Abstract
Background: Many manual procedures have long been involved in the management of chronic obstructive pulmonary disease (COPD). Few literatures evaluated the COPD responses to individual or multiple manipulative techniques, so effects are unclear and poorly understood. Aim: to explore ventilatory functions (VF) and functional capacity (FC) responses to diaphragmatic or costal manipulation or both in COPD patients. Methods: 195 male patients were randomly assigned into diaphragmatic manipulation group (group-A; n=46), rib raising group (group-B; n=53), both procedures group (group-C; n=50) and control group (group-D; n=46). Treatment regimens were applied twice weekly for 12 weeks. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FC (by 6 minute walk test "6MWT") were evaluated before and after the study. Results: At the end of the study; FVC, FEV1 and 6MWT mean values and percentages of increases were [3.63 +/- 0.56 (4.52%), 2.46 +/- 0.51 (14.42 %), 416.35 +/- 28.62 (3.82 %)], [3.56 +/- 0.38 (5.97 %), 2.43 +/- 0.48 (16.63), 415.28 +/- 37.81 (3.04 5)] and [3.93 +/- 0.54 (16.92), 2.86 +/- 0.5 (33.44 %), 433.03 +/- 46.76 (6.9 %)] for group-A, B and C respectively (P < 0.05). There were also significant differences in FVC, FEV1 and 6MWT mean values between groups at the end of the study but in favor of group-C (P<0.05). Conclusions: Diaphragmatic and costal manipulative procedures are effective therapeutic tools in improving VF and FC in COPD patients especially if applied together.