Essay Sample: Physiotherapy and Spirometry Insights

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Introduction

A physiotherapy assessment is an in-depth analysis of subjective history and current level of physical activity of a patient. This is based on collecting the information by using different tools and techniques for designing the intervention of the condition and coming up with a treatment plan for the patient (O’Connor et al., 2018). Spirometry is a test used to help diagnose and monitor lung conditions by measuring the amount of air breathed out in one forced breath (Struchkov & Drozdov, 2020).

It helps to measure the function of the lung including the evaluation of its volume and airflow as a result of inhalation and exhalation and is one of the most common forms of pulmonary function tests (PFTs) (Graham et al., 2019).

It is also used in clinical practices for assessing and diagnosing different respiratory diseases such as cystic fibrosis, asthma, and Chronic obstructive pulmonary disease (COPD) (Brit-thoracic, 2022). Interpreting relevant and authentic research conducted on evaluating the reliability and reliance on spirometry as a physiotherapy assessment technique will be discussed.

Usefulness

Spirometry can be used as a screening tool to help know how well the lungs work through inhaling and exhaling and also diagnosing respiratory disorders earlier e.g., asthma, emphysema, and chronic obstructive pulmonary disease (COPD) (Villaret al., 2018). Earlier diagnosis means treatment such as pulmonary rehabilitation can be started promptly. A study conducted by Liu et al established that pulmonary rehabilitation can potentially help reduce the cost-effectiveness of COPD (Liu et al., 2020).

Studies have also shown that COPD diagnosed at an advanced stage is due to the underdiagnosis in primary care and the lack of the use of spirometry in health care settings (johns et al., 2014). John et al has suggested that this might also be due to the difficulty in assessing lung function testing. Good quality spirometry requires co-operation between the patient and the therapist. (Hei et al., 2020). Villar et al has conducted a study to see if earlier diagnosis of COPD can be achieved in hospitalized patients who had acute exacerbation (Villaret al., 2018).

Spirometry was able to confirm COPD in 90% of patients with no known prior obstruction and it was also conducted in patients after post bronchodilator therapy. In this study the test was performed by the same nurse at the same time and it can help reduce any variabilities that might have been caused in this study. This test may also not be possible in a health care setting with limited time and staff (PCRS-UK, 2022). Earlier diagnosis of COPD by the spirometer have showed early delivery of medication for the patient and a reduction in hospital re-admissions.

FEV1 is the amount of air you can force from your lung in one second and significant in the diagnosis of COPD. A decrease in FEV1 value is linked to breathing obstruction (Enright et al., 2007). Increase in FEV1 might be due to other factors such as drugs used in this study (Villaret al., 2018). Furthermore, currently spirometry cannot be performed in hospitalized patients until 8-12 weeks after discharge.

Smart phone spirometer makes spirometry even more easily accessible and convenient for both patient and therapist. This essential when access to lung function test is unavailable especially during COVID-19 (Rodriguez et al., 2020).

Furthermore, Virtual consultancy has shown better self-management and patient engagement as more person-centered care is provided (Richardson et al., 2022). During the COVID-19 pandemic there has been an increase in online consultations. Smartphone spirometer help rehabilitation to take place without delaying patient treatment and by keeping everyone safe (Navarrete et al., 2021). Patients from disadvantaged family background might have difficulty with mobile spirometry due to financial issues and when support is not provided by family members especially older patients who might not be familiar with modern technology.

Effectiveness

Recent studies have suggested that spirometry can be used as a motivational tool in smoking cessation when combined with smoking cessation advice (Westerdahl et al., 2019). Aramburu et al conducted a study to evaluate the effectiveness of spirometry test when combined with the information on their test result towards smoking cessation (Aramburu et al., 2013). This study was conducted on patients over the age of 40 and on patients who are asymptomatic. A trained nurse performed the test and after 10 days the result were provided by the doctor.

Combing spirometry result together with smoking cessation advice can be effective as it can make patient aware of their lung age and adverse impact smoking can have on their health. Moreover, earlier detection of airway obstruction can help reduce the mortality rates and other medical condition such as COPD as patients can be motivated to bring a change in their lifestyle.

There is limited number of studies confirming how effective spirometry is on its own in smoking cessation. In this study we are also not aware how effective spirometry can be in younger smokers and patients who are not asymptomatic. Nonetheless, spirometry was able to show a slight reduction in decline of the FEV1 in COPD patients.

The spirometry results can be something that can be included when providing smoking cessation advice to the patient by the clinician. (Fredj et al,2022). However, smoking does have a high risk of relapse. Therefore, when tailoring program for patients’ physiotherapists might need to address the emotional needs of the patient such as self- esteem and self- confidence for long term health benefits (Fredj et al., 2021).

Another study conducted by Kulik-Parobczy (2019) to evaluate the effectiveness of physiotherapy in patients who passed through the oncological intervention considering the spirometry indicators including FEV1, Vital capacity, person’s maximum speed of expiration, forced vital capacity, forced mid-expiratory flow (FEF25 and 76) and forced expiratory flow (FEF50 and 75). Also, in this study, the impact of the physiotherapy duration on the ventilation activity of the lungs is accessed.

A total of 91 women who underwent breast cancer therapy were selected for the outpatient therapy, the rate of their respiratory disorder and other parameters were taken by using the spirometry test (Parobczy et al, 2019). Results of the study showed that physiotherapy helped in enhancing the lung functions of the patients.

Reliability

Results produced by the spirometer are reliable and reproducible and can be used in a variety of settings such as primary, private clinics and even during online consultations (Villaret al., 2018). A study was done by Enright et al to find any limitations affecting spirometry repeatability and how accurate spirometry results can be. This study was performed in patients who were referred for outpatient spirometry (Enright et al., 2004).

Spirometry was able to provide good repeatability in about ninety percentage of the patients. Good repeatability of spirometry is important as it can affect the confidence in the interpretation of the patient response to medication such as bronchodilator (Cooper, 2010). However, having to follow strict criteria can be frustrating for the patients especially as it takes longer time.

Enright et al found out that characteristics of the patients do not have an impact on the spirometry results. The results are purely dependent upon the clinician experience and training (Enright et al., 2004). However, there is variability in the result found in different studies. Swanney et al found out in his study only 67% of test met the required criteria (Borg et al., 2012). The study shows that with constant feedback, training and experience the repeatability of the test can be improved to meet the desired criteria). With increased training the repeatability of the spirometry criteria has improved from 39% to 58% internationally (Borg et al., 2012).

Smartphone game-based assessment (SGA) have recently been used for monitoring the physical activity of the patients while they do game exercises. Joo, Lee, and Song (2018) conducted a study to access the effectiveness of SGA in relation to pulmonary functionality in comparison with spirometry. Results of the study showed that SGA is reliable for assessing pulmonary functionality in patients with stroke (Pramanik et al., 2021). Hence, can be used for rehabilitation to enhance the clinical monitoring and functionality of stroke patients.

Conclusion

The use of spirometry is an effective technique and can be used in assisting patients in the rehabilitation procedure. Spirometry is an essential tool in the earlier diagnosis of respiratory disorders such as COPD. Performing spirometry on hospitalized patients can be seen as an opportunity for earlier diagnosis of respiratory disorders. However, this is not currently possible and can be only done once the patient is stable enough to prevent further complications. Having smart phone spirometer make spirometry more easily accessible and help deliver better patient centered care.

This can be a useful measure during online consultations as it can prevent further transmission of disease during times such as COVID-19. Spirometer can be used as a motivational tool to help patients with smoking cessation as it shows the patient the adverse effect smoking has on them rather than just providing advice. It is recommended that proper training must be provided to achieve more reliable and accurate spirometry results for better prognosis. It is also recommended before planned surgery to check if the lungs function adequately before the operation.

References

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Alcázar-Navarrete, B. and Echave-Sustaeta, J.M. (2021) ‘Microspirometers in the follow-up of COPD: advantages and disadvantages’,Archivos de bronconeumología (English ed.), 57(3), pp. 160–161. doi: 10.1016/j.arbr.2020.06.015.

Brit-thoracic.org.UK., 2022. Spirometry | British Thoracic Society | Better lung health for all. [online] Available at: https://www.brit-thoracic.org.uk/quality-improvement/clinical-resources/copd-spirometry/spirometry/.

Ben Fredj, M.et al.(2022) ‘Spirometry as a motivator for smoking cessation among patients attending the smoking cessation clinic of Monastir’,BMC public health, 22(1), pp. 1164–1164. doi:10.1186/s12889-022-13583-1.

Ben Fredj, M.et al.(2021) ‘Spirometry feedback as a motivational tool for tobacco cessation’,European journal of public health, 31(Supplement_3). doi:10.1093/eurpub/ckab165.655.

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Enright, P.et al.(2007) ‘Spirometry utilization for COPD: How do we measure up?’,Chest, 132(2), pp. 403–409.

Enright, P.L., Beck, K.C. and Sherrill, D.L. (2004) ‘Repeatability of Spirometry in 18,000 Adult Patients’,American journal of respiratory and critical care medicine, 169(2), pp. 235–238. doi:10.1164/rccm.200204-347OC.

Fernández-Villar, A.et al.(2018) ‘Reliability and usefulness of spirometry performed during admission for COPD exacerbation’,PloS one, 13(3), pp. e0194983–e0194983. doi:10.1371/journal.pone.0194983.

Graham, B.L.et al.(2019) ‘Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement’,American journal of respiratory and critical care medicine, 200(8), pp. e70–e88. doi:10.1164/rccm.201908-1590ST.

Heffler, E.et al.(2018) ‘Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients’,Respiratory medicine, 142, pp. 48–52. doi:10.1016/j.rmed.2018.07.015.

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Irizar-Aramburu, M.I.et al.(2013) ‘Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study’,BMC family practice, 14(1), pp. 185–185. doi:10.1186/1471-2296-14-185.

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Management’,International journal of environmental research and public health, 17(14), p. 5112. doi:10.3390/ijerph17145112.

Joo, S., Lee, K. and Song, C., 2018. A Comparative Study of smartphone game with spirometry for pulmonary function assessment in stroke patients.BioMed Research International,2018.

Johns, D.P., Walters, J.A.E. and Walters, E.H. (2014) ‘Diagnosis and early detection of COPD using spirometry’,Journal of thoracic disease, 6(11), pp. 1557–1569. doi:10.3978/j.issn.2072-1439.2014.08.18.

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