Guidelines for the physiotherapy management of …

1 Guidelines for the physiotherapy management of the adult, medical , spontaneously breathing patient Julia Bott, Sharron Blumenthal, Maria Buxton, Sheric Ellum, Caroline Falconer, Rachel Garrod, Alex Harvey, Tracey Hughes, Melanie Lincoln, Christine Mikelsons, Catherine Potter, Jennifer Pryor, Lesley Rimington, Frances Sinfield, Catherine Thompson, Pamela Vaughn, John White On behalf of the British Thoracic Society physiotherapy Guideline Development Group, a subgroup of the British Thoracic Society Standards of Care Committee, and the Association of Chartered Physiotherapists in Respiratory Care, a clinical interest subgroup of the Chartered Society of physiotherapy Contents Volume 64 Number Suppl I | THORAX May 2009. Guidelines for the physiotherapy management of the adult, medical , spontaneously breathing patient Guideline development group Section 7 physiotherapy workforce i1 considerations Journal of the British Thoracic Society i42.

2 Impact Factor: Summary of recommendations Editor-in-Chief i2 Introduction Conclusion J A Wedzicha (UK). Editor i2 Chronic obstructive pulmonary disease (COPD) i43. S L Johnston (UK). Associate Editors i3 Asthma and disordered breathing References P M A Calverley (UK) i43. M Dusmet (UK) D A Lomas (UK) i3 Cystic fibrosis J S Elborn (N Ireland) D M Mannino (USA). J M FitzGerald (Canada) F D Martinez (USA) i5 Non-cystic fibrosis-related bronchiectasis Appendices J A Fleetham (Canada) C Robertson (Australia) i49 Appendix A Glossary of physiotherapy terms N M Foley (UK) B Schonhofer (Germany) i5 Restrictive lung conditions I Hall (UK) G A Silvestri (USA) i51 Appendix B Algorithm for the management of R Hubbard (UK) G I Town (New Zealand) i6 Neuromuscular diseases and musculoskeletal patients with neuromuscular weakness J R Hurst (UK) M K B Whyte (UK).

3 Disorders of the chest wall Statistical Editors i51 Appendix C Instructions for performing cough R Newson (UK) i7 Conclusion T M McKeever (UK). peak flow measurements in patients with L Tata (UK) neuromuscular weakness Images Editors Introduction and background to the J M FitzGerald (Canada). J R Mayo (Canada) Guidelines Online appendices J C Hogg (Canada) i7 Purpose of the Guidelines 1 Complementary therapies Letters Editor J R Hurst (UK) i7 A brief history of respiratory physiotherapy and 2 Example of an evidence table Lung Alert Editors A Bhowmik (UK). its relationship to the BTS 3 Patient information leaflet COPD. J Quint (UK). President, British Thoracic Society Guideline development 4 Patient information leaflet asthma P Ormerod i8 5 Patient information leaflet hyperventilation Editorial Office BMJ Publishing Group Ltd, BMA House, syndrome Tavistock Square, London WC1H 9JR, UK Section 1 Chronic obstructive T: +44 (0)20 7383 6147 6 Patient information leaflet bronchiectasis F: +44 (0)20 7383 6668.

4 Pulmonary disease (COPD). E: i9 7 Patient information leaflet chest wall disease ISSN: 0040-6376 (print). 8 Patient information leaflet spinal cord injury ISSN: 1468-3296 (online) Section 2 Asthma and disordered Disclaimer: Thorax is owned and published by the breathing (hyperventilation syndrome) 9 Patient information leaflet neuromuscular disease British Thoracic Society and BMJ Publishing Group Ltd, a wholly owned subsidiary of the British medical i15 Section 2a Asthma 10 Action plan for patients with neuromuscular Association. The owners grant editorial freedom to the Editor of Thorax. i17 Section 2b Disordered breathing weakness Thorax follows Guidelines on editorial independence produced by the World Association of medical Editors (hyperventilation syndrome and vocal cord 11 Devices, manufacturers and suppliers of and the code on good publication practice of the Committee on Publication Ethics.)

5 Dysfunction) physiotherapy equipment Thorax is intended for medical professionals and is provided without warranty, express or implied. Statements in the Journal are the responsibility of their Section 3 Cystic fibrosis Available at: authors and advertisers and not authors' institutions, i18. the BMJ Publishing Group Ltd, the British Thoracic Society or the BMA unless otherwise specified or determined by law. Acceptance of advertising does Section 4 Non-cystic fibrosis-related not imply endorsement. To the fullest extent permitted by law, the BMJ bronchiectasis Publishing Group Ltd shall not be liable for any loss, injury or damage resulting from the use of Thorax or i25. any information in it whether based on contract, tort or otherwise. Readers are advised to verify any information they choose to rely on. Section 5 Restrictive lung conditions Copyright: E 2009 BMJP ublishingGroupLtdandthe i31 This journal is a member of and subscribes to the principles of the British Thoracic Society.

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7 Box 437, Emigsville, PA 17318 0437, USA. Joint guideline Guidelines for the physiotherapy management of the adult, medical , spontaneously breathing patient J Bott, S Blumenthal, M Buxton, S Ellum, C Falconer, R Garrod, A Harvey, T Hughes, M Lincoln, C Mikelsons, C Potter, J Pryor, L Rimington, F Sinfield, C Thompson, P Vaughn, J White, on behalf of the British Thoracic Society physiotherapy Guideline Development Group c Additional Appendices are GUIDELINE DEVELOPMENT GROUP Section 3 Cystic fibrosis published online at http://thorax. On behalf of the Association of Chartered Steering group Physiotherapists in Cystic Fibrosis issueSupplI and http://www. Julia Bott (Chair), support to Section 6, Consultant Physiotherapist, Surrey PCT NW Locality Penny Agent, Service Lead Physiotherapist, Royal Brompton & Harefield NHS Trust Sheric Ellum, support to Section 5, Consultant Physiotherapist, Guy's & St Thomas' NHS Trust, Gillian Davie, Senior I Physiotherapist, Cystic Correspondence to: London Fibrosis Team, Aberdeen Royal Infirmary Mary Dodd, Consultant Physiotherapist in Dr Rachel Garrod, support to Section 1, Reader, School of physiotherapy , Faculty of Health and Cystic Fibrosis, University Hospital of South Social Care Sciences, Kingston University and St Manchester NHS Foundation Trust Received 19 November 2008 Dr Sarah Elkin, Respiratory Physician, St Mary's George's, University of London.

8 Accepted 15 February 2009 Hospital, London Dr Jennifer Pryor, support to Sections 3 and 4, Senior Research Fellow in physiotherapy , Royal Tracey Hughes (Chair), Senior I Physiotherapist, Brompton & Harefield NHS Trust Leeds Regional Adult Cystic Fibrosis Unit, Leeds Dr Lesley Rimington, support to Section 2, Teaching Hospitals NHS Trust Lecturer School of Health and Rehabilitation, Margaret MacLeod, Senior I Physiotherapist, Keele University Cystic Fibrosis Team, Aberdeen Royal Infirmary Nicola Mills, Senior I Physiotherapist, Adult Cystic Fibrosis Unit, University Hospitals of Section 1 COPD Leicester Sharon Baines, Clinical Specialist Physiotherapist, Chronic Lung Disease Service, NHS Central Lancashire Section 4 Non-cystic fibrosis-related Amanda Dryer, physiotherapy Clinical Lead in bronchiectasis Respiratory Care, Central Manchester and Alex Harvey (Co-Chair)

9 , Lecturer in Manchester Children's University Hospital physiotherapy , Brunel University Robert Goddard, Superintendent Physiotherapist, Fran Sinfield (Co-Chair), Superintendent County Durham and Darlington NHS Foundation Physiotherapist, Oxford Centre for Respiratory Trust Medicine, The Churchill Hospital, Oxford Catherine Thompson, Senior Lecturer, York St Dr Robert Wilson, Respiratory Physician, Royal John University Brompton & Harefield NHS Trust Dr John White (Chair), Respiratory Physician, York Hospitals NHS Trust Section 5 Non-obstructive/restrictive lung diseases Section 2 Asthma and disordered breathing Debbie Dykes, Clinical Specialist Respiratory Caroline Falconer (Co-Chair), Senior physiotherapy , St. Richards Hospital, Royal West Physiotherapist, Papworth Hospital NHS Sussex NHS Trust, Chichester Foundation Trust Katie Ford, Team Lead, Respiratory Lianne Jongepier, Respiratory Specialist physiotherapy , Bristol Royal Infirmary, Bristol Physiotherapist, Service Lead COPD Team, Rachael Mitchell, Specialist Respiratory Primary Care Centre, Colchester Physiotherapist, Luton and Dunstable Hospital Melanie Lincoln (Co-Chair), Team Leader NHS Foundation Trust Physiotherapist, Papworth Hospital NHS Catherine Potter (Chair), Specialist Respiratory Foundation Trust Physiotherapist, The Whittington Hospital NHS.

10 Christine Mikelsons, Consultant Respiratory Trust, London Physiotherapist, Royal Free Hospital Fiona Rushmer, physiotherapy Manager, Dr Mike Thomas, General Practitioner, Asthma Ashtead Hospital, Surrey UK Senior Research Fellow, University of Dr Paul Tate, Respiratory Physician, St. Richards Aberdeen Hospital, Royal West Sussex NHS Trust, Jo Williams, Senior Pulmonary Rehabilitation Chichester Specialist Glenfield Hospital, University Hospitals Jennifer Tomkinson, Respiratory Specialist of Leicester NHS Trust Physiotherapist, Bristol Primary Care Trust Thorax 2009;64(Suppl I):i1 i51. i1. Joint guideline Section 6 Neuromuscular diseases and chest wall disorders c Assess the effectiveness of a gutter rollator frame in the Dr Steve Banham, Respiratory Physician, Glasgow Royal acute setting, for patients with COPD severely disabled by Infirmary breathlessness, especially the elderly.