Kistik fibrozisli çocuklarda inspiratuar kas eğitiminin postüral stabilite, denge, solunum fonksiyonları ve fonksiyonel kapasite üzerine etkisi / Effects of inspiratory muscle training on postural stability, balance, pulmonary function and functional capacity in children with cystic fibrosis

Abstract

Cystic fibrosis (CF) is a genetic disorder affecting multiple organs and systems including lungs, pancreas, liver, gastrointestinal system and reproductive system which rely extensively on exocrine secretion. Lung-related problems are the most important cause of morbidity and mortality in these patients. It is stated in the guidelines that physiotherapy approaches for improving airway clearance should be included in the routine treatment of CF patients. Although inspiratory muscle training (IMT) is effectively used in various cardiopulmonary diseases, the literature related to its use in CF patients is conflicted. The number of the studies investigating the involvment of postural stability and balance in chronic lung diseases is rising and it is reported that postural stability may be affected due to respiratory or peripheral muscle weakness, increased work of breathig or hyperinflation. But the literature is limited regarding the involment of postural stability and its related mechanisms in CF patients. Aim of this study was to analyze the factors which may be related to postural stability and balance in CF patients and, to investigate the effects of IMT in addition to a comprehensive chest physiotherapy program on postural stability, balance, pulmonary function and functional capacity. Thirty two children aged between 8-18 who are diagnosed with CF were randomised into experimental or control group. Body composition analysis, pulmonary function test (PFT), respiratory and peripheral muscle strentgth assessments, 6-min walk test (6MWT) and, postural stability, limits of stability and sensory integration of balance tests in Biodex Balance System® were applied to all patients. A comprehensive chest physiotherapy program including thoracic expansion exercises, incentive spirometer, oscillatory positive pressure device, postural drainage, techniques for improving the effectiveness of cough and physical activity counselling was given to the control group to be repeated twice a day, seven days a week for 8 weeks. In addition to the comprehensive chest physiotherapy program, IMT at an intensity of 30% of MIP with Threshold IMT® device was given to the experimental group to be repeated twice a day for 15 minutes. All assessments were repeated at the end of the eighth week. Data was analyzed using SPSS v.20. For analyzing the independent predictors of the balance among the respiratory parameters, linear regression analysis was conducted on thirty-two subjects. Paired Sample T-test or Wilcoxon Test was used for in-group comparisons and Independent Samples T-tes or Mann Whitney U test was used for between-groups comparisons depending on the distribution properties of the data. The results were considered significant with P-values < 0,05. Regression analysis revealed that maximal expiratory pressure (MEP) value was an independent predictor for the overall score of limits of stability test. Subjects with higher MEP value had better overall score of limits of stability test (R=0,514; R2=0,264; p=0,003). After eight weeks of treatment, forced vital capacity, forced expiratory flow in 1 second, peak expiratory flow, MIP, MEP, 6MWT distance, M. Quadriceps strength and overall score of limits of stability test significantly improved in each group (p<0,01). Increase in the MIP value was higher in the experimental group compared to the control group (p<0,001). Improvements in PFT parameters, MEP, functional capacity and overall score of limits of stability test did not differ between groups (p>0,05). In our study, MEP value, which reflects the abdominal muscle strength was found to be an independent predictor for overall score of limits of stability test which evaluates dynamic balance ability, and the improvements in MEP value gained through the treatment reflected positively on the dynamic balance ability of the patients. It is reported in the literature that abdominal muscle strength is closely related to dynamic balance in both healthy subjects and patients with chronic lung diseases. According to our results, it can be assumed that a similar relationship may also exist in children with CF. Considering the previous studies and our results, it is concluded that IMT may be applied selectively to CF patients with significant respiratory muscle weakness but there is insufficient evidence to support its routine implementation in all patients. Beyond the improvement in airway clearance, a comprehensive chest physiotherapy program also improved pulmonary function, respiratory muscle strength and functional capacity in our study; this emphasizes the importance of including chest physiotherapy in the routine treatment of CF patients.