Authors (including presenting author) :
Tsui AYY(1), Chau RMW(1), Kwan HY(2), Ling SO(2), Yim CW(2), Yau A(2), Cheng RYF, Ng PK(2), Tsang SMH(3), Cheing GLY(3)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital,(2)Department of Respiratory Medicine, Kowloon Hospital,(3)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
Introduction :
Accelerated decline in pulmonary function is a hallmark for patients with COPD. Clinical trials have demonstrated a positive correlation between pulmonary function and chest wall expansion in COPD patients. Decrease in chest wall expansion compromises rib cage mobility and functional length of the respiratory muscles that ultimately jeopardize the efficacy and function of the respiratory system.
Objectives :
To investigate the effectiveness of additional chest wall mobilizations in improving respiratory function in patients with severe degree of COPD
Methodology :
Thirty male adults (mean age:74.97±6.29) suffered from severe degree of COPD were recruited from the patients who had follow-up at Specialist Out-patient Clinic of Department of Respiratory Medicine in Kowloon Hospital. The patients were randomly allocated to either the intervention group (chest wall mobilizations) or control group. Both groups received standardized rehabilitation including education and walking exercise. Patients in the intervention group received additional chest wall mobilizations performed by a physiotherapist expert in manual therapy. Respiratory muscle strength measured by MicroRPM (Respiratory Pressure Meter), thoracic excursion, and thoracic range of movement were evaluated at pre-program, post-program and 3-month follow-up.
Result & Outcome :
The intervention group but not the control group showed significant increase in maximum inspiratory pressure (MIP: p<0.001), maximum expiratory pressure (MEP: p<0.001), thoracic excursion (upper thoracic: p=0.003; lower thoracic: p<0.001), and thoracic range of movement (p<0.001) except thoracic flexion. The improvement was well maintained in the 3-month follow-up session. There was also significant between-group difference in MIP and MEP (p<0.001) and lower thoracic excursion (p<0.01) after respiratory rehabilitation with chest wall mobilization. In addition, the lower thoracic excursion is strongly associated with an increase in both MIP (β=13.64, p<0.001) and MEP (β=16.23, p<0.001). In fact, thoracic range of movement especially extension (p<0.001) and bilateral rotation (p<0.01) exhibit a strong relationship with an increase in lower thoracic excursion (adjusted R²=0.876) as shown in multiple regression analysis.
Enhancement of thoracic extension and rotation would definitely increase the lower thoracic excursion after chest wall mobilizations. The significant improvement in chest expansion capacity allows the respiratory muscles to work at a more optimal functional length which result in greater respiratory muscle strength in patients with COPD. Thus, it would be beneficial to have chest wall mobilization to be included as a core component in respiratory rehabilitation to optimize the rehabilitation outcomes for patients with severe COPD.
