The Journal of the American Osteopathic Association, 2006/08, 106(8):474. doi: 10.7556/jaoa.2006.106.8.471, type of study: ,ppt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

chronic obstructive pulmonary disease [31]
COPD [40]
LPT [27]
lymphatic pump technique [43]
pretest posttest design [241]

Abstract:

Hypothesis: There will be no significant difference between operators using a thoracic lymphatic pump technique in persons with COPD. Methods: A standard description of the thoracic lymphatic pump technique was developed. Operators A and B reviewed and practiced the protocol several times together at the onset of a study testing the effects of manipulation techniques on pulmonary function parameters in persons with COPD. Pulmonary function parameters were measured at baseline and 30 minutes after a five-minute session in which this standardized thoracic lymphatic pump technique was applied. Subjects were randomly assigned. Results: Each operator treated 12 subjects. The mean residual volume (RV) decreased by 243 ml ±281 (standard deviation) for operator A, but increased by 144 ml ±455 for operator B, P=0.0094. The mean total gas volume (TGV) decreased by 214 ml ±150 for operator A and increased by 88 ml ±391 for operator B, P=0.0193. The mean total lung capacity (TLC) decreased by 258 ml ±256 for operator A, and increased by 99 ml ±376 for operator B, P=0.0153. The mean forced expiratory volume in one second (FEV1) decreased by 85 ml ±0.11 for operator A and decreased by 20 ml ±97 for operator B, P=0.0458. Post study review found differences in how operators A and B interpreted and used the protocol technique during the study. Operator A used progressive compressive forces on exhalation, with slow release on inhalation, while operator B used steady pumping throughout, without compressive forces. Conclusion: The “compressive” operator A version of the technique reduced lung volumes in persons with COPD, while version B did not. Differences in how techniques are applied can lead to significant differences in physiologic effects. This highlights the need for stricter protocol standardization in research, and the need to study different versions and applications of osteopathic techniques. Lines of research organized in this manner will begin to sort out how to perform OMT in order to maximize physiological effects.