The Vest for delivering high-frequency chest wall oscillation in people with complex neurological needs

The technology described in this briefing is The Vest. It is intended to deliver high-frequency chest wall oscillation for clearing airways. The focus of this briefing is its use in adults and children with complex neurological needs, such as cerebral palsy and motor neurone disease (also known as amyotrophic lateral sclerosis).

The innovative aspects are that it delivers therapy in a more standardised and consistent way compared with manual therapy.

The intended place in therapy would be as an alternative to chest wall percussion – a manual airway clearance technique used as part of chest wall physiotherapy by respiratory physiotherapists or trained carers.

The main points from the evidence summarised in this briefing are from 5 US studies: 4 in cerebral palsy (including 54 people) and 1 in motor neurone disease (including 36 people). All studies in cerebral palsy showed that The Vest reduced the number of hospital admissions, but the reduction was not significant. The study in motor neurone disease showed that The Vest significantly reduced the number of infections.

Key uncertainties around the evidence are that it is limited in quality and quantity. A randomised controlled trial with relevant outcomes comparing The Vest with manual airway clearance techniques in an NHS pathway would improve the evidence base. Also, there is no established place in therapy for high-frequency chest wall oscillation in this patient group.

The cost of The Vest is £6,995 per unit (excluding VAT). The resource impact would be greater than standard care but costs might be offset by reducing the number of hospital admissions.