Abstract
Background and objectiveThe thoracic injuries are a common problem in our environment and can leave sequelae such fibrothorax secondary to hemothorax and chronic pain. Standards and clinical guidelines recommend a guideline physiotherapy for all patients with rib fractures but the scientific evidence is scant respect. It would be interesting to describe the most appropriate physiotherapy techniques.The aim this study was to assess effectiveness of positive expiratory pressure (PEP)-bottle device in terms of retained secretion, pain management, thoracic mobility, recovery of respiratory function and pleuropulmonary radiological alterations in the immediate phase of thoracic injuries with ≥3 rib fractures compared to a control group that did not use the PEP-bottle device. Material and methodsProspective and randomized study. Intervention group (PEP group) and control group. Main outcomes measures: retained secretion (SEVA test), pain management (EN test), thoracic mobility (thoracic perimeter), chest X-ray and forced spirometry. Outcomes measures were recorded at admission, hospital discharge and at one month. Results40 patients were analyzed. The PEP group had lower retained secretions (SEVA 0.70±1.1 vs 1.68±1.7, p=0.039), better pain management (EN 1.40±1.3 vs 2.72±2.5, p=0.048), greater thoracic mobility (6.33cm±2.1 vs 4.55cm±1.2, p=0.023) and better radiological resolution than the control group. Forced spirometry showed a mean FVC (% of ref. value) of 85±12.4 in the PEP group vs. 73±14.1 in the control group (p=0.012). ConclusionsThe technique with a PEP-bottle device in patients admitted with thoracic injuries with 3 or more rib fractures with or without pleuropulmonary lesions, improves retained secretion, pain management, and thoracic mobility, with better recovery of functional parameters and pleuropulmonary radiological alterations one month after thoracic injuries compared to the control group.Article registered in the Clinical Trials under the number NTC04548466.
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