Role of physiotherapy in hospitalized patients with pneumonia: respiratory interventions, mobilization, and functional recovery

Abstract

Introduction: Pneumonia is a major cause of hospitalization and can lead to significant impairment of respiratory function, secretion accumulation, altered oxygenation, reduced exercise tolerance, and loss of functional capacity. During hospitalization—particularly in elderly or frail patients, or those undergoing mechanical ventilation—these effects can be exacerbated by immobility and clinical severity. In this context, respiratory physiotherapy is part of multidisciplinary care, employing strategies aimed at airway clearance, improved ventilation, early mobilization, and functional recovery. Objective: To synthesize the available evidence on physical therapy interventions used in hospitalized patients with pneumonia and their effects on respiratory function, secretion clearance, oxygenation, mobility, functional capacity, and clinical outcomes. Methods: This is an integrative literature review of a qualitative and descriptive nature. The search was conducted in the PubMed/MEDLINE, SciELO, and Virtual Health Library databases using descriptors related to pneumonia, respiratory physiotherapy, breathing exercises, bronchial hygiene, early mobilization, lung function, and rehabilitation, combined using the Boolean operators AND and OR. Initially, 243 records were identified, 23 of which were duplicates. Following the screening and eligibility stages, eight studies met the inclusion criteria and comprised the final sample. The data were analyzed descriptively and qualitatively. Results: The included studies featured various designs, including an epidemiological study, a randomized clinical trial, systematic reviews, meta-analyses, a scoping review, and a consensus study. The main interventions analyzed involved bronchial hygiene techniques, breathing exercises, positioning, early mobilization, physical training, positive pressure techniques, and strategies for patients undergoing mechanical ventilation. The main outcomes evaluated were secretion clearance, oxygen saturation, lung compliance, lung function, functional capacity, muscle strength, dyspnea, quality of life, length of hospital stay, duration of mechanical ventilation, and mortality. Overall, the findings indicated benefits primarily regarding secretion removal, certain respiratory parameters, mobility, muscle strength, and functional capacity. Early mobilization and exercise programs also demonstrated the potential to promote functional recovery and reduce the length of hospital stay in specific groups. However, the results were heterogeneous and did not show consistent benefits across all outcomes—particularly mortality and cure rates—underscoring the need for individualized intervention strategies. Conclusion: Respiratory physiotherapy plays a significant role in the care of hospitalized patients with pneumonia, especially when tailored to the respiratory and functional needs identified during assessment. Airway clearance techniques, breathing exercises, early mobilization, and physical training can contribute to clinical and functional recovery. However, the evidence does not support the indiscriminate application of a single protocol; instead, the approach must be individualized based on pneumonia severity, the presence of secretions, the need for ventilatory support, and the patient's functional status. Further clinical studies using standardized protocols are needed to strengthen the evidence regarding the most effective physiotherapy strategies.