Physiotherapy in hospitalized medical patients

Few data on exercise training in hospitalized patients are available, but because exercise may help and it unlikely to harm, some sort of early and maximal mobilization should be attempted. Breathing exercises as practiced currently have little apparent effect beyond the temporary benefit of inducing a slow, deep breathing pattern. New breathing exercises, based on data from physiology laboratories, should be formulated and evaluated. Postural drainage and percussion represent the physiotherapist's mainstay in dealing with exacerbations of chronic obstructive disease. In some patients, these maneuvers increase production of sputum and produce improvements in pulmonary function that, although not large, are significant. Other patients show no acute benefit. Current belief holds that patients with large sputum volumes, notably those with cystic fibrosis and bronchiectasis, are the most likely to be helped by postural drainage and percussion; but definitions vary as to what is a large sputum volume. Two studies have assessed the effect of postural drainage and percussion on the clinical course of patients with pneumonia and patients with exacerbations of chronic bronchitis, and both produced negative results.