title: The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial.
abstract: OBJECTIVE
  In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen?
  
  
  METHODS
  Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors.
  
  
  METHODS
  Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease.
  
  
  METHODS
  The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen.
  
  
  METHODS
  The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments.
  
  
  RESULTS
  The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small.
  
  
  CONCLUSIONS
  The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease.
  
  
  BACKGROUND
  NCT02212184.
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Taciano
authors.initials: T
authors.lastname: Rocha
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Helga
authors.initials: H
authors.lastname: Souza
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Daniela Cunha
authors.initials: DC
authors.lastname: Brandão
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Catarina
authors.initials: C
authors.lastname: Rattes
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Luana
authors.initials: L
authors.lastname: Ribeiro
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Shirley Lima
authors.initials: SL
authors.lastname: Campos
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Aliverti
authors.affiliation: Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil.
authors.forename: Armèle Dornelas
authors.initials: AD
authors.lastname: de Andrade
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D003964:Diaphragm / Q000503:physiopathology*; D004311:Double-Blind Method; D015444:Exercise; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D007320:Inspiratory Capacity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: COPD; Manual therapy; Optoelectronic plethysmography; Respiratory therapy; Ultrasonography