Article

Respiratory disorders in multiple sclerosis (MS) are an important
issue. They can occur early during the course of the disease, are associated with
the neurological impairment,
and can lead to pneumonia and respiratory failure,
which are the main causes of death in advanced MS.
Prevailing impaired expiratory
muscles and cough abilities has been demonstrated in this population and might
constitute a specific target for rehabilitation interventions. However,
international guidelines lack recommendations regarding respiratory
rehabilitation in MS. Here we performed a systematic review of the published
literature related to respiratory rehabilitation in MS. METHODS: We searched the
databases MEDLINE via PubMed, PEDro and Cochrane Library for English or French
reports of clinical trials and well-designed cohorts published up to December
2016 with no restriction on start date by using the search terms "multiple
sclerosis", "respiratory rehabilitation", "respiratory muscle training", "lung
volume recruitment", "cough assistance", and "mechanical in-exsufflation".
Literature reviews, case reports and physiological studies were excluded. The
Maastricht criteria were used to assess the quality of clinical trials. We
followed the Oxford Centre for Evidence-Based Medicine guidelines to determine
level of evidence and grade of recommendations. RESULTS: Among the 21 reports of
studies initially selected, 11 were retained for review. Seven studies were
randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational
studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a
portable resistive mouthpiece was the most frequently evaluated technique, with 2
level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All
reviewed studies evaluated home-based rehabilitation programs and focused on
spirometric outcomes. The disparities in outcome measures among published studies
did not allow for a meta-analysis and cough assistance devices were not evaluated
in this population. CONCLUSION: Although respiratory muscle training can improve
maximal respiratory pressure in MS and lung volume recruitment can slow the
decline in vital capacity, evidence is lacking to recommend specific respiratory
rehabilitation programs adapted to the level of disability induced by the disease.
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Langue : ANGLAIS