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Three Part Question

In [infants with bronchiolitis] does [physiotherapy] reduce [duration of illness, clinical severity or length of hospital stay]

Clinical Scenario

A 6 month old baby is admitted to hospital with a 4 day history of coryzal symptoms, increasing cough, wheeze and decreased feeding. Respiratory syncytial virus was detected in nasopharyngeal secretions. She is needing oxygen and is on nasogastric feed. You wonder whether starting physiotherapy will improve her clinical condition.

Search Strategy

Medline 1902-2008. Embase 1980-2008. Cochrane database (database of systematic reviews and cochrane central register of controlled trials.)
Medline: (bronchiolitis or RSV bronchiolitis) AND (physiotherapy or chest physiotherapy) LIMIT to humans. Embase: (bronchiolitis or RSV bronchiolitis) AND (physiotherapy or chest physiotherapy) LIMIT to humans. Cochrane Library: bronchiolitis AND physiotherapy.

Search Outcome

Medline: 8 hits, Embase: 27 hits, Cochrane database: 2 hits. A total of 3 clinical trials were found. The rest were irrelevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Webb MSC et al 1985 UK	90 patients Physiotherapy (n=44) vs control (n=46)	Clinical trial.	Clinical score	No significant difference.	Relevant baseline characteristics not documented. Statistical power of study results unknown.
			Duration of hospital stay	No significant difference.
			Length of acute illness	No significant difference.
Bohe L et al. 2004 Argentina	32 patients Physiotherapy (n=16) vs control (n=16)	Clinical trial	Clinical score	No significant difference	Small study.
			Duration of hospital stay	No significant difference

Comment(s)

Only 3 trials were identified. There were no significant differences in clinical score, duration of hospital stay and length of illness in the physiotherapy group compared to control group. In the study by Bohe et al. one child in the group receiving physiotherapy was with drawn after developing complications.

Clinical Bottom Line

Current evidence does not support the use of physiotherapy in bronchiolitis.

References

1. Webb MSC, Martin JA, Cartlidge PHT, Ng YK, Wright NA. Chest physiotherapy in acute bronchiolitis. Archives of disease in childhood 1985:60(11);1078-9.
2. Nicholas KJ, Dhouieb MO, Marshall TG, et al. An evaluation of chest physiotherapy in the management of acute bronchiolitis: changing clinical practice Physiotherapy 1999;85:669-74
3. Bohe L, Ferrero ME, Cuestas E, Polliotto L, Genoff M. Indications of conventional chest physiotherapy in acute bronchiolitis. Medicina 2004;64(3):198-200.