Physiotherapy secretion removal techniques in people with spinal cord injury: a systematic review.
OBJECTIVE
To address whether secretion removal techniques increase airway clearance in people with chronic spinal cord injury (SCI).


METHODS
MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions and outcomes. Inclusion criteria for articles were a research study, irrespective of design, that examined secretion removal in people with chronic SCI published in English.


METHODS
Two reviewers determined whether articles met the inclusion criteria, abstracted information, and performed a quality assessment using PEDro or Downs and Black criteria. Studies were then given a level of evidence based on a modified Sackett scale.


RESULTS
Of 2416 abstracts and titles retrieved, 24 met the inclusion criteria. Subjects were young (mean, 31 years) and 84% were male. Most evidence was level 4 or 5 and only 2 studies were randomized controlled trials. Three reports described outcomes for secretion removal techniques in addition to cough, whereas most articles examined the immediate effects of various components of cough. Studies examining insufflation combined with manual assisted cough provided the most consistent, high-level evidence. Compelling recent evidence supports the use of respiratory muscle training or electrical stimulation of the expiratory muscles to facilitate airway clearance in people with SCI.


CONCLUSIONS
Evidence supporting the use of secretion removal techniques in SCI, while positive, is limited and mostly of low level. Treatments that increase respiratory muscle force show promise as effective airway clearance techniques.
Muscle Biophysics Lab, Department of Physical Therapy, University of British Columbia, British Columbia, Canada. darlene.reid@ubc.ca
W Darlene
WD
Reid
Jennifer A
JA
Brown
Kristin J
KJ
Konnyu
Jennifer M E
JM
Rurak
Brodie M
BM
Sakakibara
D002986:Clinical Trials as Topic; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000009:adverse effects; D012121:Respiration, Artificial / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*