Eficácia da técnica de liberação miofascial do diafragma na melhora da força muscular respiratória de indivíduos com doença de Parkinson: estudo piloto randomizado

Abstract

Introduction: Parkinson’s disease (PD), the second most prevalent neurodegenerative condition worldwide, presents both motor and non-motor symptoms, among which ventilatory dysfunctions are prominent. Often overlooked, these impairments are associated with increased morbidity and mortality. Diaphragmatic myofascial release has shown benefits in chronic respiratory conditions; however, its application in PD remains largely unexplored. Objective: To conduct a pilot study aimed at evaluating the preliminary effects of DMR on respiratory muscle strength (RMS) in individuals with early-stage PD, as well as to assess logistical feasibility and estimate sample size parameters for a definitive clinical trial. Methods: This pilot study was designed as a randomized controlled trial (RCT), parallel, blinded, with two arms, including 14 participants diagnosed with early-stage PD (modified Hoehn & Yahr stages 0–3–0), on regular Levodopa therapy, physically and cognitively capable of undergoing the protocol, non-smokers, and without diagnosed respiratory or other neurological disorders. Participants were recruited from outpatient services in Manaus, Amazonas, Brazil. Individuals who missed three consecutive sessions or were unable to complete the assessments were excluded. Participants were randomly assigned to two groups receiving ten sessions: the intervention group (IG) received Diaphragmatic myofascial release, and the control group (CG) received a sham intervention. RMS was measured using manovacuometry (maximum inspiratory and expiratory pressures – MIP and MEP), before and after the intervention. Statistical analysis included Student's t-test, ANOVA, and Tukey’s post hoc test, with a significance level of p < 0.05. The protocol followed CONSORT guidelines for non-pharmacological interventions and adhered to all ethical standards for research involving human subjects. Results: The technique was well tolerated, with no adverse events, indicating good adherence and logistical feasibility. Although the IG showed an increase in mean RMS values, no statistically significant differences were observed between groups, possibly due to the small sample size. Based on the observed effect size, a definitive trial would require a sample of 54 participants (27 per group) to achieve 80% statistical power. Conclusion: Diaphragmatic myofascial release proved to be a safe, feasible, and well-tolerated intervention in individuals with early-stage PD. Although no detected statistically significant changes in RMS were detected, these preliminary findings support the feasibility and design of future RCTs with larger samples to confirm the potential efficacy of this technique as a complementary strategy in respiratory rehabilitation for this population.