Summary of findings 5. CCPT versus AD.
| CCPT compared with AD for cystic fibrosis | ||||||
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Patient or population: children and adolescents with cystic fibrosis Settings: outpatient Intervention: CCPT Comparison: AD | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| AD | CCPT | |||||
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FEV1: % predicted Follow‐up: medium term (8 weeks) and long term (12 months) |
Mean FEV1 % predicted was 1.81% higher in the CCPT group than the AD group (2.52% lower to 6.14% higher). | NA | 54 (2) |
⊕⊝⊝⊝ Very lowa,b |
There was no difference in FEV1 % predicted between groups. | |
|
FVC: % predicted Follow‐up: medium term (8 weeks) and long term (12 months) |
Mean FVC % predicted was 0.39% higher in the CCPT group than the AD group (3.62% lower to 4.40% higher). | NA | 54 (2) |
⊕⊝⊝⊝ Very lowa,b |
There was no difference in FVC % predicted between groups. | |
|
FEF25–75: % predicted Follow‐up: medium term (8 weeks) and long term (12 months) |
Mean FEF25–75 % predicted was 2.23% higher in the CCPT group than the AD group (8.96% lower to 13.42% higher). | NA | 54 (2) |
⊕⊝⊝⊝ Very lowa,b |
There was no difference in FEF25–75 % predicted between groups. | |
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Respiratory exacerbations: number of respiratory exacerbations per year Follow‐up: long term (12 months) |
— | No studies reported number of respiratory exacerbations per year. 1 long‐term study reported slightly more hospital admissions in the CCPT group than the AD group (MD 0.24, 95% CI 0.06 to 0.42; P = 0.008) (McIlwaine 2010). There was a discrepancy here between our analysis and the results reported in the paper. Our analysis showed a difference favouring the AD group (mean number of admissions was 1 vs 0.76). It was unclear if this is a clinically important difference. |
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| QoL | — | Not reported | ||||
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Adherence to therapy and individual preference Follow‐up: long term (12 months) |
Adherence not reported. Individual preference: there was a preference for AD in all participants who subjectively considered it worked best, gave increased expectoration and gave more independence and freedom. |
Not available | 36 (1) |
⊕⊝⊝⊝ Very lowa,b |
Only the first arm of the study was reported as a high proportion of participants allocated to AD for the first phase either refused to switch to CCPT for the second phase or incorporated AD breathing technique into their CCPT treatment (cross‐over effect). Results reported narratively from the original study paper (McIlwaine 2010). |
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| Mucus weight | — | Not reported | ||||
| *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). AD: autogenic drainage; CCPT: conventional chest physiotherapy; CI: confidence interval; FEF25–75: average forced expiratory flow between 25% and 75% of FVC; FEV1: forced expiratory volume at 1 second; FVC: forced vital capacity; MD: mean difference; NA: not applicable; QoL: quality of life. | ||||||
| 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 the studies. b Downgraded once due to imprecision from small numbers of participants in the individual studies and overall.