<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04399993</url>
  </required_header>
  <id_info>
    <org_study_id>OST1- 001</org_study_id>
    <nct_id>NCT04399993</nct_id>
  </id_info>
  <brief_title>Effect of Osteopathic Manual Techniques on the Diaphragm Muscle and Its Repercussions</brief_title>
  <official_title>Effect of Osteopathic Manual Techniques on the Diaphragm Muscle and Its Repercussions in Healthy Young Adults</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Escola Superior de Tecnologia da Saúde do Porto</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Escola Superior de Tecnologia da Saúde do Porto</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Determining the effects of an intervention plan on the diaphragm related to the center of&#xD;
      gravity and range of motion in the lumbar spine (static and dynamic) in healthy individuals&#xD;
      is an area that lacks evidence and proper studies. Has such, the investigators consider this&#xD;
      a interesting topic to study, therefore it is intended to improve the knowledge on this area.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      All diaphragmatic activity is controlled by metabolic mechanisms and emotional states which&#xD;
      may cause restrictions that might be related to disorders in the lower back.&#xD;
&#xD;
      The diaphragm and the lumbar segment of the spine are connected through the diaphgramathic&#xD;
      pillars that connect the central tendon and the vertebrae of L2 (left side) and L3/L4 (right&#xD;
      side). Consequently, the contraction of the pillars may be related to the fixation of the&#xD;
      lumbar spine.&#xD;
&#xD;
      Proper function of the diaphragm is related to better parameters of static balance. It is&#xD;
      also possible to conclude that a change in the proper function of the diaphragm is associated&#xD;
      with changes in the center of gravity in healthy individuals.&#xD;
&#xD;
      This theme lacks scientific evidence, since no studies were found that focus on the analysis&#xD;
      of diaphragmatic treatment only. In this way, the investigators intend to collaborate to&#xD;
      increase knowledge in this area, determining the effects of the intervention plan on the&#xD;
      diaphragm in relation to the range of motion and center of gravity in the lumbar spine&#xD;
      (static and dynamic) in healthy individuals.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Not yet recruiting</overall_status>
  <start_date type="Anticipated">January 2024</start_date>
  <completion_date type="Anticipated">September 2024</completion_date>
  <primary_completion_date type="Anticipated">September 2024</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Other</primary_purpose>
    <masking>Double (Participant, Outcomes Assessor)</masking>
    <masking_description>The volunteers will be allocated randomly using a website called radom.org, which ensures that neither neither the volunteer nor the assessor will know the final allocation.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Change from Baseline of Center of gravity immediately after the intervention</measure>
    <time_frame>Immediately after the intervention</time_frame>
    <description>To obtain the center of gravity measurements, it will be used the system Qualisys Track Manager. First, it will be placed in the subject spheric markers on the spinous processes of T12, L3 and S2 and both anterior and posterior superior iliac spines.&#xD;
The cameras will be arranged to cover the area to the test, which it will be performed in a hard surface with the help of reflector-markers that will evaluate the movements.&#xD;
The data will be collected twice, with the eyes open and closed. They'll be standing in the platform for 90 seconds each time and the data will be collected at the 30, 60 and 90 seconds.&#xD;
The software is going to be used to convert the data in coordinates in the x, y and z axis, which it will allow to analyse the tridimensional kinematics of the lumbar spine Through the intrinsical board of Qualysis Track Manager it will be evaluated the relation of the center of pressure with the vertical projection of the center of mass through the distance between both.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change from Baseline in Range of Movement of the lumbar spine immediately after the intervention</measure>
    <time_frame>Immediately after the intervention</time_frame>
    <description>To obtain the center of gravity measurements, it will be used the system Qualisys Track Manager. First, it will be placed in the subject spheric markers on the spinous processes of T12, L3 and S2 and both anterior and posterior superior iliac spines.&#xD;
The cameras will be arranged to cover the area to the test, which it will be performed in a hard surface with the help of reflector-markers that will evaluate the movements.&#xD;
The data will be collected by asking the volunteer to perform certain movements such as anterior and lateral flexion.&#xD;
The software is going to be used to convert the data in coordinates in the x, y and z axis, which it will allow to analyse the tridimensional kinematics of the lumbar spine Through the intrinsical board of Qualysis Track Manager it will be evaluated the relation of the center of pressure with the vertical projection of the center of mass through the distance between both.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">60</enrollment>
  <condition>Healthy</condition>
  <arm_group>
    <arm_group_label>Intervention Protocol in Diaphragm</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>In each volunteer, after a brief questionnaire, it will be measured the center of gravity and the range of movement of the lumbar spine before the technique.&#xD;
Each volunteer will stay in supine position with arms along their body, in which their legs may be either extended or flexed.&#xD;
Next, the researcher will perform the intervention protocol in Diaphragm. Then, all the measurements described before, will be repeated by the assessor right after the technique.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Sham Technique</arm_group_label>
    <arm_group_type>Sham Comparator</arm_group_type>
    <description>In each volunteer, after a brief questionnaire, it will be measured the center of gravity and the range of movement of the lumbar spine before the technique.&#xD;
Each volunteer will stay in supine position with arms along their body, in which their legs may be either extended or flexed.&#xD;
Next, the researcher will perform the Sham technique. Then, all the measurements described before, will be repeated by the assessor right after the technique.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Intervention Protocol in Diaphragm</intervention_name>
    <description>The protocol consists of three techniques. The two first techniques will be applied for 10 respiratory cycles.&#xD;
Muscle Stretching Technique:&#xD;
the researcher will perform a cephalic traction on the inferior costal border with the ulnar border during the inspiratory phase.&#xD;
Phrenic-center inhibition technique:&#xD;
the researcher, with a hand on the sternum to caudal and other hand on the umbilical region to cranial, will approach his hands on the horizontal plane, when the volunteer exales.&#xD;
Functional diaphragm technique:&#xD;
the researcher will perform a vertical pressure on the diaphragm for 5 minutes and will search for the facilitated parameters and maintain them until the release of all the periarticular elements.</description>
    <arm_group_label>Intervention Protocol in Diaphragm</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Sham technique</intervention_name>
    <description>In the sham group a manual contact without any therapeutic intention will be performed, in a distant region of the diaphragm (for example on the trapezius muscle). This contact will be maintained during the same amount of time as for the treatment group.</description>
    <arm_group_label>Sham Technique</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Ages between 18 and 30 years old;&#xD;
&#xD;
          -  Both genders;&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Treatments with manual therapy in the last three months or more than three times in&#xD;
             the previous year;&#xD;
&#xD;
          -  Lumbar spine pathology (infection, spinal fracture or more severe neurological&#xD;
             impairment, such as cauda equina syndrome) and respiratory pathologies;&#xD;
&#xD;
          -  Psychiatric illness;&#xD;
&#xD;
          -  Recent history of trauma;&#xD;
&#xD;
          -  History of cancer;&#xD;
&#xD;
          -  Systemic inflammatory conditions;&#xD;
&#xD;
          -  Recent history of spinal surgery;&#xD;
&#xD;
          -  Abdominal pain at the time of the intervention;&#xD;
&#xD;
          -  Body mass index (BMI) equal to or greater than 31kg / m2, due to the difficulty in&#xD;
             accessing the diaphragm;&#xD;
&#xD;
          -  All of those that acquired a higher knowledge within the area of manual therapy, which&#xD;
             may compromise its validation.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>30 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Natália MO Campelo, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Escola Superior de Saúde do Politécnico do Porto</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Natália MO Campelo, PhD</last_name>
    <phone>+351 938674365</phone>
    <email>ncampelo.estsp.ipp@gmail.com</email>
  </overall_contact>
  <location>
    <facility>
      <name>Escola Superior de Saúde do Politécnico do Porto</name>
      <address>
        <city>Porto</city>
        <zip>4200-072</zip>
        <country>Portugal</country>
      </address>
    </facility>
    <contact>
      <last_name>Natália MO Campelo, PhD</last_name>
      <phone>+351938674365</phone>
      <email>ncampelo.estsp.ipp@gmail.com</email>
    </contact>
  </location>
  <location_countries>
    <country>Portugal</country>
  </location_countries>
  <reference>
    <citation>Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Man Ther. 2013 Dec;18(6):533-40. doi: 10.1016/j.math.2013.05.006. Epub 2013 Jun 10.</citation>
    <PMID>23759340</PMID>
  </reference>
  <reference>
    <citation>Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin. 1994 Dec;(14):iii-iv, 1-25.</citation>
    <PMID>7987418</PMID>
  </reference>
  <reference>
    <citation>Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012 Mar-Apr;32(2):E51-70. doi: 10.1148/rg.322115127.</citation>
    <PMID>22411950</PMID>
  </reference>
  <reference>
    <citation>Grams ST, von Saltiel R, Mayer AF, Schivinski CI, de S Nobre LF, Nobrega IS, Jacomino ME, Paulin E. Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility. Clin Physiol Funct Imaging. 2014 Jan;34(1):18-25. doi: 10.1111/cpf.12058. Epub 2013 Jun 4.</citation>
    <PMID>23730805</PMID>
  </reference>
  <reference>
    <citation>van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2(Suppl 2):S169-91. doi: 10.1007/s00586-006-1071-2. No abstract available.</citation>
    <PMID>16550447</PMID>
  </reference>
  <reference>
    <citation>Marti-Salvador M, Hidalgo-Moreno L, Domenech-Fernandez J, Lison JF, Arguisuelas MD. Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial. Arch Phys Med Rehabil. 2018 Sep;99(9):1720-1729. doi: 10.1016/j.apmr.2018.04.022. Epub 2018 May 19.</citation>
    <PMID>29787734</PMID>
  </reference>
  <reference>
    <citation>Savigny P, Watson P, Underwood M; Guideline Development Group. Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ. 2009 Jun 4;338:b1805. doi: 10.1136/bmj.b1805. No abstract available.</citation>
    <PMID>19502217</PMID>
  </reference>
  <reference>
    <citation>Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011 Jun;36(13):E825-46. doi: 10.1097/BRS.0b013e3182197fe1.</citation>
    <PMID>21593658</PMID>
  </reference>
  <reference>
    <citation>Hagg O, Fritzell P, Nordwall A; Swedish Lumbar Spine Study Group. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J. 2003 Feb;12(1):12-20. doi: 10.1007/s00586-002-0464-0. Epub 2002 Oct 24.</citation>
    <PMID>12592542</PMID>
  </reference>
  <reference>
    <citation>Bagheri R, Ebrahimi Takamjani I, Dadgoo M, Ahmadi A, Sarrafzadeh J, Pourahmadi MR, Jafarpisheh AS. Gender-Related Differences in Reliability of Thorax, Lumbar, and Pelvis Kinematics During Gait in Patients With Non-specific Chronic Low Back Pain. Ann Rehabil Med. 2018 Apr;42(2):239-249. doi: 10.5535/arm.2018.42.2.239. Epub 2018 Apr 30. Erratum In: Ann Rehabil Med. 2018 Dec;42(6):888.</citation>
    <PMID>29765877</PMID>
  </reference>
  <reference>
    <citation>Shahbazi Moheb Seraj M, Sarrafzadeh J, Maroufi N, Ebrahimi Takamjani I, Ahmadi A, Negahban H. The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O'Sullivan Classification System: A Cross-sectional Study. Arch Bone Jt Surg. 2018 Nov;6(6):560-569.</citation>
    <PMID>30637313</PMID>
  </reference>
  <reference>
    <citation>Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I; Standardization and Terminology Committee of the International Society of Biomechanics. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002 Apr;35(4):543-8. doi: 10.1016/s0021-9290(01)00222-6.</citation>
    <PMID>11934426</PMID>
  </reference>
  <reference>
    <citation>Masani K, Vette AH, Kouzaki M, Kanehisa H, Fukunaga T, Popovic MR. Larger center of pressure minus center of gravity in the elderly induces larger body acceleration during quiet standing. Neurosci Lett. 2007 Jul 18;422(3):202-6. doi: 10.1016/j.neulet.2007.06.019. Epub 2007 Jun 17.</citation>
    <PMID>17611029</PMID>
  </reference>
  <reference>
    <citation>Doyle RJ, Hsiao-Wecksler ET, Ragan BG, Rosengren KS. Generalizability of center of pressure measures of quiet standing. Gait Posture. 2007 Feb;25(2):166-71. doi: 10.1016/j.gaitpost.2006.03.004. Epub 2006 Apr 19.</citation>
    <PMID>16624560</PMID>
  </reference>
  <reference>
    <citation>Qualisys, A. B., &amp; Gothenburg, S. (2011). Qualisys track manager. New York: User Manual.</citation>
  </reference>
  <reference>
    <citation>Zemková, E. (2011). Assessment of balance in sport: Science and reality. Serbian Journal of Sports Sciences, (4).</citation>
  </reference>
  <reference>
    <citation>Donlon, T., Franklin, B., Machamer, C., Mogelnicki, C., Verneus, J., &amp; Taber, C. (2018). FMS Squat Assessment and 2D Video Motion Analysis as Screening Indicators of Low Back Pain: A Cross Sectional Case-Study.</citation>
  </reference>
  <reference>
    <citation>Souchard, P. E. (1989). O diafragma. Summus editorial.</citation>
  </reference>
  <verification_date>February 2023</verification_date>
  <study_first_submitted>May 19, 2020</study_first_submitted>
  <study_first_submitted_qc>May 19, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">May 22, 2020</study_first_posted>
  <last_update_submitted>February 28, 2023</last_update_submitted>
  <last_update_submitted_qc>February 28, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">March 1, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Escola Superior de Tecnologia da Saúde do Porto</investigator_affiliation>
    <investigator_full_name>Natália Maria Oliveira Campelo</investigator_full_name>
    <investigator_title>Professor</investigator_title>
  </responsible_party>
  <keyword>Osteopathy</keyword>
  <keyword>Diaphragm</keyword>
  <keyword>Center of Pressure</keyword>
  <keyword>Range of Motion</keyword>
  <keyword>Thoracolumbar</keyword>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04399993
org study id: OST1- 001
nct id: NCT04399993
lead sponsor: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
Determining the effects of an intervention plan on the diaphragm related to the center of
      gravity and range of motion in the lumbar spine (static and dynamic) in healthy individuals
      is an area that lacks evidence and proper studies. Has such, the investigators consider this
      a interesting topic to study, therefore it is intended to improve the knowledge on this area.
All diaphragmatic activity is controlled by metabolic mechanisms and emotional states which
      may cause restrictions that might be related to disorders in the lower back.

      The diaphragm and the lumbar segment of the spine are connected through the diaphgramathic
      pillars that connect the central tendon and the vertebrae of L2 (left side) and L3/L4 (right
      side). Consequently, the contraction of the pillars may be related to the fixation of the
      lumbar spine.

      Proper function of the diaphragm is related to better parameters of static balance. It is
      also possible to conclude that a change in the proper function of the diaphragm is associated
      with changes in the center of gravity in healthy individuals.

      This theme lacks scientific evidence, since no studies were found that focus on the analysis
      of diaphragmatic treatment only. In this way, the investigators intend to collaborate to
      increase knowledge in this area, determining the effects of the intervention plan on the
      diaphragm in relation to the range of motion and center of gravity in the lumbar spine
      (static and dynamic) in healthy individuals.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Other
masking: Double (Participant, Outcomes Assessor)
masking description: The volunteers will be allocated randomly using a website called radom.org, which ensures that neither neither the volunteer nor the assessor will know the final allocation.
measure: Change from Baseline of Center of gravity immediately after the intervention
time frame: Immediately after the intervention
description: To obtain the center of gravity measurements, it will be used the system Qualisys Track Manager. First, it will be placed in the subject spheric markers on the spinous processes of T12, L3 and S2 and both anterior and posterior superior iliac spines.
The cameras will be arranged to cover the area to the test, which it will be performed in a hard surface with the help of reflector-markers that will evaluate the movements.
The data will be collected twice, with the eyes open and closed. They'll be standing in the platform for 90 seconds each time and the data will be collected at the 30, 60 and 90 seconds.
The software is going to be used to convert the data in coordinates in the x, y and z axis, which it will allow to analyse the tridimensional kinematics of the lumbar spine Through the intrinsical board of Qualysis Track Manager it will be evaluated the relation of the center of pressure with the vertical projection of the center of mass through the distance between both.
measure: Change from Baseline in Range of Movement of the lumbar spine immediately after the intervention
time frame: Immediately after the intervention
description: To obtain the center of gravity measurements, it will be used the system Qualisys Track Manager. First, it will be placed in the subject spheric markers on the spinous processes of T12, L3 and S2 and both anterior and posterior superior iliac spines.
The cameras will be arranged to cover the area to the test, which it will be performed in a hard surface with the help of reflector-markers that will evaluate the movements.
The data will be collected by asking the volunteer to perform certain movements such as anterior and lateral flexion.
The software is going to be used to convert the data in coordinates in the x, y and z axis, which it will allow to analyse the tridimensional kinematics of the lumbar spine Through the intrinsical board of Qualysis Track Manager it will be evaluated the relation of the center of pressure with the vertical projection of the center of mass through the distance between both.
arm group label: Intervention Protocol in Diaphragm
arm group type: Experimental
description: In each volunteer, after a brief questionnaire, it will be measured the center of gravity and the range of movement of the lumbar spine before the technique.
Each volunteer will stay in supine position with arms along their body, in which their legs may be either extended or flexed.
Next, the researcher will perform the intervention protocol in Diaphragm. Then, all the measurements described before, will be repeated by the assessor right after the technique.
arm group label: Sham Technique
arm group type: Sham Comparator
description: In each volunteer, after a brief questionnaire, it will be measured the center of gravity and the range of movement of the lumbar spine before the technique.
Each volunteer will stay in supine position with arms along their body, in which their legs may be either extended or flexed.
Next, the researcher will perform the Sham technique. Then, all the measurements described before, will be repeated by the assessor right after the technique.
intervention type: Other
intervention name: Intervention Protocol in Diaphragm
description: The protocol consists of three techniques. The two first techniques will be applied for 10 respiratory cycles.
Muscle Stretching Technique:
the researcher will perform a cephalic traction on the inferior costal border with the ulnar border during the inspiratory phase.
Phrenic-center inhibition technique:
the researcher, with a hand on the sternum to caudal and other hand on the umbilical region to cranial, will approach his hands on the horizontal plane, when the volunteer exales.
Functional diaphragm technique:
the researcher will perform a vertical pressure on the diaphragm for 5 minutes and will search for the facilitated parameters and maintain them until the release of all the periarticular elements.
arm group label: Intervention Protocol in Diaphragm
intervention type: Other
intervention name: Sham technique
description: In the sham group a manual contact without any therapeutic intention will be performed, in a distant region of the diaphragm (for example on the trapezius muscle). This contact will be maintained during the same amount of time as for the treatment group.
arm group label: Sham Technique
criteria: 
gender: All
minimum age: 18 Years
maximum age: 30 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Natália MO Campelo, PhD
role: Principal Investigator
affiliation: Escola Superior de Saúde do Politécnico do Porto
last name: Natália MO Campelo, PhD
phone: +351 938674365
email: ncampelo.estsp.ipp@gmail.com
facility: 
contact: 
country: Portugal
citation: Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Man Ther. 2013 Dec;18(6):533-40. doi: 10.1016/j.math.2013.05.006. Epub 2013 Jun 10.
PMID: 23759340
citation: Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin. 1994 Dec;(14):iii-iv, 1-25.
PMID: 7987418
citation: Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012 Mar-Apr;32(2):E51-70. doi: 10.1148/rg.322115127.
PMID: 22411950
citation: Grams ST, von Saltiel R, Mayer AF, Schivinski CI, de S Nobre LF, Nobrega IS, Jacomino ME, Paulin E. Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility. Clin Physiol Funct Imaging. 2014 Jan;34(1):18-25. doi: 10.1111/cpf.12058. Epub 2013 Jun 4.
PMID: 23730805
citation: van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2(Suppl 2):S169-91. doi: 10.1007/s00586-006-1071-2. No abstract available.
PMID: 16550447
citation: Marti-Salvador M, Hidalgo-Moreno L, Domenech-Fernandez J, Lison JF, Arguisuelas MD. Osteopathic Manipulative Treatment Including Specific Diaphragm Techniques Improves Pain and Disability in Chronic Nonspecific Low Back Pain: A Randomized Trial. Arch Phys Med Rehabil. 2018 Sep;99(9):1720-1729. doi: 10.1016/j.apmr.2018.04.022. Epub 2018 May 19.
PMID: 29787734
citation: Savigny P, Watson P, Underwood M; Guideline Development Group. Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ. 2009 Jun 4;338:b1805. doi: 10.1136/bmj.b1805. No abstract available.
PMID: 19502217
citation: Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011 Jun;36(13):E825-46. doi: 10.1097/BRS.0b013e3182197fe1.
PMID: 21593658
citation: Hagg O, Fritzell P, Nordwall A; Swedish Lumbar Spine Study Group. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J. 2003 Feb;12(1):12-20. doi: 10.1007/s00586-002-0464-0. Epub 2002 Oct 24.
PMID: 12592542
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responsible party type: Principal Investigator
investigator affiliation: Escola Superior de Tecnologia da Saúde do Porto
investigator full name: Natália Maria Oliveira Campelo
investigator title: Professor