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This study is designed to explore the effects of a 4-week protocol of inspiratory muscle training (IMT) at 50% maximum inspiratory pressure (MIP) on respiratory function, diaphragm thickness, balance control, exercise capacity, and quality of life in people after stroke. To ascertain the effect of IMT on the relationship between diaphragm muscle contraction and activation of other trunk muscles, this study also explores whether any effect of the 4-week IMT protocol on balance control is associated with changes in the anticipatory posture adjustments (APAs) time - the onset time of postural muscles during a required task (e.g., the rapid shoulder flexion test).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A (sham IMT- stable group) | Sham Comparator | conventional treatment + sham IMT |
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| Group B (IMT-stable group) | Experimental | conventional treatment + target IMT while sitting on a stable surface |
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| Group C (IMT-unstable group) | Experimental | conventional treatment + target IMT while sitting on an unstable surface |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| sham IMT | Other | with 10% maximum inspiratory pressure (MIP) as the training intensity, IMT will be conducted on a stable surface |
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| Measure | Description | Time Frame |
|---|---|---|
| Diaphragmatic thickness | The diaphragmatic thickness of both the left and right diaphragms will be measured by ultrasound. (Mindray M9, Shenzhen, China). | baseline, after 4 weeks of intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Inspiratory Pressure (MIP) | Maximum Inspiratory Pressure (MIP) is a measure used in pulmonary function testing to assess the strength of the respiratory muscles, particularly the muscles used for inhalation. It will be measured using the spirometer. | baseline, after 4 weeks of intervention |
| Forced Vital Capacity (FVC) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Fang LIU | Contact | +86 13603049475 | s1350035@live.hkmu.edu.hk | |
| William Wai-nam Tsang | Contact | 085239708703 | wntsang@hkmu.edu.hk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shenzhen Second People's Hospital | Recruiting | Shenzhen | None Selected | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41423385 | Derived | Liu F, Jones AY, Tsang RC, Yam TT, Tsang WW. Inspiratory muscle training with balance challenge improves diaphragmatic thickness, respiratory function, balance, exercise capacity and quality of life in people after stroke: a randomised trial. J Physiother. 2026 Jan;72(1):42-52. doi: 10.1016/j.jphys.2025.12.004. Epub 2025 Dec 20. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Feb 19, 2025 | Feb 20, 2025 | Prot_SAP_002.pdf |
| ICF | No | No | Yes | Informed Consent Form | Feb 19, 2025 | Feb 20, 2025 | ICF_003.pdf |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| IMT-stable group (sitting on a stable surface) | Other | 50% MIP as the training intensity, IMT will be conducted while sitting on a stable surface |
|
| IMT-unstable group (sitting on an unstable surface) | Other | 50% MIP as the training intensity, IMT will be conducted while sitting on an unstable surface |
|
| Conventional treatment | Other | Participants in all groups will receive a standardised conventional rehabilitation protocol. It includes limb range of motion, muscle tone reduction, strengthening and endurance of limb muscles, transfer skills, task-directed movements, general gait training, and activities of daily living training. |
|
Forced Vital Capacity (FVC) is a measurement used in pulmonary function tests to assess lung function. It refers to the total volume of air that a person can forcibly exhale from their lungs after taking the deepest breath possible. It will be measured using the spirometer. |
| baseline, after 4 weeks of intervention |
| Forced Expiratory Volume in one second (FEV1) | Forced Expiratory Volume in one second (FEV1) measures the volume of air a person can forcibly exhale in the first second of a forced breath. It will be measured using the spirometer. | baseline, after 4 weeks of intervention |
| Sitting Balance | A force plate will be used to measure changes in the center of pressure during the performance of various tasks in sitting positions. | baseline, after 4 weeks of intervention |
| Trunk Impairment Scale (TIS) | The TIS is a rating scale used to measure static sitting balance, dynamic sitting balance, and trunk coordination. The total TIS score ranges from 0 to 23 points, with a higher score indicating better trunk function. | baseline, after 4 weeks of intervention, 12-week follow-up after the end of intervention |
| Timed Up and Go Test (TUG) | TUG is a test to measure the time that a participant needs to stand up from a standard armchair, walk a short distance of about 3 meters, turn around, walk back to the chair, and sit down again. | baseline, after 4 weeks of intervention, 12-week follow-up after the end of intervention |
| Falls efficacy scale international | The Falls Efficacy Scale-International (FES-I) is a questionnaire measuring fear of falling in older adults. It has 16 items, scored from 1 to 4, with higher scores indicating greater fear. It's used in clinical settings to assess fall risk and tailor interventions. | baseline, after 4 weeks of intervention, 12-week follow-up after the end of intervention |
| 6-Minute Walk Test | The 6-Minute Walk Test (6MWT) measures how far someone can walk in six minutes. It assesses exercise capacity and mobility. | baseline, after 4 weeks of intervention |
| Stroke Impact Scale | The Chinese version of the Stroke Impact Scale 3.0 (SIS) will be used to measure the quality of life. A higher overall score suggests better physical, emotional, and social functioning, while a lower score may indicate more significant impairment or limitations. | baseline, after 4 weeks of intervention, 12-week follow-up after the end of intervention |
| Trunk muscle activity | Surface electromyography (sEMG) (Noraxon USA, Inc., Scottsdale, AZ, USA) will be used to measure the bilateral muscle activity of the erector spinae, rectus abdominis, external oblique muscle, internal oblique muscle, and transversus abdominis during sitting balance tests on the force plate. | baseline, after 4 weeks of intervention |
| Anticipatory posture adjustments (APAs) time of trunk muscles | Participants will be requested to perform a rapid shoulder flexion test on the force plate. Surface electromyography (sEMG) (Noraxon USA, Inc., Scottsdale, AZ, USA) will be used to measure Anticipatory posture adjustments (APAs) time of trunk muscles. | baseline, after 4 weeks of intervention |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |