Summary of findings 3. CCPT versus ACBT.
| CCPT compared with ACBT for cystic fibrosis | ||||||
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Patient or population: children and adults with cystic fibrosis Settings: outpatient Intervention: CCPT Comparison: ACBT (no studies compared to ACBT directly, but they compared with FET, which is a component of both CCPT and ACBT) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| ACBT | CCPT | |||||
|
FEV1: annual decline in FEV1 % predicted Follow‐up: 3 years |
There was no difference between groups in FEV1 % predicted (P = 0.09). | MD 2.80 (−0.39 to 5.99) | 63 (1) |
⊕⊝⊝⊝ Very lowa,b |
1 short‐term study concluded that directed coughing was as effective as CCPT. No data reported (Bain 1988). | |
|
FVC: annual decline in FVC % predicted Follow‐up: 3 years |
There was no difference between groups in FVC % predicted (P = 0.18). | MD 1.80 (−0.83 to 4.43) | 63 (1) |
⊕⊝⊝⊝ Very lowa,b |
1 short‐term study concluded that directed coughing was as effective as CCPT. No data reported (Bain 1988). | |
|
FEF25–75: annual decline in FEF25–75 % predicted Follow‐up: 3 years |
Annual decline in FEF25–75 was worse in the FET only group. | MD 6.00 (0.55 to 11.45) | 63 (1) |
⊕⊝⊝⊝ Very lowa,b |
1 short‐term study r concluded that directed coughing was as effective as CCPT. No data reported (Bain 1988). | |
|
Respiratory exacerbations: time to first exacerbation Follow‐up: 1.3−2.8 years |
See comment. | 1 study reported the number of hospital admissions for an exacerbation and found that 8 participants in the FET group had 15 admissions compared with 5 participants and 8 admissions in the CCPT group (RR 0.61, 95% CI 0.23 to 1.62; P = 0.32) (Reisman 1988). The same study also reported the number of days in hospital for respiratory exacerbations and found that 8 participants in the FET group spent 197 days in hospital compared to 5 participants spending 73 days in hospital. The original paper stated that there was no evidence of a difference (Reisman 1988). |
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| QoL: change in CFQ score | — | Not reported | ||||
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Adherence to therapy and individual preference: self‐reported scoring system. Follow‐up: 1.3–2.8 years |
64/67 participants were consistently compliant with their therapy. | NA | ⊕⊝⊝⊝ Very lowa,b |
No data available for analysis and so results were reported narratively. | ||
|
Mucus weight Follow‐up: NA |
See comment. | No data available for analysis for this outcome. 1 short‐term study reported no difference in mucus weight between CCPT and directed coughing group (Bain 1988). Similarly, a medium‐term study also reported no difference between groups (Steen 1991). |
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| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CCPT: conventional chest physiotherapy; CFQ: Cystic Fibrosis Questionnaire; CI: confidence interval; FEF25–75: average forced expiratory flow between 25% and 75% of FVC; FET: forced expiration technique; FEV1: forced expiratory volume at 1 second; FVC: forced vital capacity; IV: intravenous; MD: mean difference; NA: not applicable; QoL: quality of life; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
a Downgraded twice due to risk of bias within 1 study reporting on this outcome. There were particular concerns around incomplete outcome data reporting and withdrawals being biased towards CCPT. b Downgraded once due to imprecision from small numbers of participants from only 1 study.