The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial.
QUESTIONS
In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen?


DESIGN
Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors.


PARTICIPANTS
Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease.


INTERVENTION
The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen.


OUTCOME MEASURES
The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments.


RESULTS
The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small.


CONCLUSION
The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease.


TRIAL REGISTRATION
NCT02212184.
['Rocha|Taciano|T|', 'Souza|Helga|H|', 'Brandão|Daniela Cunha|DC|', 'Rattes|Catarina|C|', 'Ribeiro|Luana|L|', 'Campos|Shirley Lima|SL|', 'Aliverti|Andrea|A|', 'de Andrade|Armèle Dornelas|AD|']
D000368:Aged D001945:Breathing Exercises D003964:Diaphragm D004311:Double-Blind Method D015444:Exercise D017079:Exercise Tolerance D005260:Female D006801:Humans D001239:Inhalation D007320:Inspiratory Capacity D008297:Male D008875:Middle Aged D029424:Pulmonary Disease, Chronic Obstructive D016896:Treatment Outcome
Ultrasonography Optoelectronic plethysmography COPD Manual therapy Respiratory therapy