A Randomized Case-Control Study on High-Frequency Chest Wall Oscillator Versus Conventional Chest Physical Therapy in Spinal Cord Injury Subjects

Abstract

Study Design: This study is a randomized case-control trial. Setting: Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India. Background: Spinal cord injury (SCI) often results in severe respiratory dysfunction, leading to increased morbidity and mortality. Respiratory complications, including atelectasis and pneumonia, are prevalent and exacerbated by compromised lung function and ineffective cough. CCPT poses risks like hypoxemia and arrhythmias. HFCWO has emerged as a promising alternative, facilitating airway clearance and improving lung function without manual intervention. Despite its efficacy in other conditions, its specific benefits in SCI require further study. Objective: To study the effect of High-Frequency Chest Wall Oscillator versus Conventional Chest Physical Therapy in candidates with Spinal Cord Injury. Methodology: A sample of 78 SCI patients was selected, with 71 completing the study. Patients were divided into Group A (HFCWO) and Group B (CCPT). Baseline vital, clinical, and radiological parameters were recorded. Group A received HFCWO twice daily for 15 minutes over 5 days, while Group B received CCPT that included positioning, percussions on the affected lobe, and mechanical vibration for 5 days as indicated. Suctioning was performed post-intervention in both groups. Parameters were re-evaluated post-treatment and after 5 days by an intensivist. Results: The median (IQR) age of participants was 32 (18 to 60). Wilcoxon signed- rank test was used for intragroup analysis. The intervention group (HFCWO) had a median age of 49, and the control group (CCPT) had a median age of 22.In the HFCWO group, RR significantly decreased and SpO2 significantly increased (p<0.05) from Day 1 to Day 5. No significant changes were observed in HR and MAP. PEEP, FiO2, and ROASSCI significantly decreased (p<0.05). In the CCPT group, RR, HR, and MAP significantly increased (p<0.05), with no significant change in SpO2. PEEP and FiO2 significantly decreased, but ROASSCI did not change. Both groups showed significant improvement in Chest X-ray scores (p<0.05). Conclusion: This study compares High-Frequency Chest Wall Oscillator (HFCWO) with conventional chest physical therapy (CCPT) in spinal cord injury patients. HFCWO showed superior improvements in clinical and radiological parameters, facilitating earlier ventilator weaning. These findings suggest that HFCWO is a more effective alternative to CCPT for airway clearance in intubated SCI patients.