Patient’s Perspective of Awake Proning: A Cross-Sectional Interview-Based Survey From COVID-19–Recovered Patients

Abstract

IMPORTANCE AND OBJECTIVES: To assess the knowledge, attitude, and practice of the patients who underwent prone positioning during their COVID-19 illness in the hospital. DESIGN: Cross-sectional study. SETTING: Aga Khan University Hospital, Karachi, Pakistan. PARTICIPANTS: COVID-19–recovered patients. INTERVENTIONS: None. MAIN OUTCOMES AND MEASURES: Knowledge was assessed by five questions with a dichotomous response (yes/no). An yes response was awarded 1 score. Since there were five questions, five would be the highest score. Patients’ perceptions of the therapy were assessed by four questions, each scored on a Likert scale of 5 (5 = strongly agree, 4 = agree, 3 = neither agree nor disagree, 2 = disagree, and 1 = strongly disagree). As it had four questions, the maximum score achieved could therefore be 20. Proning practices were assessed using seven questions: four were used to calculate practice scores, whereas three were open-ended regarding the patient’s experience. Each question carries a different score, and the maximum score was 8. RESULTS: The study included 98 patients. The mean age of the patients was 57 years (sd, 12.2 yr). Majority of the patients were males (70.4%). 69.1% of males and 76.6% of females fell in the poor knowledge group. The poor knowledge cohort had an educational level of 48% in high school, 45.5% in graduates, and 6% in postgraduates. Compared with 56.5% of males, 73% of females preferred prone positioning. Sixty percent of those with a high school education viewed prone positioning favorably, whereas 46% of those with graduate and postgraduate did. Seventy-nine percent of males and 63% of females scored positively on the practice questionnaire. Eighty percent of graduates and postgraduates preferred proning practices to 67% of participants with high school education levels. CONCLUSIONS AND RELEVANCE: Our study population had a little understanding of awake proning, found it unpleasant, and practiced for a shorter period than advised. Despite the overall negative attitude toward the position, our patients highly recommend this position to future patients.

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

“…This obstacle may be addressed through strategies such as using additional pillows or rolled towels [ 18 ], and the adoption of novel positions like the dolphin prone position [ 31 ], Reverse Trendelenburg position [ 11 ], alternating prone positioning [ 32 ], and Rodin’s position [ 33 ]. Our study also found that the lack of knowledge and misconceptions about prone position were major factors affecting patients’ psychological capability, which may be related to their limited ability to understand and accept information, similar to the survey by Sethi et al [ 19 ]. Moreover, these factors may also lead to patients’ fear of prone position ventilation, thereby weakening their confidence in adhering to the prescribed course of action.…”

“…Additionally, the study found a new result that daily habits had both positive and negative effects on adherence. Those who prefer to sleep on their stomach can last longer in treatment, but for others, it can be a difficult posture to maintain and an uneasy maneuver to perform [ 19 ]. Notably, participants with higher compliance reported an increased tolerance for the prone position over time, suggesting that healthcare professionals could encourage patients to gradually increase the duration of each session and try the prone position several times throughout the day.…”

“…Besides, it should be noted that unlike prone positioning with which patients are intubated, sedated, or even paralyzed, effective APP requires significant patient cooperation. Previous trials emphasized discomfort and fatigue as the most common barriers to patient adhesion [ 15 , 18 , 19 ], and patients’ knowledge, attitudes, and experience with APP impact adherence to prone ventilation therapy [ 19 ]. Even though quantitative studies have found factors that affect patient compliance, few interviews with non-intubated patients have been conducted to date, which can seek to produce a deeper, more complex, and all-encompassing understanding of experience, illness, or behavior [ 20 ].…”

Awake prone positioning effectiveness in moderate to severe COVID-19 a randomized controlled trial

“…More severely ill patients are more likely to be cared for in settings with greater access to staff for support in turning and maintaining APP, whereas patients with lower oxygen requirements, cared for in less intensive environments, are more able to move themselves to a position of their choice. Studies in the UK, Pakistan and China which have examined acceptability from patient perspectives suggest overall negative attitudes to APP related to discomfort, physical consequences and social factors which may influence patients’ willingness to self-prone (15–17). Concurrent patient perspectives from randomised controlled trials remains lacking.…”

The physiological effect of prone positioning and lateral decubitus in non-intubated patients with severe COVID-19: a prospective cohort study

“…Despite prone position that been combined with oxygen therapy can physiologically improve pulmonary function, this position is not very comfortable for the patients because they have to lie on their stomachs for a while when the oxygen therapy and other monitoring devices are still attached 6 . Furthermore, some patients move their bodies to be more comfortable, and it was far from the standard of prone position form.…”