title: Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis.
abstract: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision).
  
  
  
  The literature search was made in the electronic databases PubMed®, EBSCO, Web of Science®, PEDro and Scopus®. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed.
  
  
  
  We included 17 randomized controlled trials in the systematic review, of which, 12 were included for the PPC meta-analysis and 11 for the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk Ratio (RR) = 0.50, 95%CI: 0.39, 0.64, I2=0.0%), and a decrease in LOS (Mean Difference = -1.41, 95%CI: -2.07, -0.75, I2= 0.0%).
  
  
  
  IMT is effective to reduce PPC and LOS in patients undergoing surgery. Implications for Rehabilitation Physiotherapy interventions with inspiratory muscle training (IMT) are effective to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS) after major surgery, and should start preoperatively. Rehabilitation with IMT is beneficial at all ages and risk levels, but older and high-risk patients benefit more, as well as pulmonary surgery patients. IMT is more effective if it is supervised, and prescription target at least two-week period, sessions with more than 15 minutes, with imposed load increment, and adding other exercise modes.
authors.affiliation: a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal.|b Polytechnic Health Institute of the North, CESPU, Gandra , Paredes , Portugal.|c Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Kendall
authors.affiliation: c Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Oliveira
authors.affiliation: d EPIUnit - Institute of Public Health , University of Porto , Porto , Portugal.|e Department of Clinical Epidemiology, Predictive Medicine and Public Health , Faculty of Medicine, University of Porto , Porto , Portugal.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Peleteiro
authors.affiliation: a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinho
authors.affiliation: a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal.
authors.forename: Pedro Teixeira
authors.initials: PT
authors.lastname: Bastos
mesh_terms: D000005:Abdomen / Q000601:surgery; D001945:Breathing Exercises; D006801:Humans; D007902:Length of Stay; D053580:Muscle Strength / Q000502:physiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012132:Respiratory Muscles / Q000502:physiology; D019616:Thoracic Surgical Procedures
keywords: Respiratory muscle training; abdominal surgery; cardiac surgery; postoperative outcomes; pulmonary surgery