Physiotherapeutic approaches

Question

Hello,

I keep reading in American CF forums about therapeutic approaches that are not practiced in Germany (anymore?), as for instance using the Vest® or tapping patients with special percussion cups. Upon inquiry, I was told that autogenic drainage was known but considered by far not as effective by Americans. Our (German) physiotherapist claims the opposite and says Europe/Germany is more advanced in physiotherapy.

Are these just two opposing views or are there actually any figures/study results backing the different claims?

Many thanks for your advice!

Answer

Hello,

to begin with, I would like to say that the existing difference between physiotherapeutic techniques used in the U.S. and Germany is certainly due to cultural differences:

When using the Vest® or applying certain percussion devices, there is no physical contact between therapist and patient, whereas autogenic drainage, which is often combined with manual vibrations and compressions, requires much closer physical contact between therapist and patient. This would not be feasible as such in the U.S.

I am not aware of a comparative study of autogenic drainage and the Vest®; however, a comparative study of the PEP mask, which is very similar to the Pari®-PEP system combined quite frequently with autogenic drainage in Germany, and the Vest® has just been presented in June at the European CF Congress in Dublin. (Canadian national airway clearance study: positive expiratory pressure mask versus high frequency chest wall oscillation; M. McIlwaine et.al)

This multi-centre, controlled, randomized Canadian study included 107 patients who had been using either the Vest® or the PEP mask for a year and examined the number of respiratory infections that occurred. The result was that the group with the PEP mask showed significantly fewer exacerbations than the group with the Vest®. This outcome should not be underestimated, given that this was a long-term study with a large patient cohort.

I hope I could answer your question at least partially.

Kind regards,
B. Dittmar
Chairperson, pysiotherapy working group, Mukoviszidose e.V. (German CF patient association)

01.08.2012