Research report Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment in determining a simulated breathing pattern q Rosalba Courtney a, * , Marc Cohen b , John Reece c a RMIT University, School Health Science,11 Binburra Avenue, Avalon, NSW 2107, Australia b School of Health Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia c Division of Psychology, School of Health Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia article info Article history: Received 28 January 2008 Received in revised form 5 September 2008 Accepted 16 October 2008 Available online xxx Keywords: Dysfunctional breathing Breathing pattern Breathing assessment MARM Hi Lo 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. Partici- pants 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 assess- ment 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 tech- niques. 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. Ó 2008 Published by Elsevier Ltd. 1. Introduction Breathing pattern disturbance and abnormal function of the respiratory muscles have been proposed to contribute to symptoms such as dyspnea, 1,2 neck and shoulder girdle pain, 3 and temporomandibular joint disorders. 4 It has also been argued that a person’s habitual breathing patterns may influence posture and spinal stability, and it has been proposed that correct breathing is the foundation for the correction of dysfunctional movement and postural patterns. 5,6 It is difficult to evaluate the impact of breathing pattern on symptoms, movement and postural patterns on the basis of these previous studies because the characteristics of correct or dysfunctional breathing pattern were not clearly defined and the measurement techniques used to evaluate breathing pattern had not been standardized or validated. Nevertheless in the clinical environment, breathing pattern is often assessed by observation and palpation and several palpatory q Funding: This study was part of a PhD and supported by RMIT University. The Australian Osteopathic Association provided additional funds and administrative support. * Corresponding author. Tel.: þ61 2 99183460. E-mail address: courtney2107@optusnet.com.au (R. Courtney). Contents lists available at ScienceDirect International Journal of Osteopathic Medicine journal homepage: www.elsevier.com/locate/ijosm ARTICLE IN PRESS 1746-0689/$ – see front matter Ó 2008 Published by Elsevier Ltd. doi:10.1016/j.ijosm.2008.10.002 International Journal of Osteopathic Medicine xxx (2009) 1–6 Please cite this article in press as: Courtney R, et al., Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing..., Int J Osteopath Med (2009), doi:10.1016/j.ijosm.2008.10.002