Abstract:
Background: Muscle wasting and limitation in physical activity
have been reported in patients with hemodialysis; this leads to poor
quality of life at the end.
Objective: To develop the respiratory training device and to
determine the efficiency of the prototype on respiratory muscle
strength, functional capacity and dyspnea perception in hemodialysis
patients.
Design, setting and participants: the development of
respiratory device was created and then effects of respiratory device
were examined in hemodialysis patients. A total of 25 patients with
quasi experimental study was recruited in the present study with aged ≥
35 years old. All participants had a history of hemodialysis 3 days per
week.
Outcome measurements and statistical analysis: The protocol was
conducted 15 inhales, three set per day with 40% of maximal inspiratory
pressure; totally 45 inhales. The participants were asked to perform for
three times per week during on hemodialysis. Respiratory muscle
strength, the 6minute walk test and rate of dyspnea scores were assessed
before and after 8-week intervention program. Paired t-tests was used to
compare between initial values and follow-up values in respiratory
prototype.
Results: Of 25 patients at initially was enrolled, 22
individuals (88%) completed in the 8-week program. Significant improve
in inspiratory muscle strength, 6minite walk distance and rate of
dyspnea was observed after 8-week intervention (Δ12.44± 3.55
cmH2O, Δ24.78 ± 8.89 meters, and Δ0.50 ± 0.19,
respectively).
Conclusion: Using porotype of respiratory device can
effectively improve cardiorespiratory performance which is marked by
increasing inspiratory muscle functional capacity and rate of dyspnea in
hemodialysis patients after 8-week training program.
Keywords: respiratory device, hemodialysis, dyspnea,
respiratory muscle, functional capacity, rehabilitation
Thai Clinical Trials Registry (TCTR) number is
TCTR20171107003.
Introduction
Muscle wasting and limitation in physical activity have been reported in
patients with end stage renal disease. In addition, myopathy uraemia has
been described in chronic renal failure (CRF), and this leads to decline
in muscle strength including respiratory muscle. It has been reported
that respiratory muscle training in CRF patients could increase in
respiratory muscle strength and thereby increase in functional capacity1. Pellizzaro et al reported the effect of respiratory
muscle training in CRF patients during hemodialysis and found that
respiratory muscle strength and functional capacity had a significantly
improvement while the control group who did not any intervention were
not improved 1. In addition, a correlation was found
between inspiratory muscle strength and functional capacity (defined as
the 6-minute walk test). Inspiratory muscle training (IMT) commonly
performs a threshold loading IMT such as POWERbreathe. Using the
threshold loading IMT should inspire through a mouthpiece with adjusted
or different resistance in the inspiration. Therefore, inspiratory
muscle training might be carried by using accessory muscle for example
scalene muscle or sternocleidomastoid muscle. According to the previous
study, we created a respiratory prototype (named TU-Breath Training)
that attached on the lower costal muscle instead. Further, it has been
shown that training with TU-breathe could reduce blood pressure in
hypertensive participants 2. Therefore, the study was
aimed to design and develop a new prototype of respiratory version II
and explore the effect of the prototype version II on cardiorespiratory
performance (i.e., respiratory muscle strength, functional capacity) and
dyspnea score among hemodialysis patients.