Clinical trial NCT05678816: Effect Of Breather On Pulmonary And Physical Function In Post Stroke Survivors
Official title: Effect Of Breather On Pulmonary And Physical Function In Post Stroke Survivors
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Stroke
Lead sponsor: Cairo University
Sponsor class: OTHER
First posted: 2023-01-10
Enrollment: 50
Sex: ALL
Minimum age (years): 40
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Stroke is the second major cause of death and disability worldwide with over 13 million new cases annually.

Egypt, a low-middle-income country, is the most populated nation in the Middle East with a high overall crude prevalence rate of stroke (963/100,000 inhabitants), accounting for 6.4% of all deaths and the incidence of stroke annually is approximately 150,000-210,000.

Stroke has a direct impact on health systems, resulting in high costs, and is also considered a global public health problem due to serious disabilities, functional limitations and compromised quality of life (QoL).

The Breather a drug-free, evidence-based inspiratory/expiratory respiratory muscle training (RMT) device used by Dysphagia, COPD, CHF, Parkinson's, and neuromuscular disease patients, as well as children 4+ and adults interested in healthy aging.

Detailed description: Stroke is a leading cause of death and disability in globally and particularly in low and middle-income countries, and this burden is increasing.

The expected spontaneous biological recovery follows the "proportional recovery rule" - most patients recover 70% of their impaired motor or verbal function during the first three months after stroke however, 90% of them have residual deficit.

Stroke patients may experience a reduction of up to 50% in respiratory function when compared to age- and gender-matched norms. The reduction in respiratory function can lead to decreased endurance, dyspnea and increased sedentary behaviour, as well as an elevated risk of recurrent stroke. The reduction in respiratory function may also cause aspiration, leading to pneumonia. Previous research showed that pneumonia was an independent risk factor for mortality and a poor prognosis in stroke patients. Research also showed that a reduction in respiratory muscle and abdominal muscle strength contributed to pulmonary and respiratory dysfunction following a stroke.

After a stroke, the respiratory center and related motor pathways can directly decrease respiratory muscle strength and subsequently induce a change in breathing patterns. As a result, pneumonia, pulmonary ventilation disorders, lung injury, lung ischemia reperfusion injury, decreased pulmonary compliance, abnormal posture, and obstructive sleep apnea can occur following a stroke. Thus, pulmonary rehabilitation is critical to reducing these complications. The main forms of pulmonary rehabilitation include exercise training, respiratory muscle training, oxygen therapy, noninvasive ventilation, nutrition support, social psychological support, and health education.

The inspiratory muscles can be specifically trained, with improvement of both muscle strength and endurance by using the breather device.

As result utilizing the breather may help stroke patients recover quickly and avoid respiratory complication.

Eligibility criteria: Inclusion Criteria:

* Sixty patients were selected from both sexes.Their age were from 50 to 65 years old
* All patients were medically stable.
* All patients had the ability to understand and follow simple verbal instructions.
* All patients were in subacute stage from about 3 to 6 months post lesion.

Exclusion Criteria:

* Patients with severe acute illness.
* Chronic unstable pulmonary and/or cardiac disease.
* Impaired level of consciousness and evidence of gross cognitive problems.
* Patients undergoes chemotherapy.
* Active hemoptysis, untreated pneumothorax, recent esophageal surgery.
* Recent oral, facial or skull trauma / surgery, acute sinusitis, epistaxis.
* Smokers.
* Any oral dysfunction that interfere with using the breather.
* Un controlled BP systole more than180 or diastole more than 90.

Primary outcomes:
measure: forced expiratory volium in first second FEV1 in litres
timeFrame: 6 weeks
measure: foced vital capacity FVC in litres
timeFrame: 6 weeks
measure: peak inspiratory flow PIF in litres per second
timeFrame: 6 weeks
measure: peak expiratory flow PEF in litres per second
timeFrame: 6 weeks
Secondary outcomes:
measure: Chest expansion in centimeters using tape measurement
timeFrame: 6 weeks
measure: oxygen saturation in percentage using spirometer
timeFrame: 6 weeks
measure: six minute walk distance in metersused to assess functional capacity of patients
timeFrame: 6 weeks
measure: stroke impact scale to assess the effect of stroke on different domains astanderdized score ranging from 0 to 100 is calculated for all domains with higher score indicating a higher quality of life
timeFrame: 6 weeks
Other outcomes:
Locations:
city: Giza
country: Egypt
facility: Cairo University
city: Giza
country: Egypt
facility: Faculty of Phsical Therapy
Study officials:
affiliation: Cairo University
name: NESREEN AL NAHAS, PROFESSOR
role: STUDY_CHAIR
References:
citation: Lindsay MP, Norrving B, Sacco RL, Brainin M, Hacke W, Martins S, Pandian J, Feigin V. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int J Stroke. 2019 Oct;14(8):806-817. doi: 10.1177/1747493019881353. No abstract available.
citation: Aref H, Zakaria M, Shokri H, Roushdy T, El Basiouny A, El Nahas N. Changing the Landscape of Stroke in Egypt. Cerebrovasc Dis Extra. 2021;11(3):155-159. doi: 10.1159/000521271. Epub 2021 Dec 3.
citation: Krishnamurthi RV, Ikeda T, Feigin VL. Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017. Neuroepidemiology. 2020;54(2):171-179. doi: 10.1159/000506396. Epub 2020 Feb 20.
citation: Gungen BD, Tunc A, Aras YG, Gundogdu AA, Gungen AC, Bal S. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program. BMC Neurol. 2017 Jul 11;17(1):132. doi: 10.1186/s12883-017-0912-4.