Evaluating Flutter device and the active cycle of breathing technique in patient with bronchiectasis: prospective, randomised, crossover study

Tıpta Uzmanlık TeziBronşektazili hastalarda solunum fizyoterapisi tedavinin önemli bir parçasıdır. Hastanın aktif olarak tedaviye katılımını esas alan aktif solunum teknikleri döngüsü ve Flutter cihazı ile solunum fizyoterapisi teknikleri evde uygulanabilen, geleneksel yöntemlere alternatif olarak geliştirilmişlerdir. Bu çalışmada klinik olarak stabil 40 bronşektazili hastaya 4 hafta süre ile ev programı şeklinde aktif solunum teknikleri döngüsü ve Flutter cihazı ile fizyoterapi teknikleri uygulanarak fizyoterapinin semptomlar, balgam çıkarma, solunum fonksiyon testleri, dispne skoru ve yaşam kalitesi üzerine etkilerini incelemeyi ve iki tekniğin etkinliğini karşılaştırmayı amaçladık. Fizyoterapi ile öksürük, halsizlik yakınmalarının azaldığını (sırası ile p=0,000, p=0,004), balgam çıkışında artma sağlandığını (p=0,002), dispne algılamasında azalma olduğunu ("Medical Research Council" için p=0,001, Borg Dispne Skalası için p=0,002), Short Form-36 yaşam kalitesi anketi sonuç skorlarından fiziksel durum değerlendirmesinde kısmen iyileşme olduğunu (p=0,001) saptadık. İki grubun ayrı ayrı değerlendirilmesinde ise, Flutter grubunda daha fazla olumlu etki saptadık. Her iki grupda da balgam miktarında artış sağlandı (Flutter için p=0,003, aktif solunum teknikleri döngüsü için p=0,004). Borg Dispne skorunda azalma yalnız Flutter grubunda anlamlı iken (0,006), Medical Research Council'de her iki grupda da azalma anlamlıydı (Flutter için p=0,012, aktif solunum teknikleri döngüsü için p=0,021). SF-36 anketi fiziksel durum değerlendirmesi sonuç skorunda artış Flutter grubunda sağlanırken (p=0,005), aktif solunum teknikleri döngüsünde artış saptamadık. İki grubun karşılaştırmada ise, yaşam kalitesinde genel sağlık ve ağrı algısı alt başlıkları dışında diğer bulgularda istatistiksel anlamlılık bulunmazken, etkinlik açısından fark saptamadık. Tedavi periyodu süresince hastaların solunum fonksiyon testlerindeki değişikliklerin tedavi ile korelasyon göstermediğini saptadık. Sonuç olarak, fizyoterapi ile stabil bronşektazili hastalarda etkili sekresyon atılımı sağlanabilmekte, sık görülen semptomlar ve dispne algılaması azaltılabilmekte ve hastaların yaşam kalitesinde belirli ölçüde iyileşme sağlanabilmektedir. Aktif solunum teknikleri döngüsü ve Flutter cihazının her ikisi de evde solunum fizyoterapisi için uygun tekniklerdir. Flutter cihazı bazı parametreleri düzeltmede aktif solunum teknikleri döngüsünden daha etkin olup, bronşektazili hastalarda hava yolu klirensini sağlamada ev tabanlı tedavide kullanılabilecek etkin bir yöntemdir. Anahtar kelimeler: Fizyoterapi, bronşektazi, balgam, dispne, yaşam kalitesi.AbstractChest physiotherapy is an important part of the routine treatment of patients with bronchiectasis. Patients can attendance treatment actively with active cycle of breathing techniques and Flutter device chest physiotherapy techniques. These techniques are usefull for home-based treatment and has been proposed as an alternative to conventional airway clearance techniques. The aim of this study was to compared the efficacy of active cycle of breathing techniques with Flutter as methods of airway clearance in 40 clinically stable bronchiectasis patients during 4 weeks as an home programme. We compared symptoms, sputum expectorated, pulmonary function tests, dyspnea scores and Health-Related Quality of Life with two different physiotherapy techniques. We determined cough and weakness was reduced (respectively p=0,000, p=0,004), sputum expectoration was increased (p=0,002), dyspnea score was reduced (for Medical Research Council p=0,001, for Borg Dyspnea Scale p=0,002) and Short Form-36 `Physical Health? component summaries score was improved partly (p=0,001) with physiotherapy. When we compared groups outcomes one by one, in Flutter group, most of the outcomes was effected anymore positive. Both of the groups, sputum expectoration was increased (Flutter p=0,003, active cycle of breathing techniques p=0,004). We determined in Flutter group, each of two dyspnea scores was reduced (Brog p=0,006, Medical Research Council p=0,012). In active cycle of breathing techniques group only Medical Research Council score reduced and this was significant statistically (p=0,021). Short Form-36 `Physical Health? component summaries score was improved partly in Flutter group (p=0,005), but we doesn?t established any improvement in active cycle of breathing techniques group. When we compared two techniques, we found except only general health and pain feeling, there was no statistically significant differences between the two techniques and there was no differences efficiency. Ventilatory function did not changed significantly during either treatment period. In conclusion, chest physiotherapy is a effective method increasing sputum expectoration, reducing symptoms and dyspnea score and party improvement Health-Related Quality of Life. active cycle of breathing techniques and Flutter techniques are suitable usage at home-based treatment. Some of the parameters of Flutter device is more effective and this technique can most effective for providing airway clearance. Key words: Physiotherapy, bronchiectasis, sputum, dyspnea, quality of life

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis - implications for public health communications in Australia

Objective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19). Main outcome measures Primary outcome: responses to question € If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions. Results Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine. Conclusions Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates