Challenges and importance of thoracic expansion measuring device: A systemic review

Nidhi Ved; Amit Sharma

doi:10.4103/ijptr.ijptr_1_22

REVIEW ARTICLE

Year : 2022 | Volume : 4 | Issue : 2 | Page : 97-102

Challenges and importance of thoracic expansion measuring device: A systemic review

Nidhi Ved, Amit Sharma
Department of Cardiovascular and Pulmonary, School of Physiotherapy, RK University, Rajkot, Gujarat, India

Date of Submission	01-Jan-2022
Date of Decision	05-Mar-2022
Date of Acceptance	27-Jun-2022
Date of Web Publication	19-Jan-2023

Correspondence Address:
Dr. Nidhi Ved
Richa Apartment, 3^rd Floor, Dr. Yagnik Road, Rajkot - 360 001, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_1_22

Abstract

Keywords: Biofeedback, Chest expansion, Chest movement, Chest sensors, Digital device, Measuring tap, Respiratory evaluation, Thoracic movement

How to cite this article:
Ved N, Sharma A. Challenges and importance of thoracic expansion measuring device: A systemic review. Indian J Phys Ther Res 2022;4:97-102

How to cite this URL:
Ved N, Sharma A. Challenges and importance of thoracic expansion measuring device: A systemic review. Indian J Phys Ther Res [serial online] 2022 [cited 2023 Jun 6];4:97-102. Available from: https://www.ijptr.org/text.asp?2022/4/2/97/368045

Introduction

Thoracic expansion is defined as the difference in chest circumference between maximal exhalation and maximal inhalation. The ability to accurately evaluate thoracic expansion is important in diagnosing and evaluating the severity of disorders such as chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, and ankylosing spondylitis as a noninvasive tool for assessing respiratory patterns. According to the Japanese guidelines – thoracic expansion score is considered the most standardized noninvasive method for knowing the effectiveness of any respiratory treatment in pulmonary rehabilitation.^[1]

Movements of the ribs occur at the costotransverse and the costovertebral joints. The orientation of these joints varies in the upper and lower ribs. Due to this pump handle movement is seen in the upper ribs, whereas bucket handle movement is seen in the lower ribs. Therefore, the upper, middle, and lower thoracic expansions should be assessed. Pathologic changes in the lungs or thoracic cage can restrict thoracic movement. Reversal of disease condition by medical, surgical, and physiotherapeutic can improve the thoracic expansion. Therefore, the measurement of thoracic expansion plays an important role in the medical and paramedical fields. For the upper thoracic expansion landmark taken is the axilla (2^nd intercostal space), for measurement of the middle thoracic expansion landmark taken is the nipple (5^th intercostal space), whereas for the lower thoracic expansion landmark taken is the xiphoid process.^[2]

Thoracic expansion score varies among healthy and diseased individuals, it ranges from 4 to 7 cm in healthy individuals while among individuals having lung pathology it decreases, and the more the severity of the disease the lesser the value of thoracic expansion. The normal range of thoracic expansion decreases with age (50%–60% between 15 and 75 years). Various studies suggested that thoracic expansion among men is 20% more than in women because male lungs are wider and bigger as compared to female lungs.^[3]

Hence, to understand the current trends and development for measuring chest expansion, a thorough review of present evidence was done. To achieve the highest accuracy relevant keywords such as instruments for measuring chest expansion, sensors for detecting chest expansion, instrument for respiratory evaluation, and instrument for chest examination were used for the searching article through the electronic databases such as PubMed, PEDro, Cochrane Library, and Google Scholar from January 2011 to December 2021. An open-source reference management software Mendeley was used to manage bibliographic data and the duplicate research article was canceled out using which the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was created. Downs and Black checklist was used to measure the methodological quality of 188 articles and based on its assessed criteria, only 96 articles were eligible for the final list with an average score of 42 which is good in terms of the grading of the scale. The scoring of the scale was done by the reviewer and the external reviewer and the discrepancies were sorted out in the one-to-one meeting. The full text of these 96 research articles was reviewed for different methods and tools used for the measurement of thoracic expansion.

In clinical practice, a simple and inexpensive technique for the measurement of thoracic expansion is a taping measure. It is often used by physiotherapists to diagnose and evaluate treatment effectiveness, in different patient groups. During this maneuver, the circumference around the thorax is measured at specific measuring points during maximal inspiration and maximal expiration at three-level, i.e., at the axilla, nipple, and xiphoid process. To date, chest expansion is measured clinically by measuring tape, so the chances of human error persist, constant and continuous data are not possible until it is performed manually, and it is difficult for the subject to interpret it as it is subjective and temporary.^[3],[4]

Few researchers had developed chest expansion measuring devices but the reliability and validity of a few devices were very low, while few devices such as optic electronic plethysmography, respiratory movement measuring device (RMMD), motion capture system, terahertz wave method, strain sensor instrument, breath instrument for measuring chest expansion, ultrasound sensor method, and accelerometer method required huge setup with various sensors, camera, and computer unit which are not easy to handle and not widely available. Suggesting further research on developing an accurate, cost-effective, easy-to-use, and easily available chest expansion measuring device.^[3],[5]

Subjects and Methods

Relevant keywords were used for the searching through the electronic database PubMed, PEDro, Cochrane Library, and Google Scholar from January 2011 to December 2021. An open-source reference management software Mendeley was used to manage bibliographic data and related research materials. Keywords used are related to the thoracic expansion and its measuring device, which are listed in [Table 1].

Table 1: Available device for measuring the thoracic expansion

Click here to view

Inclusion criteria

The study associated with chest expansion
Study allied to the anatomy of thoracic expansion
Study relating the availability of chest expansion measuring device
Study-related to sensor-based chest expansion measuring device
Publication in peer-reviewed journals
The publication is in between January 2001 and December 2021
Full-text English language articles.

Exclusion criteria

Gray literature
Predatory journals
Unpublished articles
Personal blogs
Press column.

Further, the methodological quality of intervention studies was assessed using the Downs and Black checklist. The abstract of the located articles was read to select the appropriate article and full text was evaluated of the relevant research.

General procedure

The related research material was managed in the Mendeley, the duplicate research article was canceled out and the PRISMA flow diagram was created [Figure 1]. Downs and Black checklist was used to measure the methodological quality of 188 articles and based on its assessed criteria, only 96 articles were eligible for the final list with an average score of 42 which is good in terms of the grading of the scale. The scoring of the scale was done by the reviewer and the external reviewer and the discrepancies were sorted out in the one-to-one meeting.

Figure 1: PRISMA flow diagram. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Click here to view

Detection method

The full text of these 96 research articles was reviewed for different method and tools used for the measurement of thoracic expansion.

Result and Discussion

The primary outcome of the study was to evaluate the available device for measuring thoracic expansion along with its cost, working mechanism, equipment required, the expertise required to operate it, reliability and validity of the device, and its commercial availability in the market. The secondary outcome was to assess the availability of the wearable device for measuring thoracic expansion. This study fulfills the alternative hypothesis that there are challenges among existing thoracic expansion measuring devices.

There is a variety of instruments and techniques which were used for the measurement of thoracic expansion given in [Table 1].

Various studies in form of randomized controlled trials have been conducted worldwide to analyze the effectiveness of different chest expansion measuring devices. A few of such research are listed below.

Erik Vanegas et al. (2020)^[15] conducted a systemic review on available sensing systems for respiratory monitoring, 198 articles were reviewed based on sensing techniques and sensors, respiratory parameters, sensor location, sensor size, processing unit, sensor validation, etc., and the study concluded that there is a requirement to form feasible, affordable, accurate, and unobstructed respiratory sensing system.^[15]

Chu et al.^[12] conducted a study on measuring respiratory rate and respiratory volume using a strain sensor among eight healthy normal individuals and concluded that this sensor is effective in measuring respiratory rate and respiratory volume during a steady inclined state and not during ambulation or exercise. Furthermore, the author further added that the reliability of this device was very low and further research is required in it.^[12]

Vieira et al.^[16] conducted a study to assess the effectiveness of optoelectronic plethysmography (OEP) on measuring chest expansion and inspiratory capacity among 17 healthy normal individuals and concluded that OEP is a valid evaluation tool to assess chest expansion during rest as well as during exercise, but it requires a closed chamber with highly equipped face mask and sensing operating system. Hence, further research should be done to develop a device that can easily and accurately measure chest expansion.^[16]

Hagman et al. (2016)^[17] conducted a study on measuring breathing patterns and respiratory movements with an RMMD among 20 normal healthy individuals and concluded that RMMD is significantly useful in measuring the rate, rhythm, and movement of the thorax.^[17]

Nishigaki et al.^[5] conducted a study on the development of a new measurement system of thoracic excursion with biofeedback on 33 normal healthy individuals, individuals were divided into two groups: initially in Group 1, chest excursion was measured by breath device (biofeedback integrated thoracic excursion measuring device) later chest excursion was measured by measuring tape, while in Group 2, vice versa was performed. The study concluded that the breath device is a reliable and valid tool to measure thoracic excursion and thoracic excursion was significantly more than when measured by breath as compared to measuring tape due to biofeedback provided by the breath device. The author also suggested implementing this while planning a pulmonary rehabilitation for pulmonary patients.^[5]

Ando et al.^[1] conducted a study on the biofeedback effect on a thoracic excursion in chest expansion training among 33 normal healthy individuals. Individuals were divided into two groups: Group A initially took 10 breaths with visual biofeedback and Group B initially took 10 breaths without visual biofeedback after 5 min break vice versa was done. The study concluded that biofeedback has a remarkable impact on thoracic excursion hence it should be included in the respiratory exercise regimen for people having reduced lung volume and capacity.^[1]

Ando et al. (2011)^[1] conducted a study to evaluate the effect of visual biofeedback on thoracic expansion using a biofeedback integrated thoracic expansion device. Two healthy males were taken for the study subject 1 performed 3 deep breaths with visual biofeedback then took a break for 5 min followed by 3 deep breaths without visual biofeedback, whereas subject 2 performed it vice versa. The study concluded that when biofeedback was not used then thoracic expansion was less due to tiredness but when visual biofeedback was used subjects were able to sustain the thoracic expansion larger and longer.^[18]

Monika Olsen et al. (2011)^[13] conducted a study on measuring chest expansion by two different techniques: the first traditional method via measuring tape and the second via RMMD. One hundred healthy individuals were divided into two groups: in Group A chest expansion was measured via measuring tape while in Group B chest expansion was measured via RMMD. The study concluded that RMMD is more accurate and sensitive in detecting chest expansion than measuring tape, but it is very expensive as it requires six laser sensors along with a huge processing unit, so it is not easy to handle and rarely available worldwide.^[19]

Hence, various such studies were taken into consideration and the conclusion was made that it is required to develop an accurate, cost-effective, easy to use, and easily available chest expansion measuring device which can be used in clinical practice for assessing patient's thoracic expansion and evaluating the effectiveness of treatment among patients.

Limitation of the study

The study included full-text articles only
Review of literature published between January 2001 and December 2021 was taken into consideration
Articles focusing on thoracic abnormalities such as scoliosis, kyphosis, and lordosis were not taken into consideration
Collaborative research was not done with other occupational expertise.

Strength of the study

The study included 90+ articles for analyzing the available research
A systematic method was used to analyze and interpret the available data
Good quality articles checked by the Downs and Black checklist were only included for the systemic review
A research gap was strongly found, recommending the development of a wearable thoracic expansion measuring device.

Further recommendation of the study

To develop a thoracic expansion measuring device that can indicate the expansion at three different levels: upper lobe, middle lobe, and lower lobe
Biofeedback can be added along with a thoracic expansion measuring device so that by audiovisual biofeedback, outcome measures can be enhanced improving lung volume and capacity
It should be cost-effective, wearable, accurate, easy to use, and easily available
Developing such a device will be of utmost usefulness in assessing the patient and checking the effectiveness of treatment
As it is an innovation, funding can be applied under the various government schemes.

Conclusion

The study concludes that there is a need to develop an accurate, cost-effective, easy use, and easily available chest expansion measuring device which can be used in clinical practice for assessing patients' thoracic expansion and evaluating the effectiveness of treatment among patients.

Impact of study on society and public health

In the community, various pulmonary patients are suffering from a disease such as asthma, COPD, bronchiectasis, pneumonia, interstitial lung disease, and post-COVID-19 syndrome. They have reduced lung volume and capacity due to which symptoms such as dyspnea are very common. Developing a thoracic expansion measuring device with biofeedback integrated with it can help such pulmonary patients in assessing and improving their conditions at an early stage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Ando T, Kawamura K, Fujitani J, Koike T, Nishigaki Y, Mizuguchi H, et al. Biofeedback effect of thoracic excursion in chest expansion training. J Biomech Sci Eng 2012;7:328-34.
2.	Pagare RS, Pedhambkar RB. Assessment of reference values of chest expansion among healthy adults in Pune, India. Orig Res Artic Int J Physiother Res 2017;5:1819-42.
3.	Reddy RS, Alahmari KA, Silvian PS, Ahmad IA, Kakarparthi VN, Rengaramanujam K. Reliability of chest wall mobility and its correlation with lung functions in healthy nonsmokers, healthy smokers, and patients with COPD. Can Respir J 2019;2019:5175949.
4.	Adedoyin RA, Adeleke OE. Reference Values for Chest Expansion among Adult Residents in Ile-Ife. J Yoga Phys Ther 2012;02:4.
5.	Nishigaki Y, Mizuguchi H, Takeda E, Koike T, Ando T, Kawamura K, et al. Development of new measurement system of thoracic excursion with biofeedback: Reliability and validity. J Neuroeng Rehabil 2013;10:45.
6.	Tamiya H, Mitani A, Isago H, Ishimori T, Saito M, Jo T, et al. Measurement of chest wall motion using a motion capture system with the one-pitch phase analysis method. Sci Rep 2021;11:1-14.
7.	Li H, Lv H, Jiao T, Lu G, Li S, Li Z, et al. Measurement of chest wall displacement based on terahertz wave. Appl Phys Lett 2015;106:1-5.
8.	Dey R, Thakur U, Sunny L, D'Almeida L, Chakravarty K. Digital Chest Expansion Measurement & Its Biomedical Application. 2015 E-Health and Bioengineering Conference (EHB); 2016. p. 2-5.
9.	Arthittayapiwat K, Pirompol P, Samanpiboon P. Chest expansion measurement in 3-dimension by using accelerometers. Eng J 2019;23:71-84.
10.	Wang C, Goel R, Noun M, Ghanta RK, Najafi B. Wearable sensor-based digital biomarker to estimate chest expansion during sit-to-stand transitions – A practical tool to improve sternal precautions in patients undergoing median sternotomy. IEEE Trans Neural Syst Rehabil Eng 2020;28:165-73.
11.	Kaneko H, Horie J, Ishikawa A. New scale to assess breathing movements of the chest and abdominal wall: Preliminary reliability testing. J Phys Ther Sci 2015;27:1987-92.
12.	Chu M, Nguyen T, Pandey V, Zhou Y, Pham HN, Bar-Yoseph R, et al. Respiration rate and volume measurements using wearable strain sensors. NPJ Digit Med 2019;2:1-9.
13.	Olsén MF, Romberg K. Reliability of the respiratory movement measuring instrument, RMMI. Clin Physiol Funct Imaging 2010;30:349-53.
14.	Massaroni C, Carraro E, Vianello A, Miccinilli S, Morrone M, Levai IK, et al. Optoelectronic plethysmography in clinical practice and research: A review. Respiration 2017;93:339-54.
15.	Vanegas E, Igual R, Plaza I. Sensing systems for respiration monitoring: A technical systematic review. Sensors (Switzerland). 2020;20:1-84.
16.	Vieira DS, Pereira DA, Barbosa MH, Parreira VF. Is optoelectronic plethysmography a valid instrument to measure inspiratory capacity? Fisioter Pesqui 2015;22:155-60.
17.	Hagman C, Janson C, Malinovschi A, Hedenström H, Emtner M. Measuring breathing patterns and respiratory movements with the respiratory movement measuring instrument. Clin Physiol Funct Imaging 2016;36:414-20.
18.	Ando T, Kawamura K, Fujitani J, Koike T, Fujimoto M, Fujie MG. Thoracic ROM measurement system with visual bio-feedback: System design and biofeedback evaluation. Annu Int Conf IEEE Eng Med Biol Soc 2011;2011:1272-4.
19.	Olsén MF, Lindstrand H, Broberg JL, Westerdahl E. Measuring chest expansion; A study comparing two different instructions. Adv Physiother 2011;13:128-32.