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Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis

  • Review
  • Intervention

Authors


Abstract

Background

Chest physiotherapy is widely used in people with cystic fibrosis in order to clear mucus from the airways.

Objectives

To determine the effectiveness and acceptability of chest physiotherapy compared to no treatment or spontaneous cough alone to improve mucus clearance in cystic fibrosis.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 09 February 2009.

Selection criteria

Randomised or quasi-randomised clinical trials in which a form of chest physiotherapy (airway clearance technique) were taken for consideration in people with cystic fibrosis compared with either no physiotherapy treatment or spontaneous cough alone.

Data collection and analysis

Both authors independently assessed trial eligibility, extracted data and assessed trial quality.

Main results

One hundred and twenty-six trials were identified by the search, of which six cross-over trials with 66 participants were found eligible for inclusion in the review. Five studies were single treatment studies; in one study each treatment regimen was used twice daily for two consecutive days. Three studies, involving 36 participants, found a higher amount of expectorated secretions during chest physiotherapy as compared to a control period. Two studies, involving 24 participants found no significant effect on pulmonary function variables following intervention. In four studies radioactive tracer clearance was used as an outcome variable. In three of these, involving 28 participants, it was found that chest physiotherapy, including coughing, increased radioactive tracer clearance as compared to the control period. One study of eight participants, reported no significant difference between chest physiotherapy, without coughing, compared to the control period.

Authors' conclusions

The results of this review show that airway clearance techniques have short-term effects in the terms of increasing mucus transport. No evidence was found on which to draw conclusions concerning the long-term effects.

摘要

背景

比較胸部物理治療和未經胸部物理治療對囊狀纖維化的影響

胸部物理治療被廣泛地用於清理呼吸道中的黏液,以治療囊狀纖維化的病人。

目標

決定胸部物理治療與不治療或是自體的咳嗽比較起來,其效力以及可接受度,是否在清理囊狀纖維化的黏液上,較為有利。

搜尋策略

我們搜尋了考科藍囊狀纖維化與基因遺傳疾病的登記試驗族群資料庫,該資料庫包含了完整的電子資料庫以及相關期刊與會議記錄。囊狀纖維化試驗登記的最新搜尋日期為:2006年9月。

選擇標準

在隨機或是類隨機的臨床試驗中,比較利用胸部物理治療(呼吸道清理技術)來照顧囊狀纖維化的病人,與不利用物理療法,或是僅用自體咳嗽的方式,其間的優劣差別。

資料收集與分析

試驗者分別獨立地判斷試驗的適格性,取得資料,並評價試驗的質量。

主要結論

這次調查的126個試驗中,有6個包含66名受試者的交叉試驗,被認可作為結論的考量。五項研究為單一療法的研究;在每個研究中,每一種療法皆一天被施予兩次,連續兩天。涉及36名受試者的三項研究顯示,與對照週期比較,胸部物理治療使得咳出的痰量增加。涉及24受試者兩項研究顯示,該療法肺功能異常沒有顯著的效用。在四項關於放射性追蹤物質清理程度的研究中,結果有所不同。在其中三項包含28名受試者的研究中顯示,與對照週期比較,胸部物理治療包括咳嗽,放射性追蹤物質的清理程度有所增加。另一項包含8名受試者的研究則顯是,與對照週期比較,胸部物理治療不包括咳嗽,其清理程度並沒有顯著差異。

作者結論

審查結果顯示,呼吸道清理技術對於黏液的輸送,在短期內有其效力。但沒有證據能為長期的效力背書。

翻譯人

本摘要由臺灣大學附設醫院秦祥銘翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於囊狀纖維化病人施予胸部物理治療,存在著短期上有其效益的佐證,但長期上則沒有。黏液的過量製造會造成反覆的感染,以及囊狀纖維化病人肺部組織的損害。所以用藥物或是胸部物理治療來清理分泌物是很重要的。物理治療係藉由多種引流與呼吸技巧,或是儀器設施,或是雙管齊下的方法,來清理分泌物。每日的物理治療須花費大量的時間與精神。呼吸道的清理技術對於黏液的輸送有著短期上的效益。四個測量放射性追蹤物質清理程度的研究,發現胸部物理治療有幫助清理程度的提升;三個測量所吐出的痰的研究,顯示胸部物理治療能幫助吐出更多的痰。目前沒有明顯的證據支持該方法在長期上,對於胸部清理、生活品質以及存活率的影響。

Plain language summary

Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis

The lungs of people with cystic fibrosis produce excess mucus. This leads to repeated infection and tissue damage in the lungs. It is important to clear the mucus using drugs and chest physiotherapy (CPT). Physiotherapy clears mucus by various techniques or by using mechanical devices or both. Daily physiotherapy takes a lot of time and trouble. We found that techniques for clearing the airways have short-term benefits for mucus transport. Four studies measured radioactive tracer clearance and found increased clearance with CPT; three studies measured sputum which had been coughed up, found a higher amount with CPT. At present there is no clear evidence of long-term effects in chest clearance, quality of life or survival with CPT.

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