# The Effectiveness of Pump Techniques and Compages: A Systematic Review
## 4 Discussion  
This review aimed to investigate the effectiveness of pump techniques and pompages on subjective parameters (e.g., pain, physical function) and objective parameters (lung function, blood count cell, length of hospitalization) on adults. The results of this review showed that pump techniques and pompages were applied in a wide spectrum of populations and using very different outcome measures. The studies on pump techniques were conducted both on healthy, young or elderly subjects, and in different clinical conditions as COPD, pneumonia, other pulmonary diseases, and patients submitted by surgery. The studies on pompages were done on pulmonary diseases, tension-type headache, fibromyalgiaalgia, and knee osteoarthritis. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline  & \multicolumn{3}{c}{**Quality**} & \multicolumn{3}{c}{**Summary of Findings**} \\ \hline
**Outcome** & & & & & & **Effect Size** \\
**(No. of Studies)** & **RoB** & **Inconsistency** & **Indirectness** & **Imprecision** & **No. of Participants** & **(SMD)** & **GRADE \({}^{*}\)** \\ \hline
**Pain** & & & & & & **with CI \({}^{*}\)** & \\ ([PERSON] 2016 [58]) & Not serious & Not assessable & Not serious & Serious & 23 & \# & LOW \\
**Fatigue** & & & & & & **with CI \({}^{*}\)** & \\
**[PERSON] 2016 [58]** & Not serious & Not assessable & Not serious & Serious & 23 & \# & LOW \\
**Sleep quality** & & & & & & **with CI \({}^{*}\)** & \\ ([PERSON] 2016 [58]) & Not serious & Not assessable & Not serious & Serious & 23 & \# & LOW \\
**[PERSON] 2016 [58]** & Not serious & Not assessable & Not serious & Serious & 23 & \# & LOW \\  & & & & & & **with CI \({}^{*}\)** & \\
**Pain** & & & & & & & **with CI \({}^{*}\)** & \\
**[PERSON] 2008 [59]** & Not serious & Not assessable & Not serious & Serious & 16 & \# & LOW \\  & & & & & & **\({}^{*}\)**_Knee pompage + exercise versus educational lectures_ & & & \\
**Pain** & & & & & & **with CI \({}^{*}\)** & \\
**[PERSON] 2017 [60]** & Not serious & Not assessable & Not serious & Serious & 22 & \# & LOW \\
**Postural balance** & & & & & & & **with CI \({}^{*}\)** & \\
**([PERSON] 2017 [60])** & Not serious & Not assessable & Not serious & Serious & 22 & \# & LOW \\
**Muscle strength** & & & & & & & **with CI \({}^{*}\)** & \\
**([PERSON] 2017 [60])** & Not serious & Not assessable & Not serious & Serious & 22 & \# & LOW \\  & & & & & & **\({}^{*}\)**_Manual Diaphragm Release Technique versus light touch_ & & & \\
**Functional capacity** & & & & & & & **with CI \({}^{*}\)** & \\
**([PERSON] 2015 [57])** & Serious & Not assessable & Not serious & Serious & 20 & \# & VERY VERY \\  & & & & & & & LOW \\
**Pompage + postural treatment versus pulmonary rehabilitation protocol** & & & & & & **with CI \({}^{*}\)** & \\
**Functional capacity** & & & & & & & **with CI \({}^{*}\)** & \\
**([PERSON] 2013 [61])** & Not serious & Not assessable & Not serious & Serious & 5 & \# & LOW \\ \hline \hline \end{tabular}  
* Effect Size (SMD) with CI = Effect Size (Standardized Mean Difference with Confidence Interval). # Effect size is not reported because meta-analysis was not performed. \({}^{*}\) GRADE for the study had been calculated only for before treatment and after treatment (short-term) outcomes. \({}^{*}\) 50% RoB moderate and 50% RoB high.  
\end{table} 
Table 5: \(Cont.\)All studies combined various pump techniques or added these techniques to other treatments, with different procedures. In example, the treatment performed by [PERSON] and colleagues [48] included thoraco-lumbar soft tissue treatment, rib raising, diaphragm doming, cervical soft tissue treatment, subocipital decompression, inlet relaxation, together with thoracic lymphatic pump and pedal pump. Instead, [PERSON] and colleagues [51] performed chest wall and diaphragm manipulation, combined with manual compressions on the sternal, dorsal, and clavicular areas.