Clinical Efficacy of Respiratory Exercise for Respiratory Function in Stroke Rehabilitation: A Network Meta-Analysis

Importance Determining the most effective intervention to improve respiratory function is complex. Objective This study aimed to determine the effectiveness of various cardiorespiratory physical therapist interventions to improve respiratory function in patients with stroke and to prioritize them. Data Sources This network meta-analysis examined randomized controlled trials published between 2000 and 2023. Study Selection Randomized controlled trials that enrolled patients with stroke and examined various cardiorespiratory physical therapist interventions were selected. The interventions included combined aerobic and breathing training, combined inspiratory and expiratory training (CIET), conventional training (CT), expiratory training, ground-based aerobic training (GBAT), inspiratory training (IT), and sham intervention (S). Data Extraction and Synthesis Data were independently extracted by 2 authors. Comprehensive Meta-Analysis Software program was used to analyze the data and determine effect sizes. Main Outcomes and Measures Outcome variables were maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), and peak expiratory flow (PEF). Results Thirteen studies, involving 416 participants, were selected. CIET was more effective than CT in improving MEP, MIP, and PEF, with Hedges g (g) values of 0.890 (95% CI = 0.560 to 1.220), 0.948 (95% CI = 0.648 to 1.248), and 1.014 (95% CI = 0.636 to 1.391), respectively. IT was more effective than S for MEP (g = 0.582, 95% CI = 0.091 to 1.072) and more effective than CT for MIP (g = 0.934, 95% CI = 0.576 to 1.293). PEF analysis revealed that CIET was more effective than GBAT (g = −1.215, 95% CI = −2.035 to −0.395). Conclusions and Relevance: CIET or IT may improve respiratory function in patients with stroke more effectively than uniformly applied GBAT or CT. CIET and IT are effective regardless of age or intervention duration. Cardiopulmonary training is encouraged during the chronic phase of stroke to improve respiratory muscle strength, with at least 6 weeks of training recommended.