Management of Sleep-Disordered Breathing in a Spinal Cord Injury Rehabilitation Center: Model of Care Adaptation and Implementation

Author:

Graco Marnie123,Weber Gerard4,Saravanan Krisha125,Curran Jacqueline4,Whitehead Nicole4,Ross Jacqueline13,DelaCruz Charito4,Sood Samritti4,Heriseanu Roxana E.4,Chai-Coetzer Ching Li67,Berlowitz David J.125,Joffe David8

Affiliation:

1. 1Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia

2. 2Department of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia

3. 3Department of Physiotherapy, Austin Hospital, Heidelberg, VIC, Australia

4. 4Spinal Injuries Unit, Royal Rehab, Ryde, NSW, Australia

5. 5Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, VIC, Australia

6. 6Adelaide Institute for Sleep Health: A Flinders Center of Research Excellence, Flinders University, SA, Australia

7. 7Respiratory, Sleep & Ventilation Services, Southern Adelaide Local Health Network, SA Health, SA, Australia

8. 8Royal North Shore Hospital, St Leonards, NSW, Australia

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent and poorly managed in spinal cord injury (SCI). Alternative management models are urgently needed to improve access to care. We previously described the unique models of three SCI rehabilitation centers that independently manage uncomplicated OSA. Objectives: The primary objective was to adapt and implement a similar rehabilitation-led model of managing OSA in an SCI rehabilitation center in Australia. Secondary objectives were to identify the local barriers to implementation and develop and deliver tailored interventions to address them. Methods: A clinical advisory group comprised of rehabilitation clinicians, external respiratory clinicians, and researchers adapted and developed the care model. A theory-informed needs analysis was performed to identify local barriers to implementation. Tailored behavior change interventions were developed to address the barriers and prepare the center for implementation. Results: Pathways for ambulatory assessments and treatments were developed, which included referral for specialist respiratory management of complicated cases. Roles were allocated to the team of rehabilitation doctors, physiotherapists, and nurses. The team initially lacked sufficient knowledge, skills, and confidence to deliver the OSA care model. To address this, comprehensive education and training were provided. Diagnostic and treatment equipment were acquired. The OSA care model was implemented in July 2022. Conclusion: This is the first time a rehabilitation-led model of managing OSA has been implemented in an SCI rehabilitation center in Australia. We describe a theory-informed method of adapting the model of care, assessing the barriers, and delivering interventions to overcome them. Results of the mixed-methods evaluation will be reported separately.

Publisher

American Spinal Injury Association

Subject

Neurology (clinical),Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation

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