Assessing the Reliability of the Dynamic-Index of Inspiratory Muscle Strength in Cardiac Surgery Candidates
-
Bahareh Mehregan Far
,
Sedigheh Sadat Naimi
,
Seyed Ahmad Raeissadat
,
Mohsen Abedi
,
Parsa Salemi
,
Mahmood Beheshti Monfared
,
Alireza Akbarzadeh Baghban
,
Hasan Shamsi
Abstract
Background: The inspiratory muscle strength is one of the important predictors in development of pulmonary complications after cardiac surgery. The Strength-Index (S-index), a novel non-invasive tool, dynamically assesses inspiratory muscles, which is associated with lower risks for heart patients than static tests. This study aims to investigate the reliability of the S-Index in patients preparing for cardiac surgery.
Methods: This study involved 20 preoperative cardiac surgery candidates (11 males, 9 females, mean age 56 ± 13 years). The S-Index, peak inspiratory flow (PIF), and vital capacity (VC) were evaluated using the Power Breath K5 - electronic respiratory device. These measurements were conducted by an examiner at two distinct intervals, spaced one hour apart. The average and best values for each index were evaluated for reliability using the Intra-class Correlation Coefficient (ICC).
Results: the study revealed excellent (ICC>.9) and good (ICC>.8) intra-examiner reliability, respectively for the best and average values of the S-index and PIF. Also the results of the present study showed excellent intra-examiner reliability for the best and average values of the VC (ICC>.9).
Conclusion: The ICC results of the present study showed that the S-index can be used to determine the dynamic strength of the inspiratory muscles with an Acceptable repeatability in cardiac surgery candidates. One of its advantages could be determining the appropriate load in inspiratory muscle training (IMT) exercises, during the hospitalization phase of these patients in a dynamic manner without breath holding.
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6. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scandinavian cardiovascular journal. 2011;45(5):286-93.
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9. Fortes JVS, Borges MGB, Marques MJdS, Oliveira RL, Rocha LRd, Castro ÉMd, et al. Effects of Inspiratory Muscle Training Using an Electronic Device on Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial. International Journal of Cardiovascular Sciences. 2020;34:44-52.
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12. Silva PE, de Carvalho KL, Frazão M, Maldaner V, Daniel CR, Gomes-Neto M. Assessment of maximum dynamic inspiratory pressure. Respiratory care. 2018;63(10):1231-8.
13. Scharf SM, Woods BOb, Brown R, Parisi A, Miller MM, Tow DE. Effects of the Mueller maneuver on global and regional left ventricular function in angina pectoris with or without previous myocardial infarction. The American journal of cardiology. 1987;59(15):1305-9.
14. Polkey M, Green M, Moxham J. Measurement of respiratory muscle strength. Thorax. 1995;50(11):1131.
15. Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, et al. Comparison of New York Heart Association class and patient-reported outcomes for heart failure with reduced ejection fraction. JAMA cardiology. 2021;6(5):522-31.
16. Zanini M, Nery RM, de Lima JB, Buhler RP, da Silveira AD, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a randomized clinical trial. Journal of cardiopulmonary rehabilitation and prevention. 2019;39(6):E19-E25.
17. Far BM, Naimi SS, Abedi M, Raeissadat SA, Monfared MB, Baghban AA. Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates. Journal of Modern Rehabilitation. 2024.
18. Cordeiro ALL, Melo TAd, Neves D, Luna J, Esquivel MS, Guimarães ARF, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Brazilian journal of cardiovascular surgery. 2016;31(2):140-4.
19. Mehregan-Far B, Naimi SS, Abedi M, Salemi P, Raeis-Sadat SA, Beheshti-Monfared M. The impact of threshold-loaded inspiratory muscle training and respiratory biofeedback on preserving inspiratory muscle strength and vital capacity after CABG: a randomized clinical trial. American Journal of Cardiovascular Disease. 2024;14(6):375.
20. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.
21. Bland JM, Altman DG, Warner DS. Agreed statistics: measurement method comparison. The Journal of the American Society of Anesthesiologists. 2012;116(1):182-5.
22. Sedgwick P. Limits of agreement (Bland-Altman method). Bmj. 2013;346.
23. Pilannejad S, Naimi SS, Okhovatian F, Attarbashi Moghadam B, Jamalian SA, Akbarzadeh Bagheban A. Effect of the first phase of cardiac rehabilitation on quality of life and functional capacity of patients with heart failure. Scientific Journal of Rehabilitation Medicine. 2017;6(2):82-90.
24. Rahbar S, Naimi SS, Soltani AR, Rahimi A, Baghban AA. Are twenty-four sessions of aerobic exercise sufficient for improving cardiac parameters in diabetes mellitus? A randomized controlled trial. The Journal of Tehran University Heart Center. 2018;13(2):43.
25. Yáñez-Sepúlveda R, Verdugo-Marchese H, Duclos-Bastías D, Tuesta M, Alvear-Ordenes I. Effects of Inspiratory Muscle Training on Muscle Oxygenation during Vascular Occlusion Testing in Trained Healthy Adult Males. International Journal of Environmental Research and Public Health. 2022;19(24):16766.
26. Cordeiro ALL, De Carvalho BSC, Da Silva EG, Santos NDS, de Melo TA, Guimarães ARF, et al. Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial. Journal of Clinical and Translational Research. 2022;8(4):266.
27. de Aquino TN, de Faria Rosseto S, Lucio Vaz J, de Faria Cordeiro Alves C, Vidigal FdC, Galdino G. Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization. Journal of Cardiac Surgery. 2021;36(9):3166-73.
28. Mirenayat MS, Moradkhani A, Abedi M, Abedini A, Zahiri R, Karimzadeh S, et al. Role of Inspiratory Muscle Training on Pulmonary Rehabilitation in Patients with COVID-19: A Pilot Study. Tanaffos. 2022;21(4):466.
29. da Silva FM, Cipriano Jr G, Lima AC, Andrade JM, Nakano EY, Chiappa GR, et al. Maximal dynamic inspiratory pressure evaluation in heart failure: a comprehensive reliability and agreement study. Physical therapy. 2020;100(12):2246-53.
30. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Medicine and science in sports and exercise. 2003;35(2):237-44.
31. Manifield J, Chynkiamis N, Alexiou C, Megaritis D, Hume E, Barry G, et al. Acute thoracoabdominal and hemodynamic responses to tapered flow resistive loading in healthy adults. Respiratory Physiology & Neurobiology. 2021;286:103617.
32. Cordeiro ALL, Melo TAd, Neves D, Luna J, Esquivel MS, Guimarães ARF, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Brazilian journal of cardiovascular surgery. 2016;31:140-4.
33. Matheus GB, Dragosavac D, Trevisan P, Costa CEd, Lopes MM, Ribeiro GCdA. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Brazilian Journal of Cardiovascular Surgery. 2012;27:362-9.
34. Brown PI, Johnson MA, Sharpe GR. Determinants of inspiratory muscle strength in healthy humans. Respiratory physiology & neurobiology. 2014;196:50-5.
35. Roldán A, Forte A, Monteagudo P, Cordellat A, Monferrer-Marín J, Blasco-Lafarga C. Determinants of dynamic inspiratory muscle strength in healthy trained elderly. Postgraduate medicine. 2021;133(7):807-16.
36. Walterspacher S, Pietsch F, Walker DJ, Roecker K, Kabitz H-J. Activation of respiratory muscles during respiratory muscle training. Respiratory physiology & neurobiology. 2018;247:126-32.
2. Weissman C, editor Pulmonary complications after cardiac surgery. Seminars in cardiothoracic and vascular anesthesia; 2004: Westminster Publications, Inc. 708 Glen Cove Avenue, Glen Head, NY 11545, USA.
3. Miskovic A, Lumb A. Postoperative pulmonary complications. BJA: British Journal of Anaesthesia. 2017;118(3):317-34.
4. Siafakas N, Mitrouska I, Bouros D, Georgopoulos D. Surgery and the respiratory muscles. Thorax. 1999;54(5):458-65.
5. Cargnin C, Karsten M, da Costa Guaragna JCV, Dal Lago P. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: a randomized controlled trial. Journal of cardiopulmonary rehabilitation and prevention. 2019;39(5):E1-E7.
6. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scandinavian cardiovascular journal. 2011;45(5):286-93.
7. Karanfil ET, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery–a systematic review. Dan Med J. 2018;65(3):A5450.
8. Dsouza FV, Amaravadi SK, Samuel SR, Raghavan H, Ravishankar N. Effectiveness of inspiratory muscle training on respiratory muscle strength in patients undergoing cardiac surgeries: a systematic review with meta-analysis. Annals of Rehabilitation Medicine. 2021;45(4):264-73.
9. Fortes JVS, Borges MGB, Marques MJdS, Oliveira RL, Rocha LRd, Castro ÉMd, et al. Effects of Inspiratory Muscle Training Using an Electronic Device on Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial. International Journal of Cardiovascular Sciences. 2020;34:44-52.
10. Lee K-B, Kim M-K, Jeong J-R, Lee W-H. Reliability of an electronic inspiratory loading device for assessing pulmonary function in post-stroke patients. Medical science monitor: international medical journal of experimental and clinical research. 2016;22:191.
11. Areias GdS, Santiago LR, Teixeira DS, Reis MS. Concurrent validity of the static and dynamic measures of inspiratory muscle strength: comparison between maximal inspiratory pressure and s-index. Brazilian journal of cardiovascular surgery. 2020;35(4):459-64.
12. Silva PE, de Carvalho KL, Frazão M, Maldaner V, Daniel CR, Gomes-Neto M. Assessment of maximum dynamic inspiratory pressure. Respiratory care. 2018;63(10):1231-8.
13. Scharf SM, Woods BOb, Brown R, Parisi A, Miller MM, Tow DE. Effects of the Mueller maneuver on global and regional left ventricular function in angina pectoris with or without previous myocardial infarction. The American journal of cardiology. 1987;59(15):1305-9.
14. Polkey M, Green M, Moxham J. Measurement of respiratory muscle strength. Thorax. 1995;50(11):1131.
15. Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, et al. Comparison of New York Heart Association class and patient-reported outcomes for heart failure with reduced ejection fraction. JAMA cardiology. 2021;6(5):522-31.
16. Zanini M, Nery RM, de Lima JB, Buhler RP, da Silveira AD, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: a randomized clinical trial. Journal of cardiopulmonary rehabilitation and prevention. 2019;39(6):E19-E25.
17. Far BM, Naimi SS, Abedi M, Raeissadat SA, Monfared MB, Baghban AA. Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates. Journal of Modern Rehabilitation. 2024.
18. Cordeiro ALL, Melo TAd, Neves D, Luna J, Esquivel MS, Guimarães ARF, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Brazilian journal of cardiovascular surgery. 2016;31(2):140-4.
19. Mehregan-Far B, Naimi SS, Abedi M, Salemi P, Raeis-Sadat SA, Beheshti-Monfared M. The impact of threshold-loaded inspiratory muscle training and respiratory biofeedback on preserving inspiratory muscle strength and vital capacity after CABG: a randomized clinical trial. American Journal of Cardiovascular Disease. 2024;14(6):375.
20. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.
21. Bland JM, Altman DG, Warner DS. Agreed statistics: measurement method comparison. The Journal of the American Society of Anesthesiologists. 2012;116(1):182-5.
22. Sedgwick P. Limits of agreement (Bland-Altman method). Bmj. 2013;346.
23. Pilannejad S, Naimi SS, Okhovatian F, Attarbashi Moghadam B, Jamalian SA, Akbarzadeh Bagheban A. Effect of the first phase of cardiac rehabilitation on quality of life and functional capacity of patients with heart failure. Scientific Journal of Rehabilitation Medicine. 2017;6(2):82-90.
24. Rahbar S, Naimi SS, Soltani AR, Rahimi A, Baghban AA. Are twenty-four sessions of aerobic exercise sufficient for improving cardiac parameters in diabetes mellitus? A randomized controlled trial. The Journal of Tehran University Heart Center. 2018;13(2):43.
25. Yáñez-Sepúlveda R, Verdugo-Marchese H, Duclos-Bastías D, Tuesta M, Alvear-Ordenes I. Effects of Inspiratory Muscle Training on Muscle Oxygenation during Vascular Occlusion Testing in Trained Healthy Adult Males. International Journal of Environmental Research and Public Health. 2022;19(24):16766.
26. Cordeiro ALL, De Carvalho BSC, Da Silva EG, Santos NDS, de Melo TA, Guimarães ARF, et al. Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial. Journal of Clinical and Translational Research. 2022;8(4):266.
27. de Aquino TN, de Faria Rosseto S, Lucio Vaz J, de Faria Cordeiro Alves C, Vidigal FdC, Galdino G. Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization. Journal of Cardiac Surgery. 2021;36(9):3166-73.
28. Mirenayat MS, Moradkhani A, Abedi M, Abedini A, Zahiri R, Karimzadeh S, et al. Role of Inspiratory Muscle Training on Pulmonary Rehabilitation in Patients with COVID-19: A Pilot Study. Tanaffos. 2022;21(4):466.
29. da Silva FM, Cipriano Jr G, Lima AC, Andrade JM, Nakano EY, Chiappa GR, et al. Maximal dynamic inspiratory pressure evaluation in heart failure: a comprehensive reliability and agreement study. Physical therapy. 2020;100(12):2246-53.
30. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Medicine and science in sports and exercise. 2003;35(2):237-44.
31. Manifield J, Chynkiamis N, Alexiou C, Megaritis D, Hume E, Barry G, et al. Acute thoracoabdominal and hemodynamic responses to tapered flow resistive loading in healthy adults. Respiratory Physiology & Neurobiology. 2021;286:103617.
32. Cordeiro ALL, Melo TAd, Neves D, Luna J, Esquivel MS, Guimarães ARF, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Brazilian journal of cardiovascular surgery. 2016;31:140-4.
33. Matheus GB, Dragosavac D, Trevisan P, Costa CEd, Lopes MM, Ribeiro GCdA. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Brazilian Journal of Cardiovascular Surgery. 2012;27:362-9.
34. Brown PI, Johnson MA, Sharpe GR. Determinants of inspiratory muscle strength in healthy humans. Respiratory physiology & neurobiology. 2014;196:50-5.
35. Roldán A, Forte A, Monteagudo P, Cordellat A, Monferrer-Marín J, Blasco-Lafarga C. Determinants of dynamic inspiratory muscle strength in healthy trained elderly. Postgraduate medicine. 2021;133(7):807-16.
36. Walterspacher S, Pietsch F, Walker DJ, Roecker K, Kabitz H-J. Activation of respiratory muscles during respiratory muscle training. Respiratory physiology & neurobiology. 2018;247:126-32.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Dynamic inspiratory strength Heart surgery Reliability | ||
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How to Cite
1.
Mehregan Far B, Naimi SS, Raeissadat SA, Abedi M, Salemi P, Beheshti Monfared M, Akbarzadeh Baghban A, Shamsi H. Assessing the Reliability of the Dynamic-Index of Inspiratory Muscle Strength in Cardiac Surgery Candidates. jmr. 2025;(-).
