COVID-19 is an infectious disease that can cause long-term health problems even after theacute infection has resolved. Many people who have recovered from COVID-19 continue toexperience breathing difficulties, fatigue, and reduced physical capacity. These ongoingproblems are often related to decreased lung function and weakness of the breathingmuscles, especially the diaphragm, which plays a major role in breathing.In women after COVID-19, respiratory muscle weakness may result from inflammation duringinfection, prolonged bed rest, and increased effort required to breathe. This can lead toreduced inspiratory strength, shortness of breath, and limitations in daily activities.Respiratory rehabilitation is therefore important to help restore breathing musclestrength and improve overall respiratory function.One rehabilitation approach is indirect diaphragmatic muscle training using pressurebiofeedback. This method provides visual or tactile feedback during breathing exercisesto help patients activate and strengthen the diaphragm more effectively. Pressurebiofeedback has been used as part of post-COVID-19 rehabilitation in Indonesia, but itseffectiveness in improving inspiratory strength and diaphragmatic function, particularlyin women after COVID-19, has not been fully evaluated.The purpose of this study is to examine the relationship between improvements in maximalinspiratory pressure and improvements in diaphragmatic strength in women recovering fromCOVID-19 who perform indirect diaphragmatic muscle training using pressure biofeedback.The study hypothesizes that indirect diaphragmatic training guided by pressurebiofeedback can improve diaphragmatic strength and increase maximal inspiratory pressurein women after COVID-19.
Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-CoV-2), has resulted in a growing population of individuals experiencing persistent
symptoms after the acute phase of infection. Post-COVID-19 conditions frequently involve
respiratory impairment, characterized by reduced lung capacity, decreased maximal
inspiratory pressure, and weakness of the respiratory muscles, particularly the
diaphragm. These impairments are attributed to systemic inflammation, cytokine storm,
prolonged immobilization, increased respiratory workload, and neuromuscular involvement
during and after COVID-19 infection.
The diaphragm is the primary inspiratory muscle and plays a critical role in maintaining
adequate ventilation. Diaphragmatic dysfunction following COVID-19 may manifest as
reduced diaphragmatic excursion, decreased muscle thickness, and diminished inspiratory
pressure generation. Maximal inspiratory pressure (MIP) is a widely used, non-invasive
parameter for assessing inspiratory muscle strength and reflects the functional capacity
of the diaphragm and accessory inspiratory muscles. Reduced MIP values indicate
inspiratory muscle weakness and are associated with impaired respiratory function and
reduced physical capacity.
Women after COVID-19, particularly in the postpartum period, represent a vulnerable
population for respiratory muscle weakness. Physiological changes related to pregnancy
and childbirth, combined with the effects of COVID-19 infection, may exacerbate
diaphragmatic weakness and impair respiratory mechanics. Despite the clinical relevance
of this condition, data regarding targeted respiratory rehabilitation interventions in
this population remain limited.
Respiratory rehabilitation has been shown to improve respiratory muscle strength, reduce
dyspnea, and enhance quality of life in post-COVID-19 patients. One rehabilitation
approach is indirect diaphragmatic muscle training using pressure biofeedback. This
technique utilizes a pressure-sensing device placed at the lumbosacral region to provide
real-time feedback during diaphragmatic breathing exercises. The feedback allows patients
to optimize diaphragmatic activation while minimizing excessive chest wall movement,
thereby promoting effective and controlled diaphragmatic contraction.
Indirect diaphragmatic training with pressure biofeedback is designed to strengthen the
diaphragm by encouraging abdominal expansion during inspiration. Repeated training
sessions aim to increase diaphragmatic endurance and strength, leading to improvements in
maximal inspiratory pressure and overall respiratory function. This method has been used
in respiratory rehabilitation settings in Indonesia; however, its specific effectiveness
in improving diaphragmatic strength and inspiratory pressure in women after COVID-19 has
not been adequately studied.
This study employs a randomized, single-blind clinical trial design to evaluate the
relationship between changes in maximal inspiratory pressure and changes in diaphragmatic
strength following indirect diaphragmatic muscle training using pressure biofeedback.
Participants are allocated to either a control group or an intervention group. The
intervention group receives structured indirect diaphragmatic training with pressure
biofeedback over a defined training period, while both groups undergo standardized
assessments of inspiratory pressure and diaphragmatic muscle function at predetermined
time points.
Diaphragmatic strength is assessed using ultrasonographic evaluation of diaphragmatic
movement and thickness, while maximal inspiratory pressure is measured using a pressure
manometer. These measurements allow for objective evaluation of respiratory muscle
function and enable analysis of the correlation between inspiratory pressure improvement
and diaphragmatic muscle strengthening following the intervention.
The primary scientific focus of this study is to determine whether improvements in
maximal inspiratory pressure are correlated with improvements in diaphragmatic strength
following indirect diaphragmatic muscle training guided by pressure biofeedback. By
examining this relationship, the study aims to provide evidence supporting the role of
pressure biofeedback-guided diaphragmatic training as a respiratory rehabilitation
modality for women recovering from COVID-19.
The findings of this study are expected to contribute to the development of
evidence-based respiratory rehabilitation strategies for post-COVID-19 conditions,
particularly in women, and to support the integration of pressure biofeedback techniques
into comprehensive post-COVID-19 rehabilitation programs.
Device: Pressure Biofeedback Unit
Diaphragmatic muscle training using a pressure biofeedback unit is provided as part of
post-COVID-19 respiratory rehabilitation. The pressure biofeedback unit is placed at the
lumbosacral region to provide real-time feedback during diaphragmatic breathing
exercises. Participants are instructed to perform controlled diaphragmatic breathing
aimed at enhancing diaphragmatic activation and increasing inspiratory muscle strength.
Inclusion Criteria:
- Female patients treated at Persahabatan Hospital.
- History of COVID-19 infection.
- Attending the Pulmonology Clinic and/or the Medical Rehabilitation Clinic at
Persahabatan Hospital.
- Willing to participate in indirect diaphragmatic training using pressure biofeedback
for four consecutive weeks.
- Willing to participate as research subjects.
Exclusion Criteria:
- Female patients not treated at Persahabatan Hospital
- No history of COVID-19 infection
- Not participating in indirect diaphragmatic training using pressure biofeedback for
four consecutive weeks
- Presence of other pulmonary disease such as tuberculosis, chronic obstructive
pulmonary disease, or asthma
Rumah Sakit Umum Pusat Persahabatan
Jakarta, DKI Jakarta, Indonesia
Not Provided