• Rocha H
• Souza R
• Rocha T
• Alcoforado L
• Brandão DC
• de Andrade AD

• Affiliation / Estacio College. Department of Physical Therapy
• Affiliation / Federal University of Paraíba. Department of Statistics
• Affiliation / Federal University of Pernambuco. Department of Physical Therapy
• Affiliation / London Health Science Centre. Verspeeten Family Cancer Centre
• Affiliation(G) / Brazil / Bahia / Juazeiro
• Affiliation(G) / Brazil / Paraíba
• Affiliation(G) / Brazil / Pernambuco / Recife
• Affiliation(G) / Canada / Ontario / London
• Diaphragm
• Musculoskeletal Manipulations
• Pulmonary Disease, Chronic Obstructive
• Respiratory Function Tests

Objective: The purpose of this study was to evaluate the feasibility of a study to measure the effects of a protocol combining Rib mobilization technique (RMT) and diaphragm release technique (DRT) in patients with chronic obstructive pulmonary disease (COPD), investigating its impact on diaphragmatic mobility, pulmonary function, and functional capacity.

Methods: A clinical trial including 14 patients divided into 2 groups: RMT+DRT and DRT. Six intervention sessions were conducted, with assessments performed at Pre, Post 1, Post 6, and Follow-up time points. Outcomes included diaphragmatic mobility (ultrasound), thoracoabdominal kinematics (optoelectronic plethysmography), maximal respiratory pressures (manovacuometry), functional capacity (six-minute walk test [6MWT]), and perceived improvement (patients’ global impression of change scale).

Results: The protocol was well tolerated, with strong compliance and no adverse events reported. The RMT+DRT group demonstrated a clinically relevant improvement in diaphragmatic mobility (19.58 mm) and in the 6MWT distance (27.23 m), both exceeding the clinically significant difference thresholds. A relative reduction in maximal expiratory pressure was observed in the RMT+DRT group. No statistically significant differences were observed between groups for thoracoabdominal kinematics and maximal inspiratory pressure.

Conclusion: This feasibility study suggests that a study of the combination of rib mobilization and diaphragmatic release is a feasible and well-tolerated intervention for patients with COPD, and may have a positive impact on respiratory mechanics and functional capacity. The findings provide a basis for sample size calculation and protocol refinement in future clinical trials to confirm its therapeutic effects.

Author Keywords: Diaphragm; Respiratory Function Tests; Pulmonary Disease; Chronic Obstructive; Musculoskeletal Manipulations

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