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A Comparison of the Therapeutic Effectiveness

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A Comparison of the Therapeutic Effectiveness A COMPARISON OF THE THERAPEUTIC EFFECTIVENESS AND ACCEPTANCE OF CONVENTIONAL POSTURAL DRAINAGE AND PERCUSSION, INTRAPULMONARY PERCUSSIVE VENTILATION AND IDGH FREQUENCY CHEST WALL COMPRESSION IN HOSPITALIZED PATIENTS WITH CYSTIC FIBROSIS A Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Sarah Meredith Varekojis, B.S. ***** The Ohio State University 1998 Master's Examination Committee: Approved by Mr. F. Herbert Douce, Adviser Dr. Phil Hoberty Adviser Dr. Karen McCoy School of Allied Medical Professions ABSTRACT A significant clinical manifestation of cystic fibrosis is abnormally abundant and viscous bronchial secretions. This leads to obstruction of bronchi in the lungs and predisposes the individual to chronic pulmonary infections. Bronchopulmonary hygiene is an essential part of the care of a patient with cystic fibrosis in order to enhance mucociliary clearance. Currently, several modalities of therapy are available, including high frequency chest wall compressions (HFCC), intrapulmonary percussive ventilation (IPV) and conventional postural drainage and percussion (PD&P). This study was designed to directly compare the sputum produced with HFCC, IPV and PD&P. Twenty-seven hospitalized patients were recruited for the study. Each patient received two consecutive days of each form of therapy in random order. All therapies were delivered three times a day for thirty minutes. Any sputum produced during the treatment time was expectorated and collected. Sputum was collected for a total of sixty minutes: fifteen minutes before the treatment during aerosol delivery, during the thirty minute treatment and for fifteen minutes post therapy. Sputum expectorated during each session was weighed wet and then dried and weighed again. The mean wet weight for HFCC was 4.95 (4.00) grams, IPV was 6.77 (5.77) grams and PD&P was 5.10 (5.56) ii grams. The mean dry weight for HFCC was 0.25 (0.17) grams, IPV was 0.38 (0.44) grams and PD&P was 0.33 (0.27) grams. Mean weights were analyzed using ANOVA with repeated measures. The mean wet sputum weight results approached statistical significance with p=0.050. The mean dry sputum weight results were not statistically significant with a p=0.140. Based on this study, it can be concluded that HFCC and IPV are at least as effective as conventional PD&P for the hospitalized patient with cystic fibrosis. The participants were also asked to complete a questionnaire regarding their feelings about the comfort, convenience, ease of use and efficacy of each of the modalities. The majority of respondents felt IPV and PD&P were somewhat or very comfortable, while they were divided on the comfort of HFCC. Almost all participants felt the three therapies were convenient and easy to use. PD&P and IPV were considered more effective than HFCC. The results of this study suggest that each patient needs to determine the correct balance of comfort, convenience, ease and efficacy for themselves when selecting a bronchopulmonary hygiene modality. iii Dedicated to all those afflicted with cystic fibrosis IV ACKNOWLEDGMENTS I wish to thank all the members of my committee for their expertise, patience and support. I appreciate your taking the time to guide me through this process. Also thanks to Jill Clutter for her statistical assistance and her suggestions and reassurance. I want to extend an additional thank-you to Dr. Robert Castile for his assistance with the protocol development and for his willingness to collaborate on this project. Also, thanks to Christa Williams and Tina Armstrong for their help getting this project off its feet. I also want to commend the respiratory care staff and the nursing staff at Columbus Children's Hospital for the wonderful job they did working with the participants. They were willing to follow the protocols and were an instrumental factor in the success of the study. Thank-you to my friends and family, especially to Marie Bontempo for encouragement and to my parents for confidence and emotional support. To my husband Mark, I thank you for your patience and understanding, your support and most importantly your unconditional love. v VITA February 16, 1973 ..................................... Born - Cincinnati, Ohio 1995 - 1997 ............................................... Respiratory Therapist Columbus Children's Hospital Columbus, Ohio 1996 .......................................................... B.S., The Ohio State University Columbus, Ohio 1996 - 1998 ............................................... Graduate Teaching Associate The Ohio State University Columbus, Ohio FIELDS OF STUDY Major Field: Allied Medical Professions Vl TABLE OF CONTENTS ~ Abstract. .......................................................................................................................... ii Dedication ...................................................................................................................... .iv Acknowledgments ............................................................................................................ Y Vita ................................................................................................................................. Yi List ofTables .................................................................................................................. ix Chapters: 1. Introduction ................................................................................................................ .1 Background .......................................................................................................... 1 Significance and Purpose of the Study .................................................................. .3 Research Questions ............................................................................................... 4 Definition of Terms ............................................................................................... 5 2. Literature Review ........................................................................................................ 6 3. Methods .................................................................................................................... 11 Research Design ................................................................................................. .! 1 Subject Selection ................................................................................................ .12 Methods ............................................................................................................. .13 Data Analysis ...................................................................................................... 17 4. Results ...................................................................................................................... .18 Wet and Dry Sputum Weights ............................................................................. 19 General Perceptions of Therapy .......................................................................... 20 Perceptions of Effectiveness and Sputum Weights ............................................... 23 Vil Demographic Information ................................................................................... 24 5. Summary and Conclusions ......................................................................................... 26 Summary ............................................................................................................ 26 Discussion of the Results .................................................................................... 27 Limitations .......................................................................................................... 30 Implications ........................................................................................................ 31 List ofReferences.......................................................................................................... 33 Appendix A .................................................................................................................... 3 S Appendix B ........................................................................................................ , ........... Al Appendix C .................................................................................................................... A7 Appendix D .................................................................................................................... 51 V111 LIST OF TABLES 3.1 Study Design ...................................................................................................... .14 4.1 Wet Sputum Weights (in grams) from three bronchopulmonary hygiene modalities ................................................................. 19 4.2 Dry Sputum Weights (in grams) from three bronchopulmonary hygiene modalities ............................. : ................................... 20 4.3 Participants perceptions of three bronchopulmonary hygiene modalities (all data expressed as percentage of respondents) ............................... 22 4.4 Participant comparisons of three bronchopulmonary hygiene modalities (all data expressed as percentage ofrespondents) ............................... 23 4.5 Ranked percent ofresponses for effectiveness of three bronchopulmonary hygiene modalities ................................................................. 24 4.6 Demographic information, reported as mean (SD), comparing study sample
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