title: Findings from the MATREX study: a treatment protocol for the delivery of manual chest therapy in respiratory care.
abstract: BACKGROUND
  One of the difficulties in comparing the numerous studies on manual chest therapy (MCT) is the wide variety of techniques used and terms employed to describe the intervention. This lack of consistency in therapeutic approach and the absence of defined tools for evaluation  have led to a continued air of skepticism about its true value. This paper presents a treatment protocol used in a large randomized controlled trial examining the efficacy and cost effectiveness of MCT for patients hospitalized with exacerbations of COPD.
  
  
  METHODS
  Consensus development meetings  with key physical therapists were held to identify the essential elements of MCT, address potential areas of ambiguity, and provide a set of clear parameters within which treatment would be based and recorded. This iterative approach resulted in a treatment protocol that combined best clinical  practice with the research evidence available to date.
  
  
  RESULTS
  In the Management of Exacerbations of COPD (MATREX) trial, 658 sessions of MCT were delivered by physical therapists over a 3 year period. A high level of adherence to the treatment protocol was seen for all but one of the protocol  elements.
  
  
  CONCLUSIONS
  With respect to the essential elements of MCT, the treatment protocol used in the MATREX trial offers sufficient flexibility to the therapist, while being robust enough to maintain clinical trial integrity. The level of adherence by therapists indicates its professional  acceptability with respect to delivering and evaluating this therapy.
authors.affiliation: School of Allied Health Professions, University of East Anglia, Norwich, Norfolk, UK. j.cross@uea.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Cross
authors.forename: Frances
authors.initials: F
authors.lastname: Elender
mesh_terms: D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012138:Respiratory Therapy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom