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Physiotherapy differences worldwide and prognosis

In the USA, CF patients are treated from the first year of life with a vibration vest, that should lead to a better coughing up of the mucus via mechanical support. In Germany this is not recommended. Why are the opinions so different? Are there any studies/data about the question if such a mechanical vibration leads to an improvement or to a worsening of the lung function? How is it justified here in our country, that those vests are not recommended? Are there any differences in the prognosis of CF patients in the USA and Germany?
indeed the physiotherapeutical treatment strategies vary from country to country. The reasons are diverse, however are for sure connected, concerning the USA, to different law systems and other ethical beliefs about how close the body contact during a treatment can be.
In using the vibration vest, there is no body contact between the therapist and the patient, therefore it is widely used in the USA.
Manual vibrations and copmpression on the other hand, that are standard in Europe in treating babies and toddlers, have a much closer body contact between therapist and patient.
Therefore here, the manual vibrations, that are taught from the CF therapist also to the parents and should then also be regularly performed by them, opposite the vibration vest.
In addition, the vibrations alone do not represent a good therapy. A comparative study with the PEP-mask, that is nearly identical to the freuqently usded Pari-PEP system in Germany, was able to show a clear superiority of the PEP-mask compared to "the vest". (Canadian national airway clearance study: positive expiratory pressure mask versus high frequency chest wall oscillation; M. McIlwaine

PEP means "positive expiratory pressure": in the expiration phase it comes to a positive counterpressure, that keeps the airways wide and leads therefore to a better airing of the lung and a better transport of secretions.
In the above cited multicenter randomized Canadian trial of the year 2012, 107 patients were included, who used for one year either the vest or the PEP-mask. Then the number of exacerbations was investigated.
It could be shown that in the group using the PEP-mask significantly fewer exacerbations occurred compared to the group using the vest.
This result should not be underestimated, as it deals with a well performed long-term study.
This principle of PEP breathing is in Germany introduced very early into the treatment of toddlers: in the form of blowing games, bubbling water or later via airway therapy devices like RC-Cornet, Flutter or the mentioned Pari PEP system.
With this, the passive technique of manual vibration is completed as early as possible by an acitve breathing technique, the priciple of PEP-breathing, with a good data base for the PEP mask.
I hope to have answered your question satisfyingly.
Best regards,
B. Dittmar