Abstract
BackgroundManual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. However, methodological limitations in existing research have led to a state of clinical equipoise with respect to this treatment. Thus, for patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), clinical preference tends to dictate whether MCP is given to assist with sputum clearance. We standardised the delivery of MCP and assessed its effectiveness on disease-specific quality of life.MethodsIn this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ) at six months post randomisation. Analyses were by intention to treat (ITT). This study was registered, ISRCTN13825248.ResultsAll patients were included in the analyses, of which 372 (71%) provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI −0·14 to 0·19).ConclusionsThese data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.
Highlights
Manual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions
This paper summarises the efficacy of MCP administered to patients hospitalised with Chronic Obstructive Pulmonary Disease (COPD) exacerbation on disease-specific quality of life (QOL) at six months post intervention
The remaining exclusions were due to clinical contraindications for MCP (8%) or inability to give informed consent (7%). 748 patients were approached to participate in the study, 526 of whom gave their consent (71%)
Summary
Manual chest physiotherapy (MCP) techniques involving chest percussion, vibration, and shaking have long been used in the treatment of respiratory conditions. For patients hospitalised with an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), clinical preference tends to dictate whether MCP is given to assist with sputum clearance. Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations some of which result in increased cough and excessive sputum production caused by mucus hyper-secretion and ciliary dysfunction. Manual chest physiotherapy (MCP) involves external manipulation of the thorax using percussion and vibration techniques. Their purpose of these is to intermittently to apply kinetic energy to the chest wall to dislodge bronchial secretions. Reviews of clinical trials report that airway clearance techniques may improve sputum expectoration, there is no high quality evidence of either short or long term value [1,2,3,4]
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