Investigating Manual Therapy as a Treatment for COPD

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There is not enough evidence that manual therapy—a clinical approach of using skilled, physical, hands-on procedures to improve function, lessen pain, and facilitate movement—can successfully be used to treat chronic obstructive pulmonary disease (COPD).

Manual therapy (MT) techniques have no effect on lung functions in patients with chronic obstructive pulmonary disease (COPD), according to a metanalysis of random controlled trials (RTCs). The authors suggest more evidence must be gathered before MT should be implemented as treatment in rehabilitation programs for patients with COPD, considering the RTCs included in the study were determined to be of poor methodological quality and collectively posed a high risk of bias.

Respective to this review, MT has been defined as a clinical approach using skilled, physical, hands-on procedures to treat musculoskeletal, soft tissue, and joint dysfunctions with the intent to improve function, lessen pain, and facilitate movement.

“This systematic review has provided low-quality evidence showing that a variety of MT techniques and programs, although feasible, have no effects on lung function in COPD patients,” the authors wrote. “Contrasting results have been found regarding the effects on exercise capacity and health-related quality of life.”

A total of 555 RTCs, obtained from a database search of MEDLINE, EMBASE, Physiotherapy Database, and Cochrane Central Register of Controlled Trials, were screened for information that could help determine the effectiveness of MT. The studies contained a similar hypothesis that MT decreased respiratory muscle hyperactivity and increased mobility of the thoracic structures involved in respiratory mechanics. RTCs excluded were those in which MT was not applied by hand contact and those including complementary, as well as holistic healing, treatments. Others excluded were those in which MT only involved gentle massage, passive stretching, manual chest physiotherapy, and secretion clearance techniques.


Only 6 heterogeneous RTCs were found to meet the study’s inclusion criteria, including a description of the study design, the number of participants, diagnosis of COPD based on the Global Initiative for COPD system, spirometry, baseline mean of forced expiratory volume in 1 second (FEV1), baseline mean of percentage of predicted FEV1, assessment of the 6-minute walking test (6MWT), and assessments of dyspnea, dyspnea at rest, and exercise-induced dyspnea.

Participants in the included RTCs were adults with moderate to severe COPD with no age restriction. RTCs including patients who were identified to have a supplementary lung condition, such as asthma, were excluded from the study.

The authors intended to analyze the efficiency of MT treatment regarding exercise on lung viability, the potential of patients to attain exercise, and the effect on patients’ overall quality of health. Specific outcome measures were determined by lung operation, using FEV1, and exercise aptitude, by 6MWT.

The rationale for proposing MT for treatment recognizes COPD patients’ frequent occurrences of musculoskeletal disorders, migraines, and chronic pain. Musculoskeletal disorders and pain have also been linked to causing impaired physical performance and reduced physical activity in patients with COPD.

While pulmonary rehabilitation programs have proven to improve symptoms of patients suffering from COPD, evidence that MT can have the same effects remain unconvincing, according to the authors.

Future research can be used to more successfully determine the effectiveness of MT in COPD patients, they suggested.

“Further studies with better standardization and scientific validity are needed to assess the effects of MT on exercise capacity, symptoms, disability, and quality of life,” the authors concluded.


Simonelli C, Vitacca M, Vignoni M, Ambrosino N, Paneroni M. Effectiveness of manual therapy in COPD: A systematic review of randomized controlled trials [published online February 7, 2019] Pulmonology. doi: 10.1016/j.pulmoe.2018181818.