title: Use of mechanical airway clearance devices in the home by people with neuromuscular disorders: effects on health service use and lifestyle benefits.
abstract: BACKGROUND
  People with neuromuscular disorders (NMD) exhibit weak coughs and are susceptible to recurrent chest infections and acute respiratory complications, the most frequent reasons for their unplanned hospital admissions. Mechanical insufflation-exsufflation (MI-E) devices are a non-invasive method of increasing peak cough flow, improving cough efficacy, the clearance of secretion and overcoming atelectasis. There is limited published evidence on the impact of home use MI-E devices on health service utilisation. The aims of the study were: to assess the self-reported health and lifestyle benefits experienced as a result of home use of MI-E devices; and evaluate the effects of in-home use of MI-E devices on Emergency Department (ED) presentations, hospital admissions and inpatient length of stay (LOS).
  
  
  METHODS
  Individuals with NMD who were accessing a home MI-E device provided through Muscular Dystrophy Western Australia were invited to participate in a quantitative survey to obtain information on their experiences and self-assessed changes in respiratory health. An ad-hoc record linkage was performed to extract hospital, ED and mortality data from the Western Australian Department of Health (DOHWA). The main outcome measures were ED presentations, hospital separations and LOS, before and after commencement of home use of an MI-E device.
  
  
  RESULTS
  Thirty seven individuals with NMD using a MI-E device at home consented to participate in this study. The majority (73%) of participants reported using the MI-E device daily or weekly at home without medical assistance and 32% had used the machine to resolve a choking episode. The survey highlighted benefits to respiratory function maintenance and the ability to manage increased health care needs at home. Not using a home MI-E device was associated with an increased risk of ED presentations (RR = 1.76, 95% CI 1.1-2.84). The number of hospital separations and LOS reduced after the use of MI-E device, but not significantly. No deaths were observed in participants using the MI-E device at home.
  
  
  CONCLUSIONS
  Home use of a MI-E device by people living with NMD may have a potential impact on reducing their health service utilisation and risk of death. Future research with greater subject numbers and longer follow-up periods is recommended to enhance this field of study.
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. trinity.mahede@health.wa.gov.au.
authors.forename: Trinity
authors.initials: T
authors.lastname: Mahede
authors.affiliation: Data Linkage Branch, Department of Health Western Australia, Perth, Australia. geoff.davis@health.wa.gov.au.
authors.forename: Geoff
authors.initials: G
authors.lastname: Davis
authors.affiliation: Data Linkage Branch, Department of Health Western Australia, Perth, Australia. April.rutkay@health.wa.gov.au.
authors.forename: April
authors.initials: A
authors.lastname: Rutkay
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. genomics@health.wa.gov.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baxendale
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. wenxing.sun@health.wa.gov.au.
authors.forename: Wenxing
authors.initials: W
authors.lastname: Sun
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. hugh.dawkins@health.wa.gov.au.|Centre for Comparative Genomics, Murdoch University, Perth, Australia. hugh.dawkins@health.wa.gov.au.|Centre for Population Health Research, Curtin University of Technology, Perth, Australia. hugh.dawkins@health.wa.gov.au.|School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia. hugh.dawkins@health.wa.gov.au.
authors.forename: Hugh J S
authors.initials: HJ
authors.lastname: Dawkins
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. caron.molster@health.wa.gov.au.
authors.forename: Caron
authors.initials: C
authors.lastname: Molster
authors.affiliation: Office of Population Health Genomics, Department of Health Western Australia, Perth, Australia. caroline.graham@health.wa.gov.au.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007327:Insufflation / Q000295:instrumentation*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D011788:Quality of Life; D012449:Safety; D055815:Young Adult