Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial

Abstract

BackgroundManual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. However, methodological limitations in existing research have led to a state of clinical equipoise with respect to this treatment. Thus, for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), clinical preference tends to dictate whether MCP is given to assist with sputum clearance. We standardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life.MethodsIn this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ) at six months post randomisation. Analyses were by intention to treat (ITT). This study was registered, ISRCTN13825248.ResultsAll patients were included in the analyses, of which 372 (71%) provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI −0·14 to 0·19).ConclusionsThese data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.

Results of Physiotherapy Treatments in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review

“…Cross and colleagues 31,35 and Osadnik and colleagues 27 showed no difference between groups in outcomes, whereas other studies were associated with a positive effect on dyspnea, FEV1%, and exacerbations at 6 months. 22 The main reason for this disparity is likely to be the different modalities of techniques and outcomes; however, all the articles included measures of functional status.…”

“…The authors divided the different treatment modalities into several groups: seven studies included chest physical therapy, 22,27,29,31,32,35,38 one study used breathing techniques, 28 three studies included physical exercise, 26,30,36 two studies used electrostimulation, 33,34 three studies included a combination of treatment modalities, [23][24][25] and one study included standard physical therapy (not specified). 37 …”

Outcome Measures Used in Pulmonary Rehabilitation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review

“…2016. Most studies were randomized control trials (n = 31) 15,16, conducted with inpatients (n = 27), 15,16,29,30,33,35,[37][38][39][40][41]43,[45][46][47][48][51][52][53][54][55][56][57][58][59][60][61] followed by hospital outpatient departments (n = 6), 15,37,38,42,44,49 inpatients plus patients' homes (n = 3), 31,32,50 community settings (n = 3), 34,62,63 and patients' homes (n = 1) 36 (Tabs. 1 and 2).…”

“…Twenty-three PROMs and 18 clinical outcome measures were identified. The most common patient-reported outcomes assessed were dyspnea (n = 24), using the modified Borg Scale (mBorg) 30,32,38,39,42,44,46,[52][53][54][55]58,62,63 (n = 14), and health-related quality of life (n = 23), using the St George Respiratory Questionnaire (SGRQ) 16,[34][35][36][37]39,42,44,[49][50][51]54,56,58,59 (n = 15). The most common clinical outcomes assessed were functional exercise capacity (n = 24), using the 6-minute walk test 16,[30][31][32]37,38,41,43,44,48,49,[51][52][53]56,58,63 (n = 21), and lung function (n = 13), using the FEV1 16,…”

Techniques manuelles de drainage bronchique des adultes et adolescents : quel niveau de preuve ?

“…L'efficacité de l'ACBT est majorée quand elle est assistée par un physiothé-rapeute [56]. Quatre des 17 études présentent un score PEDro supérieur à 5 [41,44,50,52]. [57].…”