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Stroke affects respiratory functions by causing structural and strength impairments in both inspiratory and expiratory respiratory muscles. Weakening of the diaphragm leads to a decrease in maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which may result in respiratory insufficiency, postural instability, and urinary incontinence (UI). Additionally, post-stroke reduction in diaphragmatic mobility and decreased activity of the diaphragm and abdominal muscles on the paretic side may disrupt the piston mechanism between the diaphragm and pelvic floor muscles. These mechanical changes may trigger the development of urinary incontinence. This study aims to investigate the relationship between diaphragm muscle strength and endurance and urinary incontinence in 50 stroke patients. In addition, diaphragmatic function and posture-related respiratory changes will be evaluated using functional tests based on the Dynamic Neuromuscular Stabilization (DNS) approach. The relationship between respiratory muscle strength (MIP, MEP) and endurance and the scores of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) will be analyzed. Furthermore, individuals with and without urinary incontinence symptoms will be evaluated in terms of diaphragmatic function and contribution to respiration.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stroke Patients | 50 individuals diagnosed with stroke will undergo assessments of diaphragmatic function, respiratory muscle strength and endurance, and urinary incontinence. |
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| Measure | Description | Time Frame |
|---|---|---|
| Diaphragm Muscle Function | Diaphragm muscle function will be assessed using the Dynamic Neuromuscular Stabilization (DNS) approach. The evaluation consists of three components: (1) the diaphragm's contribution to respiration, (2) its role in postural stabilization, and (3) active respiration during postural stabilization. Each component will be rated separately using a 4-point scale: none (3), mild (2), moderate (1), and severe (0). Higher total scores reflect greater impairment in diaphragm-related respiratory function. | Baseline (single assessment) |
| Urogenital Distress Inventory (UDI-6) | The Urogenital Distress Inventory (UDI-6) consists of 6 items and is rated on a four-point Likert scale. The total score ranges from 0 to 18, with higher scores indicating greater symptom distress and a more impaired quality of life. | Baseline (single assessment) |
| Incontinence Impact Questionnaire (IIQ-7) | The Incontinence Impact Questionnaire (IIQ-7) consists of 7 items and is rated on a four-point Likert scale. The total score ranges from 0 to 21, with lower scores indicating less impact on quality of life. | Baseline (single assessment) |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory Muscle Strength | Respiratory muscle strength will be assessed using a portable device capable of measuring maximal inspiratory (MIP) and expiratory (MEP) mouth pressures electronically (MicroRPM, Micro Medical, Kent, UK). Measurements will be conducted with the participant in a seated position, wearing a nose clip to prevent air leakage. For MIP, the participant will perform a maximal exhalation followed by a maximal inhalation against an occluded airway for at least 1.5 seconds. For MEP, a maximal inhalation will be followed by a maximal exhalation under the same conditions. Each measurement will be repeated three times with less than 10% variability, and the highest value will be used for analysis. |
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Inclusion Criteria:
Exclusion Criteria:
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Bahçelievler Medical Park Hospital
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Özge Çakmak, MSc | Contact | +905359463069 | ozgeckmakk@gmail.com | |
| Yunus Emre Tütüneken | Contact | +905435912455 | yunus.tutuneken@istinye.edu.tr |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31844133 | Background | Zachovajeviene B, Siupsinskas L, Zachovajevas P, Venclovas Z, Milonas D. Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial. Sci Rep. 2019 Dec 16;9(1):19192. doi: 10.1038/s41598-019-55724-4. | |
| 32826013 | Background | Kobesova A, Davidek P, Morris CE, Andel R, Maxwell M, Oplatkova L, Safarova M, Kumagai K, Kolar P. Functional postural-stabilization tests according to Dynamic Neuromuscular Stabilization approach: Proposal of novel examination protocol. J Bodyw Mov Ther. 2020 Jul;24(3):84-95. doi: 10.1016/j.jbmt.2020.01.009. Epub 2020 Feb 8. |
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The study will share de-identified, summary-level outcome data, including group-level means, standard deviations, effect sizes, and p-values derived from statistical analyses. These data will be provided to support transparency and allow for interpretation of the study findings.
Summary-level data and supporting documents (e.g., study protocol and statistical analysis plan) will be available within 12 months following the final publication of study results and will remain accessible for at least 5 years via institutional repository or upon reasonable request.
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D014549 | Urinary Incontinence |
| D053120 | Respiratory Aspiration |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Baseline (single assessment) |
| Respiratory Muscle Endurance | Respiratory muscle endurance will be assessed using a threshold loading test with the PowerBreathe device (HaB International Ltd., Southam, UK). The test will begin at 20% of the participant's maximal inspiratory pressure (MIP) and will be increased in two-minute intervals to 40%, 60%, 80%, and finally 100% of MIP. During the test, the device will be placed in the participant's mouth and a nose clip will be used to prevent nasal breathing. Participants will be instructed to breathe through the mouth for 10 minutes. Oxygen saturation and perceived dyspnea will be measured before the test, at the end of each two-minute stage, and after the test. Test results will be calculated by multiplying the total test duration by the corresponding pressure level at each stage. | Baseline (single assessment) |
| 41704224 | Derived | Tutuneken YE, Cakmak O, Demir B, Yildirim SY, Anlar E, Ozkul ME. Relationship between diaphragmatic muscle function and urinary incontinence in individuals with stroke: a prospective observational study. Top Stroke Rehabil. 2026 Feb 18:1-10. doi: 10.1080/10749357.2026.2634288. Online ahead of print. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D014555 | Urination Disorders |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D059411 | Lower Urinary Tract Symptoms |
| D020924 | Urological Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D010335 | Pathologic Processes |