Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
The Effect of Soft Tissue Manual Therapy Intervention on Lung Function in Severe Chronic Obstructive Pulmonary Disease: a Proof of Concept Study
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.
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).
;
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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