Chest Physiotherapy and Cystic Fibrosis: Compliance With Chest Physical Therapy
Compliance with daily CPT has been shown to slow pulmonary deterioration in patients with CF. A variety of studies indicate that while daily treatment might be advised, most patients do not comply. In general, CPT has the lowest compliance rate of any aspect of CF management, patient rate of compliance ranging from 26 to 47%. Davids and Heneley (1990) and Fong et al (1988) found that 52.7 and 74%, respectively, of patients performed physiotherapy only once or twice a week.
Given the poor compliance rates, the studies of CPT conducted over months or years may need to be reassessed, and in particular, those studies that compare unsupervised techniques including exercise. Reisman et al (1988) concluded from their 3-year study of FET vs conventional CPT (including PD and percussion) that conventional CPT should remain a standard component of CPT, since the FET group showed increased rates of pulmonary deterioration. The group performing conventional CPT may have been assisted or under supervision, thus leading to a greater compliance and efficacy of treatment. This factor alone may account for the superiority of this form of treatment over FET. this
Oberwalder et al (1986) compared the use of high-pressure PEP to conventional CPT over an 18-month period, consisting of 10 months of daily treatment using only the PEP mask, 2 months of twice daily conventional CPT, and 6 months of daily PEP treatment. In the PEP treatment periods only, subjects were reviewed every 2 weeks to check and fine-tune their technique. Results showed a marked decline in pulmonary function during the 2 months of conventional CPT. The authors propose that this decline reflects the natural downhill course of the disease; however, it is possible that the 2-week review promoted better technique and compliance.
Recognition of the poor compliance rate to daily CPT should prompt investigators comparing unsupervised treatment regimens to monitor the frequency and efficacy of such techniques to reduce this confounding variable.