Effectiveness of Chest Wall Mobilization Program in Improving Respiratory Function for Patients With Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 入组人数
- 30
- 试验地点
- 2
- 主要终点
- Lung Function
研究概览
简要总结
Patients with severe COPD will be recruited from the Respiratory Outpatient Clinic of Kowloon Hospital.
Baseline (pre-intervention) assessment for all recruited subjects will be conducted by one physiotherapist assessor who is blinded to the group allocation of the subject for respiratory function, musculoskeletal performance, physical performance and quality of life. Then, the subjects will be randomly allocated into either the intervention group with therapist-assisted chest wall mobilization exercises, low intensity walking exercise, home exercises and education sessions or the control group with low intensity walking exercise, home exercises and education sessions. The intervention program will last for 6 weeks with 2 sessions / week (i.e. a total of 12 sessions) in accordance to the recommendation for exercise training programs for patients with COPD by the American College of Sports Medicine. Post-program evaluation will be conducted upon program completion at 6 week.
A follow-up session on 3 month after the completion of the program will be carried out to evaluate the cumulative effect of the chest wall mobilization program on respiratory function, musculoskeletal performance, exercise performance and quality of life of the patients.
详细描述
I. Intervention for Study Group
Structured Chest Wall Mobilization Program
Chest Wall Mobilization Chest wall mobilization is one of the important techniques in chest physical therapy for increasing chest wall mobility and improving ventilation. Either passive or active chest mobilizations help to increase chest wall mobility, flexibility, and thoracic compliance. The mechanism of this technique increases the length of the intercostal muscles and therefore helps in performing effective muscle contraction. It improves the biomechanics of chest movement by enhancing direction of anterior-upward movement of lower costal and downward movement of diaphragm. Maximal relaxed recoiling of the chest wall helps in achieving effective contraction of intercostal muscle. Chest wall mobilization with breathing exercise was showed to effect clinical benefit in chronic lung disease especially COPD with lung hyperinflation or barrel-shaped chest. The technique of chest wall mobilization helps in chest wall flexibility, respiratory muscle function and ventilatory pumping, which helps to reduce dyspnoea and respiratory accessory muscle use.
The chest wall mobilization techniques include:
- Lateral flexion of chest wall
- Chest wall extension
- Lateral gliding of thoracic spine
- Pectoralis major muscle stretching
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •COPD patients in out-patient setting: Patients with FEV1/FVC < 0.70 and
- •GOLD stage III ( Severe) :
- •30% < or = FEV1 < 50% predicted
- •*GOLD - Global Initiative for Chronic Obstructive Lung Disease
- •Able to communicate
- •Competent to give written consent
排除标准
- •Contraindications to chest wall mobilization:
- •Severe and unstable rib fracture
- •Metastasis bone cancer
- •Tuberculosis spondylitis
- •Severe osteoporosis
- •Hospitalization due to acute exacerbation of COPD in recent 1 month
- •Current Smoker
研究组 & 干预措施
Interventional group
Chest Wall Mobilization Program
干预措施: Chest Wall Mobilization Program (Other)
Control Group
Routine limbs exercises and education
干预措施: Control (Other)
结局指标
主要结局
Lung Function
时间窗: 4.5 months
FEV1, FVC and Ratio
Respiratory Muscles Function
时间窗: 4.5 months
Maximum Inspiratory Pressure, Maximum Expiratory Pressure
次要结局
- Cervical and Respiratory Muscles Activity(4.5 months)
- Thoracic Excursion(4.5 months)
- Pressure Pain Threshold(4.5 months)
- Respiratory Muscle Oxygenation(4.5 months)
- Cervical and Thoracic Range of Movement(4.5 months)
- Six-Minute Walk Test(4.5 months)
- Visual Analogue Scale(4.5 months)
- St George's Respiratory Questionnaire(4.5 months)