Physiotherapy interventions for the respiratory management of people with spinal cord injury: recommendations from an Australian and New Zealand clinical practice guideline

Abstract

Study design: Development of respiratory recommendations in a Clinical Practice Guideline (CPG).

Objectives: (i) To describe the evidence recommendations and consensus-based opinion statements for the effectiveness of respiratory interventions to improve respiratory muscle strength, lung volumes and secretion clearance. (ii) To outline the clinical rationale for these recommendations and statements.

Setting: Australia and New Zealand METHODS: Sixteen clinical questions relating to respiratory interventions for people with spinal cord injury (SCI) were presented in PICO format (Participant, Intervention, Comparison, Outcome) and decided a-priori by a respiratory guideline committee. Systematic reviews were conducted to answer each of the questions using rigorous methodology to synthesise evidence from randomised controlled trials. Evidence was assessed for risk of bias and quality using Grading of Recommendations Assessment Development and Evaluation (GRADE). Details were presented to a guideline panel who voted on each question and developed either an evidence recommendation or a consensus-based opinion statement.

Results: Eighteen randomised controlled trials met the inclusion criteria and were relevant for eight questions. Three of these trials had interventions and outcomes relevant to more than one question. Overall, ten, eight and two trials answered questions related to improving respiratory muscle strength, lung volumes and secretion clearance, respectively.

Conclusion: The Australian and New Zealand CPGs for the physiotherapy management of people with SCI ( www.sciptguide.com ) provide evidence recommendations and consensus-based opinion statements to inform respiratory management of people with SCI.