Efficacy of Transcutaneous Electrical Diaphragmatic Stimulation and Myofascial Release on Mobility and Function in COPD Patients: A Research Protocol

Introduction: The progressive respiratory condition known as Chronic Obstructive Pulmonary Disease (COPD) is characterised by decreased diaphragmatic excursion, impaired pulmonary function and a limited ability to carry out Activities of Daily Living (ADL). Myofascial Release (MFR) and Transcutaneous Electrical Diaphragmatic Stimulation (TEDS) have become viable techniques to improve respiratory kinematics and functional performance. Need of the study: In people with COPD, the diaphragm often struggles to move properly due to an overinflated lung. This constant strain puts the muscle at a mechanical disadvantage that worsens with time. TEDS can trigger muscle contractions by delivering small electrical signals and help to strengthen the breathing muscles. Similarly, diaphragmatic MFR has reduced breathlessness and increased Peak Expiratory Flow Rate (PEFR) in COPD patients. However, specific research on its combined impact on the diaphragm remains limited. Aim: To evaluate the efficacy of TEDS and MFR improves ADL performance, diaphragmatic mobility and Pulmonary Function Test (PFT) indices in COPD patients. Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, MM (DU), Mullana, Ambala, Haryana, India, from July 2025 to February 2026, involving participants who meet predefined inclusion criteria. Subjects will be randomly allocated to either an experimental or a control group. The experimental group will receive TEDS at 30 Hz for 20 minutes daily, five days per week, alongside diaphragmatic MFR administered in two sets of 10 repetitions with a one-minute rest interval. The control group will undergo sham TEDS and an identical MFR regimen. Both groups will receive interventions over a period of three weeks. Pre- and post-treatment evaluations will include ultrasonography assessment of diaphragmatic mobility and thickness, spirometric analysis of PFT parameters and ADL measurement via the London Chest ADL Scale. For normally distributed data, paired t-tests (within groups) and independent t-tests (between groups) will be used; for non normally distributed data, Wilcoxon signedrank tests (within groups) and Mann-Whitney U tests (between groups) will be used. A p-value of <0.05 will be considered as statistically significant.