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Chest physiotherapy in paediatric patients hospitalised with community-acquired pneumonia: a randomised clinical trial [with consumer summary]
Lukrafka JL, Fuchs SC, Fischer GB, Flores JA, Fachel JM, Castro-Rodriguez JA
Archives of Disease in Childhood 2012 Nov;97(11):967-971
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Chest physiotherapy has been used to treat children hospitalised with pneumonia with no clear scientific evidence to support a beneficial effect. The objective of the current study was to evaluate the efficacy of chest physiotherapy as an adjuvant treatment in children hospitalised with acute community-acquired pneumonia. METHODS: Children (aged 1 to 12 years) with a clinical and confirmed radiological diagnosis of pneumonia sequentially admitted to a tertiary children hospital were eligible for this study. Participants were randomly selected to receive a standardised respiratory physiotherapy (positioning, thoracic vibration, thoracic compression, positive expiratory pressure, breathing exercises and forced exhalation with the glottis open or 'huffing') three times daily in the 'intervention group' or a non-mandatory request to breathe deeply, expectorate the sputum and maintain a lateral body position once a day in the 'control group'. The primary outcomes were reduction in respiratory rate and severity score (respiratory rate, recession, fever, oxygen saturation and chest x-ray) from baseline to discharge. Secondary outcome was duration of hospitalisation. RESULTS: In all, 72 patients were randomly allocated to the intervention (n = 35) or control (n = 37) groups. There were no differences at admission on severity of pneumonia between groups. Respiratory rate and severity score significant decreased between admission to discharge within each group; however, there were no differences when comparing groups. Also, there was no significant difference in duration of hospitalisation between the control and intervention groups (6 versus 8 days, p = 0.11, respectively). CONCLUSIONS: This clinical trial suggests that, in children hospitalised with moderate community-acquired pneumonia, chest physiotherapy did not have clinical benefits in comparison to control group.
Reproduced with permission from the BMJ Publishing Group.

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