Effects of Modified Diaphragmatic Training on Gastroesophageal Reflux Disease Questionnaire Score, Diaphragmatic Excursion, and Maximum Inspiratory Pressure in Adults with Gastroesophageal Reflux Disease After COVID-19: A Single-Blinded Randomized Control

Authors

  • Siti Chandra Widjanantie Doctoral Program in Medical Sciences Faculty of Medicine Universitas Indonesia http://orcid.org/0000-0003-0889-7740
  • Ari Fahrial Syam Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Nury Nusdwinuringtyas Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Agus Dwi Susanto Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia - Persahabatan Hospital, Jakarta, Indonesia
  • Rudy Hidayat Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Aria Kekalih Department of Public Health, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Maria Regina Rachmawati Physical Medicine and Rehabilitation, Anatomy Department, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia.
  • Won Ah Choi Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.
  • Seong Woong Kang Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.

Keywords:

COVID-19, diaphragmatic training, gastroesophageal reflux disease questionnaire score, diaphragmatic excursion, maximal inspiratory pressure

Abstract

Background: Although diaphragmatic training has been shown to improve gastroesophageal reflux disease (GERD) symptoms, its effectiveness in adults with GERD after COVID-19 has not been evaluated. This study examined the effectiveness of modified diaphragmatic training (MDT) on GERD questionnaire (GERDQ) score, diaphragmatic excursion, and maximum inspiratory pressure (MIP) in adults with GERD after COVID-19. Methods: This single-blinded randomized control trial was conducted at Persahabatan Hospital from February to April 2023. The medical records of 364 patients with persistent gastrointestinal symptoms were evaluated; among these potential participants, 302 had symptoms before, and 62 after, COVID-19 infection. Fifty of these patients fulfilled the study inclusion and exclusion criteria and were randomly assigned to the intervention (n = 25) or control (n = 25) groups. Four weeks of diaphragmatic training were followed by MDT or standard diaphragmatic training. A follow-up assessment was conducted 30 days after the beginning of the training. Results: The GERDQ score was significantly decreased in the pre–post-intervention group (10.44 ± 2.00 vs 1.84 ± 2.17) and the control group (8.64 ± 0.57 vs 3.32 ± 1.49), with p < 0.001. The intervention group showed significant improvements in the right diaphragmatic excursion (RDE) (44% vs 11.87%), left diaphragmatic excursion (LDE) (46.61% vs 13.62%), and MIP (75.26% vs 23.97%) compared with the control group. Conclusion: MDT in adults after COVID-19 with GERD enhanced diaphragmatic excursion and MIP and decreased symptoms of gastroesophageal reflux by 8.60 points of GERDQ. Respiratory symptoms and other side effects were comparable between the groups.

Author Biographies

Siti Chandra Widjanantie, Doctoral Program in Medical Sciences Faculty of Medicine Universitas Indonesia

Siti Chandra Widjanantie is an MD, Physical Medicine and Rehabilitation Specialist at Persahabatan Hospital with 17 years of experience helping Chronic Respiratory Disease patients with Respiratory Dysfunction, and Consultant in Cardiorespiratory Rehabilitation; she uses that experience as an Assistant Professor in Physical Medicine and Rehabilitation Residency Training Program in the Faculty of Medicine Universitas Indonesia.

Ari Fahrial Syam, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Professor of Internal Medicine, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia

Nury Nusdwinuringtyas, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Associate Professor of Physical Medicine and Rehabilitation, Division Cardiorespiratory Rehabilitation, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia

Agus Dwi Susanto, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia - Persahabatan Hospital, Jakarta, Indonesia

Professor of Pulmonology and Respiratory Medicine, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia

Rudy Hidayat, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Assistant Professor of Internal Medicine, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia

Aria Kekalih, Department of Public Health, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Assistant Professor of Public Health, Department of Public Health, Faculty of Medicine Universitas Indonesia

Maria Regina Rachmawati, Physical Medicine and Rehabilitation, Anatomy Department, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia.

Associate Professor of Physical Medicine and Rehabilitation, Anatomy Department, Faculty of Medicine, Universitas Gunadarma

Won Ah Choi, Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.

Professor of Physical Medicine and Rehabilitation, Department of Rehabilitation Medicine, Yonsei University College of Medicine

Seong Woong Kang, Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.

Professor of Physical Medicine and Rehabilitation, Department of Rehabilitation Medicine, Yonsei University College of Medicine

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Published

2023-11-01

How to Cite

Widjanantie, S. C., Syam, A. F., Nusdwinuringtyas, N., Susanto, A. D., Hidayat, R., Kekalih, A., Rachmawati, M. R., Choi, W. A., & Kang, S. W. (2023). Effects of Modified Diaphragmatic Training on Gastroesophageal Reflux Disease Questionnaire Score, Diaphragmatic Excursion, and Maximum Inspiratory Pressure in Adults with Gastroesophageal Reflux Disease After COVID-19: A Single-Blinded Randomized Control. Acta Medica Indonesiana, 55(3), 269. Retrieved from https://actamedindones.org/index.php/ijim/article/view/2465

Issue

Vol. 55 No. 3 (2023): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

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