Routine chest physiotherapy is not more effective than usual supportive care in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis: A systematic review

  • Anri Human
  • Karien Mostert-Wentzel


Purpose: To determine the effectiveness of chest physiotherapy (percussion, postural drainage and suctioning) in non-ventilated paediatric bronchiolitis patients aged 0 to 24 months.

Background: The field of paediatric cardiopulmonary physiotherapy has a limited evidence base and findings from this study may assist in choosing effective treatment options.

Methods: The follow ing databases were reviewed by making use of a specified search strategy: African Health Line, CINAHL, Cochrane, Ebsco-Host, E-theses/dissertations, PEDro, Medline Ovid, Sabine!, Science Direct and Up-To­ Date. Pre-set eligibility criteria were applied to the article title and/or abstract and full-text. Appraisal tools (CASP and PEDro scale) were used to evaluate and score the included studies. A qualitative synthesis was done as a meta­ analysis was not possible.

Results: Evidence does not support routine chest physiotherapy in uncomplicated viral bronchiolitis in non-ventilated paediatric  patients. Chest physiotherapy does not have a significant influence on various outcomes measures.

Conclusion:  Routine chest physiotherapy should not be prescribed for  non-ventilated paediatric patients with bronchiolitis.


Barben, J., Kuehni, C.E., Trachsel, D., & Hammer, J. (2008).

Management of acute bronchiolitis: can evidence-based

guidelines alter clinical practice? Thorax ,63, 1103-1109.

Bhogal, S.K., Teasel!, R.W., Foley, N.C., &Speechley, M.R. (2005). The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad Scale in stroke rehabilitation literature. Journal of Clinical Epidemiology, 58,668-673.

Bleakley, C.M. (2008). PEDro scores were based on information in the paper.Australian Journal of Physiotherapy, 54(4),289.

Bohe, L., Ferrero, M.E., Cuestas, E., Polliotto, L., Genoff, M. (2004).1ndicacion de Iafisioterapiarespiratoriaconvencional en Ia bronquiolitisaguda .[lndications of conventional chest physiotherapy in acute bronchiolitis).Medicina (BuenosAires), 64(3), 1g8-200.

Cour iel, J. (1999).Non-asthma airway problems in

children. Medicine (UK ed.),27(9), 49-53.

Goldsmith, M.R ., Bankhead , C.R ., & Austoker, J . (2007). Synthesising quantitative and qualitative research in evidence-based patient information.Journal of Epidemiology and Community Health, 61, 262-270 .

Green, R.J., Zar, H.J., Jeena, P.M., Madhi, S.A., & Lewis, H. (201O). South African guideline for the diagnosis, management and prevention of ]acute viral bronchiolitis in children. South African Medical Journal, 100(5),320-325

Jeena, P.M. (2004). Role of respiratory Syncytial Virus in Bronchiolitis: current and future management options. The Specialist Forum,4(7),30-42.

Kercsmar, C.M.(2003). Current trends in neonatal and paediatric respiratory care: conference summary. Respiratory Care, 48(4), 459-464.

Maher, C.G., Sherrington, C., Herbert, R.D., Moseley, A.M., & Elkins, M. (2003).Reliability of the PEDro scale forrating Quality of Randomised Control Trials.Physical Therapy, 83(8), 713-719.

Martin6n-Torres, F., Rodriguez Nunez, A., &Martin6n Sanchez, J .M. (2001). La bronquiolitisaguda: evaluaci6n de Ia terapiabasada en Ia evidencia. [Acute bronchiolitis:evaluation of evidence-based therapy). AnalesEspanoles de Pediatria, 55(4 ), 345-54.

Moseley, A .M., Herbert, R.D., Sherrington, C., & Maher, C.G. (2002). Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physiotherapy,48,43-49.

Nicholas, K.J., Dhouieb, E.M.O., Marshall, T.G., Edmunds, A.T., & Grant,M.B.(1999).An evaluation of chest physiotherapy in the management of acute bronchiolitis: Changing clinical practice. Physiotherapy, 85(12).669-674.

Piedra, P.A., & Stark, A.R. (2009).Treatment, outcome, and prevention of bronchiolitis in infants and children. Retrieved April23, 2009, from

Perotta,C.,Ortiz,Z..& Roque, M.(2008).Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old (rev.). Cochrane Database of Systematic Reviews, lssue4.