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.