The Effect of Several Physiotherapeutic Interventions on Tracheobronchial Clearance.

The Effect of Several Physiotherapeutic Interventions on Tracheobronchial Clearance

van Hengstum M. Amsterdam, the Netherlands 1013 LG, Thesis Publishers, 1990, paperback, 96 pp, illus, $17. There is no explicit purpose stated in the introduction to this short text, but its focus is to evaluate and present a case for the forced expiratory technique to replace more traditional types of respiratory care. The audience for whom the text is intended is not stated, but it could be used by all health professionals involved in respiratory care. The text is largely a series of small studies comparing the forced expiratory technique with various aspects of respiratory care on different groups of patients. In the introduction, the author would have us accept the premise that all efforts to mobilize secretions are best evaluated by measuring tracheobronchial clearance. This is a premise to which not all who work in respiratory care would ascribe. Chapter 2 describes a technique by which the author measured tracheobronchial clearance rates in 10 subjects without respiratory problems in order to establish the variability of clearance within and across subjects. Chapters 3 through 5 compare the forced expiratory technique with conventional physical therapy, positive expiratory pressure mask breathing, and oral high-frequency oscillation breathing, respectively. Chapter 6 describes the use of tracheobronchial clearance measurement to compare the forced expiratory technique when used with several inhalation solutions. Chapter 7 examines tracheobronchial clearance in five patients with Kartagener syndrome, and chapter 8 determines that sauna has no effect on tracheobronchial clearance in five patients with chronic bronchitis. The text ends with a two-page final discussion and a three-page summary. The material is adequately written and is very understandable. Figures are reproduced well, with the exception of several in chapter 7. It is difficult to recommend for or against this text, as it is not really a text but a compilation of studies. This reviewer believes that the scientific validity and research methods used would have difficulty being accepted in a refereed journal such as Physical Therapy. One of the major deficits in each study is the very small number of subjects. Chapter 2 had 10 subjects without respiratory problems with a mean age of 27 years, from whom the author makes global claims about tracheobronchial clearance. Chapter 3 used a total of 8 subjects from two distinctly different populations. Chapters 4 through 6 used 8 subjects, chapter 7 had 6 subjects, and chapter 8 used 5 subjects. It seems unusual for a group of studies such as those that appear in this text not to have been submitted to an appropriate journal for peer review. I believe the material could have been strengthened by this type of submission, and I question the publication in book format. The only audience for whom this text would have some interest and by whom the text should be considered include those working in, teaching about, and pursuing research in respiratory care. The text should also be considered for libraries in colleges and universities that house a physical therapy program. Jan Stephen Tecklin, PT Beaver College Glenside, Pa