The effects of nonpharmacological therapeutic interventions on pain and physical function in adults with rib fractures: a systematic review
Date
2020
Authors
Weinberg, Beverley Joan
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Abstract
Background:
Rib fractures are the most common thoracic injury encountered following blunt chest trauma and are notable source of chest pain. Chest pain may lead to compromised respiratory function and physical function. Consequently, prolonged lengths of stay as well as high morbidity and mortality rates may be observed. Non-pharmacological therapeutic interventions often form part of the care plan of patients diagnosed with rib fractures, however these treatment interventions are frequently published in isolation and no concise summary of management options exists.
Purpose:
This systematic review aims to establish what non-pharmacological therapeutic interventions are utilised to treat pain following acute rib fractures, as well as to determine the effects of these non-pharmacological therapeutic interventions on pain and physical function in adults with rib fractures. Secondary outcomes included length of stay (LOS), respiratory function and respiratory complications.
Methods:
A systematic review was conducted to answer the aims of the study. A three-step search strategy was utilised, and databases searched included MEDLINE using PubMed, EMBASE, PsycINFO, Scopus, CENTRAL, CINAHL Plus and PEDro and Google Scholar, OpenGrey (SIGLE), Cochrane Library and the International prospective register of systematic reviews (PROSPERO). The Joanna Briggs Institute’s System for the Unified Management, Assessment and Review of Information (SUMARI) was used to conduct the study. Metaanalysis was conducted for pre-bundle of care versus post-bundle of care implementation for the outcome measures of hospital length of stay (LOS), incidence of pneumonia and mortality rate. The GRADE approach for grading quality of evidence was followed, and a summary of findings table generated for each included outcome.
Results:
Sixteen studies were included for final review. No interventions were identified which objectively improved physical function. Acupuncture, continuous positive airway pressure, physiotherapy modalities and transcutaneous electrical nerve stimulation (TENS) reduced pain. Acupuncture, TENS and non-invasive ventilation (NIV) improved respiratory function. Physiotherapy modalities, acupuncture, NIV and multidisciplinary care pathways reduced pulmonary complications. NIV modalities and multidisciplinary care pathways resulted in reduced LOS and mortality rate. Meta-analysis of pre versus post bundle of care implementation on incidence of pneumonia revealed a 63% reduction in risk of developing pneumonia in comparison to those managed without care bundles (p < 0.00).
Conclusion:
Non-pharmacological therapeutic interventions were shown to aid pain relief, improve respiratory function and reduce the incidence of pneumonia following rib fractures in the acute care setting. Bundled care pathways were identified as important management strategies
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in the treatment of patients following acute rib fractures, aiding identification of early respiratory compromise and promoting standardisation of care and multidisciplinary team collaboration.
Description
A dissertation submitted in fulfilment of the requirements for the degree Master of Science (Physiotherapy) to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020