Talking All Things Cardiopulm
This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences.The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Talking All Things Cardiopulm
Episode 85: Assessing MIP and MEP
Respiratory muscle training is by far one of my favorite interventions and continues to show itself in research. Anytime RMT is added, you can hypothesize that your patient will improve in a number of different categories (gas exchange, respiratory strength, 6MWD, QOL scales, blood pressure, and the list continues). I honestly continue to be impressed by RMT.
But in order to incorporate RMT, you have to have an assessment tool that can show you a true pre-post for respiratory muscle strength. That assessment is MIP (maximal inspiratory pressure) and MEP (maximal expiratory pressure). Join me in this episode as we discuss devices, protocols, predictive equations and normative data, so you can assess MIP and MEP too.
In this episode:
- How to assess MIP and MEP
- Devices available to perform MIP and MEP
- ATS/ERS and SEPAR protocols
- Predictive equations for MIP and MEP
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Resources:
Laveneziana P., Albuquerque A., Aliverti A., et al. Spengler CM, Vogiatzis I, Verges. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019;53 doi: 10.1183/13993003.01214-2018.
· Highly recommend reading the “supplementary material”
Lista-Paz et al. Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness. Arch Bronconeumol. 2023 Dec;59(12):813-820. English, Spanish. doi: 10.1016/j.arbres.2023.08.016. Epub 2023 Sep 29. PMID: 37839949.
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Welcome to Talking All Things Cardiopulm. I am your host, r Rachel Barisi, physical therapist and board-certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring cardiopalm to the forefront of conversation. Thanks for joining me today, and let's get after it. Before we jump into today's episode, let's take a moment to introduce Jane, the clinic management software and EMR that I use in my own practice. Jane has just introduced even more affordable, balanced, practice and thrive pricing plans to offer flexibility, allowing you to easily switch from one plan to another, depending on your current and future needs. There is no long-term commitment either, just simple month-to-month payments that let you focus on running your clinic, and with every plan you get features like one-on-one telehealth, email, appointment reminders and unlimited support. As your clinic evolves, your EMR will evolve with you. Visit janeapp backslash pricing to find a plan that fits your needs, starting at just $39 a month. And when you're ready to get started, use my code cardiopalm1mo at the time of sign-up for a one-month grace period applied to your new account. Thanks again, jane. All right, welcome.
Rachele Burriesci:We are cruising through November. This year is like flying, flying, flying. I'm going to keep saying it. We have spectacular weather today Super cool in the morning, very fall feel, and then we just had some nice 60 degree weather with sun, and I am so happy because it has been super dreary for the last few weeks, so it was just really nice to have some sun and so I sat outside and my face is even a little flush, but totally worth it. Sun is 100% energy boosting for me. I definitely rely on photosynthesis, without a doubt.
Rachele Burriesci:Some updates from the patio. We are done, kind of. We are done with most. I'm going to say we're 95% done. If we had snow tomorrow, we're good. So the only thing we have left is adding palmeric sand in that little section where we had, you know, snow tomorrow. We're good. So the only thing we have left is adding palmeric sand in that little section where we had to do those little tight cuts and then tamping down that area.
Rachele Burriesci:Update since last time I think we really we were doing really good and we were trying to do some work. You know, after a work day, which is getting harder and harder because it's like dark at five o'clock now, but we've got some light systems and so, besides the like motivation to do it, we can get it done. So I decided to do the palmeric sand while Nikki was still at work, so that when she came home all we had to do was the tamping and the machine is a Maxa 2, so there's no way I could have done it on my own and it's a little bit of like a tango with moving the boards on top of the pavers, so it was a little bit of a thing. Anyway, I thought it was really going to save us some time. Get the palmeric sand down, get it all sweeped ready to go, and typically you leave like a little excess on top. The part that I did not consider was the temp change. So it went from, like you know, 65 degrees to almost low 40s and with that comes dew. And I don't know if you know anything about palmeric sand, but it's basically like the adhesive sand that goes between the pavers to like lock them in, kind of turns into semi-cement, not quite as strong, but similar concept. Well, the excess sand on top created concrete on top of the pavers. So you know, the saving time turned into not saving time, literally, after we tamped everything down and got all the excess swept away.
Rachele Burriesci:I want to say like 60% of the pavers still had caked on palmeric sand, so we had to figure out how to get it off. We're like scraping it. It's not really coming off nicely. It looks like a hot mess. We Google thank God for Google. I really don't know what the hell we would have done without it. There was a suggestion for white vinegar, so, ps, white vinegar is like the savior for all of the things and is always on hand. And when I tell you this water soap I actually wasn't supposed to water vinegar mix did the trick. It was still a pain in the ass. We literally had to scrape every single paver, but it looks brand new and there's no like concrete step to every paver. That would have been a complete disaster.
Rachele Burriesci:So we did pretty good and then we just finished up cutting the last of the pavers. And I say we, I mean Nicki and I am the 100% helper here and totally had to use our COVID shields to help protect us against the, you know, dust and such. But she did an awesome job. I am like constantly impressed with her ability to learn a new task and like do something so well, just like precision, precision. So we were almost done and, as per usual, like it doesn't fit perfect, because we're working around, basically a drain box which has an angle, so we're like grinding it down, pulling it out, grinding it down, pulling out. But this one piece was huge and is quite a pain to pull out, in and out, in and out. So, whatever we do one last fit just to make sure we're good, and we went too far, and so now there's a gap and, as per Nikki, it looked like shit. So she was not. She was not going to let it be. I put a poll up on Instagram and I think 75% of you said she wasn't going to be able to live with it, and so the other day we did the last piece. She nailed it. It looks great. Now we just have to fill in that last little bit.
Rachele Burriesci:And expectations understand that when the goal is met, there's always more right, and I think that's how I've always thrived. That's just how I've always been right. You set a goal, you meet that goal, and then something else needs to happen or you perfect it right. Even if you've finished the thing, have met the outcome, you can always improve on it, and so that's what this patio is going to be. There's going to be more improvements to come, but at this point we can call it pretty much done, and if winter started tomorrow, we're in a in a good spot, but still more to come on that. All right, I won't bore you with my DIY.
Rachele Burriesci:What I wanted to talk about today was MIP and MEP. So respiratory muscle training is just one of those things that I have been following in the literature probably since my residency, and I've dabbled in it a little bit in residency and then later on I think I've mentioned it before this was going to be my path of research in academia and then COVID happened. So it's just something that's really been at the forefront of my brain In the literature. Anytime RMT is brought into the mix, the outcomes are always improved. There are so many different diagnoses that it's been used with, and I mean for the most part. It's like why aren't we doing RMT with everyone? So RMT is respiratory muscle training.
Rachele Burriesci:I like to say RMT versus IMT, which is where a lot of the literature exists. Imt is inspiratory muscle training. In my personal opinion, I think it's important to train both inspiratory and expiratory muscles and provide resistance to that breathing training in both inhalation and exhalation, because we use those mechanics for different things, right, especially for things like airway clearance. Exhalation is super important, so you can move into, like, the neuromuscular diagnoses that really have an impact on their expiratory muscle strength and therefore impact on their airway clearance, which can lead to significant decline in independence in one respect can be a lot of times when we start using higher level devices like insufflator, exufflator maybe, requirement for venting and things like that. So, in my opinion, I think assessing and training both inspiration and expiration is important. That's just my opinion. So I was going to lean my research towards RMT both and therefore you're definitely going to assess both. So the way that you kind of start this process is by having some preliminary data, right, and so the data that you want when you're doing RMT is MIP and MEP maximal inspiratory pressure and maximal expiratory pressure.
Rachele Burriesci:I wanted to go into this a little bit more in detail than a previous podcast I did on RMT because it's important, right. It's kind of a starting thing and the protocols that exist, the instructions that are given, aren't clear cut. There is some advice from American Thoracic Society, as well as ERS, european Respiratory Society, and that is very helpful. Their last update was in 2019. The one before that was 2002. This on my own, with my own case study patients, with my own clients, with myself for that matter.
Rachele Burriesci:There are a number of things that we need to consider when we're going to assess MIP and MEP. The first thing is device right. Like. What device can I utilize to physically assess this parameter or these parameters? And the primary one that I had found in research previously was the micro RPM. It was the most consistently stated throughout a number of different RMT studies.
Rachele Burriesci:The micro RPM is a great device. It has basically the ability to assess MIP, mep and SNP and it has a digital manometer and has different adapters for inspiratory and expiratory effort. And then it has a mouthpiece with a filter attached, and that mouthpiece has changed over time. The older version was a tube mouthpiece and then the updated version, which they updated prior to me obtaining the micro RPM, was a flange mouthpiece and there's literature on the differences between mouthpieces, but there isn't a standard right and that's kind of the point of this is to really talk about some things that we need to consider when we're assessing MIP and MEP. So mouthpiece device is one and then mouthpiece is the second. The mouthpiece, the flange of the micro RPM is quite large and it's a little uncomfortable in my opinion, but it's doable and the mouth, the flange, I think, compared to the tube, helps prevent some of that air leak, because air leak plays a role in accuracy of MIP and MIP.
Rachele Burriesci:The micro RPM pretty standard across the literature, is probably the most common one that I saw, and then I think it was maybe last year. I think it was last year I had a colleague of mine reach out to me and said that their device was starting to break down from cleaning and they were looking to replace parts and all that kind of stuff and during that time we found out that it was being discontinued. So she told me that I had looked it up and I was still able to see that I could buy like replacement parts, new mouthpieces, things like that. But officially on the website the last time I looked was probably this month sometime or October it officially says on the website that it has been discontinued. So the micro RPM was something like $1,200 to $1,500. So a little bit pricey on price point. It's updated version is called the NumoTrack with RMS and that's the link that you are then directed to from the micro RPM site. And now that device is $2,600. So steep incline.
Rachele Burriesci:So I've been looking at new devices because, although I have mouthpieces available, probably quite a few left Eventually I'm going to run out, and you know what do you do then. So I've been looking, and outside of the Pneumo track there are two other devices that I found Contech RPM10, which is $289, and a company called Pro2 Health, and they have two devices with like different levels of fanciness. One just has a digital reader on the device itself and then one has the ability to add to the app so you can see the software like in real time, and so the range and pricing there is between $3.95 and $5.95. The cool thing about the Pro 2, which I'm going to do a podcast on its own, potentially with the people from Pro 2, is that it's not just an assessment device, it's also the device that can provide intervention. So then that money comes a longer way. Right, you're spending $500 on a device, but you can actually use it for the training piece of it. So you know something to kind of consider there.
Rachele Burriesci:While doing this research, um, I actually found a new device and I think it was from. It was a, it was a European country, it was a. It was a european country, I cannot remember off the top of my head now it was called ervo ervo 2, I believe. Um, and it looked very similar to the pro 2. The issue was the device doesn't have interchangeable mouthpieces, so it's kind of like a one person use and I believe they were cleaning it in between people. So you know there might be a hygiene question there. I haven't dove completely. Air O Fit Pro 2. Excuse me, I just found my device name, so it's Air O Fit Pro 2.0. And so one of the commentary in the article was actually that it didn't have the ability to change out mouthpieces between clients or subjects, and I believe they were cleaning in between versus I think it was like 100 people in the study versus like having 100 AeroFit Pro 2s. So I think the price range was like somewhere in the $200, $300 category as well. But, like I said, I haven't gone completely into it. So the two that I'm looking into right now are the ConTech and the Pro 2 Health. So hopefully I'll be able to do a comparison trial of those two devices and make a decision for myself, and I'll also give you the information on pros and cons and such. So just picking out the device is part of this.
Rachele Burriesci:Right, you have to have the appropriate equipment to assess MIP and MEP and or SNP. The mouthpiece plays a role flange versus tube. It's documented in the literature. There seems to be some pros to using the flanged mouthpiece, but the con is that it typically has lower values compared to the tube, and I will attest to this because when I use the micro RPM, I am well below normal value. So it's interesting that they lean towards the flanged, even though it is known to give lower value across the board, and that seems to be pretty consistent in the literature. So I'm not quite sure the why behind that.
Rachele Burriesci:The other piece is using a nose clip. Right? Do you use the nose clip, do you not? In the literature it's it's used or not used and it's typically I really quote that typically documented. So I'm going to refer to a study that I thought was great. It's actually, I think, a 2023 study. It's probably the most recent assessment on MIPMAP study that I've seen and it compares the CPAR protocol, which is a protocol from Spain, versus the ATS-ERS protocol for MIPMAP assessment, and the CPAR protocol specifically used the nose clip and allegedly the ATS-ERS. They were following the recommendation, they did not use a nose clip for those clients or subjects so interesting in that regard, I personally didn't see advice on using the nose clip or not in the last update in 2019. So something to consider.
Rachele Burriesci:The nose clip, from personal experience, can be hard to navigate, pending the instructions on actually performing MIPMEP and I'll get to that in a little bit but basically, when you have the nose clip on and your mouth is around the device that is a one-way valve, so you're not getting any air in can feel suffocating and for someone who has an irrational fear of suffocating, it can freak you out. So anxiety can increase with that. And timing of the nose clip I find to be very important in the instruction piece. So something else to keep in mind do you use the nose clip or do you not use the nose clip? The other simple part is you know just how much air leak is allowed. It doesn't really talk about what's allowed, but they basically say that they suggest at least I believe it's two centimeters of water. So there's actually an awareness that you will have an air leak and that that is okay. So there's an acceptable amount of air leak, but you don't want too much air leak, because essentially then you're going to lose value on your attempt on the maneuver itself.
Rachele Burriesci:Calibration is also another question. Spoke with the representatives at Pro2 this week and I asked them about calibration and how frequently you need to calibrate, and their device apparently does not need recalibration. It's supposed to be lifetime calibrated the micro RPM. I had an older device in academia before obtaining the new device and we were convinced that it wasn't calibrated because we kept getting these significantly low values for both MIP and MEP and they had a kit to help calibrate. So I actually bought the kit with the new micro RPM in the event that I ever needed to recalibrate. So calibration is always a question, right Like is this device calibrated? Is it reliable? Accuracy is another piece. A lot of times they'll tell you what the accuracy of the device is compared to, like a true PFT. So that's always good to see. It's actually why I went with the micro RPM. I think it was like a 2% difference.
Rachele Burriesci:So something else to consider when picking a device. And then it's just the instructions, right like do we have a set verbiage for our instructions? Especially if you're doing something like research, you want to be as consistent as possible. So having that verbiage to to accurately perform the maneuvers. So typically when we're performing MIP, we're performing it from residual volume, so you're going to cue your patient to exhale completely out and then inhale maximally, and so that's going to give you MIP. Opposite is true for MIP. You're going to perform it at TLC. So basically you're going to max inhale first and then forcefully exhale out.
Rachele Burriesci:How long you sustain the inhale or exhale for MIP and MIP is another question. So ATS says you need to sustain for about 1.5 seconds, for about 1.5 seconds, with one second allowing for like a plateau pressure, and the SEPAR uses a three to five second time. So something to consider. How long do they perform the inhale or exhale maneuver for? And then how many trials right? So typically with most of these devices, how many trials right? So typically with most of these devices, whether you're performing MIP, mep or you're using a peak flow meter, typically three trials is what you do and you take the highest effort.
Rachele Burriesci:So with MIP and MEP there's a little more specificness of the maneuvers. So with ATS they want you to have three trials with less than 10% variability between the trials and a minimum or a maximum of five to six trials in general. So they basically don't want to tire the person out but they want to have some consistency in the numbers. So less than 10%, you get it within three. You take the highest of the three. Same is true for MEP.
Rachele Burriesci:The SEPAR version from Spain was a little bit more. They did max of 10 reps to measure both MEP and MIP with a minimum of six acceptable maneuvers. So they wanted less than 5% variability between the attempts. So a little tighter on that. How much time should you rest between maneuvers? So I don't believe ATS gives a specific time between. But the CPAR protocol had resting one minute between reps and then five minutes before starting the next one. So if you were doing MIP you would do one minute rest breaks between each trial and then before you started MEP, or vice versa, you would rest five minutes before the next set. And that makes sense because they're doing a max of 10 reps with a minimum of six. So they're doing more trials overall. But you start to increase your time that it's going to take to complete and also how many attempts right. Your client might become more fatigued.
Rachele Burriesci:So the article that compares CPAR protocol to the ATS protocol I'll link it below the information on it. Basically, they did a comparison of the protocols to see how far apart they were. Was there any significant difference between them? They used the same device overall and then they compared them to predictive equations. We'll talk about predictive equations in a second, because I think this is where I have some frustration in general with MIP and MEP. So, between the CPAR and the ATS protocol, from a comfort perspective most of the clients or subjects chose ATS protocol to be more comfortable, and in this study the client performed both CPAR and ATS, so it was a complete side-by-side comparison with the same person. And they also had variability in which protocol was performed first as to not cause fatigue in the opposite protocol. So that was, I thought, pretty good as well.
Rachele Burriesci:For the SEPAR protocol they use an equation that was specific to Spanish people. There is a article from Morales et al that has a specific population in Spain. It's actually a very good study where it's across all of Spain, so lots of different populations, lots of different age groups. So the Morales et al is specific to the Spanish population and then they use the Wilson et al equation for the Caucasian population to try to get it closer, based on race and region. So I was really a great study because I really think it was the first time that a study truly laid out the protocols in probably the most specific manner and a good side by side comparison. So I really liked the study. It pulled out a lot of different things to consider when performing it yourself.
Rachele Burriesci:The device that they used I was not familiar with. I actually looked it up and I could not find it as like a purchasing type of thing. Across the board they had higher values with the SEPAR protocol and lower values with ATS and it was significantly different. So curious if it's because of the time of hold to perform could be part of it. Also, compared to the equations the Morales et al equation completely overestimated MIP and MET equation completely overestimated MIP and MEP compared to the actual performed MIP and MEP. So I think that's an issue just across the board with predictive equations is that they can over or underestimate. From the number of equations that I have tried in the MIP MEP world they seem to overestimate. I always fall under pretty significantly. So I don't know if it's a me thing or a protocol thing, but in academia we would do this in a lab and pretty regularly the students would be significantly lower than the predictive norms for their age group or gender. So I think the equation piece is something to talk about next. So the equations is an issue for a number of reasons. The first reason is there are many there are over 50 predictive equations for MIP and MET and they're very similar but they're all different.
Rachele Burriesci:I've put my information into a number of different equations and there's a lot of variability in numbers. Some get pretty close, which I find interesting and you know helpful, and some are wildly different. So, kind of playing with those, I'll give you some names if you've ever heard of any of these or ones to kind of look out. For there's a set from Evans et al and this one's nice because it covers age group up to about 70 years old. It has a difference between MIP and MEP for males and females and then within the equation they're going to use age as difference in prediction and this protocol also has a lower limit normal, which is something that we'll talk about in a little bit. But that seems to be a big push of importance to have a lower limit normal for both males and females, and that can be very helpful in determining a definition for respiratory muscle weakness. So something to kind of keep out for. The Black and Hyatt protocol is from 1969.
Rachele Burriesci:I had this one as one of my equations and normative data when I was teaching in academia and it has difference between male and female and age as well. The numbers vary compared to Evans quite a bit, just from like a numbers perspective. So just interesting. I'm not sure how they come up with the equations, but there's definitely some difference between the two. And then of course we have Wilson et al, which I had just talked about, and same thing they use age and gender as well. The Morales study has a little bit more specificity in the equation itself, so it has age, bmi and gender as part of the equation, which I find really interesting. And I'm actually curious as to why it overestimated so much, because I thought adding BMI and age would actually make it a closer fit, so to speak.
Rachele Burriesci:So there's over 50 equations. Which equation do you use? Which equation do you use for your norm? There's no consensus is the answer. So if you're going to pick one, stick with it and use it across the board. Don't be switching back and forth unless you're using it for a specific reason. For instance, race is part of the conversation as differences between MIP and MEP for different populations. So we do need to kind of think about all of these variables.
Rachele Burriesci:There are things that we do know for fact, right. So some things that we know for sure is that MIP and MEP are different for men and women, and men are higher in both MIP and MEP across the board, all age groups, from children to elderly, and the percent is and 41 to 57% higher for MEP males versus females across the board in any age group. Age is definitely a piece as well. So from childhood to adolescence you actually have an increased MIP and MEP. As you get older towards adulthood, obviously, height, size, those things are going to play a part in that. The opposite is true for older age. Somewhere around the 60-year-old marker, you have a decline in MIP and MEP across the board, both men and women. So we know that. We know that we're going to have a change in MIP and MEP with age. We know there's difference in gender. We also know there's difference between weight, height, right. Size of your lungs is going to play a role in this.
Rachele Burriesci:The other piece that has been brought in in some more recent studies is ethnicity and region of location. There was a really great study on Brazilian women, and so they compared just Brazilian women across different age groups and conversation was you know what is their level of fitness, what is their level of activity, maybe compared to a different region? So something to consider when you're looking at research across the board. To consider when you're looking at research across the board. Level of fitness period despite ethnicity, region needs to be considered as well, right, someone who is sedentary is going to be much different than someone who is actively exercising or an athlete, so difference in that as well it's going to play a part, going to play a role. So there's lots of variables that come into play when we're looking at MIP and MEP. The other piece is just the normative data that exists. Because of the variability in age, gender, height, weight, race, region, activity level, the normative data is quite variable. I like the ability to have a range with normative data, like a plus minus type thing. It gives at least a place to see what would be close. But we know, right, that there's going to be a lot of variability based on the things we just talked about. So something to consider. So if you don't have normative data and predictive equations may or may not overestimate you.
Rachele Burriesci:Then what, how? You know, how are we using this? And one of the conversations is basically to use it against yourself, right, your pre-post. And from a clinical perspective, this is great. Yes, it's always good. I actually just had this situation with a current client of mine. She's like, well, is that good or bad? And I'm like it is right. I already knew when we performed it that we had a ton of air leak, we weren't able to use the flange correctly and there was some issues with maneuver. So I think her MIP MEP is completely lower than it should be based on technique. But if we compare it to her later, we'll see what we get. I'm going to try a different device, if I can obtain it soon. So we'll see if the flange piece versus the tube will actually help her in this situation. We'll find out, but it's something to consider, right? You could use it against the person. So I scored this now.
Rachele Burriesci:I then perform respiratory muscle training, I do a post-test and we look at what the difference is. So then, knowing what clinically significant difference is also going to be important, and I don't have an answer for that yet. But some things to consider, right? I'm not always here for the answers. I'm here to kind of give you. What do you need to think about when you're thinking about these things? All right, what else we got? Predictive equations is a big piece, and figuring out which one you're going to use is a big piece. And are you going to compare it to normative data? Are you going to respect the existing normative data for what it is? At least compare it to which brings the next thing like what are you using the normative data for? Are you using it to help determine weakness?
Rachele Burriesci:And the last issue is that we don't have a consensus on definition for respiratory muscle weakness based on MIP-MEP. In the 2002 report from ATS, they said anything less than negative. 80 centimeters of water for MIP was considered inspiratory muscle weakness. In 2003, there was a textbook that basically said negative 60 was within normal limits, and I've seen quite a bit of that in different textbooks, in different articles. So there is not consensus. So I think that's really where it would be helpful to have more information, more articles, more conversation with healthy adults versus lung disease, versus heart disease. You know, continue with the populations.
Rachele Burriesci:There is another great article from Spain, separate from the SEPAR ATS, actually might be the Morales et al article where they looked at lower limit and they created a or they came up with a lower limit for females and males, for both MIP and MEP. So for MIP they said lower limit of normal was 62 for females and 83 for males, and then for MEP, 81 for females and 109 for males. So that at least gives you some information as to where your client subject sits, because one of the other questions is at what percent of norm is considered safe for respiratory muscle training, right? So that's going to be a different conversation for a different episode, but it is a piece of it, right? At what percent of norm is it safe to consider RMT?
Rachele Burriesci:I have my own opinions on that, and not just about percent, but based on mechanics of breathing as well. I think that has to be considered. So, overall, mipmep is an easy assessment, so to speak I'm doing air quotes because it uses a digital device, a handheld device. It's definitely more cost effective than some of the higher level devices for, like PFT assessment, it can be used pre-post for both research as well as intervention and it can give you some good information on improvement, and so I think we're going to continue to see more research coming out on MIP-MEP compared to different populations, as well as its correlation to other things.
Rachele Burriesci:The last thing I wanted to say, excuse me, is MIP and MEP have been used with hand grip strength to help determine or predict sarcopenia, and so I think that is a huge piece that we're going to see. I'm also curious to see, over time, balance and falls risk coming into the mix with this. So there's just so much information that we can look at, you know, from this perspective. We know that if we are dysmic, patients become more sedentary. We know that if we are exercising or an athlete, we might quit because of fatigue, and that fatigue is likely due to the respiratory system saying hey, you've gone too far, far right. So we know that if we are at least working on breathing, respiratory muscle strength, that we can make improvements in and the list is endless in increase in six-minute walk distance, in improvement in your MEP, decrease hospital length of stay, decrease time in the ICU right, there is a number of things that we can really utilize this tool with. So MIP MEP is the starting piece.
Rachele Burriesci:Mip MEP is your assessment, and I personally think that you have to perform assessments pre and post when you're doing specific interventions because it gives you data. It gives the patient data, it shows the improvement, even if the patient isn't feeling that improvement yet. It is data that will help them see it right, and we can talk about this across the board in physical therapy. Sometimes patients don't even realize how much improvement they've made, but when you can show them pre and post this is where we started with your MIP, mip, this is where you are now. It's a blank percent improvement. It would be nice to know clinical significant difference, to then give that added information. Same is true for gait speed and Berg balance test and six-minute walk distance. Right, we know we have these cutoffs that can help predict improvement in mortality, morbidity and so on and so forth. So I think having an assessment tool that is easily available can be a great starting point if you're doing research.
Rachele Burriesci:But my real big hope is that this becomes more common practice across the board in physical therapy. I truly believe that people can benefit from breathing exercises and respiratory muscle training period, no matter what level of activity they are, from sedentary and lung and cardiac diseases all the way to elite athletes. There can be improvement and I think it really can be a missing link in our intervention in our practice, so I'm going to leave it right there. I hope this was helpful. I hope that you got a new piece of information out of this.
Rachele Burriesci:If you have any questions, please reach out to me. If you have any questions about follow-up podcasts, I have some ideas on RMT in general, so just kind of getting all those pieces together. I think this is definitely something that should be in the forefront and utilized in a number of different settings, so reach out if you have any questions. Dm text I'll link it below. If you want mentoring on a topic like this, link below. Sign up for some one-on-one mentoring. I love to talk about this stuff and help you integrate it, not only in practice, but even into research. All right, I hope you all have a wonderful day and whatever you have to do again after.
