Comparison of Respiratory Proprioceptive Neuromuscular Facilitation and Segmental Breathing on Pulmonary functions, Dyspnoea and Exercise Tolerance in COPD Patients: A Comparative Study

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease marked by airflow limitation, destruction of lung parenchyma and other associated respiratory symptoms (e.g., dyspnoea and coughing). Pathological changes and symptoms do not appear altogether, symptoms may not appear but pathological changes are likely to be present. Segmental breathing and Proprioceptive Neuromuscular Facilitation (PNF) techniques are both effective techniques in improving pulmonary functions in COPD patients. Aim: To compare PNF and Segmental breathing with respect to pulmonary functions to relieve dyspnoea and improve exercise capacity in COPD patients. Materials and Methods: This was a comparative study conducted from July 2020 to June 2021 at Department of Physiotherapy, SGT University, Gurugram, Haryana, India. On 30 in-patient aged between 40-60 years with Forced Expiratory Volume in 1st second/Forced Vital Capacity (FEV1/ FVC) < 0.7, hospitalised clinically stable patients . Out of these, 15 were allocated in the segmental breathing group and another 15 participants were allocated into the respiratory PNF group through the sealed envelope. The session was of 10-15 minutes under the protocol of 18-20 repetitions of each technique in segmental breathing and respiratory PNF in either respective group. The dyspnoea was assessed by Modified Borg Scale, pulmonary functions was done with spirometry, followed by the 6-Minute Walk Test (6-MWT). The data was statistically analysed using Statistical Package for Social Sciences(SPSS) version 24.0. Paired t-test was used to compare the means of measurements within the groups. The independent t-test was used to compare the means of all the variables between the groups. Results: Both of these techniques improved SpO2 (change in mean from 81.27 to 86.20 and 82.13 to 90.67 in segmental and PNF group, respectively) and relieve dyspnoea post-exertion (8.33 to 6.60 and 8.0 to 5.67 in segmental and PNF groups) within 1-week of intervention (p < 0.01). There was improvement seen in pulmonary functions (FEV1 from 0.87 to 0.95 and 0.78 to 1.02 in segmental and PNF groups) and exercise tolerance (6- Minute Walk Test (MWT) from 149.47 to 204.80 and 151.77 to 242.20 in segmental and PNF groups) as well. And out of both, respiratory PNF is more efficient in improving pulmonary function, dyspnoea and exercise tolerance in a week (p<0.01) which makes the master improvement and pulmonary rehabilitation can proceed with further advancement. Conclusion: Segmental breathing and respiratory PNF are effective techniques for patients with COPD admitted to hospital whose modified Borg’s dyspnoea score is higher even at rest and intolerant to physical exercise and peripheral capillary oxygen saturation is lower than 88%.

Keywords

• breathlessness
• exercise capacity
• lung functions
• spirometry
• chronic obstructive pulmonary dysfunction