Clinically useful outcome measures for physiotherapy airway clearance techniques: a review

Marques, Alda; Bruton, Anne; Barney, Anna

doi:10.1179/108331906x163441

Cited by 46 publications

(40 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Frequently used outcome measures for airway clearance techniques are limited in their accuracy and reliability, and most are difficult to tie to the effects of airway clearance specifically. 12,46,47 Some measures, such as sputum weight or volume, have limited repeatability and specificity. Similarly, pulmonary function test results depend on the subject's effort and motivation, may be variably interpreted, and may not accurately reflect the effectiveness of a given clearance modality.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

et al. 2013

View full text Add to dashboard Cite

SummaryNonpharmacologic airway clearance techniques are used to reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of nonpharmacologic interventions that health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients without cystic fibrosis, over the age of 12 months. We searched MEDLINE and other databases from 1990 to 2012 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes, and assigned overall quality ratings. The 32 studies meeting the review criteria included 24 randomized controlled trials, 7 crossover randomized controlled trials, and one prospective cohort study. Studies were typically small and together included a total of 2,453 subjects (mean 76/study). Studies generally examined chest physical therapy/physiotherapy modalities in postoperative or critically ill subjects or those with COPD. Interventions, comparators, and populations varied considerably across studies, hampering our ability to draw firm conclusions. Interventions, including conventional chest physical 2160RESPIRATORY CARE • DECEMBER 2013 VOL 58 NO 12 therapy/physiotherapy, intrapulmonary percussive ventilation, and positive expiratory pressure, typically provided small benefits in pulmonary function, gas exchange, oxygenation, and need for/duration of ventilation, among other outcomes, but differences between groups were generally small and not significant. Harms of the techniques were not consistently reported, though airway clearance techniques were generally considered safe in studies that did comment on adverse effects. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and harms of these techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Similarly, pulmonary function test results depend on the subject's effort and motivation, may be variably interpreted, and may not accurately reflect the effectiveness of a given clearance modality. [46][47][48] We summarize study results by key outcomes below.…”

Section: Discussionmentioning

confidence: 99%

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

et al. 2013

View full text Add to dashboard Cite

show abstract

“…However, addressing these issues has been highly challenging since available respiratory measures such as spirometry are dependent on patient motivation and cooperation, and other tests such as blood gas analysis and imaging are not available in all clinical settings and are expensive. 2,3 Computerized respiratory sound analysis (CORSA), which consists of recording patients' respiratory sounds with an electronic device and analyzing them based on specific signal characteristics, is a simple, objective, and noninvasive method to detect and characterize adventitious respiratory sounds (ARSs), ie, crackles (CRs) and wheezes (WHs). ARSs provide crucial information on respiratory dysfunction, 4 and changes in their characteristics (eg, intensity, duration, timing) might inform the clinical course of respiratory diseases and treatments.…”

Section: Introductionmentioning

confidence: 99%

Computerized Adventitious Respiratory Sounds as Outcome Measures for Respiratory Therapy: A Systematic Review

2013

View full text Add to dashboard Cite

INTRODUCTION:There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be objectively characterized with computerized respiratory sound analysis (CORSA) and have been shown to contribute for diagnosis purposes; however, their potential for use as outcome measures is unknown. Thus, this systematic review synthesizes the evidence on the use of computerized adventitious respiratory sounds as outcome measures. METHODS: The Web of Knowledge, MEDLINE, EMBASE, and SCOPUS databases were searched. Reviewers independently selected studies according to the eligibility criteria. Effect sizes and 95% CIs were computed. RESULTS: Twelve studies with different designs (observational, n ‫؍‬ 3; quasi-experimental n ‫؍‬ 7; and randomized controlled trial, n ‫؍‬ 2) were included. Eight studies were conducted with adults, and 4 studies with children. Most studies explored only one type of adventitious respiratory sound. For wheezes, the occupation rate seemed to be the most promising parameter to be used as an outcome measure, with high/medium effect sizes (0.62-1.82). For crackles, the largest deflection width showed high effect sizes (1.31 and 1.04); however, this was explored in only one study. Crackle number and 2-cycle duration presented conflicting information, with high/poor effect sizes depending on the study. CONCLUSIONS: Specific variables of each adventitious respiratory sound detected and characterized by CORSA showed high effect sizes and, thus, the potential to be used as outcome measures. Further research with robust study designs and larger samples (both of children and adult populations), and following CORSA guidelines is needed to build evidence-based knowledge on this topic.

show abstract

“…[1,2] The use of outcome measures is important to determine patients' responses to treatment received and evaluate the usefulness of treatment techniques employed. [9,10] Even though regular assessment of patient readiness for mobilisation was reported, it was interesting to find that respondents did not often use outcome measures such as dynamometry or the Medical Research Council scale to assess patients' peripheral muscle strength. Calculation for the presence of hypoxaemia or decreased lung compliance was rarely done.…”

Section: Resultsmentioning

confidence: 99%

Physiotherapy practice in South African intensive care units

Lottering

Aswegen

2016

S Afr J Crit Care

View full text Add to dashboard Cite

Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists' practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed 'very often' included ICU chart assessment (n=90, 83.3%), chest auscultation (n=94, 81.8%) and cough effort (n=81, 75%). Treatment techniques performed 'very often' included manual chest clearance (n=101, 93.5%), in-bed mobilisation and positioning (n=91, 84.3%; n=91, 84.3%, respectively), airway suctioning (n=89, 82.4%), out-of-bed mobilisation (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises (n=72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p=0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p=0.01), were involved with weaning patients from MV (42 v. 19%, p=0.00) and used incentive spirometry (76 v. 46%, p=0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p=0.00), extubation (60 v. 25%, p=0.00) and adjustment of MV settings (30 v. 12%, p=0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.

show abstract

Clinically useful outcome measures for physiotherapy airway clearance techniques: a review

Cited by 46 publications

References 83 publications

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

Computerized Adventitious Respiratory Sounds as Outcome Measures for Respiratory Therapy: A Systematic Review

Physiotherapy practice in South African intensive care units

Contact Info

Product

Resources

About