Commentary on "The Effect of Inspiratory Muscle Training on Duchenne Muscular Dystrophy: A Meta-analysis".

Abstract

“How could I apply this information?” Children with muscular dystrophy have progressive muscle weakness of striated and respiratory muscles. The application of the inspiratory muscle training (IMT) methods and the results of this meta-analysis are limited. Little information is provided to the reader about the specific method of IMT, which is important for a clinician interested in providing IMT for a person with muscular dystrophy. For example, 3 of the included studies use IMT methods with more laboratory-based equipment (despite 2 of the studies being home-based) and the fourth study used an incentive spirometer (with less potential for IMT). One of the studies provided both inspiratory and expiratory muscle training. These important clinical factors need further discussion to facilitate the application of the information in this meta-analysis to clinical practice, as well as, with interpreting the results. “What should I be mindful about when applying this information?” Generalization of the results of this meta-analysis should be applied cautiously due to the above comments as well as (1) substantial heterogeneity in the 4 included studies, which, although not reported, can be seen in Figures 3 and 4, (2) no reporting on the quality of the included studies using the PEDro or other scale, (3) use of less common meta-analytic methods, and (4) a modest number of relevant studies identified via PubMed of “IMT and breathing exercises in patients with muscular dystrophy” (n = 23 and 47 publications, respectively) some of which could have been included in this article as a “systemic review and meta-analysis” providing more useful information for the interested clinician. Although briefly discussed in this meta-analysis, the possibility of respiratory muscle fatigue and subsequent respiratory failure is concerning in this population. Further discussion on clinical signs and symptoms of respiratory muscle fatigue and failure, as well as IMT methods to prevent these problems, is needed. James G. Moore, PT, PhD Pediatric Residency Program, Nicklaus Children's Hospital, University of Miami Miami, Florida Lawrence P. Cahalin, PT, PhD Department of Physical Therapy, University of Miami Coral Gables, Florida