physiotherapy for cystic fibrosis in australia: a ... · pdf filetherapy, exercise,...

Click here to load reader

Post on 21-Aug-2019

213 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • The Thoracic Society of Australia and New Zealand

    The Thoracic Society of Australia and New Zealand i

    Physiotherapy for Cystic Fibrosis in Australia: A Consensus Statement

    Foreword This Consensus Statement has been written by physiotherapists who are experienced in the management of cystic fibrosis in Australia. The document was developed as a project of the Australian Chapter, International Physiotherapy Group for Cystic Fibrosis.

    Chairperson: Dr Brenda Button

    Senior Clinician Physiotherapist

    Alfred Hospital, Melbourne

    Editor: Dr Anne Holland

    Associate Professor, Physiotherapy

    La Trobe University / Bayside Health, Melbourne

    Writing group:

    Ianthe Astley-Bowden Launceston General Hospital, Tasmania

    Antonia Bedford Alfred Hospital, Victoria

    Jenny Bishop Westmead Hospital, NSW

    Margaret Bradshaw Barwon Health Geelong Hospital, Victoria

    Jenny Busch Royal Hobart Hospital, Tasmania

    Brenda Button Alfred Hospital, Victoria

    Robyn Cobb The Prince Charles Hospital, Queensland

    Rosie Day John Hunter Children’s Hospital, NSW

    Ruth Dentice Royal Prince Alfred Hospital, NSW

    Julie Depiazzi Princess Margaret Hospital, Western Australia

    Michael Doumit Sydney Children’s Hospital, NSW

    Jane Ethelston North West Regional Hospital, Tasmania

    Jenny Follett The Children’s Hospital at Westmead, NSW

    Cameron Geddes Monash Medical Centre, Victoria

    Kathleen Hall The Prince Charles Hospital, Queensland

    Anne Holland La Trobe University / Bayside Health, Victoria

  • The Thoracic Society of Australia and New Zealand ii

    Annemarie Lee Alfred Hospital, Victoria

    Rachael McAleer Monash Medical Centre, Victoria

    Prue Munro Alfred Hospital, Victoria

    Jenny Murphy Mater Adult’s Hospital, Queensland

    Ranj Patra Monash Medical Centre and Alfred Hospital, Victoria

    Sarah Pike Royal Children’s Hospital, Queensland

    Angela Potter Women’s and Children’s Hospital, South Australia

    Esta-Lee Tannenbaum Royal Children’s Hospital, Victoria

    Nathan Ward Royal Hobart Hospital, Tasmania

    Dianne White Royal Adelaide Hospital, South Australia

    Kathryn Williamson Sir Charles Gairdner Hospital, Western Australia

    Christine Wilson Royal Children’s Hospital, Queensland

    Michelle Wood Mater Adults’ Hospital, Queensland

    Our thanks are extended to the following professionals for their valuable comments and review of this document:

    Dr Mark Elkins, Dr Judy Morton, Dr Peter Middleton, Dr Kathy Stiller, Ms Kate McQueen, Ms Colleen Jackson.

    We would also like to acknowledge the assistance of the Dietitian’s Association of Australia Cystic Fibrosis Interest Group, whose input aided the process of development and layout of the document.

    Review Date: This document is due for review in 2012

  • The Thoracic Society of Australia and New Zealand iii

    Table of Contents

    Foreword.........................................................................................................................i

    Table of Contents ..........................................................................................................iii

    List of Abbreviations ..................................................................................................... ix

    Executive Summary....................................................................................................... xi

    1 Introduction........................................................................................1

    1.1 Background to the consensus statement ........................................................1

    1.2 Purpose and Scope .........................................................................................1

    1.3 Consultation Process......................................................................................2

    1.4 Methods..........................................................................................................3

    1.5 Review process ..............................................................................................3

    1.6 Disclosure statement ......................................................................................6

    2 Airway Clearance Techniques..........................................................7

    2.1 Rationale for Airway Clearance Techniques in Cystic Fibrosis ....................7

    2.2 Active Cycle of Breathing Technique............................................................8

    2.3 Autogenic Drainage .......................................................................................9

    2.4 Positive Expiratory Pressure (PEP) Therapy ...............................................10

    2.5 High Pressure PEP .......................................................................................11

    2.6 Bottle PEP....................................................................................................12

    2.7 Oscillating PEP ............................................................................................12

    2.7.1 The Flutter®.........................................................................................13

    2.7.2 Acapella® ............................................................................................14

  • The Thoracic Society of Australia and New Zealand iv

    2.7.3 RC-Cornet®.........................................................................................14

    2.8 Postural Drainage.........................................................................................15

    2.8.1 Postural Drainage in gravity-assisted positions ...................................15

    2.8.2 Modified postural drainage ..................................................................16

    2.9 Percussion and vibration ..............................................................................17

    2.10 Other airway clearance techniques ..............................................................18

    2.10.1 High Frequency Chest Wall Oscillation (HFCWO) ............................18

    2.10.2 Intrapulmonary Percussive Vibration (IPV) ........................................19

    2.11 Physical Exercise as Airway Clearance.......................................................20

    2.12 Clinical Decision Making regarding Airway Clearance Techniques ..........21

    3 Inhalation Therapy as an Adjunct to Physiotherapy ...................24

    3.1 Inhalation Therapy Technique (including Adjuncts to Inhalation Therapy)24

    3.2 Mode of Delivery.........................................................................................25

    3.3 Mixing Inhaled Medications ........................................................................26

    3.4 Timing and Order of Inhaled Medications...................................................27

    3.5 Nebuliser Maintenance ................................................................................29

    3.6 Clinical Monitoring of Inhalation Therapy..................................................30

    3.7 Recommendations........................................................................................30

    4 Exercise .............................................................................................32

    4.1 Assessment of exercise capacity..................................................................32

    4.1.1 Six minute walk test.............................................................................32

    4.1.2 The 3-minute step test..........................................................................34

    4.1.3 Modified Shuttle test (walk/run)..........................................................35

  • The Thoracic Society of Australia and New Zealand v

    4.1.4 Choosing a test of exercise capacity ....................................................36

    4.2 Exercise prescription in cystic fibrosis ........................................................37

    4.3 Recommendations........................................................................................39

    5 Musculoskeletal Complications of Cystic Fibrosis .......................40

    5.1 Pain ..............................................................................................................40

    5.2 Low Bone Mineral Density..........................................................................40

    5.3 Vertebral compression and rib fractures ......................................................41

    5.4 Increased thoracic kyphosis .........................................................................41

    5.5 Muscle strength............................................................................................41

    5.6 Muscle length...............................................................................................42

    5.7 CF related arthropathy .................................................................................42

    5.8 Physiotherapy intervention for musculoskeletal problems ..........................43

    5.8.1 Optimise physical activity to maintain bone mineral density and muscle mass ........................................................

View more