***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background The use of manipulation has long been advocated in the treatment of chronic obstructive pulmonary disease ( COPD ) , but few r and omized controlled clinical trials have measured the effect of manipulation on pulmonary function . In addition , the effects of individual manipulative techniques on the pulmonary system are poorly understood . Therefore , the purpose of this study was to determine the immediate effects of four osteopathic techniques on pulmonary function measures in persons with COPD relative to a minimal-touch control protocol . Methods Persons with COPD aged 50 and over were recruited for the study . Subjects received five , single-technique treatment sessions : minimal-touch control , thoracic lymphatic pump ( TLP ) with activation , TLP without activation , rib raising , and myofascial release . There was a 4-week washout period between sessions . Protocol s were given in r and om order until all five techniques had been administered . Pulmonary function measures were obtained at baseline and 30-minutes posttreatment . For the actual pulmonary function measures and percent predicted values , Wilcoxon signed rank tests were used to test within-technique changes from baseline . For the percent change from baseline , Friedman tests were used to test for between-technique differences . Results Twenty-five subjects were enrolled in the study . All four tested osteopathic techniques were associated with adverse posttreatment changes in pulmonary function measures ; however , different techniques changed different measures . TLP with activation increased posttreatment residual volume compared to baseline , while TLP without activation did not . Side effects were mild , mostly posttreatment chest wall soreness . Surprisingly , the majority of subjects believed they could breathe better after receiving osteopathic manipulation . Conclusion In persons with COPD , TLP with activation , TLP without activation , rib raising , and myofascial release mildly worsened pulmonary function measures immediately posttreatment relative to baseline measurements . The activation component of the TLP technique appears to increase posttreatment residual volume . Despite adverse changes in pulmonary function measures , persons with COPD subjectively reported they benefited from osteopathic manipulation Background Patients with COPD present a major recruitment of the inspiratory muscles , predisposing to chest incoordination , increasing the degree of dyspnea and impairing their exercise capacity . Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity ; however , the systemic effects of stretching remain unknown . Objective The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD . Design This study was a r and omized and controlled trial . Participants A total of 30 patients were allocated to a treatment group ( TG ) or a control group ( CG ; n=15 , each group ) . Intervention The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching . Both groups performed 24 sessions ( twice a week , 12 weeks ) of aerobic training . Evaluations Functional exercise capacity ( 6-minute walk test ) , thoracoabdominal kinematics ( optoelectronic plethysmography ) , and respiratory muscle activity ( surface electromyography ) were evaluated during exercise . Analysis of covariance was used to compare the groups at a significance level of 5 % . Results After the intervention , the TG showed improved abdominal ( ABD ) contribution , compartmental volume , mobility , and functional exercise capacity with decreased dyspnea when compared with the CG ( P<0.01 ) . The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG ( P<0.001 ) . Conclusion Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional exercise capacity with decreased dyspnea in patients with COPD . These effects are associated with an increased efficacy of the respiratory muscles and participation of the ABD compartment Background Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain . However , it is unclear whether spinal manipulation needs to be specific to a vertebral level . Objective The purpose of this study was to analyze the immediate effects of a single , region-specific spinal manipulation defined during the clinical examination versus a single non – region-specific spinal manipulation ( applied on an upper thoracic vertebra ) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment . Design This was a 2-arm , prospect ively registered , r and omized controlled trial with a blinded assessor . Setting The study was conducted in an outpatient physical therapy clinic in Brazil . Patients The study participants were 148 patients with chronic nonspecific low back pain ( with pain duration of at least 12 weeks ) . R and omization The r and omization schedule was generated by an independent statistician and was concealed by using consecutively numbered , sealed , opaque envelopes . Interventions A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non – region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group . Measurements Pain intensity was measured by a 0 to 10 numeric pain rating scale . Pressure pain threshold was measured using a pressure algometer . Limitations It was not possible to blind the therapist and participants . Results A total of 148 patients participated in the study ( 74 in each group ) . There was no loss to follow-up . Both groups improved in terms of immediate decrease of pain intensity ; however , no between-group differences were observed . The between-group difference for pain intensity and pressure pain threshold were 0.50 points ( 95 % confidence interval=−0.10 to 1.10 ) and −1.78 points ( 95 % confidence interval=−6.40 to 2.82 ) , respectively . No adverse reactions were observed . Conclusion The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non – region-specific manipulation techniques in patients with chronic low back pain CONTEXT Osteopathic manipulative treatment ( OMT ) has long been advocated for patients with respiratory disorders , but little definitive evidence exists to support its use in this population . OBJECTIVE To investigate the immediate effect of OMT on pulmonary function parameters in elderly subjects with chronic obstructive pulmonary disease . METHODS Subjects aged 65 years or older with a forced expiratory volume in 1 second to forced vital capacity ratio of less than 70 % were recruited and r and omly assigned to receive either OMT or sham therapy . The OMT protocol consisted of seven st and ardized osteopathic manipulative techniques , while the sham therapy protocol comprised light touch applied to the same anatomic regions and for the same duration ( 20 min ) . All subjects received baseline and posttreatment pulmonary function testing . A telephone survey was conducted 1 day after the intervention to collect subjective feedback and assess the success of blinding protocol s. RESULTS Of the 35 study participants , 18 were r and omly assigned to the OMT group and 17 to the sham group . Compared with the sham group , the OMT group showed a statistically significant decrease in the forced expiratory flow at 25 % and 50 % of vital capacity and at the midexpiratory phase ; the expiratory reserve volume ; and airway resistance . The OMT group also had a statistically significant increase in the residual volume , total lung capacity , and the ratio of those values compared with the sham group . Most subjects ( 82 % , OMT group ; 65 % , sham group ) reported breathing better after receiving their treatment . Only 53 % of subjects in the OMT group and 41 % in the sham group correctly guessed their group assignment . CONCLUSION Results suggest an overall worsening of air trapping during the 30 minutes immediately following one multitechnique OMT session relative to the sham group OBJECTIVE The purpose of this preliminary study was to demonstrate the feasibility of a study that measures the short-term effects of a course of manual therapy ( MT ) and exercise ( Ex ) in people with moderate chronic obstructive pulmonary disease ( COPD ) . METHODS Fifteen participants ( 9 males ; mean age , 56.1 years ) , with moderate COPD ( mean % predicted forced expiratory volume in the first second [ FEV1 % predicted ] , 61.8 % ) , were r and omly allocated to 1 of 3 groups : soft tissue therapy only ( ST ) ; ST and spinal manipulation ( SM ) ; or ST , SM , and Ex . The intervention continued for 4 weeks . Outcome measures included FEV1 , forced vital capacity ( FVC ) , chronic respiratory question naire ( CRQ-SAS ) scores , distance walked in a 6-minute walking test , and monitoring for adverse events . RESULTS There was an increase in FVC for the SM + ST + Ex group compared with ST only and ST + SM ( 1.01 and 1.00 L , respectively ) . Distance walked increased in the ST + SM and ST + SM + Ex groups compared with ST only ( 120.0 and 168.0 m , respectively ) . Dyspnea levels decreased in the ST + SM and ST + SM + Ex groups compared with ST only ( 0.64 and 0.44 , respectively ) . There were no major or moderate adverse events reported following ST or SM interventions . CONCLUSIONS For this small group of patients , combining MT with Ex produced short improvements in FVC , distance walked , and dyspnea levels , with no major or moderate adverse events . This preliminary study showed that a larger study evaluating the clinical outcomes of MT for people with moderate COPD appears feasible Study design : R and omized clinical trial . Objective : To investigate the effect of including manual therapy ( MT ) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease ( COPD ) . Background : The primary source of exercise limitation in people with COPD is dyspnea . The dyspnea is partly caused by changes in chest wall mechanics , with an increase in chest wall rigidity ( CWR ) contributing to a decrease in lung function . As MT is known to increase joint mobility , administering MT to people with COPD carries with it the potential to influence CWR and lung function . Methods : Thirty-three participants with COPD , aged between 55 and 70 years ( mean = 65·5±4 years ) , were r and omly assigned to three groups : pulmonary rehabilitation ( PR ) only , soft tissue therapy ( ST ) and PR , and ST , spinal manipulative therapy ( SM ) , and PR . Outcome measures including forced expiratory volume in the 1st second ( FEV1 ) , forced vital capacity ( FVC ) , 6-minute walking test ( 6MWT ) , St. George 's respiratory question naire ( SGRQ ) , and the hospital anxiety and depression ( HAD ) scale were recorded at 0 , 8 , 16 , and 24 weeks . Results : There was a significant difference in FVC between the three groups at 24 weeks ( P = 0·04 ) . For the ST+SM+PR group versus PR only the increase was 0·40 l ( CI : 0·02 , 0·79 ; P = 0·03 ) . No major or moderate adverse events ( AE ) were reported following the administration of 131 ST and 272 SM interventions . Discussion : The increase in FVC is a unique finding . Although the underlying mechanisms responsible for this outcome are not yet understood , the most likely explanation is the synergistic effect result ing from the combination of interventions . These results support the call for a larger clinical trial in the use of MT for COPD OBJECTIVE To determine comorbidities that cause pain and the potential contributors to pain in individuals with chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve cross-sectional survey study . SETTING Pulmonary rehabilitation programs of 6 centers . PARTICIPANTS A convenience sample of individuals with COPD ( N=137 ) who attended pulmonary rehabilitation programs . In total , 100 ( 73 % ) returned the survey packages . Of those responders , 96 participants ( 70 % ) were included in the analyses . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Pain was measured using the  Brief Pain Inventory .  The question naire used to obtain information about health conditions that might contribute to pain and a medication record asked , in lay terms , about comorbidities that cause pain . The health conditions that cause pain were then vali date d by health professionals . Demographics , fatigue , dyspnea , quality of life , and self-efficacy were also measured using question naires . RESULTS Pain was reported in 71 % ( 68/96 ) of participants . Low back pain was the most common location ( 41 % ) . Arthritis ( 75 % ) , back problems ( 47 % ) , and muscle cramps ( 46 % ) were the most common comorbidities that caused pain . Lower self-efficacy , and renting rather than home ownership increased the likelihood of pain ( P<.05 ) . Pain severity and Brief Fatigue Inventory scores contributed to pain interference scores ( P<.05 ) . CONCLUSIONS Pain was highly prevalent in pulmonary rehabilitation program participants with COPD . The most common causes of pain were musculoskeletal conditions . Pain severity and higher levels of fatigue contributed to how pain interfered with daily aspects of living . The assessment and management of pain need to be addressed within the overall care of individuals with COPD QUESTIONS In people with chronic obstructive pulmonary disease , does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment , or cumulatively ? Does the technique also improve exercise capacity , maximal respiratory pressures , and kinematics of the chest wall and abdomen ? DESIGN R and omised , controlled trial with concealed allocation , intention-to-treat analysis , and blinding of participants and assessors . PARTICIP 
    Output:
    
No effect on lung function was found , while results on exercise capacity were contrasting .
Few RCTs of poor method ological quality are available on the effects of MT in COPD .