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Sinderholm Sposato N, Bjerså K, Gilljam M, Lannefors L, Fagevik Olsén M. Effectiveness of manual therapy interventions in cystic fibrosis care: a pilot study. J Bodyw Mov Ther 2024; 39:323-329. [PMID: 38876647 DOI: 10.1016/j.jbmt.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Cystic fibrosis (CF) is a severe genetic condition that affects multiple organ systems and imposes a substantial treatment burden. Regarding the lungs and airways, the progressive pathophysiological changes place a significant strain on the musculoskeletal components of the respiratory system for people with CF. This pilot study investigated the effectiveness of manual therapy interventions (MTIs) on thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain. METHOD A study with a pretest-posttest design was conducted with 15 eligible people with CF at the Sahlgrenska University Hospital CF Centre. After an initial set of diagnostic tests at baseline, the participants underwent eight weekly 30-min MTIs. The MTIs included passive joint mobilisation and soft tissue manipulation of primary and secondary anatomical areas of the musculoskeletal respiratory system. On the day of the final intervention, the baseline measurements were repeated. RESULTS Trends of increased thoracic mobility were observed following the intervention, with a statistically significant increase in respiratory muscle strength. No change in lung function was observed. Musculoskeletal pain before and after the intervention showed a significant decrease in tender points, and all participants reported positive experiences with MTIs. CONCLUSION MTIs may improve thoracic mobility, alleviate pain, and enhance respiratory muscle strength in people with CF. Further research is needed to confirm their potential role as a CF physiotherapy supplement. CLINICAL TRIAL ID NCT04696198.
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Affiliation(s)
- Niklas Sinderholm Sposato
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Primary Care, Närhälsan Majorna, Gothenburg, Sweden
| | - Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Lannefors
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Khirani S, Griffon L, Thébault C, Aubertin G, Dupont P, Mbieleu B, Galodé F, Canavesio C, Fleurence E, Labouret G, Cros P, Barzic A, Lubrano Lavadera M, Giovannini-Chami L, Gilardoni JM, Gourdan P, Moreau J, Matecki S, Zitvogel F, Durand M, Perisson C, Le Clainche L, Taytard J, Fauroux B. Lung volume recruitment and airway clearance for children at home in France. Respir Med 2024; 231:107726. [PMID: 38950683 DOI: 10.1016/j.rmed.2024.107726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/06/2024] [Accepted: 06/29/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Airway clearance (ACT) and lung volume recruitment (LVR) techniques are used to manage bronchial secretions, increase cough efficiency and lung/chest wall recruitment, to prevent and treat respiratory tract infections. The aim of the study was to review the prescription of ACT/LVR techniques for home use in children in France. METHODS All the centers of the national pediatric noninvasive ventilation (NIV) network were invited to fill in an anonymous questionnaire for every child aged ≤20 years who started a treatment with an ACT/LVR device between 2022 and 2023. The devices comprised mechanical in-exsufflation (MI-E), intermittent positive pressure breathing (IPPB), intrapulmonary percussive ventilation (IPV), and/or invasive mechanical ventilation (IMV)/NIV for ACT/LVR. RESULTS One hundred and thirty-nine patients were included by 13 centers. IPPB was started in 83 (60 %) patients, MI-E in 43 (31 %) and IPV in 30 (22 %). No patient used IMV/NIV for ACT/LVR. The devices were prescribed mainly by pediatric pulmonologists (103, 74 %). Mean age at initiation was 8.9 ± 5.6 (0.4-18.5) years old. The ACT/LVR devices were prescribed mainly in patients with neuromuscular disorders (n = 66, 47 %) and neurodisability (n = 37, 27 %). The main initiation criteria were cough assistance (81 %) and airway clearance (60 %) for MI-E, thoracic mobilization (63 %) and vital capacity (47 %) for IPPB, and airway clearance (73 %) and repeated respiratory exacerbations (57 %) for IPV. The parents were the main carers performing the treatment at home. CONCLUSIONS IPPB was the most prescribed technique. Diseases and initiation criteria are heterogeneous, underlining the need for studies validating the indications and settings of these techniques.
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Affiliation(s)
- Sonia Khirani
- ASV Santé, F-92000, Gennevilliers, France; Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, F-75004, Paris, France.
| | - Lucie Griffon
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, F-75004, Paris, France
| | - Charlotte Thébault
- Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France
| | - Guillaume Aubertin
- Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France; Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), F-75014, Paris, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, 92100, Boulogne-Billancourt, France
| | - Pierre Dupont
- Pediatric intensive care unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | - Blaise Mbieleu
- Pediatric intensive care unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | - François Galodé
- Pediatric pulmonology unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - Coline Canavesio
- SMR pédiatrique ESEAN APF France handicap (Paediatric Rehabilitation Services), F-44200, Nantes, France
| | - Emmanuelle Fleurence
- SMR pédiatrique ESEAN APF France handicap (Paediatric Rehabilitation Services), F-44200, Nantes, France
| | - Géraldine Labouret
- Pediatric pulmonology and allergology unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Pierrick Cros
- Pediatric department, CHU Brest, 29200, Brest, France
| | - Audrey Barzic
- Pediatric department, CHU Brest, 29200, Brest, France
| | - Marc Lubrano Lavadera
- Respiratory Diseases, Allergy and CF Unit, Pediatric Department, University Hospital Charles Nicolle, 76000, Rouen, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Jean-Marc Gilardoni
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Pierre Gourdan
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Johan Moreau
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, 34000, Montpellier, France
| | - Stefan Matecki
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Functional Exploration Laboratory, Physiology Department, University Hospital, 34000, Montpellier, France
| | - Françoise Zitvogel
- Pediatric intensive care unit, CHU Strasbourg, 67000, Strasbourg, France
| | - Marine Durand
- Service des maladies neurologiques rares, CHU SUD Réunion, F-97448, Saint Pierre, La Réunion, France
| | - Caroline Perisson
- Service des maladies neurologiques rares, CHU SUD Réunion, F-97448, Saint Pierre, La Réunion, France
| | - Laurence Le Clainche
- Pediatric noninvasive ventilation department, AP-HP, Hôpital Robert Debré, F-75018, Paris, France
| | - Jessica Taytard
- Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France; Sorbonne Université, INSERM UMR-S 1158, Paris, France
| | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, F-75004, Paris, France
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Good A, Shannon J, Brinton JT, Hoppe JE. Implementation and outcomes of a quality improvement project to systematically assess the gross motor skills in school-aged children with cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38780201 DOI: 10.1002/ppul.27073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Limited data exist on the gross motor abilities of children with cystic fibrosis (CF). The objective of this research project was to implement a systematic gross motor assessment in children with CF ages 4-12 years. Secondarily, we aimed to assess demographic characteristics associated with gross motor delays. METHODS Physical therapists aimed to evaluate at least 50% of eligible children (4-12 years) at our CF Center over 1 year using the Bruininks-Oseretsky Test of motor Proficiency, second edition (BOT-2). Delays are defined by scores less than 18th percentile. Demographic and clinical data included body mass index, hospitalizations, genotype, and comorbidities. Basic descriptive statistics summarized patient information. Parametric and nonparametric methods compared groups of interest. Linear regression assessed associations between BOT-2 measures and clinical characteristics. RESULTS The BOT-2 evaluation was successfully implemented with 69% of eligible patients being evaluated. Forty-five (62.5%) scored below average. Impaired strength (22.2%) was most common, followed by impaired balance (16.7%), running speed and agility (15.3%), and bilateral coordination (8.3%). 15.5% scored below average on their total motor composite score (TMC). Increased age, comorbidities and hospitalizations were associated with a lower TMC. CONCLUSIONS The BOT-2 was successfully implemented as part of routine CF care to screen for gross motor delays in children. Results suggest that a high percentage of children with CF, especially older children with comorbid conditions or a history of hospitalization, have impaired gross motor function. These findings support the need for routine gross motor evaluations and physical therapy interventions within pediatric CF clinics.
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Affiliation(s)
- Abby Good
- Department of Physical Therapy at the Children's Hospital of Colorado, Aurora, USA
| | - Jackie Shannon
- Department of Physical Therapy at the Children's Hospital of Colorado, Aurora, USA
| | - John T Brinton
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Jordana E Hoppe
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Poulsen M, Holland AE, Button B, Jones AW. Preferences and perspectives regarding telehealth exercise interventions for adults with cystic fibrosis: A qualitative study. Pediatr Pulmonol 2024; 59:1217-1226. [PMID: 38289142 DOI: 10.1002/ppul.26889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Physical activity and exercise are key components in the management of cystic fibrosis (CF). Completing exercise programs online may minimize the risk of cross-infection and increase access for people with CF. This study aimed to understand the perspectives of people with CF regarding intervention content for a telehealth exercise program. METHODS Individual semistructured qualitative interviews were conducted in adults with CF purposefully sampled for age, disease severity, and social demographics. Interviews were recorded, transcribed verbatim, and analyzed thematically by two researchers independently. RESULTS Participants were 23 adults with CF (14 females) aged from 21 to 60 years. Three major themes (subthemes) were generated: "Personalizing components to an exercise program" (customizing an exercise program to the individual person and their unique health and exercise needs, enjoyment and variety of exercise activities, accessibility and exercise fitting around competing demands or commitments), "The importance of maintaining connections" (challenges regarding face-to-face interactions for people with CF, accountability of scheduled exercise sessions with others, shared experiences between people with CF and specialist support from the CF care team), and "Monitoring health and exercise" (perception of health status and monitoring and recording exercise participation and health). CONCLUSION This study provides important information regarding the preferences of adults with CF for telehealth exercise interventions. Interventions should be tailored to the individual person with CF, include an opportunity to maintain connections with peers and the CF multidisciplinary team, and provide a method to monitor progress over time.
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Affiliation(s)
- Megan Poulsen
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Brenda Button
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Monash University, Melbourne, Victoria, Australia
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Cooper L, Johnston K, Williams M. Physiotherapy-led, community-based airway clearance services for people with chronic lung conditions: a retrospective descriptive evaluation of an existing model of care. BMC Health Serv Res 2024; 24:98. [PMID: 38238725 PMCID: PMC10795339 DOI: 10.1186/s12913-024-10550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Airway clearance interventions are recommended for people with chronic lung conditions and mucus hypersecretion, but there are few published models of care or descriptions of airway clearance service provision. This evaluation describes a dedicated, physiotherapy-led, community-based airway clearance service in a metropolitan local health network. DESIGN Retrospective evaluation using existing airway clearance service administrative database. PARTICIPANTS All first referrals to the airway clearance service in a 5-year period (1/1/2017 to 31/12/2021). MAIN OUTCOME MEASURES Available service data grouped into four domains: participant demographics, referral demographics, service provision and outcomes. RESULTS Of the 1335 first referrals eligible for inclusion, 1157 (87%) people attended. Bronchiectasis was the commonest condition (n = 649/1135, 49%). A total of 2996 occasions of service (face to face clinic n = 2108, 70%, phone n = 736, 25%, telehealth n = 99, 3%, home visit n = 53, 2%) were delivered. Airway clearance devices frequently prescribed were the Aerobika (525/1157, 45%), bubble-positive expiratory pressure (263/1157, 23%) and the Acapella (127/1157, 11%). On average, initial appointment with the airway clearance service occurred within 36 days of referral and people attended the service three times. Individuals voluntarily completed both pre/post service questionnaires around a third of the time. At least half of responders reported an improvement in respiratory symptom outcome measures consistent with the minimum clinically important difference. CONCLUSIONS This evaluation describes an airway clearance service as it exists, providing an example from which airway clearance services can be planned, implemented and improved.
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Affiliation(s)
- Laura Cooper
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia.
- Southern Adelaide Local Health Network, Respiratory GP Plus Out of Hospital Services, Noarlunga GP Plus Super Clinic, Alexander Kelly Drive, Adelaide, South Australia, 5168, Australia.
| | - Kylie Johnston
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia
| | - Marie Williams
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia
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De Marchis M, Montemitro E, Boni A, Federici A, Di Giovanni D, Cristiani L, Cutrera R, Fiocchi AG. Lung clearance index short-term variability in cystic fibrosis: a pre-post pulmonary exacerbation study. Ital J Pediatr 2024; 50:6. [PMID: 38233941 PMCID: PMC10795345 DOI: 10.1186/s13052-023-01574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Multiple Breath washout (MBW) represents an important tool to detect early a possible pulmonary exacerbation especially in Cystic Fibrosis (CF) disease. Lung clearance index (LCI) is the most commonly reported multiple breath washout (MBW) index and in the last years was used as management measure for evaluation. Our aim was to analyze clinical utility of LCI index variability in pulmonary exacerbation in CF after intravenous (IV) antibiotic therapy. METHODS A single-center study was conducted at CF Unit of Bambino Gesù Children's Hospital among hospitalized > 3 years patients for pulmonary exacerbations and treated with antibiotic IV treatment for 14 days. MBW and spirometry were evaluated within 72 h of admission to hospital and at the end of hospitalization. Descriptive analysis was conducted and correlations between quantitative variables were investigated. RESULTS Fifty-seven patients (M22/F35) with an average age 18.56 (± 8.54) years were enrolled. LCI2.5 was significantly reduced at the end of antibiotic treatment in both pediatric and adult populations with an average reduction of -6,99%; 37/57 patients denoted an improvement, 20/57 are stable or worsened in LCI2.5 values and 4/57 (7.02%) had a significant deterioration (> 15%) at end of treatment. On the contrary a significative elevation of FEV1 and FVC were found, respectively of + 7,30% and of + 5,46%. A positive good correlection among LCI 2.5 and Scond (rho = + 0,615, p = 0.000) and LCI 2.5 and Sacin (rho = + 0,649, p = 0.000) and a negative strong correlation between FEV1 and LCI 2.5 were found in post treatment period. A similar modification of LCI 2.5 and FEV1 was noticed in both adult and pediatric population. CONCLUSIONS LCI may have a role in the routine clinical care of both adult and pediatric CF patients as a good tool to assess response to IV antibiotic end-therapy in the same way as FEV1.
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Affiliation(s)
- Matteo De Marchis
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
- University of Magna Graecia of Catanzaro, Calabria, Italy.
| | - Enza Montemitro
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Boni
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Federici
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniele Di Giovanni
- Industrial Engineering Department, University of Rome Tor Vergata, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Luca Cristiani
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Renato Cutrera
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Katz TE, Wakefield CE, Signorelli C, Day AS, Vernon-Roberts A, Ooi CY. Gastroenterology services for patients with Cystic Fibrosis across Australia and New Zealand: a multi-stakeholder assessment of patients' and professionals' perspectives. Front Pediatr 2023; 11:1322941. [PMID: 38161436 PMCID: PMC10755025 DOI: 10.3389/fped.2023.1322941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Gastrointestinal (GI) symptoms are common in individuals with Cystic Fibrosis (CF). International research has highlighted that GI care for this group of patients is lacking. Gastroenterology services to CF clinics across Australasia are yet to be examined. This study aimed to describe the current service delivery model and identify areas for improvement that may lead to positive patient outcomes. Materials and methods CF clinicians (dietitians, clinical nurse consultants, respiratory consultants), gastroenterologists (GE), and patients or their carers from Australia and New Zealand (NZ) were surveyed online to gather their opinions on CF gastroenterology services provided in their region. Data were analysed using descriptive statistics (frequencies and percentages). Likert scale questions were analysed by grouping responses 1-5 and 6-10, presented alongside the median and interquartile range (IQR). Mann-Whitney U and chi-square tests were used to look at differences between stakeholder groups. Results One hundred and fifty-six health professionals and 172 patients or their carers completed the survey. Results showed that the current GI model of care is predominantly a publicly funded service delivered outside of CF clinic time. GE are largely not integrated into the CF team and report a lack of training opportunities. There is a higher level of dissatisfaction with the current service model in NZ than Australia. Discussion No stakeholder group deemed the current CF gastroenterology service model as adequate, leaving opportunity for transformations in this field. Ideally this study will invigorate the need for promotion and integration of GI services that would ultimately benefit the whole CF community.
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Affiliation(s)
- Tamarah E. Katz
- Department of Nutrition and Dietetics, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia
| | - Christina Signorelli
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia
| | - Andrew S. Day
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
- Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Chee Y. Ooi
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
- Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia
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Watson K, Koenig E, Bannister A, Mayne V, Jacques A, Sawyer A, Wood J. Modified forced expiration technique using expiratory resistance in adults with cystic fibrosis. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1196-1199. [PMID: 37793978 PMCID: PMC10632078 DOI: 10.1111/crj.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Participation in airway clearance techniques (ACT) is important to minimise development of irreversible airway obstruction in patients with cystic fibrosis (CF). Positive expiratory pressure (PEP) and expiratory resistance devices (ERD) are often used as they can improve collateral ventilation and aid in the shearing of mucus from airways. This project looked to identify whether utilising an ERD during a forced expiration technique (FET) improves ease of expectoration, sputum amount and coughing frequency in patients with CF. METHOD Patients with CF admitted for a respiratory exacerbation completed two sessions of 10 cycles of their usual ACT with half of the FET components performed with an ERD, half with FET alone. RESULTS EOE, sputum wet weight, cough frequency and patient preference were similar between groups. Improved EOE without the ERD was found in participants who usually use PEP for their ACT regime. CONCLUSION Combining the FET with a PEP mask did not improve EOE and other outcomes in this small study. Investigating the efficacy of this technique within a larger population is warranted.
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Affiliation(s)
- Kathryn Watson
- Physiotherapy DepartmentSir Charles Gairdner HospitalPerthAustralia
- Physiotherapy DepartmentFiona Stanley HospitalPerthAustralia
| | - Emma Koenig
- Physiotherapy DepartmentSir Charles Gairdner HospitalPerthAustralia
| | | | - Virginia Mayne
- Physiotherapy DepartmentSir Charles Gairdner HospitalPerthAustralia
| | - Angela Jacques
- Department of ResearchSir Charles Gairdner HospitalPerthAustralia
| | - Abbey Sawyer
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jamie Wood
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Hamedi N, Kajbafvala M, ShahAli S, Pourahmadi M, Eshghi A, Estahbanati MM. The effects of aerobic exercises compared to conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life in children and adolescents with cystic fibrosis: a study protocol for randomized controlled trial study. Trials 2023; 24:695. [PMID: 37898788 PMCID: PMC10612191 DOI: 10.1186/s13063-023-07719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by abnormal function of the chloride ion channels and characterized by pancreatic insufficiency and chronic endobronchial airway infection. Pulmonary dysfunction is very common and could lead to a reduction in the quality of life. Airway clearance techniques (ACT) and physical exercises are introduced as one of the main components of treatment. Therefore, it will be of interest to examine the effect of aerobic exercises compared to conventional chest physiotherapy (CPT) on pulmonary function, functional capacity, sputum culture, and quality of life in patients with CF. METHODS Thirty patients with CF will participate in a double-blind parallel controlled trial containing 18 sessions of treatment. Group A consists of CPT and placebo aerobic exercise, and group B includes aerobic exercise and placebo CPT. Pulmonary function, functional capacity, sputum culture, and quality of life will be evaluated with a spirometry test, 6-min walk test (6MWT), sputum culture test, and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), respectively, before and after the intervention. DISCUSSION We will evaluate and compare the effectiveness of aerobic exercises and conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life. Comparing these two treatment patterns can contribute to a better understanding of the effectiveness. Therefore, if there is a significant difference between the two treatments, the superior treatment will be prioritized clinically. TRIAL REGISTRATION https://www.irct.ir , IRCT20210505051181N5. Registered on 19 February 2023.
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Affiliation(s)
- Nadia Hamedi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Kajbafvala
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Pourahmadi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Eshghi
- Department of Paediatrics, School of Medicine, Ali-Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Modaresi Estahbanati
- Department of Paediatrics, School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS. Guidance and standard operating procedures for functional exercise testing in cystic fibrosis. Eur Respir Rev 2023; 32:230029. [PMID: 37558263 PMCID: PMC10410399 DOI: 10.1183/16000617.0029-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.
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Affiliation(s)
- Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mathieu Gruet
- Laboratory of the Impact of Physical Activity on Health (IAPS), University of Toulon, Toulon, France
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK
| | - Brenda Button
- Department of Physiotherapy, Melbourne School of Health Science, University of Melbourne, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marlies Wagner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Abbey Sawyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helge Hebestreit
- Paediatric Department, University Hospitals Würzburg, Würzburg, Germany
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Don S Urquhart
- Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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11
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 7:CD013610. [PMID: 37462324 PMCID: PMC10353490 DOI: 10.1002/14651858.cd013610.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic disorder predominantly affecting the lungs and pancreas. Airway clearance techniques (ACTs) and exercise therapy are key components of physiotherapy, which is considered integral in managing CF; however, low adherence is well-documented. Poor physiotherapy adherence may lead to repeated respiratory infections, reduced exercise tolerance, breathlessness, reduced quality of life, malaise and reduced life expectancy, as well as increased use of pharmacology, healthcare access and hospital admission. Therefore, evidence-based strategies to inform clinical practice and improve adherence to physiotherapy may improve quality of life and reduce treatment burden. OBJECTIVES To assess the effects of interventions to enhance adherence to airway clearance treatment and exercise therapy in people with CF and their effects on health outcomes, such as pulmonary exacerbations, exercise capacity and health-related quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 1 March 2023. We also searched online trials registries and the reference lists of relevant articles and reviews. Date of last search: 28 March 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of parallel design assessing any intervention aimed at enhancing adherence to physiotherapy in people with CF versus no intervention, another intervention or usual care. DATA COLLECTION AND ANALYSIS Two review authors independently checked search results for eligible studies and independently extracted data. We used standard procedures recommended by Cochrane and assessed the certainty of evidence using the GRADE system. MAIN RESULTS Two RCTs (77 participants with CF; age range 2 to 20 years; 44 (57%) males) met the inclusion criteria of this review. One study employed an intervention to improve adherence to exercise and the second an intervention to improve adherence to ACT. Both studies measured outcomes at baseline and at three months, but neither study formally assessed our primary outcome of adherence in terms of our planned outcome measures, and results were dependent on self-reported data. Adherence to ACTs One RCT (43 participants) assessed using specifically-composed music alongside ACTs compared to self-selected or no music (usual care). The ACT process consisted of nebuliser inhalation treatment, ACTs and relaxation or antibiotic nebuliser treatment. We graded all evidence as very low certainty. This study reported adherence to ACTs using the Morisky-Green questionnaire and also participants' perception of treatment time and enjoyment, which may influence adherence (outcome not reported specifically in this review). We are uncertain whether participants who received specifically-composed music may be more likely to adhere at six and 12 weeks compared to those who received usual care, risk ratio (RR) 1.75 (95% confidence interval (CI) 1.07 to 2.86) and RR 1.56 (95% CI 1.01 to 2.40) respectively. There may not be any difference in adherence when comparing specifically-composed music to self-selected music at six weeks, RR 1.21 (95% CI 0.87 to 1.68) or 12 weeks, RR 1.52 (95% CI 0.97 to 2.38); or self-selected music to usual care at six weeks, RR 1.44 (95% CI 0.82 to 2.52) or 12 weeks, RR 1.03 (95% CI 0.57 to 1.86). The music study also reported the number of respiratory infections requiring hospitalisation at 12 weeks, with no difference seen in the risk of hospitalisation between all groups. Adherence to exercise One RCT (24 participants) compared the provision of a manual of aerobic exercises, recommended exercise prescription plus two-weekly follow-up phone calls to reinforce exercise practice over a period of three months to verbal instructions for aerobic exercise according to the CF centre's protocol. We graded all evidence as very low certainty. We are uncertain whether an educational intervention leads to more participants in the intervention group undertaking increased regular physical activity at three months (self-report), RR 3.67 (95% CI 1.24 to 10.85), and there was no reported difference between groups in the number undertaking physical activity three times per week or undertaking at least 40 minutes of physical activity. No effect was seen on secondary outcome measures of spirometry, exercise capacity or any CF quality of life domains. This study did not report on the frequency of respiratory infections (hospitalised or not) or adverse events. AUTHORS' CONCLUSIONS We are uncertain whether a music-based motivational intervention may increase adherence to ACTs or affect the risk of hospitalisation for a respiratory infection. We are also uncertain whether an educational intervention increases adherence to exercise or reduces the frequency of respiratory infection-related hospital admission. However, these results are largely based on self-reported data and the impact of strategies to improve adherence to ACT and exercise in children and adolescents with stable CF remains inconclusive. Given that adherence to ACT and exercise therapy are fundamental to the clinical management of people with CF, there is an urgent need for well-designed, large-scale clinical trials in this area, which should conform to the CONSORT statement for standards of reporting and use appropriate, validated outcome measures. Studies should also ensure full disclosure of data for all important clinical outcomes.
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Affiliation(s)
- Mandy Jones
- c/o Cochrane Cystic Fibrosis, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alex Harvey
- School of Health Sciences and Social Care, Brunel University London, Uxbridge, UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Corda J, E Holland A, Berry CD, Westrupp N, Cox NS. Validation of the 25 level modified shuttle test in children with cystic fibrosis. Pediatr Pulmonol 2023. [PMID: 37144876 DOI: 10.1002/ppul.26452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the validity and reliability of the modified shuttle 25-level test (MST-25) in children with cystic fibrosis (CF). METHODS A prospective single center study in clinically stable children with CF. Participants undertook two testing conditions on different days: (1) 2xMST-25 tests; (2) cardiopulmonary exercise test (CPET). Test order was randomized. Nadir oxygen saturation (SpO2 ), peak heart rate (HR), breathlessness (modified Borg), rate of perceived exertion (RPE), energy expenditure (EE) and metabolic equivalents (MET) from the MST-25 and CPET were compared to assess validity, while outcomes from 2xMST-25 tests were compared for reliability. CPET was performed using breath-by-breath analysis and EE from the MST-25 obtained using the SenseWear Armband. RESULTS Strong correlations were found between MST-25 distance and peak oxygen uptake, peak work and minute ventilation on CPET (all r > 0.7, p < 0.01). Moderate correlations were found between MST-25 distance and CPET for METs (r = 0.5) and HR (r = 0.6). Weak associations between tests were evident for nadir SpO2 (r = 0.1), modified Borg (rs = 0.2) and RPE (rs = 0.2). Test-retest reliability was excellent for MST-25 distance (ICC 0.91), peak EE (ICC 0.99) and peak METs (ICC 0.90). Good reliability was achieved for HR (ICC 0.84) and modified Borg score (ICC 0.77), while moderate reliability for nadir SpO2 (ICC 0.64) and RPE (ICC 0.68) was observed. CONCLUSION The MST-25 is a valid and reliable field test for the assessment of exercise capacity in children with CF. The MST-25 can be used to accurately monitor exercise capacity and prescribe exercise training, particularly when CPET is not available.
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Affiliation(s)
- Jennifer Corda
- Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
- Infection and Immunity group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
- Infection and Immunity group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Narelle S Cox
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
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13
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Schofield LM, Singh SJ, Yousaf Z, Wild JM, Hind D. Personalising airway clearance in chronic suppurative lung diseases: a scoping review. ERJ Open Res 2023; 9:00010-2023. [PMID: 37342087 PMCID: PMC10277870 DOI: 10.1183/23120541.00010-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/14/2023] [Indexed: 06/22/2023] Open
Abstract
Background Personalised airway clearance techniques are commonly recommended to augment mucus clearance in chronic suppurative lung diseases. It is unclear what current literature tells us about how airway clearance regimens should be personalised. This scoping review explores current research on airway clearance technique in chronic suppurative lung diseases, to establish the extent and type of guidance in this area, identify knowledge gaps and determine the factors which physiotherapists should consider when personalising airway clearance regimens. Methods Systematic searching of online databases (MEDLINE, EMBASE, CINAHL, PEDro, Cochrane, Web of Science) was used to identify full-text publications in the last 25 years that described methods of personalising airway clearance techniques in chronic suppurative lung diseases. Items from the TIDieR framework provided a priori categories which were modified based on the initial data to develop a "Best-fit" framework for data charting. The findings were subsequently transformed into a personalisation model. Results A broad range of publications were identified, most commonly general review papers (44%). The items identified were grouped into seven personalisation factors: physical, psychosocial, airway clearance technique (ACT) type, procedures, dosage, response and provider. As only two divergent models of ACT personalisation were found, the personalisation factors identified were then used to develop a model for physiotherapists. Conclusions The personalisation of airway clearance regimens is widely discussed in the current literature, which provides a range of factors that should be considered. This review summarises the current literature, organising findings into a proposed airway clearance personalisation model, to provide clarity in this field.
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Affiliation(s)
- Lynne M. Schofield
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
- Paediatric Physiotherapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sally J. Singh
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Zarah Yousaf
- Patient and Public Involvement Member, Leeds Teaching Hospitals NHS Trust, UK
| | - Jim M Wild
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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14
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Abstract
Exercise and airway clearance techniques (ACTs) have been a cornerstone of treatment for people with cystic fibrosis (pwCF) for many decades. Exercise may confer both respiratory and nonrespiratory benefits for pwCF, with greater exercise capacity associated with improved survival. A wide variety of exercise interventions for pwCF have been investigated. ACTs may assist in reducing respiratory symptoms for pwCF and are currently recommended to be performed daily, with the types of ACTs used varying globally. While recommended components of care, both exercise and ACTs are time-intensive and maintaining adherence to the recommendations over the longer term can be challenging. It has been proposed that with advances in the therapeutic options for pwCF, a rationalization of the therapeutic regimen may be possible. We summarize the current evidence for the use of exercise and ACTs by pwCF, discuss the implications of the introduction of cystic fibrosis transmembrane conductance regulator modulators on both exercise and ACTs, and highlight areas for further research.
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Andrews K, Smith M, Cox NS. The physiotherapy consultation: A qualitative study of the experience of parents of infants with cystic fibrosis in Australia. Physiother Theory Pract 2023; 39:540-546. [PMID: 35042441 DOI: 10.1080/09593985.2021.2023932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physiotherapy is an essential component in the management of cystic fibrosis (CF). OBJECTIVE To explore how parents of infants with CF experience physiotherapy clinic consultations. METHODS A qualitative study, informed by hermeneutic phenomenology, utilizing in-depth semi-structured interviews and daily diaries was conducted with 13 parents of infants (aged 0-2 yrs.) receiving physiotherapy care for CF in Australia. RESULTS Three themes arose from the text. The first was that parents' physiotherapy clinic experience is influenced by the manner in which health professionals communicate to parents about physiotherapy in CF, as well as their own prior experience and knowledge. Secondly, parents receive conflicting messages from the physiotherapy consultation, but perceive the key message to be to prioritize adherence to physiotherapy. The final theme was that parents' expectations of the physiotherapy interaction were often not met, in particular a lack of practical physiotherapy education and training was reported. CONCLUSION Parents of infants with CF seek an optimistic, practical and hands on approach during physiotherapy consultations. Exploring options for providing physiotherapy input outside of traditional clinic environments may help accommodate individual needs. Investigation into the manner in which physiotherapy education is communicated to parents is warranted in light of the influence on parents' expectations of physiotherapy.
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Affiliation(s)
- Kristen Andrews
- School of Allied Health, Exercise & Sports Sciences, Charles Sturt University, Albury, NSW, Australia
| | - Megan Smith
- Faculty of Science and Health, Charles Sturt University, Albury, NSW, Australia
| | - Narelle S Cox
- Respiratory Research at Alfred, Department of Immunology and Pathology, Monash University and Institute for Breathing and Sleep, Austin Hospital, Heidelberg, VIC, Australia
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16
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Raywood E, Shannon H, Filipow N, Tanriver G, Stanojevic S, Kapoor K, Douglas H, O'Connor R, Murray N, Black B, Main E. Quantity and quality of airway clearance in children and young people with cystic fibrosis. J Cyst Fibros 2023; 22:344-351. [PMID: 36210322 DOI: 10.1016/j.jcf.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 05/01/2023]
Abstract
Children and young people with CF (CYPwCF) get advice about using positive expiratory pressure (PEP) or oscillating PEP (OPEP) devices to clear sticky mucus from their lungs. However, little is known about the quantity (number of treatments, breaths, or sets) or quality (breath pressures and lengths) of these daily airway clearance techniques (ACTs) undertaken at home. This study used electronic pressure sensors to record real time breath-by-breath data from 145 CYPwCF (6-16y) during routine ACTs over 2 months. ACT quantity and quality were benchmarked against individual prescriptions and accepted recommendations for device use. In total 742,084 breaths from 9,081 treatments were recorded. Individual CYPwCF maintained consistent patterns of ACT quantity and quality over time. Overall, 60% of CYPwCF did at least half their prescribed treatments, while 27% did fewer than a quarter. About 77% of pre-teens did the right number of daily treatments compared with only 56% of teenagers. CYPwCF usually did the right number of breaths. ACT quality (recommended breath length and pressure) varied between participants and depended on device. Breath pressures, lengths and pressure-length relationships were significantly different between ACT devices. PEP devices encouraged longer breaths with lower pressures, while OPEP devices encouraged shorter breaths with higher pressures. More breaths per treatment were within advised ranges for both pressure and length using PEP (30-31%) than OPEP devices (1-3%). Objective measures of quantity and quality may help to optimise ACT device selection and support CYPwCF to do regular effective ACTs.
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Affiliation(s)
- Emma Raywood
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Harriet Shannon
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nicole Filipow
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gizem Tanriver
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sanja Stanojevic
- Community Health and Epidemiology, Dalhousie University Halifax, Canada
| | - Kunal Kapoor
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Helen Douglas
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK; Paediatric Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel O'Connor
- Paediatric Cystic Fibrosis Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicky Murray
- Paediatric Cystic Fibrosis Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Bridget Black
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eleanor Main
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK.
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Żak M, Gauchez H, Boberski M, Stangret A, Kempinska-Podhorodecka A. Effectiveness of Autogenic Drainage in Improving Pulmonary Function in Patients with Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3822. [PMID: 36900829 PMCID: PMC10001450 DOI: 10.3390/ijerph20053822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
The use of autogenic drainage (AD) in patients with cystic fibrosis (CF) has been officially approved; therefore, the purpose of this study was to compare the efficiency of the leading therapeutic techniques based on AD in patients with CF; Among patients with CF assessments were made of spirometric parameters, percent blood oxygen saturation, and the general feeling of the patients (Borg, VAS, and mMRC dyspnea scale) before and after therapy using AD, using AD in connection with a belt or a Simeox device and AD in combination with both a belt and Simeox device simultaneously. The best therapeutic effects were generated by the combination of AD with the belt and with the Simeox device. The greatest improvements were observed for FEV1, FVC, PEF, FET, saturation, and patient comfort. In patients <10.5 years of age, the increase in the level of FEV3 and FEV6 was significant in comparison to older patients. Due to their efficacy, therapies connected with AD should be applied not only in hospital departments but also during daily patient care. Given the particular benefits observed in patients <10.5 years of age, it is important to guarantee real accessibility to this form of physiotherapy, especially in this age group.
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Affiliation(s)
- Magdalena Żak
- Physiotherapist’s Office Children’s Therapy in Szczecin, 71-502 Szczecin, Poland
| | - Hugues Gauchez
- Centre de Kinésithérapie Respiratoire et Fonctionnelle du Nord in Marcq en Baroeul, 59700 Marcq-en-Barœul, France
| | - Marek Boberski
- Institute of Respiratory and Neurodevelopmental Support for Children in Szczecin, 71-502 Szczecin, Poland
| | - Anna Stangret
- Department of Medical Biology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
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Malik S, Levi B, Chan A, Cotnam H, Martineau L, Thieu E, Zabjek K, Sisodia P, Wu K. Current Practice, Barriers to, and Facilitators of Exercise Testing and Training by Physiotherapists in Cystic Fibrosis Specialized Centres in Canada. Physiother Can 2023; 75:1-9. [PMID: 37250729 PMCID: PMC10211377 DOI: 10.3138/ptc-2021-0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 02/11/2024]
Abstract
Purpose: This study surveyed physiotherapists working at Canadian cystic fibrosis (CF) specialized centres to investigate the current practice, barriers to, and facilitators of exercise testing and training. Method: Physiotherapists were recruited from 42 Canadian CF centres. They responded to an e-questionnaire regarding their practice. The data were analyzed using descriptive statistics. Results: Eighteen physiotherapists responded (estimated response rate of 23%); median years of clinical experience was 15 (range, min-max, 3-30) years. Aerobic testing was administered by 44% of respondents, strength testing by 39%, aerobic training by 78%, and strength training by 67%. The most frequently reported barriers across all four types of exercise testing and training were insufficient funding (reported by 56%-67% of respondents), time (50%-61%) and staff availability (56%). More late career than early career physiotherapists reported utilizing aerobic testing (50% vs. 33% of respondents), strength testing (75% vs. 33%), aerobic training (100% vs. 67%), and strength training (100% vs. 33%). Conclusions: Exercise testing and training is underutilized in Canadian CF centres. Experienced physiotherapists reported utilizing exercise testing and training more than less-experienced physiotherapists. Post-graduate education and mentorship, especially for less-experienced clinicians, are recommended to emphasize the importance of exercise testing and training. Barriers of funding, time, and staff availability should be addressed to further improve quality of care.
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Affiliation(s)
- Sarib Malik
- Co-first authors
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Bella Levi
- Co-first authors
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alan Chan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Hilary Cotnam
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Luc Martineau
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Eldon Thieu
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Karl Zabjek
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Poonam Sisodia
- Toronto Adult Cystic Fibrosis Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kenneth Wu
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Adult Cystic Fibrosis Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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19
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Sposato Sinderholm N, Bjerså K. Manual therapies in cystic fibrosis care: a scoping review. Chiropr Man Therap 2023; 31:7. [PMID: 36747207 PMCID: PMC9903555 DOI: 10.1186/s12998-023-00478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To review the use of manual therapies (MT) for pain, respiratory muscle strength and pulmonary function in cystic fibrosis (CF) care. METHODS A search with a systematic approach was conducted by two independent reviewers, using the databases Medline, PubMed, Scopus and Cinahl from their respective inception dates to March 2021. RESULTS A total of 199 publications were initially screened by title and abstract, after which 190 were excluded. Following a full-text review of the remaining articles, six studies with a total of 234 participants were included. Decreased pain levels following MT were observed in two studies and, in three studies, patient reports on improvement in ease of breathing and peak airflow were presented. No significant effects on spirometry measures were observed and none of the included studies investigated respiratory muscle strength. CONCLUSION Current research on MT in CF care indicates positive trends based on subjective measures. However, research in this context is sparse and disparate in terms of both interventions and methodology. Further investigations including MT as part of multimodal interventions are therefore suggested before any specific recommendations for clinical implementation of MT in CF can be provided.
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Affiliation(s)
- Niklas Sposato Sinderholm
- grid.8761.80000 0000 9919 9582Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
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20
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Pulmonary disorders in pregnancy: Bronchiectasis, cystic fibrosis, sarcoidosis and interstitial diseases. Best Pract Res Clin Obstet Gynaecol 2022; 85:114-126. [PMID: 36244873 DOI: 10.1016/j.bpobgyn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
This chapter aims to provide expert guidance to obstetricians, general practitioners, allied health staff and women with lung disease about the interactions between pregnancy and different lung diseases. This chapter will cover other airway diseases such as bronchiectasis and cystic fibrosis (CF) together with sarcoidosis and interstitial lung disease (ILD), noting that another chapter covers asthma. The physiological changes which occur in pregnancy, such as the changes in airway physiology, resting ventilation and sleep, are summarised in another chapter. This chapter extends the evidence-based approach and clinical expertise of the recent European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) taskforce. The papers selected were based on the population (pregnant women with lung disease other than asthma) and the effects of these diseases on risks of pregnancy-associated complications and miscarriages, breastfeeding, nutritional considerations, lung function, long-term maternal outcomes and management considerations during pregnancy. As there are very few randomised control trials in the area, the majority of the literature consists of observational studies (prospective or retrospective), cross-sectional surveys and case series. Other guidelines have also recently been published, which may be helpful to the reader.
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21
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Potter A, Singh B, Scutter E, Maher C. The feasibility of collecting the physiotherapy outcomes airway clearance, physical activity and fitness for the Australian Cystic Fibrosis Data Registry. BMC Pulm Med 2022; 22:342. [PMID: 36088311 PMCID: PMC9463726 DOI: 10.1186/s12890-022-02141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physiotherapy-related data, such as airway clearance techniques (ACTS), physical activity and aerobic fitness are not consistently included in international cystic fibrosis (CF) data registries. This study aimed to pilot the collection of ACTS, physical activity and fitness in a hospital CF clinic, as a step towards informing future national implementation.
Methods
This study was undertaken in a CF clinic within a major tertiary hospital. Patients and families were invited to participate. Participants completed self-report questionnaires on ACT use and those aged ≥ 10 years completed a physical activity questionnaire (Core Indicators and Measures of Youth Health Survey) and aerobic fitness test (the A-STEP test). Participants also completed a survey to explore the tolerance and acceptability of the fitness test, and the perceived accuracy of the self-reported data collection.
Results
Forty patients agreed to participate in the study (mean age = 9.8, SD = 4.1 years old; 52.5% female). All patients and/or families that were approached agreed to participate and completion rate for the ACTs and physical activity surveys was 98% and 100% (respectively). Completion rate for the fitness test was 55%, due to time constraints. Most participants agreed (≥ 90%) they could accurately provide ACT and physical activity data, and the assessments were tolerable and acceptable.
Conclusions
Patients with CF and their families are able to and can acceptably provide physiotherapy-related data, and collecting self-report ACTs and physical activity data is highly feasibly during routine CF clinic visits. However, aerobic fitness testing using the A-STEP test may be less feasible in clinic environments, due to time constraints.
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Bokov P, Gerardin M, Brialix G, Da Costa Noble E, Juif R, Foucher AV, Le Clainche L, Houdouin V, Mauroy B, Delclaux C. Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease. BMC Pulm Med 2022; 22:241. [PMID: 35729620 PMCID: PMC9210656 DOI: 10.1186/s12890-022-02039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Airway clearance techniques are supposed to be a necessary adjunct for the enhancement of impaired peripheral clearance in cystic fibrosis (CF). The objective was to assess the effect of one physiotherapy session (autogenic drainage: AD) on mucus clearance (sputum wet weight) and impulse oscillometry system (IOS) indices, including those obtained from extended Resistance-Inertance-Compliance (eRIC) modelling, considering the degree of bronchial congestion. Methods Thirty children with CF (median age: 12.7 years) in a stable condition prospectively underwent IOS measurements at baseline and after AD. They were divided in two groups: with (visual analog scale of bronchial congestion by the physiotherapist ≥ 5/10) and without (scale < 5/10) bronchial congestion. Paired-comparison of the effects of AD on airway resistance measurements was done with Wilcoxon test. Results The congestion scale correlated with the wet weight of sputum production during the session (Pearson test: p < 0.0001, R = 0.66). Ten children had bronchial congestion and 20 were without congestion. In the whole group, R5–20 Hz significantly decreased after AD (P = 0.049), which was related to a decrease in the children with congestion (P = 0.025), whereas it was not significantly modified in the children without congestion (P = 0.327). The eRIC model allowed the calculation of the peripheral resistance of the respiratory system, which also decreased in the children with congestion (P = 0.037), however, not modified in the children without congestion (P = 0.390). Conclusion One session of autogenic drainage has the ability to decrease peripheral resistance obtained from IOS measurements, more specifically in children with CF with moderate to severe bronchial congestion. Trial registration ClinicalTrials.gov Identifier: NCT04094441.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France
| | - Michèle Gerardin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Géraldine Brialix
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Emmanuelle Da Costa Noble
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Romain Juif
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Antonia Vital Foucher
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Laurence Le Clainche
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Benjamin Mauroy
- Laboratoire JA Dieudonné, CNRS, Université Nice Côte d'Azur, 06108, Nice, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France.
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Audag N, Dubus JC, Combret Y. [Respiratory physiotherapy in pediatric practice]. Rev Mal Respir 2022; 39:547-560. [PMID: 35738979 DOI: 10.1016/j.rmr.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 01/11/2023]
Abstract
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
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Affiliation(s)
- N Audag
- Institut de recherche expérimentale et clinique, pôle de pneumologie, ORL & dermatologie, groupe recherche en kinésithérapie respiratoire, université Catholique de Louvain, Bruxelles, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, Bruxelles 1200, Belgique.
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-Enfants, Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - Y Combret
- Secteur de kinésithérapie, Groupe Hospitalier du Havre, 76600 Le Havre, France
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Abstract
BACKGROUND Autogenic drainage is an airway clearance technique that was developed by Jean Chevaillier in 1967. The technique is characterised by breathing control using expiratory airflow to mobilise secretions from smaller to larger airways. Secretions are cleared independently by adjusting the depth and speed of respiration in a sequence of controlled breathing techniques during exhalation. The technique requires training, concentration and effort from the individual but it has previously been shown to be an effective treatment option for those who are seeking techniques to support and promote independence. However, at a time where the trajectory and demographics of the disease are changing, it is important to systematically review the evidence demonstrating that autogenic drainage is an effective intervention for people with cystic fibrosis. OBJECTIVES To compare the clinical effectiveness of autogenic drainage in people with cystic fibrosis with other physiotherapy airway clearance techniques. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews, as well as two ongoing trials registers (02 February 2021). Date of most recent search of the Cochrane Cystic Fibrosis Trials Register: 06 July 2021. SELECTION CRITERIA We identified randomised and quasi-randomised controlled studies comparing autogenic drainage to another airway clearance technique or no therapy in people with cystic fibrosis for at least two treatment sessions. DATA COLLECTION AND ANALYSIS Data extraction and assessments of risk of bias were independently performed by three authors. The authors assessed the quality of the evidence using the GRADE system. The authors contacted seven teams of investigators for further information pertinent to their published studies. MAIN RESULTS Searches retrieved 64 references to 37 individual studies, of which eight (n = 212) were eligible for inclusion. One study was of parallel design with the remaining seven being cross-over in design; participant numbers ranged from 4 to 75. The total study duration varied between four days and two years. The age of participants ranged between seven and 63 years with a wide range of disease severity reported. Six studies enrolled participants who were clinically stable, whilst participants in two studies received treatment whilst hospitalised with an infective exacerbation. All studies compared autogenic drainage to one (or more) other recognised airway clearance technique. Exercise is commonly used as an alternative therapy by people with cystic fibrosis; however, there were no studies identified comparing exercise with autogenic drainage. The certainty of the evidence was generally low or very low. The main reasons for downgrading the level of evidence were the frequent use of a cross-over design, outcome reporting bias and the inability to blind participants. The review's primary outcome, forced expiratory volume in one second, was the most common outcome measured and was reported by all eight studies; only three studies reported on quality of life (also a primary outcome of the review). One study reported on adverse events and described a decrease in oxygen saturation levels whilst performing active cycle of breathing techniques, but not with autogenic drainage. Seven of the eight included studies measured forced vital capacity and three of the studies used mid peak expiratory flow (per cent predicted) as an outcome. Six studies reported sputum weight. Less commonly used outcomes included oxygen saturation levels, personal preference, hospital admissions, intravenous antibiotics and pseudomonas gene expression. There were no statistically significant differences found between any of the techniques used with respect to the outcomes measured except when autogenic drainage was described as being the preferred technique of the participants in one study over postural drainage and percussion. AUTHORS' CONCLUSIONS Autogenic drainage is a challenging technique that requires commitment from the individual. As such, this intervention merits systematic review to ensure its effectiveness for people with cystic fibrosis, particularly in an era where treatment options are changing rapidly. From the studies assessed, autogenic drainage was not found to be superior to any other form of airway clearance technique. Larger studies are required to better evaluate autogenic drainage in comparison to other airway clearance techniques in view of the relatively small number of participants in this review and the complex study designs. The studies recruited a range of participants and were not powered to assess non-inferiority. The varied length and design of the studies made the analysis of pooled data challenging.
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Affiliation(s)
- Paul Burnham
- Servicio de Medicina Fisica y Rehabilitacion, Hospital La Paz, Madrid, Spain
| | - Gemma Stanford
- Department of Cystic Fibrosis, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Insititute, Imperial College London, London, UK
| | - Ruth Stewart
- Royal Hospital for Children and Young People, Edinburgh, UK
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Chin M, Aaron SD. Disconcerting and Counter-Intuitive Findings from a Trial of Exercise in Cystic Fibrosis- Can Exercise Make our Patients Worse? Am J Respir Crit Care Med 2021; 205:269-270. [PMID: 34856109 PMCID: PMC8887002 DOI: 10.1164/rccm.202110-2446ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Melanie Chin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;
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Castilho T, Gonçalves Wamosy RM, Cardoso J, Camila Mucha F, Jandt U, Schivinski CIS. Coughing and diaphragmatic breathing exercise: What is the repercussion on respiratory mechanics of children and adolescents with cystic fibrosis? Int J Clin Pract 2021; 75:e14879. [PMID: 34525264 DOI: 10.1111/ijcp.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the immediate effect of coughing episodes and diaphragmatic breathing exercise (DBE) on respiratory mechanics of children/adolescents with cystic fibrosis (CF). METHODS It is a cross-sectional analytical study that occurred in a reference center for children with CF. Forty-five children/adolescents with CF (60% male; mean age 10.22 ± 2.84 years old; mean forced expiratory volume in 1 second 73.74 ± 21.38% predicted) were divided into 3 groups according to the R5 parameter response to the DBE: G1 (increased R5), G2 (no change R5), and G3 (decreased R5). The children/adolescents performed 5 successive coughs and 10 DBE. The main outcome measures were the impulse oscillometry system (IOS) parameters evaluated before, during, and after the interventions. RESULTS In the total sample, the IOS parameters (Z5, R5, and R20) were worse after coughing, and they did not change after the DBE. In the G1, the parameters were progressively worsening during the interventions. In the G2, they worsened after coughing and after the DBE. In the G3, they worsened after coughing; however, after the DBE, the IOS parameters have improved and returned close to the baseline. CONCLUSIONS The children/adolescents with CF airway resistance got worse after coughing episodes, and 10 DBE repetitions did not affect the respiratory mechanics in most of the sample. Meanwhile, in the group with older children, the DBE worsened the respiratory mechanics, yet in the younger group it improved.
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Affiliation(s)
- Tayná Castilho
- Physiotherapy Department, University of the State of Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | | | - Juliana Cardoso
- Physiotherapy Department, University of the State of Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Francieli Camila Mucha
- Physiotherapy Department, University of the State of Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Uriel Jandt
- Physiotherapy Department, University of the State of Santa Catarina (UDESC), Florianópolis, SC, Brazil
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Andrews K, Smith M, Cox NS. Physiotherapy: At what cost? Parents experience of performing chest physiotherapy for infants with cystic fibrosis. J Child Health Care 2021; 25:616-627. [PMID: 33249885 DOI: 10.1177/1367493520976481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiotherapy is one of the most burdensome aspects of cystic fibrosis (CF) care. Healthcare requirements for older children with CF are reported to impact parental quality of life and physiotherapy adherence. How parents of infants experience performing chest physiotherapy as a part of CF care is unknown. This study aimed to explore the experience of performing chest physiotherapy for parents of infants with CF. In this study, 13 parents of infants (aged 1-2 years) with CF participated in one in-depth semi-structured interview and completed a daily diary for five days. Principles of hermeneutic phenomenology guided interpretation of interview transcripts, diary entries, and field notes. For these parents, being responsible for performing chest physiotherapy was an ever-present experience of pressure, doubt, and guilt. Managing chest physiotherapy resulted in sacrifices that were perceived by parents as an expected and necessary part of meeting the healthcare needs of their child. Despite perceived sacrifices, performing chest physiotherapy was also experienced by parents as an opportunity to positively impact the health of their child. Awareness of parental perceptions and experiences of chest physiotherapy in CF may enhance the personalization of physiotherapy and minimize burden.
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Affiliation(s)
- Kristen Andrews
- School of Community Health, 1109Charles Sturt University, Albury, NSW, Australia
| | - Megan Smith
- Faculty of Science, 1109Charles Sturt University, Albury, NSW, Australia
| | - Narelle S Cox
- Monash University & Institute for Breathing and Sleep, 2541Monash University, Australia
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Methods Used to Evaluate the Immediate Effects of Airway Clearance Techniques in Adults with Cystic Fibrosis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10225280. [PMID: 34830562 PMCID: PMC8625729 DOI: 10.3390/jcm10225280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
This review reports on methods used to evaluate airway clearance techniques (ACT) in adults with CF and examined data for evidence of any effect. Sixty-eight studies described ACT in adequate detail and were included in this review. Frequently reported outcomes were sputum expectoration (72%) and spirometric lung function (60%). Compared with cough alone, following any ACT, there was a trend for greater sputum wet weight, however FEV1 was not different. The mean (95% CI) within-group effect for sputum wet weight following any ACT was 12.43 g (9.28 to 15.58) (n = 30 studies) and for FEV1 was 0.03 L (−0.17 to 0.24) (n = 14 studies). Meta-regression demonstrated that, when compared with cough alone, greater sputum wet weight was reported in groups that received additional ACT by between 2.45 and 3.94 g (F3,66 = 2.97, p = 0.04). These data suggest the addition of ACT to cough alone may optimise sputum clearance; however, FEV1 lacked sensitivity to detect this change. Importantly, this review highlights the lack of appropriate measures to assess ACT efficacy.
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Hebestreit H, Kriemler S, Schindler C, Stein L, Karila C, Urquhart DS, Orenstein DM, Lands LC, Schaeff J, Eber E, Radtke T. Effects of a Partially Supervised Conditioning Program in Cystic Fibrosis: An International Multicenter Randomized Controlled Trial (ACTIVATE-CF). Am J Respir Crit Care Med 2021; 205:330-339. [PMID: 34735776 PMCID: PMC8887001 DOI: 10.1164/rccm.202106-1419oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale The long-term effects of vigorous physical activity (PA) on lung function in cystic fibrosis are unclear. Objectives To evaluate effects of a 12-month partially supervised PA intervention using motivational feedback. Methods In a parallel-arm multicenter randomized controlled trial (ACTIVATE-CF), relatively inactive patients aged at least 12 years were randomly assigned (1:1 ratio) to an intervention group or control group. The intervention group consented to add 3 hours of vigorous PA per week, whereas the control group was asked not to change their PA behavior. Primary endpoint was change in percent predicted FEV1 (ΔFEV1) at 6 months. Secondary endpoints included PA, exercise capacity, exercise motives, time to first exacerbation and exacerbation rates, quality of life, anxiety, depression, stress, and blood glucose control. Data were analyzed using mixed linear models. Measurements and Main Results A total of 117 patients (40% of target sample size) were randomized to an intervention (n = 60) or control group (n = 57). After 6 months, ΔFEV1 was significantly higher in the control group compared with the intervention group (2.70% predicted [95% confidence interval, 0.13–5.26]; P = 0.04). The intervention group reported increased vigorous PA compared with the control group at each study visit, had higher exercise capacity at 6 and 12 months, and higher PA at 12 months. No effects were seen in other secondary outcomes. Conclusions ACTIVATE-CF increased vigorous PA and exercise capacity, with effects carried over for the subsequent 6 months, but resulted in better FEV1 in the control group.
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Affiliation(s)
| | | | - Christian Schindler
- Universitat Basel, 27209, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lothar Stein
- Hannover Medical School, 9177, Hannover, Germany
| | - Chantal Karila
- Hopital universitaire Necker-Enfants malades, 246596, Paris, France
| | - Don S Urquhart
- Royal Hospital for Sick Children, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - David M Orenstein
- Univ. of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Larry C Lands
- Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Ernst Eber
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Graz, Austria
| | - Thomas Radtke
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Potter A, Pancholi B, Smith L, Maher C. Should the physiotherapy outcomes airway clearance, physical activity and fitness be recorded on the Australian Cystic Fibrosis Data Registry? A consensus approach. BMC Pulm Med 2021; 21:298. [PMID: 34548053 PMCID: PMC8456641 DOI: 10.1186/s12890-021-01669-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physiotherapy is a cornerstone of cystic fibrosis (CF) management, yet the Australian CF Data Registry (ACFDR) currently does not record physiotherapy-related data. This study aimed to gather opinions from lead Australian CF physiotherapists regarding the importance and feasibility of collecting physiotherapy-related data on the ACFDR. METHODS A three-round online Delphi survey was conducted to gather expert stakeholder opinion and consensus agreement. Lead physiotherapists from all 23 Australian CF centres were invited to participate. Round one explored the potential benefits, barriers and importance of recording three physiotherapy-related domains on the ACFDR: airway clearance, physical activity and fitness. Subsequent rounds were developed based on the findings from the previous round and sought consensus (80% agreement) for the inclusion of physiotherapy-related data on the ACFDR and for the most appropriate methods of collecting such data. RESULTS The response rate was > 80% for all rounds. Participants agreed that collection of airway clearance, physical activity and fitness data on the ACFDR was important and feasible. Findings suggested that airway clearance and physical activity should be collected using self-reported questionnaires, while fitness should be measured using a field-based test. CONCLUSIONS Australian lead CF physiotherapists believe that collection of airway clearance, physical activity and fitness on the ACFDR is important and feasible. Future work is needed to pilot the data collection procedure to examine its feasibility in real-world clinical settings. This study demonstrates how Delphi methodology can provide a contemporary summary of expert clinicians' opinion that may underpin nation-wide health service improvement.
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Affiliation(s)
- Angela Potter
- Physiotherapy Department, Women's and Children's Hospital, SA Health, 72 King William Rd, North Adelaide, SA, 5006, Australia
| | - Bhavita Pancholi
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Lahni Smith
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Carol Maher
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia. .,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
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Blanco-Orive P, Del Corral T, Martín-Casas P, Ceniza-Bordallo G, López-de-Uralde-Villanueva I. Quality of life and exercise tolerance tools in children/adolescents with cystic fibrosis: Systematic review. Med Clin (Barc) 2021; 158:519-530. [PMID: 34507821 DOI: 10.1016/j.medcli.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This systematic review aims to analyze the validity and reliability of available tools to assess health-related quality of life (HRQoL) and exercise tolerance in children and adolescents with cystic fibrosis (CF). MATERIALS AND METHODS A review of observational studies studying the validity and reliability of the tools was conducted. The COSMIN (COnsesus-based Standards for the selection of health Measurements INstruments) guide was followed to analyze the quality of these tools. RESULTS A total of 18 studies were selected. Of the eight HRQoL tools, five generic and three specific, analyzed in 14 studies, the Cystic Fibrosis Questionnaire-Revised (CFQ-R) presents the best properties. Of the four tools analyzed to assess exercise tolerance, cycle ergometry and the modified shuttle test are the most valid and reliable. CONCLUSIONS The CFQ-R, cycloergometry and the modified shuttle test have the best properties for the assessment of children with CF, but more studies are needed.
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Affiliation(s)
- Paula Blanco-Orive
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Tamara Del Corral
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España.
| | - Guillermo Ceniza-Bordallo
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
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Cardoso J, Scalco J, Mucha F, Caputo F, Schivinski CS. Relationship between peripheral muscle strength, exercise capacity and body composition in children and adolescents with cystic fibrosis. Physiother Theory Pract 2021; 38:3010-3017. [PMID: 34470539 DOI: 10.1080/09593985.2021.1973165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN This was a transversal analytical study. BACKGROUND Exercise capacity is usually decreased in cystic fibrosis, impacting the disease prognosis. As well, peripheral muscle strength and nutritional status seem to be related to exercise capacity (EC). OBJECTIVE To verify the relationship between peripheral muscle strength, pulmonary function and body composition with EC in children and adolescents with CF. METHODS The study included CF children/adolescents that were clinically stable. The disease's severity was classified according to the Schwachman-Doerschuk score. Initially the subjects underwent bioimpedance and spirometry tests. Quadriceps muscle strength (QMS) and handgrip strength (HG) were evaluated by dynamometry. The Modified Shuttle Walk Test (MSWT) was conducted along with gas analysis in order to measure EC. RESULTS Twenty-five children/adolescents (10.30 ± 2.33 years old) participated in the survey. 72% were eutrophic, with a mean FEV1 of 68.55%, predicted percentage of the MSWT walked distance (%WD) was 70.91%, and QMS 65.80%. QMS presented significant correlations with absolute WD (r = 0.54), oxygen peak consumption (r = 0.72), lean body mass (LM) (r = 0.83), and body mass index (BMI) (r = 0.69). HG was related with BMI (r = 0.45) and LM (r = 0.65). There was a difference in the %WD between the groups with higher/lower strength (p = .02). CONCLUSION There was no correlation between HG and EC in this studied sample. Early involvement of QMS was observed even in individuals with low disease severity. This finding reinforces the importance of including this QMS assessment in CF reference centers to monitor, prevent and prescribe adequate exercise training for these individuals.
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Affiliation(s)
- Juliana Cardoso
- Physiotherapy Department, State University of Santa Catarina, Florianópolis, SC, Brazil
| | - Janaina Scalco
- Physiotherapy Department, State University of Santa Catarina, Florianópolis, SC, Brazil
| | - Francieli Mucha
- Physiotherapy Department, State University of Santa Catarina, Florianópolis, SC, Brazil
| | - Fabrizio Caputo
- Department of Physical Education, State University of Santa Catarina, Florianópolis (Sc), Brazil
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Sawyer A, Cavalheri V, Jenkins S, Wood J, Singh B, Hill K. Endurance cycle ergometry tests performed at a sub-maximal work rate elicit peak physiological and symptom responses in adults with cystic fibrosis. Intern Med J 2021; 51:1168-1172. [PMID: 34278700 DOI: 10.1111/imj.15408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
Time to symptom limitation (Tlim ) achieved during constant work rate tests is considerably more responsive to change than measures commonly recorded during ramp-based tests, such as peak rate of oxygen uptake and maximal work rate (Wmax ). There is limited literature on the use of, and physiological and symptom responses to, constant work rate cycle ergometry tests in people with cystic fibrosis (CF). The results of this study provide evidence that the constant work rate cycle ergometry test, when conducted at 80% of the Wmax , elicits peak physiological and symptom responses and appears to be safe in adults with CF. For clinicians prescribing exercise at an intensity approaching or equivalent to 80% of the Wmax in a non-laboratory-based setting, consideration needs to be given to the level of supervision and patient monitoring required.
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Affiliation(s)
- Abbey Sawyer
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia.,Allied Health, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Jamie Wood
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research Institute, Sydney, Western Australia, Australia.,School of Human Sciences, University of Western Australia, Sydney, Western Australia, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
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Currie G, Tai A, Snelling T, Schultz A. Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians. BMJ Open Respir Res 2021; 8:8/1/e000956. [PMID: 34266854 PMCID: PMC8286763 DOI: 10.1136/bmjresp-2021-000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/15/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials. METHODS Physicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices. RESULTS Forty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice. CONCLUSIONS Variation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.
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Affiliation(s)
- Grace Currie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Anna Tai
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Institute for Respiratory Health, Nedlands, Western Australia, Australia.,School of Medicine, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - André Schultz
- School of Medicine, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia .,Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Respiratory Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
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35
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Lee AL, Baenziger S, Louey A, Jennings S, Solin P, Hoy R. A review of physiotherapy practice for people with bronchiectasis. ERJ Open Res 2021; 7:00569-2020. [PMID: 34109238 PMCID: PMC8181622 DOI: 10.1183/23120541.00569-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023] Open
Abstract
People with bronchiectasis experience chronic productive cough and acute exacerbations, which are linked to poorer quality of life and a higher rate of disease progression. The clinical guidelines for bronchiectasis management recommend physiotherapy [1, 2]. These guidelines advise the prescription of airway clearance techniques (ACTs) to improve sputum clearance and reduce symptoms [1, 2]. Mucoactive agents may be cautiously considered when required [1, 2]. Individuals with reduced exercise tolerance are recommended to engage in pulmonary rehabilitation or undertake exercise or physical activity [1, 2]. Surveys of physiotherapy management for people with bronchiectasis have described commonly applied ACTs [3, 4] but have not alluded to technique combinations, a strategy considered a key approach towards personalising therapy [3–5]. Other audits have highlighted that ACTs were applied in only 49% and 52% of people with bronchiectasis in Europe and Australia respectively, reflecting a potential underuse of this therapeutic approach [6, 7]. Low referral rates to pulmonary rehabilitation have been noted [3, 7], and the prescription of exercise and physical activity beyond pulmonary rehabilitation is unknown [3]. A combination of airway clearance techniques are applied for people with bronchiectasis, together with recommendations for exercise and suggestions for management of common comorbiditieshttps://bit.ly/2U3c99H
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Affiliation(s)
- Annemarie L Lee
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | | | | | - Sophie Jennings
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia.,Cabrini Health, Malvern, Australia
| | | | - Ryan Hoy
- Cabrini Health, Malvern, Australia.,Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Australia
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Du Berry C, Westrupp N, Shanthikumar S, Welsh L. Associations between peak oxygen uptake, lung function, and bronchiectasis in children with cystic fibrosis in the era of CFTR modulators. Pediatr Pulmonol 2021; 56:1490-1495. [PMID: 33458944 DOI: 10.1002/ppul.25275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND With the emergence of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, forced expiratory volume in 1 s (FEV1 ) may become a less sensitive measure of pulmonary disease progression in children with cystic fibrosis (CF). Increasing evidence shows that peak oxygen uptake (VO2peak ) is a strong predictor of prognosis in CF. The primary aim of this study was to describe the associations between peak oxygen uptake, lung function, and bronchiectasis in children with CF in the era of CFTR modulators. METHODS Spirometry and a maximal cardiopulmonary exercise test (CPET) were performed on the same day and compared to markers of disease severity. Markers of disease severity included a number of pulmonary exacerbations resulting in hospital admission within the preceding 12 months, body mass index, Pseudomonas aeruginosa (PsA) infection, and bronchiectasis. RESULTS Fifty-two subjects (24 female) with CF participated in the study with a mean (SD) age of 13.8 (2.4) years, range 8-18 years. Forty-nine participants met satisfactory criteria for a maximal CPET. A significant correlation was found between relative VO2peak %predicted and FEV1 %predicted (r = .546, p < .001). A total of 4/49 children demonstrated an impaired aerobic capacity despite normal spirometry. Participants who had experienced one or more pulmonary exacerbations in the previous 12 months had a significantly lower relative VO2peak %predicted (p = .02). CONCLUSIONS In children with CF who have mild pulmonary disease, there is significant correlation between FEV1 and VO2peak . In all, 8.2% of participants had an abnormal CPET result despite normal spirometry, and preceding pulmonary exacerbations were associated with poorer CPET outcomes. CPET may offer important prognostic information for clinical decision making in this new era of CFTR modulators.
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Affiliation(s)
- Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
| | - Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
| | - Liam Welsh
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Parkville, Victoria, Australia
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Sawyer A, Cavalheri V, Wood J, Hill K. Exercise testing and exercise training within cystic fibrosis centres across Australia and New Zealand: what is considered important and what is current practice? Intern Med J 2021; 50:1091-1099. [PMID: 31389138 DOI: 10.1111/imj.14443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/21/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Within Australian and New Zealand cystic fibrosis (CF) centres, exercise testing and exercise training are common components of clinical care, but current practices regarding these components have not been reported. AIM To determine the extent, scope and importance placed on exercise testing and exercise training within CF centres across Australia and New Zealand. METHODS Information pertaining to exercise testing and training practices was sought by administering a survey to health professionals working in CF centres across Australia and New Zealand. The survey comprised five sections (46 questions) and was sent via an online link (Qualtrics). Response rate was optimised using the Dillman approach. Approval for this study was granted from the Human Research Ethics Committee at Curtin University (HRE2018-074). Completion of the survey was taken as informed consent. RESULTS A response rate of 80% (n = 32/40) was achieved. Each state/territory in Australia, except the Northern Territory was represented in the survey responses. Eight of the 12 major regions in New Zealand were also represented. Regarding tests of exercise capacity, field-based tests were performed more commonly than laboratory-based tests (n = 28/32; 88% vs n = 11/32 centres; 34%; difference: 54%; 95% confidence interval 31-70%). Most (89%) respondents perceived field tests to be at least 'somewhat' important, whereas 91% of respondents perceived laboratory tests to be 'a little' to 'somewhat' important. Physical activity and/or exercise were discussed by at least one health professional in the CF team at every clinic appointment and/or annual review. Most centred offered outpatient exercise training each year to their patients (n = 24/32; 75%). CONCLUSION This survey captures the current practices of exercise testing and training in CF centres across Australia and New Zealand.
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Affiliation(s)
- Abbey Sawyer
- Faculty of Health Sciences, Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Vinicius Cavalheri
- Faculty of Health Sciences, Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Jamie Wood
- Faculty of Health Sciences, Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.,Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Kylie Hill
- Faculty of Health Sciences, Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.,Institute for Respiratory Health, Perth, Western Australia, Australia
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Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review. Antibiotics (Basel) 2021; 10:antibiotics10050486. [PMID: 33922413 PMCID: PMC8144952 DOI: 10.3390/antibiotics10050486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/08/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that causes absence or dysfunction of a protein named transmembrane conductance regulatory protein (CFTR) that works as an anion channel. As a result, the secretions of the organs where CFTR is expressed are very viscous, so their functionality is altered. The main cause of morbidity is due to the involvement of the respiratory system as a result of recurrent respiratory infections by different pathogens. In recent decades, survival has been increasing, rising by around age 50. This is due to the monitoring of patients in multidisciplinary units, early diagnosis with neonatal screening, and advances in treatments. In this chapter, we will approach the different therapies used in CF for the treatment of symptoms, obstruction, inflammation, and infection. Moreover, we will discuss specific and personalized treatments to correct the defective gene and repair the altered protein CFTR. The obstacle for personalized CF treatment is to predict the drug response of patients due to genetic complexity and heterogeneity of uncommon mutations.
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Kalamara EI, Ballas ET, Pitsiou G, Petrova G. Pulmonary rehabilitation for cystic fibrosis: A narrative review of current literature. Monaldi Arch Chest Dis 2021; 91. [PMID: 33792230 DOI: 10.4081/monaldi.2021.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Pulmonary rehabilitation is a key component in cystic fibrosis care. This review summarizes the recent evidence in the area of pulmonary rehabilitation for cystic fibrosis in the form of questions and answers regarding interventions, indications, benefits and risks of pulmonary rehabilitation. Pulmonary rehabilitation includes airway clearance techniques, exercise training, education and behaviour change and can improve patients' exercise capacity, muscle strength, quality of life and nutritional status. Airway clearance techniques have beneficial effects for clearing mucous. Over the past years, evidence for the beneficial effects of exercise training on exercise capacity and overall lung health is growing. In cystic fibrosis, multiple factors result in reduced exercise capacity. All modalities of pulmonary rehabilitation should be offered to patients with cystic fibrosis, as the benefits in most cases outweigh the risks, though the optimal regimens need to be yet defined.
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Affiliation(s)
- Evgenia I Kalamara
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece.
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki; Medical School, Aristotle University of Thessaloniki, Greece.
| | - Guergana Petrova
- Medical University of Sofia; Pediatric Clinic, University Hospital Alexandrovska, Sofia, Bulgaria.
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40
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Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, Bush A, Chalmers JD, Hill AT, Karadag B, Midulla F, McCallum GB, Powell Z, Snijders D, Song WJ, Tonia T, Wilson C, Zacharasiewicz A, Kantar A. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:13993003.02990-2020. [PMID: 33542057 DOI: 10.1183/13993003.02990-2020] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Leanne Bell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
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41
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Johnston LM. Appraisal of Clinical Practice Guideline: Physiotherapy for cystic fibrosis in Australia and New Zealand. J Physiother 2021; 67:68. [PMID: 33353829 DOI: 10.1016/j.jphys.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Leanne M Johnston
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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42
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Ward N, Morrow S, Stiller K, Holland AE. Exercise as a substitute for traditional airway clearance in cystic fibrosis: a systematic review. Thorax 2020; 76:thoraxjnl-2020-215836. [PMID: 33443204 DOI: 10.1136/thoraxjnl-2020-215836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Exercise and traditional airway clearance techniques (ACTs) are both routinely recommended for people with cystic fibrosis (CF), with some people using exercise as a substitute for traditional ACTs. The effectiveness of this is unclear. We systematically reviewed the evidence for using exercise as a substitute for traditional ACTs in people with CF. METHODS A systematic database and literature search were undertaken of studies comparing exercise to rest or traditional ACTs. Primary outcomes were respiratory function, respiratory exacerbations and health-related quality of life. Secondary outcomes included mucociliary clearance (MCC), sputum weight and ease of expectoration. Data are mean difference (95% CI). RESULTS A total of 12 studies (15 reports) were included, all of short duration (single session to 2 weeks). In crossover trials, exercise did not improve forced expiratory volume in one second in comparison to rest, but peak expiratory flow was increased during treadmill exercise (mean difference (MD) range 1.00-1.16 L/s) and cycle ergometry (1.19 (0.96 to 1.42) L/s). Treadmill exercise improved MCC (2.6 (1.6 to 3.6)%) and ease of expectoration (MD range 1.3-1.8 cm) compared with rest. No consistent differences in respiratory function were evident when exercise was compared with traditional ACTs (four crossover studies). There was no significant difference in MCC or sputum weight in studies where forced expirations were included in the exercise intervention. CONCLUSIONS Exercise improves ease of expectoration and sputum clearance compared with rest. Exercise, incorporating forced expirations, may have similar effects to traditional ACTs over the short term. There are no data comparing exercise to traditional ACTs over the longer term. PROSPERO REGISTRATION NUMBER CRD42018102780.
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Affiliation(s)
- Nathan Ward
- Physiotherapy and Cystic Fibrosis Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Scott Morrow
- Physiotherapy and Cystic Fibrosis Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathy Stiller
- Allied Health, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anne E Holland
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Allergy, Immunology and Respiratory Medicine, Monash University, Clayton, Victoria, Australia
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43
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Ward N, Ward B, Stiller K, Kenyon A, Holland AE. Development of a device to measure adherence and pressure characteristics of positive expiratory pressure therapies used by adults with cystic fibrosis. Physiother Theory Pract 2020; 38:1469-1477. [PMID: 33307911 DOI: 10.1080/09593985.2020.1858465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Positive expiratory pressure (PEP) and oscillating positive expiratory pressure (OscPEP) therapies are often used by people with cystic fibrosis (CF) to facilitate airway clearance. However, suboptimal adherence and poor technique may reduce their effectiveness.Objective: To develop a device (PEPtrac) to accurately measure and provide preliminary clinical data of adherence and technique characteristics when airway clearance is performed using PEP/OscPEP devices.Methods: This study comprised two distinct phases: 1) a benchtop validation study; and 2) clinical study. Benchtop study: Accuracy of PEPtrac was measured by comparing it to video analysis for five different PEP/OscPEP devices. Clinical study: Clinical data were then collected for 18 adults with CF using one of three PEP/OscPEP devices (PariPEP S®, Acapella DH® or Aerobika®) unsupervised.Results: There was 100% agreement between PEPtrac and video analysis data. Clinical data revealed significant variability in expiratory duration and pressure properties between the three PEP/OscPEP devices and between participants. For example, expiratory duration with PariPEP S® (mean [SD] = 4.8 [1.2] sec) was longer (p < .001) than Acapella DH® (3.7 [0.8] sec) and Aerobika® (2.9 [1.1] sec) and Aerobika® had a higher oscillation amplitude than Acapella DH® (6.4 [1.7] vs 5.3 [1.5] cmH2O, p < .001).Discussion: Accurate measurement of PEP/OscPEP adherence and technique using a device such as PEPtrac was possible. Further research is required to investigate the clinical importance of the variability in technique seen in our clinical data.
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Affiliation(s)
- Nathan Ward
- Physiotherapy and Cystic Fibrosis Services, Royal Adelaide Hospital, Adelaide, Australia.,Physiotherapy, La Trobe University, Melbourne, Australia
| | - Bruce Ward
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathy Stiller
- Allied Health, Central Adelaide Local Health Network, Adelaide, Australia
| | - Amanda Kenyon
- Physiotherapy and Cystic Fibrosis Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Anne E Holland
- Physiotherapy, La Trobe University, Melbourne, Australia.,Physiotherapy, Alfred Health, Melbourne, Australia
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology, goal setting and text message feedback. HRB Open Res 2020; 3:21. [PMID: 33283151 PMCID: PMC7689601 DOI: 10.12688/hrbopenres.13025.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov
NCT03672058 (14/09/2018)
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Affiliation(s)
- Maire Curran
- School of Allied Health, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Audrey C Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Ireland.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | | | | | | | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brenda Button
- Departments of Respiratory Medicine and Physiotherapy, The Alfred, Melbourne, Australia.,Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
| | | | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Helper N, Kodesh E, Sokol G, Hakimi R, Vilozni D, Efrati O. The benefits of mechanical insufflator-exsufflator compared to autogenic drainage in adults with cystic fibrosis. Pediatr Pulmonol 2020; 55:3046-3052. [PMID: 32776649 DOI: 10.1002/ppul.25020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/21/2020] [Accepted: 08/01/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Autogenic drainage (AD) is used for airway clearance in individuals with cystic fibrosis (CF). The mechanical insufflator-exsufflator (MI-E) device is commonly used in patients with neuromuscular diseases for airway clearance by increasing inspiratory volume and expiratory flow. MI-E use has not been studied extensively in CF patients. OBJECTIVES To examine whether there are advantages to using the MI-E device in patients with CF. SUBJECTS Fourteen males and eight females from the national center for CF, with an average FEV1 of 54% were recruited DESIGN: Prospective cross-over trial (IRB 3009-16-SMC). INTERVENTION Subjects received either AD or MI-E in a random order. Sputum was collected and weighed immediately after treatment. Subjects performed lung function tests at baseline, 20 minutes after and 1 hour after treatment; additionally, a 2-minute walk test was performed at the end of all lung function tests. Saturation, dyspnea scores while resting and after a 2-minute walk and subjective fatigue were recorded. RESULTS Thirty-six percent more sputum was collected following MI-E than AD treatment (P < .0001). A significant difference in saturation in response to the 2MWT was noted in both treatments significantly less desaturation was recorded after the 2MWT in the MI-E treatment (P < .01). CONCLUSIONS Treatment with the MI-E was more effective for clearing sputum in CF subjects, initial evidence suggests that the MI-E may be successfully incorporated into treatment protocols. Further studies are needed to assess the long-term benefits of MI-E in patients with CF.
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Affiliation(s)
- Nir Helper
- Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Einat Kodesh
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Gil Sokol
- Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ran Hakimi
- Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology. HRB Open Res 2020; 3:21. [DOI: 10.12688/hrbopenres.13025.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)
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Santuzzi CH, Liberato FMG, Morau SAC, de Oliveira NFF, Nascimento LR. Adherence and barriers to general and respiratory exercises in cystic fibrosis. Pediatr Pulmonol 2020; 55:2646-2652. [PMID: 32558990 DOI: 10.1002/ppul.24912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the adherence and the self-reported barriers to general and respiratory exercises reported by individuals with cystic fibrosis (CF). STUDY DESIGN An exploratory, experimental study. METHODS Community-dwelling individuals aged 16 years and over, diagnosed with CF, who were accompanied in referral centers were included. Information regarding adherence to exercises was obtained by a questionnaire and reported as a ratio between prescribed exercises and self-reported adherence. The weekly frequency was used to verify adherence to exercise initiation, and the amount of session duration concluded was used to verify adherence to exercise duration. Values above 0.70 were considered as high adherence. Eight demographic and clinical factors were examined to explore their relationships with adherence, and the barriers to exercises were also collected by questionnaire. RESULTS Thirty-four participants met the inclusion criteria. Overall, adherence to exercise initiation was 0.40 (standard deviation [SD] = 0.3) for general exercises and 0.63 (SD = 0.4) for respiratory exercises. Adherence to exercise duration was 0.76 (SD = 0.4) for general exercises and 0.73 (SD = 0.4) for respiratory exercises. Forced vital capacity (r = 0.39; P = .02) was associated with adherence to the duration of general exercises, and body mass index (r = -0.33; P = .05) was associated with adherence to the duration of respiratory exercises. The main reported barriers were lack of interest, motivation and time, tiredness, noncommitment, and do not recognize the benefits of exercises. CONCLUSIONS Individuals with CF minded completing the sessions of prescribed exercises once they have initiated it, but most of the days they did not practice general or respiratory exercises.
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Affiliation(s)
- Cíntia Helena Santuzzi
- Department of Physical Therapy, Center of Health Science, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | | | | | | | - Lucas Rodrigues Nascimento
- Department of Physical Therapy, Center of Health Science, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
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A Survey of Pediatric Competencies in Entry-Level Physical Therapy Programs in Australia. Pediatr Phys Ther 2020; 32:356-365. [PMID: 32925813 DOI: 10.1097/pep.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe perspectives of pediatric physical therapy clinical facilitators on contemporary curricula for Australian entry-level physical therapy programs. METHODS Physical therapy clinical facilitators completed an online survey based on the Academy of Pediatric Physical Therapy of the APTA essential competencies. RESULTS Conditions including cerebral palsy, cystic fibrosis, and prematurity were highly rated by most participants to include in an entry-level program. Exercise prescription, goal-directed training, and group-based physical therapy were the highest rated interventions. Outcome measures considered important to include were the Alberta Infant Motor Scale and Goal Attainment Scale. Students should demonstrate knowledge and skills using relevant frameworks and have practical opportunities to interact with children. CONCLUSION Pediatric clinical facilitators perceived that theoretical knowledge on frameworks, human development, movement skills, pediatric conditions, exercise prescription, and outcome measurement as well as face-to-face experiences with children are important to include in Australian entry-level physical therapy programs.
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High-Intensity Interval Training Is Effective at Increasing Exercise Endurance Capacity and Is Well Tolerated by Adults with Cystic Fibrosis. J Clin Med 2020; 9:jcm9103098. [PMID: 32992871 PMCID: PMC7601335 DOI: 10.3390/jcm9103098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To optimize outcomes in people with cystic fibrosis (CF), guidelines recommend 30 to 60 min of moderate-intensity aerobic exercise on most days. Accumulating this volume of exercise contributes importantly to the substantial treatment burden associated with CF. Therefore, the main aim of this study was to investigate the effects of low-volume high-intensity interval training (HIIT) on exercise capacity in people with CF. METHODS This randomized controlled trial included people with CF aged ≥15 years, who were allocated to either eight weeks of thrice-weekly 10-min sessions of HIIT (experimental group) or eight weeks of weekly contact (control group). Before and after the intervention period, participants completed measurements of time to symptom limitation (Tlim) during a constant work rate cycle ergometry test (primary outcome), and maximal work rate (Wmax) during a ramp-based cycle ergometry test and health-related quality of life (HRQoL). RESULTS Fourteen participants (median (IQR) age 31 (28, 35) years, forced expiratory volume in 1 second (FEV1) 61 (45, 80) % predicted) were included (seven in each group). Compared to the control group, participants in the experimental group demonstrated a greater magnitude of change in Tlim, Wmax (p = 0.017 for both) and in the physical function domain of HRQoL (p = 0.03). No other between-group differences were demonstrated. Mild post-exercise muscle soreness was reported on a single occasion by four participants. Overall, participants attended 93% of all HIIT sessions. DISCUSSION Eight weeks of low-volume (i.e., 30-min/week) HIIT produced gains in exercise capacity and self-reported physical function and was well tolerated by people with CF.
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Lang RL, Stockton K, Wilson C, Russell TG, Johnston LM. Exercise testing for children with cystic fibrosis: A systematic review. Pediatr Pulmonol 2020; 55:1996-2010. [PMID: 32453897 DOI: 10.1002/ppul.24794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise testing is routinely used to measure exercise capacity in children with cystic fibrosis (CF). Various tests are available, however the psychometric properties of these measures have not been systematically reviewed for this population. METHOD A systematic search of electronic databases (PubMed, Web of Science, Medline, CINHAL, Cochrane, and PEDro) was performed to identify papers that: (a) reported original psychometric data, (b) examined a measure of exercise capacity, (c) examined children with CF aged eight to 18 years; and (d) were published in English after 1950. The level of psychometric evidence was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS Searches identified 1025 papers. Forty-six papers were included, covering 15 tests: incremental cardiopulmonary exercise test using a cycle ergometer (CPET(cycle)) or treadmill (CPET(treadmill)), 6 minute walk test (6MWT), modified shuttle test (MST), 3-minute step test (3MST), 2 minute walk test (2MWT), Bratteby walk test, intermittent sprint test, speed ramp test, incremental step test, forward-backwards jump test (FBJT), astride jump test (AJT), motor quotient test, Munich fitness test, and Glittre ADL test. CONCLUSION There is a plethora of exercise tests available with varying psychometric robustness. The CPET, 6MWT, and MST have fair to good psychometric properties, but each with their clinical advantages and limitations. Thus, a Selection Guide was developed to assist clinicians and researchers in selecting the most appropriate exercise test for various situations.
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Affiliation(s)
- Ray Lei Lang
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Kellie Stockton
- Department of Physiotherapy, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Services, South Brisbane, Australia
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Services, South Brisbane, Australia
| | - Trevor Glen Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Leanne Marie Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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