Effectiveness of Adding Thoracic Manual Therapy to Conventional Pulmonary Rehabilitation for Improving Pulmonary...

Background and Objective: Restrictive ventilatory impairment is characterized by reduced lung volumes and may be accompanied by reduced thoracic mobility. The purpose of this study was to determine if the addition of thoracic manual therapy to conventional pulmonary rehabilitation (PR) was superior to conventional PR alone in improving pulmonary function and chest expansion in adults with restrictive ventilatory impairment. Methods: This was a randomized controlled trial (RCT) involving 48 patients with restrictive ventilatory impairment, who were randomly assigned to two groups: conventional pulmonary rehabilitation (Group A, n = 24) and conventional pulmonary rehabilitation with thoracic manual therapy (Group B, n = 24). Forced vital capacity (FVC), as a percentage of the predicted value, was the prespecified primary outcome. Secondary outcomes were forced expiratory volume in 1 s (FEV₁), total lung capacity (TLC), FEV₁/FVC ratio, and chest expansion at the 2nd and 4th intercostal spaces and the xiphoid level. Assessment of outcomes was conducted at baseline, after 8 weeks of treatment, and at a 4-week follow-up. Results: There were significant group vs. time interactions for FVC, FEV₁, TLC, FEV₁/FVC, and chest expansion at each of the thoracic levels measured (all p < 0.001), suggesting that the change over time was different among groups. Between-group differences were greatest after intervention and at 4-week follow-up, with Group B showing greater gains than Group A. Conclusions: In adults with restrictive ventilatory impairment, thoracic manual therapy in addition to conventional pulmonary rehabilitation resulted in greater improvement in selected pulmonary function and chest-expansion measures at 8 weeks and follow-up than conventional pulmonary rehabilitation alone. These differences were maintained during the four-week follow-up period.