1999 OPEN FORUM Abstracts

EVIDENCE-BASED MEDICINE IN CARDIOPULMONARY PHYSICAL THERAPY.

Tetsuo Miyagawa, PhD, RRT, PT, RCET; Department of Physical Therapeutics, College of Medical Sciences, Showa University, Yokohama, 226-8555, Japan.

Background: Many of the techniques of chest physical therapy (Chest PT) for chronic respiratory disease were first described in the early 1900s and these methods have remained remarkably unchanged since then. However, It is still unclear whether many techniques are effective, because a large number of papers have been reported that conventional Chest PT was associated many complications. The purpose of this study was to determine the effect of cardiopulmonary physical therapy techniques on the evidence-based medicine.

Method: Computerized bibliographic data bases (MEDLINE) were searched from 1966 to 1997. For this search I used the following items: chest physical therapy (physiotherapy), postural drainage, diaphragmatic breathing, breathing retraining, incentive spirometry (IS), positive expiratory pressure (PEP), flutter valve, autogenic drainage and early mobilization.

Results: 1948 citations were found using the search strategies for primary research. I selected 42 trials for postoperative complication and acute respiratory failure and 41 trials for chronic respiratory failure. The analysis was based on examination of the effect size (ES) or Odds ratio (OR). 1) Chest PT decreased oxygenation in acute respiratory failure, ES -0.31(-0.57»-0.05). 2) Chest PT was not effective for postoperative pulmonary complications, OR 0.80 (0.57»1.13). 3) IS and diaphragmatic breathing was effective for post operative pulmonary complications, OR 0.41 (0.25»0.68), OR 0.2 (0.11»0.36). 4) CPAP mask was more effective than chest PT in postoperative pulmonary complications, OR 0.49 (0.28»0.87). 5) Chest PT, IS or early mobilization did not reduce hospitalization, ES 0.09(-0.11»0.29), ES 0.28(0.04»0.53), ES 0.15(-0.20»0.50). 6) Comprehensive cardiopulmonary PT reduced postoperative pulmonary complication and hospitalization, OR 0.02 (0.16»0.30), ES 0.63(0.52»0.74). 7) Chest PT increased sputum expectoration in chronic respiratory failure, ES 2.23(1.76»2.70). 8) Percussion or vibration was not effective in chronic respiratory failure, ES 0.2(-0.10»0.50). 9) Combined aerosol therapy and Chest PT was more effective than chest PT in chronic obstructive pulmonary disease. ES1.46 (0.72»2.18). 10) Chest PT, PEP, huffing, cough, exercise, flutter valve and autogenic drainage were the same effects of sputum expectoration volume in chronic obstructive pulmonary disease.

Conclusions: Conventional Chest PT that included postural drainage, percussion and vibration was not effective. These results suggested more comprehensive cardiopulmonary PT was effective.

OF-99-228