Chest Physiotherapy and Cystic Fibrosis: Definition of Techniques
The rationale for this support includes the inability of severely compromised patients to undertake exercise at the levels required, problems with compliance, acute exacerbation necessitating altered physical activity, and the concern that as the disease progresses, exercise may add another stress to an already stressed system. Given the beneficial effects of exercise on physiologic and psychological parameters, it would appear that in CF patients in whom the respiratory component of the disease is mild or moderate (in both “stable” and acute respiratory infections), exercise should have a place as an adjunct and in some cases as an alternative to daily CPT. Compliance with exercise programs should be monitored and assured on a regular basis. buy zyrtec online
In general, individual CPT techniques are poorly defined within studies, and this is perhaps the most confounding factor when reviewing the literature. While the later studies (1988 onward) make a concerted effort to describe techniques in detail or reference a source for clarification, most studies are unclear regarding which components are specifically included. This is particularly evident in studies comparing treatment regimens, for example, PEP vs FET, multimodality CPT vs cough, and exercise vs conventional CPT. The terms multimodality and conventional CPT provide nebulous descriptions of which techniques are included. The studies investigating multimodality CPT, which includes PD as part of the treatment, provide a good example of poor definition. This technique, as originally described by Thacker (1956), maintains that the patient should be placed in a drainage position and that the position should be maintained for at least 10 min, during which deep breathing exercises should be performed. DeBoeck and Zinman (1984) and Desmond et al (1983) carried out postural drainage for 2 min in each of the 11 positions. Breathing exercises were not performed throughout drainage. Both of these studies showed poor results for multimodality CPT. Studies including unrecognized technique variations as part of standard physiotherapy treatments produce poor results regarding the effectiveness of those techniques.