Submitted on March 11, 2003
Accepted on May 7, 2003
Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration and shaking in an animal model
Wai Pong Wong1*, Jennifer D Paratz2, Kathy Wilson3, and Yvonne R Burns4
1 Department of Physiotherapy, Singapore General Hospital, Singapore; Department of Physiotherapy, University of Queensland, Brisbane, Queensland, Australia
2 Physiotherapy Department, Alfred Hospital, Prahran, Victoria, Australia; School of Physiotherapy, La Trobe University, Victoria, Australia
3 Cardiac Research Theatre, The Prince Charles Hospital, Queensland, Australia
4 Department of Physiotherapy, University of Queensland, Brisbane, Queensland, Australia
* To whom correspondence should be addressed. E-mail: gpywwp{at}sgh.com.sg.
Chest clapping, vibration and shaking were studied in 10 physiotherapists who applied these techniques on an anesthetized animal model. Hemodynamic variables (such as heart rate, blood pressure, pulmonary artery pressure and right atrial pressure) were measured during the application of these techniques to verify claims of adverse events. In addition, expired tidal volume and peak expiratory flow rate were measured to ascertain effects of these techniques. Physiotherapists in this study applied chest clapping at a rate of 6.2 ± 0.9 Hz, vibration at 10.5 ± 2.3 Hz and shaking at 6.2 ± 2.3 Hz. Using these rates, esophageal pressure swings of 8.8 ± 5.0 mm Hg, 0.7 ± 0.3 mm Hg and 1.4 ± 0.7 mm Hg resulted from clapping, vibration and shaking respectively. Variability in rates and "forces" generated by these techniques was below 20% in average coefficients of variation. In addition, clinical experience accounted for 76% of the variance in vibration rate (p = 0.001). Cardiopulmonary physiotherapy experience and layers of towel used explained about 79% of the variance in clapping "force" (p = 0.004), while age and clinical experience over 80% of variance in shaking "force" (p = 0.003). Application of these techniques by physiotherapists was found to have no significant effects on hemodynamic and most ventilatory variables in this study. From this study, we conclude that chest clapping, vibration and shaking can be 1) consistently performed by physiotherapists, 2) are significantly related to physiotherapists' characteristics particularly clinical experience and 3) caused no significant hemodynamic effects.
