Inspiratory muscle training: A theoretical framework for its selected application in orthopaedic enhancing recovery pathways

This paper explores a theoretical framework for integrating Inspiratory Muscle Training (IMT) into enhanced recovery pathways, emphasising its potential role in mitigating respiratory decline, reducing hospital stays, and improving functional mobility for selected patients. IMT has shown benefits in high-risk surgical populations, including those with chronic respiratory conditions, obesity, obstructive sleep apnea, and frailty. Standardised screening protocols involving respiratory muscle function tests are recommended to identify suitable candidates, with structured IMT programs ideally commencing 6–8 weeks before surgery. Implementing IMT within an enhanced recovery pathway may enhance the ability for early mobilisation, improve oxygenation, and support the functional recovery of patients. While IMT has demonstrated efficacy in various surgical populations, its specific benefits to orthopaedic patients require further consideration and investigation. Indeed, future research should focus on optimising IMT protocols and assessing patient outcomes in the short-term (e.g. length of stay and complications), and the medium-term (e.g. return to activities of daily living). By incorporating IMT into prehabilitation and rehabilitation protocols, we propose that healthcare systems may be able to improve surgical outcomes and patients’ well-being while reducing postoperative complications and healthcare burden for at-risk patients.