Summary of findings 6. Autogenic drainage versus Flutter®.
| AD compared with Flutter®for CF | ||||||
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Patient or population: adults and children with CF Settings: outpatients Intervention: AD Comparison: Flutter® | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Flutter® | AD | |||||
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FEV1 (L) Follow‐up:up to 12 months. |
The mean FEV1 was 0.21 L higher (0.64 L lower to 1.21 L higher) in the AD group in the parallel study The mean FEV1 was 0.10 L higher (0.95 L lower to 1.15 L higher) in the AD group in the cross‐over study |
NA | 39 participants (2 studies including one cross‐over study)d | ⊕⊕⊝⊝ lowa,b | A significant deterioration in FEV1 (% predicted) was also observed for the cohort of the parallel study. |
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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. | |
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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). | |
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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 | ||
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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; 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. b. Downgraded once due to unclear risk of bias; 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. d. Data from the cross‐over study were analysed at the end of the first treatment period, before cross‐over occurred.