Change in physiotherapy management of children with cystic fibrosis in a large urban hospital

Abstract

A retrospective audit was conducted in 1998 and 2000 to review the physiotherapy management of hospitalized children with cystic fibrosis (CF) at the Brisbane Royal Children's Hospital (RCH). The objective was to detect and explore possible changes in patient management in this time period and investigate whether these changes reflected changes in the current theory of CF management. All children over two years of age with CF admitted during 1998 and 2000 with pulmonary manifestation and who satisfied set criteria were included (n = 249). Relative frequency of each of six treatment modalities used were examined on two occasions, revealing some degree of change in practice reflecting the changes in current theory. There was a significant decrease in the frequency of usage of postural drainage with head-down tilt (p < 0.001), and autogenic drainage (p < 0.001) between 1998 and 2000. Modified postural drainage without head-down tilt (p < 0.001), and positive expiratory pressure devices (p < 0.001) were used more frequently in 2000 (p < 0.001). No significant changes were identified in the use of Flutter VRP1 (p = 0.145) and exercise (p = 0.763). No significant differences were found in population demographics or occurrence of concomitant factors that may influence patient management.

Respiratory exacerbations in children with cystic fibrosis: Physiotherapy treatment outcomes

“…This Table 1 for rating scales). suggests that changes in physiotherapy techniques such as increased use of PEP and decreased use of drainage with head down tilt (Farbotko et al, 2005) did not have an adverse effect on the outcome measures reported here. It is important in the implementation of evidence-based practice that studies investigate the relationship between changes in clinical practice and their effect on physiotherapy outcomes.…”

“…Interestingly Farbotko et al (2005) showed that physiotherapy management of the children in this study had altered between 1998 and 2000, reflecting advances in knowledge. It appears, therefore, that despite changes in physiotherapy practice (and concurrent with no change in medical management) physiotherapy intervention was equally efficacious in 1998 and 2000.…”

Intervenções de fisioterapia respiratória para crianças e adolescentes com fibrose cística: uma revisão integrativa

“…Na presente revisão, foram identificados, 22 estudos que utilizaram intervenções fisioterapêuticas, para a remoção de secreção das vias aéreas de crianças e adolescentes com FC, com leve/moderado comprometimento pulmonar. Houve grande variabilidade nas intervenções reportadas pelas pesquisas, embora tenha ocorrido um leve predomínio das intervenções convencionais, nesse mapeamento conduzido pela revisão 14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] . Dentre essas, as mais frequentes foram a drenagem postural, a percussão e a vibração, sendo que muitas estavam associadas às demais terapêuticas 14,18,19,21-23,25,29-32 . O guia de tratamento da FC 10 relata que, apesar dos efeitos da drenagem postural serem questionáveis, sua aplicação de forma combinada a outras intervenções de FR parece ser eficaz.…”

Mechanical Behaviors of Flutter VRP1, Shaker, and Acapella Devices

“…4 -6 Many recent techniques of bronchial clearance are described in the literature in an attempt to provide patients with greater independence. [7][8][9] Among these physiotherapy techniques, positive expiratory pressure (PEP) combined with high-frequency oscillation (HFO) can be produced by devices that produce oscillatory positive pressures during expiration. These devices produce short and successive interruptions of the air flow, promoting vibrations during expiration by different mechanisms.…”