Clinical effects of specialist and on-call respiratory physiotherapy treatments in mechanically ventilated children: A randomised crossover trial.
OBJECTIVE
The study investigated treatment outcomes when respiratory physiotherapy was delivered by non-respiratory on-call physiotherapists, compared with specialist respiratory physiotherapists.


METHODS
Prospective, randomised crossover trial.


METHODS
Paediatric, tertiary care hospital in the United Kingdom.


METHODS
Mechanically ventilated children requiring two physiotherapy interventions during a single day were eligible. Twenty two physiotherapists (10 non-respiratory) and 93 patients were recruited.


METHODS
Patients received one treatment from a non-respiratory physiotherapist and another from a respiratory physiotherapist, in a randomised order. Treatments were individualised to the patients' needs, often including re-positioning followed by manual lung inflations, chest wall vibrations and endotracheal suction.


METHODS
The primary outcome was respiratory compliance. Secondary outcomes included adverse physiological events and clinically important respiratory changes (according to an a priori definition).


RESULTS
Treatments delivered to 63 patients were analysed. There were significant improvements to respiratory compliance (mean increase [95% confidence intervals], 0.07 and 0.08ml·cmH2O(-1)·kg(-1) [0.01 to 0.14 and 0.04 to 0.13], p<0.01, for on-call and respiratory physiotherapists' treatments respectively). Case-by-case, there were fewer clinically important improvements following non-respiratory physiotherapists' treatments compared with the respiratory physiotherapists' (n=27 [43%] versus n=40 [63%], p=0.03). Eleven adverse events occurred, eight following non-respiratory physiotherapists' treatments.


CONCLUSIONS
Significant disparities exist in treatment outcomes when patients are treated by non-respiratory on-call physiotherapists, compared with specialist respiratory physiotherapists. There is an urgent need for targeted training strategies, or alternative service delivery models, to be explored. This should aim to address the quality of respiratory physiotherapy services, both during and outside of normal working hours.


BACKGROUND
Clinicaltrials.gov, NCT01999426.
Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom. Electronic address: h.shannon@ucl.ac.uk.
Harriet
H
Shannon
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
Janet
J
Stocks
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Rachael K
RK
Gregson
Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Catherine
C
Dunne
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Intensive Care Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Mark J
MJ
Peters
Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
Eleanor
E
Main
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059825:Physical Therapists; D011446:Prospective Studies; D012121:Respiration, Artificial; D012138:Respiratory Therapy / Q000379:methods* / Q000592:standards*; D016037:Single-Blind Method; D006113:United Kingdom
Acute respiratory; After-hours care; Paediatric intensive care units; Physiotherapy specialty