| 제목 |
Effect of hand splinting for coughing in patient with rib fractures |
| 소속 |
Pusan National University Hospital, Biomedical Research Institute1, Pusan National University Hospital, Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital2 |
| 저자 |
Jang Mi Lee1*, Dong Ho Yoo2, Sang Hoon Han2, Min Soo Choi2, Young Mo Kim2, Ji Won Hong2, Sang Hun Kim2† |
Introduction
Effective removal of airway secretions after chest trauma is important. Splinted coughing is a simple and effective way to educate patients. Although research has been conducted on the effects of splinted coughing on vital capacity and inspiratory pressure in previous studies, there is a limitation of insufficient data on peak cough flow indicating coughing ability. The aim of this study was to evaluate pain, inspiratory volume and cough ability to confirm the effect of splinted coughing in patients with rib fractures
Methods
This study recruited eighteen patients (13 males and 5 females; average age 59.0 ± 8.2 years) with unilateral rib fractures who experience pain of visual analogue scale (VAS) 3 or higher when coughing. Voluntary and splinted coughing were performed in random order. We applied splinted pressure at a level that did not increase the pain to the wound of a patient in a Fowler's position. For splinted coughing, the assessor used a hand control mitts (Figure 1) with a 2cm thick soft cushion. Participants rested several minutes until the new pain disappeared, and then switched to another coughing method for the second test. The peak cough flow (PCF) was measured with peak flow meter (Clement Clarke International, UK) and recorded as the mean value of three trials with short and forceful expiration after maximal inspiration. The inspiratory volume was measured with incentive spirometer (Coach 2, UK) and recorded as the mean value of three trials with breath in slowly and as deeply as possible. Pain was measured through a VAS.
Results
Paired t-test was performed to compare the changes of PCF between splinted and voluntary coughing. The mean PCF for splinted and voluntary coughing was 257.03 ± 93.83 and 237.77 ± 89.00, respectively (p <0.001). When data were analyzed with repeated-measures ANOVA with Bonferroni correction, pain was higher in splinted and voluntary coughing than at rest but there was no significant difference between voluntary and splinted coughing (Figure 2).
Conclusion
Pain worsens during coughing in rib fracture patients, but splinted coughing could make a stronger PCF than voluntary coughing. In this study, the clinical significance of splinted coughing for sputum removal could be presented quantitatively.
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Figure 1. A. Hand control mitts B. Splinted coughing in a Fowler's position
Figure 2 A. Mean values of the VAS in each condition B. Mean peak cough flow in each coughing method
Table 1. Characteristics of subjects
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