1997 OPEN FORUM Abstracts
BRONCHOPULMONARY HYGIENE PHYSICAL THERAPY AND CHRONIC AIRWAYS DISEASE: A SYSTEMATIC REVIEW.
Arthur Jones, EdD, RRT, Brian Rowe, MD.
Question: What are the therapeutic effects of bronchopulmonary hygiene physical therapy (BHPT) on patients with chronic airways obstruction?
Methods: We used the following terms to search the Cochrane Airways Group database: Postural drainage OR physical therapy OR percussion OR physiotherapy. This database includes trials involving asthma, bronchiectasis, bronchiolitis, COPD, sleep apnea and wheezing. It is a composite of the MEDLINE database from 1966 to 1995, Embase from 1980 to 1995, and CINAHL from 1982 to 1995. Besides the computer search, we examined reference lists of trials and reviews for additional trials. Also, we queried primary authors of trials on the existence of other trials. Two reviewers applied inclusion/exclusion criteria to potential trials and assessed the methodological quality of the RCTs. We used Cochrane's system for categorizing allocation concealment and a modified version of Jadad's 5 point scale for quality assessment. Weighted kappa (Kw) and simple agreement (SA) measured agreement between evaluators. Consensus was reached via email dialogue. Data were extracted by one reviewer, then verified by the other. We used Cochrane Review Manager, Windows version 2.1a to compile and analyze the data. As the dependent variables were continuous, weighted mean differences with 95% confidence intervals measured effects. Results: The initial search identified 95 potential trials. Four more were identified from reference lists. Application of inclusion/exclusion criteria left 10 trials to review. The Kw and SA for allocation concealment and trial quality were (1.0, 1.0) and (0.1, 0.25), respectively. The mean quality score was 1.4 (5 = highest). Within the 10 included trials, there were 13 separate comparisons-of-interest, that addressed 11 different dependent variables. The trials were incommensurable for statistical aggregation because trials that addressed similar interventions used disparate dependent variables. Therefore, we computed neither composite effect magnitude nor measures of homogeneity. Since the studies could not be aggregated, the sensitivity analysis for quality and effects could not be done. Notably, there was only one trial that scored 3 out of a possible 5 on the quality scale. This was the second largest trial (N=33) and found no significant effects. The predominant significant effects favor BHPT for clearance of sputum and radioaerosol particles from the lung. But, there was no evidence that lung function was improved by BHPT. These results are based on a total of 153 patients. Studies with positive results involved at total of 67 patients. Conclusions: Given the size and quality of the trials, the research on BHPT is confused. Therefore, we cannot support the routine application of BHPT to patients with chronic airways obstruction. There is an apparent need to conduct adequately-sized RCTs that examine the effects of BHPT on clinical outcomes related to mortality and morbidity.