Meta-Analysis
Copyright ©The Author(s) 2023.
World J Clin Cases. May 6, 2023; 11(13): 2981-2991
Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.2981
Table 1 Characteristics of the six included studies
No.
Ref.
Country
Intervention
Control
Intervention group
Control group
Patients (male: female)
Mean age
Surgery type
Patients (male: female)
Mean age
Surgery type
1Hulzebos et al[12], 2006NetherlandsThreshold IMT + incentive spirometry + education in an active cycle of breathing techniques + forced expiration techniquesUsual care (i.e. instruction on deep breathing maneuvers, coughing, and early mobilization) + postoperative incentive spirometry, chest physical therapy, and mobilization scheme139 (108:31)66.5 (9.0)CABG: 139137 (107:30)67.3 (9.2)CABG: 137
2Savci et al[17], 2011 TurkeyThreshold IMT + mobilization + active exercises of upper and lower limbs + breathing exercises + coughing techniquesUsual care (mobilization, active exercises of upper and lower limbs, breathing exercises, and coughing techniques)22 (19:3)62.82 (8.69) CABG: 2221 (19:2)57.48 (11.48)CABG: 21
3Moises et al[18], 2014BrazilThreshold IMT + breathing exercises + postoperative physical therapyGuidelines ward routine + postoperative physical therapy35 (23:12)58.90 ± 9.53CABG: 3535 (29:6)61.40 ± 8.43CABG: 35
4Valken et al[6], 2016NetherlandsThreshold IMT + incentive spirometry + education (deep breathing maneuvers, coughing, and early mobilization)Postoperative deep breathing maneuvers, coughing, and early mobilization incentive spirometry and chest physical therapy119 (93:26)66 (9.2)CABG: 99; CABG + valve:20116 (93:23)67.5 (9.7)CABG: 87; CABG + valve: 29
5Chen et al[19], 2019ChinaThreshold IMT + usual care (education coughing, and early mobilization) and abdominal breathing training + postoperative chest physical therapy and mobilization schemeThreshold IMT [the intensity was fixed at the minimum load of the device (9 cmH2O)] + usual care (education coughing and early mobilization) and abdominal breathing training + postoperative chest physical therapy and mobilization scheme98 (73:25)61.68 ± 8.12CABG: 69; valve: 18; CABG + valve: 1199 (68:31)61.68 ± 7.73CABG: 70; valve: 21; CABG + valve: 8
6Weber et al[20], 2021GermanyThreshold IMT + walking below the threshold of subjective exhaustion + mobilization protocol and individual physiotherapyPostoperative physiotherapy58 (27:31)82.2 ± 5.8TAVR: 5850 (26:24)81.7 ± 5.0TAVR: 50
Table 2 Inspiratory muscle training used in each study
No.
Ref.
Length
Frequency
Duration
Supervision
Intensity
1Hulzebos et al[12], 2006≥ 2 wk preoperativelyOnce a day20 mins6 times a week without supervision and once a week with supervision30% of MIP. Resistance increases incrementally, based on the RPE scored on the Borg scale
2Savci et al[17], 20115 d preoperatively + 5 d postoperativelyTwice a day30 minsEach session was under the supervision of a physical therapist15% of MIP. The resistance was increased incrementally between 15% and 45% based on patient’s tolerance in the following days
3Moises et al[18], 2014Preoperative (length not mentioned)Once a day20 minsEach session was under supervision40% of MIP. Intensity increase not mentioned
4Valkenet et al[6], 2016Not mentionedOnce a day20 min6 times a week without supervision and once a week with supervision30% of MIP. Increased incrementally based on the RPE as scored on the Borg scale. If patients recorded an RPE score < 5 after a training session, they were instructed to increase the inspiratory load of the threshold device by 5% before the next training session. The threshold load was unchanged for RPE scores ≥ 5
5Chen et al[19], 20195 d preoperativelyTwice a day20 minEach session was under the supervision of a physical therapist30% of MIP. Increased incrementally, based on the RPE scored on the Borg18 scale. If the RPE was less than 5, the resistance of the inspiratory threshold trainer was then increased incrementally by 5%. Training loads were adjusted to maintain 30% of the maximal inspiratory pressure every day
6Weber et al[20], 2021≥ 2 wk preoperativelyOnce a day20 minNot mentionedNot mentioned