Cargando…

Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) impairs the function of the diaphragm by placing it at a mechanical disadvantage, shortening its operating length and changing the mechanical linkage between its various parts. This makes the diaphragm's contraction less effective in rais...

Descripción completa

Detalles Bibliográficos
Autores principales: Nair, Aishwarya, Alaparthi, Gopala Krishna, Krishnan, Shyam, Rai, Santhosh, Anand, R., Acharya, Vishak, Acharya, Preetam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335861/
https://www.ncbi.nlm.nih.gov/pubmed/30719351
http://dx.doi.org/10.1155/2019/6364376
_version_ 1783387975565967360
author Nair, Aishwarya
Alaparthi, Gopala Krishna
Krishnan, Shyam
Rai, Santhosh
Anand, R.
Acharya, Vishak
Acharya, Preetam
author_facet Nair, Aishwarya
Alaparthi, Gopala Krishna
Krishnan, Shyam
Rai, Santhosh
Anand, R.
Acharya, Vishak
Acharya, Preetam
author_sort Nair, Aishwarya
collection PubMed
description BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) impairs the function of the diaphragm by placing it at a mechanical disadvantage, shortening its operating length and changing the mechanical linkage between its various parts. This makes the diaphragm's contraction less effective in raising and expanding the lower rib cage, thereby increasing the work of breathing and reducing the functional capacity. AIM OF THE STUDY: To compare the effects of diaphragmatic stretch and manual diaphragm release technique on diaphragmatic excursion in patients with COPD. MATERIALS AND METHODS: This randomised crossover trial included 20 clinically stable patients with mild and moderate COPD classified according to the GOLD criteria. The patients were allocated to group A or group B by block randomization done by primary investigator. The information about the technique was concealed in a sealed opaque envelope and revealed to the patients only after allocation of groups. After taking the demographic data and baseline values of the outcome measures (diaphragm mobility by ultrasonography performed by an experienced radiologist and chest expansion by inch tape performed by the therapist), group A subjects underwent the diaphragmatic stretch technique and the group B subjects underwent the manual diaphragm release technique. Both the interventions were performed in 2 sets of 10 deep breaths with 1-minute interval between the sets. The two outcome variables were recorded immediately after the intervention. A wash-out period of 3 hours was maintained to neutralize the effect of given intervention. Later the patients of group A and group B were crossed over to the other group. RESULTS: In the diaphragmatic stretch technique, there was a statistically significant improvement in the diaphragmatic excursion before and after the treatment. On the right side, p=0.00 and p=0.003 in the midclavicular line and midaxillary line. On the left side, p=0.004 and p=0.312 in the midclavicular and midaxillary line. In manual diaphragm release technique, there was a statistically significant improvement before and after the treatment. On the right side, p=0.000 and p=0.000 in the midclavicular line and midaxillary line. On the left side, p=0.002 and p=0.000 in the midclavicular line and midaxillary line. There was no statistically significant difference in diaphragmatic excursion in the comparison of the postintervention values of both techniques. CONCLUSION: The diaphragmatic stretch technique and manual diaphragm release technique can be safely recommended for patients with clinically stable COPD to improve diaphragmatic excursion.
format Online
Article
Text
id pubmed-6335861
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-63358612019-02-04 Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial Nair, Aishwarya Alaparthi, Gopala Krishna Krishnan, Shyam Rai, Santhosh Anand, R. Acharya, Vishak Acharya, Preetam Pulm Med Clinical Study BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) impairs the function of the diaphragm by placing it at a mechanical disadvantage, shortening its operating length and changing the mechanical linkage between its various parts. This makes the diaphragm's contraction less effective in raising and expanding the lower rib cage, thereby increasing the work of breathing and reducing the functional capacity. AIM OF THE STUDY: To compare the effects of diaphragmatic stretch and manual diaphragm release technique on diaphragmatic excursion in patients with COPD. MATERIALS AND METHODS: This randomised crossover trial included 20 clinically stable patients with mild and moderate COPD classified according to the GOLD criteria. The patients were allocated to group A or group B by block randomization done by primary investigator. The information about the technique was concealed in a sealed opaque envelope and revealed to the patients only after allocation of groups. After taking the demographic data and baseline values of the outcome measures (diaphragm mobility by ultrasonography performed by an experienced radiologist and chest expansion by inch tape performed by the therapist), group A subjects underwent the diaphragmatic stretch technique and the group B subjects underwent the manual diaphragm release technique. Both the interventions were performed in 2 sets of 10 deep breaths with 1-minute interval between the sets. The two outcome variables were recorded immediately after the intervention. A wash-out period of 3 hours was maintained to neutralize the effect of given intervention. Later the patients of group A and group B were crossed over to the other group. RESULTS: In the diaphragmatic stretch technique, there was a statistically significant improvement in the diaphragmatic excursion before and after the treatment. On the right side, p=0.00 and p=0.003 in the midclavicular line and midaxillary line. On the left side, p=0.004 and p=0.312 in the midclavicular and midaxillary line. In manual diaphragm release technique, there was a statistically significant improvement before and after the treatment. On the right side, p=0.000 and p=0.000 in the midclavicular line and midaxillary line. On the left side, p=0.002 and p=0.000 in the midclavicular line and midaxillary line. There was no statistically significant difference in diaphragmatic excursion in the comparison of the postintervention values of both techniques. CONCLUSION: The diaphragmatic stretch technique and manual diaphragm release technique can be safely recommended for patients with clinically stable COPD to improve diaphragmatic excursion. Hindawi 2019-01-03 /pmc/articles/PMC6335861/ /pubmed/30719351 http://dx.doi.org/10.1155/2019/6364376 Text en Copyright © 2019 Aishwarya Nair et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Nair, Aishwarya
Alaparthi, Gopala Krishna
Krishnan, Shyam
Rai, Santhosh
Anand, R.
Acharya, Vishak
Acharya, Preetam
Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title_full Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title_fullStr Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title_full_unstemmed Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title_short Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial
title_sort comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: a randomized crossover trial
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335861/
https://www.ncbi.nlm.nih.gov/pubmed/30719351
http://dx.doi.org/10.1155/2019/6364376
work_keys_str_mv AT nairaishwarya comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT alaparthigopalakrishna comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT krishnanshyam comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT raisanthosh comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT anandr comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT acharyavishak comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial
AT acharyapreetam comparisonofdiaphragmaticstretchtechniqueandmanualdiaphragmreleasetechniqueondiaphragmaticexcursioninchronicobstructivepulmonarydiseasearandomizedcrossovertrial