Introducing Mechanically Assisted Cough for Patients With Progressive Neurological Disease: Patient-Physical Therapist Interaction and Physical Therapist Perspective

Objective. The goal of this study was to explore the patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (Ml-E) device treatment for patients with progressive neurological disease. Methods. Qualitative content analysis of participant's observation of interaction between patients and physical therapists during 9 Ml-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. Results. The introduction of Ml-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home use in an inclusive dialog with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support. Conclusion. Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing Ml-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing Ml-E to patients. Further research is needed to explore this from the patient's perspective. Impact. This study added to the body of knowledge regarding Ml-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care. Keywords: Mechanical Insufflation--Exsufflation, Neuromuscular Disease, Physical Therapy, Qualitative
Introduction Patients affected by progressive neurological disease in the later stages are prone to pulmonary complications, (1) characterized by impaired ventilation and cough, which can increase morbidity and mortality. (2) [...]