Physiotherapists play an important role in the provision of multidisciplinary team-based care in the ICU. No studies have reported usual care respiratory management or usual care on the wards following ICU discharge by these providers. This study aimed to investigate usual care physiotherapy for ICU subjects during acute hospitalization.
METHODS:
One hundred subjects were recruited for an observational study from a tertiary Australian ICU. The frequency and type of documented physiotherapist assessment and treatment were extracted retrospectively from medical records.
RESULTS:
The sample had median (interquartile range) APACHE II score of 17 (13–21) and was mostly male with a median (interquartile range) age of 61 (49–73) y. Physiotherapists reviewed 94% of subjects in the ICU (median of 5 [3–9] occasions, median stay of 4.3 [3–7] d) and 89% of subjects in acute wards (median of 6 [2–12] occasions, median stay of 13.3 [6–28] d). Positioning, ventilator lung hyperinflation, and suctioning were the most frequently performed respiratory care activities in the ICU. The time from ICU admission until ambulation from the bed with a physiotherapist had a median of 5 (3–8) d. The average ambulation distance per treatment had a median of 0 (0–60) m in the ICU and 44 (8–78) m in the acute wards. Adverse event rates were 3.5% in the ICU and 1.8% on the wards.
CONCLUSIONS:
Subjects received a higher frequency of physiotherapy in the ICU than on acute wards. Consensus is required to ensure consistency in data collection internationally to facilitate comparison of outcomes.
SchweickertWD, PohlmanMC, PohlmanAS, NigosC, PawlikAJ, EsbrookCL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 2009; 373(9678):1874–1882.
2.
BurtinC, ClerckxB, RobbeetsC, FerdinandeP, LangerD, TroostersT, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med, 2009; 37(9):2499–2505.
3.
NeedhamDM, DavidsonJ, CohenH, HopkinsRO, WeinertC, WunschH, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med, 2012; 40(2):502–509.
4.
HerridgeMS, TanseyCM, MattéA, TomlinsonG, Diaz-GranadosN, CooperA, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med, 2011; 364(14):1293–1304.
5.
BerneyS, HainesK, DenehyL. Physiotherapy in critical care in Australia. Cardiopulm Phys Ther J, 2012; 23(1):19–25.
6.
DenehyL, BerneyS. Physiotherapy in the intensive care unit. Phys Ther Rev, 2006; 11:49–56.
7.
ChangAT, BootsR, HodgesPW, ParatzJ. Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice. Aust J Physiother, 2004; 50(1):51–54.
8.
ThomasPJ, ParatzJD, StantonWR, DeansR, LipmanJ. Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Aust Crit Care, 2006; 19(4):122–126.
9.
NorrenbergM, VincentJL. A profile of European intensive care unit physiotherapists. European Society of Intensive Care Medicine. Intensive Care Med, 2000; 26(7):988–994.
10.
KumarJA, MaiyaAG, PereiraD. Role of physiotherapists in intensive care units of India: a multicentre survey. Ind J Crit Care Med, 2007; 11(4):198–203.
11.
HodginKE, Nordon-CraftA, McFannKK, MealerML, MossM. Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med, 2009; 37(2):561–566.
12.
NavaS, AmbrosinoN. Rehabilitation in the ICU: the European phoenix. Intensive Care Med, 2000; 26(7):841–844.
13.
SkinnerEH, ThomasP, ReeveJ, PatmanS. Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: a modified Delphi technique. Physiother Theory Pract, 2016; in press.
14.
GosselinkR, BottJ, JohnsonM, DeanE, NavaS, NorrenbergM, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med, 2008; 34(7):1188–1199.
15.
StillerK. Physiotherapy in intensive care: towards an evidence-based practice. Chest, 2000; 118(6):1801–1813.
16.
ChaboyerW, GassE, FosterM. Patterns of chest physiotherapy in Australian intensive care units. J Crit Care, 2004; 19(3):145–151.
17.
SkinnerEH, BerneyS, WarrillowS, DenehyL. Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy, 2008; 94(3):220–229.
18.
WilesL, StillerK. Passive limb movements for patients in an intensive care unit: a survey of physiotherapy practice in Australia. J Crit Care, 2010; 25(3):501–508.
19.
JonesAY-M. Intensive care physiotherapy: medical staff perceptions. Hong Kong Physiother J, 2001; 19(1):9–16.
20.
JonesAY-M, HutchinsonRC, OhTE. Chest physiotherapy practice in intensive care units in Australia, the UK and Hong Kong. Physiother Theory Pract, 1992; 8(1):39–47.
21.
KingJ, CroweJ. Mobilization practices in Canadian critical care units. Physiother Canada, 1998; 50:206–211.
22.
LewisM. Intensive care unit rehabilitation within the United Kingdom. Physiotherapy, 2003; 89(9):531–538.
23.
AppletonRTD, MacKinnonM, BoothMG, WellsJ, QuasimT. Rehabilitation within Scottish intensive care units: a national survey. J Intensive Care Soc, 2011; 12(3):221–227.
24.
SkinnerEH, HainesKJ, HayesK, SellerD, TooheyJC, ReeveJC, et al. Future of specialised roles in allied health practice: who is responsible?. Aust Health Rev, 2015:39(3):255–259.
25.
SaverBG, TaylorTR, TreadwellJR, ColeWG. Do physicians do as they say? The case of mammography. Arch Fam Med, 1997; 6(6):543–548.
26.
MorrisPE, GoadA, ThompsonC, TaylorK, HarryB, PassmoreL, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 2008; 36(8):2238–2243.
27.
KayambuG, BootsR, ParatzJ. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med, 2013; 41(6):1543–1554.
28.
ParkerA, TehranchiKM, NeedhamDM. Critical care rehabilitation trials: the importance of “usual care”. Crit Care, 2013; 17(5):183.
29.
ZanniJM, KorupoluR, FanE, PradhanP, JanjuaK, PalmerJB, et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care, 2010; 25(2):254–262.
30.
PohlmanMC, SchweickertWD, PohlmanAS, NigosC, PawlikAJ, EsbrookCL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med, 2010; 38(11):2089–2094.
31.
BerneyS, HainesK, SkinnerEH, DenehyL. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther, 2012; 92(12):1524–1535.
32.
DenehyL, SkinnerEH, EdbrookeL, HainesK, WarrillowS, HawthorneG, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months follow up. Crit Care, 2013; 17(4):R156444.
33.
BerneySC, HarroldM, WebbSA, SeppeltI, PatmanS, ThomasPJ, DenehyL. ICU mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc, 2013; 15(4):260–265.
34.
TEAM Study Investigators, HodgsonC, BellomoR, BerneyS, BaileyM, BuhrH, et al. Early mobilisation and recovery in mechanically ventilated patients in ICU: a bi-national, multi-centre, prospective cohort study. Crit Care, 2015; 19:81.
35.
HoldsworthC, HainesKJ, FrancisJF, MarshallA, O'ConnorD, SkinnerEH. Mobilizing ventilated patients in the intensive care unit: an elicitation study using the theory of planned behaviour. J Crit Care, 2015; doi:10.1016/j.jcrc.2015.08.010.
36.
SkinnerEH, WarrillowS, DenehyL. Health-related quality of life in Australian survivors of critical illness. Crit Care Med, 2011; 39(8):1896–1905.
37.
PatmanSM, DennisDM, HillK. Exploring the capacity to ambulate after a period of prolonged mechanical ventilation. J Crit Care, 2012; 27(6):542–548.
38.
BerneyS, DenehyL. A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int, 2002; 7(2):100–108.
39.
BerneyS, DenehyL, PrettoJ. Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated. Aust J Physiother, 2004; 50(1):9–14.
40.
ChiangLL, WangLY, WuCP, WuHD, WuYT. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther, 2006; 86(9):1271–1281.
41.
MartinUJ, HincapieL, NimchukM, GaughanJ, CrinerGJ. Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med, 2005; 33(10):2259–2265.
42.
BahadurK, JonesG, NtoumenopoulosG. An observational study of sitting out of bed in tracheostomised patients in the intensive care unit. Physiotherapy, 2008; 94:300–305.
43.
ThomsenGE, SnowGL, RodriguezL, HopkinsRO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med, 2008; 36(4):1119–1124.
44.
StillerK, JenkinsS, GrantR, GeakeT, TaylorJ, HallB. Acute lobar atelectasis: a comparison of five physiotherapy regimens. Physiother Theory Pract, 1996; 12(4):197–209.
45.
NtoumenopoulosG, PresneillJJ, McElholumM, CadeJF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med, 2002; 28(7):850–856.
46.
ThomasPJ, ParatzJD, LipmanJ, StantonWR. Lateral positioning of ventilated intensive care patients: a study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart Lung, 2007; 36(4):277–286.
47.
PatmanS, JenkinsS, StillerK. Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury. Intensive Care Med, 2009; 35(2):258–265.
48.
PatmanS, SandersonD, BlackmoreM. Physiotherapy following cardiac surgery: is it necessary during the intubation period?. Aust J Physiother, 2001; 47(1):7–16.
49.
StillerK. Physiotherapy in intensive care: an updated systematic review. Chest, 2013; 144(3):825–847.
50.
QuachS, HennessyDA, FarisP, FongA, QuanH, DoigC. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv Res, 2009; 9:129.
51.
NeedhamDM, WangW, DesaiSV, Mendez-TellezPA, DennisonCR, SevranskyJ, et al. Intensive care unit exposures for long-term outcomes research: development and description of exposures for 150 patients with acute lung injury. J Crit Care, 2007; 22(4):275–284.
BerneyS, OpdamH, BellomoR, LiewS, SkinnerE, EgiM, DenehyL. An assessment of early tracheostomy after anterior cervical stabilization in patients with acute cervical spine trauma. J Trauma, 2008; 64(3):749–753.
54.
TerragniPP, AntonelliM, FumagalliR, FaggianoC, BerardinoM, PallaviciniFB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA, 2010; 303(15):1483–1489.
55.
SkinnerEH, HainesKJ, HoweB, HodgsonCL, DenehyL, McArthurCJ, et al. Health-related quality of life in Australasian survivors of H1N1 influenza undergoing mechanical ventilation: a multicenter cohort study. Ann Am Thorac Soc, 2015; 12(6):895–903.
56.
HerridgeMS, CheungAM, TanseyCM, Matte-MartynA, Diaz-GranadosN, Al-SaidiF, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med, 2003; 348(8):683–693.
57.
BaileyP, ThomsenGE, SpuhlerVJ, BlairR, JewkesJ, BezdjianL, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med, 2007; 35(1):139–145.
58.
HainesKJ, SkinnerEH, BerneyS, Austin Health POST Study Investigators. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy, 2013; 99(2):119–125.
59.
LeditschkeIA, GreenM, IrvineJ, BissettB, MitchellIA. What are the barriers to mobilizing intensive care patients?. Cardiopulm Phys Ther J, 2012; 23(1):26–29.
60.
WangYT, HainesTP, RitchieP, WalkerC, AnsellTA, RyanDT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care, 2014; 18(4):R161.
61.
SkinnerEH, BerneyS, WarrillowS, DenehyL. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc, 2009; 11(2):110–115.
