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Human A.1,2, Corten L.2, Jelsma J.2, Morrow B.3
1Sefako Makgatho Health Sciences University, Physiotherapy, Pretoria, South Africa, 2University of Cape Town, Health and Rehabilitation Sciences (Division Physiotherapy), Observatory, Cape Town, South Africa, 3University of Cape Town, Paediatrics and Child Health, Rondebosch, Cape Town, South Africa
Background: Various non-pharmacological techniques improve airway clearance. Chest physiotherapy is an important part of respiratory care and includes various techniques, such as percussions, vibrations, thoracic squeezing, and cough stimulation/augmentation. Chest physiotherapy is advised in children presenting with respiratory muscle weakness and a weak cough.
Purpose: To explore what South African physiotherapists perceived as best respiratory care in non-ventilated paediatric and adolescent patients with neuromuscular diseases (NMDs) in acute and chronic settings. The researchers also wanted to determine which chest physiotherapy techniques are currently being used by physiotherapists in South Africa.
Methods: A cross-sectional descriptive research study design was implemented and a non-probability purposive sampling frame was used. A self-constructed questionnaire was distributed to 475 physiotherapists with a special interest or expertise in the field of Respiratory care and/or Paediatrics, using an online survey platform.
Results: The overall response rate was 16%. Of these respondents, 80% were eligible because they have previously worked with patients with NMDs. The majority of participants worked in private practice and/or hospital wards and had less than five years of working experience. The most frequently chosen techniques used for acute general respiratory care were supplemental oxygen delivery and 24-hour postural management. Vibrations, positioning and breathing exercises were favoured for mobilising secretions and manually assisted cough was strongly supported for cough augmentation. The majority either did not know about mechanical insufflation-exsufflation as an alternative cough augmentation technique or was aware of the device, but have never used it before. For chronic management, the majority of participants supported inspiratory muscle training and breathing exercises as part of respiratory muscle training and lung compliance exercises. However, 50% of participants were unsure about the use of breath stacking/hyperinflation/glosso-pharyngeal breathing during chronic management. Nebulisation and positioning were favoured as secretion mobilisation techniques whilst manually assisted cough was strongly supported for airway clearance and cough assistance. Further, 24-hour postural management and non-invasive ventilation were mostly used for respiratory support. Only six participants recently treated children and adolescents with NMDs. They used vibrations, adapted postural drainage, positioning and breathing exercises as part of acute respiratory management; whereas breathing exercises, adapted postural drainage, positioning and autogenic drainage were used as chronic care techniques by all six participants. Mechanical insufflation-exsufflation was not used by any of them in the past six months.
Conclusion(s): The main findings indicate that South African physiotherapists are aware of internationally published clinical guidelines for patients with NMDs, but traditional chest physiotherapy techniques are still favoured. Furthermore, secretion clearance and cough augmentation techniques such as breath stacking/hyperinflation/glossopharyngeal breathing and mechanical insufflation-exsufflation are only used by a minority. South African physiotherapists seemingly have limited exposure and experience in managing paediatric and adolescent patients with NMDs.
Implications: Information regarding evidence based practice and new technologies in the field of NMDs should be made more widely available through workshops, presentations and integration into undergraduate curricula. Additional research is recommended to identify the most efficient, cost-effective and safe respiratory care techniques in South African children with NMDs.
Funding acknowledgements: This work is supported by the URC Equipment Grant (Western Cape); SMU Research Development Grant; and the SASP PhD grant.
Topic: Cardiorespiratory
Ethics approval: Human Research Ethics Committee (UCT): 513/2015
All authors, affiliations and abstracts have been published as submitted.
