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Andersson Marforio S, Hansen C, Ekvall Hansson E, Lundkvist Josenby A. Frequent body position changes and physical activity as effective as standard care for infants hospitalised with acute respiratory infections - a randomised controlled trial. Multidiscip Respir Med 2023; 18:885. [PMID: 36743946 PMCID: PMC9892929 DOI: 10.4081/mrm.2023.885] [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: 10/03/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023] Open
Abstract
Background No definite consensus has been reached yet on the best treatment strategy for the large group of infants hospitalised with bronchiolitis or pneumonia. Minimal handling is often recommended, although not evaluated scientifically. There is a need to evaluate the management, as the infants often are critically affected, and the costs for society are high. The aim of this RCT was to evaluate the most common physiotherapy intervention in Sweden for this patient group, including frequent changes in body position and stimulation of physical activity, compared to standard care. Methods Infants 0-24 months old, without previous cardiac or respiratory diagnoses and born in gestational week 35+, were recruited in two Swedish hospitals. The participants (n=109) were randomised to either interventions in addition to standard care (intervention group) or to standard care alone (control group). The primary outcome measure was time to improvement. The secondary outcomes were immediate changes in oxygen saturation, heart rate and respiratory rate, time to improved general condition (parents' assessment), and lung complications. Results The median time to improvement was 6 hours in both groups (p=0.54). The result was similar when we adjusted for age in months, sex, tobacco smoke exposure, heredity for asthma/atopic disease, and early stage of the infection (for those with RSV), p=0.69. Analyses of the immediate changes showed no significant differences either (p=0.49-0.89). Time to improved general condition was median 3 hours in the intervention group and 6 hours in the control group, p=0.76. No lung complications occurred. Conclusions No statistically significant differences in outcomes were detected between the intervention group and the control group. Both strategies were found to be equally effective and safe, indicating that the current recommendation of minimal handling for these infants should be reconsidered. Furthermore, the findings suggest that this treatment can be safely continued.
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Affiliation(s)
- Sonja Andersson Marforio
- Department of Health Sciences, Lund University, Lund,Skåne University Hospital, Lund, Sweden,Department of Health Sciences, Lund University, Margaretavägen 1B, Lund, S-22240, Sweden.
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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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Torreiro Diéguez L, Martí JD, Souto Camba S, González Doniz L, López García A, Lista-Paz A. Respiratory physiotherapy in Spanish Pediatric and Neonatal Intensive Care Units. Med Intensiva 2022; 46:341-345. [PMID: 35550353 DOI: 10.1016/j.medine.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 06/15/2023]
Affiliation(s)
- L Torreiro Diéguez
- Asociación de Personas con Lesión Medular y Otras Discapacidades Físicas de Galicia (ASPAYM Galicia), A Coruña, Spain
| | - J-D Martí
- UCI de cirugía cardiovascular, Instituto Clínico Cardiovascular (ICCV), Hospital Clinic, Barcelona, Spain
| | - S Souto Camba
- Facultad de Fisioterapia de la Universidade da Coruña. Campus Universitario de Oza, A Coruña, Spain; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional. Universidade da Coruña, Campus Universitario de Oza, A Coruña, Spain
| | - L González Doniz
- Facultad de Fisioterapia de la Universidade da Coruña. Campus Universitario de Oza, A Coruña, Spain; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional. Universidade da Coruña, Campus Universitario de Oza, A Coruña, Spain
| | - A López García
- Facultad de Fisioterapia de la Universidade da Coruña. Campus Universitario de Oza, A Coruña, Spain; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional. Universidade da Coruña, Campus Universitario de Oza, A Coruña, Spain
| | - A Lista-Paz
- Facultad de Fisioterapia de la Universidade da Coruña. Campus Universitario de Oza, A Coruña, Spain; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional. Universidade da Coruña, Campus Universitario de Oza, A Coruña, Spain.
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Andersson-Marforio S, Lundkvist Josenby A, Hansen C, Ekvall Hansson E. Physiotherapy interventions encouraging frequent changes of the body position and physical activity for infants hospitalised with bronchiolitis: an internal feasibility study of a randomised control trial. Pilot Feasibility Stud 2022; 8:76. [PMID: 35351205 PMCID: PMC8966163 DOI: 10.1186/s40814-022-01030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background The effect of a treatment that includes frequent changes of the body position for infants with bronchiolitis has not been evaluated, although it is often used in Swedish hospitals. Because of this, a randomised control trial (RCT) has begun with the aim to evaluate this treatment, comparing the effect of an individualised physiotherapy intervention, a non-individualised intervention, and standard care in a control group. The objective of this internal pilot study was to address uncertainties concerning the ongoing RCT and to determine whether the trial is feasible or not, possibly with adjustments to the protocol. Methods Descriptive analyses of the recruitment, retention, data supply for the primary end point, and the usability of the primary outcome measure in the full RCT were performed. A safety analysis was conducted by an independent analysis group. Results Ninety-one infants were included, 33 (36.3%), 28 (30.8%), and 30 (33.0%) in the respective allocation groups. Fifty-nine (64.8%) were boys. The median age was 2.5 (min–max 0.2–23.7) months. They remained in the study for a median of 46 hours (min–max 2–159). The recruitment rate was 19%. The data supply for the primary end point and for the primary outcome measure was lower than anticipated in the original sample size calculation. Difficulties concerning utilising the primary outcome measure were identified. The safety analysis detected no risks of harm related to participation in the study. Conclusions It is feasible to continue the RCT with modifications of the analysis plan. Participation in the study was not associated with any safety risks. Trial registration
ClinicalTrials.gov NCT03575091. Registered 2 July 2018. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01030-2.
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Affiliation(s)
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Lund University, Margaretavägen 1B, S-22240, Lund, Sweden.,Children's Hospital, Skåne University Hospital, S-22185, Lund, Sweden
| | - Christine Hansen
- Children's Hospital, Skåne University Hospital, S-22185, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Margaretavägen 1B, S-22240, Lund, Sweden
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Torreiro Diéguez L, Martí JD, Souto Camba S, González Doniz L, López García A, Lista-Paz A. Respiratory physiotherapy in Spanish Pediatric and Neonatal Intensive Care Units. Med Intensiva 2021; 46:S0210-5691(21)00167-4. [PMID: 34294447 DOI: 10.1016/j.medin.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 11/21/2022]
Affiliation(s)
- L Torreiro Diéguez
- Asociación de Personas con Lesión Medular y Otras Discapacidades Físicas de Galicia (ASPAYM Galicia), A Coruña, España
| | - J-D Martí
- UCI de Cirugía Cardiovascular, Instituto Clínico Cardiovascular (ICCV), Hospital Clínic, Barcelona, España
| | - S Souto Camba
- Facultad de Fisioterapia, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España
| | - L González Doniz
- Facultad de Fisioterapia, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España
| | - A López García
- Facultad de Fisioterapia, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España
| | - A Lista-Paz
- Facultad de Fisioterapia, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España; Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional, Universidade da Coruña, Campus Universitario de Oza, A Coruña, España.
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