Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment in determining a simulated breathing pattern☆

Abstract 

Aim

The aim of this study was to assess and compare the validity and potential utility of two manual breathing assessment procedures: the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment. A secondary aim was to gauge the relationships between experience and the ability to perform these assessment techniques, by comparing the performance of students with practitioners.

Method

56 osteopaths and osteopathic students were taught the MARM and the Hi Lo Breathing Assessment and trained to simulate breathing patterns. The participants, acting alternatively as breathers and examiners, then attempted to accurately determine whether the breathing patterns simulated by their partner were predominately abdominal, thoracic or, in the case of the Hi Lo, paradoxical. Participants were surveyed on their confidence in the use of each technique, their perceived ease in using each technique, and their intended future use of the techniques. Student and practitioner abilities to detect simulated breathing patterns were compared for the MARM and Hi Lo.

Results

Overall scores for correctly determining breathing patterns were not significantly different for the MARM or the Hi Lo, and there was no notable moderation of this effect according to experience, with both practitioners and students demonstrating a high level of performance on both techniques. There were some differences in accuracy of performance across different breathing styles, with Hi Lo assessment of paradoxical breathing being more difficult to identify correctly. Ease of learning was similar for MARM and Hi Lo but confidence in using the techniques, and intended future use was higher for the MARM. There were some significant relationships between these utility measures and performance, particularly on the MARM.

Conclusions

This study builds on our previous study to strengthen the evidence for the validity of the MARM and also supports the validity of the Hi Lo. Responses to the survey indicate that, overall, participants preferred the MARM to the Hi Lo. This study is a preliminary investigation of these techniques. Future studies to test the validity of these techniques should be performed in a clinical setting on individuals with actual rather than simulated breathing pattern disturbances.

Keywords: Dysfunctional breathing, Breathing pattern, Breathing assessment, MARM, Hi Lo