur J Phys Rehabil Med. 2016;52(2):233–43.PubMed

21.

Kegelmeyer DA, Kloos AD, Siles AB. Selecting measures for balance and mobility to improve assessment and treatment of individuals after stroke. Top Stroke Rehabil. 2014;21(4):303–15. https://doi.org/10.1310/tsr2104-303.CrossRefPubMed

22.

Calmels P, Degache F, Courbon A, et al. The faisability and the effects of cycloergometer interval-training on aerobic capacity and walking performance after stroke. Preliminary study. Ann Phys Rehabil Med. 2011;54(1):3–15. https://doi.org/10.1016/j.rehab.2010.09.009.CrossRefPubMed

23.

Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sport Med. 2006;36(11):929–39. https://doi.org/10.2165/00007256-200636110-00002.CrossRef

24.

Slupska L, Halski T, Żytkiewicz M, et al. Proprioceptive neuromuscular facilitation for accessory respiratory muscles training in patients after ischemic stroke. Adv Exp Med Biol. 2019;1160:81–91. https://doi.org/10.1007/5584_2018_325.CrossRefPubMed

25.

Gontijo LB, Pereira PD, Neves CDC, Santos AP, Machado DDCD, Bastos VHDV. Evaluation of strength and irradiated movement pattern resulting from trunk motions of the proprioceptive neuromuscular facilitation. Rehabil Res Pract. 2012;2012:281937. https://doi.org/10.1155/2012/281937.CrossRefPubMedPubMedCentral

26.

Smedes F, Heidmann M, Schäfer C, Fischer N, Stępień A. The proprioceptive neuromuscular facilitation-concept: the state of the evidence, a narrative review. Phys Ther Rev. 2016;21(1):17–31. https://doi.org/10.1080/10833196.2016.1216764.CrossRef

27.

Lourenço R, Veras R. Mini-Exame do Estado Mental: características psicométricas em idosos ambulatoriais. Rev Saude Publica. 2006;40(4):712–9.CrossRef

28.

Durstine JL. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. Champaign: Human Kinetics; 2009.

29.

Borg G. Borg’s Perceived Exertion and Pain Scales Champaign: Human Kinetics; 1998.

30.

Sage M, Middleton L, Tang A, Sibley K, Brooks D, McIlroy W. Validity of rating of perceived exertion ranges in individuals in the subacute stage of stroke recovery. Top Stroke Rehabil. 2013;20(6):519–27. https://doi.org/10.1310/tsr2006-519.CrossRef

31.

Kitagawa K, Yamamoto Y, Arima H, et al. Effect of standard vs intensive blood pressure control on the risk of recurrent stroke. JAMA Neurol. 2019:1–10. https://doi.org/10.1001/jamaneurol.2019.2167.CrossRef

32.

Crapo RO, Casaburi R, Coates AL, et al. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7. https://doi.org/10.1164/rccm.166/1/111.CrossRef

33.

Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2):75–82. https://doi.org/10.1080/16501970410017215.CrossRefPubMed

34.

Eng JJ, Dawson AS, Chu KS. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil. 2003;85(1):113–8. https://doi.org/10.1016/s0003-9993(03)00436-2.CrossRef

35.

Salbach NM, Brooks D, Romano J, Woon L, Dolmage TE. Cardiorespiratory responses during the 6-minute walk and ramp cycle ergometer tests and their relationship to physical activity in stroke. Neurorehabil Neural Repair. 2014;28(2):111–9. https://doi.org/10.1177/1545968313498826.CrossRefPubMed

36.

Balady GJ, Arena R, Sietsema K, et al. Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191–225. https://doi.org/10.1161/CIR.0b013e3181e52e69.CrossRefPubMed

37.

Miyamoto ST, Lombardi I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004;37(9):1411–21. https://doi.org/10.1590/S0100-879X2004000900017.CrossRefPubMed

38.

Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. Stroke. 1999;30(7):1362–9.CrossRef

39.

Lima R, Teixeira-Salmela L, Magalhães L, Gomes-Neto M. Propriedades psicométricas da versão brasileira da escala de qualidade de vida específica para acidente vascular encefálico: aplicação do modelo Rasch. Rev Bras Fisioter. 2008;12(2):149–56.CrossRef

40.

Aliverti A, Pedotti A. Opto-electronic plethysmography. Monaldi Arch Chest Dis. 2003;59(1):12–6.PubMed

41.

Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26(1):153–61.CrossRef

42.

Pereira CADC. Espirometria. J Bras Pneumol. 2002;28(Suppl. 3):S1–S82. https://doi.org/10.1590/S1806-37132007000400008.CrossRef

43.

Moore VC. Spirometry: step by step. Breathe. 2012;8(3):232–40. https://doi.org/10.1183/20734735.0021711.CrossRef

44.

Pessoa IMBS, Houri Neto M, Montemezzo D, Silva LAM, de Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014;18(5):410–8. https://doi.org/10.1590/bjpt-rbf.2014.0044.CrossRefPubMedPubMedCentral

45.

Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Brazilian J Med Biol Res. 1999;32(6):719–27.CrossRef

46.

Baba R, Nagashima M, Goto M, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996;28(6):1567–72. https://doi.org/10.1016/S0735-1097(96)00412-3.CrossRefPubMed

47.

Hollenberg M, Tager IB. Oxygen uptake efficiency slope: an index of exercise performance and cardiopulmonary reserve requiring only submaximal exercise. J Am Coll Cardiol. 2000;36(1):194–201. https://doi.org/10.1016/S0735-1097(00)00691-4.CrossRefPubMed

48.

Jin H, Jiang Y, Wei Q, Chen L, Ma G. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke. NeuroRehabilitation. 2013;32(2):327–35. https://doi.org/10.3233/NRE-130852.CrossRefPubMed

49.

Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF. Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. J Physiother. 2016;62(3):138–44. https://doi.org/10.1016/j.jphys.2016.05.014.CrossRefPubMed

Title: Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial
Authors: Renata Janaína Pereira de Souza
Daniella Cunha Brandão
José Vicente Martins
Juliana Fernandes
Armele Dornelas de Andrade
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Stroke
Published in: Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-019-3923-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial

Abstract

Background

Objective

Methods/design

Discussion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods/design

Discussion

Trial registration

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