Feasibility of inspiratory muscle training for patients with persistent dyspnoea after COVID-19 infection: A pilot study

Romain Collet; Maarten van Egmond; Marike van der Schaaf; Mel Major

doi:10.2340/jrmcc.v6.6507

Authors

Romain Collet Faculty of Health, Department of Physical Therapy, Amsterdam University of Applied Sciences
Maarten van Egmond Faculty of Health, Department of Physical Therapy, Amsterdam University of Applied Sciences; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences; Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences
Marike van der Schaaf Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences; Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef; Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, The Netherlands
Mel Major Faculty of Health, Department of Physical Therapy, Amsterdam University of Applied Sciences; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences

DOI:

https://doi.org/10.2340/jrmcc.v6.6507

Keywords:

COVID-19, Dyspnea, Maximal Respiratory Pressures, Physical Therapy Modalities

Abstract

Objective: This study investigates the feasibility of delivering inspiratory muscle training as part of the physical therapy treatment for patients with post-COVID dyspnoea.
Design: Mixed-methods pilot study.
Subjects/patients: Patients with complaints of dyspnoea after COVID-19 infection and their physical therapists.
Methods: The Amsterdam University of Applied Sciences and the Amsterdam University Medical Centers conducted this study. Participants performed daily inspiratory muscle training at home for 6 weeks, consisting of 30 repetitions against a pre-set resistance. The primary outcome was feasibility assessed as acceptability, safety, adherence and patient- and professional experience obtained through diaries and semi-structured interviews. The secondary outcome was maximal inspiratory pressure.
Results: Sixteen patients participated. Nine patients and 2 physical therapists partook in semi-structured interviews. Two patients dropped out before initiating the training. Adherence was 73.7%, and no adverse events occurred. Protocol deviations occurred in 29.7% of the sessions. Maximal inspiratory pressure changed from 84.7% of predicted at baseline to 111.3% at follow-up. Qualitative analysis identified barriers to training: ‘Getting acquainted with the training material’ and ‘Finding the right schedule’. Facilitators were: ‘Support from physical therapists’ and ‘Experiencing improvements’.
Conclusion: Delivering inspiratory muscle training to patients with post-COVID dyspnoea seems feasible. Patients valued the simplicity of the intervention and reported perceived improvements. However, the intervention should be carefully supervised, and training parameters adjusted to individual needs and capacity.

LAY ABSTRACT
Many people who have recovered from a COVID-19 infection develop persistent shortness of breath, fatigue and difficulties with memories, learning new things or making decisions. This condition affects their daily life and is called post-COVID syndrome. Inspiratory muscle training is a technique that aims to help people to breathe more easily by strengthening and improving the coordination of breathing muscles. We undertook this study to determine if performing such training was possible for these patients. We interviewed 2 physiotherapists who provided the training and 9 of their patients. In addition, we looked into the diaries 16 patients kept about their training to learn about their experiences or unexpected (medical) problems they might have had with the training. We found that the training seemed reasonable since patients and their physiotherapists found it simple, and no negative experiences happened. However, patients said it helped if the physiotherapist supervised them during the training.