Muscle Energy Technique for Chronic Obstructive Pulmonary Disease

Intervention: Muscle Energy Technique Muscle Energy Technique is a gentle manual therapy technique used by manual therapists (osteopaths, physiotherapists, chiropractors, myotherapists) around the world. The goal of the technique is to lengthen hypertonic muscles and improve range of motion of joints in the body. Essential elements of the manual technique involve the following steps: - Practitioner puts the muscle to be treated on stretch - Patient is instructed to contract the specific muscle in a specific direction for 3-5 seconds - Practitioner resists the movement in a controlled fashion for 3-5 seconds - Patient is instructed to stop contracting the muscle. In this period the practitioner further stretches the muscle slowly to a new resting length - Repeat this muscle contraction 3-5 times. The positions that the participant may be positioned in- supine, prone, sidelying, seated. The regions that will be treated include: neck, back (upper and lower), rib cage and associated muscles. Materials provided to patients: Participants may be shown an A4 page of images depicting the types of positions that the participant may be asked to be in and the type of application of technique. The materials can be accessed from the researcher and intervention provider. The intervention provider is a registered Osteopath with Australian Healthcare Practitioner Regulation Agency (AHPRA). Mode of delivery- 'hands on' from the intervention provider. The intervention is provided to the individual participant for up to 15 minutes prior to the Pulmonary Rehabilitation session. The location of the intervention sessions will be at he Austin Hospital in the physiotherapy department. The intervention will be applied in a private room next to the exercise room. In the room is a hospital bed that can be moved electronically. The intervention is applied concurrently with Pulmonary Rehabilitation, over 8 weeks. The intervention is applied prior to the exercise session for up to 15 minutes (maximum) in week 1,2,3,5,6 and 7 (total of 6 intervention sessions over the 8 week program). There is no intervention applied in week 4 and 8. The frequency of the application of the intervention is once per week for up to 15 minutes. This is one-on-one with the person administering the intervention. The person administering the intervention is an AHPRA registered osteopath. The intervention is semi-standardised. This means that each individual participant is assessed in the same regions (i.e neck left/ right, upper and lower back left/ right) and then the intervention is applied tailored to the individual findings. Individual findings will not change the type of intervention applied. It will only change the regions treated. For example, if the findings require the positioning of the upper extremity in a certain position, but the individual is unable to lift their arm to the required position, the intervention is able to be modified in terms of treating another region, or in another position. Individual findings also means that treatment (intervention) is applied to a finding, and regions are not treated unnecessarily. The intervention has not currently been modified during the study. No intervention adherence or fidelity was assessed as there have been no modifications. Strategies used to monitor participant adherence include an individualised session attendance check list given to the participant at baseline; where the dates of intervention have been negotiated and discussed between the researcher and the individual, and written on the checklist for the individual to take home.