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ABSTRACT
Positive expiratory pressure (PEP) therapy involves the application of a resistance to expiration to produce positive airway pressure. PEP therapy is an effective treatment strategy; however, little is known about its current clinical use. The purpose of this study was to describe the clinical use of PEP therapy. The study was a cross sectional design using a written survey. Participants were physiotherapists from public hospitals in New South Wales, Australia (n=149). The response rate was 60% (n=89). PEP therapy was regularly used in the clinical practice of 68 (76%) respondents. The patient group most frequently treated with PEP therapy were those with respiratory medical conditions (n=59, 87%) and the most commonly selected indication for use was excessive respiratory secretions (n=60, 88%). Improvised devices such as bubble (or bottle) PEP were used by more respondents (n=61, 90%) than commercially-available devices (n=30, 44%) and were constructed using a variety of methods, often non-standardised. PEP therapy (particularly variably constructed bubble-PEP) was regularly employed for the treatment of patients with cardiorespiratory conditions. Further research into the effectiveness of PEP delivered with improvised devices and more specific training of healthcare practitioners regarding optimal design parameters for PEP therapy may be beneficial.
Johnston CL, James R, Mackney JH (2013) The current use of positive expiratory pressure (PEP) therapy by public hospital physiotherapists in New South Wales. New Zealand Journal of Physiotherapy 41 (3): 88-93.
Key words: Physiotherapy, Respiratory Therapy, Positive expiratory pressure (PEP) therapy
INTRODUCTION
Positive Expiratory Pressure (PEP) therapy involves the application of a resistance to expiration in order to produce positive airway pressure (Darbee et al 2004). Positive expiratory airway pressure is thought to stabilise airways, prevent premature airway closure, improve ventilation and reduce gas trapping (Darbee et al 2004, Lannefors et al 1992, Mcllwaine et al 2001, O'Neill et al 2002). PEP therapy has been used, and is recommended, as a component of respiratory physiotherapy management for varying adult and paediatric patient groups including those with cystic fibrosis (Lagerkvist et al 2006, Mcllwaine 1997, Mcllwaine 2001), acute and chronic respiratory disease (Bjorkqvist et al 1997, Brooks et al 2003, Hill et al 2010, Langer et al 2009, Lee et al 2008, Tang et al 2010), and in the post-operative setting (Campbell et al 1986, Orman and...