Manual Therapy in Chronic Obstructive Pulmonary Disease
Condition: Chronic Obstructive Pulmonary Disease
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease
      characterized by progressive airflow limitation that is associated with an inflammatory
      response to noxious particles or gases.

      Manual therapy (MT) has been defined as a therapeutic intervention that uses the hands to
      provide treatment to the musculoskeletal and/or visceral systems. It includes techniques such
      as massage, myofascial release, muscle energy technique, ligament balance, joint mobilization
      and joint manipulation. The suggestion that MT could deliver long-term benefits to people
      with COPD was first put forward in 2009. Since then a number of small studies have reported
      medium term improvements in lung function and exercise capacity following repeated
      applications of MT intervention.

      Our aim is to measure the immediate effect on lung function of a single application of soft
      tissue manual therapy in patients with severe and very-severe chronic obstructive pulmonary
      disease.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease
      characterized by progressive airflow limitation that is associated with an inflammatory
      response to noxious particles or gases.

      Changes in the anatomy of the airways and lung parenchyma occur as the result of bronchial
      hypersecretion and bronchoalveolar instability which cause expiratory flow limitation and air
      trapping. This is known clinically as dynamic hyperinflation. The phenomenon leads to an
      increase in expiratory reserve volume, residual volume and functional residual capacity, also
      referred to as end expiratory lung volume. These increases limit tidal volume and inspiratory
      reserve volume eventually affecting inspiratory capacity. They alter the position of the ribs
      causing a state similar to sustained inspiration over time, often referred to as 'inspiratory
      block'. This phenomenon is responsible for the characteristic 'barrel chest' commonly seen in
      patients with more advanced stages of COPD. In this state the position of the diaphragm is
      flattened and shortened reducing its ability to generate force. Accessory respiratory muscles
      are recruited as a compensatory adaptation leading to shortening and over-activation of these
      muscles over time (over-adaptation). The surrounding cervicothoracic fascia contracts
      producing postural changes such as anterior projection of the head, neck hyperextension,
      increased thoracic kyphosis and internal rotation of shoulders. These changes contribute to
      an increase in chest tightness, a decrease in the ability to generate inspiratory pressures
      and volumes and an increase in the amount of effort required to breath.

      Manual therapy (MT) has been defined as a therapeutic intervention that uses the hands to
      provide treatment to the musculoskeletal and/or visceral systems. It includes techniques such
      as massage, myofascial release, muscle energy technique, ligament balance, joint mobilization
      and joint manipulation. The suggestion that MT could deliver long-term benefits to people
      with COPD was first put forward in 2009. Since then a number of small studies have reported
      medium term improvements in lung function and exercise capacity following repeated
      applications of MT intervention.

      Our aim is to measure the immediate effect on lung function of a single application of soft
      tissue manual therapy in patients with severe and very-severe chronic obstructive pulmonary
      disease.

      We recruitment patients with COPD in Rehabilitation Program in Hospital San José de Santiago
      de Chile, and we assessment: total lung capacity (TLC); vital capacity (VC); residual volume
      (RV); expiratory reserve volume (ERV); inspiratory capacity (IC); and airway resistance
      (Raw). Secondary: heart rate (HR); respiratory rate (RR); and oxygen saturation (SpO2).
    

Intervention name(s): Soft tissue manual therapy protocol
Intervention type(s): Procedure
Intervention description(s): The STMTP consisted of a pre-determined set of seven (7) soft tissue techniques delivered as part of a single treatment session lasting approximately 30 minutes. The techniques and their respective durations were: suboccipital release (5 minutes), anterior thoracic myofascial and sternum release (5 minutes), anterior cervical myofascial release (5 minutes), costal ligament balance (5 minutes) and muscular energy technique (MET) to the following muscles - scalenes (1 minute and 40 seconds), pectoralis minor (1 minute and 40 seconds) and latissimus dorsi and serratus anterior (1 minute and 40 seconds)
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment