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PubMed2004

Impact of a financial incentive on case and control participation in a telephone interview.

The authors investigated the effect of a 5.00 dollars incentive on participation in a telephone interview among cases and controls in an ongoing study of colorectal cancer. Cases and matched community controls were sent a letter introducing the study. One week later, a nurse called to invite the person to participate in a 30-minute telephone interview. After 1 year of data collection (which began in June 2001), the authors began enclosing a 5.00 dollars bill in the initial letter as an incentive. Incentives were mailed to all potential controls. The authors randomized 50% of a subset of cases to receive the incentive. In the year prior to institution of the incentive, 44.2% of 851 controls participated in the interview, as compared with 56.2% of 1,043 controls in the year after the incentive was instituted (p < 0.001). Among cases randomized to receive the incentive (n = 199), 63.8% participated as compared with 68.4% in the nonincentive group (n = 193) (p > 0.05). Among cases aged 60-69 years, the response rate in the incentive group was reduced by 17% (p = 0.03). Thus, among controls, a small monetary incentive appears to promote a feeling of goodwill toward the research. It does not seem to have an equivalent effect among cases, and in the worst case it may insult or annoy some cases who may otherwise have participated.

Age Distribution↗

PubMed2005

Meta-analysis of randomised trials of monetary incentives and response to mailed questionnaires.

STUDY OBJECTIVE: To quantify the increase in mailed questionnaire response attributable to a monetary incentive. DESIGN: A systematic search for randomised controlled trials of monetary incentives and mailed questionnaire response was conducted. For each trial identified, logistic regression was used to estimate the odds ratio for response per 0.01 dollars incentive increase. Odds ratios were pooled in a series of random effect meta-analyses stratified by the minimum and maximum amounts offered. Piecewise logistic regression was used to estimate the odds ratio for response per $0.01 increase given in each of five incentive ranges. SETTING: Populations in several developed countries, predominantly the USA. PARTICIPANTS: 85,671 randomised participants from 88 trials. MAIN RESULTS: The pooled odds ratios for response per 0.01 dollars incentive decreased monotonically as the maximum amount of incentive offered increased. The piecewise logistic regression model estimated that for incentive amounts up to 0.50 dollars, each additional 0.01 dollars increased the odds of response by about 1% (pooled OR = 1.012, 95%CI 1.007 to 1.016). The effects on response above 0.50 dollars were smaller and decreased monotonically in the ranges: 0.50-0.99 dollars, 1-1.99 dollars, 2-4.99 dollars, 5.00 dollars and over, but remained statistically significant up to 5 dollars. CONCLUSIONS: This meta-analysis of the best available evidence shows that monetary incentives increase mailed questionnaire response. Researchers should include small amounts of money with mailed questionnaires rather than give no incentive at all.

Health Services Research↗

PubMed2004

No difference in response rate to a mailed survey among prostate cancer survivors using conditional versus unconditional incentives.

Mailed surveys are widely used to collect epidemiological and health service data on cancer populations. Nonresponse can threaten the validity of surveys and various strategies, including the enclosure of modest incentives, are often used to increase response rates. A study was undertaken to determine whether response rate to a mailed survey differed with provision of immediate versus delayed incentives. A six-page mailed survey to ascertain dietary supplement use was sent to 1402 men who had been diagnosed with prostate cancer. Subjects were block randomized into two groups based on age (< or =65 years versus >65 years), race (white versus nonwhite), and disease status (locoregional versus distant). One group received a 30-min prepaid phone card concurrently with their blank survey (unconditional incentive), whereas the other group received the incentive only on receipt of their completed survey (conditional incentive). A 60% overall response rate was achieved, and no differences in response rates were noted between conditional and unconditional incentive groups (overall, as well as within defined age, race, and disease-defined strata). Nonwhites, however, were significantly less likely to respond than whites (P < 0.0001). In conclusion, acceptable response rates to a mailed survey can be achieved in a general population of cancer survivors using modest incentives. Given no differences in response rates using conditional versus unconditional incentives, the decision to provide immediate versus delayed incentives is one that should be considered on a study-specific basis, and a decision based primarily on cost. Other means, however, appear necessary to achieve acceptable response rates among minority group cancer survivors.

Aged↗

PubMed2006

Nucleus accumbens corticotropin-releasing factor increases cue-triggered motivation for sucrose reward: paradoxical positive incentive effects in stress?

BACKGROUND: Corticotropin-releasing factor (CRF) is typically considered to mediate aversive aspects of stress, fear and anxiety. However, CRF release in the brain is also elicited by natural rewards and incentive cues, raising the possibility that some CRF systems in the brain mediate an independent function of positive incentive motivation, such as amplifying incentive salience. Here we asked whether activation of a limbic CRF subsystem magnifies the increase in positive motivation for reward elicited by incentive cues previously associated with that reward, in a way that might exacerbate cue-triggered binge pursuit of food or other incentives? We assessed the impact of CRF microinjections into the medial shell of nucleus accumbens using a pure incentive version of Pavlovian-Instrumental transfer, a measure specifically sensitive to the incentive salience of reward cues (which it separates from influences of aversive stress, stress reduction, frustration and other traditional explanations for stress-increased behavior). Rats were first trained to press one of two levers to obtain sucrose pellets, and then separately conditioned to associate a Pavlovian cue with free sucrose pellets. On test days, rats received microinjections of vehicle, CRF (250 or 500 ng/0.2 microl) or amphetamine (20 microg/0.2 microl). Lever pressing was assessed in the presence or absence of the Pavlovian cues during a half-hour test. RESULTS: Microinjections of the highest dose of CRF (500 ng) or amphetamine (20 microg) selectively enhanced the ability of Pavlovian reward cues to trigger phasic peaks of increased instrumental performance for a sucrose reward, each peak lasting a minute or so before decaying after the cue. Lever pressing was not enhanced by CRF microinjections in the baseline absence of the Pavlovian cue or during the presentation without a cue, showing that the CRF enhancement could not be explained as a result of generalized motor arousal, frustration or stress, or by persistent attempts to ameliorate aversive states. CONCLUSION: We conclude that CRF in nucleus accumbens shell amplifies positive motivation for cued rewards, in particular by magnifying incentive salience that is attributed to Pavlovian cues previously associated with those rewards. CRF-induced magnification of incentive salience provides a novel explanation as to why stress may produce cue-triggered bursts of binge eating, drug addiction relapse, or other excessive pursuits of rewards.

Animals↗

PubMed2006

Effect of incentives on student performance on Milemarker examinations.

OBJECTIVES: The objective of this study was to evaluate the effect of incentives on student performance on comprehensive cumulative examinations administered at the College of Pharmacy, University of Houston. METHODS: This study is a retrospective longitudinal study conducted over a period of 6 years, from 2000 to 2005. Passing rates on the cumulative examinations administered during the first 3 years of the doctor of pharmacy curriculum were obtained. These cumulative examinations, known as the Milemarker assessments, involve 3 examinations: Milemarker I, II and III, each offered after completion of each progressive year. Milemarker I and II examinations were phased in throughout the years with various incentives to increase student performance. Incentives for these examinations included books, achievement letters, bonus points, and remediation exercises. Incentives with respect to Milemarker III examination was determination of students' progression into the experiential year of the curriculum and did not change over the study period. Passing rates were compared for these examinations before and after the implementation of these incentives. RESULTS: Passing rates for Milemarker I increased significantly by 185% from 2003 to 2004 when incentives were changed from awards such as books and achievement letters from the Dean's office to bonus points towards future examinations and a remediation process. Similar results were seen for Milemarker II, where the passing rates increased by 590% during the same period for similar incentives. However, passing rates were much higher throughout the time period for Milemarker III due to the high-stakes incentive of stops on progression to the next year. CONCLUSION: Appropriate incentives may be effective in changing student performance on comprehensive cumulative examinations.

Education, Pharmacy↗

PubMed2003

Dissociable contributions of the human amygdala and orbitofrontal cortex to incentive motivation and goal selection.

Theories of incentive motivation attempt to capture the way in which objects and events in the world can acquire high motivational value and drive behavior, even in the absence of a clear biological need. In addition, for an individual to select the most appropriate goal, the incentive values of competing desirable objects need to be defined and compared. The present study examined the neural substrates by which appetitive incentive value influences prospective goal selection, using positron emission tomographic neuroimaging in humans. Sated subjects were shown a series of restaurant menus that varied in incentive value, specifically tailored for each individual, and in half the trials, were asked to make a selection from the menu. The amygdala was activated by high-incentive menus regardless of whether a choice was required. Indeed, activity in this region varied as a function of individual subjective ratings of incentive value. In contrast, distinct regions of the orbitofrontal cortex were recruited both during incentive judgments and goal selection. Activity in the medial orbital cortex showed a greater response to high-incentive menus and when making a choice, with the latter activity also correlating with subjective ratings of difficulty. Lateral orbitofrontal activity was observed selectively when participants had to suppress responses to alternative desirable items to select their most preferred. Taken together, these data highlight the differential contribution of the amygdala and regions within the orbitofrontal cortex in a neural system underlying the selection of goals based on the prospective incentive value of stimuli, over and above homeostatic influences.

Adult↗

PubMed2005

The effect of physician disclosure of financial incentives on trust.

BACKGROUND: Many physicians receive financial incentives to limit their ordering of expensive tests and procedures. While Medicare mandates disclosure of incentives, it is not clear how to inform patients without undermining trust. METHODS: Our objective was to determine public opinion about physician disclosure of financial incentives and how this might be best communicated to patients. The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households. The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image. Respondents heard 1 of 6 randomly selected disclosure strategies. The measurements included ratings of trust, satisfaction, agreement with the physician's decision, and likelihood of remaining with the physician/health plan or seeking a second opinion. RESULTS: Nearly half (48.8%) of respondents had previously heard of financial incentives to limit test ordering. Of the respondents, 94.8% wanted to be told about incentives, at the time of enrollment in a health plan (80.5%), by a health plan representative (44.8%), their physician (17.1%), or both (38.1%). Of the 6 different disclosure strategies, "addressing emotions" and "negotiation" were associated with the best outcomes, while "common enemy" and "denying influences" were most negatively perceived. Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion. CONCLUSIONS: The public wants information about physician financial incentives. Specific communication styles enhance how this information is conveyed to patients, increasing trust and supporting the physician-patient relationship.

Analysis of Variance↗

PubMed2000

Effects of a monetary incentive on primary care prescribing in Ireland: changes in prescribing patterns in one health board 1990-1995.

BACKGROUND: In an attempt to curb the rapidly rising costs of primary care prescribing in Ireland, the government introduced a financial incentive scheme in 1993, to encourage general practitioners to restrain their prescribing. PURPOSE: To investigate the effects of a financial incentive scheme on GP prescribing in Ireland on prescribing costs and volume, and on some specific therapeutic areas. METHODS: Prescribing for 3 years before (1990-1992) and 3 years (1993-1995) after the introduction of incentives, based on a defined cohort of 233 general practitioners in the area of one health board. GPs were divided into tertiles based on their performance against their prescribing budgets into 'savers' (generally underspent and received incentive payments), modest overspenders and large overspenders. RESULTS: Savers were always lower cost prescribers than the other groups. They contained their rate and costs of prescribing in contrast to the other groups, e.g. percentage rise in prescribing costs in the year after the introduction of the scheme -7.9%, +1.2% and +7.3% respectively, (P < 0.05) for savers, modest overspenders and large overspenders respectively. This effect was short lived however and was gone by the third year of the study. CONCLUSIONS: The financial incentives had a marked effect on prescribing volume and cost on some practices who could achieve targets and hence incentive payments. The incentives had little effect on high spending practices. Such incentive schemes need careful evaluation if they are not to become perverse to the good health of patients.

Drug Utilization↗

PubMedDate not supplied

The neural basis of drug craving: an incentive-sensitization theory of addiction.

This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.

Adaptation, Physiological↗

PubMed1994

Incentives enhance postpartum compliance among adolescent prenatal patients.

OBJECTIVE: To test the hypothesis that incentives enhance compliance with postpartum appointments. METHOD: We studied a multiracial group of 240, poor, 12-to-19 year olds. At 34 weeks gestation consecutively enrolled patients were randomized to incentive and non-incentive groups. Patients in the incentive group were told that they would receive a Gerry "Cuddler" if they returned for an examination within 12 weeks of delivery. The groups were compared with Student's t-tests and chi-square and logistic regression analyses. RESULTS: We found no significant group differences in age, race, Medicaid status, gravidity, parity, the timing of the first prenatal visit, compliance with prenatal appointments, or well-baby care site. One hundred and seventy-five (73%) of the 240 patients returned for a postpartum examination. Patients randomized to the incentive group were significantly more likely to return for an examination within 12 weeks of delivery (82.4% vs. 65.2%, chi 2 = 9.0; p = .003). The logistic regression analysis revealed that in addition to membership in the incentive group, three characteristics were significantly associated with postpartum compliance: primiparity, compliance with prenatal care, and school enrollment. CONCLUSIONS: Among adolescents who obtained prenatal care in a multidisciplinary adolescent-oriented maternity program, the offer of an incentive significantly improved compliance with the 6-week postpartum appointment. Since other factors associated with improved postpartum compliance are less amenable to change we recommend that health care providers consider offering a postpartum incentive, especially to their multiparous adolescent patients who are not enrolled in school and/or are non-compliant with prenatal appointments.

Adolescent↗

PubMed2007

Financial incentive for diet recall accuracy does not affect reported energy intake or number of underreporters in a sample of overweight females.

Underreporting of energy intake in diet recalls is common, especially among obese individuals. Incentives have been used to ameliorate the problem, but are typically provided without efficacy assessment. The present study sought to determine whether financial incentives decrease underreporting in diet recalls. Three groups were used to assess incentive timing effects in this parallel group crossover study. One group received a $50 bonus for accurate diet recalls on the first two of four recalls. Accuracy was purportedly verified by salivary analysis. Another group received the $50 bonus for the last two recalls. A third group received no incentive. Mean energy intake during the first two visits was compared to mean energy intake during the last two visits to assess differences resulting from the incentive. Underreporters were identified using a Goldberg cutoff and energy intake <76% of estimated energy expenditure. Energy intake did not differ within or between groups at any time, and the number of underreporters was not associated with group at any time. Overall, the incentive was ineffective in this small, homogeneous sample. Future studies should assess different forms of incentives, other study populations, and the probability of incentives causing undereating.

Adult↗

PubMed2004

Retailer participation in cigarette company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores.

PURPOSE: The retail outlet is the cigarette companies' major marketing channel to reach present and future customers. Of the $11.2 billion spent by them to market their products in 2001, approximately 85% was spent on retailer and consumer incentives to stimulate sales. This study examines the extent of retailer participation in these incentive programs, and the relationship between participation and the amount and placement of cigarette marketing materials and products, and prices in stores. METHODS: Observational assessments of cigarette marketing materials, products, and prices were conducted in 468 stores in 15 U.S. states. Telephone interviews were conducted with store owners or managers of these stores to determine the details of their participation in incentive programs. RESULTS: Cigarette companies engaged 65% of retailers in an incentive program. Nearly 80% of participating retailers reported cigarette company control over placement of marketing materials in their stores. Stores that reported receiving over $3,000 from incentive programs in the past 3 months averaged 19.5 cigarette marketing materials, and stores receiving no money averaged only 8.2 marketing materials. In multivariate analyses, participation in incentive programs offered by Philip Morris and R.J. Reynolds was positively related to the number of cigarette marketing materials for each of these companies' brands in stores and the placement of their cigarettes on the top shelf. The price of Newports was significantly lower in stores that received incentives; no price difference was found for Marlboro. CONCLUSIONS: Stores that participate in cigarette company incentive programs feature more prominent placement of cigarettes and advertising, and may have cheaper cigarette prices.

Advertising↗

PubMed2004

Predicting incentives to change among adolescents with substance abuse disorder.

While interest in understanding the incentives to change among individuals with substance abuse disorders is growing, little is known about incentives among adolescents with substance abuse disorders who are participating in formal services. The present research assesses the degree and nature of motivation and treatment readiness among adolescents admitted to substance abuse services, and whether such factors vary across significant subgroups of youth based on their social, legal, or clinical profiles. Data are based on interviews with 249 youth between 12 and 18 years of age who have been admitted to either inpatient, residential, or outpatient substance abuse treatment. Measures are adapted from an instrument developed to assess multiple domains of motivation to change (e.g., intrinsic and extrinsic motivation, treatment readiness). Results suggest that the incentive to change among adolescents with substance-abusing behavior is modest at best, regardless of dimension. Nonetheless, ethnicity, type of substance use, and psychopathology significantly predict incentives to change, though the predictors depend on which dimension is considered. The most robust predictor of incentives is the severity of negative consequences associated with youth's substance use--the greater the severity, the greater the incentives. Findings underscore the need to examine the utility and dimensionality of incentive for treatment planning, while at the same time, they identify factors that treatment planners can consider as they seek ways to enhance incentives and help adolescents with substance use disorders attain positive outcomes.

Adolescent↗

PubMed1998

Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives.

OBJECTIVES: The effects of incentive size on physicians' response rates to a mail survey were determined. METHODS: One thousand US primary care physicians were assigned randomly to receive a survey with either a $5 bill or a $2 bill as an incentive. For each of the two incentive groups, the overall response rate for three mailing waves, the total cost, and the total cost per usable response were measured. RESULTS: The response rate among those receiving the $5 bill (61%) was 32% higher than the response rate among those receiving the $2 bill (46%); overall costs were slightly higher in the $5 group, but the cost per response for each group was similar ($15.46 versus $14.93). For the same cost, a higher response rate could have been achieved in the $2 group if costs saved from foregoing the third mailing were instead used to increase the incentive for a portion of the subjects. CONCLUSIONS: A $5 bill incentive yielded a higher response rate among the physicians in this study than did a $2 bill incentive. Moreover, the powerful effect of the incentive size, combined with the consequent decline in the costs of subsequent mailing waves, suggests that resources in a fixed survey budget are allocated more efficiently to increasing the initial incentive rather than to providing a third wave to nonresponders.

Budgets↗

PubMedDate not supplied

Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain.

OBJECTIVE: Sex differences in pain perception have been widely reported, with women typically displaying greater pain sensitivity than men, but the mechanisms underlying these differences remain unclear. One possible explanation suggests that men are more motivated to tolerate and suppress expressions of pain because of the masculine sex role, whereas the feminine sex role encourages pain expression and produces lower motivation to tolerate pain among women. METHODS: To examine the influence of motivation on perceptual and cardiovascular responses to pain among women and men, different levels of monetary incentive (high vs. low incentive) were provided to a group of 81 healthy young adults undergoing the cold pressor pain procedure. It was anticipated that men would have greater endogenous motivation and would therefore be less affected by the external incentive. RESULTS: Men had higher pain thresholds and tolerances and lower pain ratings than women, but the incentive condition produced no significant effect on pain responses. Resting blood pressure was positively correlated with pain tolerance among the low incentive group, whereas blood pressure reactivity to the cold pressor predicted pain tolerance in the high incentive group. CONCLUSIONS: Thus, monetary incentive did not influence pain responses, but the relationship between cardiovascular measures and pain responses was influenced by the incentive manipulation. Potential explanations for the observed results are presented, and the implications for applying the biopsychosocial model to pain research are discussed.

Adult↗

PubMed2006

An investigation into food preferences and the neural basis of food-related incentive motivation in Prader-Willi syndrome.

BACKGROUND: Research into the excessive eating behaviour associated with Prader-Willi syndrome (PWS) to date has focused on homeostatic and behavioural investigations. The aim of this study was to examine the role of the reward system in such eating behaviour, in terms of both the pattern of food preferences and the neural substrates of incentive in the amygdala and orbitofrontal cortex (OFC). METHOD: Participants with PWS (n = 18) were given a food preference interview to examine food preferences and to inform the food-related incentive task to be conducted during the neuroimaging. Thirteen individuals with PWS took part in the positron emission tomography (PET) study, the design of which was based on a previous study of non-obese, non-PWS controls. For the task, participants were asked to consider photographs of food and to choose the food they would most like to eat in two conditions, one of high and one of low incentive foods, tailored to each participant's preferences. For comparison of the food preference data, 12 non-PWS individuals were given one part of the interview. RESULTS: Individuals with PWS expressed relative liking of different foods and showed preferences that were consistent over time, particularly for sweet foods. The participants with PWS did give the foods in the high incentive condition a significantly higher incentive value than the foods in the low incentive condition. However, activation of the amygdala and medial OFC was not associated with the prospect of highly valued foods as predicted in those with PWS. CONCLUSIONS: It would appear that incentive motivation alone plays a less powerful role in individuals with PWS than in those without the syndrome. This is likely to be due to the overriding intrinsic drive to eat because of a lack of satiety in those with PWS, and the impact of this on activity in the incentive processing regions of the brain. Activity in such reward areas may not then function to guide behaviour selectively towards the consumption of high preference foods.

Adolescent↗

PubMed2006

Public attitudes toward incentives for organ donation: a national study of different racial/ethnic and income groups.

Attitudes toward monetary and nonmonetary incentives for living (LD) and deceased donation (DD) among the U.S. general public and different racial/ethnic and income groups have not been systematically studied. We studied attitudes via a telephone questionnaire administered to persons aged 18-75 in the continental United States. Among 845 participants (85% of randomized households), less than one-fifth participants were in favor of incentives for DD (range 7-17%). Most persons were in favor of reimbursement of medical costs (91%), paid leave (84%) and priority on the waiting list (59%) for LD. African Americans and Hispanics were more likely than Whites to be in favor of some incentives for DD. African Americans were more likely than Whites to be in favor of monetary incentives for LD. Whites with incomes less than $20 000 were more likely than Whites with greater incomes to be in favor of reimbursement for deceased donors' funeral expenses or medical expenses. The U.S. public is not generally supportive of incentives for DD, but is supportive of limited incentives for LD. Racial/ethnic minorities are more supportive than Whites of some incentives. Persons with low income may be more accepting of certain monetary incentives.

Adult↗

PubMed2001

The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing.

STUDY OBJECTIVES: The study evaluated the impact of the additional imposed work of breathing (WBimp) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications (PPCs). Additionally, we investigated whether maximal inspiratory pressure (PImax) is an easy estimate of the WBimp imposed by incentive spirometers. DESIGN: Prospective, randomized, single-blind clinical trial. SETTING: ICU of a university hospital. INTERVENTIONS AND MEASUREMENTS: Thirty male patients were assigned to a group at high risk for PPCs (group A; inspiratory capacity [IC], < 1.6 L) or to a group at moderate risk for PPCs (group B; IC, 1.6 to 2.5 L) after upper-abdominal, thoracic, or two-cavity surgery. On the first or second postoperative day WBimp, IC, and PImax were recorded without spirometers (baseline) and during incentive spirometry with the Mediflo spirometer (Medimex; Hamburg, Germany) (high WBimp) and the Coach spirometer (Kendall; Neustadt, Germany) (low WBimp) using a pneumotachograph. In group A, the baseline and the ICs for both spirometers only differed slightly. In group B, the IC was significantly reduced for the Mediflo (p < 0.05), which imposed a WBimp twice as high as the Coach (p < 0.01). PImax was significantly increased for both the Mediflo and the Coach (p < 0.01). PImax was positively correlated with WBimp (r = 0.8). CONCLUSIONS: Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance. PImax might be an easy clinical estimate for the WBimp during incentive spirometry. Incentive spirometers with low WBimp permit increased maximal sustained inspiration and, thus, enhanced incentive spirometry performance, and, therefore, it might be more suitable for use in postoperative respiratory care.

Humans↗