BACKGROUND: Clinical trials have demonstrated positive correlation between pulmonary function and chest wall expansion in COPD. Decrease in chest wall expansion in patients with COPD compromises rib cage mobility and functional length of respiratory muscles that ultimately jeopardize the efficacy and function of respiratory system. METHOD: Thirty male adults (mean age 74.97 +/- 6.29) suffered with severe COPD were randomly allocated to either experimental group (chest wall mobilizations) or control group. Both groups received standardized education and walking exercise (twice/week) for 6 weeks. Patients in experimental group received additional chest wall mobilizations that include stretching and joints mobilization. Pulmonary function, respiratory muscle strength, thoracic excursion, cervical and thoracic range of movement were evaluated at baseline, post-program and at 3-month follow-up. RESULTS: There were significantly greater improvements in respiratory muscle strength, thoracic excursion and thoracic range of movement (p < 0.01) except thoracic flexion. Lower thoracic excursion is strongly associated with increase in maximum inspiratory pressure (beta 13.64, p < 0.001) and maximum expiratory pressure (beta 16.23, p < 0.001). Thoracic range of movement especially extension (p < 0.001) and bilateral rotation (p < 0.01) exhibit a strong relationship with increase in lower thoracic excursion (adjusted R2 0.876) as shown in multiple regression analysis. CONCLUSION: Additional chest wall mobilization in the rehabilitation of patients with COPD is likely to enhance thoracic extension and rotation which increase lower thoracic excursion. This significant improvement in chest expansion capacity allows respiratory muscles to work at an optimal functional length which result in greater respiratory muscle strength in patients with severe COPD.

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