Facultad de Económicas y CC Empresariales

Background: Previous reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poorquality studies (PEDro score ≤4). Objectives: With this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and mediumterm in post-stroke. Methods: Databases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool. Results: Nine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27 −1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17−1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71−1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43 −1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03−1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term. Conclusions: The meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone.

To develop a mapping and umbrella review with a meta-meta-analysis (MMA) to critically evaluate the current evidence of motor imagery (MI), action observation and mirror therapy (MT) on pain intensity. The study involved a systematic search of PubMed, PEDro, Scielo, EBSCO and Google Scholar. Ten systematic reviews were included in the qualitative synthesis, 70% of which showed high methodological quality. Three reviews found a significant reduction in chronic musculoskeletal pain as the result of applying movement representation methods (MRM) plus usual-care (UC), with a large clinical effect (standardized mean difference [SMD] of −1.47; 95% CI −2.05 to −0.88; heterogeneity Q = 1.66; p = 0.44; I2 = 0%). However, two reviews showed no statistically significant reduction in acute and postsurgical pain as a result of applying MI plus UC. Four reviews showed no significant reduction in phantom limb pain (PLP) as a result of applying MT plus UC interventions. In four reviews, the MMA showed a significant reduction in complex regional pain syndrome (CRPS) as a result of applying MT plus UC, with a large clinical effect (SMD −1.27; 95% CI −1.87 to −0.67; heterogeneity Q = 3.95; p = 0.27; I2 = 24%). In two reviews, the MMA showed no significant differences in poststroke pain as a result of applying MT plus UC. Results show that MRM could be effective for chronic musculoskeletal pain, with low to moderate-quality evidence. The results also show a reduction in pain intensity through MT interventions in patients with CRPS, although these results were not found in patients with PLP or poststroke pain. This umbrella review analysed systematic reviews evaluating movement representation techniques, with the aim of synthesizing the available evidence regarding motor imagery, action observation and mirror therapy on pain. The results provide relevant information about the potential clinical use of movement representation techniques in different types of patients with painful conditions.

To assess the effects of aerobic exercise (AE) on patients with migraine in terms of pain intensity, frequency and duration of migraine, and quality of life. A systematic review and meta-analysis of randomized controlled trials were conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. A total of 10 articles from 1950 to 2019 were included, involving 508 patients. The meta-analysis showed statistically significant differences in the decrease in pain intensity (five studies, n = 166; SMD = 1.25; 95% CI 0.47-2.04), frequency (six studies, n = 214; SMD = 0.76; 95% CI 0.32-1.2) and duration of migraine (four studies, n = 106; SMD = 0.41; 95% CI 0.03-0.8), in the short-term. In addition, the meta-analysis showed statistically significant differences in the increase in quality of life (four studies, n = 150; SMD = 2.7; 95% CI 1.17-4.24), even though the Egger's test suggested significant evidence of publication bias for the analysis of quality of life (intercept = 5.81; t = 6.97; P = .02). There is low- and moderate-quality evidence that in patients with migraine AE can decrease the pain intensity, frequency and duration of migraine and can also increase quality of life.