A statement on the physiotherapy Vest by the Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF)

A piece of physiotherapy equipment, known as the Vest, is also known to physiotherapists as a High Frequency Chest Wall Oscillation device (HFCWO). It creates electric air pulses and pushes these into an inflatable jacket (vest) which vibrates the chest of the person wearing it. Read the statement below by the Association of Chartered Physiotherapists in Cystic Fibrosis, which shows the current evidence in studies about the Vest.

Good quality airway clearance can be achieved in a variety of ways. The Vest is just one device designed to help with airway clearance.

The use of different airway clearance techniques (ACT) in people with CF has been reviewed and published many times in the last 20 years but there is little evidence to say that one technique is better than another.

However, two recent well-constructed studies showed that people using the High Frequency Vest Oscillation, (the Vest) as their chosen airway clearance technique, may get more infections and get them more quickly than people using other types of airway clearance techniques. These two studies were done in children. There are at least two studies in adults that show that less or just the same amount of secretions were cleared in people using the Vest compared to people using other techniques. There are at least two studies demonstrating an improvement in lung function when using other airway clearance techniques when compared to the vest. One study identified that a significant drop in oxygen saturations can occur in people with moderate to severe disease when using the Vest when compared to other techniques, recommending that oxygen monitoring should be carried out in this group.

The ACPCF therefore recommends that the Vest is not used as the only ACT, especially in children with cystic fibrosis. The ACPCF recognises that some patients may prefer to use the Vest and feel benefits from using it. We advise people thinking about wanting to use the Vest to discuss the pros and cons with their physiotherapist. The ACPCF recommends that for people with cystic fibrosis choosing to use the Vest, some other ACT such as the active cycle of breathing, PEP, with huffing and coughing is also done with the Vest on. The Vest could be considered when adherence with other airway clearance techniques is difficult or not achievable.

When considering which airway clearance technique to recommend to their patients, physiotherapists will consider their patient’s age, their choices and circumstances, as well as their health and chest symptoms and their ability to use the techniques and devices being recommended. More than one technique can be used together. A physiotherapist will consider all costs involved for the person and the healthcare provider when considering the Vest as a treatment option.

The Vest part of the HFCWO device is for single patient use only and must not be used for any other person.