Pectus excavatum without surgery; can physical therapy improve chest wall or cardiopulmonary function?

Objective(s): To investigate available evidence regarding physical therapy (PT) for management of uncorrected pectus excavatum (PE) in adults. PE, inward sternal displacement, can reduce chest wall mobility, cardiopulmonary function, and activity tolerance.

Data Sources: PubMed, ProQuest Nursing & Allied Health Premium, Cochrane Library, CINAHL Complete, and Academic Search Complete were searched for English-language articles (1931-2021), using terms: pectus excavatum and treatment, conservative, surgical indications, physical therapy, exercise and cardiopulmonary.

Study Selection: Sixty-one articles were identified. Articles were excluded only for not addressing treatment. Twenty-two were included by multiple reviewers for further review and data extraction, as they addressed treatment for PE in adult or pediatric populations.

Data Extraction: Available evidence is scarce, hindering an evaluation of quality. For selected studies, 3 reviewers extracted data into a modified PICOT framework.

Data Synthesis: Seven articles included conservative management, with addressing exercise or PT. One experiment suggested significant improvement in pulmonary function and activity tolerance in children with PE after completing an exercise program. The lone study addressing effects of exercise in an adult with PE concluded that PT provided significant improvement. Three studies treated exercise as a possible confounder to the results, eg, noting the potential effects of baseline fitness levels or varying participation in exercise.

Conclusions: Two studies targeted PT treatment, one in children18 and the other a single adult. Both suggested potential benefit. Additionally, several articles acknowledged that exercise may have confounded the results, and may speak to the utility of PT as an effective treatment. Surgery carries significant risk, and there is no standard of care for the 50% or more who are not surgical candidates. This review highlights the need for investigation into the effects of PT for this population.

Author(s) Disclosures: There is no conflict of interested associated with this study for any of the authors.