Updating the Evidence: Suctioning Practices of Physiotherapists in Ontario.

Purpose: The purpose of this article is to describe current tracheal suctioning practices of physiotherapists in the province of Ontario and to determine what factors influence these practices. Method: A cross-sectional online survey was conducted. An online survey link and quick response code were mailed to Ontario physiotherapists who were actively providing patient care and were authorized to perform tracheal suctioning as identified by the College of Physiotherapists of Ontario. Results: Ninety physiotherapists participated in the survey (23% response rate). Most (66%) suctioned in an intensive care setting, and many (41%) reported frequently using a closed endotracheal suctioning system. Hyperoxygenation was frequently performed before suctioning by 48% of participants, and only 18% frequently hyperoxygenated after suctioning. Most participants reported infrequently performing saline instillation (52%) and infrequently hyperinflating before suctioning (79%). Clean gloves were reported as the personal protective equipment most frequently worn across all suctioning approaches, and goggles and sterile gloves were least often worn while suctioning. Previous suctioning experience had the most influence on suctioning practices, and limited access to equipment had the least influence. Conclusions: Some of the tracheal suctioning practices of physiotherapists in Ontario vary from evidence-based clinical guidelines.

Objectif : décrire les pratiques actuelles d'aspiration de la trachée utilisées par les physiothérapeutes de la province de l'Ontario et déterminer les facteurs qui influencent ces pratiques. Méthodologie : sondage transversal en ligne. Les physiothérapeutes de l'Ontario qui donnaient des soins aux patients et étaient autorisés à effectuer des aspirations trachéales conformément aux données de l'Ordre des physiothérapeutes de l'Ontario ont reçu le lien vers un sondage en ligne et vers un code de réponse rapide. Résultats : au total, 90 physiothérapeutes ont participé au sondage (taux de réponse de 23 %). La plupart (66 %) procédaient à l'aspiration en soins intensifs, et bon nombre (41 %) déclaraient souvent utiliser un système d'aspiration trachéale fermé. De plus, 48 % des répondants utilisaient souvent l'hyperoxygénation avant l'aspiration, mais seulement 18 % y avaient souvent recours après l'aspiration. La plupart des participants ont déclaré instiller rarement du sérum physiologique (52 %) et procéder rarement à l'hyperinflation avant l'aspiration (79 %). Pour toutes les méthodes d'aspiration, les gants propres étaient l'équipement de protection individuelle le plus porté, mais les lunettes et les gants stériles étaient les moins utilisés. Les expériences d'aspiration antérieures avaient le plus d'influence sur les pratiques d'aspiration, et l'accès limité à l'équipement en avait le moins. Conclusion : On constate une variabilité entre les pratiques d'aspiration trachéale des physiothérapeutes de l'Ontario et les directives cliniques fondées sur des données probantes.

Older adults exhibit variable responses in stepping behaviour following unexpected forward perturbations during gait initiation.

With the socioeconomic burden associated with falls expected to rise as the average age of the Canadian population increases, research is needed to elucidate the nature of postural responses generated by older adults (OA) following a posture-destabilizing event. This knowledge is even more imperative for novel and difficult tasks, such as gait initiation (GI), a task known to pose a postural threat to stability for OA. A common technique to regain stability following an unexpected perturbation is reactive stepping. A deficiency in the execution of a reactive control strategy following a destabilizing event may be the cause of many unexpected falls in OA. The purpose of this study is to explore age related changes in the nature of these responses during a challenging GI task combined with an unexpected forward perturbation of the support surface. A total of 18 young adults (YA) and 16 OA performed 36 trials containing 20 unexpected perturbations. We calculated step width, length, time and COM velocity in the first unperturbed step and the second perturbed step. Results revealed that, during unperturbed GI, OA had a reduced forward velocity and took shorter, faster steps. Following forward perturbations, OA altered stepping patterns, perhaps to reduce single support duration, via reduced base of support and shorter step length compared to YA. Additionally, OA executed both forward and backwards directed steps however YA only generated forward steps. Regression analyses revealed that reduced forward velocity was predictive of step direction; which is possibly an unfavorable motor control strategy as OA who walk slower generated a posterior directed step immediately following the perturbation. This strategy is of concern as rapid responses by the trail limb are required to recover successfully, and these alterations may be associated with an elevated risk of falls.

Age-related alterations in reactive stepping following unexpected mediolateral perturbations during gait initiation.

BACKGROUND: A common technique to regain stability following an unexpected perturbation is reactive stepping, aimed to control the accelerated center of mass (COM). Many older adults (OA) struggle to execute the fast, coordinated stepping strategy required to arrest COM movement within the base of support (BOS) during these unexpected events, likely due to age-related physiological declines. Recent ecological data also suggests that many falls in OA occur due to errors in transferring or shifting body weight during activities of daily living. The present study utilized gait initiation, which requires a coordinated transition from quiet stance to dynamic gait, as an example of one of these difficult transitional movements. RESEARCH QUESTION: Our goal was to combine this inherently unstable task, gait initiation, with an unexpected mediolateral (ML) perturbation of the support surface to examine age-related changes in reactive stepping patterns during a novel transitional gait task. METHODS: A total of 18 young adults (YA) and 16 OA (>65 years) performed 35 trials containing 10 unexpected ML perturbations of the support surface. To quantify age-related differences, we calculated step width, length, time and COM velocity in the first two steps following the perturbation. RESULTS: We observed that, in general, OA walked slower and took shorter, faster steps (reducing time in single support) compared to YA. Following the perturbation, OA altered their stepping patterns by reducing their BOS (more narrow step width compared to YA), and required more than the two steps used by YA to complete the goal-directed task. SIGNIFICANCE: These age-related changes are concerning as a multi-step recovery strategy has been previously associated with an elevated risk of falls in OA.