Lambrinos Elizabeth, Elkins Mark R, Menadue Collette, McGuiness Olivia A, Melehan Kerri L, Piper Amanda J
Respiratory Support Service, Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
Centre for Education and Workforce Development, Sydney Local Health District, Sydney, New South Wales, Australia.
Respir Care. 2023 Dec 28;69(1):91-98. doi: 10.4187/respcare.11031.
Mechanical insufflation-exsufflation (MI-E) is a cough augmentation technique used to support people with an ineffective cough. MI-E can be complex due to the number of different pressure, flow, and temporal setting adjustments needed to optimize cough efficacy. Many clinicians identify inadequate training, limited experience, and low confidence as barriers to MI-E use. The purpose of this study was to determine if an online education course could improve confidence and competence in the delivery of MI-E.
An e-mail invitation to participate was disseminated to physiotherapists with a caseload that involved airway clearance for adults. The exclusion criteria were self-reported confidence and clinical expertise in MI-E. The education was created by physiotherapists with extensive experience in the provision of MI-E. The education material reviewed theoretical and practical components and was designed to take 6 h to complete. Physiotherapists were randomized to either the intervention group, who had 3 weeks of access to the education or the control group who received no intervention. Respondents in both groups completed a baseline and a post-intervention questionnaire by using visual analog scales, 0 to 10, with the primary outcomes being confidence in the prescription and confidence in the application of MI-E. Ten multiple-choice questions that covered key components of MI-E fundamentals were also completed at baseline and post-intervention.
The intervention group had a significant improvement in the visual analog scale after the education period with a between-group difference of mean 3.6 (95% CI 4.5 to 2.7) for prescription confidence and mean 2.9 (95% CI 3.9 to 1.9) for application confidence. There was also an improvement in the multiple-choice questions with a between-group difference of mean 3.2 (95% CI 4.3 to 2).
Access to an evidence-based online education course improved confidence in the prescription and application of MI-E, and may be a valuable tool for training clinicians in the application of MI-E.
机械通气辅助咳痰（MI-E）是一种用于帮助咳嗽无力者的咳嗽增强技术。由于优化咳嗽效果需要对不同的压力、流量和时间设置进行多种调整，MI-E可能较为复杂。许多临床医生认为培训不足、经验有限和信心不足是使用MI-E的障碍。本研究的目的是确定在线教育课程是否能提高实施MI-E的信心和能力。
向负责成人气道清理的物理治疗师发送参与电子邮件邀请。排除标准为自我报告的在MI-E方面的信心和临床专业知识。该教育课程由在提供MI-E方面有丰富经验的物理治疗师创建。教育材料涵盖理论和实践部分，设计为需6小时完成。物理治疗师被随机分为干预组（可在3周内访问该教育课程）或对照组（不接受干预）。两组的受访者均使用0至10的视觉模拟量表完成基线和干预后问卷，主要结果是对MI-E处方的信心和对MI-E应用的信心。在基线和干预后还完成了涵盖MI-E基本要素关键部分的10道多项选择题。
干预组在教育期后的视觉模拟量表上有显著改善，处方信心的组间平均差异为3.6（95%可信区间4.5至2.7），应用信心的组间平均差异为2.9（95%可信区间3.9至1.9）。多项选择题也有改善，组间平均差异为3.2（95%可信区间4.3至2）。
获得基于证据的在线教育课程提高了对MI-E处方和应用的信心，可能是培训临床医生应用MI-E的有价值工具。
