Fisioterapia respiratória para adultos com pneumonia
Appendices
Appendix 1. Previous search
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register; MEDLINE (1966 to August Week 1, 2009); EMBASE (1974 to August 2009); CBM (1978 to August 2009); the National Research Register (August 2009); and Physiotherapy Evidence Database (PEDro) (1929 to August 2009).
We used the following search terms in MEDLINE in conjunction with the Cochrane Highly Sensitive Search Strategy for identifying RCTs in MEDLINE (Lefebvre 2008) for identification of randomised clinical trials. We modified these terms as appropriate for other databases.
MEDLINE (OVID)
#1 exp pneumonia/
#2 exp respiratory tract infections/
#3 (pneumonia$ or lung inflammation$ or respiratory tract infection$ or respiratory infection$).mp.
#4 1 or 2 or 3
#5 exp physical therapy modalities/
#6 exp drainage, postural/
#7 exp vibration/
#8 exp positive‐pressure respiration/
#9 exp breathing exercises/
#10 exp electric stimulation therapy/
#11 exp massage/
#12 exp musculoskeletal manipulations/
#13 (physical therap$ or physiotherapy$ or physical treatment$ or postural drainag$ or chest clap$ or chest percussion or chest shak$ or oscillati$ or vibration or directed cough$ or forced exhalation or forced expiration or positive pressure ventilation or positive expiratory pressure or breathing exercise$ or diaphragmatic breathing or thoracic expansion exercise$ or breathing train$ or ventilatory muscle train$ or electrostimulation or huff$ or massag$).mp.
#14 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13
#15 4 and 14
#16 randomized controlled trial.pt.
#17 controlled clinical trial.pt.
#18 randomized.ab.
#19 placebo.ab.
#20 randomly.ab.
#21 trial.ab.
#22 groups.ab.
#23 16 or 17 or 18 or 19 or 20 or 21 or 22
#24 15 and 23
See: Appendix 2, Appendix 3 and Appendix 4 for individual search strategies for CBM, EMBASE and PEDro respectively.
CBM search strategy (in Chinese)
#1 pneumonia/exp
#2 "respiratory tract infections"/exp
#3 pneumonia or "respiratory tract infection"
#4 #1 or #2 or #3
#5 "physical therapy modalities"/exp
#6 "drainage, postural"/exp
#7 "positive‐pressure respiration"/exp
#8 "breathing exercises"/exp
#9 "electric stimulation therapy"/exp
#10 "massage"/exp
#11 "physical therapy" or "postural drainage" or "chest clap" or "chest percussion" or vibration or "forced exhalation" or "positive pressure ventilation" or "breathing exercise" or "thoracic expansion exercise" or "ventilatory muscle train" or "electrostimulation" or "massage"
#12 #5 or #6 or #7 or #8 or #9 or #10 or #11
#13 #4 and #12
EMBASE search strategy (via EMBASE.COM)
#1 'pneumonia'/exp
#2 'respiratory tract infections'/exp
#3 pneumonia* or lung inflammation* or respiratory tract infection* or respiratory infection*
#4 #1 or #2 or #3
#5 'physical therapy modalities'/exp
#6 'drainage, postural'/exp
#7 'vibration'/exp
#8 'positive‐pressure respiration'/exp
#9 'breathing exercises'/exp
#10 'electric stimulation therapy'/exp
#11 'massage'/exp
#12 'musculoskeletal manipulations'/exp
#13 physical therap* or physiotherapy* or physical treatment* or postural drainag* or chest clap* or chest percussion or chest shak* or oscillati* or vibration or directed cough* or forced exhalation or forced expiration or positive pressure ventilation or positive expiratory pressure or breathing exercise* or diaphragmatic breathing or thoracic expansion exercise* or breathing train* or ventilatory muscle train* or electrostimulation or huff* or massag*
#14 #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13
#15 #4 and #14
#16 'randomized controlled trial':it
#17 'controlled clinical trial':it
#18 randomized:ab
#19 placebo:ab
#20 randomly:ab
#21 trial:ab
#22 groups:ab
#23 #16 or #17 or #18 or #19 or #20 or #21 or #22
#24 #15 and #23
PEDro search strategy
#1 pneumonia AND "physical therapy"
#2 "respiratory tract infection" AND "physical therapy"
#3 #1 OR #2
Appendix 2. Embase.com search strategy
#36 #32 AND #35
#35 #33 OR #34
#34 random*:ab,ti OR placebo*:ab,ti OR factorial*:ab,ti OR crossover*:ab,ti OR 'cross over':ab,ti OR 'cross‐over':ab,ti OR volunteer*:ab,ti OR assign*:ab,ti OR allocat*:ab,ti OR ((singl* OR doubl*) NEAR/1 blind*):ab,ti
#33 'randomized controlled trial'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp
#32 #9 AND #31
#31 #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30
#30 (osteopath* NEAR/3 (manipulat* OR treatment* OR therap* OR techniq*)):ab,ti
#29 ((respirat* OR ventilat*) NEAR/2 'muscle training'):ab,ti
#28 massag*:ab,ti
#27 electrostimulat*:ab,ti AND [embase]/lim 1947
#26 'positive pressure ventilation':ab,ti OR 'positive expiratory pressure':ab,ti
#25 (breath* NEAR/2 (control* OR techni* OR train* OR exercis*)):ab,ti
#24 (cough* NEAR/2 (directed OR maneuver* OR manoeuver* OR techniq*)):ab,ti
#23 (forced NEAR/2 (exhal* OR expir*)):ab,ti
#22 ((chest OR thora*) NEAR/3 (clap* OR shak* OR compress)):ab,ti
#21 oscillat*:ab,ti OR vibrat*:ab,ti OR percuss*:ab,ti OR huff*:ab,ti
#20 'postural drainage':ab,ti OR (patient* NEAR/3 position*):ab,ti
#19 'manipulative medicine'/exp
#18 'electrostimulation therapy'/de
#17 'massage'/de
#16 'electrostimulation'/de
#15 'breathing exercise'/de
#14 'postural drainage'/de
#13 'positive end expiratory pressure'/de OR 'forced expiration'/de
#12 'vibration'/de OR 'high frequency oscillation'/de OR 'oscillation'/de OR 'whole body vibration'/de
#11 physiotherap*:ab,ti OR 'physio therapy':ab,ti OR (physical NEAR/1 (therap* OR treatment*)):ab,ti
#10 'physiotherapy'/exp
#9 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR # 8197040
#8 (pleural NEAR/2 (effusion OR empyema)):ab,ti OR pleurisy:ab,ti
#7 'pleurisy'/exp
#6 (lung NEAR/2 (inflamm* OR infect*)):ab,ti
#5 (lower NEAR/3 'respiratory tract infection'):ab,ti OR (lower NEAR/3 'respiratory tract infections'):ab,ti OR (lower NEAR/3 'respiratory infection'):ab,ti OR (lower NEAR/3 'respiratory infections'):ab,ti OR lrti:ab,ti
#4 'lower respiratory tract infection'/de
#3 bronchopneumon*:ab,ti OR pleuropneumon*:ab,ti
#2 pneumon*:ab,ti
#1 'pneumonia'/exp
Appendix 3. PEDro search strategy
Abstract and title: pneumonia
Method: clinical trial
New records added since: 6 January 2009
Appendix 4. CINAHL (Ebsco) search strategy
S40 S30 AND S39
S39 S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR S37 OR S38
S38 (MH "Quantitative Studies")
S37 TI placebo* OR AB placebo*
S36 (MH "Placebos")
S35 TI random* OR AB random*
S34 TI ((singl* or doubl* or trebl* or tripl*) W1 (blind* or mask*)) OR AB ((singl* or doubl* or trebl* or tripl*) W1 (blind* or mask*))
S33 TI clinic* W1 trial* OR AB clinic* W1 trial*
S32 PT clinical trial
S31 (MH "Clinical Trials+")
S30 S10 AND S29 S
S29 S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28
S28 TI (osteopath* N3 (manipulat* or treatment* or therap* or techni*)) OR AB (osteopath* N3 (manipulat* or treatment* or therap* or techni*))
S27 TI ((respirat* or ventilat*) N2 muscle train*) OR AB ((respirat* or ventilat*) N2 muscle train*)
S26 TI massag* OR AB massag*
S25 TI electrostimulat* OR AB electrostimulat*
S24 TI (positive pressure ventilation* or positive expiratory pressure*) OR AB (positive pressure ventilation* or positive expiratory pressure*)
S23 TI (breath* N2 (control* or techni* or train* or exercis*)) OR AB (breath* N2 (control* or techni* or train* or exercis*))
S22 TI ( cough* N2 (directed or maneuver* or manoeuver* or techni*) ) OR
AB (cough* N2 (directed or maneuver* or manoeuver* or techni*))
S21 TI (forced N2 (exhal* or exhil*)) OR AB (forced N2 (exhal* or exhil*))
S20 TI ((chest* or thora*) N3 (clap* or shak* or compress*)) OR AB ((chest* or thora*) N3 (clap* or shak* or compress*))
S19 TI (oscillat* or vibrat* or percuss* or huff*) OR AB (oscillat* or vibrat* or percuss* or huff*)
S18 TI patient* N3 position* OR AB patient* N3 position*
S17 TI postural drain* OR AB postural drain*
S16 (MH "Drainage, Postural")
S15 (MH "Positive Pressure Ventilation+")
S14 (MH "Respiratory Therapy+")
S13 (MH "Vibration")
S12 TI (physiotherap* or physical therap* or physical treatment*) OR AB (physiotherap* or physical therap* or physical treatment*)
S11 (MH "Physical Therapy+")
S10 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9
S9 TI pleurisy OR AB pleurisy
S8 TI (pleural N3 (empyema or effusion*)) OR AB (pleural N3 (empyema or effusion*))
S7 (MH "Empyema") OR (MH "Pleural Effusion") OR (MH "Pleurisy")
S6 TI (lung* N3 (inflam* or infect*)) OR AB (lung* N3 (inflam* or infect*))
S5 TI (lower respiratory tract infection* or lower respiratory infection* or lrti) OR AB (lower respiratory tract infection* or lower respiratory infection* or lrti)
S4 (MH "Respiratory Tract Infections")
S3 TI (bronchopneumon* or pleuropneumon*) OR AB (bronchopneumon* or pleuropneumon*)
S2 TI pneumon* OR AB pneumon*
S1 (MH "Pneumonia+")
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 Chest physiotherapy plus routine treatment versus routine treatment alone, outcome: 1.1 Mortality.
Forest plot of comparison: 1 Chest physiotherapy plus routine treatment versus routine treatment alone, outcome: 1.2 Cure rate.
Forest plot of comparison: 3 OMT plus routine treatment versus placebo plus routine treatment, outcome: 3.1 Mortality.
Forest plot of comparison: 3 OMT plus routine treatment versus placebo plus routine treatment, outcome: 3.2 Cure rate.
Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 1 Mortality.
Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 2 Cure rate.
Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 3 Duration of hospital stay.
Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 4 Duration of fever.
Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 5 Rate of improvement of chest X‐ray.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 1 Cure rate.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 2 Duration of hospital stay.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 3 Rate of improvement of chest X‐ray.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 4 Duration of antibiotic therapy.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 5 Duration of sputum production.
Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 6 In‐patient sputum weight.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 1 Mortality.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 2 Cure rate.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 3 Duration of hospital stay.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 4 Duration of fever.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 5 Rate of improvement of chest X‐ray.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 6 Duration of oral antibiotic therapy.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 7 Duration of intervenous therapy.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 8 Duration of total antibiotic therapy.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 9 Duration of leukocytosis.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 10 Change in leukocyte count.
Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 11 Mean leukocyte count.
Comparison 4 Positive expiratory pressure plus routine treatment versus routine treatment alone, Outcome 1 Duration of hospital stay.
Comparison 4 Positive expiratory pressure plus routine treatment versus routine treatment alone, Outcome 2 Duration of fever.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mortality Show forest plot | 2 | 225 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.15, 7.13] |
| 2 Cure rate Show forest plot | 2 | 225 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.91, 1.04] |
| 3 Duration of hospital stay Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4 Duration of fever Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5 Rate of improvement of chest X‐ray Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Cure rate Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 2 Duration of hospital stay Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3 Rate of improvement of chest X‐ray Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4 Duration of antibiotic therapy Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5 Duration of sputum production Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5.1 In‐patient | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.2 Out‐patient | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 5.3 Total | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 6 In‐patient sputum weight Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mortality Show forest plot | 2 | 79 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.27 [0.05, 1.57] |
| 2 Cure rate Show forest plot | 2 | 79 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.54 [0.97, 2.46] |
| 3 Duration of hospital stay Show forest plot | 2 | 79 | Mean Difference (IV, Fixed, 95% CI) | ‐2.02 [‐3.46, ‐0.58] |
| 4 Duration of fever Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5 Rate of improvement of chest X‐ray Show forest plot | 2 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.16 [0.77, 1.73] |
| 6 Duration of oral antibiotic therapy Show forest plot | 2 | 79 | Mean Difference (IV, Random, 95% CI) | 0.97 [‐1.25, 3.20] |
| 7 Duration of intervenous therapy Show forest plot | 2 | 79 | Mean Difference (IV, Fixed, 95% CI) | ‐2.11 [‐3.36, ‐0.87] |
| 8 Duration of total antibiotic therapy Show forest plot | 2 | 79 | Mean Difference (IV, Fixed, 95% CI) | ‐1.93 [‐3.12, ‐0.74] |
| 9 Duration of leukocytosis Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 10 Change in leukocyte count Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 10.1 Change between Day 3 and 1 from admission | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 10.2 Change between Day 5 and 1 from admission | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 11 Mean leukocyte count Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 11.1 Day 3 from admission | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 11.2 Day 5 from admission | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Duration of hospital stay Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2 Duration of fever Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
