A Cochrane review [Abstract] 1 included 6 studies with a total of 434 adult subjects with pneumonia. The studies appraised four types of chest physiotherapies (i.e. conventional chest physiotherapy, active cycle of breathing techniques, osteopathic manipulative treatment and positive expiratory pressure). None of the physiotherapies compared to placebo or no physiotherapy improved mortality rates. Conventional chest physiotherapy compared to no physiotherapy, active cycle of breathing techniques compared to no physiotherapy, and osteopathic manipulative treatment compared to placebo, did not increase the cure rate or chest X-ray improvement rate. Osteopathic manipulative treatment compared to placebo (MD -2.0 days, 95% CI -3.5 to -0.6 days) and positive expiratory pressure compared to no physiotherapy (MD -1.4 days, 95% CI -2.8 to -0.0 days) reduced the mean duration of hospital stay. Conventional chest physiotherapy and active cycle of breathing techniques did not. Positive expiratory pressure compared to no physiotherapy reduced fever duration (MD -0.7 day, 95% CI -1.4 to -0.0 days). Osteopathic manipulative treatment did not. Osteopathic manipulative treatment compared to placebo reduced duration of intravenous (MD -2.1 days, 95% CI -3.4 to -0.9 days) and total antibiotic treatment (MD -1.9 days, 95% CI -3.1 to -0.7 days).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding, and inadequate intention-to-treat adherence ) and by imprecise results (limited study size for each comparison).
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