Development and evaluation of a community respiratory physiotherapy service for children with severe neurodisability

Area of Science:

• Pediatric Rehabilitation
• Respiratory Medicine
• Health Services Research

Background:

• Children with severe disabilities frequently experience impaired secretion clearance, leading to recurrent respiratory infections and prolonged hospitalizations.
• These challenges significantly impact patient quality of life and place a considerable burden on healthcare resources.

Purpose of the Study:

• To evaluate the effectiveness of a newly developed community respiratory physiotherapy service for children with severe disabilities.
• To assess the impact of the service on hospital admissions, bed days, and associated costs for respiratory tract infections and other causes.

Main Methods:

• A 'before and after' evaluation design was employed over 28 months.
• Data on hospital admissions (respiratory and all causes), bed days, and costs were collected for 34 eligible children (aged 1-19 years) with severe disabilities (cerebral palsy, neurodegenerative, neuromuscular conditions).
• Comparisons were made between the 12 months preceding and the 12 months during the service implementation.

Main Results:

• Admissions for respiratory tract infections decreased from 43 to 25 (p<0.05).
• Respiratory admission bed days reduced from 383 to 236 (p<0.01).
• Total non-elective admissions fell from 64 to 40 (p<0.01), with annual cost savings of GBP 78,155 (52%).

Conclusions:

• A community-based respiratory physiotherapy service can effectively reduce hospital admissions and bed days for children with severe disabilities.
• The service demonstrated significant cost savings, potentially offsetting its operational expenses.
• This model of care offers a viable solution for managing respiratory complications in this vulnerable pediatric population.