title: Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial.
abstract: OBJECTIVE
  Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB.
  
  
  METHODS
  Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed.
  
  
  RESULTS
  At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (-1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance).
  
  
  CONCLUSIONS
  Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.
  
  
  CONCLUSIONS
  Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources. Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB. However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.
authors.affiliation: School of Health Science and Social Care, Brunel University , London , UK .
authors.forename: Mandy
authors.initials: M
authors.lastname: Jones
authors.forename: Fiona
authors.initials: F
authors.lastname: Troup
authors.forename: John
authors.initials: J
authors.lastname: Nugus
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.forename: Margaret
authors.initials: M
authors.lastname: Hodson
authors.forename: Charlotte
authors.initials: C
authors.lastname: Rayner
authors.forename: Frances
authors.initials: F
authors.lastname: Bowen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pryor
mesh_terms: D000328:Adult; D001007:Anxiety; D003863:Depression; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D012131:Respiratory Insufficiency / Q000523:psychology* / Q000534:rehabilitation*; D012138:Respiratory Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Breathing exercises; dysfunctional breathing; manual therapy; physiology