Instrumental Respiratory Physiotherapy: Levels of evidence and clinical applications

Abstract

Instrumental Respiratory Physiotherapy (FRI) uses devices to improve lung function and quality of life in patients with respiratory diseases. Despite their effectiveness, it is crucial to evaluate the levels of evidence supporting each technique. An exhaustive bibliographic review was carried out in databases such as PubMed, Cochrane Library and PEDro, including systematic review articles, meta-analysis and randomized controlled clinical trials published in the last 10 years. Various FRI techniques were identified with different levels of evidence and clinical applications. Expiratory Positive Airway Pressure (EPAP) and Non-Invasive Mechanical Ventilation (NIV) showed strong evidence in the management of atelectasis, COPD and acute respiratory failure, respectively. High Frequency Oral Oscillation (HFO) presented moderate evidence in improving expectoration, while Continuous Positive Airway Pressure (CPAP) Therapy demonstrated strong evidence in the treatment of OSA. Other techniques such as Intermittent Positive Pressure (IPPV), Flutter/Acapella and Inspiratory Muscle Trainer also showed moderate evidence in various clinical applications. FRI offers a wide range of techniques with different levels of evidence for the management of various respiratory pathologies. The choice of the appropriate technique should be based on the available evidence, the specific condition of the patient and the therapeutic objectives. It is essential that respiratory physiotherapists stay up to date on advances in this field to provide quality, evidence-based care, optimizing clinical outcomes and improving patients' quality of life.