SECRETION MANAGEMENT

Secretion Management



SECRETION MANAGEMENT

Introduction

Secretion management is characterised by intractable dyspnoea, reduced functional capacity and episodes of acute exacerbation. Physiotherapy plays a key role in multidisciplinary interventions. The evidence in relation to airway clearance, pulmonary rehabilitation, inspiratory muscle training and non-invasive ventilation is now robust whilst further evidence is required for other interventions in order to clarify where application, skills and training should be focused. The challenge is to translate sound clinical evidence-based practice into novel models of service with resultant improvements in care for patients with COPD (Haas, 1993).

The use of informative and behavioural modification procedures such as treatment goals is presumed to be a likely way of advancing this understanding. While remedy goals are utilised often in physiotherapy, there is debate about their effectiveness in advancing compliance. The behavioural alterations needed for exercising, such as changing daily usual actions to encompass workout meetings, are thought to assist to the poor compliance with workout programmes, especially at the time of initiation of the events (Dzewaltowski, 1994). However, during the acute stage of disorders, patients' symptoms may proceed as a punctual to exercise particularly if they are reassured by it. Unfortunately, about a third of people attending physiotherapy have chronic recurrent disorders which benefit from exercises as a preventive measure irrespective of the intensity of symptoms (Cott, 1991). In these situations, it is lack of symptoms which is considered to assist to poor levels of compliance (Sluijs and Knibbe, 1991). Nevertheless, there are some people who, irrespective of the intensity of the symptoms, seem to be inspired enough to persist with their suggested treatments. Consequently, it has been suggested that the use of motivational methods may help persons to continue with therapeutic workout programmes, especially when the symptoms are no longer present to act as cues (Ley, 1988).

Treatment goals are advised to be one method of motivating patients to obey with long-term treatment programmes which have an workout component. The use of patient physiotherapist collaboratively set goals for rheumatoid arthritis patients who undertook a home exercise programme (Kendall, 1971). These goals were set individually with each persevering to suit 'his or her workout needs. It was found that 77% of the participants in the collaborative group 'increased their exercise load, compared with 20% of subjects in the no goals group (Falvo, 1985). These results seem to support the relation that meaningful, realistic goals are set when there is collaboration between the patient and clinician. For these reasons collaborative goals may be more effective than those set solely by a clinician (Dishman, 1987). However, not all research completely supports the use of treatment goals as a motivational technique. The end result seems to be that physiotherapists feel more comfortable telling their patients what the recommended treatment is expected to achieve as opposed to setting treatment goals with them (Groth, 1995).

Method

Seventeen physiotherapists volunteered to take part in the study, with 15 of them performing in the personal part and two in the public ...