Summary of findings 2. Cough augmentation therapy compared with standard care for people with neuromuscular diseases.

Cough augmentation therapy compared with standard care for people with neuromuscular disease
Patient or population: participants with chronic neuromuscular diseases Settings: – Intervention: cough augmentation therapy Comparison: standard care
Outcome	Summary of results	No of participants (studies)	Certainty of the evidence (GRADE)	Comments
Number of unscheduled hospital admissions for 'maintenance' therapy	No study reported the number of unscheduled admissions.			1 parallel‐group RCT of manual breathstacking compared to standard care (67 participants) planned to measure these outcomes; however, only an abstract is available and data are not fully reported (Katz 2019). Lack of quantitative data precludes assessment of precision.
Duration of hospital stay (days) for 'rescue' therapy	No study reported the duration of hospital stay.
Quality of life for 'maintenance' therapy	No study reported quality of life
Peak cough flow for 'rescue' or 'maintenance' therapy	No study reported peak cough flow
Any adverse events for 'rescue' and 'maintenance' therapy Follow‐up: 2 years	1 parallel‐group RCT reported that no adverse events had occurred during the 2‐year study, but this outcome was not quantitatively reported and it was unclear how it was measured.	67 (1 study)	⊕⊝⊝⊝ Verylowa	We are unable to draw a conclusion.
Quality of life for 'maintenance' therapy	No study reported quality of life.			1 parallel‐group RCT of manual breathstacking compared to standard care (67 participants) planned to measure quality of life; however, only an abstract is available and data are not fully reported (Katz 2019).
Participant preference or satisfaction for 'rescue' or 'maintenance' therapy	No study measured or reported participant preference.
*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). CI: confidence interval; RCT: randomised controlled trial.
GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate.

^aDowngraded three times, twice for study limitations and once for imprecision. Data were from one parallel‐group RCT, with high risk of performance and reporting bias. This outcome was not quantitatively reported and unclear how it was measured. Lack of quantitative data precludes assessment of precision but the trial was small (67 participants).