Cochrane · systematic review · CD003147
Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis
McIlwaine, M, Button, B, Nevitt, SJ · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Cystic Fibrosis and Genetic DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
26
No studies
9
Included studies
NR
No studies 9 · 25.7%Ungraded 0 · 0%Very low 3 · 8.6%Low 18 · 51.4%Moderate 3 · 8.6%High 2 · 5.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings ‐ PEP compared with PDPV for cystic fibrosis
Population: adults and children with CF
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1: change from baseline (% predicted) Summary of findings ‐ PEP vs PDPV | no estimate extracted | 5 studies · 155 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Number of respiratory exacerbations Summary of findings ‐ PEP vs PDPV | no estimate extracted | 1 study · 66 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Direct measures of mucus clearance: radio‐labelled aerosol clearance Summary of findings ‐ PEP vs PDPV | no estimate extracted | 20 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Exercise tolerance Summary of findings ‐ PEP vs PDPV | no estimate extracted | 1 study · 66 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Well being: QWB scale Summary of findings ‐ PEP vs PDPV | no estimate extracted | 1 study · 66 participants | Low Downgraded: risk of bias, imprecision, indirectness |
LCI Summary of findings ‐ PEP vs PDPV | no estimate extracted | NR | No studies |
Adverse events Summary of findings ‐ PEP vs PDPV | no estimate extracted | 2 studies · 66 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings ‐ PEP compared to oscillating PEP for cystic fibrosis
Population: adults and children with CF
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1: change from baseline (% predicted) Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 7 studies · 217 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Number of respiratory exacerbations: requiring either IV antibiotics or hospitalisation Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 3 studies · 112 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Direct measures of mucus clearance Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | NR | No studies |
Exercise tolerance: modified shuttle test Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 2 studies · 68 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Well being: QWB scale. CF Short Form ‐36 and Chronic Respiratory Questionnaire Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 2 studies · 75 participants | Low Downgraded: risk of bias, imprecision, indirectness |
LCI Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 1 study · 30 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Adverse events Summary of findings ‐ PEP vs oscillating PEP | no estimate extracted | 22 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings ‐ PEP compared to HFCWO for cystic fibrosis
Population: adults and children with CF
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1: change from baseline (% predicted) Summary of findings ‐ PEP vs HFCWO | no estimate extracted | 4 studies · 174 participants | Low Downgraded: risk of bias, imprecision |
Number of respiratory exacerbations Summary of findings ‐ PEP vs HFCWO | RR 0.73 [0.55, 0.95] | 1 study · 107 participants | High |
Direct measures of mucus clearance Summary of findings ‐ PEP vs HFCWO | no estimate extracted | NR | No studies |
Exercise tolerance Summary of findings ‐ PEP vs HFCWO | no estimate extracted | NR | No studies |
Well being Summary of findings ‐ PEP vs HFCWO | no estimate extracted | NR | No studies |
LCI Summary of findings ‐ PEP vs HFCWO | no estimate extracted | 15 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ PEP vs HFCWO | no estimate extracted | 1 study · 107 participants | High |
Summary of findings ‐ PEP compared to BiPAP for cystic fibrosis
Population: adults and children with CF
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 Summary of findings ‐ PEP vs BiPAP | no estimate extracted | 2 studies · 52 participants | Low Downgraded: risk of bias, imprecision |
Number of respiratory exacerbations Summary of findings ‐ PEP vs BiPAP | no estimate extracted | NR | No studies |
Direct measures of mucus clearance Summary of findings ‐ PEP vs BiPAP | no estimate extracted | NR | No studies |
Exercise tolerance: 6‐minute walk test Summary of findings ‐ PEP vs BiPAP | no estimate extracted | 1 study · 32 participants | Low Downgraded: risk of bias, imprecision |
Well being Summary of findings ‐ PEP vs BiPAP | no estimate extracted | NR | No studies |
LCI Summary of findings ‐ PEP vs BiPAP | no estimate extracted | 1 study · 32 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ PEP vs BiPAP | no estimate extracted | 20 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings ‐ PEP compared to airway clearance techniques for cystic fibrosis
Population: adults and children with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1: change from baseline (% predicted) Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 95 participants | Low Downgraded: risk of bias, imprecision |
Number of respiratory exacerbations Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 43 participants | Very low Downgraded: risk of bias, imprecision |
Direct measures of mucus clearance: radioisotope retention Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 31 participants | Low Downgraded: risk of bias, imprecision |
Exercise tolerance: modified shuttle test Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision |
Well being: Short Form ‐36 Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision |
LCI Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | 6 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Summary of findings ‐ PEP vs airway clearance techniques | no estimate extracted | NR | No studies |