Does manual therapy provide additional benefit to breathing retraining in the management of dysfunctional breathing? A randomised controlled trial

Introduction: Dysfunctional breathing (DB) is a respiratory disorder associated with significant patient morbidity. It is characterized by unexplained breathlessnes and an abnormal breathing pattern, with combinations of erratic breathing, episodic breath holding and sighing, or hyperventilation. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy has been used as a treatment component; but no evidence exists to validate its use. We sought to investigate the effects of manual therapy in addition to breathing retraining in patients with DB. Methods: 60 subjects with primary DB were randomized into either breathing retraining (standard treatment; n=30) or breathing retraining plus manual therapy (intervention; n=30). Both groups received standardised respiratory physiotherapy: DB education; breathing retraining; home regime; audio disc. Subjects in the intervention group received additional manual therapy. Results: No significant difference was found between groups for the primary outcome Nijmegen score or any secondary outcome measures (Table 1). Table 1. Analysis of primary and secondary outcomes Measurement Treatment Effect (95% CI) p value Nijmegen score 2.8 (–1.1 to 6.6) 0.16 HAD Anxiety 0.6 (–0.8 to 2.0) 0.39 HAD Depression 0.3 (–0.6 to 1.2) 0.51 Breath hold 1.4 (–2.0 to 4.8) 0.41 FEV1 0.02 (–0.04 to 0.09) 0.45 FVC 0.01 (–0.09 to 0.1) 0.91 Conclusion: Breathing retraining is the primary management for patients with DB. Our results suggest the additional use of manual therapy provides no further benefit and cannot be recommended in clinical practice.