Types of studies

We considered all randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for adult participants with any type of pneumonia. We included trials which also included other basic respiratory diseases, once pneumonia was diagnosed; we analysed such trials separately. We excluded trials in which physiotherapy was administered for the prevention of pneumonia, as pneumonia could occur in many conditions, such as trauma, cerebral vessels disease and postoperative conditions. We included both published and unpublished trials.

Types of participants

Adult participants (older than 18 years of age) of either gender, with any type of pneumonia. Pneumonia was defined by each original trial author. We included intubated or non‐intubated participants.

Types of interventions

Chest physiotherapy of any type was compared with no chest physiotherapy. We included trials using traditional chest physiotherapy. We included trials using mechanical devices which have the same effect as traditional chest physiotherapy. We considered the following methods: postural drainage, chest percussion, vibration, thoracic oscillation, chest shaking, huffing, directed coughing, thoracic expansion, forced exhalation or expiration techniques and manual hyperinflation.

Types of outcome measures

Electronic searches

For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2012, Issue 11, part of The Cochrane Library, www.thecochranelibrary.com (accessed 21 November 2012), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (August 2009 to November week 2, 2012), EMBASE (August 2009 to November 2012), Physiotherapy Evidence Database (PEDro) (August 2009 to November 2012), CINAHL (2009 to November 2012) and CBM (1978 to November 2012). Please see Appendix 1 for details of the previous search.

We used the following search strategy to search CENTRAL and MEDLINE. We combined the MEDLINE search with the Cochrane Highly Sensitive Search Strategy for identifying randomised trials in MEDLINE: sensitivity‐ and precision‐maximising version (2008 revision), Ovid format (Lefebvre 2011). We adapted these search terms to search EMBASE (see Appendix 2), PEDro (see Appendix 3) and CINAHL (see Appendix 4).

Searching other resources

We handsearched related journals. We did not impose any language or publication restrictions.

Selection of studies

Two review authors (XLY, BYW) independently searched the databases. Two review authors (BYW, YPY) independently assessed the titles and abstracts to identify potentially relevant articles. We excluded the trials which failed to meet the inclusion criteria. Differences were resolved by the arbitrator (BRD).

Data extraction and management

Two review authors (XLY, BYW) independently extracted data using a standardised form. A third review author (MY) checked the extracted data. Extracted data included, where possible:

• description of participants (including age, gender, type of pneumonia);

• severity of pneumonia;

• basic conditions and setting;

• description of intervention (details of chest physiotherapy, including type, frequency, intensity and time);

• description of control therapy;

• methodological details (including design and recruitment);

• method of randomisation;

• sample size;

• trial inclusion and exclusion criteria;

• withdrawals;

• description of outcomes (including mortality, duration of hospital stay, adverse events, cure, healing time, rate of clearing of X‐ray film and duration of fever); and

• source of funding.

Assessment of risk of bias in included studies

Two review authors (XLY, BYW) independently assessed trial quality based on the generation of the allocation sequence, allocation concealment, blinding and follow‐up. Finally, we assessed the risks of bias as follows: A = low risk of bias (all of the criteria met); B = moderate risk of bias (one or more criteria partly met); C = high risk of bias (one or more criteria not met). Differences were resolved by the arbitrator (BRD).

The detailed quality components were as follows.

Measures of treatment effect

We expressed dichotomous data, such as cure rate or mortality, as risk ratios (RR). We expressed continuous data, such as duration of fever, as mean differences (MD). We reported all outcomes with 95% confidence intervals (CIs).

Unit of analysis issues

The unit of analysis was the individual, because all RCTs included in this review were simple parallel‐group trials in which participants were randomly allocated to several groups and a single result for each outcome from each individual was collected and analysed. There were no complicated designs, such as cross‐over or cluster‐randomisation, used in the included RCTs.

Dealing with missing data

We contacted trial authors (by e‐mail, letter or fax) to search for additional papers, and to confirm data extraction and obtain missing data.

Assessment of heterogeneity

We assessed heterogeneity in trial results by inspecting the forest plots to detect non‐overlapping CIs, applying the Chi² test with a P value of 0.10 indicating statistical significance, and implementing the I² statistic (with a value of 50% to denote moderate levels of heterogeneity). In the case of heterogeneity between studies, we made efforts to explore sources of heterogeneity due to various factors, such as type of pneumonia and type of physiotherapy.

Assessment of reporting biases

We could not perform a funnel plot analysis to identify reporting biases because of the small number of included studies.

Data synthesis

We used RevMan (version 5.0) (RevMan 2011) to combine some outcomes. We used a fixed‐effect model unless significant heterogeneity was noted; in which case we used a random‐effects model. We calculated both the effect sizes and the summary measures with their 95% CIs.

Subgroup analysis and investigation of heterogeneity

We performed a subgroup analysis for different types of chest physiotherapies and outcomes.

Sensitivity analysis

We did not perform a sensitivity analysis in this review.