The effects of 'on-call/out of hours' physical therapy in acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

Objective: To assess the effectiveness of an on-call physical therapy programme in the management of acute exacerbations of chronic obstructive pulmonary diseases. Design: Randomized controlled trial. Setting: Secondary care level, rural hospital. Subjects: Thirty-eight patients with acute exacerbations of chronic obstructive pulmonary disease. Interventions: Regular physical therapy and on-call physical therapy was given to two groups of patients with 19 in each arm. On-call physical therapy included providing respiratory physical therapy as required by the patient out of business hours. Main measures: Peak expiratory flow rate, sustained maximal inspiration, six-minute walk distance and rating of perceived exertion post six-minute walk test. Results: In the group receiving on-call physical therapy, peak expiratory flow rate and six-minute walk test showed a significant difference (52.1 L/min and 98.16 m, respectively) when compared with the control group (211.57 +/- 51.12 L/min and 159.47 +/- 67.78 L/min; P = 0.01 and 387.89 +/- 110.1 m and 289.73 +/- 103.2 m; P = 0.004 respectively). The difference in peak expiratory flow rate (Delta peak expiratory flow rate) was seen to be more in the on-call group (120 L/min) when compared to the control group (50 L/min), P = 0.002. Improvements in sustained maximal inspiration and Borg's rating of perceived exertion after the six-minute walk test were also observed (P > 0.05). Conclusion: On-call physical therapy brings about a significant increase in peak expiratory flow rates, six-minute walk distance and sustained maximal inspiration.