Riegler Thomas F, Marcin Thimo, Brun Patrick
Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
Berner Reha Zentrum, Center for Rehabilitation & Sports Medicine, Insel Group, University Hospital of Bern, University of Bern, Bern, Switzerland.
BMC Health Serv Res. 2024 Dec 18;24(1):1585. doi: 10.1186/s12913-024-12041-5.
Physiotherapists play a key role in the administration of supplemental oxygen during physical activity in pulmonary rehabilitation. However, supplemental oxygen requires a medical prescription making processes cumbersome for physiotherapists. This study aimed to implement and evaluate an advanced practice role for physiotherapists (APO) allowing them to prescribe oxygen during physical activity.
Training and certification process for respiratory physiotherapists employed in an inpatient rehabilitation clinic was implemented. A mixed-method approach for retrospective evaluation was used. Quantitative analysis included routine clinical data from oxygen prescriptions, titrations, and exercise capacity. Additionally, healthcare professionals' experiences and perceptions of the new APO role was explored using a survey. Qualitative data included interprofessional interviews, survey comments, and data from the critical incidence reporting system.
In 15% of patients during the evaluation period, certified APO were involved in oxygen prescription. These patients had more frequent titrations (median 8 [interquartile 6, 10] vs. 5 [4, 8]), prescription adjustments (3 [2, 4] vs. 1 [1, 2]), and narrower oxygen dosage ranges prescribed (2 [1, 3] vs. 4 [3, 4]). No significant difference in exercise capacity was observed and no adverse events reported. Survey data from 19 healthcare professionals and interviews indicated that the specialised expertise of APO positively impacts interprofessional collaboration and workflow efficiency.
Physiotherapy-led oxygen prescription during physical activity in pulmonary rehabilitation is feasible, safe, and perceived as beneficial for the workflow and interprofessional collaboration across healthcare professions.
According to Swiss law (Human Research Act, Art. 2), ethics approval for the study and informed consent were not required and were waived off. All methods were in accordance with the regulations and guidelines of the Swiss Human Research Act and Swiss ethics law.
在肺康复的体育活动中，物理治疗师在补充氧气的管理方面发挥着关键作用。然而，补充氧气需要医疗处方，这使得物理治疗师的操作流程繁琐。本研究旨在实施并评估物理治疗师的高级实践角色（APO），使其能够在体育活动期间开具氧气处方。
对一家住院康复诊所聘用的呼吸物理治疗师实施培训和认证流程。采用混合方法进行回顾性评估。定量分析包括来自氧气处方、滴定和运动能力的常规临床数据。此外，通过一项调查探索了医疗保健专业人员对新APO角色的经验和看法。定性数据包括跨专业访谈、调查评论以及来自关键事件报告系统的数据。
在评估期间，15%的患者有获得认证的APO参与氧气处方。这些患者的滴定更频繁（中位数8[四分位间距6,10]对5[4,8]）、处方调整更多（3[2,4]对1[1,2]），并且开具的氧气剂量范围更窄（2[1,3]对4[3,4]）。未观察到运动能力有显著差异，也未报告不良事件。来自19名医疗保健专业人员的调查数据和访谈表明，APO的专业知识对跨专业协作和工作流程效率有积极影响。
在肺康复的体育活动中由物理治疗师主导的氧气处方是可行、安全的，并且被认为对医疗保健专业之间的工作流程和跨专业协作有益。
根据瑞士法律（《人类研究法》第2条），该研究无需伦理批准和知情同意，并已获豁免。所有方法均符合瑞士《人类研究法》和瑞士伦理法的规定和指南。
