title: A randomized trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults.
abstract: BACKGROUND
  Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization  of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest.
  
  
  METHODS
  A single-center, randomized trial among hospitalized intubated and non-intubated adult patients requiring chest  physical therapy comparing CCPT and HFCWC. The primary outcome measure was hospital stay.
  
  
  RESULTS
  A total of 280 per-protocol patients (out of an a priori estimated 320 patients required to demonstrate a 20% relative reduction in hospital stay) were randomly assigned to receive CCPT (no.  = 146, 52.1%) or HFCWC (no. = 134, 47.9%). The hospital stay was 12.5 ± 8.8 days for patients randomized to CCPT and 13.0 ± 8.9 days for patients randomized to HFCWC (P = .62). Patient comfort was assessed using a visual analog scale (increasing score reflects greater  discomfort) and was statistically greater for patients randomized to CCPT compared to HFCWC (2.2 ± 0.8 vs 1.9 ± 0.8, P = .009). The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC (5.2 ± 4.3 d vs 6.5 ±  5.2 d, P = .051). All other secondary outcomes, including hospital mortality and nosocomial pneumonia, were similar for both treatment groups.
  
  
  CONCLUSIONS
  This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential  use of HFCWC or CCPT for intubated and non-intubated adult patients. HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.).
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Darnetta
authors.initials: D
authors.lastname: Clinkscale
authors.forename: Kathleen
authors.initials: K
authors.lastname: Spihlman
authors.forename: Peggy
authors.initials: P
authors.lastname: Watts
authors.forename: Daniel
authors.initials: D
authors.lastname: Rosenbluth
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D035641:Chest Wall Oscillation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007440:Intubation / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods; D010557:Personnel Administration, Hospital / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D026741:Physical Therapy Modalities; D011182:Postoperative Care / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D016896:Treatment Outcome