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Plain language summary

Chest physiotherapy for pneumonia in adults

Review question

Is chest physiotherapy effective and safe as a supportive treatment for adults with pneumonia?

Background

Pneumonia is one of the most common health problems affecting all age groups around the world. Antibiotics represent the mainstay of pneumonia treatment, whilst some other supportive therapies, such as supplementary oxygen, might also be beneficial in improving patient outcomes. Chest physiotherapy, an airway clearance technique, has been widely used as a supportive therapy for pneumonia in adults without reliable evidence.

Search date

The evidence is current to May 2022.

Study characteristics

We included eight studies involving a total of 974 participants. We included two new studies (540 participants) in this update. All studies included hospitalised patients. The studies looked at five types of chest physiotherapy, namely conventional chest physiotherapy (manual handling techniques to help clear sputum), active cycle of breathing techniques (a set of breathing exercises to help clear sputum), osteopathic manipulative treatment (OMT) (a therapeutic application of manually guided forces by a physiotherapist to improve respiratory function and sputum clearance), positive expiratory pressure (use of a device that increases airflow resistance to improve sputum clearance), and high-frequency chest wall oscillation (chest wall vibration with a specialised device to promote sputum clearance).

Key results

1. Death

Conventional chest physiotherapy, OMT, and high-frequency chest wall oscillation (versus no physiotherapy or placebo therapy) may have little to no effect on reducing death, but the certainty of evidence is very low.

2. Cure rate

OMT (versus placebo therapy) may improve cure rate as defined by the study authors, but the certainty of evidence is very low. Conventional chest physiotherapy (versus no physiotherapy) and active cycle of breathing techniques may have little to no effect on improving cure rate, but the certainty of evidence is very low.

3. Duration of hospital stay

Positive expiratory pressure (versus no physiotherapy) may reduce the duration of hospital stay by 1.4 days, but the certainty of evidence is very low. OMT, conventional chest physiotherapy, and active cycle of breathing techniques (versus placebo therapy or no physiotherapy) may have little to no effect on duration of hospital stay, but the certainty of evidence is very low.

4. Duration of fever

Positive expiratory pressure (versus no physiotherapy) may reduce the duration of fever by 0.7 days, but the certainty of evidence is very low. Conventional chest physiotherapy (versus no physiotherapy) or OMT (versus placebo therapy) may have little to no effect on duration of fever, but the certainty of evidence is very low.

5. Duration of antibiotic use

OMT (versus placebo therapy) and active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on the duration of antibiotic use, but the certainty of evidence is very low.

6. Duration of intensive care unit (ICU) stay

High-frequency chest wall oscillation (versus no physiotherapy) may reduce the duration of ICU stay by 3.8 days in people with severe pneumonia who received mechanical ventilation (use of a machine to help people breathe), but the certainty of evidence is very low.

7. Duration of mechanical ventilation

High-frequency chest wall oscillation (versus no physiotherapy) may reduce the duration of mechanism ventilation by three days in people with severe pneumonia who received mechanical ventilation, but the certainty of evidence is very low.

8. Adverse events (unwanted events that cause harm to the patient)

One study reported three serious adverse events (not specified) that caused early withdrawal of participants after OMT. One study reported adverse events as short-term muscle tenderness after treatment in two participants. Another study reported no adverse events.

Certainty of the evidence

In summary, the certainty of evidence is very low due to research limitations, the small number of participants, and/or imprecision of the results (estimated effects of the treatment were very imprecise). Very low certainty evidence suggests that some physiotherapies may slightly shorten hospital stays, fever duration, antibiotic treatment duration, and ICU stay, as well as mechanical ventilation, but this needs to be further explored.