Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial.

Abstract

Study design: Randomized clinical trial. Objective: To investigate the effect of including manual therapy (MT) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). Background: The primary source of exercise limitation in people with COPD is dyspnea. The dyspnea is partly caused by changes in chest wall mechanics, with an increase in chest wall rigidity (CWR) contributing to a decrease in lung function. As MT is known to increase joint mobility, administering MT to people with COPD carries with it the potential to influence CWR and lung function. Methods: Thirty-three participants with COPD, aged between 55 and 70 years (mean565.5¡4 years), were randomly assigned to three groups: pulmonary rehabilitation (PR) only, soft tissue therapy (ST) and PR, and ST, spinal manipulative therapy (SM), and PR. Outcome measures including forced expiratory volume in the 1st second (FEV 1 ), forced vital capacity (FVC), 6-minute walking test (6MWT), St. George's respiratory questionnaire (SGRQ), and the hospital anxiety and depression (HAD) scale were recorded at 0, 8, 16, and 24 weeks. Results: There was a significant difference in FVC between the three groups at 24 weeks (P50.04). For the STzSMzPR group versus PR only the increase was 0.40 l (CI: 0.02, 0.79; P50.03). No major or moderate adverse events (AE) were reported following the administration of 131 ST and 272 SM interventions. Discussion: The increase in FVC is a unique finding. Although the underlying mechanisms responsible for this outcome are not yet understood, the most likely explanation is the synergistic effect resulting from the combination of interventions. These results support the call for a larger clinical trial in the use of MT for COPD.

The effect of combining manual therapy with exercise for mild chronic obstructive pulmonary disease: study protocol for a randomised controlled trial

“…The minimum clinically important difference for FVC is 200 mL with the standard deviation obtained from previous studies [22, 23]. With a power of 0.8 (80%) and an alpha of 0.05, the minimum sample size per group is 92.…”

“…This is the same MTP that was used in two previous trials on patients with COPD [22, 23]. It consists of a combination of soft tissue (ST) therapy and thoracic spinal manipulation (SM).…”

Ultrasound Evaluation of Diaphragmatic Mobility and Contractility After Osteopathic Manipulative Techniques in Healthy Volunteers: A Prospective, Randomized, Double-Blinded Clinical Trial

“…12 In contrast, other studies reported improvements in lung function in severe COPD patients after OMT. [13][14][15] Hand-held ultrasound instruments allow for the morphology and function of the diaphragm to be assessed in different settings and under different conditions. 16 Ultra-sonography is currently the only noninvasive, nonionizing imaging technique widely available to directly assess diaphragmatic function.…”

Acute Effect of Combined Manual Therapy and Therapeutic Exercise versus Short-Acting Bronchodilator on Ventilatory Function in Patients with COPD

“…Recently, manual therapy has proved to be very beneficial in improving many health outcomes in COPD patients [5][6][7][8][9][10][11][12]. Myofascial release based-manual therapy might have contributed to producing clinically remarkable improvements in ventilatory function and subjective feelings of dyspnea and fatigue in COPD patients [11,12].…”