Comparing the effects of conventional chest physiotherapy with other airway clearance techniques for cystic fibrosis patients

Abstract

Overview: Cystic fibrosis (CF) is a life-limiting genetic condition characterised by the build-up of thick mucus within the lungs that leads to repeated infections and inflammation, eventually causing deterioration in lung function. The biggest contribution physiotherapy has in the management of the disease is through the use of airway clearance techniques (ACTs). This review set out to compare the efficacy of Conventional Chest Physiotherapy (CCPT) to more contemporary techniques. PICO Elements: Population (P): Patients Diagnosed with Cystic Fibrosis, Intervention (I) : Conventional Chest Physiotherapy, Comparison (C): Other Airway Clearance Techniques, Outcomes (O): Effects on pulmonary status. Research Question: ‘How does Conventional Chest Physiotherapy compare to other Airway Clearance Techniques in the physiotherapeutic management of Cystic Fibrosis?’. Inclusion Criteria: Systematic reviews (SRs) and Meta-analysis, performed within the last 10 years, which compare CCPT to other ACTs as a single treatment in people with CF. Outcome of Search: A search was conducted across 4 electronic databases using keywords and synonyms identified for each PICO element. After analysing the studies against the eligible criteria, 5 SRs were chosen. The included studies compared CCPT with Active Cycle of Breathing Technique, Autogenic Drainage, Positive Expiratory Pressure devices and Oscillatory Devices. Methods of Appraisal: A critical appraisal was performed using the CASP SR Checklist (2018). Results: The results comparing CCPT to other ACTs did not demonstrate any statistically significant differences in the outcome measures studied (lung function tests, sputum weight and number of pulmonary exacerbations). Therefore, no definite conclusion could be drawn as to whether CCPT is more effective than alternative ACTs in the management of CF patients. Conclusion: As there is no evidence supporting the superiority of any ACT to CCPT, CCPT should still be considered as an effective ACT and prescribed when its use is indicated. Implications and Recommendations: Physiotherapists should also take into consideration patient centred outcomes when prescribing ACTs. Further research should include trials with larger number of participants and long-term follow-ups.