Comparison of Thoracic Squeeze and Manual Diaphragmatic Release Technique in COPD Patients

Comparison of Thoracic Squeeze and Manual Diaphragmatic Release Technique on Respiratory Parameters and Functional Capacity in COPD Patients

The goal of this randomized control trial is to evaluate and compare the efficacy of two physiotherapy techniques-Thoracic Squeeze Technique (TST) and Manual Diaphragmatic Release Technique (MDRT)-on improving respiratory parameters, functional capacity, and quality of life in patients with mild to moderate Chronic Obstructive Pulmonary Disease (COPD).

Objectives:

• Assess the impact of TST and MDRT on respiratory parameters (FEV1, FVC, FEV1/FVC ratio, and chest expansion).
• Compare the functional capacity outcomes of the two techniques using the 6-Minute Walk Test (6MWT).
• Evaluate the effects of TST and MDRT on patient wellbeing and daily life through the COPD Assessment Test (CAT).

Study Design:

The study involves 34 participants, divided into two groups (n=17 each) via sealed envelope randomization. Both groups will receive their respective interventions (TST or MDRT) alongside a standardized pulmonary rehabilitation protocol (pursed-lip breathing, diaphragmatic breathing, active cycle of breathing, and endurance exercises). The intervention will be conducted three times per week for three weeks.

Outcome Measures:

Primary outcomes include respiratory parameters assessed through spirometry and chest expansion using a measuring tape. Secondary outcomes include functional capacity (6MWT) and patient wellbeing (CAT scores). Baseline and post-intervention measures will be analyzed using SPSS, employing Mixed ANOVA to determine interaction effects.

Study Overview

• Status: Completed
• Conditions: COPD (Chronic Obstructive Pulmonary Disease)
• Intervention / Treatment: Other: Thoracic squeeze technique; Other: Manual diaphragmatic release technique

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory condition of the respiratory system that progressively impairs airflow, leading to significant limitations in physical capacity and quality of life. COPD is a global health concern, being the third leading cause of death worldwide, with an increasing prevalence due to aging populations and environmental pollution. Despite advancements in pharmacological treatments, COPD management requires comprehensive rehabilitation strategies, particularly for improving respiratory function and functional capacity.

Two physiotherapy techniques, the Thoracic Squeeze Technique and Manual Diaphragmatic Release Technique, have been individually employed to address respiratory function in COPD patients. However, direct comparisons of their effectiveness on respiratory parameters, functional capacity, and overall quality of life are scarce. This study aims to evaluate and compare the effects of these techniques, combined with conventional pulmonary rehabilitation, to identify the more effective intervention for optimizing COPD treatment.

The trial will be conducted at Lady Reading Hospital, Peshawar, over six months following ethical approval.

This study will provide evidence-based insights into the relative efficacy of Thoracic Squeeze and Manual Diaphragmatic Release techniques. Findings will guide physiotherapists in optimizing rehabilitation protocols for COPD patients, improving respiratory function, functional capacity, and overall quality of life. Moreover, the research aims to contribute to the standardization of physiotherapy practices for COPD management, ensuring consistent and effective patient care.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • KPK
    • Peshawar, KPK, Pakistan
      • Lady Reading Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients with mild or moderate COPD according to the GOLD criteria.GOLD 1: Mild FEV1 ≥ 80% predicted value, GOLD 2: Moderate FEV1 between 50% and 80% predicted value.
• Age between 40- 60 years.
• Both male and female.
• Patients who are willing to give voluntary consent to practice.

Exclusion Criteria:

• Patients with unstable hemodynamic parameters (arterial pressure <100mmHg Systolic and <60 mmHg diastolic blood pressure.
• Patients who have undergone recent 6 to 12 weeks cardio thoracic or abdominal surgery.
• Patients who have a recent history of chest wall or abdominal trauma; substantial chest wall deformity History of recent fractures and cognitive impairments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Thoracic squeeze technique; The Thoracic Squeeze Technique is a manual physiotherapy intervention aimed at improving lung function, airway clearance, and respiratory mechanics. It involves the application of gentle, rhythmic compression to the chest wall during the exhalation phase of breathing, followed by a release. This technique can be performed with the patient in a sitting, semi-reclined, or supine position, depending on their condition and comfort level.	Other: Thoracic squeeze technique; The Thoracic Squeeze Technique is a manual therapy method used primarily in respiratory physiotherapy to improve lung expansion, enhance respiratory function, and facilitate secretion clearance in patients with respiratory conditions.
Experimental: Manual Diaphragmatic release technique; The Manual Diaphragmatic Release Technique is a soft tissue manipulation technique used to improve the mobility, function, and efficiency of the diaphragm. It is commonly applied in physiotherapy, particularly in respiratory, musculoskeletal, and manual therapy practices, to address breathing dysfunctions, postural imbalances, and associated pain or discomfort.	Other: Manual diaphragmatic release technique; The Manual Diaphragmatic Release Technique is a soft tissue manipulation technique used to improve the mobility, function, and efficiency of the diaphragm. It is commonly applied in physiotherapy, particularly in respiratory, musculoskeletal, and manual therapy practices, to address breathing dysfunctions, postural imbalances, and associated pain or discomfort.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Respiratory parameter FEV1/FVC ratio	The Gold standard tool used in the diagnosis of COPD is spirometry. In today GOLD guidelines the diagnosis of pulmonary function test based on a bronchodilator FEV1/FVC ratio of less than 0. 7.	1 week
Respiratory parameter Forced Expiratory Volume	Forced Expiratory Volume in 1 Second (FEV1 measures the volume of air that can be forcefully exhaled in the first second serving as an indicator of airway obstruction severity.	1 week
Respiratory parameter Forced Vital Capacity (FVC)	Forced Vital Capacity (FVC) the total volume of air exhale during a forced breath assessing overall lung capacity.	1 week
Functional capacity	Six Minute walk test: The 6-Minute Walk Test (6MWT) is a simple and practical test used to assess the functional exercise capacity of individuals. It measures the distance an individual can walk quickly on a flat hard surface in a period of six minutes. The test is commonly used in patients with chronic respiratory diseases such as COPD.	1 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest excursion	Chest excursion measurement is a simple clinical test used to assess the mobility of thoracic cage during respiration. This can be particularly useful in diagnosing and monitoring respiratory conditions such as COPD to measure lung expansion. Chest expansion will be measured at three levels; Upper Lobe: at the level of the fourth rib. Middle Lobe: at the level of the xiphoid process. Lower Lobe: at the level of the tenth rib.	1 week
Quality of life self-administered questionnaire	The COPD assessment test (CAT) is a self-administered questionnaire that consist of eight questions to explore different symptoms and impacts of COPD. .	3 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Maria Naeem, DPT, MS-CPPT, Riphah International University

Publications and helpful links

General Publications

• Braz Junior DS, Dornelas de Andrade A, Teixeira AS, Cavalcanti CA, Morais AB, Marinho PE. Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD): a pilot study. Int J Chron Obstruct Pulmon Dis. 2015 Jan 12;10:125-32. doi: 10.2147/COPD.S73751. eCollection 2015.

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2025
• Primary Completion (Actual): May 30, 2025
• Study Completion (Actual): June 30, 2025

Study Registration Dates

• First Submitted: January 14, 2025
• First Submitted That Met QC Criteria: January 23, 2025
• First Posted (Actual): January 24, 2025

Study Record Updates

• Last Update Posted (Actual): August 22, 2025
• Last Update Submitted That Met QC Criteria: August 18, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: quality of life; COPD; functional capacity; Thoracic squeeze technique; Manual diaphragmatic release technique; digital spirometry
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: Sabaoon Ijaz

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No