Proforma for Regestration of Subjects for Dissertation
RAJIVGANDIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGESTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of thecandidate and
address / Mohan babu .R
Natarajer kovil street
Keela ulur
Orathanadu
Thanjavur
Tamil nadu 614904
2 / Name of the institution / Goutham college of physiotherapy
3 / Course study and subjects / Master of physiotherapy
Cardio respiratory and intensive care
4 / Date of admission / 06/06/2007
5 / Title of the topic
EFFICACY OF INCENTIVE SPIROMETRY OVER CONVENTIONAL BREATHING EXERCISE IN INSPIRATORY MUSCLE TRAINING TO ALLEVATING DYSPNEA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
A COMPARATIVE STUDY
BRIEF RESUME OF THE INTENTED WORK
6.1 NEED OF STUDY:
The shortness of breathing experienced by subjectchronic obstructive pulmonary disease
at rest or during activities of daily living can lead to a progressive deterioration in functional capacity, and possible isolation at home. As the inactivity progress. Cardiovascular function and skeletal Muscle mass decline. Thedeterioration in fitness and strength creates a vicious cycle that leads to greater breathlessness with exertion, muscular fatigue, an eventual loss of functional independence. therefore, intervention need to control dyspnea in patient with COPD
Respiration in COPD subjects is severly reduced due to the weakness of the inspiratory muscle andsurround musculature. Strengthening of the inspiratory muscles might improve aeration and thoracic expansion and decrease dyspnea in COPD subjects. The incentive spirometry might train the inspiratory muscle reduce dyspnea in COPD subjects
However The purposes of this study is to determine whether physical performance, quality of life,and dyspnea with activities of daily living improved followingboth short-term and long-term pulmonary rehabilitation across COPD patient to examinethe differences in these parameters between men and women, andto determine whether the effect of incentive spirometry in inspiratory muscle training is much better over the conventional breathing exercise treating dyspnea in patients with chronic obstructive pulmonary disease
HYPOTHESIS
EXPRIMENTAL HYPOTHESIS
There will be a significant difference between inspiratory muscle training by incentive spirometry and conventional breathing exercise in alleviating dyspnea in patients with chronic obstructive pulmonary disease
NULL HYPOTHESIS
There will not be a significant difference between inspiratory muscle training by incentive spirometry and conventional breathing exercise in alleviating dyspnea in patients with chronic obstructive pulmonary disease
6.2 REVIEW OF LITERATURES
WHO (1999) “COPD is a disease state characterized by airflow limitation
that is not fully reversible. The airflow limitation is usually both progressive and associated
with an abnormal inflammatory response of the lungs to noxious particles or gases”.
The American Thoracic Society (1999) stated that subjective experience of
breathing discomfort in reduce quality of life and reduce physical endurance and strength
of inspiratory muscle.
AmericanCollege ofSports Medicine (2002The Breathing difficulty in persons with COPD can be improved by incentive spirometry light to moderate intensity 10 to15 minutes a day. Controlled breathing exercise can reduce dyspnea associated with COPD by improving inspiratory muscle endurance and strength,
as well as breathing efficiency and tolerance.
Rudolf (2001). In his study Persons with COPD who follow an individualized progressive exercise program can often increase their functional capacity by reducing dyspnea after six weeks of training of spirometry
Inal-Ince Det al(2005) on his studies The dyspnea in subjects with servere chronic obstructive pulmonary disease (COPD) and healthy subjects. The subjects performed pulmonary function tests and 6-minute walk test (6MWT). As per and post-testwas taken using the Borg score and heart rate was taken. Functional dyspnea was measured using Medical Research Council dyspnea scale. The distance and external work of 6MWT were lower in severe COPD subjects than health subjects. Here the researcher concluded that the dyspnea in COPD subjects is reduced
Rudolph H.Dressendorfer (2002)A randomized controlled trial of prescribed exercise involving inspiratory muscle trainingwas conducted in COPD subjects. The subjects improved their physical capacity, greater independence in daily activities, and improved quality of life. Decrease in breathless, and reduced fatigue was also observed.
Hodgev VA et al (2003). On his studies in The cardiovascular and dyspnea responses to Six Minute walk Test and Shuttle Walking Distance test in subjects with Chronic obstructive pulmonary disease They stated that the SiMinute Walk Test and shuttle Walking Distance test showed similar correlation coefficients with the Baseline Dyspnea Index, the clinical Symptom Scale andthe mean pulmonary artery pressure, Doppler echocardiograph
with similar response in more limitedfunctional capacity of COPD subject. They concluded
that cardiovascular and dyspnea response by shuttle Walking Distance test is greater than
Six Minute Walk Test but not statistically significant
Adolph maulerstudyon 2001 in spirometry stated that targeted IMT relieves dyspnea,increases the capacity to walk, and improves in COPD patients.
Ernst ( 2002) in his study onthe effectiveness of breathing techniques used in asthma is
Four independent literature searches identified six randomized controlled trails.
Collectively the data imply that diaphragmatic breathing techniques may have some potential
in benefiting subjects with COPD and concluded that too few studies have been carried
out to explain the possible role of breathing exercise in pulmonary rehabilitation.
Holloway E et al (2004).the evidence for the efficacy of breathing exercise in the treatment of subjects with asthma Reviews were taken from the CochraneGroup trails register, Cochrane complementary medicine field trails register, World congress of Physical therapy proceedings (1995) were journals which used breathing exercises
in the treatment of COPD was included.
M Vitacca et al (1998)The study on the impact of deep diaphragmatic breathing in severe hypersonic chronic obstructive pulmonary disease subjects by comparison of natural breathing and deep diaphragmatic breathing showed with anincrease in transcutaneous partial pressure of oxygen and significant decreases intranscutaneous partial pressure of carbon dioxide. They concluded that severe chronic obstructive pulmonary disease subjects with chronic hypercapnia
deep diaphragmatic breathing is associated with improvement of blood gases at
the expenseof a greater inspiratory muscles loading.
Gulmans VA et al (1996) in his study The reproducibility , validity and criterion for a 6 – minute walking test with children having cystic fibrosis, which simulated normal childhood activities is The subjects performed two standardized 6 – minute walking
tests with 1 week between tests. There was no significant difference between the
two walking distance and there was a strong correlation between the two walking distance
reached by the individuals. Thus they concluded that the 6 – minute walking tests is valid
and useful test to assess exercise tolerance and endurance.
Kendrick KR et al (2000) he made a study on The effectiveness of the modified Borg Scale in assessing the degree of dyspnea in subjectswith COPD and asthma. The MBS was
added to the treatment protocol for management of subjects with COPD.
102 males with COPD and asthma presented with a chief complaint of dyspnea
were selected for the study. The MBS scores decreased as the peak flow measurement
increased indicating the relief of dyspnea. This study suggests that the MBS is a valid
and reliable assessment tool for dyspnea.
Worth H (2002)in his study on The effect of subject with dyspnea in COPD . The evaluation
of numerous structured education programs for adult asthmatics revealed an increase of quality
of life of the educated subjects, reduced morbidity with less asthmatic attacks, a decrease
of emergency visit sick leaves days and hospitalization due to asthma.
6.3 Objectives of the study
- To find out the effects of incentive spirometry in inspiratory
patients with chronic obstructive pulmonary disease
- To find out the effects of conventional breathing exercise to
with chronic obstructive pulmonary disease
- To compare the effects of incentive spirometry over conventional
dyspnea
7 / Material and methods:
7.1 source of data
30 patients with COPD from age group of 30 to 50 years will be
Selected from narayana hospital Bangalore. All subjects will be considered
for the study only after they sign a clinically approved consent form
Inclusion Criteria
- Subjects with moderate to severe COPD with grade 3 dyspnea
- Subjects undergoing medications for COPD
- Subjects with COPD with grade 3 dyspnea of age group between 30 – 50 years of both genders.
Subjects associated with
- Cardio vascular conditions liable to be aggravated by exercises
- Unstable angina
- Recent myocardial infarction
- Significant aortic stenosis
- Significant aortic aneurism
- Uncontrolled hypertension
- Restrictive lung condition
- Spinal and thoracic musculoskeletal disorders
- Intermittent claudication
- Subjects who are not able to cooperate with treatment programme.
- Peak expiratory flow rate –measuring through peak flow meter
- Rate of perceived exertion (dyspnea)-10-point Borg scale
- Chest expansion through inch tape measurement
- Six minute walking distance test
7.3Intervention to conducted on participants(methodology)
30 subjects clinically diagnosed as chronic obstructive pulmonary
disease with grade 3 dysnea will be selected based on inclusion and
exclusion criteria by purposeful randomized sampling method and divided
into two groups such as
Group A and Group B consisting of 15 subjects each
The baseline measurements of above mentioned parameters will be
recorded before the intervention
Study design
This study is based on experimental study design
Experimental Group A
15patients will be treated with incentive spirometry likeinspiration
through spirometry and hold the breath for one second then exhalation this will be
lasts for 5 -10 minutes two times per day for four week
Experimental Group B :
15patients will be treated with Diaphragmatic breathing like inspiration
through nose hold the breath one second and exhale through mouth
5-10 minutes/session and it will beContinued twice a day for four weeks.
The total treatment period will be four weeks. and all the parameters will be
Measured and recorded at the end of four week
Pre and post test data will be analysed statistically to assess the effects
ofinspiratory muscle training by incentive spirometry over the conventional
breathing exercise to alleviate dyspnea in patients with COPD
7.4ETHICAL CLEARANCE:
Ethical permission for the study Will be obtained from
The institution where the subjects belong. Informed and written consent will be taken from
guardians of each subjects to participate in this study
statistical analysis:
Effect of inspiratory muscle training within the
group will be statistically analyzed using dependent t’ test and comparative effect of
incentive spirometry and conventional breathing exercise will be statistically analyzed
using independent t’ test
9 / Signature of the candidate:
10 / Remarks of the guide
11 / Name and designation of
(IN BLOCK LETTERS)
11.1 Guide
11.2 Signature
11.3 Co-guide(If any)
11.4 Signature
11.5Head of the department
11.6 Signature
12 / 12.1 Remarks of the principal
12.2 Signature