Proving it works

I am currently on my cardio placement and i have been treating this 77yo italian lady who has been recently diagnosed with mild bronchiectasis. Previous to her admission, she has been fit and healthy without any major complaints. In the last 6months she has had increasing SOB, increase sputum production and decrease ex tolerance (due to SOB). She was admitted due to her increasing SOB and yellow-brown sputum. This lady speaks minimal-moderate english.

On initial assessment and treatment, it was just my luck that her two daughters were there. So they helped me to interpret. I'd asked the patient the relevant questions regarding her SOB, cough and ex tolerance. She indicates she only gets SOB when she goes for long walks (>1hour) and there is minimal sputum pre-admission. She also states that she is able to cope at home well (she lives with her daughter). However, upon speaking to the daughters, this 77yo lady has been struggling with SOB and has had 10 falls in the last year! Her falls are mainly mechnical, either from someone bumping into her or tripping over something.

Her main problems with dyspnea, impaired airway clearance and decrease ex tolerance. My treatment started with teaching her breathing strategies to combat dyspnea. She was hesitant in wanting to perform breathing control as she thought it didn't help (even when the daughters have explained to her several times). I then educated her on the importance of deep breathing exercises (TEEs) in order to get air behind secretions and push them up the respiratory tract. She also had trouble understanding the mechanism/reason behind the exercise. She expressed to her daughters of how such simple exercise can help with sputum clearance. She was not sold on the idea. I still managed to get her to do a few TEEs and to make things worse, she didn't clear any sputum with the exercise (here i was thinking if the TEEs worked and helped her clear secretions, she would be compliant with the exercise). I was certain that once i'd left the room she would not continue with those breathing exercises. At the end of the treatment I had this feeling that she didn't find physiotherapy to be useful.

I have only seen the patient once. I need to find ways to prove to her that physio works. I'm still thinking about it. I thought maybe get her in a dyspneoic situation (ie, long walks) and try get her to do what she normally does and then get her dyspneoic again and use breathing strategies and see whether that makes a difference. And also try TEEs (with ACBT) on a day when she is little bit more productive and maybe she can clear some sputum. I've learnt that you may not see changes/results immediately after your treatment and you can lose patient confidence at that time because of it. Next time i will try a different tactic and maybe put the patient in the situation (ie, dyspneoic or unable to clear secretions) and then apply the physiotherapy techniques. Or just simply persist with the treatment for a couple more sessions and hopefully see an effect. Will discuss with my supervisor tomorrow about strategies that i can use to overcome this problem.