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Background The emergence of the Coronavirus (COVID-19) pandemic increased the need for an effective treatment for respiratory conditions exponentially. To meet this challenge, we reevaluated the effectiveness of our physical therapy protocols for respiratory conditions. Protocols of interest were categorized as decongestive, neurogenic, mechanical, and immune modulating. Objective The objective of this study is to evaluate which of our existing treatment protocols or protocol combinations produce the best outcome. To do so, we analyzed which ones can meet the following criteria when compared to all other treatments: test statistic (> 2.0) in parametric and non-parametric tests, [statistical significance (p < 0.05)], effect size larger than 0.2, difference in the Patient Identified Problem Scale (PIP) score above Minimal Clinically Important Difference (MCID), and sample size minimum 15 treatments. Design Retrospective multivariate analysis using a modified adaptive platform design. Methods A computerized sampling using respiratory related key words from a blinded dataset yielded 178 patients with respiratory complaints or pain in the chest area. Additional statistical analysis using parametric and non-parametric tests evaluated the difference between each treatment protocol and the rest of the treatments provided. Results Several protocol combinations and one individual protocol passed the study criteria. Cardiac vascular venous thoracic (CVVT) protocol was used most frequently within these combinations (7), followed by Urinary Drainage (UD) (4). Other protocols in this group were Cardiac Cervical Cranial Vascular (CCCV), Venous Thoracic Cardiopulmonary (VTCP), and Diaphragm Cranial Sinus (DCS). Among the respiratory specific protocols, CVVT was significantly better than VTCP (0.40, p < 0.001). Discussion and Conclusion For the patient population studied, CVVT appears to be the primary protocol to consider, followed by UD, CCCV, VTCP, and DCS. Combining CVVT with Barral Abdominal Motility protocol (Barral) or VTCP with Lower Abdominal Urogenital (LAUG) on the same day might be required with acute patients.

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Some of the challenges in evaluating the effectiveness of physical therapy practice stem from the common lack of interventional standardization, as well as problems with both the availability and routine use of specific, valid outcome tools. But even if these issues are dealt with, there are still significant validity threats when trying to understand the effectiveness of physical therapy interventions. Among the most critical internal validity threats: repeated testing effect, study sample uniformity, and increase in type I or type II error. The purpose of this analysis is to illustrate how these internal validity threats were controlled using the Halili Physical Therapy Statistical Analysis Tool (HPTSAT). The original concept behind the HPTSAT tool was the adaptive platform design used in the PREVAIL I and II protocols(1,2,3). However, this concept has been significantly expanded upon in the HPTSAT design to allow for the simultaneous analysis of hundreds of treatment combinations while controlling for the above-mentioned critical internal validity threats. HPTSAT allows for concurrent computerized analysis modeled and improved upon the adaptive platform design used in the PREVAIL I and II protocols. This analysis is possible because the tool isolates the average rate of change (ARC5) instead of average change after treatment. This paper provides the mathematical basis for the algorithm used in the tool to control for several internal validity threats including repeated testing effect, study sample uniformity, and increase in type I and II error.

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