Manual Therapy in Patients With Chronic Obstructive Pulmonary Disease: An Overview of Systematic Reviews With Meta-Analysis and Meta-Regression

Purpose: The main aim was to assess the effects of manual therapy (MT) in patients with chronic obstructive pulmonary disease (COPD). Methods: We searched in Medline (PubMed), Embase, CINAHL, and Scopus. The outcome measures were pulmonary function parameters (FEV 1 and forced vital capacity [FVC]) and exercise capacity. Methodological quality was analyzed using AMSTAR-2. The Graphical Representation of Overlap for OVErviews tool (GROOVE) was used to explore the overlap of primary studies among systematic reviews. Pooled effects were calculated as standardized mean differences (SMDs) and 95% confidence intervals for the outcomes using a random effects model. Results: Seven systematic reviews were included, from which a total of 9 primary studies were found. The meta-analysis showed no significant differences in favor of the MT group in FEV 1 (SMD = −0.27 [−0.60 to 0.05, P = .051]) and FVC (SMD = −0.40 [−0.83 to 0.04, P = .05]). However, the meta-analysis showed significant differences in favor of the MT group in exercise capacity with a small clinical effect (SMD = −0.47 [−0.71 to −0.23], P < .001). The meta-regression analysis revealed that the intervention time and the number of sessions of MT were not associated with the improvement of pulmonary function parameters (R 2 = 0.5%–14.94%, P > .05) nor exercise capacity (R 2 = 5.56%–13.56%, P > .05). Conclusions: MT does not seem to have a significant impact on the improvement of pulmonary function in patients with COPD, although it appears to improve exercise capacity. Finally, more intervention time as well as more sessions of MT do not seem to result in a greater clinical effect in patients with COPD.