The current use of positive expiratory pressure (PEP) therapy by public hospital physiotherapists in New South Wales

Positive expiratory pressure (PEP) therapy involves the application of a resistance to expiration to produce positive airway pressure. PEP therapy is an effective treatment strategy; however, little is known about its current clinical use. The purpose of this study was to describe the clinical use of PEP therapy. The study was a cross sectional design using a written survey. Participants were physiotherapists from public hospitals in New South Wales, Australia (n=149). The response rate was 60% (n=89). PEP therapy was regularly used in the clinical practice of 68 (76%) respondents. The patient group most frequently treated with PEP therapy were those with respiratory medical conditions (n=59, 87%) and the most commonly selected indication for use was excessive respiratory secretions (n=60, 88%). Improvised devices such as bubble (or bottle) PEP were used by more respondents (n=61, 90%) than commercially-available devices (n=30, 44%) and were constructed using a variety of methods, often non-standardised. PEP therapy (particularly variably constructed bubble-PEP) was regularly employed for the treatment of patients with cardiorespiratory conditions. Further research into the effectiveness of PEP delivered with improvised devices and more specific training of healthcare practitioners regarding optimal design parameters for PEP therapy may be beneficial.