Letter to the Editor
Respiratory assessment in people with spinal cord injury
Evaluación respiratoria en personas con lesión medular
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As a result of this international initiative, the validated Spanish version has been recently published in <span class="elsevierStyleSmallCaps">Medicina Clínica</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">First, it is important to note that in the published study no data on the validation process of the Spanish version is provided. While the method describes that a Kappa symmetry test was used for qualitative variables and an intraclass coefficient for quantitative variables, this is not shown in the results nor in the discussion. Besides, it also describes the use of <span class="elsevierStyleItalic">t</span> Student test, ANOVA, Chi-square and Pearson correlation coefficient, however, only descriptive statistics are presented in the results. There are recommendations regarding the validation process of such questionnaires<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> but, with the data provided, one cannot conclude whether this version meets all the characteristics expected in a health questionnaire in order to be validated.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We consider this initiative to be a good first step, but as specialists in respiratory disease, we want to emphasize that this questionnaire has been created with significant deficiencies regarding variables that must be evaluated as priority in patients with SCI, and that, in light of recent scientific literature, play a key role in reducing the prevalence of respiratory complications.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The most important of these is cough efficacy. This can be evaluated by the peak cough flow (PCF). Reports show that values below 270<span class="elsevierStyleHsp" style=""></span>l/min generate an increased risk in the development of respiratory complications.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In a study of our group, 100% of subjects with high spinal cord injury had values lower than this threshold. From this evaluation, effective training strategies can be established so that this barrier can be overcome, helping with the normalization of some cases.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Another variable to measure is the respiratory muscle strength, which is evaluated through a simple and inexpensive method. We know that the level of inspiratory and expiratory muscle compromise is closely related to the level and type of injury. Studies have shown that inspiratory muscle strength is limited approximately 25% and 50% in the case of the expiratory strength in patients with cervical spinal cord injury.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Thus, injuries above the C5 level will significantly compromise the diaphragm, the major muscle of inspiration. A low volume of inspiration favours the appearance of atelectasis but, above all, will limit cough efficacy. Expiratory muscles may also be compromised in injuries above L2. Abdominal muscles, essential in the expulsive phase of cough and to ensure proper removal of secretions, will be compromised in a number of different ways. Consequently, the assessment of inspiratory and expiratory muscle strength on the subject with SCI will provide a functional view of the strategies to be used by the patient in order to compensate breathing through the remaining muscles. In addition, it is imperative to design treatment strategies such as respiratory muscle training. In conclusion, strength and cough should be incorporated in these patients’ evaluation arsenal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We believe that the work of Biering-Sørensen et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> initially, and Gomez-Garrido et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> with their validation into Spanish, is a very important first step towards establishing a routine evaluation of these patients, who are usually thoroughly evaluated from a musculoskeletal point of view, but that lack the same rigour when it comes to the respiratory system. Nevertheless, we are deeply convinced that other factors, which according to literature are becoming increasingly more important, should be incorporated in any future versions of the questionnaire. That will be the only way to establish therapeutic strategies tailored to each subject, and therefore, improve their quality of life and survival.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torres-Castro R, Vilaró J, Vera-Uribe R. Evaluación respiratoria en personas con lesión medular. Med Clin (Barc). 2016;146:234–235.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validación española del cuestionario <span class="elsevierStyleItalic">International Spinal Cord Injury Pulmonary Function Basic Data Set</span> para valorar la repercusión de la lesión medular en el sistema respiratorio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Gómez Garrido" 1 => "A.M. León Espitia" 2 => "L. Montesinos Magraner" 3 => "L. Ramírez Galceran" 4 => "E. 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