Key result
Visual ultrasound biofeedback moderately increases diaphragm thickness during breathing exercises compared to verbal feedback alone.
Why the study?
Whether providing visual biofeedback using real-time rehabilitative ultrasound imaging enhances the acquisition and retention of diaphragm muscle recruitment during exercise was unknown.
Does visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) improve diaphragm muscle recruitment during breathing exercises in healthy subjects?
RCT (n=30)
Double-blind
Computer-generated block-randomization sequence
No
Does visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) improve diaphragm muscle recruitment during breathing exercises in healthy subjects?
Standardized Mean Difference: 0.764
Absolute Event Rate: 17.31% vs -5.47%
p-value: p=0.050
Visual biofeedback using real-time ultrasound imaging may provide a medium effect size improvement in diaphragm muscle recruitment during breathing exercises in healthy subjects, though retention effects did not persist at one week.
Supports RUSI biofeedback for acute diaphragm recruitment in healthy adults; extends Level 2 evidence for respiratory muscle training.
Objective: To determine if the provision of visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) enhances the acquisition and retention of diaphragm muscle recruitment during exercise.Design: Two group pretest posttest design.Methods: Thirty healthy subjects were randomly assigned to the verbal feedback group (VG, n=15) or the visual and verbal feedback group (VVG, n=15).The VG performed breathing exercises 10 times with verbal feedback, and the VVG also performed breathing exercises 10 times with verbal feedback and visual feedback with the use of RUSI to measure changes in diaphragm thickness (DT).For DT, the mid-axillary lines between ribs 8 and 9 on both sides were measured in standing, and then the chest wall was perpendicularly illuminated using a linear transducer with the patients in supine to observe the region between rib 8 and 9 and to obtain 2-dimensional images.DT was measured as the distance between the two parallel lines that appeared bright in the middle of the pleura and the peritoneum.After one week, three repetitions (follow-up session) were performed to confirm retention effects.Intra-and between-group percent changes in diaphragm muscle thickness were assessed.Results: In the VVG, the intervention value had a medium effect size compared to the baseline value, but the follow-up value decreased to a small effect size.In the between-group comparisons, during the intervention session, the VVG showed no significant effect on percent change of DT but had a medium effect size compared to the VG (p=0.050,Cohen's d=0.764).During the follow-up session, retention effect did not persist (p=0.311,Cohen's d=0.381).Conclusions: RUSI can be used to provide visual biofeedback and improve performance and retention in the ability to activate the diaphragm muscle in healthy subjects.Future research needs to establish a protocol for respiratory intervention to maintain the effect of diaphragmatic breathing training using RUSI with visual feedback.
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Cho et al. (2018) conducted an RCT in Healthy subjects (n=30). Visual biofeedback using real-time rehabilitative ultrasound imaging (RUSI) plus verbal feedback vs. Verbal feedback only was evaluated on Percent change of diaphragm thickness during the intervention session (Cohen's d 0.764, p=0.050). Visual biofeedback using real-time ultrasound imaging combined with verbal feedback produced a medium effect size (Cohen's d 0.764, p=0.050) on increasing diaphragm thickness during breathing exercises compared to verbal feedback alone.
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