Active cycle of breathing techniques contributes to pain reduction in patients with rib fractures
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Active Cycle of Breathing Techniques Contributes to Pain Reduction in Patients with Rib Fractures Prospective Clinical Trial E.Grammatopoulou, V. Belimpasaki, A.Valalas, P. Michos, E. Skordilis, D. Koutsouki
Abstract Aim: The purpose of the study was to examine the effectiveness of the active cycle of breathing techniques (ACBT) in pain reduction and in preventing pulmonary complications in patients with rib fractures. Materials-Methods: Ninety (90) patients with rib fractures, aged from 45 to 75 years, (58.02, ± 9.55) were randomly assigned to the ACBT group (N = 45, performed the ACBT trial) and control group (N = 45). All patients received routine physiotherapy for 7 days. The dependent variables were: pain score during cough, body temperature and the number of white blood cells (WBC). Results: Multivariate analyses (2 x 7 MANOVA) were used for statistical analyses. Significant multivariate interaction between group and time was found (p < .05). The univariate post hoc analysis determined significant interaction for the pain (p < .01) and the number of WBC (p < .01). No significant interaction was found for body temperature (p > .05). Further significant pain differences between the two groups were evident οn day 3 (p < .05), day 4 (p < .01), day 5 (p < .01), day 6 (p < .01) and day 7 (p < .01). Conclusion: Overall, the ACBT appeared to reduce pain in patients with rib fractures but did not prevent pulmonary complications compared to routine physiotherapy
Keywords
Physiotherapy, Rib fractures, Pain, Atelectasis, Pneumonia.
Introduction The cornerstone of management for rib fractures is to provide adequate analgesia to the patients and to prevent pulmonary complications such as atelectasis and infection [1, 2]. Chest trauma initiates a circle of pain-infection requiring immediate treatment [3].
Department of Physical Education and Sport Sciences National and Kapodistrian University of Athens, Greece Department of Thoracic Surgery General Hospital of Attika-KAT Received 31/07/2009 Accepted 12/10/2009
Adequate analgesia and effective physiotherapy are all essential components in the management of rib fractures if complications are to be avoided [4, 5, 6, 7]. To this end, a variety of physiotherapy techniques (positioning, early mobilization, effective cough, the active cycle of breathing techniques (ACBT) and incentive spirometer training), is widely used [2, 8, 9, 10]. Positioning improves ventilation/ perfusion (V/Q) matching, increasing lung volumes, reduces the work of breathing and results in mucociliary clearance [8]. Early mobilization provides cardiopulmonary fitness and functional independence [2, 8]. Incentive spirometry is used to prevent and reverse lung atelectasis [2]. The ACBT is a cycle of relaxed diaphragmatic breathing (breathing control-BC) with deep and slow inspiration, thoracic expansion (TE) exercises and forced expiration technique (FET) [2, 4]. It can be adopted for all patients and is flexible, in terms of the sequence of BC, TE, and FET2. Deep and slow inspiration mechanism promotes
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