Chest physiotherapy for pneumonia in adults
ABSTRACT Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia.
To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults.
We searched CENTRAL 2012, Issue 11, MEDLINE (1966 to November week 2, 2012), EMBASE (1974 to November 2012), Physiotherapy Evidence Database (PEDro) (1929 to November 2012), CINAHL (2009 to November 2012) and CBM (1978 to November 2012).
Randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for treating pneumonia in adults.
Two authors independently assessed trial eligibility, extracted data and appraised trial quality. Primary outcomes were mortality and cure rate. We used risk ratios (RR) and mean difference (MD) for individual trial results in the data analysis. We performed meta-analysis and measured all outcomes with 95% confidence intervals (CI).
Six RCTs (434 participants) appraised four types of chest physiotherapy (conventional chest physiotherapy; osteopathic manipulative treatment (which includes paraspinal inhibition, rib raising and myofascial release); active cycle of breathing techniques (which include active breathing control, thoracic expansion exercises and forced expiration techniques); and positive expiratory pressure).None of the physiotherapies (versus no physiotherapy or placebo) improved mortality rates of adults with pneumonia.Conventional chest physiotherapy (versus no physiotherapy), active cycle of breathing techniques (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo) did not increase the cure rate or chest X-ray improvement rate.Osteopathic manipulative treatment (versus placebo) and positive expiratory pressure (versus no physiotherapy) reduced the mean duration of hospital stay by 2.0 days (mean difference (MD) -2.0 days, 95% CI -3.5 to -0.6) and 1.4 days (MD -1.4 days, 95% CI -2.8 to -0.0), respectively. Conventional chest physiotherapy and active cycle of breathing techniques did not.Positive expiratory pressure (versus no physiotherapy) reduced fever duration (MD -0.7 day, 95% CI -1.4 to -0.0). Osteopathic manipulative treatment did not.Osteopathic manipulative treatment (versus placebo) reduced the duration of intravenous (MD -2.1 days, 95% CI -3.4 to -0.9) and total antibiotic treatment (MD -1.9 days, 95% CI -3.1 to -0.7).Limitations of this review are that the studies addressing osteopathic manipulative treatment were small, and that six published studies which appear to meet the inclusion criteria are awaiting classification.
Based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults.
SourceAvailable from: Anup Bhat[Show abstract] [Hide abstract]
ABSTRACT: Context:Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs.Aim:The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India.Settings and Design:A tertiary care hospital in Karnataka, India, and cross-sectional survey.Subjects and Methods:A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India.Statistical Analysis Used:Descriptive statistics.Results:The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists.Conclusions:Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.Indian Journal of Critical Care Medicine 06/2014; 18(6):363-8. DOI:10.4103/0972-5229.133890
[Show abstract] [Hide abstract]
ABSTRACT: This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions / interventions that received an 'inconclusive' or 'negative' evidence rating or were not covered in the report. A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added. 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were RCTs, and 10 were non-randomised primary studies. Most 'inconclusive' or 'moderate' evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation / mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive. Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.03/2014; 22(1):12. DOI:10.1186/2045-709X-22-12
[Show abstract] [Hide abstract]
ABSTRACT: Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.