Physikalische Therapie bei COPD - Evidence Based Medicine?

Zusammenfassung

Verschiedene Einzelmaßnahmen der physikalischen Therapie bei COPD zeigen deutliche Effekte auf den Organismus, die teilweise gesichert sind. Dennoch besteht noch immer eine Unsicherheit, die genauen Einflüsse auf die Erkrankung und den positiven Effekt beim Patienten zu beschreiben, zumal gegensätzliche oder widersprüchliche Ergebnisse in verschiedenen Studien berichtet werden.

Ebenfalls geht aus bestehenden Studien hervor, dass eine verbesserte Atemmechanik mit ökonomischer Atemarbeit und möglicherweise verbessertem Gasaustausch durch physikalische Maßnahmen erreicht werden kann. Daher ist bei Anwendung der physikalischen Therapie darauf zu achten, dass eine gezielte Indikationsstellung die richtigen Methoden zur Anwendung kommen lässt. Die Auswirkung auf die Erkrankung sollte kontrolliert werden.

Die Datenlage der vorhandenen Studien für die gesamte physikalische Therapie ist noch immer nicht ausreichend. Viele Studien sind vom Studienkonzept und der eingebrachten Fallzahl nicht geeignet, signifikante Ergebnisse mit relevanten Aussagen zu treffen. Deshalb ist für die Zukunft weiterhin eine ausgiebige Erforschung der Effekte der physikalischen Therapie bei COPD auf den Patienten und auf seine Erkrankung mittels kontrollierten, randomisierten, klinischen Studien zu fordern und zu fördern. Hierdurch kann eine Verbesserung in der Versorgung von COPD-Patienten erreicht und eine bessere Aussage über Benefit und Outcome solcher Patienten durch die physikalische Therapie erhalten werden.

Abstract

Several therapeutical options of physical therapy in COPD show significant effects on the organism. Some of those effects are verified, but there is still an uncertainty about the exact influences on the disease and the beneficial outcome, especially because different trials describe contradictory results.

Existing studies observed an improved respiratory mechanism with a more economical ventilatory work and a better gas exchange by use of physical therapy. Therefore the right indication for certain options of physical therapy should be defined, so that the outcome can be controlled and a benefit can be drawn from the effects.

Sufficient data of existing trials for the whole physical therapy in COPD is still deficient. Due to an inappropriate study design and/or the number of observed patients a lot of clinical studies are not qualified to lead to significant results and recommendations.

For the future it is necessary to investigate the exact effects of physical therapy with controlled, randomised, clinical trials further on. Hereby an improvement of the care of patients with COPD can be achieved and the beneficial effects and the outcome with physical therapy can better be estimated.

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