Summary of findings 4. Autogenic drainage versus positive expiratory pressure.
| AD compared with PEP for CF | ||||||
|
Patient or population: adults and children with CF Settings: outpatients Intervention: AD Comparison: PEP | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| PEP | AD | |||||
|
FEV1 (L) Follow‐up: up to 12 months |
The mean FEV1 was 2.02 L in the PEP group (also see comment). | The mean FEV1 was 0.62 L higher (0.30 L lower to 1.54 L higher) in the AD group (also see comment). | NA | 62 participants (3 studies) | ⊕⊕⊝⊝ lowa,b | Data were available for analysis for 26 participants from 1 study. A significant deterioration in FEV1 (% predicted) was also observed for the cohort of this study. In the other 2 studies, there was there was no significant difference between groups in terms of FEV1. |
|
QoL (SF‐36 and CRQ) Follow‐up: up to 12 months |
See comment. | NA |
30 participants (1 study) |
⊕⊕⊝⊝ lowa,c | There were no significant differences between groups in the mental and physical domains of the SF‐36. There were no significant differences between the dyspnoea, fatigue, emotion and mastery domains of the CRQ. | |
|
Participant preference Follow‐up: up to 12 months |
See comment. | NA |
30 participants (1 study) |
⊕⊕⊝⊝ lowa,c | 13 out of the total of 75 participants (all treatments in the study) withdrew as they did not like the treatment they were randomised to (not specified by intervention). | |
|
Exercise tolerance: modified shuttle test Follow‐up: up to 12 months |
See comment. | NA | NA | NA | No significant difference between groups. | |
| Adverse events | Not reported. | NA | NA | NA | ||
| Number of admissions to hospital | Not reported. | NA | NA | NA | ||
|
Need for extra treatment Follow‐up: up to 12 months |
See comment. | NA |
30 participants (1 study) |
⊕⊕⊝⊝ lowa,c | The median number of antibiotics courses per treatment group ranged from 1.0 to 1.5 (no further information given). | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is the event rate or mean risk in the control group unless otherwise stated. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AD: autogenic drainage; CRQ: Chronic Respiratory Questionnaire; CF: cystic fibrosis; CI: confidence interval; FEV1: forced expiratory volume in 1 second; NA: not applicable; PEP: positive expiratory pressure; QoL: quality of life; SF‐36: short form 36. | ||||||
| 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. | ||||||
a. Downgraded once due to imprecision; small numbers of participants included in the comparison. As results were not presented from paired analyses for one study, we treated the cross‐over studies as if they were parallel studies which is a conservative approach as it does not take into account within‐patient correlation. b. Downgraded once due to risk of bias; inconsistency between methods described and results reported regarding time for individuals to clear lungs and many elements of study designs not clearly described. c. Downgraded once due to risk of bias; by design, study cannot be blinded and lack of masking may have influenced subjective outcomes. Further no details of treatment used prior to baseline reported, which may also have influenced subjective outcomes.