Muscle energy technique for chronic obstructive pulmonary disease (COPD)
Creators: name: Baxter, Danielle
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420899
subject: Traditional, complementary and integrative medicine not elsewhere classified

description: Background

Chronic obstructive pulmonary disease (COPD) encompasses obstructive respiratory conditions such as emphysema and chronic bronchitis. COPD is a common cause of mortality and morbidity, with prevalence expected to increase in the coming decades. In 2017, COPD was the fifth leading cause of death in Australia. The financial and social impacts of the disease are significant, and affect not only the individual, but also society.

Risk factors include cigarette smoke and exposure to noxious particles in the occupational setting and environment. Cascading inflammation in the lungs causes destruction of parenchymal tissue (emphysema) and fibrotic narrowing in the small airways (bronchitis). The structural changes are irreversible, and lead to gas trapping and persistent airflow limitation.

Common symptoms include chronic cough, dyspnoea and wheezing. Extrapulmonary conditions, such as cardiovascular disease and musculoskeletal dysfunction, occur as the disease progresses. There is no cure for COPD. Management is directed at reducing the impact of symptoms through the use of pharmacological treatments, including bronchodilators and inhaled corticosteroids; however, these treatments are associated with a range of adverse events (AEs). The main non-pharmacological treatment is pulmonary rehabilitation (PR), but benefit is limited due to poor uptake and adherence.

People with chronic conditions such as COPD are increasingly seeking additional care from complementary and alternative medicine (CAM) therapies as they are perceived to be safe. Recent research has evaluated the role of manual therapy for the management of the musculoskeletal adaptations of COPD. There have been small benefits shown; however, recent reviews have highlighted limitations in the evidence due to limited numbers of studies, small sample sizes and heterogeneity in treatments.

Manual therapies have been hypothesised to reduce chest wall rigidity and improve breathing mechanics. Muscle energy technique (MET), a technique used by CAM and allied health practitioners, has been shown to improve muscle extensibility and spinal range of motion. These actions suggest it would be an appropriate manual technique for use in the COPD population. The role of MET in the management of COPD is an emerging area of research, with few studies evaluating its use. To ensure practice is evidence-informed, there is a need to evaluate the efficacy, safety and acceptability of MET for people with COPD. PR has been shown to improve exercise capacity and health-related quality of life (HRQoL) but has no effect on lung function. Therefore, it was considered appropriate to add MET to PR to evaluate the integration of the two treatments.

Objectives

The two key objectives of this project were to:
1. systematically review the literature to assess the efficacy and safety of MET in the management of COPD
2. assess the feasibility of implementing a manual therapy protocol within a hospital or community PR program by conducting a clinical trial and focus groups. Furthermore, measuring lung capacity during the trial would provide initial data regarding potential pulmonary changes related to the intervention.

Methods

Systematic review of the evidence in clinical trials

A systematic review of randomised controlled trials (RCTs) was completed to evaluate the clinical use and safety of MET in the management of COPD. The systematic review was guided by the methods of the Cochrane Collaboration.

Design and implementation of a clinical study

A non-controlled clinical study was conducted to evaluate the feasibility and safety of implementing MET as an adjunct to a PR program in a hospital setting. Treatment was provided for eight weeks, and participants were followed up at 12 weeks. The trial design was reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

Experiences of participants and staff in a clinical study

Qualitative methods were employed to evaluate the participant and staff experience. Data were collected through follow-up calls, focus groups and written feedback. Thematic analysis was used to examine the experiences of participants and staff.

Results

Systematic review of the evidence in clinical trials

Three RCTs were included with 90 participants. Two of the three studies combined MET with other treatments such as exercise and physiotherapy. There were no AEs related to the intervention. Individual studies showed small improvements in exercise capacity and perceived dyspnoea. Findings should be interpreted with caution due to unclear risk of bias and methodological flaws in all included studies.

Design and implementation of a clinical study

The clinical study was conducted between February 2018 and December 2020. The target sample size of 33 participants was reached, and 26 participants completed the study as planned. There were no AEs related to MET. Participants attended 76 per cent of MET sessions and 70.3 per cent of PR sessions. Results showed small improvements in Chronic Respiratory Questionnaire-Self-Administered Individualised (CRQ-SAI) dyspnoea domain and COPD Assessment Test (CAT) scores. There were no major changes in lung function; however, small changes in inspiratory capacity (IC) over time were found. Results should be interpreted with caution due to the small sample size and absence of a control group.

Experiences of participants and staff in a clinical study

Findings showed that both staff and participants had a positive experience in this trial. Participants reported symptomatic benefits when receiving MET and enjoyed participating. Staff reported minimal burden to them in the implementation of the study and discussed the improved adherence to PR due to the MET component. Both staff and participants reported benefits in having an additional health professional on site.

Conclusions

The systematic review provided preliminary evidence that MET is safe for use in people with COPD and provided small clinical benefits in dyspnoea and HRQoL. The safety of MET was confirmed in the clinical study. The study was successful in terms of timely recruitment and there were no AEs related to MET. The trial also added to the literature regarding potential effects of adding MET to PR in clinical outcomes such as IC and HRQoL. Capturing the participant and staff experience were pivotal in determining whether implementation was successful. The novel findings from this project will inform future research and provide clinicians with preliminary information about the safety of using MET as part of a wider treatment plan for COPD.