Characteristics of respiratory rehabilitation programs for people with Parkinson’s disease: a scoping review

The objective of this review was to map the characteristics of respiratory rehabilitation programs for people with Parkinson's disease. Parkinson's disease is a progressive and heterogeneous neurodegenerative disease. Respiratory dysfunction is highly prevalent in people with Parkinson's disease and is a major contributor to morbidity and mortality. People with Parkinson's disease may experience respiratory dysfunction such as ineffective coughing and dyspnea. Complications, such as atelectasis and respiratory infections, significantly impact their self-care and quality of life. To mitigate its impact on people's lives, various respiratory rehabilitation programs have been developed and implemented. Many studies have examined this topic, yet respiratory rehabilitation programs vary significantly in structure and evaluated outcomes. We considered for inclusion studies focused on respiratory rehabilitation programs implemented to prevent or target one or more symptoms for adults (18 years and older) with Parkinson's disease, regardless of the disease stage. The programs could be provided by any health professional in any health care setting. We conducted a scoping review following JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Published and unpublished literature were considered for inclusion. A literature search was conducted across PubMed, CINAHL Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (EBSCOhost), the Cochrane Database of Systematic Reviews (EBSCOhost), Scielo, Scopus, PEDro, and ClinicalTrials.gov. Unpublished studies were identified via Google Scholar, DART-Europe, and MedNar. All search strategies were conducted on April 24, 2023. Sources published in English, Spanish, and Portuguese were included and no date restrictions were applied. Study selection and data extraction, were conducted independently by 2 reviewers using a standardized extraction tool. Thirty-three studies published between 2001 and 2023 were included. Studies were conducted in USA, Brazil, Turkey, Chile, Australia, Taiwan, Czechia, Italy, Republic of Korea, Germany, India, and Israel. The sample sizes ranged from 1 participant to 75 participants. The combined sample size of all studies totals 1007 participants. Most programs integrate respiratory muscle strength training using devices, targeting people with Parkinson´s disease in Hoehn and Yahr scale stages I-III. Speech-language pathologists, physiotherapists, and medical doctors were the health professionals responsible for delivering these programs in home-based or clinical settings. A broad spectrum of outcomes related to respiratory function was reported. Additionally, the studies assessed other outcomes such as quality of life, functional capacity, motor symptoms, and fatigue. Respiratory rehabilitation programs for people with Parkinson's disease have predominantly targeted respiratory muscle strength training, without a multidisciplinary approach. More research emphasizing inclusive studies in terms of exercises/interventions in respiratory rehabilitation programs, stages of disease progression, and with the adoption of multidisciplinary approach is needed. Open Science Framework https://osf.io/hgajt.