Reproducibility of chest physiotherapy on chronic pulmonary disease

Introduction: Patients with chronic pulmonary disease often present increased sputum production. ELTGOL, or slow expiration with the glottis open in lateral posture, is a technique of chest physiotherapy to improve mucocilliary clearance. ELTGOL is assumed to deflate the lung to expiratory reserve volume (ERV), but this assumption has never been tested. Objective: This study aims to quantify ERV during ELTGOL and to describe the reproducibility of this technique. Methods: Twenty six patients (54±12 yrs) with chronic pulmonary disease participated in the study. Spirometry was conducted according to ATS/ERS recommendations to determine the severity of the disease as indicated by forced vital capacity (FVC); forced expiratory volume in the first second (FEV1) and VEF1/FVC were also recorded. ERV was measured at slow vital capacity maneuver. ELTGOL was applied with the patient on lateral posture and with the physiotherapist standing behind the patient. ERV was also measured during ELTGOL. The physiotherapist helped the patient achieve the maximal exhalation through thoracic-abdominal compression. ELTGOL was applied three times in each patient (sequence A, B, and C). Two physiotherapists (PT1 and PT2) were randomized to apply the technique. ANOVA one way was used to compare the ERV of the three sequences of ELTGOL on the same physiotherapist and to compare the ERV between the physiotherapists and the patient. Bland Altman analysis was performed to observe the variability of ERV between physiotherapists. Results: The baseline ERV was 69±37%pred. ERV altered for 60±34%pred and 68±49.0%pred during ELTGOL applied by PT1 and PT2, respectively (P=0.24). No differences in ERV were found in patients for PT1 and PT2 (P=0.67). Although the agreement between PTs was high in the intraclass correlation coefficient analysis (0.85, 0.68 to 0.92), Bland Altman analysis indicated a large variance (mean ERV difference: -8.74 (-54.7 to 37.2)] (Figure 1). Conclusion: On average, 64% of ERV may be exhaled during ELTGOL. With ERV considered, the technique significantly differs when the maneuver is compared between two physiotherapists. (Table Presented).