Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline.

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.

Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis.

OBJECTIVE: To evaluate whether preoperative inspiratory muscle training is effective in preventing postoperative pulmonary complications and reducing length of hospital stay in people undergoing cardiothoracic or upper abdominal surgery. DATA SOURCES: Medline, CINAHL, AMED, PsychINFO, Scopus, PEDro, and the Cochrane Library. REVIEW METHODS: A systematic review and meta analysis of randomized controlled trials (or quasi-randomized controlled trials) investigating a form of preoperative inspiratory muscle training, compared with sham or no inspiratory muscle training. Participants were adults (16 years and over) awaiting elective open cardiac, thoracic, or upper abdominal surgery. Methodological quality was assessed using the PEDro scale. RESULTS: Eight studies involving 295 participants were eligible for inclusion. The trained group had significantly higher maximal inspiratory pressure at the end of the preoperative training period (mean difference: 15 cm H2O, 95% confidence interval (CI): 9 to 21). This benefit was maintained through the early postoperative period, when lung function also recovered significantly more quickly in the trained group. Inspiratory muscle training also substantially reduced postoperative pulmonary complications (relative risk 0.48, 95% CI 0.26 to 0.89). Although not statistically significant, length of hospital stay also tended to favour the trained group. There were no statistically significant differences between the groups for the remaining outcomes. Participant satisfaction with inspiratory muscle training was high. CONCLUSION: Preoperative inspiratory muscle training significantly improves respiratory (muscle) function in the early postoperative period, halving the risk of pulmonary complications. The training does not increase length of stay, but more data are required to confirm whether it reduces length of stay.

Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review.

BACKGROUND: In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes. METHODS/DESIGN: A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence. DISCUSSION: This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.

Uptake of pulmonary rehabilitation in New Zealand by people with chronic obstructive pulmonary disease in 2009.

AIMS: To estimate of uptake of pulmonary rehabilitation (PR) by people with chronic obstructive pulmonary disease (COPD) in New Zealand in 2009. METHOD: A postal survey sent to all District Health Boards (DHBs), Primary Health Organisations (PHOs), and other non-government organisations (NGOs) identified as providers of PR. The survey requested information on the characteristics of PR programmes, estimates of the total number of people with COPD who were offered PR, entered PR, and completed PR in 2009. RESULTS: In 2009 PR was provided in 19 of 21 DHB regions by 23 organisations (16 DHBs, five PHOs, one DHB/PHO partnership, and 1 NGO). Twenty-one of these 23 organisations (91%) responded to the survey. In total, 2569 people with COPD were offered PR, 1786 entered PR, and 1378 completed a PR programme in 2009. CONCLUSIONS: There is a marked shortfall between the national levels of provision of PR and the prevalence of COPD, with less than 1% of people with COPD participating in PR each year in New Zealand. Incentives, leadership and coordination of services are required at a national level to increase the uptake of PR.