Long-Term Mechanical Insufflation-Exsufflation Practice: A Norwegian National Survey After More Than 20 Years’ Experience

Abstract

Background: As knowledge of mechanical insufflation-exsufflation (MI-E) expands, understanding factors influencing home use is essential to promote effective therapy. This study aimed to determine the prevalence of MI-E long-term users in Norway and describe clinicians’ self-reported experience and independence with MI-E, cough assessment practices, and MI-E initiation and follow-up in a country with over 20 years of experience. Methods: This cross-sectional study used 4 data sources (1) Norwegian Units for Medical Home-Care Equipment provided data on MI-E users, (2) Statistics Norway provided the overall count of the Norwegian population, (3) The Norwegian Patient Registry supplied population data on specialist health care service use, and (4) a survey of multidisciplinary clinicians collected self-reported data on clinicians MI-E confidence and practices. Results: In 2023, 1,131 individuals in Norway (16% under 18 years) used MI-E devices for long-term treatment, with a prevalence of 53.5 per 100,000 among specialist health care service users and 20.6 per 100,000 in the total population. Of 182 survey respondents, 163 reported MI-E experience, primarily physiotherapists (78%), followed by nurses (13%) and physicians (9%). Physiotherapists had the longest experience and highest confidence in independently initiating MI-E and assisting colleagues. Most clinicians (77%) used multiple methods to assess cough effectiveness, including qualitative assessment, cough peak flow, and swallowing evaluation. Follow-up practices varied widely 43% used patient journals, 5% digital registries, 10% paper records, 27% unspecified overview of MI-E users for follow-up purposes, and 15% had no systematic overview. Regular follow-ups were reported by 43%, whereas 19% followed up only on patient request, 30% were unaware of local routines, and 8% reported no follow-up routines. Conclusions: The MI-E prevalence highlights its role as a substantial therapy for individuals with rare disorders. Variability in follow-up practices underscores the need for standardized guidelines to improve consistency and quality in long-term MI-E care.