Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial

Abstract

Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. Results: At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (−1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Conclusion: Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.

Implications for Rehabilitation

• Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources.

• Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB.

• However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.

• Breathing exercises
• dysfunctional breathing
• manual therapy
• physiology

Acknowledgements

The authors would like to thank the patients who participated in the study, Juliana Burgess who undertook the computer randomisation. We also wish to thank Dr Robert Wilson, Clinical Director Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, for his support of the project from its inception and Dr Andy Jones for his help with preparation of the manuscript.

Declaration of interest

The study protocol was approved by Brompton, Harefield & NHLI Ethics Committee.

The authors report no declaration of interest

Many thanks to the Sir Siegmund Warburg Voluntary Settlement for its financial support, without which the study would not have been undertaken.