***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY DESIGN R and omized controlled trial . OBJECTIVES To compare a muscle energy technique ( MET ) for the glenohumeral joint ( GHJ ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion ( ROM ) in baseball players . BACKGROUND Overhead athletes often exhibit loss of GHJ ROM in internal rotation , which has been associated with shoulder pathology . Current stretching protocol s aim ed at improving flexibility of the posterior shoulder have result ed in inconsistent outcomes . Although utilization of MET has been hypothesized to lengthen tissue , there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness . METHODS Sixty-one Division I baseball players were r and omly assigned to 1 of 3 groups : MET for the GHJ horizontal abductors ( n = 19 ) , MET for the GHJ external rotators ( n = 22 ) , and control ( n = 20 ) . We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM , and conducted analyses of covariance , followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions ( P<.05 ) . RESULTS The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention ( mean ± SD , 6.8 ° ± 10.5 ° ) compared to the control group ( -1.1 ° ± 6.8 ° ) ( P = .011 ) and a greater increase in internal rotation ROM postintervention ( 4.2 ° ± 5.3 ° ) compared to the group treated with the MET for the external rotators ( 0.2 ° ± 6.3 ° ) ( P = .020 ) and the control group ( -0.2 ° ± 4.0 ° ) ( P = .029 ) . No significant differences among groups were found for any other variables ( P>.05 ) . CONCLUSION A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players . Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes . LEVEL OF EVIDENCE Therapy , level 2b- Background Patient-reported outcomes ( PRO ) question naires are being increasingly used in COPD clinical studies . The challenge facing investigators is to determine what change is significant , ie what is the minimal clinical ly important difference ( MCID ) . This study aim ed to identify the MCID for the clinical COPD question naire ( CCQ ) in terms of patient referencing , criterion referencing , and by the st and ard error of measurement ( SEM ) . Methods Patients were ≥40 years of age , diagnosed with COPD , had a smoking history of > 10 pack-years , and were participating in a r and omized , controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD . The CCQ was completed on Days 1–7 and 42 . A Global Rating of Change ( GRC ) assessment was taken to establish the MCID by patient referencing . For criterion referencing , health events during a period of 1 year after Day 42 were included in this analysis . Results 210 patients were recruited , 168 completed the CCQ question naire on Day42 . The MCID of the CCQ total score , as indicated by patient referencing in terms of the GRC , was 0.44 . The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39 , and calculation of the SEM result ed in a value of 0.21 . Conclusion This investigation , which is the first to determine the MCID of a PRO question naire via more than one approach , indicates that the MCID of the CCQ total score is 0.4 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 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 Background and objective In chronic obstructive pulmonary disease ( COPD ) , accessory respiratory muscles are recruited as a compensatory adaptation to changes in respiratory mechanics . This results in shortening and overactivation of these and other muscles . Manual therapy is increasingly being investigated as a way to alleviate these changes . The aim of this study was to measure the immediate effect on lung function of a soft tissue manual therapy protocol ( STMTP ) design ed to address changes in the accessory respiratory muscles and their associated structures in patients with severe COPD . Methods Twelve medically stable patients ( n=12 ) with an existing diagnosis of severe COPD ( ten : GOLD Stage III and two : GOLD Stage IV ) were included .  Residual volume , inspiratory capacity and oxygen saturation ( SpO2 ) were recorded immediately before and after administration of the STMTP . A Student ’s t-test was used to determine the effect of the manual therapy intervention ( P<0.05 ) . Results The mean age of the patients was 62.4 years ( range 46–77 ) . Nine were male .  Residual volume decreased from 4.5 to 3.9 L ( P=0.002 ) , inspiratory capacity increased from 2.0 to 2.1 L ( P=0.039 ) and SpO2 increased from 93 % to 96 % ( P=0.001 ) . Conclusion A single application of an STMTP appears to have the potential to produce immediate clinical ly meaningful improvements in lung function in patients with severe and very severe COPD 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 OBJECTIVES Few and contrastingly data are available about use of osteopathic manipulative treatment ( OMT ) in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Comparing the effects of the combination of pulmonary rehabilitation and OMT compared with pulmonary rehabilitation ( PR ) in patients with severely impaired COPD . SETTING Rehabilitative pulmonary department . INTERVENTIONS Patients underwent exercise training , OMT , educational support and nutritional and psychological counselling . MAIN OUTCOMES MEASURES Exercise capacity through 6 min walk test ( 6MWT-- primary outcome ) and pulmonary function test ( secondary outcomes ) were evaluated at the beginning and at the end of the training . Patients were r and omly assigned to receive PR+soft manipulation ( G1 ) or OMT+PR ( G2 ) for 5 days/week for 4 weeks . RESULTS 20 stable COPD patients ( 5 female -- mean age , 63.8±5.1 years ; FEV1 26.9±6.3 % of predicted ) referred for in-patient pulmonary rehabilitation were evaluated . Respect to the baseline , 6 MWT statistically improved in both group . In particular , G2 group gained 72.5±7.5 m ( p=0.01 ) and G1 group 23.7±9.7 m. Between group comparison showed a difference of 48.8 m ( 95 % CI : 17 to 80.6 m , p=0.04 ) . Moreover , in G2 group we showed a decrease in residual volume ( RV -- from 4.4±1.5 l to 3.9±1.5 l , p=0.05 ) . Between group comparison showed an important difference ( -0.44 l ; 95 % CI : -0.26 to -0.62 l , p=0.001 ) . Furthermore , only in G2 group we showed an increase in FEV1 . CONCLUSIONS This study suggests that OMT+PR may improve exercise capacity and reduce RV in severely impaired COPD patients with respect to PR alone Variations in the application of muscle energy technique ( MET ) for increasing the extensibility of muscles have been advocated , but little evidence exists to support the relative merit of a particular approach . This study investigated two types of muscle energy techniques that have been advocated in the osteopathic literature that differ primarily in the duration of the post-contraction stretch phase . Forty asymptomatic participants ( mean age=22.1+/-3.5 , male female=1:4 ) were r and omly allocated to one of two groups ( Group 1 : MET with 30-s post-isometric stretch phase ; Group 2 : MET with 3-s post-isometric stretch phase ) . Hamstring length was measured using active knee extension ( AKE ) . Participants received an initial application of the allocated intervention , and then a second application 1 week later . Analysis with a split-plot ANOVA revealed a significant effect of time ( F(3,36)=42.30;p<0.01 ) , but no significant time*group interaction ( F(3,36)=0.12 ; p=0.95 ) . Post-hoc analysis revealed that the significant differences over time occurred between pre- and post- 
    Output:
    
Exercise capacity and perceived dyspnoea ratings were improved in single studies .
Adverse events were unrelated to the MET intervention .
Currently , there is insufficient evidence to support the use of MET in the management of COPD .