title: Physiotherapy Intervention During Level I of Pulmonary Rehabilitation on Chronic Obstructive Pulmonary Disease: A Systematic Review.
abstract: BACKGROUND
  The progressive and chronic course of COPD, characterized by difficulty in breathing, can be aggravated by periods of increased symptoms (exacerbation). The treatment often involves in-hospital care and among the interventions applied in COPD patients, physical therapy prompts good results. However the most used techniques are not properly pinpointed and there is no consensus in the literature regarding its effectiveness.
  
  
  METHODS
  A systematic review was performed to identify which physical therapy treatment was applied in these cases. The following bibliographic databases were consulted: PubMed, and Bireme Portal, Periódicos Capes. Controlled randomized clinical trials that is under went physical therapy intervention in patients hospitalized for exacerbated COPD without the use of NIV (non-invasive ventilation) were included in the study. The PEDro scale, which has a score of 0-10, was used to evaluate the quality of studies included in this review.
  
  
  RESULTS
  The electronic search yielded a total of 302 references published in English, of which only 6 met the criteria for inclusion and exclusion.
  
  
  CONCLUSIONS
  It is possible to infer that physiotherapy's techniques used in patients hospitalized for COPD exacerbation, based on this review, were the high frequency chest wall oscillation (HFCWO) on the chest; relaxing massage and active exercises, electrical stimulation via electro-acupuncture; strengthening of the quadriceps; the ELTGOL bronchial drainage technique (expiration with the glottis open in the lateral posture) and an incentive spirometer.
authors.affiliation: Graduate Program in Electrical and Computer Engineering from Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brazil; Specialization Program in Physiotherapy on Gerontology from Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Guilherme Medeiros
authors.initials: GM
authors.lastname: de Alvarenga
authors.affiliation: Graduate Program in Electrical and Computer Engineering from Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Remigio Gamba
authors.affiliation: Specialization Program in Physiotherapy on Gerontology from Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Lilian
authors.initials: L
authors.lastname: Elisa Hellman
authors.affiliation: Specialization Program in Physiotherapy on Gerontology from Universidade Positivo, Curitiba, PR, Brazil.
authors.forename: Vanusa
authors.initials: V
authors.lastname: Ganzert Ferrari
authors.affiliation: Heart Academy, Rehabilitation Service from Hospital Cardiológico Costantini, Curitiba, PR, Brazil; Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Michel de Macedo
keywords: COPD; exacerbation; hospitalization; physiotherapy intervention