Treatment Acceptability and Satisfaction With Cough Skill Training in Parkinson's Disease: A Mixed-Methods Study

Despite evidence to suggest that rehabilitation can improve airway protection in people with Parkinson's disease (pwPD), rehabilitative therapies are underutilized. One newer treatment approach with growing evidence to support its efficacy is cough skill training (CST). To improve utilization of rehabilitations such as CST, it is important to understand patient treatment experience. Therefore, the aim of this study was to define treatment acceptability and satisfaction of CST in pwPD.

Thirteen pwPD were consecutively recruited from a trial during which participants completed two in-person sessions of CST via spirometry over 2 weeks. A mixed-methods approach was used, whereby quantitative data (obtained from questionnaires) and qualitative data (obtained from semistructured interviews) were integrated to provide a holistic understanding of patient experience. Data collection and thematic analyses (of qualitative data) were guided by the Systems Engineering Initiative for Patient Safety framework.

While treatment demonstrated adequate acceptability with a System Usability Scale median score of 70/100 (scores ≥ 70 indicate acceptability), integrative examination of patient experience revealed several themes that highlight barriers and facilitators to treatment acceptability-as they relate to CST tools (visualization, lip seal, and measurement accuracy) and tasks (practice targets, feedback, practice amount, and future training). Most (61.5%) participants were "satisfied" or "very satisfied" with CST. Four themes emerged related to satisfaction: treatment relevance, patient awareness and control over their disease, skill acquisition, and skill transference to real-life choking events.

In this study, patient responses indicated that small, personalized adaptations to equipment, training targets, and feedback may enhance their experiences, while education and personalized goal setting may enhance treatment relevance and perceived benefit. Patient perspectives and needs can inform the refinement of person-centered clinical implementation of CST and improve treatment uptake.

https://doi.org/10.23641/asha.28887167.