NIV @ Home
Lead researcher: David Berlowitz
Department of Physiotherapy
Team members: Mark Howard, Liam Hannan, Nicole Sheers
Partner organisations: Victorian Respiratory Support Service, Austin Health
People with COVID-19 are not the only ones who need a ventilator. Over 800 Victorians live well at home with non-invasive ventilation (NIV), most of whom have ventilatory failure secondary to their disability (motor neurone disease (MND), muscular dystrophies, spinal cord injury, etc). People with disabilities are understandably reluctant to attend the Austin Hospital to start NIV (usual practice) during the COVID-19 pandemic. NIV@Home will pilot whether using home NIV implementation and remote patient monitoring to substitute for day admissions and clinic attendance in people with disabilities is a feasible model for testing in a future, adequately powered, multi-centre study.
Despite slow recruitment, this study recruited the target sample size of 20 people with MND. As part of the MDI-funded extension to this project, an additional 93 people with other disabilities were referred for NIV implementation over a 12-month period and screened for this study. Of these, three people declined to participate, 87 patients were ineligible (94%) primarily because they were not naive to positive pressure therapy or required a hospital-based model of care, and three participants were randomised to be implemented on NIV@Home or NIV via Usual Care. A total of 20 participants completed the 12-week follow-up period. There was no between-group difference in the primary study outcome of NIV usage (hours per night), nor quality of life or carer burden.
Thematic analysis of semi-structured qualitative interviews revealed "positive experience" and "staff professionalism" in both groups; "convenience" was reported as an advantage for NIV@Home participants and "travel" a disadvantage in the Usual Care group. Assessing the impact of a changed healthcare delivery model on participant eligibility has been vital; it has demonstrated that any future study protocol must address the "add-ons" that are possible with a hospital-based model. Study data on clinician time, including travel and regular remote monitoring has yet to be analysed but is crucial to inform service delivery and practice change outside of this research trial.
TSANZ Victorian Branch Annual Scientific Meeting - November 2021
10th National MND Australia Conference - September 2021
JIVD International Conference on Home Mechanical Ventilation - March 2022