Prasad S A, Main E, Dodd M E
Cystic Fibrosis Unit, Great Ormond Street Hospital for Children, London, UK.
Pediatr Pulmonol. 2008 Mar;43(3):236-44. doi: 10.1002/ppul.20741.
Babies with cystic fibrosis diagnosed by neonatal screening often display no overt signs of respiratory disease. The role of traditional routine daily chest physiotherapy in this particular group of babies is unclear and has generated considerable international debate. There is currently no evidence addressing this issue and present circumstances preclude a rigorous trial in the UK. This study aimed to provide expert consensus regarding the physiotherapy management of asymptomatic infants with CF.
A Delphi consensus method was used to gather and refine expert opinions of senior paediatric physiotherapists in the UK. Agreement was sought on 16 statements reflecting aspects of physiotherapy management in 'asymptomatic' babies with cystic fibrosis.
Twenty-five senior paediatric physiotherapists from Specialist CF Centres throughout the UK participated in the study. Consensus was high amongst the respondents for 15 of the 16 statements. One statement failed to reach consensus. This related to the question of not routinely initiating a daily chest physiotherapy regimen in apparently healthy babies. Due to the lack of consensus an amendment to this statement was made, to allow a more flexible approach, where physiotherapists would not be obliged to initiate routine daily treatment in asymptomatic babies with CF, if they felt other another approach was justified.
There was high consensus of opinion amongst senior physiotherapists in the UK on most aspects of the physiotherapy management of babies with CF. Consensus could not be achieved on whether routine daily chest physiotherapy is necessary in 'asymptomatic' babies. An agreed amendment to the original statement allows professionals to modify or change traditional practice with the sanction of their senior colleagues. The results of this process will be used by the Association of Chartered Physiotherapists in Cystic Fibrosis to form the basis of national clinical guidelines.
通过新生儿筛查诊断出患有囊性纤维化的婴儿通常没有明显的呼吸道疾病迹象。传统的日常胸部物理治疗在这一特定婴儿群体中的作用尚不清楚，引发了国际上的广泛争论。目前尚无证据解决这一问题，而且当前的情况使得在英国无法进行严格的试验。本研究旨在就囊性纤维化无症状婴儿的物理治疗管理达成专家共识。
采用德尔菲共识法收集并完善英国资深儿科物理治疗师的专家意见。就反映囊性纤维化“无症状”婴儿物理治疗管理各方面的16项陈述征求意见。
来自英国各地囊性纤维化专科中心的25名资深儿科物理治疗师参与了该研究。16项陈述中的15项在受访者中达成了高度共识。有一项陈述未达成共识。这涉及到在看似健康的婴儿中不常规启动每日胸部物理治疗方案的问题。由于缺乏共识，对该陈述进行了修订，以允许采用更灵活的方法，即如果物理治疗师认为其他方法合理，他们不必在囊性纤维化无症状婴儿中启动常规每日治疗。
英国资深物理治疗师在囊性纤维化婴儿物理治疗管理的大多数方面达成了高度共识。对于“无症状”婴儿是否需要常规每日胸部物理治疗未能达成共识。对原始陈述的一项商定修订允许专业人员在其上级同事的批准下修改或改变传统做法。这一过程的结果将被英国皇家物理治疗师协会囊性纤维化分会用于形成国家临床指南的基础。
