*3.4. Effectiveness and Safety of Manual Therapies Using Pair-Wise Meta-Analysis*

Manipulation showed no differences compared with sham in lung functions (FEV1: MD 0.23 L, 95% CI from −0.12 to 0.58; FVC: MD −0.02 L, 95% CI from −0.57 to 0.53; FEV1/FVC: MD 3.01%, 95% CI from −6.90 to 12.92), exercise capacity (6MWD: MD 64.80 m, 95% CI from −12.94 to 142.54), and incidence of AE (RR 0.50, 95% CI: from 0.11 to 2.38). Additional massage significantly improved FEV1/FVC (MD 20.00%, 95% CI from 15.46 to 24.54) and total effective rate (TER) calculated using the severity of respiratory symptoms (RR 1.17, 95% CI from 1.00 to 1.38), compared with ROC alone. However, there were no differences between them in the FEV1 (MD 0.68 L, 95% CI from −0.62 to 1.99), 6MWD (MD 56.20 m, 95% CI from −8.18 to 120.58), and incidence of AE (RR 8.89, 95% CI from 0.48 to 165.55). When comparing additional acupressure with ROC alone, although there was no difference in FEV1 (MD 0.05 L, 95% CI from −0.24 to 0.34) and FEV1/FVC (MD 0.84%, 95% CI from −4.60 to 2.27), other outcomes including FVC (MD 0.33 L, 95% CI from 0.17 to 0.49), 6MWD (MD 14.38 m, 95% CI from 3.71 to 25.05), TER based on the respiratory symptom (RR 1.14, 95% CI from 1.06 to 1.23), sputum secretion (MD −5.31 mL, 95% CI from −6.00 to −4.62), SpO2 (MD 3.44%, 95% CI from 1.64 to 5.23), PaO2 (MD 13.38 mmHg, 95% CI from 9.16 to 17.60), PaCO2 (MD −8.91 mmHg, 95% CI from −12.09 to −5.72), and SaO2 (MD 9.10%, 95% CI from 5.29 to 12.91) significantly improved. Additional tuina significantly improved FEV1/FVC (MD 2.65%, 95% CI from 0.10 to 5.20), and 6MWD (MD 49.53 m, 95% CI from 27.05 to 72.00) compared with ROC alone, although there were no differences in FEV1 (MD 0.10 L, 95% CI from −0.05 to 0.25), FVC (MD 0.26 L, 95% CI from −0.05 to 0.58), and TER based on the respiratory symptom (RR 1.10, 95% CI from 0.94 to 1.28). When conducting foot reflexology in addition to ROC, 6MWD (MD 36.08 m, 95% CI from 8.45 to 63.71), and TER based on the respiratory symptom (RR 2.13, 95% CI from 1.09 to 4.16) significantly improved compared with ROC alone (Supplement S3). *Healthcare* **2021**, *9*, x 12 of 18 CI from −4.60 to 2.27), other outcomes including FVC (MD 0.33 L, 95% CI from 0.17 to 0.49), 6MWD (MD 14.38 m, 95% CI from 3.71 to 25.05), TER based on the respiratory symptom (RR 1.14, 95% CI from 1.06 to 1.23), sputum secretion (MD −5.31 mL, 95% CI from −6.00 to −4.62), SpO2 (MD 3.44%, 95% CI from 1.64 to 5.23), PaO2 (MD 13.38 mmHg, 95% CI from 9.16 to 17.60), PaCO2 (MD −8.91 mmHg, 95% CI from −12.09 to −5.72), and SaO2 (MD 9.10%, 95% CI from 5.29 to 12.91) significantly improved. Additional tuina significantly improved FEV1/FVC (MD 2.65%, 95% CI from 0.10 to 5.20), and 6MWD (MD 49.53 m, 95% CI from 27.05 to 72.00) compared with ROC alone, although there were no differences in FEV1 (MD 0.10 L, 95% CI from −0.05 to 0.25), FVC (MD 0.26 L, 95% CI from −0.05 to 0.58), and TER based on the respiratory symptom (RR 1.10, 95% CI from 0.94 to 1.28). When conducting foot reflexology in addition to ROC, 6MWD (MD 36.08 m, 95% CI from 8.45 to 63.71), and TER based on the respiratory symptom (RR 2.13, 95% CI from 1.09 to 4.16) significantly improved compared with ROC alone (Supplement S3).

#### *3.5. Comparative Effectiveness of Manual Therapies Using NMA 3.5. Comparative Effectiveness of Manual Therapies Using NMA*

NMA was possible only for the outcomes of FEV1, FVC, FEV1/FVC, and 6MWD. Therefore, pair-wise meta-analysis was performed for other outcomes because the network had no degrees of freedom for heterogeneity due to the small number of studies included. Figure 3 shows the network map of the interventions belonging to each NMA. NMA was possible only for the outcomes of FEV1, FVC, FEV1/FVC, and 6MWD. Therefore, pair-wise meta-analysis was performed for other outcomes because the network had no degrees of freedom for heterogeneity due to the small number of studies included. Figure 3 shows the network map of the interventions belonging to each NMA.

**Figure 3.** Network map of (**a**) FEV1 (L), (**b**) FVC (L), (**c**) FEV1/FVC (%), and (**d**) 6 min walking distance. ACU—acupuncture; FRF—foot reflexology; MAN—manipulation; MANP—manual percussion; MAS—massage; MECP—mechanical percussion; ROC—routine care; TUI—tuina. **Figure 3.** Network map of (**a**) FEV1 (L), (**b**) FVC (L), (**c**) FEV1/FVC (%), and (**d**) 6 min walking distance. ACU—acupuncture; FRF—foot reflexology; MAN—manipulation; MANP—manual percussion; MAS—massage; MECP—mechanical percussion; ROC—routine care; TUI—tuina.

In FEV1, only additional massage showed significantly better results compared to ROC alone (MD 0.74 L, 95% CI 0.08 to 1.40). In FVC, additional acupressure resulted in significant improvement while tuina showed borderline better results compared to ROC alone (MD 0.33 L, 95% CI from 0.17 to 0.47; MD 0.26 L, 95% CI from −0.05 to 0.58) (Table 3). In FEV1/FVC, additional massage showed significantly better results not only

3.5.1. Lung Function
