Management of respiratory problems in people with neurodegenerative conditions: a narrative review

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Jones, Una Frances ; Enright, Stephanie ; Busse, Monica (2012)

Background\ud Respiratory failure and dysfunction are problems common in many neurodegenerative conditions and although physiotherapists manage these problems, it is not known which treatments have been studied and the efficacy of those treatments. \ud Objective\ud The purpose is to review, using the PRISMA approach, evidence related to the management of respiratory problems in people with neurodegenerative conditions in order to provide evidence for physiotherapy practice. \ud Data sources\ud Comprehensive searches were conducted using the following electronic databases from inception to May 2010: HUGEnet, SIGLE, British Library Direct, CINAHL, Medline, AMED, and Web of Knowledge. Bibliographies of all studies and systematic reviews were searched by hand. \ud Study selection\ud Studies were selected based on: self ventilating participants with neurodegenerative conditions; interventions aimed at improving respiratory function; outcomes were any valid and reliable measures of respiratory function. \ud Study appraisal\ud Studies were appraised by one reviewer using the Critical Appraisal Skills Programme. Data was synthesised using a narrative approach.\ud Results\ud Thirty five studies were included in the review. The strongest evidence was for the use of non-invasive ventilation for people with amyotrophic lateral sclerosis, although this was weak. The evidence for the use of respiratory muscle training and methods to increase peak cough flow shows a positive effect, but is also weak.\ud Conclusion\ud There is weak evidence for the positive effects of physiotherapy interventions for respiratory problems in people with neurodegenerative conditions. Further work is necessary in specific neurodegenerative conditions to identify why respiratory problems occur and larger scale studies to investigate management of these problems.
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