title: Physiotherapy and cystic fibrosis: what is the evidence base?
abstract: OBJECTIVE
  To provide a comprehensive overview and evidence to support the role of physiotherapy in the management of individuals with cystic fibrosis (CF) including airway clearance, exercise, and musculoskeletal concerns which can affect activities of daily living and respiratory health.
  
  
  RESULTS
  Several long-term studies have looked at the efficacy of airway clearance techniques, including active cycle of breathing techniques, autogenic drainage, high frequency chest wall oscillation, postural drainage, positive expiratory pressure (PEP), and oscillating PEP. Each of these studies reported some efficacy of airway clearance in maintaining health with no one technique being superior to another. However, one study suggested that high frequency chest wall oscillation was not as effective as PEP in maintaining health in CF patients. Individual preference needs to be considered when selecting a technique. Recent studies have found exercise to increase mucociliary clearance peripherally. Musculoskeletal issues, including posture, bone density, urinary incontinence, and pain should be assessed and managed in individuals to improve the mechanics of breathing and overall well-being.
  
  
  CONCLUSIONS
  The role of physiotherapy in CF is complex and includes airway clearance, exercise, and management of the long-term sequelae of musculoskeletal issues. More rigorous physiotherapy studies are required to assist with evidence based practice.
authors.affiliation: Physiotherapy department, BC Children's Hospital, Vancouver, British Columbia Canada.
authors.forename: Maggie Patricia
authors.initials: MP
authors.lastname: McIlwaine
authors.forename: Nicole Marie
authors.initials: NM
authors.lastname: Lee Son
authors.forename: Melissa Lynn
authors.initials: ML
authors.lastname: Richmond
mesh_terms: D000203:Activities of Daily Living; D003550:Cystic Fibrosis / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D009079:Mucociliary Clearance; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000523:psychology*; D057240:Patient Preference; D026741:Physical Therapy Modalities; D012138:Respiratory Therapy; D014549:Urinary Incontinence / Q000523:psychology / Q000628:therapy