Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n = 22) or vice versa (group 2, n = 23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ 2 and t tests and repeatedmeasures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P = .04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] C E N Notice to CNE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Identify the unique characteristics and challenges of pulmonary hygiene for lung transplant patients. 2. Describe the difference between chest physiotherapy and high-frequency chest wall oscillation. 3. Define the limitations of this study and need for future studies on this topic.