ACPCF Infant Guideline - The Knowledge Network

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34. Dennersten U, Lannerfors L, Johansson H, Andersson M, Sellberg M, Lagerkvist A, Sahlberg M. Lung function and peak working capacity in the entire Swedish pospulation ≥ 7 years old over a three years perios. Pediatric Pulmonology 2003 (Suppl 25): A411 35. Button BM, Heine RG, Catto Smith AG, Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis. Archives of Disease in Childhood 1997; 76: 148-150 36. Heine RG, Button BM, Olinsky A, Phelan PD, Catto-Smith AG.Gastro-oesophageal reflux in infants under 6 months with cystic fibrosis.Arch Dis Child. 1998 Jan;78(1):44-8 37. Button BM, Heine RG, Catto-Smith AG, Olinsky A, Phelan PD, Ditchfield MR, Story I.Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study.Pediatr Pulmonol 2003;35: 208-13 38. Orenstein DM. Heads up! Clear those airways! Pediatr Pulmonol 2003;35:160–161 39. Dhouieb E. Evaluation of Lung Clearance Index as an Outcome Measure in Airway Clearance in Children with Cystic Fibrosis. MSc Dissertation 2007 40. Jones J, Hunter D. Consensus methods for medical and healthservices research. BMJ 1995;311:376–380. 10
Recommendations for practice Grading scheme for recommendations The criteria used for the grading of the recommendations below are based on published on behalf of the Scottish Intercollegiate Guidelines Network. 1 Grade A B C Type of recommendation Requires at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation Requires availability of well conducted clinical studies but no randomised clinical trials on the topic of the recommendation Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality. Petrie GJ, Barnwell E, Grimshaw J, on behalf of the Scottish Intercollegiate Guidelines Network. Clinical guidelines: criteria for appraisal for national use. Edinburgh: Royal College of Physicians, 1995 Recommendations • On confirmation of diagnosis, all families with newly diagnosed infants with cystic fibrosis should be referred for physiotherapy. Initial physiotherapy tuition should always be given by a specialist CF physiotherapist (Standards for the Clinical Care of Children and Adults with Cystic Fibrosis in the UK 2001. http://www.cftrust.org.uk/aboutcf/publications/consensusdoc) [C] • The infant should be reviewed on a regular basis by a physiotherapist with experience in paediatric CF care. An easily accessible physiotherapy service for assessment, advice and support is essential. Direct contact numbers for the CF physiotherapist should be available to the parents/carers, multi-disciplinary teams and to the primary care and network care teams as appropriate. [C] • All parents/carers should be taught to assess signs and symptoms, using a structure respiratory assessment tool as appropriate (Appendix 1). [C] • The emphasis should be on a holistic approach to treatment, considering the fitness of the whole child. • The beneficial effects of exercise are well documented. Advice regarding positioning, movement and exercise programmes should begin from diagnosis (Appendix 2). • Even if the baby is “asymptomatic”, all parents / carers should be taught to assess symptoms in addition to being taught an appropriate airway clearance technique. [C] • The physiotherapist is not required to routinely initiate airway clearance (Appendix 3) on diagnosis unless, following assessment, the infant or child has symptoms that respond to respiratory physiotherapy. The advice given to parents/carers as to the need for and frequency of 11
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