Impacto da fisioterapia nos diferentes tipos de bronquiolite, pacientes e locais de atendimento: revisão sistemática

| Bronchiolitis is defined as an acute episode of wheezing that occurs in the context of a respiratory condition, usually of viral origin, with a high incidence in children under 2 years of age. Considering that the role of physical therapy has been questioned in this context, it is paramount to clarify and differentiate the impact of different physical therapy techniques employed for each type of bronchiolitis, patient, and care settings. A systematic review was performed, searching the Science Direct, MEDLINE/PubMed, and SciELO databases on physical therapy techniques in children up to 2 years of age with a bronchiolitis episode. Six observational studies, 5 experimental studies without control group and 15 with control group, involving 3339 individuals were included. Fourteen studies use inpatient samples, six analyze hospital and ICU samples, and six studied outpatient samples.


CONCLUSÃO
A evidência sugere bons resultados das técnicas de fisioterapia, nomeadamente DRR, ELPr e AFE ou TP, na permeabilização das vias aéreas, na promoção da higiene brônquica e no conforto e na recuperação das funções da população estudada, independentemente da severidade da patologia e do local de atendimento.Demonstrou igualmente resultados positivos sobre dias de hospitalização, SpO 2 , pontuação clínica, FC, FR, e a necessidade de oxigenoterapia.É uma limitação o fato de não haver estudos suficientes que apresentem metodologias robustas e comparáveis, em especial com relação às diferentes severidades da patologia, para esclarecer a adequação das intervenções.Sugere-se a realização de estudos em pacientes com bronquiolites leves a moderadas e não em internamento.x Selection process 8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.

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Data collection process 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.

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Data items 10a List and define all outcomes for which data were sought.Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.

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List and define all other variables for which data were sought (e.g.participant and intervention characteristics, funding sources).Describe any assumptions made about any missing or unclear information. 2

Study risk of bias assessment
11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

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Effect measures 12 Specify for each outcome the effect measure(s) (e.g.risk ratio, mean difference) used in the synthesis or presentation of results.
x Synthesis methods 13a Describe the processes used to decide which studies were eligible for each synthesis (e.g.tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).

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13b Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.
x 13c Describe any methods used to tabulate or visually display results of individual studies and syntheses.2 13d Describe any methods used to synthesize results and provide a rationale for the choice(s).If metaanalysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.
x 13e Describe any methods used to explore possible causes of heterogeneity among study results (e.g.subgroup analysis, meta-regression).
x 13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results.x

Reporting bias assessment
14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).
x Certainty assessment 15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. x

RESULTS
Study selection 16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.
2 -Figure 1 16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.
Quality Rating: G: Good, F: Fair, P: Poor Continuação RESUMO | A bronquiolite é definida como um episódio agudo de sibilâncias que ocorre no contexto de um quadro respiratório, de origem normalmente viral, com elevada incidência nas crianças com menos de 2 anos.Considerando que o papel da Fisioterapia tem sido questionado nesse contexto, é extremamente importante esclarecer e diferenciar o impacto das diversas técnicas de fisioterapia empregadas em cada tipo de bronquiolite, paciente e local de atendimento.Foi realizada uma revisão sistemática, com busca nas bases de dados ScienceDirect, MEDLINE/ PubMed e SciELO, sobre as técnicas de fisioterapia em crianças de até 2 anos de idade com episódio de bronquiolite.Foram incluídos seis estudos observacionais, cinco experimentais sem grupo de controle e 15 com grupo de controle, envolvendo 3.339 indivíduos.São 14 os estudos com amostras em internamento, seis em internamento e unidade de cuidados intensivos (UCI) e seis em ambulatório.Dentre as técnicas de fisioterapia respiratória mais utilizadas, destacam-se a técnica de expiração lenta e prolongada (ELPr) associada à tosse provocada (TP), a aumento do fluxo expiratório (AFE), a desobstrução rinofaríngea retrógrada (DRR) e a drenagem postural (DP).Encontraram-se resultados positivos em relação às técnicas de fisioterapia respiratória, nomeadamente DRR, ELPr e AFE ou TP, na permeabilização das vias aéreas, promoção da higiene brônquica, dias de hospitalização, saturação de oxigênio, pontuação clínica, frequência cardíaca, frequência respiratória e necessidade de oxigenoterapia.Como limitações do estudo, destaca-se o fato de não haver estudos suficientes com metodologias robustas e comparáveis que permitam chegar a conclusões com maior certeza, em especial em relação às diferentes severidades da patologia, e fundamentar assim a personalização e adequação das intervenções na prática clínica.Descritores | Fisioterapia; Bronquiolite; Lactente.ABSTRACT | Bronchiolitis is defined as an acute episode of wheezing that occurs in the context of a respiratory condition, usually of viral origin, with a high incidence in children under 2 years of age.Considering that the role of physical therapy has been questioned in this context, it is paramount to clarify and differentiate the impact of different physical therapy techniques employed for each type of bronchiolitis, patient, and care settings.A systematic review was performed, searching the Science Direct, MEDLINE/PubMed, and SciELO databases on physical therapy techniques in children up to 2 years of age with a bronchiolitis episode.Six observational studies, 5 experimental studies without control group and 15 with control group, involving 3339 individuals were included.Fourteen studies use inpatient samples, six analyze hospital and ICU samples, and six studied outpatient samples.Among the most commonly used respiratory physical therapy techniques are the prolonged slow expiration (PSE) associated with provoked coughing (PC), expiratory flow increase (EFI), retrograde rhinopharyngeal clearance (RRC) and postural drainage (PD).Positive results were found regarding respiratory physical therapy techniques, namely RRC, PSE and EFI or PC, on airway permeabilization, promotion of bronchial hygiene, hospital stay, oxygen saturation, clinical score, heart rate, respiratory rate, and need for oxygen therapy.As limitations of the study, it is highlighted the lack of studies with robust and comparable methodologies to draw conclusions with greater certainty, especially regarding different severities of the pathology, thus supporting the personalization and adequacy of interventions in clinical practice.Keywords | Physical Therapy; Bronchiolitis; Infant.