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

ABSTRACT

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 (MI-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 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. RESULTS: The introduction of MI-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 MI-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 MI-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 MI-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.