Background
Methods
Positions studied
Outcome measures and defined thresholds for clinical significance
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FEV1/FVC < 0.7 is defined as obstructive disease
Results
Studies included in the review
1st Author (year) | Procedure | Posture and Test Randomization | Adjustment period to posture prior to measurement | Risk of Bias |
---|---|---|---|---|
Antunes (2016) [45] | Mini Wright® (Clement Clarke International Ltd. Edinburgh Way Harlow, Essex, UK) peak flow meter portable device with a disposable mouthpiece | Random position order | 1 min | Moderate |
Badr (2002) [46] | Pressure manometer, vitalograph (Compact, Vitalograph Ltd., Buckingham, UK) | Random position order Random test order (PEF and PEmax) Subjects instructed on equipment use, practiced before test | 5 min | Low |
Baydur (2001) [35] | Spirometry | Random position order | N/A | Moderate |
Ben-Dov (2009) [17] | Spirometry | N/A | N/A | Moderate |
Benedik (2009) [52] | Helium dilution | First position always sitting | 5 min | Moderate |
Ceridon (2011) [18] | Spirometry, DLCO measured by rebreathe technique | N/A | 30 min supine position prior to test Time prior to seated measurement not mentioned | Moderate |
Chang (2005) [53] | Spirometry, FRC measured using helium dilution | First position always supine | 5 min | Moderate |
Costa (2015) [54] | Mouth pressure meter | Random position order | 10 min | Moderate |
De (2012) [29] | Spirometry | First position was always sitting | N/A | Moderate |
Elkins (2005) [47] | Pressure manometer, spirometry - mass flow sensor | Random position and test order (PEF, PEmax) Subjects instructed on equipment use, practiced before test | 5 min | Low |
Faggiano (1998) [58] | Single breath technique using a Medical Graphics PF/DX module (Medical Graphics St. Paul, Minn, USA) for determining DLCO | Random position order | 10 min | Moderate |
Ganapathi (2015) [19] | Digital spirometry (BIOPAC System Inc. Goleta, California, USA) | N/A | N/A | Moderate |
Gianinis (2013) [48] | Portable peak expiratory flow-device | Random position order | N/A | Moderate |
Kim (2012) [36] | Spirometry | N/A | N/A | Moderate |
Linn (2000) [33] | Spirometry | Random position order | N/A | Moderate |
Manning (1999) [20] | Spirometry, single breath for determining DLCO | Two protocols (Session A & B). First chosen at random then alternated for successive subjects. First position always sitting. | 15 min | Moderate |
McCoy (2010) [49] | Peak flow meter | Random position order. Subjects instructed on equipment use, practiced before test | N/A | Moderate |
Melam (2014) [30] | Spirometry (Excel/PC-based pulmonary function tests) | Random position order | N/A | Moderate |
Meysman (1998) [3] | Spirometry, peak flow meter | Random position order | 10 min | Moderate |
Miccinilli (2016) [40] | Spirometry | N/A | N/A | Moderate |
Mohammed (2017) [31] | Spirometry | Order of positions always standing, sitting, supine, lateral decubitus | N/A | Moderate |
Myint (2017) [42] | Spirometry | Order of positions was standing, sitting, supine | N/A | Moderate |
Naitoh (2014) [39] | Spirometry, breath dynamometer (Chest Co. Ltd) | First position always sitting | N/A | Moderate |
Ogiwara (2002) [55] | Vitalpower KH-101 (Chest M.I. Inc., Japan) | Random position order | 10 min | Moderate |
Ottaviano (2016) [50] | Peak flow meter | Random position order | N/A | Moderate |
Palermo (2005) [21] | Spirometry, DLCO measured by a single breath technique | Random position order | 15 min | Moderate |
Park (2010) [34] | Spirometry | N/A | N/A | Moderate |
Patel (2015) [22] | Spirometry | First position always sitting | N/A | Moderate |
Peces-Barba (2004) [56] | Single breath technique, rebreathing technique for determining DLCO | N/A | 3–5 min | Moderate |
Poussel (2014) [38] | Spirometry | Random position order | N/A | Moderate |
Razi (2007) [32] | Spirometry | Alternately sitting, standing | N/A 15 min between positions | Moderate |
Roychowdhury (2011) [44] | Spirometry | N/A | N/A 5 min rest between positions | Moderate |
Saxena (2006) [23] | Spirometry | N/A | N/A | Moderate |
Sebbane (2015) [41] | Spirometry, multiple breath helium dilution method | First position always sitting | N/A | Moderate |
Stewart (2000) [24] | Single breath method for determining DLCO | N/A, 72 h between positions | 15 min | Moderate |
Terson de Paleville (2014) [37] | Spirometry, MP45–36-350 differential pressure transducer Validyne Engineering, (Northridge Ca, USA) | First position always sitting | 30 min | Moderate |
Terzano (2009) [57] | Single breath DLCO technique | Random position order | At least 15 min | Moderate |
Tsubaki (2009) [28] | Micro RPM 01 (Micro Medical, UK), spirometry | Random position order | N/A | Moderate |
Varrato (2001) [25] | Spirometry | N/A | N/A | Moderate |
Vilke (2000) [26] | Spirometry | First position always supine/prone | N/A | Moderate |
Wallace (2013) [51] | Peak flow meter | Random position order | N/A | Moderate |
Watson (2005) [43] | Multi-breath helium dilution, spirometry | N/A | N/A | Moderate |
Yap (2000) [27] | Spirometry, FRC was measured using helium dilution | First position always sitting | 5 min | Moderate |
1st Author (Year) | No of Participants | Age (Years) | Population | Positions | Pulmonary Function | Main Findings |
---|---|---|---|---|---|---|
Meysman (1998) [3] | 31 | 25.6 ± 3.8 | Healthy | Sitting Supine RSL LSL | PEF, FVC, FEV1, PImax, PEmax | FVC, FEV1, PEF: sitting>supine LSL, RSL, PImax: sitting>supine PEmax: p > 0.05 between positions |
Manning (1999) [20] | 19 | 62.8 ± 6.8 | Healthy older adults | Sitting LSL RSL | FVC, FEV1 DLCO/VA | FVC, FEV1: sitting>RSL & LSL DLCO/VA: p > 0.05 between positions |
Vilke (2000) [26] | 20 | Range 18–50 | Healthy males | Sitting Supine | FVC, FEV1 | FVC, FEV1: sitting>supine |
Stewart (2000) [24] | 10 | 22.3 ± 2.4 | Healthy males | Sitting Supine | FVC, VC, FEV1, FEV1/FVC, PEF, DLCO | FVC, PEF: sitting>supine DLCO: sitting< supine FEV1, VC, FEV1/FVC: p > 0.05 between positions |
Yap (2000) [27] | 10 | 62.2±1.2 Mean±SE | Healthy | Sitting Supine | FVC, FEV1, FEV1/FVC, FRC | FVC, FEV1, FRC: sitting>supine FEV1/FVC: p > 0.05 between positions |
Varrato (2001) [25] | 15 | Mean 41 | Healthy | Sitting Supine | FVC | FVC: sitting>supine |
Badr (2002) [46] | 25 | 34.0 ± 14.9 | Healthy | Standing Sitting Supine RSL | PEmax, PEF | PEmax: standing>other positions PEmax: sitting>supine & RSL PEF: standing>other positions |
Ogiwara (2002) [55] | 20 | Mean 22.8±2.1 Range 21–28 | Healthy | Sitting Supine RSL LSL | PEmax, PImax | PEmax, PImax: p > 0.05 between positions |
Peces-Barba (2004) [56] | 14 | 37.5±11.5 | Healthy | Sitting Supine | DLCO | DLCO: sitting<supine |
Chang (2005) [53] | 20 | 28.3 ± 4.8 | Healthy males | Standing Supine | FRC | FRC: standing>supine |
Palermo (2005) [21] | 14 | 61 ± 8 | Healthy | Sitting Supine LSL RSL | FEV1, FVC, VC, DLCO | FEV1, FVC, VC: p > 0.05 between positions DLCO: sitting>LSL & RSL |
Watson (2005) [43] | 5 | Mean 57 | Healthy | Sitting Supine | TLC, VC, RV, FRC | TLC, VC, RV: p > 0.05 between positions FRC sitting>supine |
Saxena (2006) [23] | 80 | Males 21.3 ± 1.5 Females 19.6 ± 1.3 | Healthy | Standing Sitting Supine | FEV1, FVC, FEV1/FVC, PEF | FEV1, FVC, PEF: standing>supine FEV1/FVC: sitting>supine |
Ben-Dov (2009) [17] | 7 | 44 ± 10 | Healthy | Sitting Supine | FVC | FVC: p > 0.05 between positions |
Terzano (2009) [57] | 10 | 59.0 ± 9.3 | Healthy | Standing Sitting Supine | DLCO | DLCO: p > 0.05 between positions |
Tsubaki (2009) [28] | 15 | 22.7 ± 2.3 | Healthy females | Sitting Supine | FVC, FEV1, FEV1/FVC, VC, PImax, PEmax | FEV1/FVC: sitting>supine FVC, FEV1, VC, PImax, PEmax: p > 0.05 between positions |
McCoy (2010) [49] | 182 | 23.5 ± 2.5 (healthy and asthmatic patients) | Healthy | Standing, Sitting | PEF | PEF: p > 0.05 between positions |
Ceridon (2011) [18] | 12 | 63 ± 9 | Healthy | Sitting Supine | FVC, FEV1, FEV1/FVC, DLCO | FVC, FEV1, DLCO: sitting>supine FEV1/FVC: p > 0.05 between positions |
Roychowdhury (2011) [44] | 100 | Range 19–22 | Healthy | Sitting Supine | VC | VC: supine>sitting in females VC: p > 0.05 between positions in males |
Gianinis (2013) [48] | 30 | 22.2 ± 2.4 | Healthy | Sitting Supine RSL LSL | PEF | PEF: sitting>supine & RSL |
Wallace (2013) [51] | 94 | 23.9 ± 3.7 | Healthy | Standing Sitting | PEF | PEF: standing>sitting |
Naitoh (2014) [39] | 20 | 28 ± 1.4 | Healthy | Sitting Supine | FEV1,VC PEmax, PImax | FEV1, VC: sitting>supine PEmax, PImax: p > 0.05 between positions |
Costa (2015) [54] | 63 | 19.7 ± 1.5 | Healthy | Sitting Supine | PImax, PEmax | PImax, PEmax: sitting>supine |
Ganapathi (2015) [19] | 20 | Range 18–25 | Healthy | Standing Sitting Supine RSL LSL | FVC, FEV1, FEV1/FVC | FVC, FEV1, FEV1/FVC: standing>supine, RSL& LSL FEV1: standing>sitting sitting>RSL FEV1/FVC: sitting>LSL |
Patel (2015) [22] | 45 | Median 21 Range 19–23 | Healthy | Standing, Sitting Supine | FVC, FEV1, PEF | FVC, FEV1, PEF: sitting>standing FVC, FEV1, PEF: sitting>supine |
Antunes (2016) [45] | 30 | 22.7 ± 2.4 | Healthy | Sitting Supine | PEF | PEF: sitting>supine |
Miccinilli (2016) [40] | 20 | 33.6 ± 10.5 | Healthy | Sitting Supine | VC, FEV1 | VC, FEV1: p > 0.05 between positions |
Ottaviano (2016) [50] | 76 | 40 ± 16 | Healthy | Standing Sitting | PEF | PEF: standing>sitting |
Myint (2017) [42] | 15 | 22.6 ± 2.0 | Healthy | Standing, Sitting Supine | FEV1/FVC | FEV1/FVC: p > 0.05 between positions |
Badr (2002) [46] | 11 | 66.8 ± 12.6 | Chronic airflow limitation | Standing Sitting Supine RSL | PEmax, PEF | PEmax: standing>supine & RSL, PEmax: sitting>supine & RSL PEF: standing>sitting, supine, RSL |
Elkins (2005) [47] | 20 | 29 ± 8 | Adult cystic fibrosis | Standing Sitting Supine RSL | PEmax, PEF | PEmax: standing & sitting>RSL PEF: standing>supine & RSL |
Razi (2007) [32] | 49 | 42.6 ± 11.8 | Obesity, asthma
(Mean BMI 36±5)
| Standing Sitting | FVC, FEV1, FEV1/FVC | FVC, FEV1, FEV1/FVC: p > 0.05 between positions |
Terzano (2009) [57] | 30
Mild 10
Moderate-severe 10
Very severe 10
| Mild 57.3 ± 8.6 Moderate-severe 59.8 ± 9.1 Very severe 63.7 ± 5.5 | COPD | Standing Sitting Supine | DLCO | DLCO: p > 0.05 between positions |
McCoy (2010) [49] | 29 | 23.5 ± 2.5 (Healthy and asthmatic patients) | Asthma | Standing Sitting | PEF | PEF: p > 0.05 between positions |
De (2012) [29] | 75 | 61.2 ± 9.2 | COPD | Standing Sitting | FVC, FEV1 | FVC, FEV1: p > 0.05 between positions |
Melam (2014) [30] | 30 | 34.3 ± 3.7 | Asthma | Standing, Sitting Supine RSL LSL | FVC, FEV1 | FVC, FEV1: standing>supine |
Mohammed (2017) [31] | 20 | 39.2 ± 8.0 | Asthma | Standing Sitting Supine RSL LSL | FVC, FEV1, PEF | FVC, FEV1, PEF: standing>supine, RSL, LSL FVC, FEV1: standing>sitting |
Myint (2017) [42] | 15 | 22.3 ± 2.0 | Asthma | Standing Sitting Supine | FEV1/FVC | FEV1/FVC: p > 0.05 between positions |
Faggiano (1998) [58] | 32 | 59 ± 10 | CHF, males | Sitting Supine | DLCO | DLCO: p > 0.05 between positions ↓DLCO in sitting in a subgroup of patients with decrease in mean pulmonary arterial pressure in this position ↑DLCO in sitting in a subgroup of patients with increase in mean pulmonary arterial pressure in this position |
Yap (2000) [27] | 10 | 61.4 ± 2.0 Mean±SE | CHF | Sitting Supine | FEV1, FVC, FEV1/FVC, VC, FRC | FVC, FEV1 VC: sitting>supine FEV1/FVC, FRC: p > 0.05 between positions |
Palermo (2005) [21] | 14 | 62 ± 8 | CHF | Sitting Supine LSL RSL | FEV1, FVC, VC, DLCO | FEV1, FVC: sitting>RSL & LSL DLCO: sitting>RSL &LSL VC: p > 0.05 between positions |
Ceridon (2011) [18] | 24 | 65 ± 8 | CHF | Sitting Supine | FEV1, FVC, FEV1/FVC, DLCO | FEV1, FVC: sitting>supine FEV1/FVC: p > 0.05 between positions DLCO: p > 0.05 between positions |
Linn (2000) [33] | 222
Tetraplegia 98
Paraplegia 124
| 40 ± 11 | SCI | Sitting Supine | FVC, FEV1, PEF | FVC, FEV1, PEF: sitting<supine in complete tetraplegia FVC, FEV1, PEF: p > 0.05 between positions in paraplegia |
Baydur (2001) [35] | 74
C3–7 injury tetraplegia 31 T—L4 injury paraplegia 43
| 40 ± 12 | SCI | Sitting Supine | FVC, FEV1 | FVC, FEV1: p > 0.05 between positions |
Ben Dov (2009) [17] | 12 | 42 ± 11 | Neurologically stable
C5–8 tetraplegia
| Sitting Supine | FVC | FVC: sitting<supine |
Park (2010) [34] | 43 | 35.0 ± 12.6 | SCI
C6-C8
| Sitting Supine | FVC | FVC: sitting<supine |
Kim (2012) [36] | 45
Cervical 15
Thoracic 13
Lumbar 17
| Cervical 43.2 ± 1.3 Thoracic 49.8 ± 4.9 Lumbar 52.2 ± 4.4 | SCI | Sitting Supine | FVC, FEV1 | FVC, FEV1: p > 0.05 between positions within cervical/thoracic/lumbar subgroups FVC, FEV1: sitting<supine in cervical and thoracic injury FVC, FEV1: sitting>supine in lumbar injury Statistically significant difference in the effect of position between cervical/thoracic/lumbar subgroups |
Terson de Paleville (2014) [37] | 27
Complete motor injury 13 Incomplete motor injury 14 Cervical 15, Thoracic 12
| 40 ± 14 | SCI | Sitting Supine | FVC, FEV1, PEmax, PImax | FVC, FEV1: p > 0.05 between positions for all patients together FVC: sitting<supine in cervical/complete motor injury FVC: sitting>supine in thoracic incomplete motor injury FEV1 sitting> supine in incomplete motor injury FEV1: sitting>supine in thoracic incomplete motor injury PEmax: sitting>supine all patients PEmax: sitting>supine in complete motor injury PEmax: sitting>supine in cervical incomplete motor injury PImax: p > 0.05 between positions for all patients together PImax: sitting>supine in thoracic complete motor injury |
Miccinilli (2016) [40] | 20
C3–7 tetraplegia 9; T1–8 paraplegia 11
| Tetraplegia 29.4 ± 10.5 Paraplegia 36.6 ± 10.3 | SCI | Sitting Supine | VC, FEV1 | VC, FEV1: sitting<supine |
Varrato (2001) [25] | 38 | 61 | ALS | Sitting Supine | FVC | FVC: sitting>supine |
Park (2010) [34] | 45 | 54.4 ± 11.1 | ALS | Sitting Supine | FVC | FVC: sitting>supine |
Poussel (2014) [38] | 58 | 42.6 ± 12.9 | Myotonic dystrophy | Sitting Supine | FVC, FEV1 | FVC, FEV1: sitting>supine |
Watson (2005) [43] | 10 | 49 ± 6 Mean ± SE | Obesity Mean BMI 44±3 Mean±SE | Sitting Supine | TLC, VC, RV, FRC, | TLC, VC, RV, FRC: p > 0.05 between positions |
Razi (2007) [32] | 51 | 39.86 ± 10.1 | Obesity
Mean BMI 36.7±4.1
| Standing Sitting | FVC, FEV1, FEV1/FVC | FVC, FEV1, FEV1/FVC: p > 0.05 between positions |
Benedik (2009) [52] | 32 | Range 18–75 | Healthy, mild-moderate obesity
Mean BMI 32.7±3.5
| Sitting Supine | FRC | FRC: sitting>supine |
Sebbane (2015) [41] | 12 | 44 ± 14 | Morbid obesity Mean BMI 45±5 S/P bariatric surgery
Mean BMI 31 ± 5
| Sitting Supine | TLC, RV, VC, FRC, FEV1 | FEV1: sitting>supine in morbid obesity TLC, RV, FRC, VC: p > 0.05 between positions in morbid obesity FRC, FEV1: sitting>supine in s/p bariatric surgery TLC, RV, VC: p > 0.05 between positions in s/p bariatric surgery |