**Outcome Measures for Respiratory Physiotherapy in Cystic Fibrosis — Challenges and Advances**

Alda Marques, Joana Cruz, Cristina Jácome and Ana Oliveira

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/60674

#### **Abstract**

Respiratory physiotherapy is part of the routine management of patients with cystic fibrosis. It normally consists of airway clearance techniques and exercise training. The evidence of such interventions has been questioned. Nevertheless, the lack of evidence should not be interpreted as lack of benefit. Instead, attention to methodological issues, such as the selection of the outcome measures, is needed, as they may hamper the establishment of the effectiveness of respiratory physiotherapy techniques. Hence, this chapter presents and discusses the strengths and weaknesses of conventional and emerging outcome measures possibly to be used (i) in clinical practice before, during and after each session of respiratory physiotherapy to monitor its effectiveness; (ii) before and after the respiratory physiotherapy treatment (i.e., normally characterised by weeks of intervention) and (iii) in applied research in respiratory physiotherapy used in the management for cystic fibrosis. A comprehensive overview of the available outcome measures is provided, with particular emphasis on their strengths and limitations that should be recognised when interpreting the results.

**Keywords:** Respiratory physiotherapy, outcome measures, cystic fibrosis

### **1. Introduction**

Respiratory physiotherapy is a non-pharmacological treatment commonly provided to patients with cystic fibrosis (CF) [1]. According to international guidelines, respiratory

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physiotherapy is a key element of care for patients with CF, as it aims at both rehabilitation and prevention [2]. Specifically, respiratory physiotherapy is used to deal with the progressive loss of pulmonary function accompanied by symptoms of cough, excessive sputum produc‐ tion, dyspnoea, exercise intolerance, reduced functionality and impaired quality of life. To respond to these multiple problems and needs, respiratory physiotherapy involves a range of strategies and techniques, such as airway clearance, exercise training and breathlessness management, which have an overall aim of reducing the progression of the disease [3, 4].

However, there is a lack of evidence to suggest the superiority of one technique over the other [5] and to determine which strategies promote the adherence of this population to regular physical activity [6]. Nevertheless, the lack of evidence does not mean lack of benefit. Instead, methodological issues, such as the selection of the outcome measures, may hamper the establishment of the effectiveness of the respiratory physiotherapy techniques.

Respiratory physiotherapists use several outcome measures to monitor and evaluate their interventions. Most of the clinically available outcome measures are not specific for the physiotherapy intervention employed and may be affected by other factors. This means that there are no gold standard outcome measures specifically related to respiratory physiotherapy interventions. Thus, in all areas of respiratory physiotherapy, one of the barriers to generate evidence has been the lack of accurate, reliable, sensitive and valid outcome measures. To overcome this problematic issue, new measures have been emerging.

This chapter starts by providing an overview of the problem. It then presents and discusses the strengths and weaknesses of the commonly used clinical outcome measures and other measures that have been gaining interest in the assessment and monitoring of respiratory physiotherapy interventions in CF. The chapter ends with a brief conclusion. A comprehensive overview of the available outcome measures is sought to be provided, with particular emphasis on their strengths and limitations that should be recognised when interpreting the results.
