The effectiveness of manual techniques in comparison to external devices for chest clearance in individuals with cystic fibrosis

Abstract

Background: Manual techniques are considered an important part of the treatment and management of individuals with cystic fibrosis (CF) and have been used as part of chest physiotherapy for decades. Advances in science and technology have brought about external devices which claim to perform the same role as manual techniques with regards to chest clearance in individuals with cystic fibrosis. Research question: Using the PICO framework, the following research question was formulated: Do manual techniques offer better efficiency in chest clearance when compared to external devices in individuals with CF? PICO elements: Population: Individuals with CF of any age, gender, and race; Intervention: Manual techniques also known as Conventional Chest Physiotherapy (CCPT); Comparison: External devices which include Mechanical Percussion (MP), High-Frequency Chest Wall Compression (HFCC) and Positive Expiratory Pressure (PEP) devices; Outcome: Chest clearance through dislodging and enhancing the removal of secretions. Methods: Based on the PICO elements, diagnosed CF individuals of any age, gender and race and studies published in English between 1970-2020 were included. This yielded 3 systematic reviews (SRs) and meta-analyses of randomised controlled trials (RCTs), and 5 RCTs. The CASP tools for systematic reviews and RCTs were applied. Results: All studies included in this PICO study did not show a significant result for either CCPT or the external device to which CCPT was being compared. All the studies showed that manual techniques are as effective as external devices in chest clearance apart from one RCT which compared CCPT with PEP and found that PEP was more effective in the long-term than CCPT. Conclusion: Manual techniques also referred to as CCPT were as effective as the external devices studied in this PICO study namely MP, HFCC and PEP in chest clearance in individuals with CF. However, patients’ preference shifted to the use of external devices due to increased independence. Recommendations: Both manual techniques and the external devices studied in this PICO study can be used either in exacerbations or non-exacerbation periods to promote chest clearance in individuals with CF due to similar efficiency.