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Andersson Marforio S, Ekvall Hansson E, Lundkvist Josenby A. The Use of Evaluation Methods for Physiotherapy Treatment in Infants With Bronchiolitis-a Survey Study. Phys Occup Ther Pediatr 2024:1-13. [PMID: 39129268 DOI: 10.1080/01942638.2024.2386475] [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: 06/22/2023] [Revised: 06/06/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024]
Abstract
AIMS The aim of this study was to identify and describe methods that physiotherapists use to evaluate the immediate effects of their interventions for infants in hospital with acute respiratory tract infections. METHODS We constructed an anonymous digital survey to physiotherapists working with infants aged 0-24 months in Sweden. The survey was distributed by e-mail and posted on web pages for seven weeks, which included a reminder. RESULTS Replies were obtained from 88 respondents, and 52 completed surveys remained to be analyzed. All 21 counties in Sweden were represented. The most prevalent answer options were as follows: more productive/increased or decreased cough (73%), increased oxygen saturation (35%), changed secretion sounds (33%), reduced work of breathing (20%), and parental report (16%). CONCLUSIONS The physiotherapists reported to use diverse methods for evaluation of their interventions. However, to a large degree they used subjective measures, which depend on the individual clinician's assessment and interpretation. The evaluation methods vary in psychometric properties and robustness. This study identifies the need for consensus about valid, reliable, and clinically relevant evaluation methods for this patient group.
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Affiliation(s)
- Sonja Andersson Marforio
- Department of Health Sciences, Lund University, Lund, Sweden
- Children's Hospital, Skåne University Hospital, Lund, Sweden
| | | | - Annika Lundkvist Josenby
- Department of Health Sciences, Lund University, Lund, Sweden
- Children's Hospital, Skåne University Hospital, Lund, Sweden
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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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Abreu V, Castro S, Sousa D, Julião E, Sousa JL. Impacto da fisioterapia nos diferentes tipos de bronquiolite, pacientes e locais de atendimento: revisão sistemática. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/21019428042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A bronquiolite é definida como um episódio agudo de sibilâncias que ocorre no contexto de um quadro respiratório, de origem normalmente viral, com elevada incidência nas crianças com menos de 2 anos. Considerando que o papel da Fisioterapia tem sido questionado nesse contexto, é extremamente importante esclarecer e diferenciar o impacto das diversas técnicas de fisioterapia empregadas em cada tipo de bronquiolite, paciente e local de atendimento. Foi realizada uma revisão sistemática, com busca nas bases de dados ScienceDirect, MEDLINE/PubMed e SciELO, sobre as técnicas de fisioterapia em crianças de até 2 anos de idade com episódio de bronquiolite. Foram incluídos seis estudos observacionais, cinco experimentais sem grupo de controle e 15 com grupo de controle, envolvendo 3.339 indivíduos. São 14 os estudos com amostras em internamento, seis em internamento e unidade de cuidados intensivos (UCI) e seis em ambulatório. Dentre as técnicas de fisioterapia respiratória mais utilizadas, destacam-se a técnica de expiração lenta e prolongada (ELPr) associada à tosse provocada (TP), a aumento do fluxo expiratório (AFE), a desobstrução rinofaríngea retrógrada (DRR) e a drenagem postural (DP). Encontraram-se resultados positivos em relação às técnicas de fisioterapia respiratória, nomeadamente DRR, ELPr e AFE ou TP, na permeabilização das vias aéreas, promoção da higiene brônquica, dias de hospitalização, saturação de oxigênio, pontuação clínica, frequência cardíaca, frequência respiratória e necessidade de oxigenoterapia. Como limitações do estudo, destaca-se o fato de não haver estudos suficientes com metodologias robustas e comparáveis que permitam chegar a conclusões com maior certeza, em especial em relação às diferentes severidades da patologia, e fundamentar assim a personalização e adequação das intervenções na prática clínica.
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Affiliation(s)
| | | | - Diana Sousa
- Escola Superior de Saúde Jean Piaget, Portugal
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Andersson-Marforio S, Lundkvist Josenby A, Ekvall Hansson E, Hansen C. The effect of physiotherapy including frequent changes of body position and stimulation to physical activity for infants hospitalised with acute airway infections. Study protocol for a randomised controlled trial. Trials 2020; 21:803. [PMID: 32958026 PMCID: PMC7504844 DOI: 10.1186/s13063-020-04681-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background Every year, many infants are infected with the respiratory syncytial virus (RSV) or other agents and need hospitalisation due to bronchiolitis. The disease causes much suffering and high costs. Thus, it is important that the treatment methods are both effective and cost-efficient. The use of different physiotherapy treatment methods is debated, and not all methods are evaluated scientifically. The clinical praxis in Sweden that includes frequent changes of body position and stimulation to physical activity has not previously been evaluated. The aim of this clinical study is to evaluate this praxis. Methods This study is a clinical two-centre individually randomised controlled trial (RCT) with three parallel groups. The participants will be randomly assigned to an individualised physiotherapy intervention, a non-individualised intervention, or a control group. All three groups will receive the standard care at the ward, and the two intervention groups will receive additional treatment, including different movements of the body. The primary outcome measure is a clinical index based on determinants for hospitalisation. Baseline assessments will be compared with the assessments after 24 h. The secondary outcome measures include vital signs, the parents’ observations, time spent at the hospital ward, and referrals to an intensive care unit. We also want see if there is any immediate effect of the first intervention, after 20 min. Discussion This study will add knowledge about the effect of two physiotherapy interventions that are commonly in use in Swedish hospitals for infants with bronchiolitis or other acute lower respiratory tract infections. Trial registration ClinicalTrials.gov NCT03575091. Registered July 2, 2018—retrospectively registered.
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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
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Margaretavägen 1B, S-22240, Lund, Sweden
| | - Christine Hansen
- Children's Hospital, Skåne University Hospital, S-22185, Lund, Sweden
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Andersson-Marforio S, Hansen C, Ekvall Hansson E, Lundkvist Josenby A. A survey of the physiotherapy treatment methods for infants hospitalised with acute airway infections in Sweden. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1663925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sonja Andersson-Marforio
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
- Children’s Hospital, Skåne University Hospital, Lund, Sweden
| | | | - Eva Ekvall Hansson
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
- Children’s Hospital, Skåne University Hospital, Lund, Sweden
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Perez–Zabalza M, Hagmeijer R, Thio BJ, Bors J, Hoppenbrouwer X, Garde A. Analysis of heart rate variability in children during high flow nasal cannula therapy. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab2d11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gomes GR, Donadio MVF. Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis. Arch Pediatr 2018; 25:394-398. [PMID: 30064712 DOI: 10.1016/j.arcped.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/16/2018] [Accepted: 06/24/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB). METHODS A literature review was done searching the Pubmed, LILACS, PEDro, and Scielo databases. The following key words were used: bronchiolitis, physiotherapy, techniques, physical therapy, and chest physiotherapy. Both controlled and uncontrolled clinical trials, without limits as to date, were selected. RESULTS Fifteen articles were included and the use of different techniques of respiratory physiotherapy showed positive results in eight studies. Most (11) were controlled clinical trials, and only two had a double-blind design. Of the 14 studies with a control group, in six this group was submitted to nasopharyngeal aspiration. The most widely used techniques were manual vibration and postural drainage (eight studies), and then tapping/percussion (seven studied). The maneuvers considered as current, e.g., prolonged slow expiration, expiratory flow acceleration, and rhinopharyngeal retrograde clearance, were used in four, four, and two studies, respectively. CONCLUSIONS The use of respiratory physiotherapy in children with AVB remains controversial. The heterogeneity of techniques evaluated in the studies limits the interpretation of efficacy, although its use was considered safe. Recent findings indicating a reduction in the length of the hospital stay remain to be confirmed.
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Affiliation(s)
- G R Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - M V F Donadio
- Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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Lestari NE, Nurhaeni N, Chodidjah S. The combination of nebulization and chest physiotherapy improved respiratory status in children with pneumonia. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blanco JH, Gastaldi AC, Gardim CB, Araujo JE, Simões MV, Oliveira LF, Carvalho EE, Souza HC. Chronic cholinergic stimulation promotes changes in cardiovascular autonomic control in spontaneously hypertensive rats. Auton Neurosci 2015; 193:97-103. [DOI: 10.1016/j.autneu.2015.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/12/2015] [Accepted: 09/29/2015] [Indexed: 11/30/2022]
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