Who needs chest physiotherapy? Moving from anecdote to evidence

Early treatment was based on intuitive reasoning but its universal acceptance makes it ethically precarious to attempt the controlled trial of treatment versus no treatment in the child with established disease or even in the newly diagnosed infant. [...]most trials involve the comparison of treatme...

Full description

Saved in:
Bibliographic Details
Published in:Archives of disease in childhood 1999-04, Vol.80 (4), p.393-397
Main Authors: Wallis, Colin, Prasad, Ammani
Format: Article
Language:English
Subjects:
Biological and medical sciences
Child
Child Health
Control Groups
Critical Care - methods
Cystic fibrosis
Cystic Fibrosis - rehabilitation
Evidence-Based Medicine
Humans
Infant, Newborn
Infants
Lung Diseases - rehabilitation
Medical sciences
Personal View
Physical Therapy Modalities
Pneumology
Postoperative Care - methods
Respiration
Respiratory diseases
Respiratory system : syndromes and miscellaneous diseases
Studies
Young Children
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Early treatment was based on intuitive reasoning but its universal acceptance makes it ethically precarious to attempt the controlled trial of treatment versus no treatment in the child with established disease or even in the newly diagnosed infant. [...]most trials involve the comparison of treatment types. 7-10 Publications are fraught with the difficulties of study design in physiotherapy trials and the inconsistency of findings leave the practitioner none the wiser in their search for an evidence base. 11 A meta-analysis of randomised trials in CF comparing the differing techniques with standard treatment showed no difference between them but did show significantly greater sputum expectoration than no treatment. 12 Because no gold standard exists for physiotherapy in CF and it is unlikely that any one technique reigns supreme, it would seem appropriate to select a technique from the spectrum available that suits the individual's requirements. 11 Bronchoalveolar lavage studies in infants with CF indicate the presence of infection and inflammation within the airways at an early stage, even before clinical manifestations. 13 14 For this reason, prophylactic chest physiotherapy is often introduced at diagnosis, but this places a great burden on the family, and adherence to chest physiotherapy in CF is known to be poor. 15 The impact of early intervention on the natural history of the disease is unknown. [...]there is the thorny issue of sputum collection. Because clearance of secretions is the goal of chest physiotherapy in many paediatric chest disorders, should the sputum produced not be the outcome measure of choice?
ISSN:0003-9888
1468-2044
DOI:10.1136/adc.80.4.393