Is inspiratory muscle training effective for individuals with cervical spinal cord injury? A qualitative systematic review

Objective: To perform a systematic review to determine the effect of inspiratory muscle training ( IMT) in adults with cervical spinal cord injury ( CSCI). Design: A systematic search of the literature on IMT and CSCI according to the Cochrane Collaboration protocol was performed. We searched electronic databases up to August 2003 including MEDLINE and CINAHL, searched reference lists from pertinent articles and books, made personal contact with authors, and hand searched targeted journals to identify potential studies for inclusion. Study selection: Inclusion criteria for the review included randomized controlled trials published in English comparing IMT with another comparison group among adults with CSCI. Data extraction: Two reviewers abstracted relevant data from included studies. Methodological quality of the studies was assessed using criteria developed by Jadad et al. We also assessed whether the comparison groups were similar at baseline and whether an intention- to- treat analysis was performed. Results: Forty articles were retrieved and three met the inclusion criteria. All studies used inspiratory resistance muscle trainers for at least 15 min, twice daily, five to seven days per week for six to eight weeks. Meta- analysis could not be performed due to differences in study design and outcomes. Only one study reported a positive effect of IMT compared to control for measures of dyspnoea and pulmonary function. Conclusion: Literature on the effect of IMT among adults with CSCI is scarce and an overall effect could not be confirmed.