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UBC Theses and Dissertations

A novel theory-based implementation intervention to increase prescription of inspiratory muscle training for people with chronic obstructive pulmonary disease Simms, Alanna Marie


INTRODUCTION: A number of implementation interventions are available to address existing gaps between research and practice; little is known about the effectiveness of these interventions among rehabilitation professionals. PURPOSE: To assess the effectiveness of a behavioural-based versus an information-based intervention for increasing health professionals’ prescription of inspiratory muscle training (IMT) in the management of chronic obstructive pulmonary disease (COPD) in out-patient pulmonary rehabilitation. STUDY DESIGN: Single Blind, Randomized Clinical Trial METHODS AND MEASURES: We recruited a convenience sample of six hospital pulmonary rehabilitation programs in Canada. After being stratified by geographical location and type of facility, paired hospitals were randomly assigned to receive either a behavioural-based or an information-based intervention. The behavioural-based intervention consisted of an interactive workshop, delivered by an expert in two 45 minute meetings, and provision of Threshold IMT devices. The first meeting included: 1) a summary of evidence for IMT in COPD; 2) prescription details for IMT; 3) skills practice. The second meeting was a semi-structured problem solving session. The information-based intervention was a 90 minute didactic lecture on: 1) evidence for IMT in COPD; 2) prescription details for IMT, which was supplemented by copies of two recent, peer-review articles. Participants in both interventions received handouts detailing how to prescribe IMT for people with COPD and a handheld respiratory pressure meter (MicroRPM). The participants were 61 health professionals, the majority being physiotherapists and respiratory therapists, and 488 patients with COPD from the six hospital out-patient pulmonary rehabilitation programs. IMT prescription was the primary outcome. A multiple choice questionnaire, used to evaluate health professionals’ knowledge on IMT for people with COPD, was a secondary outcome. Data were analyzed using Chi-square and Mann-Whitney U test. RESULTS: No patients with COPD were prescribed IMT in the participating sites during the 6-month pre-intervention phase. Prescription rates for IMT only increased in the behavioural-based intervention group: 12 of 118 patients with COPD who attended pulmonary rehabilitation were prescribed IMT, which reflected a 10.2% increase (95% CI: 5.7-17.1%). CONCLUSION: A behavioural-based intervention appears to be more effective than a lecture approach to increase health professionals’ prescription of IMT for people with COPD.

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