None listed
Conditions
Brief summary
COPD is the fifth greatest contributor to the overall burden of disease in Australia. Breathlessness is the primary symptom that limits exercise in people with COPD. Reduced exercise is associated with higher hospitalisation rates and increased mortality rates. Lung hyperinflation which is characteristic in COPD contributes to spinal rigidity which may further contribute to exertional breathlessness and subsequent reduced exercise capacity. Previous research has shown that manual therapy has immediate effects on reducing breathlessness and improving lung function. There is a known link between joint mobilization and SNS function showing immediate effects on local and centrally mediated pain, muscle and SNS function. It may therefore be hypothesized that improvements in pain and muscle function would be associated with reduced spinal rigidity, potentially improving lung function and reducing breathlessness. Several studies that have pharmacologically inhibited SNS activity have reported reduced breathlessness, so it might also be hypothesised that thoracic mobilisation may have a similar effect on breathlessness. To the best of our knowledge no studies to date have investigated the impact of manual therapy on lung function or breathlessness associated with a functional relevant activity such as walking. This study aims to investigate, in people with stable COPD who experience exertional breathlessness, whether a single treatment involving 6 minutes of Grade III central PA accessory joint mobilisation of the thoracic spine decreases breathlessness and improves lung function more than a placebo intervention. We hypothesis that joint mobilisation of the thoracic spine will decrease breathlessness and improve lung function following a 6 minute walking exercise task. If proven successful, this may permit patients to exercise more frequently and at higher intensities optimizing the benefits of exercise. This along with the potential to increase participation in physical activity may lead to a reduction in exacerbations, hospital admissions and associated cost savings.
Interventions
Participants will be asked to attend three sessions within a two-week period with each session separated by >24 hours.
Session 1: Descriptive data will be collected. Participants will undergo a brief passive accessory joint assessment of the thoracic spine in order to select the most ‘stiff’ spinal segment between T2 and T12 at which to perform the placebo and experimental interventions. If more than one spinal level is hypomobile, then the mid-point in the stiff segment will be selected. If n
Participants will be asked to attend three sessions within a two-week period with each session separated by >24 hours. Session 1: Descriptive data will be collected. Participants will undergo a brief passive accessory joint assessment of the thoracic spine in order to select the most ‘stiff’ spinal segment between T2 and T12 at which to perform the placebo and experimental interventions. If more than one spinal level is hypomobile, then the mid-point in the stiff segment will be selected. If no thoracic segments are found to be hypomobile, then a mid-thoracic segment will be selected (between T5 and T7). Participants will then perform the 6MWT and from this 80% of the average speed achieved on the 6MWT will be used to prescribe the intensity of the 6-minute treadmill walking exercise task. This intensity of exercise is consistent with that used for walking training in PRP and a period of 6 minutes is sufficient to evoke breathlessness whilst avoiding a prolonged testing session. Participants will then be familiarised with the treadmill exercise task. Sessions 2-4: All outcome measures will be taken at baseline, followed by one of the randomly ordered interventions (placebo or experimental). Participants will then undergo the standardised 6-minute exercise task. All outcome measures will then be repeated. Experimental intervention: Posterior-anterior (PA) thoracic mobilisation (Grade III) will be applied to the selected spinal segment for 3 periods of 1 minutes, each separated by 60 seconds. A grade III mobilisation is defined on the Maitland Joint Mobilization Grading Scale as large amplitude rhythmic oscillating mobilisation to point of limitation in range of movement.
Sponsors
Sir Charles Gairdner Hospital Physiotherapy department
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Diagnosis of COPD confirmed by spirometry; smoking history >10 pack years; breathless on 6-minute walk test (6MWT) or during supervised exercise training (Borg rating = 3 [‘moderate’]); stable clinical state (no exacerbation or change in respiratory medication in previous 4 weeks).
Exclusion criteria
Aged >80 years; history of thoracic surgery, spinal crush fractures, or osteomyelitis; known severe osteoporosis of spine (T-score =2.5); co-morbid conditions limiting ability or compromising safety to exercise on treadmill; severe exercise limitation (6MWD <300m); long term oxygen therapy; SpO2<80% during 6MWT or exercise training; obese (BMI >35); unable to give informed consent; pain >4/10 during thoracic spine assessment; history of chronic thoracic spinal pain; unable to sustain a supported forward lean sitting position without discomfort for 10 minutes.
Outcome results
None listed