Intervention Review

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Chest physiotherapy for pneumonia in children

  1. Gabriela SS Chaves1,
  2. Guilherme AF Fregonezi2,
  3. Fernando AL Dias3,
  4. Cibele TD Ribeiro4,
  5. Ricardo O Guerra2,
  6. Diana A Freitas1,
  7. Veronica F Parreira5,
  8. Karla MPP Mendonca2,*

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 20 SEP 2013

Assessed as up-to-date: 31 MAY 2013

DOI: 10.1002/14651858.CD010277.pub2


How to Cite

Chaves GSS, Fregonezi GAF, Dias FAL, Ribeiro CTD, Guerra RO, Freitas DA, Parreira VF, Mendonca KMPP. Chest physiotherapy for pneumonia in children. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD010277. DOI: 10.1002/14651858.CD010277.pub2.

Author Information

  1. 1

    Federal University of Rio Grande do Norte, Department of Physical Therapy, Natal, Rio Grande do Norte, Brazil

  2. 2

    Federal University of Rio Grande do Norte, PhD Program in Physical Therapy, Natal, Rio Grande do Norte, Brazil

  3. 3

    Federal University of Paraná, Department of Physiology, Curitiba, Paraná, Brazil

  4. 4

    Federal University of Rio Grande do Norte, Graduate Program in Physiotherapy, Natal, Rio Grande do Norte, Brazil

  5. 5

    Federal University of Minas Gerais, Department of Physical Therapy, Belo Horizonte, Minas Gerais, Brazil

*Karla MPP Mendonca, PhD Program in Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Bairro Lagoa Nova, Natal, Rio Grande do Norte, 59078-970, Brazil. kmorganna@ufrnet.br.

Publication History

  1. Publication Status: New
  2. Published Online: 20 SEP 2013

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Characteristics of included studies [ordered by study ID]
Lukrafka 2012

MethodsDESIGN: randomised controlled trial

METHOD OF RANDOMISATION: assigned to 2 groups. The randomisation was performed by an epidemiologist using a computerised random number generator to select blocks of 3 and 4. A separate randomisation procedure was performed in each of 2 age group subsets (12 to 59 months and 5 to 12 years)
METHOD OF ALLOCATION CONCEALMENT: randomisation was concealed using sequentially numbered opaque envelopes by the senior investigator
OUTCOME ASSESSOR BLINDING: the study radiologist, statistician and epidemiologist involved in evaluating the outcomes of this RCT did not take part in the clinical attendance and therapeutic decisions

WITHDRAWAL/DROPOUTS: after the randomisation, 4 participants underwent chest drainage (3 in the intervention group) and 3 participants had atelectasis detected by chest X-ray (all in the control group); therefore, 72 participants (n = 35 in the intervention and n = 37 in the control) remained in the study and follow-up


ParticipantsCountry: Brazil
Setting: hospital

Healthy status: children hospitalised with a clinically and radiologically confirmed diagnosis of acute community-acquired pneumonia

Total sample: 72 participants (n = 35 in the intervention and n = 37 in the control)

Age ranged: 1 to 12 years

Exclusion criteria: participants who were severely ill, such as  those hospitalised in intensive care units, with pleural effusion treated with chest drainage, atelectasis detected by X-ray, history of pneumonia or pleural effusion in the previous 6 months, or other pulmonary underlying diseases, heart diseases, cerebral palsy or immune deficiency


InterventionsDuration: active treatment: 3 times daily

Intervention group: standardised respiratory physiotherapy (positioning, thoracic vibration, thoracic compression, positive expiratory pressure, breathing exercises and forced exhalation with the glottis open or 'huffing')
Control group received a non-mandatory request to breathe deeply, expectorate the sputum and maintain a lateral body position once a day

Re-evaluated at discharge


OutcomesRespiratory rate

Temperature

Tachypnoea

Nasal flaring

Suprasternal, intercostal and subcostal recession

Oxygen saturation

X-ray

Duration of hospitalisation


NotesThe trial author has responded to our enquiries but informed us that was not possible for her to send data as means and standard deviations


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskThe randomisation was performed by an epidemiologist using a computerised random number generator to select blocks of 3 and 4

Allocation concealment (selection bias)Low riskRandomisation was concealed by the senior investigator using sequentially numbered opaque envelopes

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo blinding and the outcome is likely to be influenced by lack of blinding

Blinding of outcome assessment (detection bias)
All outcomes
Low riskBlinding of outcome assessment ensured

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

Selective reporting (reporting bias)High riskThe study protocol is available, but there is no information regarding the outcomes

Other biasUnclear riskInsufficient information to assess whether an important risk of bias exists

Paludo 2008

MethodsDESIGN: randomised controlled trial

METHOD OF RANDOMISATION: simple randomisation was performed from a table of random numbers

METHOD OF ALLOCATION CONCEALMENT: not described

OUTCOME ASSESSOR BLINDING: all attending paediatricians were blinded to group assignment and study protocol

WITHDRAWAL/DROPOUTS: 9 participants withdrew from the study


ParticipantsCountry: Brazil
Setting: hospital

Healthy status: participants hospitalised with a diagnosis of acute pneumonia (did not specify the acquisition form)
Total sample: 89 participants

Age range: children aged 29 days to 12 years

Exclusion criteria: participants who needed a chest drain, had haemodynamic instability, bone fragility or rib fractures and any other contraindication to chest physical therapy were excluded


InterventionsDuration: active treatment: twice daily

Intervention group: each session of chest physical therapy took about 30 min and consisted of postural drainage, thoracic squeezing, chest percussion, vibration, cough stimulation and aspiration of secretions (if necessary)
Control group received standard treatment for pneumonia alone

Re-evaluated at discharge


OutcomesTime to clinical resolution: afebrile, absence of severe signs (chest indrawing, nasal flaring), normal respiratory rate and arterial oxygen saturation > 95%

Length hospital stay and persistence of respiratory symptoms and signs (fever, cough, wheezing, tachypnoea, chest indrawing, adventitious sounds on lung auscultation and arterial oxygen saturation)


NotesThe author has responded to our enquiries with further details


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskSimple randomisation was performed from a table of random numbers

Allocation concealment (selection bias)Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo blinding and the outcome is likely to be influenced by lack of blinding

Blinding of outcome assessment (detection bias)
All outcomes
Low riskBlinding of outcome assessment ensured

Incomplete outcome data (attrition bias)
All outcomes
Low riskMissing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

Selective reporting (reporting bias)High riskThe study protocol is not available and one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta-analysis

Other biasUnclear riskInsufficient information to assess whether an important risk of bias exists

Zhao 2010

MethodsDESIGN: randomised controlled trial

METHOD OF RANDOMISATION: not described

METHOD OF ALLOCATION CONCEALMENT: not described

OUTCOME ASSESSOR BLINDING: not described

WITHDRAWAL/DROPOUTS: not described  


ParticipantsCountry: China
Setting: hospital

Healthy status: severe pneumonia

Total sample: 94 children (47 in each group)
Mean age: 10.79 ± 4.75 months

Age range: children aged 2 months to 2 years

Exclusion criteria: not described        


InterventionsDuration: active treatment: until the stabilisation of the patient based on oxygen saturation

Intervention group: continuous positive airway pressure
Control group received standard treatment for pneumonia with oxygen support

Re-evaluated 4 hours and 12 hours after treatment


OutcomesArterial oxygen saturation; arterial oxygen pressure; arterial carbon dioxide pressure


NotesThis paper was translated from Chinese


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskInsufficient information about the sequence generation process

Allocation concealment (selection bias)Unclear riskInsufficient information about the allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInsufficient information to permit judgement of 'low risk' or 'high risk'

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing outcome data

Selective reporting (reporting bias)Low riskThe study protocol is not available but the published reports include all expected outcomes, including those that were pre-specified

Other biasUnclear riskInsufficient information to assess whether an important risk of bias exists

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Brunetto 2002There is no control group

Campos 2007There is no control group

Lanza 2009The control group received some intervention

Santos 2009There is no control group