[논문]Effects of Rib Cage Joint Mobilization Combined with Diaphragmatic Breathing Exercise on the Pulmonary Function and Chest Circumference in Patients with Stroke

Kim, Ayeon; Song, Youngwha; Hong, Geurin; Kim, Dajeong; Kim, Soonhee

doi:10.20540/jiaptr.2020.11.3.2113

Effects of Rib Cage Joint Mobilization Combined with Diaphragmatic Breathing Exercise on the Pulmonary Function and Chest Circumference in Patients with Stroke 원문보기

Journal of international academy of physical therapy research, v.11 no.3, 2020년, pp.2113 - 2118

Kim, Ayeon (Department of Physical Therapy, Yongin University) , Song, Youngwha (Department of Physical Therapy, Dongnam Health University) , Hong, Geurin (Department of Physical Therapy, Yongin University) , Kim, Dajeong (Department of Physical Therapy, Yongin University) , Kim, Soonhee (Department of Physical Therapy, Yongin University)

Abstract ▼ AI-Helper

Background: Patients with stroke have core muscle weakness and limited rib cage movement, resulting in restrictive lung disease. Objectives: To examine the comparison of effects of rib cage joint mobilization combined with diaphragmatic breathing exercise and diaphragmatic breathing exercise on the pulmonary function and chest circumference in patients with stroke. Design: A cluster randomized controlled trial. Methods: Twenty-four patients were randomly assigned to an experimental group (rib cage joint mobilization combined with diaphragmatic breathing exercise group) and control group (diaphragmatic breathing exercise group). Patients in the experimental group underwent rib cage joint mobilization for 15 min and diaphragmatic breathing exercise for 15 min. The control group underwent diaphragmatic breathing exercise for 30 min. Both groups underwent exercise thrice a week for 4 weeks. The pulmonary function and chest circumference were measured using the MicroLab spirometer and a tape measure, respectively. Results: After the intervention, the pulmonary function and chest circumference significantly improved in both groups. These improvements were significantly higher in the experimental group than those in the control group. Conclusion: Rib cage joint mobilization combined with diaphragmatic breathing exercise improves pulmonary function and chest circumference in patients with stroke.

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문제 정의

Repeated diaphragmatic breathing exercises helped to improve posture by relaxing the rigid rib cage and reducing the kyphosis of the spine.²¹ This is considered to be the result of the positive effects on the activity of the respiratory muscles necessary for the respiratory function, ability to expand the rib cage, and improvement of the respiratory function, consistent with the results of this study. Park and Park²² showed that Maitland joint mobilization applied to patients with chronic stroke was effective in the pulmonary function and chest circumference.
This study confirmed the changes in Maitland joint mobilization and diaphragmatic breathing exercises applied to the pulmonary function and chest circumference in patients with stroke with reduced respiratory function. As a result of the study, both experimental and control groups showed significant differences between the pulmonary function and chest circumference before and after intervention.

제안 방법

All assessments were performed by an physical therapist unrelated to this study. The evaluator was thoroughly familiar with the evaluation method and blinded to the study group prior to the evaluation.
In transverse joint mobilization, both sides of the area where low mobility was recorded were compared and selected, and then, the thumb was placed in the transverse direction.⁷ Joint mobilization was applied in grade 3 according to the Maitland classification, and the intervention time was 4 sets, 5 minutes per set, and the rest time was 1 minute, for a total of 23 minutes.
Therefore, it was confirmed through this study that the diaphragmatic breathing exercise combined with rib joint mobilization was more significant for the pulmonary function and chest circumference. Since this study included patients with stroke for more than 6 months after the onset and we studied some stroke patients, future studies require various additional evaluation methods. It would be necessary to compare the differences between the methods.
The study was an assessor-blinded and Cluster randomized trial. A total of 24 adult patients who were admitted to the B hospital participated in this study.
¹⁴ Pulmonary function measurements were conducted in accordance with the pulmonary function test guidelines. The subjects sat on a chair with a backrest, looked at the front, and exhaled air into the spirometer after the maximum possible exhalation (to maintain exhalation for 6 s). The measurement variables were the peak expiratory flow (PEF), amount of effort exhalation, and forced expiratory volume in 1 s (FEV1).

대상 데이터

The study was an assessor-blinded and Cluster randomized trial. A total of 24 adult patients who were admitted to the B hospital participated in this study. These patients were hospitalized for stroke under the diagnosis of a rehabilitation medicine doctor at a nursing home hospital in Gyeonggi-do.
A total of 24 adult patients who were admitted to the B hospital participated in this study. These patients were hospitalized for stroke under the diagnosis of a rehabilitation medicine doctor at a nursing home hospital in Gyeonggi-do. The intervention period was conducted thrice a week for 30 min for four weeks.
Three physical therapists, including researchers, with >3 years of experience in neurological physical therapy participated in the intervention.

데이터처리

The independent sample t-test and chi-square test were used for the general characteristics of the subjects. A paired t-test was performed for the effects of exercise. The within-subject factor was time (before and after the test), whereas the between-subject factor was group-bytime (experimental and control groups).
Thus, parametric tests were used. The homogeneity test between the two groups was performed using an independent t-test. The independent sample t-test and chi-square test were used for the general characteristics of the subjects.
The within-subject factor was time (before and after the test), whereas the between-subject factor was group-bytime (experimental and control groups). When significant differences were the interactions or main effects (group-by-time), t-test was used. The statistical significance level was set at α=.

이론/모형

The homogeneity test between the two groups was performed using an independent t-test. The independent sample t-test and chi-square test were used for the general characteristics of the subjects. A paired t-test was performed for the effects of exercise.

성능/효과

After four weeks of intervention, all groups experienced significant increases in the pulmonary function and chest circumference. The pulmonary function and chest circumference were significantly different between the two groups (Tables 2 and 3).
In conclusion, rib cage joint mobilization with diaphragmatic breathing exercise improved FEV1, FVC, PEF, and chest circumference in patients with stroke. In addition, rib cage joint mobilization combined with diaphragmatic breathing exercise was more effective for FEV1, PEF, and upper chest circumference than only diaphragmatic breathing exercise.
The activation of the parasympathetic nerves and suppression of the sympathetic nerves have created an environment of increased rib cage mobility and diaphragm contraction. Therefore, it was confirmed through this study that the diaphragmatic breathing exercise combined with rib joint mobilization was more significant for the pulmonary function and chest circumference. Since this study included patients with stroke for more than 6 months after the onset and we studied some stroke patients, future studies require various additional evaluation methods.

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