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Guidelines for the Physiotherapy Management of the Adult, Medical, Spontaneously Breathing Patient

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Guidelines for the Physiotherapy Management of the Adult, Medical, Spontaneously Breathing Patient Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient Julia Bott, Sharron Blumenthal, Maria Buxton, Sheric Ellum, Caroline Falconer, Rachel Garrod, Alex Harvey, Tracey Hughes, Melanie Lincoln, Christine Mikelsons, Catherine Potter, Jennifer Pryor, Lesley Rimington, Frances Sinfield, Catherine Thompson, Pamela Vaughn, John White On behalf of the British Thoracic Society Physiotherapy Guideline Development Group, a subgroup of the British Thoracic Society Standards of Care Committee, and the Association of Chartered Physiotherapists in Respiratory Care, a clinical interest subgroup of the Chartered Society of Physiotherapy Contents Volume 64 Number Suppl I | THORAX May 2009 Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient Guideline development group Section 7 Physiotherapy workforce i1 considerations Journal of the British Thoracic Society i42 Impact Factor: 6.226 Summary of recommendations Editor-in-Chief i2 Introduction Conclusion J A Wedzicha (UK) Editor i2 Chronic obstructive pulmonary disease (COPD) i43 S L Johnston (UK) Associate Editors i3 Asthma and disordered breathing References P M A Calverley (UK) i43 M Dusmet (UK) D A Lomas (UK) i3 Cystic fibrosis J S Elborn (N Ireland) D M Mannino (USA) J M FitzGerald (Canada) F D Martinez (USA) i5 Non-cystic fibrosis-related bronchiectasis Appendices J A Fleetham (Canada) C Robertson (Australia) i49 Appendix A Glossary of physiotherapy terms N M Foley (UK) B Schonhofer (Germany) i5 Restrictive lung conditions I Hall (UK) G A Silvestri (USA) i51 Appendix B Algorithm for the management of R Hubbard (UK) G I Town (New Zealand) i6 Neuromuscular diseases and musculoskeletal patients with neuromuscular weakness J R Hurst (UK) M K B Whyte (UK) disorders of the chest wall Statistical Editors i51 Appendix C Instructions for performing cough R Newson (UK) i7 Conclusion peak flow measurements in patients with T M McKeever (UK) L Tata (UK) neuromuscular weakness Images Editors Introduction and background to the J M FitzGerald (Canada) Online appendices J R Mayo (Canada) guidelines J C Hogg (Canada) i7 Purpose of the guidelines 1 Complementary therapies Letters Editor J R Hurst (UK) i7 A brief history of respiratory physiotherapy and 2 Example of an evidence table Lung Alert Editors A Bhowmik (UK) its relationship to the BTS 3 Patient information leaflet COPD J Quint (UK) President, British Thoracic Society Guideline development 4 Patient information leaflet asthma P Ormerod i8 Patient information leaflet hyperventilation Editorial Office 5 BMJ Publishing Group Ltd, BMA House, syndrome Tavistock Square, London WC1H 9JR, UK Section 1 Chronic obstructive T: +44 (0)20 7383 6147 6 Patient information leaflet bronchiectasis F: +44 (0)20 7383 6668 pulmonary disease (COPD) E: [email protected] i9 7 Patient information leaflet chest wall disease ISSN: 0040-6376 (print) 8 Patient information leaflet spinal cord injury ISSN: 1468-3296 (online) Section 2 Asthma and disordered Disclaimer: Thorax is owned and published by the 9 Patient information leaflet neuromuscular disease British Thoracic Society and BMJ Publishing Group breathing (hyperventilation syndrome) Ltd, a wholly owned subsidiary of the British Medical i15 Section 2a Asthma 10 Action plan for patients with neuromuscular Association. The owners grant editorial freedom to the Editor of Thorax. i17 Section 2b Disordered breathing weakness Thorax follows guidelines on editorial independence produced by the World Association of Medical Editors (hyperventilation syndrome and vocal cord 11 Devices, manufacturers and suppliers of and the code on good publication practice of the Committee on Publication Ethics. dysfunction) physiotherapy equipment Thorax is intended for medical professionals and is provided without warranty, express or implied. Section 3 Cystic fibrosis StatementsintheJournalare theresponsibility oftheir Available at: authors and advertisers and not authors’ institutions, i18 the BMJ Publishing Group Ltd, the British Thoracic Society or the BMA unless otherwise specified or http://thorax.bmj.com/content/vol64/issueSupplI determined by law. Acceptance of advertising does Section 4 Non-cystic fibrosis-related not imply endorsement. http://www.brit-thoracic.org.uk To the fullest extent permitted by law, the BMJ bronchiectasis Publishing Group Ltd shall not be liable for any loss, injury or damage resulting from the use of Thorax or i25 anyinformationin it whetherbasedoncontract, tortor otherwise. Readers are advised to verify any information they choose to rely on. Section 5 Restrictive lung conditions This journal is a member of and subscribes to the principles of the Copyright: E2009 BMJPublishingGroupLtdandthe i31 British Thoracic Society. All rights reserved; no part of Committee on Publication Ethics this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, Section 6 Neuromuscular diseases and www.publicationethics.org.uk electronic, mechanical, photocopying, recording or otherwise without the prior permission of Thorax. musculoskeletal disorders of the chest Thorax is published by BMJ Publishing Group Ltd, typeset by The Charlesworth Group and printed in the wall UK on acid-free paper by Latimer Trend & Co Ltd, Plymouth. i32 Section 6a Chest wall disorders Thorax (USPS No: 002–143) is published monthly by BMJ Publishing Group and distributed in the USA by i33 Section 6b Spinal cord injuries SPP, 75 Aberdeen Road, Emigsville, PA 17318, USA. Periodicals postage paid at Emigsville, PA, USA. i37 Section 6c Neuromuscular disease POSTMASTER: send address changes to Thorax,PO Box 437, Emigsville, PA 17318–0437, USA. Joint BTS/AC.PRC guideline Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient J Bott, S Blumenthal, M Buxton, S Ellum, C Falconer, R Garrod, A Harvey, T Hughes, M Lincoln, C Mikelsons, C Potter, J Pryor, L Rimington, F Sinfield, C Thompson, P Vaughn, J White, on behalf of the British Thoracic Society Physiotherapy Guideline Development Group c Additional Appendices are GUIDELINE DEVELOPMENT GROUP Section 3—Cystic fibrosis published online at http://thorax. On behalf of the Association of Chartered bmj.com/content/vol64/ Steering group Physiotherapists in Cystic Fibrosis issueSupplI and http://www. Julia Bott (Chair), support to Section 6, Consultant brit-thoracic.org.uk Physiotherapist, Surrey PCT NW Locality Penny Agent, Service Lead Physiotherapist, Royal Brompton & Harefield NHS Trust Sheric Ellum, support to Section 5, Consultant Physiotherapist, Guy’s & St Thomas’ NHS Trust, Gillian Davie, Senior I Physiotherapist, Cystic Correspondence to: London Fibrosis Team, Aberdeen Royal Infirmary [email protected] Dr Rachel Garrod, support to Section 1, Reader, Mary Dodd, Consultant Physiotherapist in School of Physiotherapy, Faculty of Health and Cystic Fibrosis, University Hospital of South Social Care Sciences, Kingston University and St Manchester NHS Foundation Trust Received 19 November 2008 Dr Sarah Elkin, Respiratory Physician, St Mary’s Accepted 15 February 2009 George’s, University of London. Dr Jennifer Pryor, support to Sections 3 and 4, Hospital, London Senior Research Fellow in Physiotherapy, Royal Tracey Hughes (Chair), Senior I Physiotherapist, Brompton & Harefield NHS Trust Leeds Regional Adult Cystic Fibrosis Unit, Leeds Dr Lesley Rimington, support to Section 2, Teaching Hospitals NHS Trust Lecturer School of Health and Rehabilitation, Margaret MacLeod, Senior I Physiotherapist, Keele University Cystic Fibrosis Team, Aberdeen Royal Infirmary Nicola Mills, Senior I Physiotherapist, Adult Cystic Fibrosis Unit, University Hospitals of Section 1—COPD Leicester Sharon Baines, Clinical Specialist Physiotherapist, Chronic Lung Disease Service, NHS Central Lancashire Section 4—Non-cystic fibrosis-related Amanda Dryer, Physiotherapy Clinical Lead in bronchiectasis Respiratory Care, Central Manchester and Alex Harvey (Co-Chair), Lecturer in Manchester Children’s University Hospital Physiotherapy, Brunel University Robert Goddard, Superintendent Physiotherapist, Fran Sinfield (Co-Chair), Superintendent County Durham and Darlington NHS Foundation Physiotherapist, Oxford Centre for Respiratory Trust Medicine, The Churchill Hospital, Oxford Catherine Thompson, Senior Lecturer, York St Dr Robert Wilson, Respiratory Physician, Royal John University Brompton & Harefield NHS Trust Dr John White (Chair), Respiratory Physician, York Hospitals NHS Trust Section 5—Non-obstructive/restrictive lung diseases Section 2—Asthma and disordered breathing Debbie Dykes, Clinical Specialist Respiratory Caroline Falconer (Co-Chair), Senior Physiotherapy, St. Richards Hospital, Royal West Physiotherapist, Papworth Hospital NHS Sussex NHS Trust, Chichester Foundation Trust Katie Ford, Team Lead, Respiratory Lianne Jongepier, Respiratory Specialist Physiotherapy, Bristol Royal Infirmary, Bristol Physiotherapist, Service Lead COPD Team, Rachael Mitchell, Specialist Respiratory Primary Care Centre, Colchester Physiotherapist, Luton and Dunstable Hospital Melanie Lincoln (Co-Chair), Team Leader NHS Foundation Trust Physiotherapist, Papworth Hospital NHS Catherine Potter (Chair), Specialist Respiratory Foundation Trust Physiotherapist, The Whittington Hospital NHS Christine Mikelsons, Consultant Respiratory Trust, London Physiotherapist, Royal Free Hospital Fiona Rushmer, Physiotherapy Manager, Dr Mike Thomas, General Practitioner, Asthma Ashtead
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