P. Maheshwari1, H. Vaish1, M. Verma1, J. Kishan2
1Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar ( Deemed to be University), Mullana, Ambala, India, 2Maharishi Markandeshwar Institute of Medical Science and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, India

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an acute episode which deteriorates the respiratory symptoms and result in alteration of medication. Through a series of pathological events, AECOPD consequently result into decline in pulmonary function which affects the overall quality of life of an individual. Chest and upper limb proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapeutic interventions which works on principle of facilitation, inhibition, relaxation and muscular contraction and has been found to be effective in different conditions.      

Purpose: To evaluate the effectiveness of chest and upper limb PNF against conventional chest physiotherapy on pulmonary function parameter and quality of life in patients with AECOPD.

Methods: It was a two group pretest-posttest randomized single blinded clinical trial recruiting 30 participants aged 40-70 years ( both males and females) diagnosed with AECOPD. The participants were randomized by simple lottery method. Experimental group (N=15) received chest PNF (intercostal stretch, abdominal co-contraction and anterior basal lift) and upper limb PNF (diagonal pattern of flexion and extension) and control group (N=15) received conventional chest physiotherapy (chest vibration, pursed lip breathing and diaphragmatic breathing) treatment for 4 consecutive days for the duration of 30 minutes; both the groups continued their prescribed pharmacological treatment. The outcomes variables were spirometry (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC and peak expiratory flow rate), chest wall expansions (axillary, nipple and xiphisternal level), quality of life, respiratory rate, pulse rate and oxyhaemoglobin saturation. The outcome variables were measured at baseline and at the end of fourth day. The data was found to follow a normal distribution when assessed by Shapiro-Wilk test (p≥0.05). Between group analysis and within group analysis was performed by independent t-test and paired t-test respectively.

Results: A total of 30 participants completed the study. The mean + SD age of the participants was  56.80 + 7.61. The result showed that there was no significant difference in between group analysis at baseline representing that the data was homogeneous (p>0.05). Chest and upper limb PNF was significantly effective in improving peak expiratory flow rate (p=0.03), chest wall expansion at axillary level (p=0.002) and xiphisternal level (p=0.0001), pulse rate (p=0.0001), respiratory rate (p=0.001) and oxyhaemoglobin saturation (p=0.02) in comparison to conventional physiotherapy. There was no significant effect of chest and upper limb PNF on quality of life in between group analysis (p >0.05). 

Conclusion(s): Chest and upper limb PNF was effective in improving flow rate, chest wall expansion at axillary and xiphisternal level, oxyhaemoglobin saturation and reducing pulse rate and respiratory rate in comparison to conventional chest physiotherapy in patients with AECOPD.

Implications: The chest and upper limb PNF would be helpful in improving pulmonary function; could result in better chest wall excursion; mobilization of sputum into larger airways would result in airway clearance and thus, would help to improve symptoms in patient with AECOPD. Chest and upper limb PNF could be incorporated in the rehabilitation protocol for the treatment of patients with AECOPD. 

Funding, acknowledgements: No specific financial support was obtained for this study

Keywords: Chronic obstructive pulmonary disease, Proprioceptive neuromuscular facilitation, Respiratory function

Topic: Cardiorespiratory

Did this work require ethics approval? Yes
Institution: Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India
Committee: IEC of Maharishi Markandeshwar (Deemed to be University)
Ethics number: MMDU/IEC/1473

All authors, affiliations and abstracts have been published as submitted.

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