title: Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.
abstract: BACKGROUND
  Cystic fibrosis is an inherited life-limiting disorder, characterised by pulmonary infections and thick airway secretions. Chest physiotherapy has been integral to clinical management in facilitating removal of airway secretions. Conventional chest physiotherapy techniques (CCPT) have depended upon assistance during treatments, while more contemporary airway clearance techniques are self-administered, facilitating independence and flexibility.
  
  
  OBJECTIVE
  To compare CCPT with other airway clearance techniques in terms of their effects on respiratory function, individual preference, adherence, quality of life and other outcomes.
  
  
  METHODS
  We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched CINAHL from 1982 to 2002 and AMED from 1985 to 2002. Date of most recent search: January 2004.
  
  
  METHODS
  Randomised or quasi-randomised clinical trials including those with a cross-over design where CCPT was compared with other airway clearance techniques. Studies of less than seven days duration were excluded.
  
  
  METHODS
  Two reviewers allocated quality scores to relevant studies and independently extracted data. If we were unable to extract data, we invited authors to submit their data. We excluded studies from meta-analysis when data were lost or study design precluded comparison. For some continuous outcomes, we used the generic inverse variance method for meta-analysis of data from cross-over trials and data from parallel-designed trials were incorporated for comparison. We also examined efficacy of specific techniques and effects of treatment duration.
  
  
  RESULTS
  Seventy-eight publications were identified by the searches. Twenty-nine of these were included, representing 15 data sets with 475 participants. There was no difference between CCPT and other airway clearance techniques in terms of respiratory function measured by standard lung function tests. Studies undertaken during acute exacerbations demonstrated relatively large gains in respiratory function irrespective of airway clearance technique. Longer-term studies demonstrated smaller improvements or deterioration over time. Ten studies reported individual preferences for technique, with participants tending to favour self-administered techniques. Heterogeneity in the measurement of preference precluded these data from meta-analysis.
  
  
  CONCLUSIONS
  This review demonstrated no advantage of CCPT over other airway clearance techniques in terms of respiratory function. There was a trend for participants to prefer self-administered airway clearance techniques. Limitations of this review included a paucity of well-designed, adequately-powered, long-term trials.
authors.affiliation: Centre for Nursing and Allied Health Professionals Research, Institute of Child Health, Level 7, Old Building, Great Ormond Street Hospital, London, UK, WC1N 3JH. Maine@gosh.nhs.uk
authors.forename: E
authors.initials: E
authors.lastname: Main
authors.forename: A
authors.initials: A
authors.lastname: Prasad
authors.forename: C
authors.initials: C
authors.lastname: Schans
mesh_terms: D003550:Cystic Fibrosis / Q000628:therapy*; D006801:Humans; D009079:Mucociliary Clearance; D016032:Randomized Controlled Trials as Topic; D012138:Respiratory Therapy / Q000379:methods*