The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

META-ANALYSES OF RESPIRATORY PHYSIOTHERAPY PROGRAM IN JAPAN

Tetsuo Miyagawa, PhD,RRT,RPT,RCET, Department of Physical Therapeutics, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan Hitomi Takahashi RPT; Department of Rehabilitation Medicine, Akita City Hospital. Akita, Japan Takanobu Shioya MD; Department of Physical Therapy, College of Allied Medical Science, Akita University, Akita, Japan

INTRODUCTION: GOLD (Global Initiative for COPD) guideline was reported that pulmonary rehabilitation was one of the important strategies for patients with COPD. Especially, exercise training has stronger evidence in pulmonary rehabilitation program. The characteristics of respiratory physiotherapy program in Japan for chronic respiratory disease are involved thoracic approach (respiratory muscle stretch gymnastics, manual chest stretch exercise, and pole gymnastics). A candidate of pulmonary rehabilitation in Japan is involved not only COPD also post tuberculosis. We compared the characteristics of effects in pulmonary rehabilitation between Japan and Western countries.

METHODS:
Computerized bibliographic Japanese databases (Japana Centra Revuo Medicina) were searched from 1991 to 2002. For this search we used the following items: pulmonary rehabilitation, chest (respiratory or pulmonary) physiotherapy, diaphragmatic breathing, breathing retraining and exercise training. 840 citations were found using the search strategies for primary research. We selected 9 trials for this analysis. The analysis was based on examination of the effect size (ES) and 95%confidence interval (95% CI).

RESULTS:
Number of citations, number of patients, ES and 95%CI are shown in table 1. %VC, PImax, PEmax, chest expansion, 6 minute walking distance (6MD), dyspnea, emotional function, fatigue and mastery are improved after pulmonary rehabilitation. The comparison of pulmonary rehabilitation programs involved with thoracic approach and without it, showed in table 2. Rehabilitation programs involved thoracic approaches were more effective in %VC. 6MD and dyspnea. Residual volume is likely to reduce in thoracic approach group

COCLUSIONS:
Pulmonary rehabilitation involved thoracic approach in Japan was more effective than without it.

Table 1

  # of studies # of patients ES 95%CI
%VC 6 217 0.26 0.07~0.45
FEV1.0 9 258 0.16 -0.01~0.33
RV 4 56 -0.24 -0.61~0.13
FEV1.0% 6 217 -0.04 -0.23~0.15
PImax 6 216 0.61 0.41~0.80
PEmax 5 216 0.56 0.35~0.78
Chest Expansion 3 171 0.76 0.47~1.06
6 MD 8 95 0.45 0.27~0.64
Dyspnea 5 243 0.90 0.62~1.18
Emotional function 5 110 0.65 0.38~0.92
Fatigue 5 110 0.59 0.31~0.86
Mastery 5 110 0.58 0.31~0.85

Table 2
  Thoracic approach (+) Thoracic approach (-)
  # of patients ES 95%CI # of patients ES 95%CI
%VC 217 0.26 0.07~0.45 58 0.19 -0.17~0.56
RV 56 -0.24 -0.61~0.13 25 0.12 -0.17~0.56
6 MD 95 0.45 0.27~0.64 130 0.32 0.07~0.56
Dyspnea 243 0.90 0.62~1.18 44 0.73 0.30~1.16
Emotional function 110 0.65 0.38~0.92 44 0.59 0.16~1.02
Fatigue 110 0.59 0.31~0.86 44 0.59 0.17~1.02
Mastery 110 0.58 0.31~0.85 44 0.67 0.26~1.12
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