Efeito da técnica de liberação miofascial do diafragma no fluxo aéreo de indivíduos com Doença de Parkinson: ensaio clínico randomizado controlado

Abstract

Introduction: Parkinson’s Disease (PD), the second most prevalent neurodegenerative disorder worldwide, is characterized by both motor and non-motor symptoms. Among the non-motor symptoms, ventilatory dysfunctions are frequent and contribute significantly to morbidity and mortality, with no effective treatments currently available. Previous studies suggest that myofascial release of the diaphragm (LIMID) may improve pulmonary function in respiratory conditions; however, its application in PD remains unexplored. Objective: To evaluate the feasibility, adherence, and preliminary impact of LIMID in early-stage PD patients, aiming to determine the sample size required to detect a clinically significant change in forced expiratory volume in one second (FEV1). Methods: We conducted a pilot randomized controlled trial (RCT) with a parallel two-arm design involving 14 early-stage PD participants (modified Hoehn & Yahr scale 0–3) under regular Levodopa therapy, with physical and cognitive abilities to participate in the study, non-smokers, and without respiratory or other neurological diseases. Participants missing three consecutive sessions or unable to complete the tests were excluded. The study was double blinded for the participants and the statistician conducting the analysis. Fourteen participants were recruited from neurology outpatient clinics and CAIMIS in Manaus, Amazonas. Participants were randomized into two groups to receive 10 sessions: the intervention group (IG) received LIMID, and the control group (CG) underwent a sham treatment. An independent statistician performed Student's t-tests for means comparison, chi-square tests for proportions, and analysis of variance (ANOVA) to analyze changes in pulmonary function, respiratory muscle strength (RMS), and peak expiratory flow (PEF) across and after 10 sessions. Tukey's test was used for multiple comparisons, and all analyses were performed using SPSS 24.0. The protocol adhered to the CONSORT extension for non-pharmacological interventions and complied with all ethical standards for human research. Results: The study demonstrated protocol adherence and logistical feasibility. A trend toward improved pulmonary function (FEV1 and FVC) was observed in the IG compared to the CG, although statistical significance was not achieved due to the small sample size. We estimated that a full-scale study would require a larger sample size to detect at least a 20% difference in FEV1 with 80% power and a 95% confidence level. Conclusion: LIMID appears to be a promising, safe, and feasible approach to improve pulmonary function in individuals with early-stage PD. These preliminary findings provide a foundation for larger future studies, with the potential to integrate new therapeutic strategies for this population.