# Adding Manual Therapy to a Respiratory-Rehabilitation Program in Patients with Respiratory Disorders: A Systematic Review and Meta-Analysis with a Meta-Regression

## TL;DR

Adding manual therapy to respiratory rehabilitation slightly improves exercise capacity but not lung function in patients with respiratory disorders.

## Contribution

This study provides the first meta-analysis and meta-regression on the effects of adding manual therapy to respiratory rehabilitation.

## Key findings

- Manual therapy added to rehabilitation improved 6-minute walk test results with a small clinical effect.
- No significant improvement in pulmonary function parameters (FEV1 and FVC) was observed.
- Intervention time of manual therapy was not significantly correlated with improvements in any outcome.

## Abstract

The main aim of this study was to assess the effects of adding MT to a Respiratory Rehabilitation (RR) program in patients with Respiratory Disorders (RD).

A systematic search was carried out in PubMed, EMBASE, CINAHL, PEDro and Google Scholar (February 1st 2023). The outcome measures were pulmonary function parameters (FEV1 and FVC); and exercise capacity, through the 6-minute walk test (6-MWT). Standardized mean differences (SMDs) and 95% confidence intervals were calculated and were pooled in a meta-analysis with a random effects model.

In total, 6 studies were included. Regarding the pulmonary function parameters, no significant effects were found in favor of adding MT to a RR program. However, the meta-analysis showed a significant improvement of 6-MWT when MT were added to a RR with a small clinical effect (n = 6, SMD = –0.55 (–1.01 to –0.09)). Lastly, the meta-regression analysis revealed that the intervention time of MT was not significantly correlated with the improvement of FEV1 (R2 = 52.49%, P = .16), FVC (R2=4.22%, P = .70), or 6-MWT (R2=9.95%, P = .62).

There is low-quality evidence that adding MT to an RR program can improve the exercise capacity in patients with RD. However, MT plus RR showed no effect on pulmonary function parameters, also with low-quality evidence.