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1.
BMC Musculoskelet Disord ; 23(1): 839, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057590

RESUMO

OBJECTIVES: The paper presents insights from the Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. We aimed to explore physiotherapists and physiotherapy assistants' experiences of delivering a home-base exercise intervention following knee replacement surgery. We were particularly interested in the feasibility, potential benefits and barriers of a community-based exercise programme from the perspective of physiotherapists and physiotherapy assistants and to understand any constraints or training needs that arose.  DESIGN: Qualitative thematic analysis of semi-structured interviews.  SETTING: The Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. PARTICIPANTS: Five physiotherapists and six physiotherapy assistants with a range of clinical experience. METHODS: Interviews were digitally recorded and transcribed verbatim. We used the stages of reflexive thematic analysis suggested by Braun and Clarke. One researcher conducted the interviewers whilst three researchers with experience in qualitative research methods contributed to the coding and analysis of data. RESULTS: We developed seven themes that help to understand the benefits and challenges of delivering treatment interventions in a person's home: seeing the person in their own world; thinking outside the cubicle;developing people skills; enjoying the above and beyond; treading a fine line between patient and friend; feeling outside my comfort zone; needing a support network. CONCLUSIONS: Treating people in their own homes facilitates a holistic approach. Our findings highlight areas for clinical education: (1) how do we help clinicians to tread the fine line between friend and professional (2) how do we balance the need to provide support and structure with the freedom to work creatively and independently?


Assuntos
Fisioterapeutas , Terapia por Exercício/métodos , Humanos , Modalidades de Fisioterapia , Pesquisa Qualitativa , Projetos de Pesquisa
2.
J Med Case Rep ; 16(1): 339, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056375

RESUMO

BACKGROUND: Patients with severe coronavirus disease 2019 (COVID-19) infection require a long period of time to return to work and society due to significant physical weakness even after recovery. Here we report a patient with a history of nephrectomy who developed severe COVID-19 infection associated with muscle weakness but was able to return to society after rehabilitation therapy. CASE PRESENTATION: A Japanese man in his 40s was admitted to the hospital with PCR-based COVID-19 diagnosis. The respiratory condition worsened rapidly and was treated with extracorporeal membrane-assisted ventilation in the intensive case unit. On admission to the Rehabilitation Department on day T + 30 [T: day patient became febrile (38 °C)], he was unable to stand for a long time and used a walker. Rehabilitation therapy was postponed to prevent COVID-19 spread, but the patient was encouraged to exercise during isolation to improve trunk and lower extremity muscle strength. Physical therapy commenced on day T + 49 to improve gait and trunk and lower limb muscle strength. He was able to walk independently and later returned to work following discharge on day T + 53. A computed tomography scan showed an increase in psoas muscle volume from 276 before to 316 cm3 after physical therapy, together with a decrease in whole-body extracellular water:total body weight ratio from 0.394 to 0.389. CONCLUSIONS: We have described the beneficial effects of rehabilitation therapy in a patient with severe COVID-19 infection. In addition to exercise, we believe that nutrition is even more important in increasing skeletal muscle mass. Rehabilitation therapy is recommended to enhance the return of severely ill COVID-19 patients to routine daily activity.


Assuntos
COVID-19 , Teste para COVID-19 , Humanos , Masculino , Debilidade Muscular/etiologia , Modalidades de Fisioterapia/efeitos adversos , Respiração Artificial
3.
Tidsskr Nor Laegeforen ; 142(12)2022 Sep 06.
Artigo em Norueguês | MEDLINE | ID: mdl-36066218
4.
Am J Case Rep ; 23: e937389, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36081331

RESUMO

BACKGROUND Central pontine myelinolysis (CPM) includes symmetric demyelination of the central pons. CPM is a rare neurological disorder that generally develops after rapid correction of hyponatremia in individuals having underlying conditions, such as malnutrition, alcoholism, and severe burns. It can cause severe long-term disabilities. However, there is currently no pharmacotherapy capable of promoting remyelination, a process crucial for recovery from CPM. We present the case of a patient with alcoholism and malnutrition-related CPM, which developed following rapid correction of hyponatremia but then improved remarkably with supportive physical therapy. CASE REPORT A 44-year-old alcoholic and malnourished man was admitted to an emergency hospital for disorientation due to overdrinking, but later developed bulbar palsy after hyponatremia was unexpectedly, but rapidly, corrected. Axial scans of the diffusion-weighted brain MRI revealed a characteristic lesion known as a piglet sign in the central pons. Based on his underlying conditions, present episode of sodium correction, and MRI finding, the patient was diagnosed as having CPM, which progressively worsened, resulting in locked-in syndrome after 12 days. The patient was then transferred to a long-term care unit and received simple motion exercise daily, but no specific medication. His symptoms gradually improved, achieving discontinuation of tube feeding on day 21, independent walking on day 110, and discharge after 6 months. CONCLUSIONS This report highlights the importance of physical therapy, the potential of which is often underestimated despite its broad benefits for human health, as a readily applicable intervention for patients with CPM. Further understanding of mechanisms underlying exercise-induced myelination should contribute to establishing novel therapies for a wide spectrum of brain disorders.


Assuntos
Alcoolismo , Hiponatremia , Desnutrição , Mielinólise Central da Ponte , Adulto , Alcoolismo/complicações , Animais , Etanol , Humanos , Hiponatremia/complicações , Imageamento por Ressonância Magnética , Masculino , Desnutrição/complicações , Mielinólise Central da Ponte/etiologia , Mielinólise Central da Ponte/terapia , Modalidades de Fisioterapia , Suínos
5.
J Bras Pneumol ; 48(4): e20220121, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36074409

RESUMO

OBJECTIVE: To identify the indications for physiotherapy and to evaluate physiotherapy practices in patients with COVID-19 admitted to the ICU (on mechanical ventilation) or to the ward (spontaneously breathing). METHODS: An online, 50-item survey was completed by physiotherapists who had been treating hospitalized patients with COVID-19 in Brazil. RESULTS: Of the 644 physiotherapists who initiated the survey, 488 (76%) completed it. The main reasons for indications for physiotherapy in both settings reported as "very frequently" and "frequently" both in the ICU and the ward by most respondents were oxygenation improvement (> 95%) and prevention of general complications (> 83%). Physical deconditioning was considered an infrequent indication. When compared with mobilization strategies, the use of respiratory interventions showed great variability in both work settings, and techniques considered effective were underutilized. The most frequently used respiratory techniques in the ICU were positioning (86%), alveolar recruitment (73%), and hard/brief expiratory rib cage compression (46%), whereas those in the ward were active prone positioning (90%), breathing exercises (88%), and directed/assisted cough (75%). The mobilization interventions reported by more than 75% of the respondents were sitting on the edge of the bed, active and resistive range of motion exercises, standing, ambulation, and stepping in place. CONCLUSIONS: The least common reason for indications for physiotherapy was avoidance of deconditioning, whereas oxygenation improvement was the most frequent one. Great variability in respiratory interventions was observed when compared with mobilization therapies, and there is a clear need to standardize respiratory physiotherapy treatment for hospitalized patients with COVID-19.


Assuntos
COVID-19 , Humanos , Pulmão , Modalidades de Fisioterapia , Respiração Artificial , Terapia Respiratória
7.
Nat Rev Dis Primers ; 8(1): 59, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36075904

RESUMO

Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.


Assuntos
Bursite , Bursite/cirurgia , Bursite/terapia , Fibrose , Humanos , Modalidades de Fisioterapia
8.
BMJ Open ; 12(9): e064637, 2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115668

RESUMO

INTRODUCTION: Vertebral fragility fractures affect at least 20% of the older population in the UK. Best practice guidelines recommend the use of exercise to slow the rate of bone loss, to maintain muscle strength and physical function, and to prevent falls and further fractures. However, treatment effects are often small and difficult to sustain and adherence, or the extent to which patients engage in treatment, has been identified as an important issue by many studies. Our hypothesis is that integrating adherence intervention strategies with an exercise intervention will be beneficial. We will compare physiotherapy exercise rehabilitation with adherence support versus physiotherapy exercise rehabilitation alone in terms of effects on (A) physical function, quality of life and fear of falling and (B) exercise self-efficacy and adherence. METHODS AND ANALYSIS: A multicentre, two-arm, parallel group, superiority randomised controlled trial with blinded assessments at baseline (0) and 4, 8 and 12 months, with a nested qualitative study and health economic analysis. 116 participants will be allocated to either (1) outpatient physiotherapy which will include a musculoskeletal assessment and treatment including balance, posture, strength training and low impact weight-bearing exercises over 16 weeks or (2) OsteoPorosis Tailored exercise adherence INtervention intervention. This includes standard physiotherapy as above plus an additional, integrated assessment interview (30 min) and 60 min of adherence support spread over the subsequent 16 weeks. ETHICS AND DISSEMINATION: The study protocol was approved by West of Scotland Research Ethics Committee 4 (21/WS/0071). Trial registration number ISRCTN 14465704. The paper is based on Protocol V.4. TRIAL REGISTRATION NUMBER: ISRCTN 14465704.


Assuntos
Osteoporose , Fraturas da Coluna Vertebral , Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Medo , Humanos , Estudos Multicêntricos como Assunto , Modalidades de Fisioterapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/terapia
9.
Sensors (Basel) ; 22(17)2022 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-36080897

RESUMO

For individuals with altered sensory cues, vibrotactile feedback improves their balance control. However, should vibrotactile feedback be provided every time balance control is compromised, or only one-third of the time their balance is compromised? We hypothesized that vibrotactile feedback would improve balance control more when provided every time their balance is compromised. Healthy young adults were randomly assigned to two groups: group 33% feedback (6 males and 6 females) and group 100% feedback (6 males and 6 females). Vibrotactile feedbacks related to the body's sway angle amplitude and direction were provided, while participants stood upright on a foam surface with their eyes closed. Then, we assessed if balance control improvement lasted when the vibrotactile feedback was removed (i.e., post-vibration condition). Finally, we verified whether or not vibrotactile feedback unrelated to the body's sway angle and direction (sham condition) altered balance control. The results revealed no significant group difference in balance control improvement during vibrotactile feedback. Immediately following vibrotactile feedback, both groups reduced their balance control commands; body sway velocity and the ground reaction forces variability decreased. For both groups, unrelated vibrotactile feedback worsened balance control. These results confirmed that participants processed and implemented vibrotactile feedback to control their body sways. Less vibrotactile feedback was effective in improving balance control.


Assuntos
Sinais (Psicologia) , Equilíbrio Postural , Retroalimentação , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Vibração , Adulto Jovem
10.
Sensors (Basel) ; 22(17)2022 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-36080978

RESUMO

The scarcity of open SAR (Synthetic Aperture Radars) imagery databases (especially the labeled ones) and sparsity of pre-trained neural networks lead to the need for heavy data generation, augmentation, or transfer learning usage. This paper described the characteristics of SAR imagery, the limitations related to it, and a small set of available databases. Comprehensive data augmentation methods for training Neural Networks were presented, and a novel filter-based method was proposed. The new method limits the effect of the speckle noise, which is very high-level in SAR imagery. The improvement in the dataset could be clearly registered in the loss value functions. The main advantage comes from more developed feature detectors for filter-based training, which is shown in the layer-wise feature analysis. The author attached the trained neural networks for open use. This provides quicker CNN-based solutions implementation.


Assuntos
Gerenciamento de Dados , Redes Neurais de Computação , Bases de Dados Factuais , Modalidades de Fisioterapia
12.
J Allied Health ; 51(3): 180-188, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36100713

RESUMO

The current study aimed to investigate the long-term effects of receiving post-amputation physical therapy (PT) on individuals' self-reported functional outcomes and quality of life in middle-aged to older adults with lower limb amputation (LLA). Further, we qualitatively explored the patients' perception and experience of PT post-amputation. We assessed participants' functional outcomes using Short-Form Health Survey, Prosthetic Evaluation Questionnaire-Physical Mobility portion, and Fear of Falling Avoidance Behavior Questionnaire. Furthermore, participants' experience and perception to PT were assessed through in-person interviews guided by the custom Amputation Patient Perception Survey. Functional outcome scores were compared between participants who have (Yes-PT) and have not (No-PT) received PT following their amputations, controlling for age. Perception to PT was qualitatively analyzed. Out of the 70 participants, 56 had received PT (80%) following amputation. Functional outcome scores were not significantly different between Yes-PT and No-PT groups. Among participants in the Yes-PT group, 84% expressed overall positive perception toward their post-amputation PT care. Main positive and negative perceptions were related to outcome/benefits and unfulfilled needs/lack of benefits, respectively. Participants with LLA generally expressed a positive perception of PT. However, no significant long-term benefits were found. We recommend goal-directed intervention with patient engagement to improve care experience.


Assuntos
Acidentes por Quedas , Qualidade de Vida , Idoso , Amputação , Estudos Transversais , Medo , Humanos , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Modalidades de Fisioterapia
13.
J Allied Health ; 51(3): 189-197, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36100714

RESUMO

The purposes of this study were to assess whether a correlation existed between academic resilience with success in the first semester of a Doctor of Physical Therapy (DPT) program, measured by grade point average (GPA), and to understand the lived experiences of first-semester DPT students when they transition to graduate school. This was a mixed methods study using a retrospective non-experimental correlational design and sequential-explanatory research. The non-cognitive construct of academic resilience was measured by the Academic Resilience Scale-30, delivered online pre-enrollment. A list of questions was created to capture insight into the experiences of students in graduate school and delivered in two focus groups. There was an insignificant, negative correlation between the two variables, r= -0.011, p=0.912. Age demonstrated a significant medium negative correlation to first-semester DPT GPA, r= -0.32, p<0.001. Six themes emerged, which centered around workload, imposter syndrome, mental health, time management, study strategies, and life circumstances. In a sample of 108 DPT students, the overall mean score of academic resilience was lower than that for the general age-matched population. DPT students experience many challenges in the first semester that require academic resilience, and programs can assess the adaptive systems and protective factors in place to support their students in this phase.


Assuntos
Transtornos de Ansiedade , Estudantes , Humanos , Modalidades de Fisioterapia , Estudos Retrospectivos , Autoimagem , Estudantes/psicologia
14.
J Allied Health ; 51(3): 207-214, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36100716

RESUMO

AIMS: 1) Can virtual fall risk screens be performed safely? 2) Are older adults able to manage technology to participate in telehealth? 3) Does an algorithm aid in referral appropriate evidence-based (EBP) fall prevention programs? METHODS: An algorithm was piloted using the Zoom platform to screen for falls, to assign to intervention groups, and to guide referral to EBP. Statistical analysis of data included descriptive, parametric, and non-parametric tests. RESULTS: Forty-four participants, aged 55-94 years, were screened. A significant relationship between 30-second chair stand and referral between two programs was found (p<0.05). Spearman correlations revealed statistically significant negative correlation between 30-second chair stand and timed up-and-go (TUG) (r= -0.584; p=0.003). No safety incidents occurred. Ninety-five percent of screened participants managed technology requirements successfully. CONCLUSION: Virtual fall risk screens are feasible and offer clinicians an alternative means to screen and refer older adults for EBP.


Assuntos
Acidentes por Quedas , Modalidades de Fisioterapia , Acidentes por Quedas/prevenção & controle , Idoso , Estudos de Viabilidade , Humanos , Encaminhamento e Consulta
15.
Medicine (Baltimore) ; 101(35): e30181, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107566

RESUMO

Undergraduate students start the acquisition of a professional identity, and begin to achieve professional values and consciousness of an ethical behavior as future health professionals. The aim of this study was describe professional values and perception of knowledge regarding professional ethics of physical therapy students. A cross-sectional study was performed. A total of 351 students participated in the study. Professional values and perception of knowledge regarding professional ethics were assessed. Ethical approval was obtained from the University Ethics Review Board. The most important value was equity, while the least one was abnegation. The second educational year showed higher scores in importance of scientific quality (P = .010 vs first year), the third year in respect for life (P = .041 vs first year, respectively), and the fourth year in respect to patient's autonomy (P = .033 vs first year). First-year students showed lower scores in perception of knowledge regarding professional ethics (P < .001 vs second, third, and fourth year), while second-year students had higher scores (P < .001 vs first and third; P = .006 vs fourth year) and no differences between third- and fourth-year students were found. Those professional values highly considered by the students were mainly shared professional values, with equity ranked highest and abnegation lowest. Furthermore, second-year students had a well-established perception of knowledge regarding professional ethics, showing significant higher scores when compared to the rest of the educational years. This is the first cross-sectional study that describes these variables among physical therapy students and it is a starting point for future. Physical therapy educators might want to take into account these findings when teaching and guiding students in developing awareness for their professional values and perception of knowledge regarding professional ethics.


Assuntos
Ética Profissional , Estudantes , Estudos Transversais , Humanos , Percepção , Modalidades de Fisioterapia , Inquéritos e Questionários
16.
BMC Pediatr ; 22(1): 523, 2022 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057568

RESUMO

BACKGROUND: This study aimed to assess the clinical and radiologic outcomes of a functional brace in combination with physical therapy (FBPT) for early correction of cubitus varus in young children. METHODS: Eighteen consecutive patients with cubitus varus secondary to supracondylar fractures were enrolled between July 2017 and March 2019. We used the FBPT technique to correct varus and sagittal plane deformity for early cubitus varus in young children. The clinical evaluation included measurement of varus angulation, sagittal plane, and range of motion at three, six, and twelve months post-intervention. The clinical and radiographic results were assessed according to the Bellemore criteria. RESULTS: Pre-treatment humerus-elbow-wrist (HEW) angle measured on the affected side (varus deformity) ranged between -38° and -12° (average, -23.2°) while the post-treatment HEW angle ranged between -10° and + 15° (average, 8.8°). Compared with the unaffected side, no statistically significant difference was found in the affected side post-intervention (P > 0.05). According to the Bellemore criteria, we got excellent results in fourteen patients (77.8%), good results in three patients (16.7%), and poor result in one patient (5.5%). All patients and their parents (except one patient with residual varus deformities) were satisfied with the functional and cosmetic outcomes. CONCLUSIONS: The FBPT is effective for the treatment of cubitus varus in children, especially for young children within 6 months of the injury.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Pré-Escolar , Articulação do Cotovelo/lesões , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/terapia , Deformidades Articulares Adquiridas/complicações , Osteotomia/métodos , Modalidades de Fisioterapia , Amplitude de Movimento Articular
18.
Pain Pract ; 22 Suppl 2: 65-70, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36109843

RESUMO

BACKGROUND: Low-value care that wastes resources and harms patients is prevalent in health systems everywhere. METHODS: As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions. RESULTS: Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks. CONCLUSION: Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.


Assuntos
Cuidados de Baixo Valor , Doenças Musculoesqueléticas , Atenção à Saúde , Humanos , Doenças Musculoesqueléticas/terapia , Cervicalgia , Modalidades de Fisioterapia
20.
Cochrane Database Syst Rev ; 9: CD006338, 2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36066373

RESUMO

BACKGROUND: Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia. This is an update of a review first published in 2010 and updated in 2013. OBJECTIVES: To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults. SEARCH METHODS: We updated our searches in the following databases to May 2022: the Cochrane Central Register of Controlled Trials (CENTRAL) via OvidSP, MEDLINE via OvidSP (from 1966), Embase via embase.com (from 1974), Physiotherapy Evidence Database (PEDro) (from 1929), CINAHL via EBSCO (from 2009), and the Chinese Biomedical Literature Database (CBM) (from 1978). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of chest physiotherapy for treating pneumonia in adults. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included two new trials in this update (540 participants), for a total of eight RCTs (974 participants). Four RCTs were conducted in the United States, two in Sweden, one in China, and one in the United Kingdom. The studies looked at five types of chest physiotherapy: conventional chest physiotherapy; osteopathic manipulative treatment (OMT, which includes paraspinal inhibition, rib raising, and myofascial release); active cycle of breathing techniques (which includes active breathing control, thoracic expansion exercises, and forced expiration techniques); positive expiratory pressure; and high-frequency chest wall oscillation. We assessed four trials as at unclear risk of bias and four trials as at high risk of bias. Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving mortality, but the certainty of evidence is very low (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.15 to 7.13; 2 trials, 225 participants; I² = 0%). OMT (versus placebo) may have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.43, 95% CI 0.12 to 1.50; 3 trials, 327 participants; I² = 0%). Similarly, high-frequency chest wall oscillation (versus no physiotherapy) may also have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.75, 95% CI 0.17 to 3.29; 1 trial, 286 participants). Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.93, 95% CI 0.56 to 1.55; 2 trials, 225 participants; I² = 85%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.60, 95% CI 0.29 to 1.23; 1 trial, 32 participants). OMT (versus placebo) may improve cure rate, but the certainty of evidence is very low (RR 1.59, 95% CI 1.01 to 2.51; 2 trials, 79 participants; I² = 0%). OMT (versus placebo) may have little to no effect on mean duration of hospital stay, but the certainty of evidence is very low (mean difference (MD) -1.08 days, 95% CI -2.39 to 0.23; 3 trials, 333 participants; I² = 50%). Conventional chest physiotherapy (versus no physiotherapy, MD 0.7 days, 95% CI -1.39 to 2.79; 1 trial, 54 participants) and active cycle of breathing techniques (versus no physiotherapy, MD 1.4 days, 95% CI -0.69 to 3.49; 1 trial, 32 participants) may also have little to no effect on duration of hospital stay, but the certainty of evidence is very low. Positive expiratory pressure (versus no physiotherapy) may reduce the mean duration of hospital stay by 1.4 days, but the certainty of evidence is very low (MD -1.4 days, 95% CI -2.77 to -0.03; 1 trial, 98 participants). Positive expiratory pressure (versus no physiotherapy) may reduce the duration of fever by 0.7 days, but the certainty of evidence is very low (MD -0.7 days, 95% CI -1.36 to -0.04; 1 trial, 98 participants). Conventional chest physiotherapy (versus no physiotherapy, MD 0.4 days, 95% CI -1.01 to 1.81; 1 trial, 54 participants) and OMT (versus placebo, MD 0.6 days, 95% CI -1.60 to 2.80; 1 trial, 21 participants) may have little to no effect on duration of fever, but the certainty of evidence is very low. OMT (versus placebo) may have little to no effect on the mean duration of total antibiotic therapy, but the certainty of evidence is very low (MD -1.07 days, 95% CI -2.37 to 0.23; 3 trials, 333 participants; I² = 61%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on duration of total antibiotic therapy, but the certainty of evidence is very low (MD 0.2 days, 95% CI -4.39 to 4.69; 1 trial, 32 participants). High-frequency chest wall oscillation plus fibrobronchoscope alveolar lavage (versus fibrobronchoscope alveolar lavage alone) may reduce the MD of intensive care unit (ICU) stay by 3.8 days (MD -3.8 days, 95% CI -5.00 to -2.60; 1 trial, 286 participants) and the MD of mechanical ventilation by three days (MD -3 days, 95% CI -3.68 to -2.32; 1 trial, 286 participants), but the certainty of evidence is very low. One trial reported transient muscle tenderness emerging after OMT in two participants. In another trial, three serious adverse events led to early withdrawal after OMT. One trial reported no adverse events after positive expiratory pressure treatment. Limitations of this review were the small sample size and unclear or high risk of bias of the included trials. AUTHORS' CONCLUSIONS: The inclusion of two new trials in this update did not change the main conclusions of the original review. The current evidence is very uncertain about the effect of chest physiotherapy on improving mortality and cure rate in adults with pneumonia. Some physiotherapies may slightly shorten hospital stays, fever duration, and ICU stays, as well as mechanical ventilation. However, all of these findings are based on very low certainty evidence and need to be further validated.


Assuntos
Modalidades de Fisioterapia , Pneumonia , Terapia Respiratória , Adulto , Antibacterianos/uso terapêutico , Humanos , Modalidades de Fisioterapia/efeitos adversos , Pneumonia/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Terapia Respiratória/efeitos adversos
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