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Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients with Neurological Diseases

A meta-analysis

Wang, Zhuo PhD student1; Wang, Zhi MD2; Fang, Qi PhD. Doctoral supervisor, Professor2; Li, Huiling PhD. Doctoral supervisor, Professor3; Zhang, Lulu Master2; Liu, Xueyun Master2

American Journal of Physical Medicine & Rehabilitation: June 6, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001242
Research Article: PDF Only

Objective The aim of this review is to evaluate and summarize the results of published studies exploring the effects of expiratory muscle strength training (EMST) on swallowing and cough functions in patients with neurological diseases.

Data sources Embase, PubMed, and the Cochrane Library.

Review methods Randomized controlled trials or pretest/posttest studies of adults with neurological diseases were included. The data included basic population characteristics, penetration-aspiration scores (PAS), peak expiratory flow rate (PEFR), cough volume acceleration (CVA) and maximum expiratory pressure (PEMax).

Results Ten studies were included in this meta-analysis. Compared with the control groups, EMST in patients with neurological diseases significantly reduced the PAS (risk ratio (RR)=-0.94, 95% confidence interval (CI), 1.27–-0.61, P<0.01) but did not increase the voluntary cough PEFR (RR=0.57, 95% CI, 0.62–1.77, P=0.35), CVA (RR=33.87, 95% CI, 57.11–124.85, P=0.47) or PEMax (RR=14.78, 95% CI, 16.98–46.54, P=0.36).

Conclusion EMST might improve swallowing function in patients with neurological diseases. However, conclusive evidence supporting the use of this approach in isolation for improving cough function is unavailable. Additional multicenter, randomized clinical trials performed using reliable and valid cough function outcome measures are required to explore the effects of EMST on cough function.

1School of Nursing, Soochow University; The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

2Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

3School of Nursing, Medical College of Soochow University, Suzhou, Jiangsu, China.

Correspondence: Qi Fang. Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. Tel:+86-13606213892. E-mail:; Huiling Li, The First Affiliated Hospital of Soochow University/School of Nursing, Soochow University, No. 188 Shizi Street, Suzhou, China. Tel: +86-512-65221437

Author Disclosures: The authors read and approved the final manuscript and declare that there was no conflict of interest. This work was funded by Postgraduate Research & Practice Innovation Program of Jiangsu Province; Integrated Care Model For Patients With Dysphagia After Stroke [grant number KYCX18_254], and National Key Research And Development Program of China [grant number 2017YFC0114302]

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