B.J. Weinberg1, R. Roos1,2, H. van Aswegen1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2The Wits-JBI Centre for Evidenced-Based Practice: A Joanna Briggs Institute Centre of Excellence, Physiotherapy, Johannesburg, South Africa

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 and physical function, with prolonged lengths of stay as well as high morbidity and mortality rates being observed. Non-pharmacological therapeutic interventions form part of the care plan of patients diagnosed with rib fractures, however concise summaries of treatment options for management are not available, nor have the effects of these interventions on the outcomes of pain and physical function been established in a holistic format.

Purpose: This systematic review aims to establish what non-pharmacological therapeutic interventions are utilised to treat pain following acute rib fractures, as well as determine the effects of these interventions on pain and physical function. Secondary outcomes reviewed 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. Meta-analysis 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, with 2034 participants of which 42.5% were female and 58.0 % were male.  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(s): Non-pharmacological therapeutic interventions aided pain relief, improved respiratory function and reduced the incidence of pneumonia. No interventions were identified which lead to objective improvements in physical function. Future studies should thus be directed at identifying interventions aiding improvements in physical function and functional independence as measured by objective analysis. Bundled care pathways were identified as important management strategies in the treatment of patients following acute rib fractures, aiding recognition of early respiratory compromise and promoting standardisation of care and multidisciplinary team collaboration.

Implications: Physical therapists should thus consider the use of non-pharmacological therapeutic interventions as viable treatment options in the management of pain and restoration of both physical and respiratory function following acute rib fractures.

Funding, acknowledgements: A grant was received from the South African Society of Physiotherapy to assist with funding of this study.

Keywords: Chest trauma, Pain, Respiratory and physical function

Topic: Cardiorespiratory

Did this work require ethics approval? No
Institution: University of the Witwatersrand’s Human Research Ethics (Medical) Committee
Committee: N/A
Reason: The study is a systematic review.

All authors, affiliations and abstracts have been published as submitted.

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