Efficacy of Costal Mobilization Techniques and Manual Diaphragm Release Technique in Patients COPD

Study Overview
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Brief Summary
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To evaluate the acute and chronic effects of costal mobilization techniques and diaphragmatic release in chest cavity kinematics, diaphragmatic mobility and functional capacity in patients with chronic obstructive pulmonary disease

Detailed Description
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Study will be a controlled clinical trial in which participants will be randomized into 2 groups: GROUP A (costal mobilization techniques and Manual Diaphragm Release Technique), GROUP B (Manual Diaphragm Release Technique). After the initial evaluation, participants will undergo six sessions of care according to randomization and will be reevaluated in 3 following situations: immediately after the first session, at the end of treatment and one week after the last session. The evaluation will be performed through Optoelectronic plethysmography , Pollar, Ultrasound and 6-minutes walk test.

Official Title
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Efficacy of Costal Mobilization Techniques and Diaphragm Release in Thoracoabdominal Kinematics, Diaphragm Mobility and Submaximal Functional Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Conditions
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Copd, Chest Disorders, Diaphragmatic Disorder

Intervention / Treatment
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* Other: GROUP Costal mobilization & Diaphragm Release
* Other: GROUP Manual Diaphragm Release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of COPD (spirometry with FEV1 <80% and FEV1 / FVC <0.7) of both sexes, who are not undergoing another physiotherapeutic treatment, from to 21 years of age, clinically stable without exacerbation in the last 6 weeks. Exclusion Criteria: Patients with rheumatic or orthopedic diseases; Deformities / abnormalities in the spine that compromise the mechanics of the respiratory system; Rib fracture for less than 1 year; Respiratory co-morbidities; History of thoracic or abdominal surgery for less than 1 year; Osteoporosis and IMC > 30kg / m²

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Costal mobilization & Diaphragm Release<br>Costal mobilization. Lying: two sets of ten deep respiratory cycles with one minute interval between sets. Sitting: two series with interval of one minute between them. Manual Diaphragm Release Technique: will be applied during two series of ten deep respiratory cycles, with one minute interval between sets. | Other: GROUP Costal mobilization & Diaphragm Release<br>* Costal mobilization technique (Rib raising): The patient will be lying. The Therapist supports the last four pulps of both hands at the rib angles, gently traverses the rib angles in the posterior-anterior direction, using the stretcher as a lever to facilitate the elevation of the costal angles. Siting: The Therapist hugs the patient by supporting the ribs of the fingers at the rib angles, gently traverses the rib angles bilaterally in the anterior-lateral direction. Manual Diaphragm Release Technique: The therapist makes manual contact with the underside of the costal border of the common cartilage of the last rib. In the inspiratory phase, the therapist draws the points of contact with both hands in a cephalad direction and slightly Accompanying the movement of the rib cage.<br>* Other names: GROUP A;|
| Active Comparator: Manual Diaphragm Release<br>Manual Diaphragm Release Technique: will be applied during two series of ten deep respiratory cycles, with one minute interval between sets. | Other: GROUP Manual Diaphragm Release<br>* The therapist makes manual contact with the underside of the costal border of the common cartilage of the last rib. In the inspiratory phase, the therapist draws the points of contact with both hands in a cephalad direction and slightly Accompanying the movement of the rib cage.<br>* Other names: GROUP B;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mobility of the thoracic cage | Will be measured by optoelectronic plestimography | Three weeks total: Thirty minutes after the first intervention, after two weeks of intervention and after one week without treatment (follow up) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diaphragma mobility | Will be measured with ultrasonography | Three weeks total: Thirty minutes after the first intervention, after two weeks of intervention and after one week without treatment (follow up) | 
| functional capacity | Will be measured six minute walk test | Three weeks total: after two weeks of intervention and after one week without treatment (follow up) | 
| heart rate variability | Will be measured Pollar | 1 day: before and after the intervention |