Physiotherapy interventions encouraging frequent changes of the body position and physical activity for infants hospitalised with bronchiolitis: an internal feasibility study of a randomised control trial

Sonja Andersson-Marforio, Annika Lundkvist Josenby, Christine Hansen, Eva Ekvall Hansson, Sonja Andersson-Marforio, Annika Lundkvist Josenby, Christine Hansen, Eva Ekvall Hansson

Abstract

Background: The effect of a treatment that includes frequent changes of the body position for infants with bronchiolitis has not been evaluated, although it is often used in Swedish hospitals. Because of this, a randomised control trial (RCT) has begun with the aim to evaluate this treatment, comparing the effect of an individualised physiotherapy intervention, a non-individualised intervention, and standard care in a control group. The objective of this internal pilot study was to address uncertainties concerning the ongoing RCT and to determine whether the trial is feasible or not, possibly with adjustments to the protocol.

Methods: Descriptive analyses of the recruitment, retention, data supply for the primary end point, and the usability of the primary outcome measure in the full RCT were performed. A safety analysis was conducted by an independent analysis group.

Results: Ninety-one infants were included, 33 (36.3%), 28 (30.8%), and 30 (33.0%) in the respective allocation groups. Fifty-nine (64.8%) were boys. The median age was 2.5 (min-max 0.2-23.7) months. They remained in the study for a median of 46 hours (min-max 2-159). The recruitment rate was 19%. The data supply for the primary end point and for the primary outcome measure was lower than anticipated in the original sample size calculation. Difficulties concerning utilising the primary outcome measure were identified. The safety analysis detected no risks of harm related to participation in the study.

Conclusions: It is feasible to continue the RCT with modifications of the analysis plan. Participation in the study was not associated with any safety risks.

Trial registration: ClinicalTrials.gov NCT03575091 . Registered 2 July 2018. Retrospectively registered.

Keywords: Bronchiolitis; Feasibility studies; Physical therapy modalities; Randomised controlled trials.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the participant flow

References

    1. Munoz-Quiles C, Lopez-Lacort M, Ubeda-Sansano I, Aleman-Sanchez S, Perez-Vilar S, Puig-Barbera J, et al. Population-based analysis of bronchiolitis epidemiology in Valencia, Spain. Pediatr Infect Dis J. 2016;35(3):275–280. doi: 10.1097/INF.0000000000000993.
    1. Eber E, Midulla F. ERS Handbook of paediatric respiratory medicine. 1st. Sheffield: The European Respiratory Society; 2013.
    1. Caffrey Osvald E, Clarke JR. NICE clinical guideline: bronchiolitis in children. Arch Dis Childhood Educ Pract Ed. 2016;101(1):46–48. doi: 10.1136/archdischild-2015-309156.
    1. Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389(10065):211–224. doi: 10.1016/S0140-6736(16)30951-5.
    1. Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019;104(6):564–576. doi: 10.1136/archdischild-2018-315846.
    1. Schlapbach LJ, Straney L, Gelbart B, Alexander J, Franklin D, Beca J, et al. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J. 2017;49(6):1601648. doi: 10.1183/13993003.01648-2016.
    1. Gajdos V, Katsahian S, Beydon N, Abadie V, de Pontual L, Larrar S, et al. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial. PLoS Med. 2010;7(9):e1000345. doi: 10.1371/journal.pmed.1000345.
    1. Postiaux G, Zwaenepoel B, Louis J. Chest physical therapy in acute viral bronchiolitis: an updated review. Respir Care. 2013;58(9):1541–1545. doi: 10.4187/respcare.01890.
    1. Gomes EL, Postiaux G, Medeiros DR, Monteiro KK, Sampaio LM, Costa D. Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial. Rev Bras Fisioter. 2012;16(3):241–247. doi: 10.1590/S1413-35552012005000018.
    1. Rochat I, Leis P, Bouchardy M, Oberli C, Sourial H, Friedli-Burri M, et al. Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial. Eur J Pediatr. 2012;171(3):457–462. doi: 10.1007/s00431-011-1562-y.
    1. Gomes GR, Donadio MVF. Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis. Arch Pédiatr. 2018;25(6):394–398. doi: 10.1016/j.arcped.2018.06.004.
    1. Roquei Figuls M, Gine-Garriga M, Granados Rugeles C, Perrotta C, Vilaro J. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2016;2:CD004873.
    1. Andersson-Marforio S, Hansen C, Ekvall Hansson E, Lundkvist Josenby A. A survey of the physiotherapy treatment methods for infants hospitalised with acute airway infections in Sweden. Eur J Physiother. 2021;23(3):149–156. doi: 10.1080/21679169.2019.1663925.
    1. Andersson-Marforio S, Lundkvist Josenby A, Ekvall Hansson E, Hansen C. The effect of physiotherapy including frequent changes of body position and stimulation to physical activity for infants hospitalised with acute airway infections. Study protocol for a randomised controlled trial. Trials. 2020;21(1):803. doi: 10.1186/s13063-020-04681-9.
    1. Medical research council. Complex interventions guidance [Internet]. [cited 2020 February 24]. Available from: .
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013;50(5):587–592. doi: 10.1016/j.ijnurstu.2012.09.010.
    1. Richards DA, Hallberg IR, editors. Complex interventions in health: an overview of research methods. London: Routledge; 2015.
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1. doi: 10.1186/1471-2288-10-1.
    1. Ioannidis JPA, Greenland S, Hlatky MA, Khoury MJ, Macleod MR, Moher D, et al. Increasing value and reducing waste in research design, conduct, and analysis. Lancet. 2014;383(9912):166–175. doi: 10.1016/S0140-6736(13)62227-8.
    1. Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10(2):307–312. doi: 10.1111/j..2002.384.doc.x.
    1. Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67. doi: 10.1186/1471-2288-10-67.
    1. Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, et al. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS One. 2016;11(3):e0150205. doi: 10.1371/journal.pone.0150205.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Bmj. 2016;355:i5239. doi: 10.1136/bmj.i5239.
    1. Thabane L, Hopewell S, Lancaster GA, Bond CM, Coleman CL, Campbell MJ, et al. Methods and processes for development of a CONSORT extension for reporting pilot randomized controlled trials. Pilot Feasibility Stud. 2016;2:25. doi: 10.1186/s40814-016-0065-z.
    1. The National Institute for Health and Care Excellence (NICE). Bronchiolitis in children: diagnosis and management. NICE guideline NG9 [Internet]. Manchester: The National Institute for Health and Care Excellence; 2015 [cited 2019 16 August]. Available from: .
    1. Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis. 1992;145(1):106–109. doi: 10.1164/ajrccm/145.1.106.
    1. Folkhälsomyndigheten. RSV (Respiratory Syncytial Virus) 2018-2019 [Internet]. Solna: Public health agency of Sweden (Folkhälsomyndigheten); 2020 [cited 2020 23 November]. Available from: .
    1. Predicare. RETTS Pediatrics [Internet]. Göteborg: Predicare; [cited 2021 16 April]. Available from: .
    1. Magnusson C, Herlitz J, Karlsson T, Jiménez-Herrera M, Axelsson C. The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years. BMC Pediatr. 2019;19(1):500. doi: 10.1186/s12887-019-1857-0.
    1. Ødegård SS, Tran T, Næss-Pleym LE, Risnes K, Døllner H. A validity study of the rapid emergency Triage and treatment system for children. Scand J Trauma Resusc Emerg Med. 2021;29(1):18. doi: 10.1186/s13049-021-00832-2.
    1. Henning B, Lydersen S, Døllner H. A reliability study of the rapid emergency triage and treatment system for children. Scand J Trauma Resusc Emerg Med. 2016;24:19. doi: 10.1186/s13049-016-0207-6.
    1. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet (London, England). 2009;374(9683):86–89. doi: 10.1016/S0140-6736(09)60329-9.
    1. Lorenz W, Troidl H, Solomkin JS, Nies C, Sitter H, Koller M, et al. Second step: testing-outcome measurements. World J Surg. 1999;23(8):768–780. doi: 10.1007/s002689900578.
    1. Lorenz W, Stinner B, Bauhofer A, Rothmund M, Celik I, Fingerhut A, et al. Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). Protocol of a controlled clinical trial developed by consensus of an international study group. Part one: rationale and hypothesis. Inflamm Res. 2001;50(3):115–122. doi: 10.1007/s000110050734.
    1. Ioannidis JP, Evans SJ, Gøtzsche PC, O'Neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141(10):781–788. doi: 10.7326/0003-4819-141-10-200411160-00009.

Source: PubMed

3
Subskrybuj