Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial

In this randomised, controlled trial powered for equivalence, 526 patients hospitalised with acute COPD exacerbation were enrolled from four centres in the UK. Patients were allocated to receive MCP plus advice on airway clearance or advice on chest clearance alone. The primary outcome was a COPD specific quality of life measure, the Saint Georges Respiratory Questionnaire (SGRQ) at six months post randomisation. Analyses were by intention to treat (ITT). This study was registered, ISRCTN13825248.All patients were included in the analyses, of which 372 (71%) provided evaluable data for the primary outcome. An effect size of 0·3 standard deviations in SGRQ score was specified as the threshold for superiority. The ITT analyses showed no significant difference in SGRQ for patients who did, or did not receive MCP (95% CI ？0·14 to 0·19).These data do not lend support to the routine use of MCP in the management of acute exacerbation of COPD. However, this does not mean that MCP is of no therapeutic value to COPD patients in specific circumstances.Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations some of which result in increased cough and excessive sputum production caused by mucus hyper-secretion and ciliary dysfunction. Manual chest physiotherapy (MCP) involves external manipulation of the thorax using percussion and vibration techniques. Their purpose of these is to intermittently to apply kinetic energy to the chest wall to dislodge bronchial secretions. The patient then clears these secretions with an expiratory manoeuvre such as the forced expiration technique (FET). The assumption underlying the use of MCP is that removing sputum from the airway improves ventilation perfusion ratios and thus lung function. However, reviews of clinical trials report that although airway clearance techniques may improve sputum expectoration, there is no high quality evidence of either short or long term value [1-4].Methodological limitations inherent in e