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Kinésithérapie respiratoire pour la pneumonie chez l'adulte

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Referencias

Bjorkqvist 1997 {published data only}

Bjorkqvist M, Wiberg B, Bodin L, Bárány M, Holmberg H. Bottle‐blowing in hospital‐treated patients with community‐acquired pneumonia. Scandinavian Journal of Infectious Diseases 1997;29(1):77‐82.

Britton 1985 {published data only}

Britton S, Bejstedt M, Vedin L. Chest physiotherapy in primary pneumonia. British Medical Journal (Clinical Research Ed.) 1985;290(6483):1703‐4.

Graham 1978 {published data only}

Graham WG, Bradley DA. Efficacy of chest physiotherapy and intermittent positive‐pressure breathing in the resolution of pneumonia. New England Journal of Medicine 1978;299(12):624‐7.

Noll 1999 {published data only}

Noll DR, Shores J, Bryman PN, Masterson EV. Adjunctive osteopathic manipulative treatment in the elderly hospitalized with pneumonia: a pilot study. Journal of the American Osteopathic Association 1999;99(3):143‐6.

Noll 2000 {published data only}

Noll DR, Shores JH, Gamber RG, Herron KM, Swift J. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. Journal of the American Osteopathic Association 2000;100(12):776‐82.

Tydeman 1989 {published data only}

Tydeman D. An investigation into the effectiveness of physiotherapy in the treatment of patients with community‐acquired pneumonia. Physiotherapy Theory and Practice 1989;5(2):75‐81.

References to studies excluded from this review

Barkov 1987 {published data only}

Barkov VA, Komiachilova AS, Smirnova GI, Namestnikov VV, Rogozina TV. Treatment of abscessing pneumonia by using combination physiotherapy [Lechenie abstsediruiushchei pnevmonii s primeneniem fizioterapevticheskogo kompleksa]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1987;March‐April(2):13‐6.

Britton 1983a {published data only}

Britton S, Beijstedt M, Wedin L. Respiratory gymnastics do not help in lung inflammation [Andningsgymnastik hjalper inte vid lunginflammation]. Lakartidningen 1983;80(47):4553‐6.

Britton 1983b {published data only}

Britton S. Respiratory physiotherapy does not work in cases of primary pneumonia. Sjukgymnasten 1983;13:7‐9.

Burioka 1998 {published data only}

Burioka N, Sugimoto Y, Suyama H, Hori S, Chikumi S, Sasaki T. Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis. Respirology 1998;3:183‐6.

Cheng 2004 {published data only}

Cheng D, Xu D. Sequential non‐invasive following short‐term invasive mechanical ventilation in elderly patients of severe pneumonia with acute respiratory failure. Clinical Medical Journal of China 2004;11(6):977‐8.

Choi 2005 {published data only}

Choi JS, Jones AY. Effects of manual hyperinflation and suctioning on respiratory mechanics in mechanically‐ventilated patients with ventilator‐associated pneumonia. Australian Journal of Physiotherapy 2005;51(1):25‐30.

Confalonieri 1998a {published data only}

Confalonieri M, Potena A, Carbone G. Randomised trial of non invasive positive pressure ventilation in severe community acquired pneumonia. European Respiratory Journal 1998;Suppl 28:128.

Confalonieri 1998b {published data only}

Confalonieri M, Potena A, Gandola L. Randomised controlled study of noninvasive positive pressure ventilation in severe community acquired pneumonia. Preliminary results. American Journal of Respiratory and Critical Care Medicine 1998;157(Suppl 3):A224.

Dangour 2011 {published data only}

Dangour AD, Albala C, Allen E, Grundy E, Walker DG, Aedo C, et al. Effect of a nutrition supplement and physical activity program on pneumonia and walking capacity in Chilean older people: a factorial cluster randomized trial. PLoS Medicine 2011;8(4):e1001023.

Fu 2005 {published data only}

Fu R, Dong H, He Y. Vibratory sputum‐ejection apparatus for respiratory diseases in elderly. China Medical Equipment 2005;2(6):35‐6.

Holody 1981 {published data only}

Holody B, Goldberg HS. The effect of mechanical vibration physiotherapy on arterial oxygenation in acutely ill patients with atelectasis or pneumonia. American Review of Respiratory Disease 1981;124(4):372‐5.

Jolliet 2001 {published data only}

Jolliet P, Abajo B, Pasquina P, Chevrolet JC. Non‐invasive pressure support ventilation in severe community‐acquired pneumonia. Intensive Care Medicine 2001;27(5):812‐21.

Li 2005 {published data only}

Li Z. The application research of NIPPV on serious pneumonia sufferers. Guangzhou Medical Journal 2005;36(5):56‐7.

Mo 2004 {published data only}

Mo K, Wang Z, Ning Z. Observation of efficacy in tracheobronchial clearance using G5 vibratory sputum‐ejection apparatus in patients with lower respiratory tract infection. Anthology of Medicine 2004;23(6):764.

Noll 2008 {published data only}

Noll DR, Degenhardt BF, Fossum C, Hensel K. Clinical and research protocol for osteopathic manipulative treatment of elderly patients with pneumonia. Journal of the American Osteopathic Association 2008;108:508‐16.

Patman 2009 {published data only}

Patman S, Jenkins S, Stiller K. Physiotherapy does not prevent, or hasten recovery from, ventilator‐associated pneumonia in patients with acquired brain injury. Intensive Care Medicine 2009;35(2):258‐65.

Schultz 2006 {published data only}

Schultz K, Bergmann KC, Kenn K, Petro W, Heitmann RH, Fischer R, et al. Effectiveness of inpatient pulmonary rehabilitation (AHB). Results of a multicenter prospective observation study [Effektivitat der pneumologischen Anschluss‐Rehabilitation (AHB). Ergebnisse einer multizentrischen prospektiven Beobachtungsstudie]. Deutsche Medizinische Wochenschrift 2006;131(33):1793‐8.

Wan 2004 {published data only}

Wan Y. Ultrasonic nebulization and postural drainage for lower respiratory tract infection. Modern Medicine Health 2004;20(7):537‐8.

Wang 1997 {published data only}

Wang Y, Hua G, Li Q, Li D. Chirismus rehabilitation for lung infection. Chinese Journal of Rehabilitation Medicine 1997;12(2):85‐8.

Wu 2005a {published data only}

Wu L, Yang J. Observation of efficacy in tracheobronchial clearance using vibratory sputum‐ejection apparatus in the aged with lower respiratory tract infection. Heilongjiang Nursing Journal 2005;11(6):459‐60.

Wu 2005b {published data only}

Wu H. Chest physiotherapy for pulmonary infection. Guangxi Medical Journal 2005;27(10):1682‐3.

Wu 2005c {published data only}

Wu Z, Zeng L, Gao S. Evaluation of different sputum excretion methods in nursing of old patients with lung infection. Heilongjiang Nursing Journal 2005;11(3):167‐8.

Xia 2005 {published data only}

Xia X, Wang Y, Li Y, Tian J. Application of G5 vibratory sputum‐ejection apparatus in patients with pulmonary infection. Tianjing Nursing 2005;13(5):296‐7.

Xu 2004 {published data only}

Xu L, Wang A, Lai G. Vibratory sputum‐ejection apparatus for pulmonary infection. Journal of Fuzhou General Hospital 2004;11(49):11.

Zha 2004 {published data only}

Zhao B. Observation of efficacy of Chinese medicine nebulization and postural drainage for acute lung abscess. Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine 2004;4(6):18‐9.

Zhang 2004 {published data only}

Zhang A. Application of musculus diaphragm pacemaker expectoration in lung infection. Journal of Medical Forum 2004;25(2):13‐5.

References to studies awaiting assessment

Facto 1947 {published data only}

Facto LL. The osteopathic treatment of lobar pneumonia. Journal of the American Osteopathic Association 1947;46:385‐92.

Kuznetsov 1976 {published data only}

Kuznetsov OF. Effectiveness of massage in complex treatment of chronic pneumonia [Effektivnost' massazha v kompleksnom lechenii bol'nykh khronicheskoi pnevmoniei]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1976;5:29‐32.

Kuznetsov 1980a {published data only}

Kuznetsov OF, Lagutina TS. New massage method in the overall treatment of chronic pneumonia [Novaia metodika massazha v kompleksnom lechenii bol'nykh khronicheskoi pnevmoniei]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1980;3:13‐7.

Kuznetsov 1980b {published data only}

Kuznetsov OF, Tsar'kova LN, Pokrovskaia EL, Iakubson IM. Effect of massage on the acid‐base balance in chronic pneumonia [Vliianie massazha na kislotno‐shchelochnoi balans u bol'nykh khronicheskoi pnevmoniei]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1980;5:15‐20.

Sedov 1975 {published data only}

Sedov KR, Smol'kova OV. Value of therapeutic physical culture in the complex treatment of patients with chronic pneumonia [Znachenie lechebnoi fizkul'tury v kompleksnom lechenii bol'nykh khronicheskoi pnevmoniei]. Sovetskaia Meditsina 1975;1:65‐70.

Vorob'ev 1984 {published data only}

Vorob'ev LP, Busarova GA, Merzlikin LA, Shestakov VA. Effect of physiotherapy on the outcome of acute pneumonia [Vliianie fizioterapii na iskhody ostroi pnevmonii]. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1984;2:13‐6.

Noll {published data only}

Noll D. Is osteopathic manipulative treatment (OMT) beneficial for elderly patients hospitalized with pneumonia. www.ClinicalTrials.gov. [NCT00258661]

Bowton 1999

Bowton DL. Nosocomial pneumonia in the ICU: year 2000 and beyond. Chest 1999;115(Suppl):28‐33.

Britton 1983

Britton S. Respiratory physiotherapy does not work in cases of primary pneumonia. Sjukgymnasten 1983;13:7‐9.

Campbell 1975

Campbell AH, O'Connell JM, Wilson F. The effect of chest physiotherapy upon the FEV1 in chronic bronchitis. Medical Journal of Australia 1975;1(2):33‐5.

Chalumeau 2002

Chalumeau M, Foix‐L'Helias L, Scheinmann P, Zuani P, Gendrel D, Ducou‐le‐Pointe H. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants. Pediatric Radiology 2002;32(9):644‐7.

Cochrane 1977

Cochrane GM, Webber BA, Clarke SW. Effects of sputum on pulmonary function. British Medical Journal 1977;2(6096):1181‐3.

Colice 2004

Colice GL, Morley M, Asche C, Birnbaum H. Treatment costs of community‐acquired pneumonia in an employed population. Chest 2004;125(6):2140‐5.

Connors 1980

Connors AF, Hammon WE, Martin RJ, Rogers RM. Chest physical therapy. The immediate effect on oxygenation in acutely ill patients. Chest 1980;78(4):559‐64.

Fine 1990

Fine MJ, Orloff JJ, Arisumi D, Fang GD, Arena VC, Hanusa BH, et al. Prognosis of patients hospitalized with community‐acquired pneumonia. American Journal of Medicine 1990;88(5N):1N‐8N.

Flenady 2010

Flenady VJ, Gray PH. Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD000283]

George 1995

George RB, Light RW, Matthay MA, Matthay RA. Chest Medicine: Essentials of Pulmonary and Critical Care Medicine. Third Edition. Baltimore, Maryland USA: Williams & Wilkins, 1995.

Guessous 2008

Guessous I, Cornuz J, Stoianov R, Burnand B, Fitting JW, Yersin B, et al. Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community‐acquired pneumonia. Respiratory Medicine 2008;102(9):1257‐63.

Hanying 2005

Hanying Wu. Chest physiotherapy for patients with pulmonary infection. Guangxi Medical Journal 2005;27(10):1682‐3.

Horiuchi 1997

Horiuchi K, Jordan D, Cohen D, Kemper MC, Weissman C. Insights into the increased oxygen demand during chest physiotherapy. Critical Care Medicine 1997;25(8):1347‐51.

ICH 1997

International Conference on Harmonisation Expert Working Group. International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use. ICH harmonised tripartite guideline: guideline for good clinical practice. CFR & ICH Guidelines. Vol. 1, Barnett International/PAREXEL, 1997:1‐59.

Lefebvre 2011

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 Available from www.cochrane‐handbook.org. Chichester: Wiley‐Blackwell, 2011.

Niederman 2001

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community‐acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. American Journal of Respiratory and Critical Care Medicine 2001;163(7):1730‐54.

Ntoumenopoulos 2002

Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator‐associated pneumonia. Intensive Care Medicine 2002;28(7):850‐6.

Poelaert 1991

Poelaert J, Lannoy B, Vogelaers D, Everaert J, Decruyenaere J, Capiau P, et al. Influence of chest physiotherapy on arterial oxygen saturation. Acta Anaesthesiologica Belgica 1991;42(3):165‐70.

RevMan 2011 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.

Roqué i Figuls 2012

Roqué i Figuls M, Giné‐Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD004873.pub3]

Van der Schans 2009

Van der Schans C, Prasad A, Main E. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD001401]

Wallis 1999

Wallis C, Prasad A. Who needs chest physiotherapy? Moving from anecdote to evidence. Archives of Disease in Childhood 1999;80(4):393‐7.

Weissman 1991

Weissman C, Kemper M. The oxygen uptake‐oxygen delivery relationship during ICU interventions. Chest 1991;99:430‐5.

Weissman 1993

Weissman C, Kemper M. Stressing the critically ill patients: the cardiopulmonary and metabolic response to an acute increase in oxygen consumption. Journal of Critical Care 1993;8(2):100‐8.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Bjorkqvist 1997

Methods

Randomised, parallel‐group trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

50 treatment, 48 control

16 to 95 years old (mean 65)

Male/female: 84 /61

Conducted in Sweden

Interventions

The physiotherapy was positive expiratory pressure (PEP). In this study a bottle containing 10 cm of tap water was used. Patients were asked to sit up with their feet on the floor and blow bubbles at a calm speed into the bottle through a plastic tube (10 mm in diameter) with an air pressure just sufficient to overcome the resistance of the water. This method was used 20 times per hour from 9 am to 8 pm and continued after discharge. This study consisted of three group (A, B, C). Group A was control which underwent early mobilisation and "huffing". Group B members were given the same as A and deep breaths. Group C members were given the same as A and the method of bottle‐blowing

Outcomes

Primary outcomes: death

Secondary outcomes: duration of hospital stay (days); fever clearance time; CRP; VC; FEV1; PEF

Notes

The study was supported financially by the Orebro County Council Research Committee and the Orebro Medical Center Research Foundation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The randomised method was not clearly reported

Allocation concealment (selection bias)

Low risk

"Sealed envelopes" were used

Blinding (performance bias and detection bias)
All outcomes

High risk

No blinding

Incomplete outcome data (attrition bias)
All outcomes

Low risk

19 (13%) patients were drop‐outs. However, ITT analysis was performed

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

Unclear risk

Insufficient information

Britton 1985

Methods

Randomised, parallel‐group, single‐blind trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

83 treatment, 88 control

15 to 75 years old (control: 47.2, treatment: 47.4)

Male/female: 74/97

Conducted in Sweden

Interventions

The chest physiotherapy consisted of postural drainage, external help with breathing, percussion and vibration. The placebo was to receive advice on expectoration, deep breathing and how to exercise to avoid thrombosis

Outcomes

Primary outcomes: death; cure rate

Secondary outcomes: duration of hospital stay (days); healing time (days); fever clearance time; FEV1

Notes

The study was approved by the ethical committee of the Karolinska Hospital, Stockholm

Sources of funding were not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The randomised method was not clearly reported

Allocation concealment (selection bias)

Low risk

"Sealed envelopes" were used

Blinding (performance bias and detection bias)
All outcomes

Low risk

Outcome assessor was blinded

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

High risk

The standard deviations of duration of hospital stay and fever were not reported

Graham 1978

Methods

Randomised, parallel‐group trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

27 treatment, 27 control

Age (mean ± SD): control: 63 ± 3 years old, treatment: 61 ± 4 years old

Male/female: control 13/14, treatment 14/13

Conducted in Sweden

Interventions

The chest physiotherapy consisted of postural drainage, chest percussion and vibration, with encouragement of deep breathing and coughing. This therapy was used concomitantly with intermittent positive pressure breathing every 4 hours during the first 24 hours. Therapy was given for at least 3 days to all the treated participants, with an average duration of 5 days

Outcomes

Primary outcomes: death; cure rate

Secondary outcomes: duration of hospital stay (days); rate of clearing of X‐ray film; fever clearance time

Notes

The study was supported by a grant (PHS 17292) to the Vermont Lung Center from the National Heart, Lung, and Blood Institute, National Institutes of Health

Sources of funding not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The method of randomisation was not described

Allocation concealment (selection bias)

Low risk

"Sealed envelopes" were used

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Insufficient information

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

Unclear risk

Insufficient information

Noll 1999

Methods

Randomised, parallel‐group, double‐blind trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

11 in treatment group, 10 in control group

The mean age was 78.7 in the control group, 82.5 in the treatment group

Male/female: control 3/7, treatment 3/8

The trial was conducted in the United States

Interventions

Patients in the treatment group received a standardised osteopathic manipulative treatment protocol treatment consisting of 7 osteopathic manipulative techniques and non‐standardised osteopathic manipulative treatments from an osteopathic manipulative treatment specialist, while participants in the control group received a standardised light touch protocol treatment (sham treatment), with care taken not to move myofascial structures or to articulate joints. The session was 10 to 15 minutes, and the frequency of treatment was 2 sessions per day

Outcomes

Primary outcomes: death; cure rate

Secondary outcomes: duration of hospital stay (days); rate of clearing of X‐ray film; duration of antibiotic therapy; duration of leukocytosis

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The method of randomisation was not described

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding (performance bias and detection bias)
All outcomes

Low risk

Patients and outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

Unclear risk

Insufficient information

Noll 2000

Methods

Randomised, double‐blind, parallel trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

28 in treatment group; 30 in control group

Age (mean ± SD): control group: 77.0 ± 17.2 years old; treatment group: 77.7 ± 17.1 years old

Male/female: control group: 16/14; treatment group: 14/14

The trial was conducted in the United States

Interventions

Patients in the treatment group received a standardised osteopathic manipulative treatment protocol treatment consisting of 7 osteopathic manipulative techniques and non‐standardised osteopathic manipulative treatments from an osteopathic manipulative treatment specialist, while participants in the control group received a standardised light touch protocol treatment (sham treatment), with care taken not to move myofascial structures or to articulate joints. The session was 10 to 15 minutes, and the frequency of treatment was 2 sessions per day

Outcomes

Primary outcomes: death; cure rate

Secondary outcomes: duration of hospital stay (days); rate of clearing of X‐ray film; duration of antibiotic therapy; change in leukocyte count; mean leukocyte count

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The method of randomisation was not described

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding (performance bias and detection bias)
All outcomes

Low risk

Patients and outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

Unclear risk

Insufficient information

Tydeman 1989

Methods

Randomised, parallel‐group trial

Participants

In‐patient setting; relevant details of health status of participants; age; sex; country

12 treatment, 20 control

Age (mean ± SD): control: 36.80 ± 16.91 years old, treatment: 42.08 ± 15.59 years old

Male/female: control 10/10, treatment 9/3

Conducted in UK

Interventions

The physiotherapy was active cycle of breathing techniques, which consisted of breathing control using the diaphragm; localised expansion exercises; postural drainage; thoracic expansion exercises with vibrations on expiration; percussion. The first 2 methods were continued to discharge and the other methods were used when participants became productive of sputum. The dose of the therapy was dependent on the patient's tolerance and the sputum production

Outcomes

Primary outcomes: death; cure rate

Secondary outcomes: duration of hospital stay (days); rate of clearing of X‐ray film; duration of all antibiotic therapy; duration of production of sputum; in‐patient sputum weight

Notes

This study was under the funding of Norwich Health Authority and the East Anglian Regional Health Authority Research Committee

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The method of randomisation was not described

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding (performance bias and detection bias)
All outcomes

High risk

Blinding was not performed

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Only 4 (11%) patients did not complete the study. Among them, 1 patient died, 2 patients were re‐diagnosed as having other disease and 1 patient could not attend sufficient assessments

Selective reporting (reporting bias)

Unclear risk

Insufficient information

Other bias

Unclear risk

Insufficient information

CRP: C‐reactive protein
VC: vital capacity
FEV1: forced expiratory volume in the first second
ITT: intention‐to‐treat
PEF: peak expiratory flow
OMT: osteopathic manipulative treatment

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Barkov 1987

Physical agent; no control

Britton 1983a

Secondary publications under Britton 1985

Britton 1983b

Secondary publications under Britton 1985

Burioka 1998

The participants had diffuse panbronchiolitis

Cheng 2004

This study was not a RCT or quasi‐RCT. It covered mechanical ventilation for patients with acute respiratory failure caused by pneumonia

Choi 2005

Study was about mechanical ventilation for patients with pneumonia

Confalonieri 1998a

Study was about respiratory failure caused by pneumonia

Confalonieri 1998b

Study was about respiratory failure caused by pneumonia

Dangour 2011

It was a prevention study

Fu 2005

In addition to pneumonia, the participants also had asthma, chronic bronchitis or bronchiectasis. Not a RCT or quasi‐RCT

Holody 1981

In addition to pneumonia, the participants had atelectasis. Not a RCT or quasi‐RCT

Jolliet 2001

Not a RCT or quasi‐RCT

Li 2005

Some participants with pneumonia also had congestive heart failure or diabetes mellitus. Not a RCT or quasi‐RCT

Mo 2004

Some participants with pneumonia also had COPD or asthma. A before‐and‐after study in the same participants

Noll 2008

It was a study protocol

Patman 2009

Some participants in the study were less than 18 years old. There was no subgroup analysis for adults provided in the study

Schultz 2006

The participants also had asthma, lung cancer, COPD or pulmonary embolism

Wan 2004

Participants had lower respiratory tract infections, not only pneumonia. Not a RCT or quasi‐RCT

Wang 1997

The participants also had chronic bronchitis or acute bronchitis, not only pneumonia. Not a RCT or quasi‐RCT

Wu 2005a

Participants had a pulmonary infection, not only pneumonia. Not a RCT or quasi‐RCT

Wu 2005b

Participants had a pulmonary infection, not only pneumonia. Not a RCT or quasi‐RCT

Wu 2005c

Participants had pneumonia caused by chronic bronchitis. Not a RCT or quasi‐RCT

Xia 2005

Participants had a pulmonary infection, not only pneumonia. Not a RCT or quasi‐RCT

Xu 2004

Participants had lower respiratory tract infections, not only pneumonia. Not a RCT or quasi‐RCT

Zha 2004

The participants had acute lung abscesses. Not a RCT or quasi‐RCT

Zhang 2004

Participants had pneumonia caused by COPD, not only pneumonia. Not a RCT or quasi‐RCT

COPD: chronic obstructive pulmonary disease
RCT: randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Facto 1947

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Kuznetsov 1976

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Kuznetsov 1980a

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Kuznetsov 1980b

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Sedov 1975

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Vorob'ev 1984

Methods

Unclear

Participants

Unclear

Interventions

Unclear

Outcomes

Unclear

Notes

Characteristics of ongoing studies [ordered by study ID]

Noll

Trial name or title

Multi‐Center Osteopathic Pneumonia Study in the Elderly (MOPSE)

Methods

Randomised, double‐blind, placebo‐controlled trial

Participants

Inclusion criteria:

  • 50 years old or older

  • Patient is hospitalised in an acute care facility

  • Patient must exhibit at least 2 of the classic symptoms of pneumonia, to include:

    • respiration rate greater than or equal to 25 respirations per minute

    • new or increased cough

    • fever greater than or equal to 100.4 degrees F (38 degrees C)

    • pleuritic chest pain

    • worsening of mental or functional status

    • leukocytosis (WBC greater than 12,000 cells per cubic millimetre)

    • new or increased physical findings (rales, wheezing, bronchial breath sounds)

Exclusion criteria:

  • Lung abscess

  • Advancing pulmonary fibrosis

  • Bronchiectasis

  • Pulmonary tuberculosis

  • Lung cancer

  • Metastatic malignancy

  • Uncontrolled metabolic bone disease that places subject at risk of pathologic bone fracture (i.e. Paget's disease or hypoparathyroidism)

  • Acute or unhealed rib or vertebral fracture

  • History of pathologic bone fracture

  • Previous participation in the study

  • Respiratory failure (intubation)

Interventions

The first group: osteopathic manipulative treatment (OMT)

The second group: light touch control

The third group: conventional care only

Outcomes

Primary outcome measures: length of hospital stay, time to clinical stability, rate of symptomatic and functional recovery
Secondary outcome measures: duration of IV and oral antibiotic usage in the hospital, number of complications and deaths secondary to pneumonia, duration and severity of fever, duration and severity of leukocytosis, patient satisfaction

Starting date

March 2004

Contact information

Not available

Notes

The trial had been completed when we were drafting this review, however it has not yet been published

IV: intravenous
WBC: white blood cell

Data and analyses

Open in table viewer
Comparison 1. Chest physiotherapy plus routine treatment versus routine treatment alone

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]

Analysis 1.1

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 1 Mortality.

2 Cure rate Show forest plot

2

225

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.91, 1.04]

Analysis 1.2

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 2 Cure rate.

3 Duration of hospital stay Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.3

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 3 Duration of hospital stay.

4 Duration of fever Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.4

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 4 Duration of fever.

5 Rate of improvement of chest X‐ray Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.5

Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 5 Rate of improvement of chest X‐ray.

Comparison 1 Chest physiotherapy plus routine treatment versus routine treatment alone, Outcome 5 Rate of improvement of chest X‐ray.

Open in table viewer
Comparison 2. Active cycle of breathing techniques plus routine treatment versus routine treatment alone

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

Analysis 2.1

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 1 Cure rate.

2 Duration of hospital stay Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.2

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 2 Duration of hospital stay.

3 Rate of improvement of chest X‐ray Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 2.3

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 3 Rate of improvement of chest X‐ray.

4 Duration of antibiotic therapy Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.4

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 4 Duration of antibiotic therapy.

5 Duration of sputum production Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.5

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 5 Duration of sputum production.

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

Analysis 2.6

Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 6 In‐patient sputum weight.

Comparison 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, Outcome 6 In‐patient sputum weight.

Open in table viewer
Comparison 3. Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment

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]

Analysis 3.1

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 1 Mortality.

2 Cure rate Show forest plot

2

79

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [0.97, 2.46]

Analysis 3.2

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 2 Cure rate.

3 Duration of hospital stay Show forest plot

2

79

Mean Difference (IV, Fixed, 95% CI)

‐2.02 [‐3.46, ‐0.58]

Analysis 3.3

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 3 Duration of hospital stay.

4 Duration of fever Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.4

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 4 Duration of fever.

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]

Analysis 3.5

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 5 Rate of improvement of chest X‐ray.

6 Duration of oral antibiotic therapy Show forest plot

2

79

Mean Difference (IV, Random, 95% CI)

0.97 [‐1.25, 3.20]

Analysis 3.6

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 6 Duration of oral antibiotic therapy.

7 Duration of intervenous therapy Show forest plot

2

79

Mean Difference (IV, Fixed, 95% CI)

‐2.11 [‐3.36, ‐0.87]

Analysis 3.7

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 7 Duration of intervenous therapy.

8 Duration of total antibiotic therapy Show forest plot

2

79

Mean Difference (IV, Fixed, 95% CI)

‐1.93 [‐3.12, ‐0.74]

Analysis 3.8

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 8 Duration of total antibiotic therapy.

9 Duration of leukocytosis Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.9

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 9 Duration of leukocytosis.

10 Change in leukocyte count Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.10

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 10 Change in leukocyte count.

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

Analysis 3.11

Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 11 Mean leukocyte count.

Comparison 3 Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment, Outcome 11 Mean leukocyte count.

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]

Open in table viewer
Comparison 4. Positive expiratory pressure plus routine treatment versus routine treatment alone

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

Analysis 4.1

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 1 Duration of hospital stay.

2 Duration of fever Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 4.2

Comparison 4 Positive expiratory pressure plus routine treatment versus routine treatment alone, Outcome 2 Duration of fever.

Comparison 4 Positive expiratory pressure plus routine treatment versus routine treatment alone, Outcome 2 Duration of fever.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

'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.
Figuras y tablas -
Figure 2

'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.
Figuras y tablas -
Figure 3

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.
Figuras y tablas -
Figure 4

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.
Figuras y tablas -
Figure 5

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.
Figuras y tablas -
Figure 6

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.
Figuras y tablas -
Analysis 1.1

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.
Figuras y tablas -
Analysis 1.2

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.
Figuras y tablas -
Analysis 1.3

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.
Figuras y tablas -
Analysis 1.4

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.
Figuras y tablas -
Analysis 1.5

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.
Figuras y tablas -
Analysis 2.1

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.
Figuras y tablas -
Analysis 2.2

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.
Figuras y tablas -
Analysis 2.3

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.
Figuras y tablas -
Analysis 2.4

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.
Figuras y tablas -
Analysis 2.5

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.
Figuras y tablas -
Analysis 2.6

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.
Figuras y tablas -
Analysis 3.1

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.
Figuras y tablas -
Analysis 3.2

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.
Figuras y tablas -
Analysis 3.3

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.
Figuras y tablas -
Analysis 3.4

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.
Figuras y tablas -
Analysis 3.5

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.
Figuras y tablas -
Analysis 3.6

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.
Figuras y tablas -
Analysis 3.7

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.
Figuras y tablas -
Analysis 3.8

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.
Figuras y tablas -
Analysis 3.9

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.
Figuras y tablas -
Analysis 3.10

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.
Figuras y tablas -
Analysis 3.11

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.
Figuras y tablas -
Analysis 4.1

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.
Figuras y tablas -
Analysis 4.2

Comparison 4 Positive expiratory pressure plus routine treatment versus routine treatment alone, Outcome 2 Duration of fever.

Comparison 1. Chest physiotherapy plus routine treatment versus routine treatment alone

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

Figuras y tablas -
Comparison 1. Chest physiotherapy plus routine treatment versus routine treatment alone
Comparison 2. Active cycle of breathing techniques plus routine treatment versus routine treatment alone

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

Figuras y tablas -
Comparison 2. Active cycle of breathing techniques plus routine treatment versus routine treatment alone
Comparison 3. Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment

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]

Figuras y tablas -
Comparison 3. Osteopathic manipulative treatment plus routine treatment versus placebo plus routine treatment
Comparison 4. Positive expiratory pressure plus routine treatment versus routine treatment alone

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

Figuras y tablas -
Comparison 4. Positive expiratory pressure plus routine treatment versus routine treatment alone