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Kronik obstrüktif akciğer hastalığında inspiratuar kas eğitiminin dispne nedeniyle hareket korkusuna etkisinin değerlendirilmesi / Assessment of impact of inspiratory muscle training on fear of movement due to dyspnea in chronic obstructive pulmonary disease

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2019
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Saka, Seda
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Bezmialem Vakıf University
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Abstract
Chronic obstructive pulmonary disease (COPD) is associated with respiratory muscle weakness, which leads to dyspnea, physical inactivity, decreased exercise capacity, and impaired quality of life. Dyspnea is defined as the difficulty of breathing. Patients with COPD avoid activities that cause dyspnea or compensate by reducing the rate of activity. As a result, fear of movement occurs due to dyspnea. The aim of this study was to evaluate the effect of inspiratory muscle training on fear of movement due to dyspnea in COPD patients. In our study, 40 patients who were referred to Bezmialem University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Pulmonary Rehabilitation Laboratory which was followed-up with the diagnosis of COPD in Bezmialem Medical Faculty, Department of Chest Diseases, were included on a voluntary basis. Demographic assessment form, 6 minutes walking test (6MWT), respiratory muscle strength measurement, Breathlessness Beliefs Questionnaire (BBQ), Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), COPD Evaluation Test (CAT) were performed before and after the inspiratory muscle training program. Participants were randomized into two groups. In the training group, inspiratory muscle training was performed in 30 % of the mouth inspiratory pressure (MIP) for eight weeks, at least five days a week, twice a day for 15 minutes. Patients were checked once a week, MIP values were re-measured, and new training intensity was determined in 30 % of the new value. In the control group, 15 % of MIP was given for eight weeks, at least five days a week, and 15 minutes for twice a day. MIP assessment were also performed weekly in control group. The support of Bezmialem Vakif University Scientific Research and Projects (BAP) unit was used for the rubber mouthpieces used in the measurement of respiratory muscle strength and the Threshold-IMT devices used in inspiratory muscle training. Statistical analysis was performed with SPSS package program. The mean ± standard deviation (X ± SS) for the variables indicated by measurement and the percentage (%) for the variables indicated by counting were calculated. The t-test was used to compare the pre- and post-treatment values of the same group. Wilcoxon paired two sample tests were used if the data were not suitable for normal distribution. The t-test was used to compare the measured values of the treatment and control groups. If the data were not suitable for normal distribution, Mann Whitney U test was used. Analysis of the variables determined by counting was performed using chi-square test. The level of significance was determined as p˂0.05. The demographic characteristics and baseline outcome measures of the patients were similar. In training group, there was a statistically significant difference between pre-training and post-training forced expiratory volume in first second (FEV₁), forced vital capacity (FVC), forced expiratory volume in first second to forced vital capacity ratio (FEV₁/FVC), MIP, mouth expiratory pressure (MEP), 6MWT distance, HADS, SGRQ, CAT and BBQ results. In control group, there was statistically significant difference between pre-trainig and post-trainig MIP, MEP, SGRQ (activity), CAT, BBQ results of the patients while there was no significant difference between 6MWT distance, HADS, SGRQ (symptom, effect, total). Also, there was a statistically significant difference in favor of the training group in all outcome measures compared to the difference between the groups pre-training and post-training. As a result of our study; MIP, MEP, 6MWT distance increased, anxiety and depression levels were decreased, SGRQ and CAT quality of life scores improved with inspiratory muscle training. Also, dyspnea related fear of movement was reduced which was the main aim of our study. In conclusion, our study supported the literature related with benefical effects of inspiratory muscle training, as well as determined the benefical effect on fear of movement due to dyspnea in COPD patients. Key words: Fear of movement, dyspnea, inspiratory muscle training, COPD
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Thesis (Doctoral)--Bezmialem Vakıf University, Department of Cardiopulmonary Physiotherapy and Rehabilitation, Istanbul, 2019
Keywords
Fizyoterapi ve Rehabilitasyon = Physiotherapy and Rehabilitation, Akciğer hastalıkları = Lung diseases, Akciğer hastalıkları-obstrüktif = Lung diseases-obstructive, Dispnea = Dyspnea, Egzersiz = Exercise, Hareket korkusu = Kinesiophobia, Kaslar = Muscles
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