Aust J Physiother
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Randomized Controlled Trial
Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study.
What is the relationship between vibration of the chest wall and the resulting chest wall force, chest wall circumference,intrapleural pressure, and expiratory flow rate? Is the change in intrapleural pressure during vibration the sum of the intrapleural pressure due to recoil of the lung, chest wall compression, and chest wall oscillation? ⋯ During vibration the chest behaves as a highly linear system. Changes in intrapleural pressure occurring during vibration appear to be the sum of changes in pressure due to lung recoil and the compressive and oscillatory components of the technique, which suggests that all three components are required to optimise expiratory flow.
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Randomized Controlled Trial
Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial.
Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash? ⋯ Although the active implementation program increased guideline-consistent practice, patient outcomes and cost of care were not affected.
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Randomized Controlled Trial Clinical Trial
Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints.
An operant behavioural and time-contingent graded exercise therapy program was developed to improve functional ability irrespective of pain experience in patients with chronic shoulder complaints. The clinical effectiveness of graded exercise therapy compared to usual care was evaluated in a randomised clinical trial. Assessments were carried out before and after 12 weeks of treatment. ⋯ Subgroup analysis showed larger improvements on the mean complaints instrument in patients not reporting pain reduction over time. Graded exercise therapy seems to be less effective in restoring performance of daily activities as assessed by the SDQ in patients showing a painful arc during physical examination. Results showed that graded exercise therapy is more effective in restoring the ability to daily activities in patients with chronic shoulder complaints than usual care, although beneficial effects are small.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.
Ventilator-associated pneumonia results from bacterial colonisation of the aerodigestive tract or aspiration of contaminated secretions into the lower airways. As a consequence of infection of the lung parenchyma and alveolitis, accumulation of inflammatory exudates and infiltration of airway mucosa can lead to unfavourable respiratory mechanics in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance. ⋯ Data were recorded before, immediately after, and 30 minutes after each intervention protocol. C(L) increased by 22% and R(AW) decreased by 21%, up to 30 minutes after manual hyperinflation plus suction, but not after suction alone. This study suggests that manual hyperinflation in conjunction with suction induces beneficial changes in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.
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Randomized Controlled Trial Clinical Trial
Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients.
Postoperative physiotherapy has been shown to reduce the incidence of postoperative pulmonary complications after open abdominal surgery. This study aimed to determine if the addition of deep breathing exercises and secretion clearing techniques to a standardised physiotherapist-directed program of early mobilisation improved clinical outcomes in patients undergoing open abdominal surgery. Fifty-six patients undergoing open abdominal surgery, at high risk of developing postoperative pulmonary complications, were randomised before operation to an early mobilisation-only group or an early mobilisation-plus-deep breathing and coughing group. ⋯ The incidence of postoperative pulmonary complications in the non-deep breathing and coughing group was 14%, and the incidence of postoperative pulmonary complications in the deep breathing and coughing group was 17%, (absolute risk reduction -3%, 95% C1 -22 to 19%). There was no significant difference between groups in the incidence of fever, physiotherapist time, or the number of treatments. This study suggests that, in this clinical setting, the addition of deep breathing and coughing exercises to a physiotherapist-directed program of early mobilisation does not significantly reduce the incidence of clinically significant postoperative pulmonary complications in high risk open abdominal surgery subjects.