Oxygen transport: a physiologically-based conceptual framework for the practice of cardiopulmonary physiotherapy

Abstract

In this era of quality assurance and cost effectiveness, physiotherapy management of cardiopulmonary conditions needs to be aligned with the physiologic and scientific literature, which current practice does not reflect. This article presents a conceptual framework for practice based on oxygen transport, and describes five factors that contribute to the lack of efficacy of conventional chest physiotherapy with special reference to manual chest percussion.

First, the theoretical conceptualisation of chest physiotherapy primarily based on secretion clearance and its purported clinical goal of improved ventilation is no longer tenable. This focus is too narrow in that it fails to address oxygen transport as a whole.

Second, sputum production is a highly questionable measure of treatment outcome. Its relationship with pulmonary function and gas exchange overall is inconsistent.

Third, the potent physiologic effects of body positioning and mobilisation/exercise can explain treatment effects that are frequently attributed to conventional chest physiotherapy.

Fourth, chest physiotherapy is associated with various adverse side effects.

Fifth, the literature supports the use of judicious as opposed to routine positioning and mobilisation/exercise as primary interventions to remediate acute as well as chronic cardiopulmonary dysfunction or minimise its threat.

If cardiopulmonary physiotherapy is to be an essential physiologically-based specialty in this area of accountability, practice must be aligned with the physiologic and scientific literature and continually updated with the integration of new knowledge.