Therapeutic strategies performed by physiotherapists in three intensive care units (ICUS) in Santiago, Chile: pilot study
Date
2015
Type:
Article
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Publisher
Elsevier
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Abstract
Background: To date, there are four systematic reviews suggesting positive effects of rehabilitation and chest
physiotherapy during ICU stay. However, in Chile there is no information about the therapeutic strategies used by
physiotherapists (PTs) working in this environment. A better understanding of the interventions they perform would shed
light on possible areas of improvement.
Purpose: To describe the duration and therapeutic strategies used by PTs working at three Level 3 ICUs in Santiago, Chile.
Methods: A cross sectional study carried out in three level 3 ICUs in Santiago: a private hospital, a public hospital and a
national reference centre for cardiothoracic disorders. PTs were observed in each unit for 24 hours over the course of 8
days, using a structured observation template. Data were collected on time spent on different activities (reading of charts
and test results, assessment of patient, intervention, reassessment, writing on patients’ charts, change-of-shift report and
administrative work) and therapeutic strategies performed with patients. Frequency of use is presented for the most
common activities and the median (P25-P75) of their duration. Chi-squared was used to compare frequencies according to
ward. P-value <0.05 were considered statistically significant.
Results: 32 PTs were observed for 960 hours during 1131 visits. 121 patients received care from PTs during this period
with a median (P25-P75) APACHE II of 13 (9–19). 41 patients (33.9%) were on invasive or non-invasive mechanical
ventilation. 88% of the PTs’ working time was spent on activities related to patients’ care and 12% in administrative tasks
or clinical meetings with members of staff. The median (P25-P75) duration of a visit was 20 (12–28) min including 3 (1–4)
different therapeutic strategies. The most commonly used were: mucus clearance techniques (49%), ribcage compressiondecompression
(48%), active-assisted range of motion (ROM) (21%), sitting on edge of bed (SEB) (19%), mechanical
ventilator parameters adjustment (16%) and assisted walking (16%). Neuromuscular electric stimulation or training with
cycloergometer, steps or treadmill were not used. Passive ROM was more frequent in the ICUs than High Dependency
Units (HDUs) (20% vs 12%, p < 0.0001), while SEB (14% vs 23%, p < 0.0006), assisted standing (11% vs 17%, p < 0.044) and
assisted walking (10% vs 20%, p < 0.0001) were more common in HDUs than ICUs.
Conclusion(s): Chest physiotherapy techniques are the most commonly used techniques despite conflicting evidence on
their benefit. It is noteworthy that some forms of early mobilisation are also frequently performed, although they were
more common in HDUs than ICUs. Beliefs about safety of exercise, lack of skills, knowledge or human resources, might be
preventing the use of more active ways of rehabilitation. This should be explored in the future in order to increase the
quality of care provided.
Implications: This pilot study will help to develop a self-report questionnaire. With it, we aim to survey PTs across Chile in
order to establish the current therapeutic strategies used and human resources in the ICU. This information would help
to develop policies in relation to the minimum number of PTs and standard of care in the ICU.
Description
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Citation
Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Keywords
Standard of care, Critical care, Physical therapy modalities