Inspiratory muscle training for people with spinal cord injury: An implementation study

ObjectiveAustralian and New Zealand Guidelines for the Physiotherapy Management of People with Spinal Cord Injury recommend the use of inspiratory muscle training for people with spinal cord injury and respiratory muscle weakness. The aim of this study was to evaluate if tailored implementation strategies increased provision of inspiratory muscle training by physiotherapists.DesignA pre-post implementation study with baseline, post and follow-up measures.SettingThree spinal units in Sydney, Australia.ParticipantsTwenty-one physiotherapist-participants and 68 patient-participants across three spinal units.InterventionTailored, evidence-based, multi-faceted implementation strategies to improve physiotherapists' provision of inspiratory muscle training, delivered over a 6-week period (the implementation phase).Main measuresPhysiotherapists' provision of inspiratory muscle training was measured via a standardised audit tool. Medical records were audited at baseline, immediately after the implementation phase and then two months later to determine whether patients had been provided inspiratory muscle training.ResultsNinety-four medical records were audited of 68 patient-participants over the study period. Data at baseline indicated that inspiratory muscle training was only provided to 20% of eligible patient-participants. This improved to 91% immediately post the 6-week implementation phase but reduced to 72% two months later.ConclusionsTailored, evidence-based implementation strategies increased the provision of inspiratory muscle training by physiotherapists. These strategies can be adapted to different health care settings to improve physiotherapists' provision of inspiratory muscle training for the respiratory management of people with spinal cord injury.The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/. ACTRN: 12623001106628).