Louise Rose1, Douglas McKim2, David Leasa3, Mika Nonoyama4, Anu Tandon5, Marta Kaminska6, Colleen O'Connell7, Andrea Loewen8, Bronwen Connolly9, Patrick Murphy10, Nicholas Hart10, Jeremy Road11. 1. Department of Critical Care, Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, Canada; the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada. louise.rose@utoronto.ca. 2. Ottawa Hospital Respiratory Rehabilitation and the Ottawa Hospital Sleep Centre, University of Ottawa, Ottawa Hospital Research Institute. 3. Department of Medicine, Divisions of Critical Care & Respirology, London Health Sciences Centre, Western University, London, Ontario, Canada. 4. University of Ontario Institute of Technology, Child Health Evaluative Sciences & Respiratory Therapy, SickKids, Rehabilitation Sciences & Physical Therapy, University of Toronto, Canada. 5. Sunnybrook Health Sciences Centre, University of Toronto, Canada. 6. National Program for Home Ventilatory Assistance, McGill University Health Centre, McGill University, Montreal, Quebec, Canada. 7. Stan Cassidy Centre for Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada. 8. Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada. 9. Lane Fox Clinical Respiratory Physiology Research Centre, London, UK; the National Institute for Health Research Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation and King's College London, London, UK. 10. Lane Fox Clinical Respiratory Physiology Research Centre, London, UK; and the Centre for Human and Aerospace Physiological Sciences, King's College London, UK. 11. Vancouver General Hospital, Division of Respirology, Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: Regular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada. METHODS: This was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks. RESULTS: We received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents (P = .02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents (P = .044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, P = .02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, P = .046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, P = .007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, P = .92). Mechanical insufflation-exsufflation (MI-E) + lung volume recruitment (LVR) + manually assisted cough when CPF ≤ 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, P = .002) and inadequate community workers' knowledge (56% vs 34%, P = .002). Funding for community support was a common constraint in both countries (49% vs 42%). CONCLUSIONS: The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.
BACKGROUND: Regular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada. METHODS: This was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks. RESULTS: We received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents (P = .02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents (P = .044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, P = .02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, P = .046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, P = .007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, P = .92). Mechanical insufflation-exsufflation (MI-E) + lung volume recruitment (LVR) + manually assisted cough when CPF ≤ 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, P = .002) and inadequate community workers' knowledge (56% vs 34%, P = .002). Funding for community support was a common constraint in both countries (49% vs 42%). CONCLUSIONS: The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.
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