COMBINED EFFECT OF MUSCLE ENERGY TECHNIQUE AND JOINT MANIPULATION IN MALE AND FEMALE PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A QUASI EXPERIMENTAL STUDY

Background: Chronic Obstructive Pulmonary Disease (COPD) influence function of diaphragm muscle thus affecting maximal inspiratory pressure. So, the present study is planned to analyze combined effect of Muscle Energy Technique (MET) and Joint Manipulation (JM) on lung function and diaphragm muscle strength. Purpose: The purpose of the study was aimed to evaluate the effectiveness of both MET and JM to improve the pulmonary function by improving chest expansion, thoracic spine mobility and diaphragm muscle function. Method: Study design was one group pretest-posttest of 16 patients with COPD aged between 35-65 years. Patients were diagnosed with COPD receive MET of accessory muscle, C4-C6 spine and JM of the thoracic spine, six times for 3 week of period. Primary outcome measure is Lung function (Spirometry) and secondary outcomes Portable capsule sensing pressure gauge, Measuring tape, Pulse oximeter, Modified borg rating perceived exertion scale, COPD Assessment Tool (CAT), mMRC (modified Medical Research Council) scale of dyspnea, BODE index, diaphragm excursion(chest X-ray) and COPD GOLD ABCD Assessment Tool classification. Outcome measurements were taken on two occasions both pre and post application of independent variable. Result: Data analysis was done by paired t-test and Wilcoxon signed- rank test. The significance level value was set at 0.05. Primary outcome measure FEV1/FVC ratio showed highly significant result and in secondary outcomes measures, statistical significant improvement was seen except for Diaphragm excursion. Conclusion: There were significant improvement was seen on pulmonary function, chest expansion, maximum inspiratory pressure, dyspnea in patients with COPD after application of MET and JM.背景：慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）会影响膈肌功能，进而影响最大吸气压。本研究旨在分析肌肉能量技术（Muscle Energy Technique，MET）与关节松动术（Joint Manipulation，JM）联合应用对肺功能及膈肌肌力的联合效应。 目的：本研究旨在评估MET与JM联合应用通过改善胸廓扩张度、胸椎活动度及膈肌功能，进而改善肺功能的有效性。 方法：本研究采用单组前后测设计，纳入16名年龄35~65岁的COPD患者。确诊为COPD的患者接受辅助肌、C4-C6节段的MET及胸椎JM干预，每周6次，共持续3周。主要结局指标为肺功能（Spirometry）；次要结局指标包括便携式胶囊传感压力计、卷尺、脉搏血氧仪、改良Borg自觉劳累评分量表、COPD评估测试（CAT）、改良医学研究委员会（modified Medical Research Council，mMRC）呼吸困难量表、BODE指数、膈肌活动度（胸部X线检查）及COPD全球慢性阻塞性肺疾病防治创议（GOLD）ABCD评估工具分级。分别在干预前及干预后两个时间点采集结局指标数据。 结果：数据分析采用配对t检验及Wilcoxon符号秩检验，检验水准设定为0.05。主要结局指标FEV1/FVC比值呈现极显著差异；次要结局指标中，除膈肌活动度外，其余指标均出现具有统计学意义的改善。 结论：经MET与JM联合干预后，COPD患者的肺功能、胸廓扩张度、最大吸气压及呼吸困难症状均得到显著改善。