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G - Independence in Breathing

Figure 5.0. Capacity for Respirology and Respiratory Therapy Care. Figure 5.0 Capacit y for Respirolog y and Respirator y Therapy Care Respirologist Respiratory Therapist Assessments and Outcome Measures 0 2 4 6 8 10 12 Number of Sites Comprehensive assessment of respiratory status is integral to providing optimal care in rehabilitation. This should include respiratory history and physical examination, vital signs, pulmonary function (spirometry in supine and sitting), maximum insufflation capacity, peak cough flow, overnight oximetry (including transcutaneous carbon dioxide, if available) and sleep studies, ventilatory muscle strength, chest x-ray and arterial blood gases.15-18 Screening assessments should be conducted at rehabilitation admission for individuals with SCI at level L1 and above, with follow-up assessments conducted as necessary, based upon screening assessment results. Specific tests or assessments performed should be based on the individual’s level of SCI and respiratory impairments.19 Canadian rehabilitation sites vary in their capacity to conduct comprehensive respiratory assessments. Most sites report being able to conduct overnight oximetry (11/12) and peak cough flow (10/12) assessments (Figure 6.0). While eight of 12 sites report using pulmonary function tests to assess respiratory function, there is considerable variation in the information specifically used from this test (Figure 6.0). Most sites (11/12) used forced vital capacity, while only half used negative inspiratory force (Figure 6.0). In Canadian rehabilitation sites, respiratory assessments are conducted by a variety of healthcare professionals (Figure 7.0). While many assessments are done by respirologists (19%), respiratory therapists (18%) and physiotherapists (18%), other care providers (e.g., nurses, respiratory technicians, pulmonary function test technicians, and physiatrists) also conduct a substantial proportion of respiratory assessments (Figure 7.0). These results suggest that capacity for performing respiratory assessments can be increased through appropriate training of available clinicians. Inpatients Consult within Organization External Consult Combined Inpatients and Outpatients Combined Inpatients and Consult within Organization Combined Consult within Organization and External Consult Figure 6.0. Outcome Measures –Current Capacity to Conduct Comprehensive Assessments Figure 6.0 Outcome Measures – Current Capacit y to Conduct Comprehensive Assesments 0 2 4 6 8 10 12 Peak Cough Flow Overnight Oximetry Pulmonary Function Test Negative Inspiratory Force Forced Vital Capacity Arterial Blood Gases Number of Sites Capacity to perform respiratory assessments, or availability of a diagnostic service, does not always coincide with utilization of the specific assessment or diagnostic service. Of the eight sites that report capacity to assess arterial blood gases, only one site report using this outcome measure (Figures 6.0 and 8.0). Such lack of utilization may be appropriate (e.g., good clinical judgment, availability of alternative assessments), but the data does not give reasons for the extent of utilization. In relation, current data also does not allow identification of respiratory outcome measures that are routinely used in Canadian rehabilitation centres. 78 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


G - Independence in Breathing
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