Effect of Diaphragm Manual Release Versus Conventional Breathing Exercises and Prone Positioning on Physical Functional Performance in Women with COVID-19: A Randomized Trial

Overview

Journal J Bodyw Mov Ther

Specialties Pharmacology
Rehabilitation Medicine

Date 2023 Jun 18

PMID 37330786

Authors

Ahmad Mahdi Ahmad

Neveen Mohammed Nawar

Hossam Mohammed Dabess

Mona Abulraouf Gallab

Affiliations

Soon will be listed here.

Abstract

Introduction: Manual therapy has recently gained much interest in managing COVID-19 patients. This study aimed to mainly compare the effect of diaphragm manual release to the effect of conventional breathing exercises and prone positioning on physical functional performance in women with COVID-19.

Methods: Forty COVID-19 women patients completed this study. They were randomly assigned to two groups. Group A received diaphragm manual release, and group B received conventional breathing exercises and prone positioning. Both groups received pharmacological treatment. Inclusion criteria were moderate COVID-19 illness, women patients, and ages from 35 to 45 years. The outcome measures were 6-min walk distance (6MWD), chest expansion, Barthel index (BI), oxygen saturation, fatigue Assessment Scale (FAS), and Medical Research Council (MRC) dyspnea scale.

Results: Both groups showed significant improvements in all outcome measures compared to the baseline (p < 0.001). Compared to group B, group A showed more significant improvements in the 6MWD (MD, 22.75 m; 95% CI, 15.21 to 30.29; p < 0.001), chest expansion (MD, 0.80 cm; 95% CI, 0.46 to 1.14; p < 0.001), BI (MD, 9.50; 95% CI, 5.69 to 13.31; p < 0.001), the O saturation (MD, 1.3%; 95% CI, 0.71 to 1.89; p < 0.001), the FAS (MD, -4.70; 95% CI, -6.69 to -2.71; p < 0.001), and dyspnea severity assessed by the MRC dyspnea scale (p = 0.013) post-intervention.

Conclusion: Combined with pharmacological treatment, diaphragm manual release could be superior to conventional breathing exercises and prone positioning in improving physical functional performance, chest expansion, daily living activities, O saturation, and measures of fatigue and dyspnea in middle-aged women with moderate COVID-19 illness.

Trial Registration: Pan African Clinical Trial Registry (PACTR), retrospective, PACTR202302877569441.

Citing Articles

Impact of COVID-19 on Diaphragmatic Function: Understanding Multiorgan Involvement and Long-Term Consequences.

Pietranis K, Kostro A, Dzieciol-Anikiej Z, Moskal-Jasinska D, Kuryliszyn-Moskal A J Clin Med. 2024; 13(21).

PMID: 39518632 PMC: 11546792. DOI: 10.3390/jcm13216493.

References

Nair A, Alaparthi G, Krishnan S, Rai S, Anand R, Acharya V . Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial. Pulm Med. 2019; 2019:6364376. PMC: 6335861. DOI: 10.1155/2019/6364376. View

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

Cortinovis M, Perico N, Remuzzi G . Long-term follow-up of recovered patients with COVID-19. Lancet. 2021; 397(10270):173-175. PMC: 7833833. DOI: 10.1016/S0140-6736(21)00039-8. View

Simonelli C, Paneroni M, Vitacca M, Ambrosino N . Measures of physical performance in COVID-19 patients: a mapping review. Pulmonology. 2021; 27(6):518-528. PMC: 8221906. DOI: 10.1016/j.pulmoe.2021.06.005. View

Shah S, Vanclay F, Cooper B . Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989; 42(8):703-9. DOI: 10.1016/0895-4356(89)90065-6. View

Tamamura Y, Yoshikawa H, Matsuura M, Kashio M, Kurai K, Nozaki S . Effect of short-duration, limited rehabilitation on maintenance of the activities of daily living in patients with acute phase of COVID-19. J Phys Ther Sci. 2022; 34(4):297-305. PMC: 8989489. DOI: 10.1589/jpts.34.297. View

Charan J, Biswas T . How to calculate sample size for different study designs in medical research?. Indian J Psychol Med. 2013; 35(2):121-6. PMC: 3775042. DOI: 10.4103/0253-7176.116232. View

Gandhi R, Lynch J, Del Rio C . Mild or Moderate Covid-19. N Engl J Med. 2020; 383(18):1757-1766. DOI: 10.1056/NEJMcp2009249. View

Costa D, Cancelliero K, Ike D, Laranjeira T, Pantoni C, Borghi-Silva A . Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients. Clinics (Sao Paulo). 2011; 66(2):299-305. PMC: 3059857. DOI: 10.1590/s1807-59322011000200020. View

10.

Cucinotta D, Vanelli M . WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020; 91(1):157-160. PMC: 7569573. DOI: 10.23750/abm.v91i1.9397. View

11.

Wang T, Chau B, Lui M, Lam G, Lin N, Humbert S . Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020; 99(9):769-774. PMC: 7315835. DOI: 10.1097/PHM.0000000000001505. View

12.

Rocha T, Souza H, Brandao D, Rattes C, Ribeiro L, Campos S . The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. J Physiother. 2015; 61(4):182-9. DOI: 10.1016/j.jphys.2015.08.009. View

13.

Reddy R, Alahmari K, Silvian P, Ahmad I, Kakarparthi V, Rengaramanujam K . Reliability of Chest Wall Mobility and Its Correlation with Lung Functions in Healthy Nonsmokers, Healthy Smokers, and Patients with COPD. Can Respir J. 2019; 2019:5175949. PMC: 6410441. DOI: 10.1155/2019/5175949. View

14.

Holland A, Spruit M, Troosters T, Puhan M, Pepin V, Saey D . An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014; 44(6):1428-46. DOI: 10.1183/09031936.00150314. View

15.

Fereydounnia S, Shadmehr A, Tahmasbi A, Salehi R . The Comparison of the Effectiveness of Respiratory Physiotherapy Plus Myofascial Release Therapy Versus Respiratory Physiotherapy Alone on Cardiorespiratory Parameters in Patients With COVID-19. Int J Ther Massage Bodywork. 2022; 15(1):4-14. PMC: 8887853. DOI: 10.3822/ijtmb.v14i4.691. View

16.

Bestall J, Paul E, Garrod R, Garnham R, Jones P, Wedzicha J . Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54(7):581-6. PMC: 1745516. DOI: 10.1136/thx.54.7.581. View

17.

Morgul E, Bener A, Atak M, Akyel S, Aktas S, Bhugra D . COVID-19 pandemic and psychological fatigue in Turkey. Int J Soc Psychiatry. 2020; 67(2):128-135. PMC: 7355205. DOI: 10.1177/0020764020941889. View

18.

Noll D, Degenhardt B, Morley T, Blais F, Hortos K, Hensel K . Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010; 4:2. PMC: 2848182. DOI: 10.1186/1750-4732-4-2. View

19.

Klanidhi K, Chakrawarty A, Bhadouria S, George S, Sharma G, Chatterjee P . Six-minute walk test and its predictability in outcome of COVID-19 patients. J Educ Health Promot. 2022; 11:58. PMC: 8975019. DOI: 10.4103/jehp.jehp_544_21. View

20.

Noll D, Shores J, Gamber R, Herron K, Swift Jr J . Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc. 2001; 100(12):776-82. View