The Effect of Manual Therapy Techniques on the Mobility of the Diaphragm in People With Asthma

University of West Attica

Status: Enrolling

Conditions: Asthma

Treatments: Other: Sham Breathing Retraining Exercises Group B; Other: Experimental: Diaphragmatic Manual Therapy Group A

Study type: Interventional

Funder types: Other

Identifiers

NCT05709054

90853/04-10-2022

Details and patient eligibility

About

The mechanical alterations related to the overload of respiratory muscles observed in people with persistent asthma can lead to the development of musculoskeletal dysfunctions. Moreover, the produced lung hyperinflation and high lung volumes in the asthma crisis put the diaphragm at a disadvantage in terms of its length-tension curve and lowered its excursion and capacity to generate force. According to a preliminary study, manual therapy (MT) techniques can be used as adjunctive therapy in asthma treatment. The proposed protocol is the first randomized controlled clinical trial to assess MT's efficacy on the diaphragm's ZOA in conjunction with BRE in individuals with well controlled mild moderate and severe asthma. Many musculoskeletal and respiratory outcomes will be used to investigate the under-study therapies' impact.

Full description

The diaphragm produces a craniocaudal movement of its dome during contraction, making it the most crucial breathing muscle due to its unique anatomical structure and contribution to minute ventilation (60%-80%). Patients with (COPD) or asthma often develop diaphragmatic dysfunction (DD). This DD is related to the mechanical linkage between its various parts, placing it at a mechanical disadvantage to the muscle fibers. The capacity of the diaphragm to elevate and extend the lower rib cage at the level of the zone of apposition is impaired by this pathological change. This change increases the work of breathing and weakens the diaphragm. People with moderate or severe asthma may experience pulmonary overstretching, which can lead to functional issues. How physiotherapy may increase the mechanical efficiency of the thoracic cage and the effectiveness of the respiratory muscles during breathing has been the main focus of studies in recent decades. Although the use of specific diaphragm MT techniques does not yet have sufficient research documentation, recently published studies reported that there are indications to support their positive effect on pulmonary rehabilitation. The efficacy of diaphragm MT methods has not been investigated in adults with asthma, although it has been investigated in pediatric asthma. The effect of diaphragms MT techniques in combination with BRE has not been investigated. The present study hypothesizes that the combination of the mentioned physiotherapy techniques will contribute positively to the length-tension relationship and mobility of the diaphragm and chest expansion in patients with asthma. Secondary positive improvements are expected in the domain of functionality, (b) the feeling of dyspnea, (c) disease control and (d) abnormal respiratory pattern. The amplification of the above in people with asthma using respiratory standards and applying diaphragm mobilization techniques will contribute to better disease management.

Enrollment: 6 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Aged 18 - 60 years
• Diagnosed with well controlled asthma (mild, moderate-severe) using spirometry
• No acute exacerbation in the last two months

Exclusion criteria

• Cardiopulmonary diseases
• Previous cardiothoracic or abdominal surgery
• Patients who have a recent history of the chest wall or abdominal trauma
• Patients with unstable hemodynamic parameters (arterial pressure >140mmHg systolic and >90mmHg for diastolic inability to understand the verbal commands necessary for the outcome assessments
• Pregnancy
• Neurological diseases
• Previous or parallel participation in interventional programs.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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6 participants in 6 patient groups

Diaphragmatic excursion assessment with Ultrasonography

Experimental group

Description:

The time motion mode (M-mode) may be used to measure the diaphragm excursion in a curvilinear low-frequency transducer placed in the midclavicular line and angled in a cranial direction.

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B

Chest wall expansion

Experimental group

Description:

The difference between the values obtained during deep inspiration and expiration will be determined by tape ruler (cm), high degrees represent better outcome, low degrees represent worse outcome.

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B

Nijmegen Questionnaire

Experimental group

Description:

Screening tool used to detect patients with hyperventilation complaints and DB patterns. Scores\>20 are used as the cut-score to identify DB in patients with various conditions. NQ values in healthy individuals range from 10 to 12 ± 7 and values do tend to decrease towards these levels after breathing retraining.

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B

Asthma Control Test

Experimental group

Description:

The ACT evaluates how well asthma affects daily functioning, and overall asthma control self-assessment. The score ranges from 5 (poor control of asthma) to 25 (well control of asthma). An ACT score \>19 indicates well-controlled asthma.

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B

Sf-12v2 questionnaire

Experimental group

Description:

With one or two questions per domain, it evaluates the exact eight health dimensions as the SF-36v2: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. Higher ratings indicate better physical and mental well-functioning, ranging from 0 to 100. It has been suggested that a cut-off of 50 or less be used to identify a physical condition, while a score of 42 or less may signify clinical depression

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B

Borg scale

Experimental group

Description:

The Borg dyspnea scale is a simple, scoring system extensively used to evaluate symptoms of shortness of breath and provides valuable data. It begins with 0, where you have no breathing problems, and rises to 10, where you have the most respiratory distress. As a result, healthcare professionals need to give patients enough time to learn and make sure they comprehend before using it

Treatment:

Other: Experimental: Diaphragmatic Manual Therapy Group A

Other: Sham Breathing Retraining Exercises Group B