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This randomized controlled non-inferiority study protocol evaluates whether online Liuzijue training delivers training efficacy and patient safety comparable to face-to-face delivery in stroke survivors with respiratory dysfunction. Primary and secondary respiratory outcomes are measured pre- and post-intervention, and Liuzijue-associated adverse events are tracked to determine safety.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/comparing-online-and-face-to-face-liuzijue-training-in-stroke-survivors-with-respiratory-dysfunction-study-protocol-for-a-randomized-controlled-non-inferiority-trial/457454/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/comparing-online-and-face-to-face-liuzijue-training-in-stroke-survivors-with-respiratory-dysfunction-study-protocol-for-a-randomized-controlled-non-inferiority-trial/457454.png","ImageObject",300,407,{"name":92,"@type":93},"Marglet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main objective of this study protocol?","Question",{"text":112,"@type":113},"To test whether online Liuzijue training is non-inferior to face-to-face training in terms of training efficacy and patient safety for stroke survivors with respiratory dysfunction.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How will participants be assigned and what will each group do?",{"text":117,"@type":113},"Sixty-four stroke survivors with respiratory dysfunction will be recruited from January 2025 and randomly assigned to control, online, and offline groups. The online and offline groups will perform Liuzijue once daily, 5 days per week, for 8 weeks alongside routine rehabilitation, while the control group will not do Liuzijue training.",{"name":119,"@type":110,"acceptedAnswer":120},"Which outcomes will be measured to evaluate efficacy and safety?",{"text":121,"@type":113},"Primary outcomes include forced expiratory volume in one second and peak expiratory flow. Secondary outcomes include diaphragmatic thickening fraction during quiet breathing and diaphragmatic excursion during quiet breathing. Adverse events related to Liuzijue training will be recorded to assess safety.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},457454,1791404966,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Ma et al. Trials (2026) 27:10  \n[https://doi.org/10.1186/s13063-025-09327-2](https://doi.org/10.1186/s13063-025-09327-2)  \nTrials  \n STUDY PROTOCOL Open Access  \nComparing online and face-to-face Liuzijue training in stroke survivors with respiratory dysfunction: study protocol for a randomized controlled non-inferiority trial  \nYaqi Ma 1,2†, Yongyang Huo3†, Jie Yan2, Zhihui Hu2, Ruixue Ye2, Jiao Luo4, Xinyue Zhou1,2, Ying Xu1,2, Zeyu Yang1,2, Jia Wang1,2, Anqun Yang5* andYulong Wang2*  \nAbstract  \nBackground Stroke is a global health problem, and respiratory dysfunction post-stroke is a common complication that affects the recovery process of patients and their quality of life. In this study, we aim to investigate whether online Liuzijue training is non-inferior to the face-to-face one in terms of training efficacy and patient safety for stroke survivors with respiratory dysfunction.  \nMethods/design We will recruit 64 stroke survivors with respiratory dysfunction from January 2025 and assign them randomly into control, online, and offline groups. In addition to their routine rehabilitation therapy, patients in the online and offline groups will undergo Liuzijue training once a day, 5 days a week, for 8 weeks, while those in the control group will not engage in any Liuzijue training. The primary outcomes will include the forced expiratory volume in one second and peak expiratory flow. Secondary outcomes will include the diaphragmatic thickening fraction during quiet breathing and diaphragmatic excursion during quiet breathing. All outcomes will be measured before and after the intervention. In addition, the incidence of adverse events associated with Liuzijue training will be recorded to assess the safety of the intervention.  \nDiscussion This study provides a simple, feasible, repeatable, and fun exercise training approach. To the best of our knowledge, there are no randomized controlled trials in the existing literature on internet-based respiratory exercise applied to stroke patients. The protocol presented in our study can serve as a reference for an alternative and supplementary approach to long-term inpatient respiratory rehabilitation.  \nTrial registration Chinese Clinical Trial Register, ChiCTR2400094537 . Registered on 24 December 2024, [https://www](https://www). [chictr.org.cn/index.html](chictr.org.cn/index.html)  \nKeywords Telerehabilitation, Medicine, Chinese traditional, Randomized controlled trial, Liuzijue, Breathing exercises, Stroke  \n†Yaqi Ma and Yongyang Huo are first co-authors.  \n*Correspondence: Anqun Yang [1279854969@qq.com](1279854969@qq.com)[ ](1279854969@qq.com)Yulong Wang [ylwang668@163.com](ylwang668@163.com)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/.)[.](http://creativecommons.org/licenses/by-nc-nd/4.0/.)  \nMa et al. Trials (2026) 27:10  \nBackground  \nStroke is the second leading cause of","cbCairb7xp48cJ09","https://ap.wps.com/l/cbCairb7xp48cJ09","pdf",2182316,14,"English","# Background\n## Stroke and post-stroke respiratory dysfunction\n## Role and adoption of respiratory rehabilitation and traditional exercises\n## Rationale for comparing online versus face-to-face Liuzijue training","[{\"question\":\"What is the main objective of this study protocol?\",\"answer\":\"To test whether online Liuzijue training is non-inferior to face-to-face training in terms of training efficacy and patient safety for stroke survivors with respiratory dysfunction.\"},{\"question\":\"How will participants be assigned and what will each group do?\",\"answer\":\"Sixty-four stroke survivors with respiratory dysfunction will be recruited from January 2025 and randomly assigned to control, online, and offline groups. The online and offline groups will perform Liuzijue once daily, 5 days per week, for 8 weeks alongside routine rehabilitation, while the control group will not do Liuzijue training.\"},{\"question\":\"Which outcomes will be measured to evaluate efficacy and safety?\",\"answer\":\"Primary outcomes include forced expiratory volume in one second and peak expiratory flow. Secondary outcomes include diaphragmatic thickening fraction during quiet breathing and diaphragmatic excursion during quiet breathing. Adverse events related to Liuzijue training will be recorded to assess safety.\"}]","Comparing online and face-to-face Liuzijue training in stroke survivors with respiratory dysfunction - study protocol for a randomized controlled non-inferiority trial | PDF",1790749363,35]