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 |