Why was this Review important?
Pneumonia is a type of lung infection and the most common cause of death among young children worldwide. Every year, it kills an estimated 1.4 million children under the age of 5 (WHO, 2014). Most of these deaths are preventable if the disease is treated with a low-cost, low-tech, yet effective medication and care (WHO-GAPP, 2009). Chest physiotherapy may contribute to recovery because it can help to open airways, improve gas exchange and assist breathing. It consists of conventional (postural, coughing, squeezing), modern (like inspiratory or expiratory exercises) and/or instrumental interventions (continuous positive airway pressure - CPAP). Despite improving the child’s respiratory status and recovery, in certain situations physiotherapy may not be useful, or may even be harmful. Therefore, the developmental respiratory features or physiology in children should be considered and may limit or contraindicate the technique.
Who will be interested in this review?
- Parents and caregivers of young children
- Professionals working in child health services
- Professionals dealing with respiratory infections, especially pneumonia
- General practitioners
What is the Review Objective?
To assess the effectiveness of chest physiotherapy with regard to time until clinical resolution in children (from birth to 18 years) of either gender with any type of pneumonia.
Which studies were included in the Review?
This is an update adding further evidence to a Review published in 2013. Selection criteria were to include studies of children that compared the effect of chest-physiotherapy in pneumonia with any other type of treatment, published up until 22 February 2018. A total of 6 studies were included (3 new), involving 559 children ages birth to 18. Studies were conducted in hospitals in Bangladesh, Brazil, China, Egypt and South Africa.
The primary outcomes measured were mortality, duration of hospital stay and time to clinical resolution.
What did the evidence from the review tell us?
Chest physiotherapy has been used widely to treat people with pneumonia, but the evidence is weak
Studies had low-quality evidence, according to GRADE criteria, and lack methodology appropriateness (CONSORT 2010 statement)
Five trials described chest physiotherapy as performed by a physiotherapist, therefore, blinding of practitioners may be difficult
The overall quality of evidence is low due to few included trials, inadequate methods, design, data and differing results among studies. Therefore, reliable conclusions could not be drawn regarding the use of chest physiotherapy for children with pneumonia.
What next should happen?
Future studies should include key points of appropriate sample size (defined as the number of people observed in the study to detect expected differences), adequate methodology, standardisation of chest-physiotherapy techniques, appropriate outcomes and adverse effects.
Comment by Sunita Gudwani